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Diagnostic and Interventional Imaging 2020The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using automated feeder detection (AFD) software.
MATERIALS AND METHODS
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A structured search was performed in the PubMed, SCOPUS, and Embase databases of patients undergoing locoregional therapy of liver tumors utilizing AFD software. Demographic data, procedure data (including radiometrics) and tumor response rate were recorded. Where available, performance of AFD was compared to conventional digital subtraction angiography (DSA) and cone-beam CT (CBCT) without AFD.
RESULTS
A total of 14 full-text manuscripts met inclusion criteria, comprising 1042 tumors in 604 patients (305 men, 156 women; mean age, 68.6±6.0 [SD] years), including 537 patients with hepatocellular carcinoma, 8 with metastases from neuroendocrine tumors, and 59 patients without reported etiology. Reported sensitivity of AFD ranged between 86% and 98.5%, compared to DSA alone (38% - 64%) or DSA in combination with CBCT (69% - 81%). Three studies reported tumor response by modified response evaluation criteria in solid tumors (mRECIST) guidelines, with complete response in the range of 60% - 69%.
CONCLUSION
AFD is a promising new technology for the identification of intrahepatic and extrahepatic tumor-feeding arteries and should be considered a useful adjunct to conventional DSA and CBCT in the treatment of liver tumors.
Topics: Aged; Angiography, Digital Subtraction; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Cone-Beam Computed Tomography; Female; Humans; Liver Neoplasms; Male; Middle Aged; Software
PubMed: 32035822
DOI: 10.1016/j.diii.2020.01.011 -
AJNR. American Journal of Neuroradiology May 2021Radial artery access for cerebral angiography is traditionally performed in the wrist. Distal transradial access in the anatomic snuffbox is an alternative with several... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Radial artery access for cerebral angiography is traditionally performed in the wrist. Distal transradial access in the anatomic snuffbox is an alternative with several advantages.
PURPOSE
Our aim was to review the safety and efficacy of distal transradial access for diagnostic cerebral angiography and neurointerventions.
DATA SOURCES
We performed a comprehensive search of the literature using PubMed, Scopus, and EMBASE.
STUDY SELECTION
The study included all case series of at least 10 patients describing outcomes associated with distal transradial access for diagnostic cerebral angiography or a neurointervention.
DATA ANALYSIS
Random-effects models were used to obtain pooled rates of procedural success and complications.
DATA SYNTHESIS
A total of 7 studies comprising 348 (75.8%) diagnostic cerebral angiograms and 111 (24.2%) interventions met the inclusion criteria. The pooled success rate was 95% (95% CI, 91%-98%; I = 74.33). The pooled minor complication rate was 2% (95% CI, 1%-4%; I = 0. No major complications were reported. For diagnostic procedures, the combined mean fluoroscopy time was 13.53 [SD, 8.82] minutes and the mean contrast dose was 74.9 [SD, 35.6] mL.
LIMITATIONS
A small number of studies met the inclusion criteria, all of them were retrospective, and none compared outcomes with proximal transradial or femoral access.
CONCLUSIONS
Early experience with distal transradial access suggests that it is a safe and effective alternative to proximal radial and femoral access for performing diagnostic cerebral angiography and interventions. Additional studies are needed to establish its efficacy and compare it with other access sites.
Topics: Cerebral Angiography; Humans; Neuroendoscopy; Radial Artery; Retrospective Studies
PubMed: 33707276
DOI: 10.3174/ajnr.A7074 -
Circulation. Cardiovascular Imaging Nov 2023The efficacy of coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) among patients with stable chest pain has been studied in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy of coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) among patients with stable chest pain has been studied in several trials with conflicting results.
METHODS
We performed a systematic review and meta-analysis comparing CCTA first versus direct ICA among patients with stable chest pain, who were initially referred to ICA. PubMed, EMBASE, and Cochrane Central were searched for randomized controlled trials comparing the 2 strategies. Risk ratios (RRs) and mean differences with 95% CIs were computed for binary and continuous outcomes, respectively.
RESULTS
Five randomized controlled trials with a total of 5727 patients were included, of whom 51.1% were referred to CCTA and 22.5% of patients had evidence of ischemia on a prior functional test. In the follow-up ranging from 1 to 3.5 years, 660 of the 2928 patients randomized to CCTA first underwent ICA (23%). Patients who underwent CCTA had lower rates of coronary revascularization (RR, 0.74 [95% CI, 0.66-0.84]; <0.001) and stroke (RR, 0.50 [95% CI, 0.26-0.98]; =0.043). Cardiovascular mortality (RR, 0.55 [95% CI, 0.24-1.23]; =0.146), major adverse cardiovascular events (RR, 0.84 [95% CI, 0.64-1.10]; =0.198), nonfatal myocardial infarction (RR, 1.09 [95% CI, 0.63-1.88]; =0.768), and cardiovascular hospitalizations (RR, 0.91 [95% CI, 0.59-1.39]; =0.669) did not differ significantly between groups.
CONCLUSIONS
In patients with stable chest pain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA. CCTA was associated with a reduction in the rates of coronary revascularization and stroke compared with direct ICA.
REGISTRATION
URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023383143.
Topics: Humans; Computed Tomography Angiography; Coronary Artery Disease; Coronary Angiography; Randomized Controlled Trials as Topic; Chest Pain; Stroke
PubMed: 37988448
DOI: 10.1161/CIRCIMAGING.123.015800 -
Eye (London, England) Jul 2022To assess the association between optical coherence tomography angiography (OCTA) retinal measurements and Alzheimer's disease (AD). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To assess the association between optical coherence tomography angiography (OCTA) retinal measurements and Alzheimer's disease (AD).
METHODS
We searched MEDLINE and EMBASE from inception up to October 28th, 2020 for studies assessing the association between OCTA retinal measurements and AD. Estimates from eligible studies were meta-analysed and pooled standardized mean differences (SMDs) between AD patients and healthy participants with corresponding 95% confidence intervals (95% CI) were calculated, using the Hartung-Knapp/Sidik-Jonkman random-effects method. In addition, we quantified the minimum strength on the risk ratio scale (E value) required for an unmeasured confounder to nullify these associations.
RESULTS
Ten eligible studies for our systematic review were identified through our search strategy. The pooled SMD between the retinal vessel density of AD patients and healthy participants in the whole superficial vascular plexus (SVP), parafoveal SVP and foveal avascular zone (FAZ) was -0.41 (95% CI: -0.69 to -0.13, p value = 0.01, I = 15%, seven studies), -0.51 (95% CI: -0.84 to -0.18, p value = 0.01, I = 40%, six studies), and 0.87 (95% CI: -0.03 to 1.76, p value = 0.05, I = 91%, seven studies), respectively. An unmeasured confounder would need to be associated with a 2.26-, 2.56- and 3.82-fold increase in the risk of AD and OCTA retinal measurements, in order for the pooled SMD estimate of vessel density in whole SVP, parafoveal SVP and FAZ, respectively, to be nullified.
CONCLUSIONS
In our study, whole and parafoveal SVP vessel density were inversely associated with AD. However, prospective longitudinal studies with larger sample sizes are needed to furtherly assess these associations.
Topics: Alzheimer Disease; Fluorescein Angiography; Fovea Centralis; Humans; Prospective Studies; Retinal Vessels; Tomography, Optical Coherence
PubMed: 34193983
DOI: 10.1038/s41433-021-01648-1 -
Neuroradiology May 2021Posterior circulation perforator aneurysms (PCPAs) are a rare type of intracranial aneurysms whose natural history and optimal clinical management are still largely... (Review)
Review
PURPOSE
Posterior circulation perforator aneurysms (PCPAs) are a rare type of intracranial aneurysms whose natural history and optimal clinical management are still largely unexplored. This study aims to report our experience with treating ruptured PCPAs and to provide a systematic review of the literature to compare the two most established treatment options, endovascular stenting, and conservative management including administration of antifibrinolytic drugs and watchful waiting.
METHODS
We performed a systematic review of the literature following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Major databases were searched for case reports and case report series written in the English language between 1995 and 2020. Additionally, we retrospectively reviewed our stroke center database for cases of ruptured PCPAs between January 2014 and July 2020. Endovascular stenting and conservative treatment were compared using endpoints, including favorable outcome rate (mRS 0-2), occlusion rate, mortality rate, periinterventional complication rate, and re-hemorrhage rate.
RESULTS
We identified 31 patients treated endovascularly using stents and 33 patients treated conservatively, with the administration of antifibrinolytic drugs in 3 of them. Our analysis showed no statistically significant difference between the groups, except for the occlusion rate.
CONCLUSIONS
The optimal management strategy of PCPAs is still unknown, but stenting can be considered as an effective occlusion method with an acceptable complication rate. Preventive ventricular drainage may be necessary due to the high hydrocephalus rate encountered in ruptured PCPAs.
Topics: Aneurysm, Ruptured; Cerebral Angiography; Conservative Treatment; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Retrospective Studies; Stents; Treatment Outcome
PubMed: 33404790
DOI: 10.1007/s00234-020-02618-2 -
Catheterization and Cardiovascular... Aug 2016Radiographic contrast administration is a major cause of acute kidney injury (AKI), worldwide. Currently, contrast induced acute kidney injury (CI-AKI) is the third... (Review)
Review
INTRODUCTION
Radiographic contrast administration is a major cause of acute kidney injury (AKI), worldwide. Currently, contrast induced acute kidney injury (CI-AKI) is the third leading cause of hospital acquired renal failure in the United States. Over 50% of these cases are the result of contrast exposure during cardiac catheterization. The predictive risk factors for and clinical impact of AKI following coronary procedures have been extensively studied and documented in the literature. Similar data, however, are lacking for AKI following angiography or endovascular interventions for lower extremity peripheral artery disease (PAD).
METHODS
The present review examined the published data available for AKI in patients undergoing peripheral procedures using MEDLINE searches. Specific data on number of peripheral cases, subject characteristics, hydration strategies, and AKI incidence rates was recorded.
RESULTS
The systematic review resulted in 50 potentially relevant studies and ultimately 15 studies were selected for detailed analysis that included AKI incidence data on patients undergoing peripheral angiography or interventions. The summated studies included 11,311 patients and 10,316 peripheral procedures. The median incidence of AKI in the studies was 10%. The retrieved publications demonstrated significant variations in patient risk factors, definitions of AKI, and specificity of description of endovascular therapies.
CONCLUSIONS
The incidence, risk factors, and outcomes related to AKI in the context of peripheral angiography or endovascular therapy remain poorly described in the literature and warrant further study in a prospective, systematic fashion. © 2016 Wiley Periodicals, Inc.
Topics: Acute Kidney Injury; Angiography; Contrast Media; Endovascular Procedures; Humans; Incidence; Lower Extremity; Peripheral Arterial Disease; Radiography, Interventional; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 26946253
DOI: 10.1002/ccd.26466 -
Neurosurgical Focus May 2023Flow diverters (FDs) have demonstrated increasing safety and efficacy in treating various types of intracranial aneurysms. Although the underlying mechanism of action of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Flow diverters (FDs) have demonstrated increasing safety and efficacy in treating various types of intracranial aneurysms. Although the underlying mechanism of action of all FDs is similar, differences are noted in their intrinsic characteristics, materials, and deployment techniques. The p64 flow modulation device (p64) and the newer p48 movable wire flow modulation device (p48 MW) are not yet available in the US but have been increasingly used mainly in Europe, demonstrating optimistic results. The authors performed a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of the p64 and p48 MW FDs.
METHODS
A literature review (between January 1960 and November 2022) of the PubMed, Scopus, Embase, Web of Science, and Cochrane Central Register of Controlled Trials databases was conducted. The primary efficacy outcome was the proportion of complete angiographic occlusion at last follow-up. Complete occlusion was defined as Raymond-Roy class 1 and O'Kelly-Marotta grade D. The primary safety outcomes were the composite safety rate of ischemic and hemorrhagic events (intra- and postprocedure) and the all-cause mortality rate. Data were analyzed using a random-effects proportions meta-analysis, and statistical heterogeneity was assessed.
RESULTS
Twenty studies with 1781 patients harboring 1957 aneurysms were included in the analysis. Seventeen studies were conducted in Europe. Sixteen studies evaluated the performance of the p64 (MW). Patient ages ranged between 20 and 89 years, and most were female (78.7%). Aneurysm size ranged between 1 and 50 mm. Most aneurysms were unruptured (92.8%) and in the anterior circulation (93.1%). Single antiplatelet therapy pre- and postprocedure was used in 2 studies. Follow-up ranged from 2 to 14.5 months. For the p64 and p48 MW, complete angiographic occlusion rates were 77% (95% CI 68%-85%) and 67% (95% CI 49%-81%), adjunctive coil usage rates were 7% (95% CI 4%-12%) and 4% (95% CI 0%-24%), primary safety composite rates were 2% (95% CI 1%-4%) and 3% (95% CI 1%-11%), and mortality rates were 0.49% (95% CI 0%-1%) and 2% (95% CI 1%-6%), respectively.
CONCLUSIONS
The p64 and p48 MW have primarily been used in Europe thus far. This analysis found that both devices have an acceptable efficacy and favorable safety profile. However, further studies are needed to evaluate the efficacy and safety of prescribing a single antiplatelet regimen after implantation of the newer-generation FDs with antithrombotic coating surface modification.
Topics: Humans; Female; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Male; Treatment Outcome; Retrospective Studies; Embolization, Therapeutic; Endovascular Procedures; Intracranial Aneurysm; Cerebral Angiography; Stents
PubMed: 37127026
DOI: 10.3171/2023.2.FOCUS22648 -
Cardiovascular Intervention and... Jan 2022Coronary artery disease (CAD) and severe aortic valve stenosis frequently coexist. Given the progressive nature of CAD, silent or non-significant CAD may become... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis of delayed coronary artery access for coronary angiography with or without percutaneous coronary intervention (PCI) in patients who underwent transcatheter aortic valve replacement (TAVR).
Coronary artery disease (CAD) and severe aortic valve stenosis frequently coexist. Given the progressive nature of CAD, silent or non-significant CAD may become symptomatic or functionally relevant years after TAVR. However, there is a paucity of data documenting the feasibility of either coronary angiography and/or PCI after TAVR. We systematically searched Medline, Pubmed, Embase, Cochrane database, Google Scholar, Science Direct, Web of Science, and conference abstracts from conception to March 2020 using OvidSP in TAVR patients undergoing coronary angiography with or without PCI at least 6 months after TAVR. Patients and procedural characteristics were summarized. The primary outcome of interest was successful coronary angiography for either the left main coronary artery (LMCA) or right coronary artery (RCA) with or without PCI. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO. Eleven reports for a total of 696 coronary angiograms and 287 PCI were included in the analysis. Patients were slightly predominantly male, older and had a mean left ventricular ejection fraction of more than 50% with an intermediate STS. The summary estimate rates of successful LMCA and RCA angiography with a Medtronic self-expandable valve (SEV) were 84% (95% CI 73-90%, I = 79, p = 0.015) and 69% (95% CI 37-89%, I = 86, p = 0.23), respectively, while with the Edwards Lifesciences balloon expandable valve (BEV), the summary estimate rates for successful LMCA and RCA angiography were 94% (95% CI 72-99%, I = 66, p = 0.003) and 95% (95% CI 48-99%, I = 83, p = 0.05), respectively. The summary estimate rate of successful PCI post TAVR with either a Medtronic SEV or Edwards Lifesciences BEV was 93% (95% CI 86-96%, I = 33, p = 0.0001). The overall achievement of a successful coronary angiography with or without PCI in post-TAVR patients is high, with a lower success rate for RCA angiography in patients with the Medtronic SEV Mortality and bleeding did not differ in our analysis.
Topics: Aortic Valve; Aortic Valve Stenosis; Coronary Angiography; Coronary Vessels; Heart Valve Prosthesis; Humans; Male; Percutaneous Coronary Intervention; Stroke Volume; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ventricular Function, Left
PubMed: 33453034
DOI: 10.1007/s12928-020-00753-4 -
Catheterization and Cardiovascular... Sep 2023Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on... (Meta-Analysis)
Meta-Analysis
Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography-guided percutaneous coronary interventions: A systematic review, network meta-analysis, and meta-regression.
BACKGROUND
Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on coronary angiography (CA) and have shown to improve clinical outcomes. We sought to compare the clinical efficacy of IVUS, OCT, and conventional CA-guided percutaneous coronary interventions (PCI).
METHODS
Frequentist and Bayesian network meta-analyses of randomized clinical trials were performed to compare clinical outcomes of PCI performed with IVUS, OCT, or CA alone.
RESULTS
A total of 28 trials comprising 12,895 patients were included. IVUS when compared with CA alone was associated with a significantly reduced risk of major adverse cardiovascular events (MACE) (risk ratio: [RR] 0.74, 95% confidence interval: [CI] 0.63-0.88), cardiac death (RR: 0.64, 95% CI: 0.43-0.94), target lesion revascularization (RR: 0.68, 95% CI: 0.57-0.80), and target vessel revascularization (RR: 0.64, 95% CI: 0.50-0.81). No differences in comparative clinical efficacy were found between IVUS and OCT. Rank probability analysis bestowed the highest probability to IVUS in ranking as the best imaging modality for all studied outcomes except for all-cause mortality.
CONCLUSION
Compared with CA, the use of IVUS in PCI guidance provides significant benefit in reducing MACE, cardiac death, and revascularization. OCT had similar outcomes to IVUS, but more dedicated studies are needed to confirm the superiority of OCT over CA.
Topics: Humans; Coronary Artery Disease; Tomography, Optical Coherence; Network Meta-Analysis; Percutaneous Coronary Intervention; Bayes Theorem; Ultrasonography, Interventional; Treatment Outcome; Coronary Angiography; Death
PubMed: 37483068
DOI: 10.1002/ccd.30784 -
Eye (London, England) Oct 2023To examine the association between optical coherence tomography angiography (OCTA) retinal measurements and Parkinson's disease (PD). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To examine the association between optical coherence tomography angiography (OCTA) retinal measurements and Parkinson's disease (PD).
METHODS
We searched MEDLINE and EMBASE from inception up to November 5th, 2021 for studies examining the differences between OCTA retinal measurements in PD patients and healthy controls. We used the Hartung-Knapp-Sidik-Jonkman random-effects method to combine study-specific standardized mean differences (SMD) in pooled effect estimates and a meta-analytic extension of the E-value metric to quantify the confounding bias capable of nullifying the pooled estimates.
RESULTS
Nine eligible studies for our systematic review were identified through our search strategy. The pooled SMD between the retinal vessel density of PD patients and healthy participants in the whole superficial vascular plexus (SVP), foveal SVP, parafoveal SVP and foveal avascular zone (FAZ) was -0.68 (95% CI: -1.18 to -0.17, p value = 0.02, n = 7 studies), -0.14 (95% CI: -0.88 to 0.59, p value = 0.62, n = 5 studies), -0.59 (95% CI: -1.41 to 0.23, p value = 0.12, n = 5 studies) and -0.20 (95% CI: -0.79 to 0.38, p value = 0.39, n = 5 studies), respectively. An unmeasured confounder would need to be associated with a 3.01-fold, 1.54-fold, 2.81-fold and 1.70-fold increase in the risk of PD and OCTA retinal measurements, in order for the pooled SMD estimate of vessel density in whole SVP, parafoveal SVP and FAZ, respectively, to be nullified.
CONCLUSIONS
Our results provide evidence on an inverse association between whole SVP vessel density and PD.
Topics: Humans; Fluorescein Angiography; Tomography, Optical Coherence; Parkinson Disease; Fundus Oculi; Retinal Vessels; Fovea Centralis
PubMed: 36788361
DOI: 10.1038/s41433-023-02438-7