CardioVascular and Interventional Radiology最新文献

Purpose: To determine whether time of arrival at a major trauma centre (MTC) influences embolisation rate, time to embolisation, embolisation failure and 30-day survival in adult trauma patients.

Materials and methods: Data for adults (> 18 years) admitted to an MTC and recorded in the UK Trauma Audit and Research Network database between 01/01/17 and 31/12/21 were analysed. 'In-hours' was defined as Monday to Friday (excluding holidays) 09:00-17:00; all other times were 'out-of-hours'. Descriptive and regression analyses assessed factors associated with time to embolisation and 30-day survival, and the relationship between these outcomes.

Results: Among 2,560 patients with splenic injury (Abbreviated Injury Scale (AIS) > 2) directly admitted to an MTC, 184 (7.2%) underwent embolisation within 24 h. Of these, 79% were male (145/184) with a median age of 42 years (IQR 27-56). Embolisation within 24 h occurred in 48/600 (8.0%) of patients admitted in-hours versus 136/1,960 (6.9%) out-of-hours. Embolisation failure rate was similar between the groups (6.3% (3/48) in-hours versus 9.6% (13/136) out-of-hours). American Association for the Surgery of Trauma (AAST) grade and probability of survival were similar across groups. Median time to embolisation was 159 min (95% CI 142-213) in-hours and 238 min (95% CI 210-288) out-of-hours. After adjustment, out-of-hours patients had 1.34 times longer time to embolisation (95% CI 1.02-1.76). Regression analysis showed no strong association between time of admission and 30-day survival (odds ratio [OR] 2.13; 95% CI 0.76-5.81). Time to embolisation also showed no relationship with survival (OR 1.00; 95% CI 1.00-1.00).

Conclusion: Although out-of-hours presentation delayed embolisation, this did not affect 30-day survival, suggesting current trauma workflows maintain clinical effectiveness despite temporal disparities in interventional radiology (IR) access.

Introduction: Interventional oncology (IO) is a key component of multidisciplinary cancer care, delivering minimally invasive therapies with safety and efficacy comparable to or surpassing conventional approaches. As IO enters a transformative era, the field must continue demonstrating value within the greater world of oncology, particularly through the study and application of surrogate endpoints.

Surrogate endpoint definitions and validation criteria: A central requirement for advancing IO is the rigorous evaluation of treatment outcomes through translational research. Surrogate endpoints, including imaging-based criteria and serum biomarkers, expedite therapeutic assessment, yet their validity as predictors of clinical benefit remains under scrutiny.

Regulatory and methodological challenges: Experience from prior IO studies underscores the complex interplay between surrogate endpoints, overall survival, and quality of life metrics. Variable regulatory acceptance, incomplete validation, and inconsistencies in endpoint definition and reporting continue to challenge their adoption.

Primary liver tumors: In hepatocellular carcinoma (HCC), surrogate endpoints have informed treatment evaluation; however, their predictive strength and reproducibility remain variable across studies.

Secondary liver malignancies: Applications in metastatic liver disease similarly rely on imaging and serum-based surrogates, though performance and reliability remain heterogeneous.

Limitations: Uncertainty persists regarding the ability of surrogate endpoints to reliably predict durable clinical outcomes, limiting their broader applicability.

Future directions: Advancing IO will require the integration of modern trial methodologies, synthetic control arms, radiomics, and artificial intelligence to strengthen surrogate endpoint validation and facilitate broader clinical and regulatory acceptance.

Conclusions: By embracing its characteristically innovative spirit while maintaining a critical lens on data interpretation, the IO community can not only advance therapeutic development but also reinforce its indispensability in oncology. The beginning of a new quarter century brings a pivotal juncture, with an opportunity to reimagine IO's trajectory bridging technical ingenuity with the nuanced demands of modern cancer care.

Purpose: Assessment of the clinical feasibility of robot-assisted endovascular visceral interventions to reduce physical strain caused by prolonged standing and enabling remote interventions.

Material and methods: Between 05/2024 and 09/2024, 45 patients were included in this prospective, single-center study. Patients scheduled for elective endovascular abdominal and pelvic interventions with superselective catheterization were assigned to manual (27 patients) or robotic-assisted treatment (18 patients). Radiation dose of the interventionalist, examination time (including preparation and follow-up), procedure duration and fluoroscopy time were compared between procedures using the CorPath GRX platform (Corindus, Waltham, MA) and conventional procedures. Technical success of robotic interventions was defined as achieving stable microcatheter positioning at the predefined target treatment point in the target vessel under robotic navigation, allowing execution of the planned therapy without conversion to manual navigation.

Results: 18 patients underwent robotic-assisted interventions (mean age 68 ± 12 years; 15 male), transarterial chemoembolization (TACE) (n = 9), ^99mTc-MAA simulation (MAA)/transarterial radioembolization (TARE) (n = 2) and prostatic artery embolization (PAE) (n = 7). 27 comparable procedures were performed manually (mean age 68 ± 10 years; 21 male): TACE (n = 13); MAA/TARE (n = 7); PAE (n = 7). 16/18 (88.9%; 95%-CI (Wilson) 67.3-96.7%) robotic-assisted procedures were technically successful, with manual conversion occurring in 2 patients (11.1%; 95%-CI (Wilson) 3.1-32.8%). Neither median fluoroscopy time nor procedural dose, procedure duration or examination time differed between the robotic and conventional interventions [19 min (IQR 19.55) vs. 31 min (IQR 19.85); p = .053; 107.85 Gycm² (IQR 164.03) vs. 128.00 Gycm² (IQR 186.20); p = .286; 65 min (IQR 35.50) vs. 59 min (IQR 49.00); p = .711; 100 min (IQR 37.50) vs. 100 min (IQR 40.00); p = .853]. In comparison with conventional procedures, the operator's dose was lower in robotic interventions [0.000 mSv (IQR 0.000) vs. 0.005 mSv (IQR 0.005); p < .001].

Conclusion: Findings from this pilot case series indicate that robotic-assisted endovascular visceral interventions are feasible and demonstrate a high technical success rate, while simultaneously providing the interventionalist zero radiation exposure through remote operation from the control room.

Purpose: We investigated whether bridging therapy (BL) was more effective as compared to thrombectomy alone (DT) in the posterior circulation and M2 occlusions as compared to M1 occlusions in patients with acute ischemic stroke.

Material and methods: This study is based on data from 4853 patients that were enrolled in the nationwide registry of the German Society for Neuroradiology between 2018 and 2022. Outcome measures included the relative proportion of patients with a National Institutes of Health Stroke Scale score of 0-8 at discharge, successful reperfusion defined as a modified treatment in cerebral infarction score of 2b, 2c, or 3, the occurrence of intracranial hemorrhage, embolism in another vascular territory and mortality.

Results: There were no significant differences (p < 0.05) between the groups with DT and BL in periprocedural complications, mortality and functional outcome for patients with occlusion of the M1 and M2 segment. Significant higher recanalization rates were found for the M1 segment (BL 89.3%, DT 84.9%, p = 0.009) in patients treated with BL; no significant differences were found between the groups for the M2 segment. In patients with basilar occlusion, we found a significantly higher embolization rate in patients with BL (BL 2.7%, DT 1%, p = 0.018) and all other outcome measures did not differ significantly.

Conclusion: Our analysis does not show significant differences in mortality, hemorrhage and functional outcome rates between BL and DT for patients with M1, M2 and basilar occlusions. BL was not associated with different recanalization rates in patients with M2 and basilar occlusions.

Purpose: This study examines the efficacy of genicular artery embolization (GAE) as a treatment to reduce chronic knee pain in patients who have previously undergone total knee arthroplasty (TKA).

Materials and methods: Thirty-seven consecutive patients (13 men and 24 women) with a history of persistent pain for at least one year after TKA underwent GAE at a single center. The mean age across all patients was 72.8 ± 9.7 years, and the mean BMI was 29.3 ± 6.1 kg/m². Imipenem cilastatin particles and/or microspheres were delivered through a microcatheter to the targeted arteries by a board-certified interventional cardiologist. Clinical success was determined by degree of improvement in patient response to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) pain questionnaires at one-month and three-month intervals following successful embolization of targeted arteries.

Results: Among 37 patients, WOMAC scores at the preliminary, one-month, and three-month follow-up appointments were 64% ± 6%, 39% ± 8%, and 36% ± 8%, respectively (95% CI). VAS scores were 8.1 ± 0.6, 3.2 ± 1.1, and 3.1 ± 1.0 (95% CI). A paired t-test showed a statistically significant improvement at both one-month and three-month post-procedure evaluations. (p < 0.05). Overall, 64.9% (n = 24) of patients achieved at least a 50% improvement in pain scores by the end of the study term.

Conclusion: GAE shows efficacy as an adjunct treatment in patients with TKA and long-standing pain (> 1 year). Further research is needed to assess long-term outcomes and broader applicability.

Background: Obstructive uropathy is a very common pathology of the genitourinary system which, if untreated, leads to renal impairment, end-stage renal failure and death. Particularly in the case of acute obstructive uropathy, urgent decompression is necessary to prevent compression-mediated ischaemia of the renal parenchyma and the development of irreversible renal failure. Percutaneous nephrostomy is a well-established and relatively safe image-guided procedure used to obtain access to the renal collecting system and is the procedure of choice for the infected obstructed kidney, minimising the risk of septic shock and possible death. Subsequent internalisation via antegrade ureteric stenting is frequently employed to relieve obstruction at the level of the causative lesion.

Purpose: CIRSE Standards of Practice documents recommend a reasonable approach to, and best practices for, performing procedures, in this instance, Nephrostomy and Ureteric Stent Placement and Exchange.

Methods: The writing group, established by the CIRSE Standards of Practice Committee, consisted of five clinicians with internationally recognised expertise in this topic, and one research assistant (I.I.). The writing group reviewed the existing literature, performing a pragmatic evidence search using PubMed to search for publications in English relating to human subjects from 2001 to 2025. Relevant older primary sources were included where the data have not been updated.

Results: A document was produced, making recommendations for practice based on currently available evidence in a range of clinical scenarios.

Purpose: This study aims to compare local recurrence-free survival (LRFS) in patients with de novo HCC treated with thermal ablation (TA) using real-time CT/MRI-US fusion imaging (FI) or ultrasound (US) for needle placement.

Materials and methods: This single-center retrospective cohort study included patients with de novo HCC who underwent percutaneous TA between January 2013 and December 2021. US was the preferred image guidance modality for ultrasonographically conspicuous lesions; however, for inconspicuous lesions, FI (US-CT or US-MRI) was used for needle placement. Propensity score matching (PSM) with a 1:1 ratio was applied to balance baseline variables between the US- and FI-guided groups. LRFS, disease-free survival (DFS), and overall survival (OS) were compared before and after matching using the log-rank test. Univariate analyses using Cox regression were used to identify prognostic factors for LRFS.

Results: A total of 117 patients with 157 lesions were ablated using US and FI needle guidance in 100 and 57 tumors, respectively. PSM yielded 40 tumors in both groups. The 1-year LRFS rates were similar across the groups before and after matching (US: 0.82, FI: 0.94 (p = 0.07) and US: 0.87, FI: 0.91 (p = 0.20), respectively). Univariate analysis revealed that only tumor size was a predictive factor for LRFS. Before and after matching, the DFS and OS did not significantly differ between the groups (p > 0.05).

Conclusion: FI-guided needle placement facilitates effective targeting of HCC lesions that are ultrasonographically inconspicuous, yielding LRFS outcomes comparable to those achieved with US guidance for ultrasonographically conspicuous lesions. Level of Evidence 3b, Retrospective Cohort Study.