-
Neurologic Clinics May 2021Aneurysmal subarachnoid hemorrhage is a neurologic emergency that requires immediate patient stabilization and prompt diagnosis and treatment. Early measures should... (Review)
Review
Aneurysmal subarachnoid hemorrhage is a neurologic emergency that requires immediate patient stabilization and prompt diagnosis and treatment. Early measures should focus on principles of advanced cardiovascular life support. The aneurysm should be evaluated and treated in a comprehensive stroke center by a multidisciplinary team capable of endovascular and, operative approaches. Once the aneurysm is secured, the patient is best managed by a dedicated neurocritical care service to prevent and manage complications, including a syndrome of delayed neurologic decline. The goal of such specialized care is to prevent secondary injury, reduce length of stay, and improve outcomes for survivors of the disease.
Topics: Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage; Treatment Outcome
PubMed: 33896527
DOI: 10.1016/j.ncl.2021.02.006 -
Innere Medizin (Heidelberg, Germany) Jan 2023Pulmonary embolism is a frequent cardiovascular disease which in recent years has shown a reduction in the mortality but an increase in the incidence. Due to the... (Review)
Review
Pulmonary embolism is a frequent cardiovascular disease which in recent years has shown a reduction in the mortality but an increase in the incidence. Due to the optimization of clinical probability scores and the interpretation of the D‑dimer test, unnecessary examinations using computed tomography with respect to the exclusion of an acute pulmonary embolism can be avoided, also in pregnant women. The evaluation of the right ventricle contributes to a risk-adapted treatment. Treatment consists of anticoagulation, alone or in combination with reperfusion treatment, such as systemic thrombolysis and also catheter-assisted or surgical treatment. In addition to acute treatment of pulmonary embolisms, an adequate aftercare is important, particularly for the early detection of long-term sequelae. This review article summarizes the current recommendations of international guidelines for patients with pulmonary embolism, accompanied by clinical case examples and a critical discussion.
Topics: Pregnancy; Humans; Female; Thrombolytic Therapy; Pulmonary Embolism; Catheters; Acute Disease; Disease Progression
PubMed: 36625924
DOI: 10.1007/s00108-022-01460-3 -
Advanced Materials (Deerfield Beach,... Aug 2019Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the... (Review)
Review
Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.
Topics: Animals; Biocompatible Materials; Embolization, Therapeutic; Endovascular Procedures; Humans; Metals; Microspheres; Polymers
PubMed: 31168915
DOI: 10.1002/adma.201901071 -
Respirology (Carlton, Vic.) Aug 2022Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows... (Review)
Review
Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows real-time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image-guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.
Topics: Arteriovenous Fistula; Embolization, Therapeutic; Humans; Pulmonary Artery; Stents; Vena Cava, Superior
PubMed: 35758539
DOI: 10.1111/resp.14315 -
European Journal of Nuclear Medicine... Jan 2023In light of recently published clinical reports and trials, the TheraSphere Global Dosimetry Steering Committee (DSC) reconvened to review new data and to update...
Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group.
PURPOSE
In light of recently published clinical reports and trials, the TheraSphere Global Dosimetry Steering Committee (DSC) reconvened to review new data and to update previously published clinical and dosimetric recommendations for the treatment of hepatocellular carcinoma (HCC).
METHODS
The TheraSphere Global DSC is comprised of health care providers across multiple disciplines involved in the treatment of HCC with yttrium-90 (Y-90) glass microsphere-based transarterial radioembolization (TARE). Literature published between January 2019 and September 2021 was reviewed, discussed, and adjudicated by the Delphi method. Recommendations included in this updated document incorporate both the results of the literature review and the expert opinion and experience of members of the committee.
RESULTS
Committee discussion and consensus led to the expansion of recommendations to apply to five common clinical scenarios in patients with HCC to support more individualized efficacious treatment with Y-90 glass microspheres. Existing clinical scenarios were updated to reflect recent developments in dosimetry approaches and broader treatment paradigms evolving for patients presenting with HCC.
CONCLUSION
Updated consensus recommendations are provided to guide clinical and dosimetric approaches for the use of Y-90 glass microsphere TARE in HCC, accounting for disease presentation, tumor biology, and treatment intent.
Topics: Humans; Carcinoma, Hepatocellular; Yttrium Radioisotopes; Liver Neoplasms; Microspheres; Radiopharmaceuticals; Embolization, Therapeutic; Glass
PubMed: 36114872
DOI: 10.1007/s00259-022-05956-w -
Journal of Neurointerventional Surgery Jan 2020Preliminary clinical studies on the safety and efficacy of the pipeline embolization device (PED) for the treatment of small/medium aneurysms have demonstrated high... (Clinical Trial)
Clinical Trial
BACKGROUND
Preliminary clinical studies on the safety and efficacy of the pipeline embolization device (PED) for the treatment of small/medium aneurysms have demonstrated high occlusion rates with low complications.
OBJECTIVE
To evaluate the safety and effectiveness of the PED for treatment of wide necked small and medium intracranial aneurysms.
METHODS
PREMIER is a prospective, multicenter, single arm trial. Patients were treated with the PED for unruptured wide necked aneurysms, measuring ≤12 mm along the internal carotid artery or vertebral artery, between July 2014 and November 2015. At 1 year post-procedure, the primary effectiveness endpoint was complete occlusion (Raymond grade 1) without major parent vessel stenosis (≤50%) or retreatment, and the primary safety endpoint was major stroke in the territory supplied by the treated artery or neurologic death.
RESULTS
A total of 141 patients were treated with PEDs (mean age 54.6±11.3 years, 87.9% (124/141) women). Mean aneurysm size was 5.0±1.92 mm, and 84.4% (119/141) measured <7 mm. PED placement was successful in 99.3% (140/141) of patients. Mean number of PEDs implanted per patient was 1.1±0.26; a single PED was used in 92.9% (131/141) of patients. At 1 year, 97.9% (138/141) of patients underwent follow-up angiography with 76.8% (106/138) of patients having met the study's primary effectiveness endpoint. The combined major morbidity and mortality rate was 2.1% (3/140).
CONCLUSIONS
Treatment of wide necked small/medium aneurysms with the PED results in high rates of complete occlusion without significant parent vessel stenosis and low rates of permanent neurologic complications.
TRIAL REGISTRATION
NCT02186561.
Topics: Adult; Aged; Blood Vessel Prosthesis; Embolization, Therapeutic; Female; Follow-Up Studies; Humans; Intracranial Aneurysm; Male; Middle Aged; Prospective Studies; Retreatment; Self Expandable Metallic Stents; Treatment Outcome
PubMed: 31308197
DOI: 10.1136/neurintsurg-2019-015091 -
The British Journal of Radiology Sep 2022Interventional oncology is a rapidly emerging field in the treatment of cancer. Minimally invasive techniques such as transarterial embolization with chemotherapeutic... (Review)
Review
Interventional oncology is a rapidly emerging field in the treatment of cancer. Minimally invasive techniques such as transarterial embolization with chemotherapeutic and radioactive agents are established therapies and are found in multiple guidelines for the management of primary and metastatic liver lesions. Percutaneous ablation is also an alternative to surgery for small liver, renal, and pancreatic tumors. Recent research in the niche of interventional oncology has focused on improving outcomes of established techniques in addition to the development of novel therapies. In this review, we address the recent and current advancements in devices, technologies, and techniques of chemoembolization and ablation: thermal ablation, histotripsy, high-intensity focused ultrasound, embolization strategies, liquid embolic agents, and local immunotherapy/antiviral therapies.
Topics: Antiviral Agents; Embolization, Therapeutic; Humans; Immunotherapy; Liver Neoplasms
PubMed: 35731848
DOI: 10.1259/bjr.20211360 -
RoFo : Fortschritte Auf Dem Gebiete Der... Dec 2019Gastrointestinal (GI) bleeding is a frequently occurring disease pattern, with a broad variety of possible causes. The most acute bleeding responds well to... (Review)
Review
BACKGROUND
Gastrointestinal (GI) bleeding is a frequently occurring disease pattern, with a broad variety of possible causes. The most acute bleeding responds well to conservative, medicinal and endoscopic therapies. Nevertheless, a certain amount of endoscopically not-identifiable or controllable non-varicose GI-bleeding requires alternative, sometimes surgical, therapy concepts. The updated S2k guideline "gastrointestinal bleeding" makes the case for interventional radiology with its minimally invasive endovascular techniques.
METHODS
This review article discusses the role of interventional radiology in the therapy of non-variceal upper and lower gastrointestinal bleeding according to the current literature and updated guideline. In this regard it covers the indications, techniques, results and complications of endovascular therapy.
RESULTS AND CONCLUSION
Considering interdisciplinary therapy options, the guideline-oriented endovascular treatment of gastrointestinal bleeding, using embolization and implantion of covered stents, shows to be a reasonable option with good technical and clinical success rates and a low rate of complications. In this context solid knowledge of vascular anatomy is essential to acquire adequate hemostasis.
KEY POINTS
· Interventional radiology contributes significantly to the diagnosis and treatment of non-variceal bleedings of various etiologies.. · In this context the S2K guideline "gastrointestinal bleeding" is the foundation for the decision-making process for hemostatic therapy.. · Embolization is the first choice when it comes to endovascular treatment of gastrointestinal bleeding.. · Adequate periinterventional management increases the success rate of endovascular therapy..
CITATION FORMAT
· Augustin AM, Fluck F, Bley T et al. Endovascular therapy of gastroinestinal bleeding. Fortschr Röntgenstr 2019; 191: 1073 - 1082.
Topics: Aged; Embolization, Therapeutic; Endovascular Procedures; Female; Gastrointestinal Hemorrhage; Guideline Adherence; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Male; Middle Aged; Minimally Invasive Surgical Procedures; Radiology, Interventional; Stents
PubMed: 31026864
DOI: 10.1055/a-0891-1116 -
Cardiovascular and Interventional... Nov 2022Since its first suggestion as possible option for liver radioembolization treatment, the therapeutic isotope holmium-166 (Ho) caught the experts' attention due to its... (Review)
Review
Since its first suggestion as possible option for liver radioembolization treatment, the therapeutic isotope holmium-166 (Ho) caught the experts' attention due to its imaging possibilities. Being not only a beta, but also a gamma emitter and a lanthanide, Ho can be imaged using single-photon emission computed tomography and magnetic resonance imaging, respectively. Another advantage of Ho is the possibility to perform the scout and treatment procedure with the same particle. This prospect paves the way to an individualized treatment procedure, gaining more control over dosimetry-based patient selection and treatment planning. In this review, an overview on Ho liver radioembolization will be presented. The current clinical workflow, together with the most relevant clinical findings and the future prospective will be provided.
Topics: Humans; Liver Neoplasms; Embolization, Therapeutic; Holmium; Radioisotopes; Tomography, Emission-Computed, Single-Photon; Microspheres; Yttrium Radioisotopes
PubMed: 35729423
DOI: 10.1007/s00270-022-03187-y -
Neurosurgery Jan 2020The treatment of intracranial aneurysms has undergone a few very significant paradigm shifts in its history. Needless to say, microsurgery and surgical clipping served... (Review)
Review
The treatment of intracranial aneurysms has undergone a few very significant paradigm shifts in its history. Needless to say, microsurgery and surgical clipping served as the initial basis for successful treatment of these lesions. The pursuit of endovascular therapy subsequently arose from the desire to reduce the invasiveness of therapy. While the first breakthrough arose with Guido Guglielmi's invention of the detachable platinum coil, commercialized flow diverter therapy represents a disruptive therapy with a completely different paradigm for aneurysmal obliteration. This has not only altered the distribution of aneurysmal management strategies, but also opened the gateway to the treatment of previously inoperable lesions. With the basic flow diverter stent technology now considered an integral part of the neurointerventional armamentarium, we now consider what may lay in the future - including potential directions for research with regards to case selection; the location and type of aneurysms which may become routinely treatable; and modifications to the flow diverter, which may increase its utility and safety in terms of size, structural design, and surface modifications.
Topics: Blood Vessel Prosthesis; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Treatment Outcome
PubMed: 31838531
DOI: 10.1093/neuros/nyz343