CardioVascular and Interventional Radiology最新文献

Purpose: To evaluate the safety and feasibility of intra-arterial ¹⁷⁷Lu-PSMA-radioligand therapy (RLT) in patients with liver-dominant metastatic castration-resistant prostate cancer (mCRPC).

Materials and methods: Patients received up to six cycles of ¹⁷⁷Lu-PSMA-RLT (median 7.4 GBq) at six-week intervals. Intra-arterial administration in the hepatic artery was off-label and indicated for patients with high hepatic tumour burden. Primary endpoints were safety (clinical and biochemical adverse events) and procedural feasibility. Exploratory efficacy endpoints were prostate-specific antigen (PSA) response and imaging (PET) response.

Results: Four patients received 16 cycles (10 intra-arterial, six intravenous). All intra-arterial procedures were technically successful and without periprocedural complications. Toxicity was acceptable and comparable to intravenous treatment, comprising mainly grade 1-2 clinical events with occasional grade 3 biochemical abnormalities, and no grade 4-5 clinical toxicities were observed. PSA decreases occurred in two patients (decrease 24-99%), while two patients had increases. Imaging response was more profound for liver metastasis.

Conclusion: These preliminary findings suggest that intra-arterial ¹⁷⁷Lu-PSMA-RLT is feasible and safe in liver-dominant mCRPC. Prospective studies with dosimetry are warranted.

Purpose: To assess long-term clinical and radiological outcomes of transarterial embolization (TAE) for pulmonary arteriovenous malformations (PAVMs) in children with hereditary hemorrhagic telangiectasia (HHT).

Materials and methods: This retrospective single-center study included 29 pediatric HHT patients (62% male; mean age: 8 [SD: 3]) who underwent TAE for 63 PAVMs in 32 different events between 2004 and 2024. Clinical outcome was peripheral oxygen saturation (SpO₂), measured at 1 month, 1, 3, and 5 years. Radiological outcomes included occlusion at final follow-up, persistence, incomplete treatment, reperfusion, and recanalization rates. Regression models were used to identify predictors of SpO₂ response and radiological outcomes. Adverse events (AEs) were reported using the CIRSE classification.

Results: Median SpO₂ significantly improved from 95% (IQR: 88-97) to 98% (IQR: 95-99) (p < 0.001), 98% (p < 0.001), 98% (p = 0.002), and 97% (p = 0.03) at 1 month, 1, 3 and 5 years. Diffuse disease (p = 0.024, 0.033) and HHT type 1 (p = 0.023) were associated with lower follow-up SpO₂. Occlusion rate at final follow-up was 82.5% with persistence, incomplete treatment, reperfusion, and recanalization rates at 28.6%, 7.9%, 19.0% and 6.3%. Size (p = 0.021), diffuse lesion (p = 0.002), and draining vein number (p = 0.002) predicted persistence; diffuse lesion (p = 0.015) and feeding artery number (p = 0.030) predicted reperfusion; feeding artery number (p = 0.046) predicted recanalization; and size (p = 0.004), diffuse lesion (p < 0.001), feeding artery (p = 0.004), and draining vein number (p = 0.001) predicted incomplete occlusion at final follow-up. AE rate was 12.9%, with most events graded as minor.

Conclusion: TAE was effective and safe in pediatric HHT patients with PAVMs, achieving durable occlusion and oxygenation improvement.

Purpose: To assess whether arterial computed tomography portography guidance improves early local tumor control after percutaneous thermal ablation of small colorectal cancer liver metastases compared with standard-of-care imaging guidance, hypothesizing a ≥ 20% increase in complete ablation at 3 months confirmed by MRI and PET-CT.

Materials and methods: This prospective, single-blind, two-center trial will randomize 88 adults (1:1) with up to three colorectal liver metastases ≤ 3 cm, including at least one not visible with ultrasound, to undergo ablation under either standard imaging guidance (intravenous contrast-enhanced CT, image fusion, or CT hepatic arteriography) or arterial portography after selective mesenteric or splenic catheterization in a hybrid angio-CT suite. Operators may use radiofrequency or microwave devices. The primary endpoint is complete ablation at 3 months on MRI and PET-CT. Secondary endpoints include lesion-level success, 12-month recurrence, safety, and a translational biobank. The sample size provides 80% power to detect a 20% absolute improvement (two-sided α = 0.05).

Results: Not applicable; protocol manuscript.

Expected gain of knowledge: The MARGIN trial will test whether arterial CT portography can improve complete ablation rates versus standard imaging in colorectal liver metastases. Beyond technical outcomes, it aims to refine image guidance strategies, optimize margin control, and generate high-level evidence for interventional oncology. The translational biobank will further link imaging findings to tumor biology and immune activation.

Conclusion: This trial will test if arterial CT portography can improve early completeness of thermal ablation for colorectal liver metastases versus standard imaging.

Trial registration: ClinicalTrials.gov NCT05665322 (registered December 14, 2022).

Level of evidence: Level 1b (randomized controlled trial).

Purpose: This study aims to assess the safety and clinical outcomes of novel biodegradable biliary stents (BDBS) in the treatment of benign biliary strictures (BBS).

Materials and methods: A systematic literature search on BDBS placement for BBS was conducted in Medline. Studies reporting technical success, clinical success, and BBS recurrence rates were included. A meta-analysis of proportions was used to determine each of the outcomes.

Results: Twelve studies involving 384 patients who underwent 387 BDBS placement for BBS were included. The weighted pooled proportion of technical success was 100% (95% CI 92-100%). After a mean follow-up of 23.3 months, the weight average clinical success was 81% (95% CI 76-85%) and stricture recurrence was 20% (95% CI 14-27%). The mean time to relapse was 11.8 months. Stent migration, complication, and readmission rate were 3% (95% CI 2-6%), 11% (95% CI 5-22%), and 2% (95% CI 0-100%), respectively. No mortality was reported.

Conclusion: BDBS placement is safe and effective treatment for BBS, with high technical and clinical success with acceptable complication and migration rates.

Level of evidence: Level 3.

Purpose: This study used real-world outcomes data to compare the cost-effectiveness of percutaneous cryoablation (PCA) and robot-assisted partial nephrectomy (RAPN) in patients with T1 renal cell carcinoma (RCC).

Materials and methods: Prospective data from June 2019 to February 2021 from two Danish University hospitals, following patients with RCC stage T1 treated with either PCA or RAPN, were used to provide procedural and clinical outcome parameters. A Markov model was used to estimate quality-adjusted life years (QALYs) and costs, incorporating health states for stable disease, local recurrence, metastasis, and all-cause mortality. Propensity score matching using specific covariates was carried out to ensure that the two populations evaluated were matched. Analyses were conducted comparing time to local recurrence or metastases, duration of hospital stay, and postoperative complications. Treatment-specific mortality was not included in the model due to the low number of deaths observed.

Results: There were no significant differences between PCA and RAPN in terms of local recurrence (HR = 0.80; 95% CI = 0.34-1.85; p = 0.72), metastases (HR = 2.09; 95% CI = 0.69-6.26; p = 0.19), or Clavien-Dindo III + complications (5.5% vs 2.5%; p = 0.325). There were significant differences in the mean duration of hospital stay (1.13 days versus 1.90 days; p < 0.001). QALYs gained were nearly identical for each treatment; however, PCA was associated with a net monetary benefit of €9,045 at a willingness-to-pay threshold of €40,000/QALY.

Conclusion: The present study suggests that PCA could equally benefit patients with RCC T1 by providing cost savings, making it a more cost-effective treatment without compromising oncological outcomes.

Level of evidence: 2b, Analysis based on clinically sensible costs or alternatives, including multi-way sensitivity analyses.