CardioVascular and Interventional Radiology最新文献

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.

Purpose: To evaluate a fully automated bone removal software for cone beam computed tomography (CBCT) of the thorax, abdomen, and pelvis, enhancing vascular visualization by eliminating bone interference and improving diagnostic quality.

Material and methods: 1035 CBCT scans from adults age 66.5 ± 11.9 18-87 years (mean ± std min-max) across nine centers were retrospectively analyzed, divided into training (n = 855, 515 abdomen, 229 pelvis, 111 thorax) and testing (n = 180, 60 for each region, 114 male, 53 female, 13 unknown). Manual bone segmentation was performed using ITK-SNAP. A modified 3D U-Net was trained and clinically evaluated through multireader analysis using ordinal scales from 1 (perfect) to 4 (not usable) bone subtraction (B-rating) and erosion of non-target structures (V-rating) in addition to a vessel assessment (VA-rating), categorizing the subtracted image as "better" (1), "same" (2), or "worse" (3). Quantitative metrics include Sørensen-Dice coefficient and intersection over union (IoU).

Results: The software demonstrated high accuracy with a B-rating of 1.01 ± 0.07 and a V-rating of 1.02 ± 0.13, indicating minimal erosion of non-target structures. A VA-rating of 1.0 ± 0 suggests an improved vessel assessment and the depiction of contrast material deposition, enhancing the diagnostic quality of CBCT images. Quantitative analysis closely matched the manual expert delineation (Sørensen-Dice coefficient 0.95 ± 0.02, IoU of 0.9 ± 0.03).

Conclusion: The software provides robust, fully automated bone removal in CBCT scans. This technology may enhance vascular system visualization without compromising non-target structures, potentially improving the accuracy and efficiency of interventional and diagnostic radiology procedures.

Purpose: This CIRSE Standards of Practice document aims to provide comprehensive standards for the endovascular treatment of acute pulmonary embolism and includes recommendations for the imaging diagnosis, surveillance, intervention indications and endovascular treatments.

Methods: The CIRSE Standards of Practice Committee established a writing group of six internationally recognised interventional radiologists with expertise in pulmonary embolism interventions and one research assistant (C.I). The group conducted a pragmatic evidence-based PubMed search for relevant English-language reports on human subjects up to early 2025. The final recommendations are consensus-based.

Results: Endovascular treatment of pulmonary embolism is highly successful with low complication rates. For acute pulmonary thromboembolic disease, catheter-directed thrombolysis and mechanical thrombectomy are options for patients with intermediate-high-risk and high-risk pulmonary embolism, especially when systemic fibrinolysis fails or is contraindicated.

Conclusions: Endovascular therapy for acute pulmonary embolism is both safe and effective. This best practice document emphasises early diagnosis, appropriate patient selection and timely intervention.

Purpose: A tumor diameter > 3 cm is considered a relative contraindication for thermal ablation due to a significant risk of post-ablation recurrence. However, current advanced ablation techniques might allow for successful ablation of larger tumors. This study aimed to evaluate the impact of tumor size on outcomes of Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA).

Methods: Patients treated with HepACAGA for hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) between January 2021 and June 2025 were analyzed. All ablations were performed with microwave ablation. Patients were stratified by tumor size: ≤ 2 cm, 2-3 cm, and 3-5 cm. Outcomes assessed included local tumor progression-free survival (LTPFS), local tumor progression (LTP) rate, and complications.

Results: A total of 137 consecutive patients with 265 tumors (152 HCC and 113 CRLM) were included: 187 tumors ≤ 2 cm, 52 tumors 2-3 cm, and 26 tumors 3-5 cm. The 1-year LTPFS was most favorable for tumors ≤ 2 cm (96%; 95% CI: 93-99), followed by 2-3 cm (93%; 95% CI: 85-100), and 3-5 cm (90%; 95% CI: 78-100). No significant differences in LTPFS were found (p = 0.580). Overall, LTP occurred in 5% of tumors. Secondary LTP rates were 3% for tumors ≤ 2 cm and 4% for both tumors 2-3 cm and 3-5 cm (p = 0.966). Complication rates were 4% for tumors ≤ 2 cm, 6% for tumors 2-3 cm, and 13% for tumors 3-5 cm (p = 0.236).

Conclusion: HepACAGA proved to be effective and safe for treating patients with HCC and CRLM across a broad range of tumor sizes. These findings suggest that intermediate-sized tumors (3-5 cm) could be eligible for thermal ablation without compromising post-ablation recurrence.

Purpose: We aimed to determine whether central line-associated bloodstream infection (CLABSI) rates differ between tunneled and conventionally inserted PICCs (tPICCs and cPICCs).

Materials and methods: This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD42024616470) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were comprehensively searched from inception to November 27, 2024, to identify randomized controlled trials that compared CLABSI rates between tPICCs and cPICCs. Risk ratios along with the 95% confidence intervals (CI) were calculated for outcomes using a random-effects meta-analysis model following the Hartung-Knapp-Sidik-Jonkman method. Statistical heterogeneity was assessed using the I² statistic. Methodological quality and risk of bias were assessed using the Cochrane risk of bias tool.

Results: A meta-analysis of four relevant studies, comprising 2,659 participants (pooled mean age ± standard deviation, 59.3 ± 15.5 years; 1,481 women) and 177,879 catheter days, revealed overall CLABSI rates of 0.31 per 1,000 catheter-days in the tPICC group and 0.68 per 1,000 catheter-days in the cPICC group. The risk ratio (0.48; 95% CI, 0.28-0.81; p = 0.02) indicated a 52% reduction in the tPICC group compared with the cPICC group, with low heterogeneity (I² = 0%).

Conclusion: Subcutaneous tunneling for PICC placement is associated with a significant reduction in CLABSI rate among hospitalized adult patients.

Purpose: To evaluate the association between hemodynamic depression (HD) during CAS and major adverse cardiovascular events (MACE).

Methods: We systematically searched four major databases for studies reporting the HD and MACE during CAS. The risk of bias in the included studies was assessed using a modified version of Newcastle-Ottawa scale. The heterogeneity between the studies was evaluated based on the I² statistic and Dixon's Q-test. We assessed heterogeneity using the I² statistic. A fixed-effect model was used if I² < 50%; otherwise, a random-effects model was applied. Results were reported as ORs with 95% CIs. Funnel plots and Egger's test were used to evaluate the publication bias.

Results: Fourteen studies comprising 4418 patients were included in the meta-analysis. Evidence of low certainty indicated that the occurrence of HD was significantly associated with an increased risk of stroke (OR 2.12, 95% CI 1.4-3.22, I² = 0), transient ischemic attack (TIA) (OR 2.72, 95% CI 1.51-4.88, I² = 41.2), and all-cause mortality (OR 2.81, 95% CI 1.22-6.44, I² = 0). However, very low-certainty evidence suggested no significant association between HD and myocardial infarction (MI) (OR 1.49, 95% CI 0.61-3.61, I² = 0).

Conclusions: HD during CAS is significantly associated with a risk of TIA, stroke, and all-cause mortality, but not with the risk of MI.