Purpose To evaluate vessel diameter (VD) changes in vascular injuries (VI) by comparing pre- and post-procedural CT scans after endovascular repair with covered stents (CS), and to assess the relationship between stent oversizing and early complications. Materials and Methods This retrospective single-center study included consecutive patients treated with CS for VI between 2019 and 2025. VD was measured on pre-procedural and early post-procedural (≤2 weeks) CT scans at standardized proximal and distal landing zones. Patients were stratified by vessel size (large ≥1 cm, including the aorta; small-to-medium <1 cm), hemodynamic status, age, and sex. Stent oversizing was defined as the percentage difference between the nominal stent diameter and the mean proximal vessel diameter on pre-procedural CT. Stent-related complications were recorded. Results One hundred patients (mean age 65 ± 16 years; 70% male) were included; 57% had large-vessel injuries and 43% were hemodynamically unstable. Post-procedural VD increased significantly in small-to-medium vessels in both stable (26.0%, p=0.035) and unstable patients (62.9%, p=0.002), and in unstable large vessels (13.5%, p=0.04). Greater VD changes were observed in males younger than 70 years (p=0.035). Mean stent oversizing was 21% in small-to-medium vessels and 17% in large vessels, with a non-significant trend toward higher values in unstable small-to-medium vessels. Early stent-related complications occurred in 8% of patients, with no significant association detected with oversizing. Conclusion VI showed marked, hemodynamically driven VD changes, particularly in small-to-medium vessels. No significant association was detected between moderate stent oversizing (∼20%) and early complications, though this finding warrants cautious interpretation given the small number of events and incomplete follow-up.
PURPOSE:To evaluate the independent and interaction effects of prophylactic intra-arterial nitroglycerin-verapamil versus saline and a 6 Fr Glidesheath Slender versus a conventional 6 Fr sheath on clinical radial artery spasm during diagnostic transradial cerebral angiography. MATERIALS AND METHODS:In this prospective, single-center, 2 × 2 factorial randomized trial, 255 patients undergoing diagnostic TRCA were assigned to prophylactic intra-arterial NV or saline and radial access with either GSS or conventional 6 Fr sheath (CS). The primary outcome was clinical RAS. Secondary outcomes included radial artery occlusion (RAO) and procedural outcomes. RESULTS:Clinical RAS occurred more frequently with GSS than with CS (33.9% vs 18.8%, P = .003). NV did not significantly reduce RAS compared with saline (29.7% vs 21.7%, P = .149). RAO was also higher with GSS (23.6% vs 11.7%, P = .022). After adjustment for prespecified covariates, GSS use remained associated with clinical RAS. CONCLUSION:In this exploratory randomized trial, prophylactic intra-arterial NV did not significantly reduce clinical RAS during diagnostic TRCA. GSS use was associated with higher rates of clinical RAS and RAO under the evaluated procedural conditions. These findings should be interpreted cautiously and require validation in future studies.
PURPOSE:To evaluate the medium-term oncologic outcomes of ultrasound-guided cryoablation as part of a nonoperative management strategy for elderly or comorbid women with clinical T1-2N0 estrogen receptor-positive/HER2-negative breast cancer. METHODS:This retrospective single-center study included 113 women (median age, 84 years; range, 56-96 years) with 125 clinical T1-2N0 estrogen receptor-positive/HER2-negative breast cancers (median tumor size, 17 mm; range, 5-48 mm) who underwent ultrasound-guided cryoablation as part of a nonoperative management strategy between May 2019 and July 2024. Follow-up consisted of semiannual ultrasound and annual mammography. Patients with biopsy-proven breast cancer recurrence were managed with rescue cryoablation. The primary endpoint was breast cancer recurrence. Secondary endpoints included axillary nodal recurrence, primary and secondary local control, and recurrence-free survival. RESULTS:Median follow-up was 25.3 months (95% confidence interval [CI], 12.0-40.0 months). Continued endocrine therapy use was documented in 103 of 113 patients (91.1%). Breast cancer recurrence occurred in two patients (1.7%), both treated with rescue cryoablation; one subsequently developed multifocal ipsilateral breast recurrence with ipsilateral axillary nodal metastases. Primary local control, secondary local control, axillary nodal recurrence, and estimated 3-year recurrence-free survival rates were 98.2%, 99.1%, 0.8%, and 97.0%, respectively. CONCLUSION:Ultrasound-guided cryoablation demonstrated encouraging medium-term oncologic outcomes as part of a nonoperative management strategy in elderly or comorbid women with estrogen receptor-positive/HER2-negative breast cancer. These findings support further prospective evaluation before broader clinical implementation.
PURPOSE:To investigate the safety and efficacy of coil-assisted n-butyl-2-cyanoacrylate (NBCA) embolization in patients with pulmonary arteriovenous malformation (PAVM). MATERIALS AND METHODS:From February 2023 to December 2025, this retrospective study included previously untreated patients with PAVM who underwent coil-assisted NBCA embolization involving detachable microcoil placement in the draining vein followed by NBCA embolization of the sac and feeding artery. This technique was developed to address limitations of prior balloon-occluded NBCA embolization technique. RESULTS:Twenty-nine patients (mean age, 50.3 years ± 11.6; 27 women) with 34 sporadic PAVMs (simple type, n=33; complex type, n=1) were analyzed. Technical success rate was 100% (34/34; 95% confidence interval: 89.7%-100%). The microcoil was successfully positioned in either the draining vein (n=31) or the distal sac (n=3), facilitating controlled delivery of the NBCA mixture. Complete sac embolization was achieved using NBCA alone in all 34 PAVMs. Complete feeding artery embolization was achieved with NBCA alone in 32 PAVMs, whereas feeding artery occlusion required additional vascular plug placement in two. A total of 52 detachable microcoils were used in 34 PAVMs (mean, 1.5 per PAVM). A fixed 1:2 NBCA/iodized oil ratio was used and the mean amount of NBCA mixture per PAVM was 1.4 mL (range, 0.5-2.4 mL). No procedure-related major adverse events occurred. Transient minor pleuritic chest pain occurred in five patients (17.2%). Follow-up computed tomography in 29 patients with a mean delay of 11.3 ± 5.7 months (range, 3.4- 24 months) demonstrated complete occlusion without evidence of reperfusion during follow-up. CONCLUSION:Coil-assisted NBCA embolization may be technically feasible and effective for patients with PAVM, with complete occlusion during short-term follow-up while mitigating the risk of embolic migration.
While literature surrounding pediatric applications of cryoablation continues to grow and demonstrate potential benefits, evidence to date largely comprises small, retrospective, and uncontrolled series. To address this opportunity, a multidisciplinary panel of pediatric specialists convened virtually in a research consensus panel organized by the Society of Interventional Radiology (SIR); each panelist presented current data surrounding common applications of cryoablation in the pediatric population. A recurring theme throughout the discussion was the potential for cryoablation to increase quality of life in pediatric patients whether applied with curative or palliative intent. After presentations and discussions, research concepts were discussed and ranked on their potential impact, with the following 3 topics emerging as top priorities: (a) thoracic event-free survival and complication comparison between pulmonary metastasectomy and cryoablation of lesions amenable to either modality, (b) a prospective comparison of systemic therapy and cryoablation versus systemic therapy alone in the treatment of desmoid tumor, and (c) the biologic effects of cryoablation on healthy bone, cartilage, and growth plates as may be affected in the treatment of benign osseous lesions.
This pilot study evaluated the feasibility, safety and 12-month efficacy of outpatient ultrasound-guided cryoablation for benign thyroid nodules in ten patients. Technical success was achieved in all cases without moderate or severe adverse events. Mean nodule volume decreased significantly from 26.1±13.9 mL at baseline to 16.4±10.1; 9.8±5.7; 8.8±5.2; and 10.7±7.1 mL at 1, 3, 6 and 12 months, respectively (p≤0.004 at all time points). Mean±SD volume reduction ratios were 42.3±23.9%, 65.4±14.7%, 68.4±11.9%, and 63.7±16.2%, at corresponding intervals. Technical efficacy, defined as ≥50% volume reduction was achieved in 100% at 6 months and 90% at 12 months. Progressive shrinkage or stabilization occurred in 70% of patients, while partial regrowth and complete regrowth were observed in 20% and 10%, respectively. Calcifications increased from 40% to 60% during follow-up. Ultrasound-guided cryoablation of benign thyroid nodules appeared feasible and was not associated with moderate or severe adverse events in this preliminary cohort.
PURPOSE:To evaluate the long-term overall survival (OS), cancer-specific survival (CSS), and local tumor progression-free survival (LTPFS) of patients who underwent percutaneous image-guided thermal ablation (TA) (cryoablation, microwave ablation, and radiofrequency ablation) of oligometastatic renal cell carcinoma (omRCC). MATERIALS AND METHODS:This study cohort included 50 patients (age, 64.6 years [SD ± 13.1]; 78% [39/50] men and 22% [11/50] women) who underwent image-guided TA for omRCC between 2008 and 2019. Accounting for patient demographics, tumor characteristics, and technical outcomes, the OS, CSS, and LTPFS were derived by Kaplan-Meier analysis. Subgroup analyses were performed to assess the impact of outcomes by target lesion size, histology, location, and thermal energy using the log-rank test. All adverse events were categorized with the Society of Interventional Radiology (SIR) classification scheme. RESULTS:The study cohort comprised 100 omRCC lesions treated in 91 procedures, with a follow-up of up to 10 years (mean follow-up, 8.0 years [SD ± 2.8]). Primary and secondary technical success rates were 99% and 100%, respectively. The 10-year OS and CSS rates were 68.5% and 75.5%, respectively, with no significant difference between clear cell (P = .87) or nonclear cell (P = .52) histology. The 10-year LTPFS rate was 87.6% with no significant differences based on tumor histology (P = .47), size (P = .88), disease location (P = .72), or TA energy (P = .26). The adverse event rate of 9.9% (9/91) included 2 mild (2.2%) and 7 moderate (7.7%), mostly self-limited, events. CONCLUSIONS:Image-guided TA of omRCC was safe and effective with excellent long-term OS, CSS, and LTPFS outcomes within 10 years.
PURPOSE:To determine the technical success, long-term overall survival (OS), cancer-specific survival (CSS), and local tumor progression-free survival (LTPFS) of patients who underwent percutaneous microwave ablation (MWA) of renal cell carcinoma (RCC). MATERIALS AND METHODS:This institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study cohort included patients who underwent CT and contrast-enhanced ultrasound (US) guided percutaneous MWA between 2013 and 2017 of biopsy-proven RCC. Patient demographics, tumor characteristics, and technical outcomes were compiled, and the OS, CSS, and LTPFS were derived with Kaplan-Meier analysis and log-rank test to evaluate differences. Complications were classified per the Clavien-Dindo system. Logistic regression was used for categorical outcomes, the χ2 test was used for categorical outcomes excluding repeated measures at the patient level, and the paired t test was used for evaluating differences in preablative and postablative estimated glomerular filtration rate. RESULTS:The study cohort comprised 86 biopsy-proven RCCs from 81 patients (mean age, 67.6 years [SD ± 16.9]), with a median follow-up of 76.8 months. Overall, primary, and secondary technical success were 100% (86/86), 98% (84/86), and 100% (10/10), respectively. The 10-year OS, CSS, and LTPFS rates were 76%, 85%, and 83%, respectively. The T1b subcohort 8-year LTPFS rate was lower than the T1a subcohort (P = .003). The preablative and 2- to 3-year postablative estimated glomerular filtration rate (58.5 vs 58.4 mL/min/1.73 m2) were stable (P = .932). There was a 2% overall incidence of complications, all Grade I. CONCLUSIONS:Percutaneous image-guided MWA of T1 RCC was associated with excellent long-term OS, CSS, and LTPFS, supporting MWA as an effective treatment option.
Objective To evaluate the adequacy of Rapid Onsite Evaluation (ROSE) in relation to diagnostic yield of CT-guided percutaneous lung core needle biopsies (CNB) at a tertiary care cancer center. Methods A total of 943 CT-guided percutaneous CNB performed in the year 2022 were retrospectively reviewed. ROSE of specimens provided immediate feedback regarding the sample adequacy. The biopsies were divided into 3 groups based on ROSE results: 1) adequate on first pass; 2) adequate after repeat sampling and 3) inadequate. Patient, lesion, and procedure characteristics were analyzed in relation to ROSE adequacy using a multinomial logistic regression model. Results Median lesion size was 1.8 cm (IQR: 1.2-2.8). The first-pass adequacy rate was 64.8% (611/943), increasing to 82.4% (777/943) after seven passes, with a clear plateau after three passes; 17.9% (169/943) samplings were persistently inadequate. Complete histopathologic processing resulted in an overall diagnostic yield of 89.7% (846/943). Critically, 59.2% of biopsies deemed inadequate by ROSE ultimately yielded a diagnostic result after complete pathologic processing. ROSE demonstrated a sensitivity of 88.2%, specificity of 71.1%, positive predictive value of 96.4%, and negative predictive value of 40.8%. Larger lesion size and absence of perilesional hemorrhage were associated with higher odds of first-pass adequacy on multivariable analysis. Conclusion Lesion size and perilesional hemorrhage are independent predictors of ROSE- adequacy for lung CNB. The low negative predictive value (40.8%) and the finding that 59.2% of ROSE-inadequate biopsies ultimately yielded a diagnostic result highlight that ROSE inadequacy should not be interpreted as synonymous with biopsy failure.
PURPOSE:To test the hypothesis that transvascular radiofrequency (RF) celiac plexus denervation is technically feasible and procedurally safe for pancreatic adenocarcinoma patients with severe abdominal pain, while characterizing exploratory clinical outcomes. MATERIALS AND METHODS:Twenty adults with unresectable pancreatic cancer and severe abdominal pain were enrolled in this pilot study. Angiographic computed tomography was used for procedural planning using a transvascular approach. RF energy was delivered via standard transfemoral or transbrachial access to the celiac, common hepatic, and/or splenic arteries. A total of 131 ablations were delivered via the celiac trunk, common hepatic artery, or splenic artery. Patients were evaluated at 24 hours, 7 days, 4-6 weeks, and 3 months after the procedure for adverse events, pain severity, and opioid utilization. RESULTS:Nineteen of 20 enrolled patients were successfully treated (95% feasibility). No device- or procedure-related serious adverse events occurred. Six nonserious target-vessel events, including arterial spasms and an artery occlusion, were anticipated procedural risks and resolved with medication or no intervention. Two device deficiencies were reported related to catheter maneuverability and vessel anatomy. No distinct patterns in individual patient trajectories of clinical outcomes were observed during follow-up, likely owing to the small sample size, procedural heterogeneity, disease progression, and high attrition. CONCLUSIONS:Transvascular RF denervation of the celiac plexus was technically feasible and demonstrated a favorable procedural safety profile. As a pilot study, procedural heterogeneity and variable clinical responses revealed important insights into treatment delivery, procedural determinants of outcomes, and the range of clinical response across patients with advanced pancreatic cancer.
PURPOSE:To systematically review the literature on the use of liquid embolics (LEs) in prostate artery embolization (PAE) and to evaluate their safety and efficacy outcomes. MATERIALS AND METHODS:A comprehensive search of PubMed, Scopus, Cochrane, and Google Scholar was performed. Studies including ≥5 patients undergoing PAE with a LEs were eligible. The outcomes included adverse events (AEs), changes in prostate volume, International Prostate Symptom Score (IPSS), and quality-of-life (QoL) at follow-up. Subgroup analyses by liquid embolic type were performed when feasible. Outcomes were pooled using a random-effects meta-analysis. RESULTS:Eleven studies (913 patients; mean/median age range, 67.5-79 years) were included. The systematic review identified that only two LEs, Ethylene-vinyl alcohol copolymer (EVOH) (n = 3 studies) and Glue (n = 8 studies), were explored in PAE. The three EVOH studies included a total of 95 cases, indicating that the current evidence base for LEs in PAE is predominantly derived from Glue experience. Of the 11 included studies, 9 were noncomparative and 2 compared LEs with particles. Pooled safety outcomes demonstrated no severe AEs. At last follow-up (range, 2-36 months), pooled mean changes from baseline were -2.73 in QoL (95% CI, -3.00 to -2.47; I2 = 76%), -31.04 mL in prostate volume (95% CI, --39.04 to -23.04; I2 = 94%), and -10.7 in IPSS (95% CI, -11.46 to -9.95; I2 = 56%). CONCLUSION:LEs, particularly glue, which constitutes the majority of the available literature appear to demonstrate promising safety and efficacy in PAE. Further prospective studies are needed to better explore the role of LEs in PAE.
PURPOSE:To evaluate the technical feasibility, safety, and clinical outcomes of prostate artery embolization (PAE) in patients aged ≥80 years. MATERIALS AND METHODS:This retrospective study included patients aged ≥80 years who underwent PAE between January 2015 and August 2025 for lower urinary tract symptoms (LUTSs), catheter-dependent urinary retention, and/or hematuria. Technical and clinical success were defined as successful unilateral or bilateral embolization of the prostatic arterial supply and improvement in the primary indication within 12 months, respectively. Adverse events were classified according to the Society of Interventional Radiology (SIR) grading system. RESULTS:A total of 58 patients (mean age, 85.2 years [SD ± 3.9]) underwent PAE. Indications included LUTS in 29 (50.0%) patients, catheter-dependent urinary retention in 27 (46.6%), and hematuria in 15 (25.9%), with several patients presenting with >1 indication. Overall technical success was achieved in 57 (98.3%) patients. Clinical outcomes were evaluable in 52 (89.7%) patients after excluding those who died during follow-up, had incomplete follow-up, or had a technically unsuccessful procedure. At 12 months, mean international prostate symptom score decreased from 18.7 (SD ± 6.1) to 9.3 (SD ± 4.9), and quality-of-life score from 4.5 (SD ± 1.2) to 1.8 (SD ± 1.3; both P < .001). Catheter independence was achieved in 19 of 26 (73.1%) evaluable patients, and hematuria resolved in 12 of 12 (100%). Clinical success was achieved in 42 of 52 patients (80.8%). Postprocedural adverse events occurred in 10 of 52 (19.2%); none were severe or life threatening. CONCLUSIONS:PAE was technically feasible, safe, and effective in patients aged ≥80 years, supporting its use in nonsurgical candidates or those who prefer a less-invasive approach.
PURPOSE:To demonstrate the association between standard-of-care osteoporosis medical management (MM) following vertebral augmentation (VA) and the reduction in the incidence of additional osteoporotic vertebral compression fractures (OVCFs). MATERIALS AND METHODS:A single-center retrospective chart review was conducted on 249 patients who underwent VA for OVCFs between February 2019 and February 2024. Demographics, medical history, procedural data, and osteoporosis MM history were collected to evaluate the relationship of these variables to the incidence of additional OVCFs. RESULTS:Post-procedure, 33.3% of patients received MM, which was initiated at a mean of 6.09 months (SD = 6.31 months) following the index procedure. Multivariable logistic regression showed that within the population of patients studied, MM and age were the only patient or procedural factors significantly associated with refracture following VA. After matching MM and non-MM patients, the incidence rate of additional OVCFs after starting MM was 0.076 fractures per person-year, versus 0.519 fractures per person-year before or without MM (IRR = 6.79, 95 % CI: 3.37-15.51, p < 0.001). CONCLUSION:This analysis demonstrated that patients with OVCFs requiring VA who received MM for osteoporosis had a 6-fold decreased risk of OVCFs compared to those who did not receive MM, yet only 33.3% of patients were started on treatment at a mean of 6 months after the index procedure. This emphasizes the importance of adequate, timely osteoporosis management in patients after VA to prevent additional OVCFs.
PURPOSE:To evaluate whether genicular artery embolization (GAE) performed with imipenem/cilastatin (IPM/CS) followed by Lipiodol (IPM/CS+L) is associated with higher clinical success without increased adverse events compared with IPM/CS alone in patients with symptomatic knee osteoarthritis (OA). MATERIALS AND METHODS:This retrospective cohort study included 77 patients (IPM/CS: n=47; IPM/CS+L: n=30) treated between May 2024 and February 2025. Eligible patients had symptomatic OA (Kellgren-Lawrence grades 1-4) and persistent pain (VAS >50 mm). Primary endpoints were longitudinal changes in VAS and WOMAC scores over a 6-month follow-up; secondary endpoints included adverse events and technical/clinical success. Data were analyzed using generalized estimating equations (GEE) adjusted for baseline characteristics. RESULTS:Both groups achieved significant improvements in pain and physical function at 6 months (p < 0.05), with no significant between-group differences in overall clinical success. A significant agent-by-time interaction was observed at 1 month (p = 0.024), indicating a greater early reduction in VAS scores in the IPM/CS+L group; this effect was not sustained at 3 or 6 months. The median number of embolized arteries was lower in the IPM/CS+L group (2 vs. 3, p = 0.040). No severe adverse events occurred, and mild adverse events, including transient skin discoloration, were comparable between groups. CONCLUSION:GAE performed with either IPM/CS alone or a combined IPM/CS+L regimen is safe and provides significant symptomatic relief for knee OA. While Lipiodol offers technical advantages, it does not confer superior long-term clinical efficacy compared to IPM/CS alone.
