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. 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. 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

BACKGROUND AND OBJECTIVE:Length of stay is an important factor for managing the limited resources of a hospital. The early, accurate prediction of hospital length of stay leads to optimized disposition of resources, particularly in complex stroke treatment. In the present study, we evaluated different machine learning techniques in their ability to predict the length of stay of patients with stroke of the anterior circulation who were treated with thrombectomy. MATERIALS AND METHODS:This retrospective study evaluated four algorithms (support vector machine, generalized linear model, K-nearest neighbor, and random forest) to predict the length of hospitalization of 113 patients with acute stroke who were treated with thrombectomy. Input variables encompassed baseline data at admission, as well as peri-procedural and imaging data. Tenfold cross-validation was used to estimate accuracy. The accuracy of the algorithms was checked with a validation dataset. In addition to a regression analysis, we performed a binary classification analysis to identify patients who stayed longer than the mean length of stay. RESULTS:The median length of stay was 10.6 days (interquartile range 6-15). The sensitivity of the best performing random forest model was 0.8, the specificity was 0.68, and the area under the curve was 0.73 in the classification analysis. The mean absolute error of the best performing random forest model was 4.6 days in the validation dataset in the regression analysis. CONCLUSION:The length of stay of patients with acute ischemic stroke of the anterior circulation can be predicted with machine learning. Machine learning could aid in optimal resource allocation in clinical routine.

A 66-year-old transfeminine patient presented to our institution with a central-venous stenosis causing dysfunction of her arteriovenous (AV) graft on her left arm. The patient was treated repeatedly, because of restenosis. Due to complete occlusion of the graft and subclavian vein as well as a liquid tumor located around the stenotic segment of the vein, we resected the left subclavian vein via a trap-door thoracotomy and inserted a PTFE-graft. Histological examination of the resected tissue identified metastasis from the urothelial carcinoma as the underlying cause of the stenosis. Malignant tumors are an infrequent etiology of AV-access dysfunction, and there are hardly any data on transgender patients. This case report provides an overview of the current data concerning these unique circumstances.

Zusammenfassung Obwohl bei der transarteriellen periartikulären Embolisation (TAPE) noch viele Aspekte erforscht werden müssen, findet sie eine zunehmende Verbreitung und Akzeptanz bei der Behandlung von Gelenkschmerzen. Diese Arbeit stellt den aktuellen Stand vor, benennt mögliche Indikationen, beschreibt die interventionelle Technik und fasst die in der Literatur verfügbaren Ergebnisse zusammen.

The increasing number of women working in medical surgical professions involving ionizing radiation creates new challenges for the safety of both pregnant and breastfeeding employees and the management of prenatal radiation exposure. The aim of this manuscript is to discuss the biological effects of loosely-ionizing radiation, evaluate the associated risks, and discuss the principles of German radiation protection law in the context of pregnancy and breastfeeding. To assess the effects of prenatal radiation exposure, we reviewed relevant sources such as reports from the German Commission on Radiological Protection, United Nations Scientific Commission on Effects of Atomic Radiation (UNSCEAR), and publications from the International Commission on Radiological Protection (ICRP). Additionally, the current German legislation, with focus on radiation protection and maternity protection laws, was outlined in context. The analysis shows that adhering to regulatory dose limits minimizes the risks of pregnancy complications, congenital malformations, developmental delays, mutagenic and carcinogenic effects. Special attention is required during the first trimester, in which radiation sensitivity is highest. Adherence to legal framework and associated protective measures in Germany provides under certain conditions a safe working environment for pregnant and breastfeeding women in surgical professions that involve ionizing radiation. This work highlights that careful risk assessment and strict adherence to radiation protection and occupational safety regulations enable pregnant and lactating women to work safely in areas associated with ionizing radiation and interventional aspects of their occupation. The need for continuous monitoring and adjustment of protective measures as well as the provision of confidential counseling services, are essential to ensure the safety of pregnant and breastfeeding workers and their children.

In den letzten Jahren erfährt die transarterielle periartikuläre Embolisation (TAPE) eine zunehmende Aufmerksamkeit bei der Behandlung von chronischen Gelenkschmerzen, die z. B. durch degenerative Veränderungen wie der Arthrose aber auch durch entzündliche Veränderungen des Kapsel-Band-Apparates bedingt sein können. Ziel der Arbeit ist es, die Einsatzmöglichkeiten der TAPE bei der Behandlung der therapieresistenten Achillodynie, das prozedurale Vorgehen und die initialen Ergebnisse zu beschreiben. Die TAPE wurde bei 7 Patienten (weiblich: 1, männlich: 6) zur Behandlung der chronischen Achillodynie eingesetzt. Dabei wurden die technische Erfolgsrate und die Komplikationsrate erfasst. Ferner wurde die Veränderungen des subjektiven Schmerzes mittels einer visuellen Analogskala (VAS) und die Belastbarkeit mit dem Foot-and-Ankle-Disability-Index (FADI) analysiert. Alle Prozeduren konnten erfolgreich durchgeführt werden (technische Erfolgsrate: 100

PURPOSE:To evaluate Vessel Tracking software for determining the prostatic arteries feeding the prostate gland during prostatic artery embolization (PAE) using Conebeam-CT (CBCT). MATERIALS AND METHODS:EmboGuide is a software developed to assist interventional radiologists in performing embolization of hypervascular tumors in the liver. In this study, a single-center retrospective image collection of 120 intraprocedural CBCT of 60 patients with benign prostatic hyperplasia treated using PAE between May 2017 and January 2019 was evaluated. All patients received 1 intraprocedural CBCT per side for evaluation of vessel anatomy. The "reference standard" of the vascular anatomy was defined by segmentation of the prostatic gland and marking of the prostatic artery in conjunction with pre-embolization DSA series. The datasets were then anonymized. Three interventional radiologists with experience in PAE from different centers reviewed the images and used the automatic feeder detection to determine the prostatic artery. Finally, two clinical experts compared the feeding vessels indicated in the "reference standard" and those identified by the readers. Objectives of the study were to evaluate the clinical performance of the software based on sensitivity and the agreement between interventional radiologists. RESULTS:Sensitivity was estimated as 0.968 with a 90% confidence interval. Overall agreement was estimated as 0.801 with a 90% confidence interval. On both objectives (Sensitivity and Agreement), specifications were met. CONCLUSIONS:The results of this study suggest that EmboGuide can be used to determine the prostate arteries in PAE. The findings could be used to expand the intended use of EmboGuide to include PAE.

PURPOSE:Outcome prediction of large vessel occlusion of the anterior circulation in patients with wake-up stroke is important to identify patients that will benefit from thrombectomy. Currently, mismatch concepts that require MRI or CT-Perfusion (CTP) are recommended to identify these patients. We evaluated machine learning algorithms in their ability to discriminate between patients with favorable (defined as a modified Rankin Scale (mRS) score of 0-2) and unfavorable (mRS 3-6) outcome and between patients with poor (mRS5-6) and non-poor (mRS 0-4) outcome. METHODS:Data of 8395 patients that were treated between 2018 and 2020 from the nationwide registry of the German Society for Neuroradiology was retrospectively analyzed. Five models were trained with clinical variables and Alberta Stroke Program Early CT Score (ASPECTS). The model with the highest accuracy was validated with a test dataset with known stroke onset and with a test dataset that consisted only of wake-up strokes. RESULTS:2419 patients showed poor and 3310 patients showed favorable outcome. The best performing Random Forest model achieved a sensitivity of 0.65, a specificity of 0.81 and an AUC of 0.79 on the test dataset of patients with wake-up stroke in the classification analysis between favorable and unfavorable outcome and a sensitivity of 0.42, a specificity of 0.83 and an AUC of 0.72 in the classification analysis between poor and non-poor outcome. CONCLUSION:Machine learning algorithms have the potential to aid in the decision making for thrombectomy in patients with wake-up stroke especially in hospitals, where emergency CTP or MRI imaging is not available.

Interventional oncology (IO) employs various techniques to enable minimally invasive, image-guided treatment of tumor diseases with both curative and palliative goals. Additionally, it significantly contributes to managing tumor-related and perioperative complications, offering diverse supportive procedures for patients at all stages of their diseases. The execution of IO procedures places unique demands on the equipment, personnel, and structural organization of radiological clinics, necessitating specific expertise from interventional radiologists.This position paper aims to comprehensively outline the multifaceted aspects of IO and discuss the requisite criteria for hospitals, radiological clinics, and interventional radiologists (IRs). Furthermore, it underscores overarching considerations of quality assurance that clinics and professional societies should prioritize.The requirements for hospitals, radiological clinics, and IRs are varied and demand not only a high level of proficiency in performing IO procedures but also in-depth knowledge of the differential therapy for various tumor diseases. This expertise is essential for effectively serving as clinical partners in the interdisciplinary treatment of oncologic patients. Additionally, a thorough understanding and safe handling of ionizing radiation technologies, along with proficiency in radiation protection methods, which are fundamental aspects of radiological specialist training, is crucial for ensuring the safety of IO procedures for both patients and staff. The Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have long-established dedicated quality management programs, accrediting radiology clinics and certifying IRs. These initiatives aim to uphold the highest standards of care and meet the quality expectations set by politics in healthcare system, particularly in the realm of interventional radiology. · The various procedures in the field of interventional oncology (IO) are complex medical interventions that require not only the most advanced technical equipment but also adequate human resources, particularly specialized expertise in interventional radiology, diagnostic imaging, oncology, and radiation protection.. · This expertise is an integral part of the specialized medical training in radiology and is certified by professional societies such as the German Society for Interventional Radiology (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).. · Professional societies like DeGIR, CIRSE, and the American Society of Interventional Radiology (SIR) establish the necessary quality assurance framework for comprehensive, high-quality IO therapy through quality assurance (QA) registries, standard operating procedure (SOP) documents, and participation in guideline development.. · Currently, radiology is the only discipline that provides physicians with the theoretical and practical knowledge, skills, and competencies required to perform the demanding procedures in the field of IO through specialized training programs and tailored certification processes.. · Isfort P, Sommer CM, Bruners P et al. Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology. Rofo 2025; 197: 546-556.

Die Ambulantisierung des Gesundheitswesens ist ein zentrales Thema in aktuellen politischen Diskussionen und Entwicklungen. Auch in der Radiologie und insbesondere in der Interventionellen Radiologie eröffnen sich perspektivisch neue Möglichkeiten der Leistungserbringung und damit verbunden auch Herausforderungen. In diesem Beitrag sollen die unterschiedlichen ambulanten Versorgungsmöglichkeiten aus der Perspektive der Interventionellen Radiologie beleuchtet und deren Potenziale bzw. Bedeutung diskutiert werden.

Purpose The aim was to characterize the framework conditions in academic interventional radiology (IR) in Germany with focus on differences between genders. Materials and methods After IRB approval, all members of The German Society for Interventional Radiology and Minimally Invasive Therapy (n = 1,632) were invited to an online survey on work and research. Statistical comparisons were undertaken with the Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test. Results From 267 available questionnaires (general response rate 16.4%), 200 were fully completed. 40% of these (78/200) were involved in research (71% men vs. 29% women, p < 0.01) and eligible for further analysis. Of these, 6% worked part-time (2% vs. 17%, p < 0.05). 90% of the respondents spent less than 25% of their research during their paid working hours, and 41% performed more than 75% of their research during. leisure time. 28% received exemption for research. 88% were (rather) satisfied with their career. One in two participants successfully applied for funding, with higher success rates among male applicants (90% vs. 75%) and respondents with protected research time (93% vs. 80%). Compared to men, women rated their entrance in research as harder (p < 0.05), their research career as more important (p < 0.05), felt less noticed at congresses (93% vs. 53%, p < 0.01), less confident (98% vs. 71%, p < 0.01), and not well connected (77% vs. 36%, p < 0.01). Conclusion Women and men did research under the same circumstances; however, women were underrepresented. Future programs should generally focus on protected research time and gather female mentors to advance academic IR in Germany.

Background In recent years, transarterial periarticular embolization (TAPE) has received increasing attention in the treatment of chronic joint pain, which can be caused by degenerative changes such as osteoarthritis but also by inflammatory changes in the capsule-ligament apparatus. Objectives The aim of this study is to describe the method as well as preliminary results of TAPE in the treatment of therapy-resistant achillodynia. Material and methodsTAPE was used in the treatment of seven patients (female: 1, male: 6) with chronic achillodynia. The technical success rate and complication rates were analyzed. Furthermore, the changes in subjective pain were assessed using a visual analogue scale (VAS) and the load-bearing capacity using the Foot and Ankle Disability Index (FADI). Results All procedures were performed successfully (technical success rate: 100%); no complications were observed. In the first postoperative week, pain was reduced from an initial average VAS of 8.2 to 4.2. After 12 months, there was a further reduction to 1.4. At the same time, based on the FADI, the Achilles tendon load capacity increased on average from 45.4 initially to 60.1 after 1 week and to 89.9 after 12 months. Conclusion Our results suggest that TAPE may be a new, promising procedure in the treatment of therapy-resistant, chronic achillodynia. This technically demanding but minimally invasive procedure, performed only under local anesthesia, can significantly reduce pain and restore the patient's ability to bear weight.

Purpose To provide an overview of endovascular treatment of renal artery stenosis (RAS) using the data of the Deutsche Gesellschaft für interventionelle Radiologie (DeGIR) quality management system. Materials and Methods A retrospective analysis was performed. Pre-, peri- and postprocedural data, technical success rates, complication rates, and clinical success rates at dismissal were examined. Results Between 2018 and 2021, 2134 angiography examinations of the renal arteries were performed: diagnostic angiography in 70 patients (3 %), balloon angioplasty in 795 (37 %), stent implantation in 1166 (55 %) and miscellaneous procedures in 103 (5 %). The lesion length was less than or equal to 5 mm in 1837 patients (87 %), between 5 and 10 mm in 197 (9 %), and between 10 and 20 mm in 62 (3 %). The degree of stenosis was less than 50 % in 156 patients (7 %), greater than 50 % in 239 (11 %), and greater than 70 % in 1472 (70 %). Occlusion was treated in 235 patients (11 %). Symptoms at discharge resolved in 600 patients (29 %), improved in 1012 (49 %), were unchanged in 77 (4 %), and worsened in 5 (0.2 %). Complications were reported in 51 patients (2.5 %) and the mortality rate was 0.15 %. Conclusion A substantial number of patients with RAS and occlusions were treated by radiologists in Germany, with high technical success rates and low complication rates. The indication should be determined carefully as the current European guidelines for the treatment of RAS suggest that only carefully selected groups of patients will benefit from recanalizing treatment. Key Points:

Purpose To test the feasibility of an online, simulator-based comprehensive interventional radiology (IR) training curriculum in times of COVID-19-induced travel restrictions. Materials and Methods A network of six VIST simulators (Mentice, Gothenburg, Sweden) was installed in six geographically different radiology departments. Two courses with six sessions

An aberrant right subclavian artery (ARSA) is the most common congenital variant of the aortic arch. Usually, this variation is largely asymptomatic, but sometimes it may be involved in aortic dissection (AD). Surgical management of this condition is challenging. The therapeutic options have been enriched in recent decades by establishing individualized endovascular or hybrid procedures. Whether these less invasive approaches bear advantages, and how they have changed the treatment of this rare pathology, is still unclear. Therefore, we conducted a systematic review. We performed a review of literature from the past 20 years (from January 2000 until February 2021) complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All reported patients treated for Type B AD in the presence of an ARSA were identified and classified into three groups according to the received therapy (open, hybrid, and total endovascular). Patient characteristics, as well as in-hospital mortality, and major and minor complications were determined and statistically analyzed. We identified 32 relevant publications comprising 85 patients. Open arch repair has been offered to younger patients, but significantly less often in symptomatic patients needing urgent repair. Therefore, the maximum aortic diameter was also significantly larger in the open repair group compared with that in the hybrid or total endovascular repair group. Regarding the endpoints, we did not find significant differences. The literature review revealed that open surgical therapies are preferred in patients presenting with chronic dissections and larger aortic diameters, most likely because they are unsuitable for endovascular aortic repair. Hybrid and total endovascular approaches are more often applied in emergency situations, where aortic diameters remain smaller. All therapies demonstrated good, early, and midterm outcomes. But, these therapies carry potential risks in the long term. Therefore, long-term follow-up data are urgently needed to validate that these therapies are sustainable.

BACKGROUND Length of stay is an important factor for managing the limited resources of a hospital. The early, accurate prediction of hospital length of stay leads to the optimized disposition of resources particularly in complex stroke treatment. OBJECTIVE In the present study we evaluated different machine learning techniques in their ability to predict the length of stay of patients with stroke of the anterior circulation who were treated with thrombectomy. MATERIAL AND METHODS This retrospective study evaluated four algorithms (support vector machine, generalized linear model, K-nearest neighbour and Random Forest) to predict the length of hospitalization of 113 patients with acute stroke who were treated with thrombectomy. Input variables encompassed baseline data at admission, as well as periprocedural and imaging data. Ten-fold cross-validation was used to estimate accuracy. The accuracy of the algorithms was checked with a test dataset. In addition to regression analysis, we performed a binary classification analysis to identify patients that stayed longer than the mean length of stay. RESULTS Mean length of stay was 10.7 days (median 10, interquartile range 6-15). The sensitivity of the best-performing Random Forest model was 0.8, the specificity was 0.68 and the area under the curve was 0.73 in the classification analysis. The mean absolute error of the best-performing Random Forest Model was 4.6 days in the test dataset in the regression analysis. CONCLUSION Machine learning has potential use to estimate the length of stay of patients with acute ischaemic stroke that were treated with thrombectomy.

Objectives: Recently published results of the ANGEL-ASPECT and SELECT2 trials suggest that stroke patients presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) benefit from mechanical thrombectomy. Purpose of this retrospective study was to identify factors that are associated with a favorable outcome in patients with low ASPECTS of 4-5 and 0-3 undergoing mechanical thrombectomy.Material and methods: All patients reported in the quality registry of the German Society for Neuroradiology that were treated between 2018 and 2020 were analyzed. Favorable outcome was defined as a National Institute of Health Stroke Scale (NIHSS) score of less than 9 at dismissal. Successful recanaliza-tion was defined as Thrombolysis in Cerebral Infarction (mTICI) >= 2b. Multivari-able logistic regression analyses were performed to assess the association of baseline and treatment variables with favorable outcome.Results: 621 patients were included in the analysis, thereof 495 with ASPECTS 4-5 and 126 with ASPECTS 0-3. In patients with ASPECTS 4-5patients with favorable outcome had less severe neu-rological symptoms at admission with median NIHSS of 15 vs. 18 (p<0.001), had less often wake-up strokes (44% vs. 81%, p<0.001), received more often iv-lysis (37% vs. 30%, p<0.001), had more often conscious sedation (29% vs. 16%, p<0.001), had a higher rate of successful recanalization (94% vs. 66% and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.89-0.91) and successful recanalization (aOR 3.96, CI 2-8.56) were associated with favorable outcome. For ASPECTS 0-3, patients with favorable outcome had lower median NIHSS at admission (16 vs. 18 (p<0.001), lower number of passes (1 vs. 3, p=0.003) and a higher rate of successful recanaliza-tion (94% vs. 66%, p<0.001) and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.81-0.94) and successful recanalization, (aOR 11.19, CI 3.19-55.53), were associated with favorable outcome.Conclusion: Full recanalization with low groin punction to recanalization times and low number of passes were associated with favorable out-come in patients with low ASPECTS.