embolotherapy

Embolotherapy
  • 文章类型: Journal Article
    膝骨关节炎(OA)影响全球数百万人,导致疼痛和生活质量下降。常规治疗往往不能提供足够的救济,需要新的治疗方法。这项研究评估了使用永久性微球治疗轻中度膝关节OA患者的膝动脉栓塞(GAE)的有效性和安全性。在这个前景中,单中心研究,17名参与者接受了GAE。KOOS(膝关节损伤和骨关节炎结果评分),WOMAC(西安大略省和麦克马斯特大学关节炎指数),和IPAQ(国际身体活动问卷)得分,连同物理性能测试,药物使用,和双能X射线吸收法(DEXA)扫描,在基线和6个月的多个随访点进行评估。主端点,六个月的VAS,显着改善(中位数从66毫米减少到40毫米,p=0.0004)。所有疼痛和功能评分,以及物理性能测试,明显改善。六个月后未观察到药物使用或DEXA参数的临床相关变化。只有未成年人,发生了自我限制的不良事件。这项研究表明,GAE是一种有前途的微创治疗膝关节OA,提供显著的疼痛缓解和功能改善。然而,进一步长期,需要随机试验来证实这些发现,并建立最佳的患者选择标准.
    Knee osteoarthritis (OA) affects millions worldwide, leading to pain and reduced quality of life. Conventional treatments often fail to provide adequate relief, necessitating new therapeutic approaches. This study evaluated the efficacy and safety of genicular artery embolization (GAE) using permanent microspheres in patients with mild-to-moderate knee OA. In this prospective, single-center study, 17 participants underwent GAE. KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (The Western Ontario and McMaster Universities Arthritis Index), and IPAQ (International Physical Activity Questionnaire) scores, along with physical performance tests, medication use, and dual-energy X-ray absorptiometry (DEXA) scans, were assessed at baseline and at multiple follow-up points over six months. The primary endpoint, VAS at six months, showed significant improvement (median reduction from 66 mm to 40 mm, p = 0.0004). All pain and function scores, as well as physical performance tests, improved significantly. No clinically relevant changes in medication use or DEXA parameters were observed after six months. Only minor, self-limiting adverse events occurred. This study indicates that GAE is a promising minimally invasive treatment for knee OA, providing significant pain relief and functional improvement. However, further long-term, randomized trials are needed to confirm these findings and establish optimal patient selection criteria.
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  • 文章类型: Journal Article
    这项回顾性研究的目的是评估支气管动脉栓塞术前计算机断层扫描血管造影(CTA)对咯血患者的附加值。
    在这项回顾性研究中,我们评估了2010年至2021年因咯血入院并接受导管引导栓塞治疗的患者.建立术前计算机断层扫描(CT)的质量标准后,患者根据术前成像评估分为两组:优质CT血管造影(QCTA组)和次优术前成像(次优CTA,未增强或无CT评估;对照组)。根据放射学上的成功进行了比较,手术相关并发症,和临床成功,包括停止咯血,复发率,和总死亡率。
    我们纳入了QCTA组的31名患者,对照组为35。QCTA组的临床成功率为n=24/31(77.4%),对照组为n=27/35(77.1%)(p=0.979)。QCTA组的技术成功率为n=37/42(88.1%),对照组为n=39/42(92.86%)(p=0.820)。总复发率为10.6%。轻微并发症发生率为27.3%,报告了一个主要并发症。QCTA组受影响的出血肺与血管造影过程中病理动脉的识别之间的一致性更好(p=0.045)。罪犯动脉的平均数量(支气管,QCTA组的非支气管系统动脉[NBSA]或肺)未明显高于对照组。
    与直接血管造影相比,术前QCTA能更好地识别受影响的肺部出血和出血血管。临床成功没有区别,并发症,复发率,或观察到死亡率。
    UNASSIGNED: The aim of this retrospective study was to evaluate the added value of pre-procedural computed tomography angiography (CTA) prior to bronchial artery embolization for patients presenting with hemoptysis.
    UNASSIGNED: In this retrospective study, we evaluated patients admitted for hemoptysis from 2010 to 2021 and treated by catheter-directed embolization. After establishing quality criteria for pre-procedural computed tomography (CT), patients were divided into two groups depending on their pre-procedural imaging assessment: Quality CT-angiography (QCTA group) and suboptimal pre-procedural imaging (suboptimal CTA, unenhanced or no CT evaluation; control group). Groups were compared based on radiological success, procedure-related complications, and clinical success, including cessation of hemoptysis, recurrence rates, and overall mortality.
    UNASSIGNED: We included 31 patients in the QCTA group, and 35 in the control group. Clinical success was n = 24/31 (77.4%) in the QCTA group and n = 27/35 (77.1%) in the control group (p = 0.979). Technical success was n = 37/42 (88.1%) in the QCTA group and n = 39/42 (92.86%) in the control group (p = 0.820). Overall recurrence was 10.6%. Minor complications occurred in 27.3%, and one major complication was reported.The concordance between the affected bleeding lung and the identification of pathological arteries during angiography was better in the QCTA group (p = 0.045).The average number of culprit arteries (bronchial, non-bronchial systemic arteries [NBSA] or pulmonary) in the QCTA group was not significantly higher than that in the control group.
    UNASSIGNED: Preprocedural QCTA better identifies the affected bleeding lung and bleeding vessels compared to direct angiography. No difference in clinical success, complications, recurrence rates, or mortality was observed.
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  • 文章类型: Multicenter Study
    目的:评估与使用自膨胀装置进行外周动脉栓塞相关的封堵成功和不良事件。
    方法:这种前瞻性,单臂,使用由相对的镍钛诺纤维和流动阻塞膜组成的Caterpillar™动脉栓塞装置进行了可行性研究。20名患者(24个栓塞部位)在新西兰和澳大利亚的四个研究中心接受治疗,并随访30天。栓塞部位包括肠系膜,副肾,髂动脉和它们的分支.主要结局指标为血管造影术证实的围手术期闭塞和30天无装置相关严重不良事件(SAE)。次要观察包括闭塞时间和不良事件的评估。
    结果:围手术期闭塞100%,在30天时,与设备相关的SAE的自由度为94.7%。一名患者腹部腹胀,需要住院治疗,认为可能与设备或手术有关。24个栓塞部位中有22个被一个装置阻塞(91.7%)。平均手术时间为11.7±8.6min(设备展开时间:1.8±1.0min),平均透视时间为241±290.7s。术中所有栓塞部位均闭塞,62.5%在3分钟内闭塞,91.6%在10分钟内闭塞。无装置迁移或需要重新栓塞。设备和程序相关不良事件的发生率为84.2%。一名患者在随后的辅助腹主动脉血管内手术中死于主动脉破裂,被认为与栓塞装置或手术无关。
    结论:这项关于卡特彼勒栓塞装置的首次人体研究在30天时在所有患者中实现了围手术性闭塞,无94.7%的装置相关SAE。
    方法:2b级-前瞻性,多中心,单臂,首次在人类临床研究。使用描述性统计分析预先指定的终点。
    OBJECTIVE: To assess occlusion success and adverse events associated with the use of a self-expanding device for peripheral artery embolization.
    METHODS: This prospective, single-arm, feasibility study was conducted using the Caterpillar™ Arterial Embolization Device composed of opposing nitinol fibers and a flow-occluding membrane. Twenty patients (24 embolization sites) were treated at four investigational centers in New Zealand and Australia and followed for 30 days. Embolization sites included mesenteric, accessory renal, and iliac arteries and their branches. Primary outcome measures were peri-procedural occlusion confirmed by angiography and freedom from device-related serious adverse events (SAEs) at 30 days. Secondary observations included time to occlusion and assessment of adverse events.
    RESULTS: Peri-procedural occlusion was 100%, and freedom from a device-related SAE was 94.7% at 30 days. One patient had abdominal bloating that required hospitalization deemed possibly related to the device or procedure. Twenty-two of 24 embolization sites were occluded with one device (91.7%). Mean procedure duration was 11.7 ± 8.6 min (device deployment time: 1.8 ± 1.0 min), and mean fluoroscopy time was 241 ± 290.7 s. All embolization sites occluded during the procedure with 62.5% occluded within three minutes and 91.6% occluded within ten minutes. No devices migrated or required re-embolization. Freedom from device- and procedure-related adverse events was 84.2%. One patient died from aortic rupture during a subsequent adjunctive abdominal aortic endovascular procedure deemed unrelated to the embolization device or procedure.
    CONCLUSIONS: This first-in-human study of the Caterpillar embolization device achieved peri-procedural occlusion in all patients with a 94.7% freedom from device-related SAE at 30 days.
    METHODS: Level 2b-prospective, multicenter, single-arm, first-in-human clinical study. Pre-specified endpoints were analyzed using descriptive statistics.
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  • 文章类型: Journal Article
    目的:大血管腔内治疗,通过线圈栓塞的颅内宽颈动脉瘤通常由于完全闭塞率低和复发率高而复杂化。已证明分流器装置不仅可以安全有效地治疗大型和巨大的未破裂动脉瘤,而是中小型动脉瘤。然而,在韩国,直到最近才被批准用于<10mm的动脉瘤。本研究旨在比较血流分流和弹簧圈栓塞治疗≥7mm未破裂动脉瘤的安全性和有效性。
    方法:参与者将包括年龄在19至75岁之间的患者,这些患者首次接受未破裂脑动脉瘤≥7mm的治疗或初次血管内线圈栓塞后复发动脉瘤的治疗。分配到分流队列的参与者将使用以下任何设备进行治疗:带有屏蔽技术的管道柔性栓塞设备(Medtronic,明尼阿波利斯,MN,美国),SurpassEvolve(Stryker神经血管,弗里蒙特,CA,美国),和FRED或FREDJr.(微风,Tustin,CA,美国)。分配到线圈栓塞队列的参与者将接受传统的血管内线圈。主要终点将是在治疗后12个月通过脑血管造影证实的完全闭塞。次要安全性结果将评估围手术期和术后并发症长达12个月。
    结果:该试验将于2022年开始注册,并在注册和随访后提供临床数据。
    结论:本文描述了多中心的目标和设计,随机化,开放标签试验比较血流分流术与传统血管内治疗≥7mm未破裂脑动脉瘤的安全性和疗效.
    OBJECTIVE: Endovascular treatment of large, wide-necked intracranial aneurysms by coil embolization is often complicated by low rates of complete occlusion and high rates of recurrence. A flow diverter device has been shown to be safe and effective for the treatment of not only large and giant unruptured aneurysms, but small and medium aneurysms. However, in Korea, its use has only recently been approved for aneurysms <10 mm. This study aims to compare the safety and efficacy of flow diversion and coil embolization for the treatment of unruptured aneurysms ≥7 mm.
    METHODS: The participants will include patients aged between 19 and 75 years to be treated for unruptured cerebral aneurysms ≥7 mm for the first time or for recurrent aneurysms after initial endovascular coil embolization. Participants assigned to a flow diversion cohort will be treated using any of the following devices : Pipeline Flex Embolization Device with Shield Technology (Medtronic, Minneapolis, MN, USA), Surpass Evolve (Stryker Neurovascular, Fremont, CA, USA), and FRED or FRED Jr. (MicroVention, Tustin, CA, USA). Participants assigned to a coil embolization cohort will undergo traditional endovascular coiling. The primary endpoint will be complete occlusion confirmed by cerebral angiography at 12 months after treatment. Secondary safety outcomes will evaluate periprocedural and post-procedural complications for up to 12 months.
    RESULTS: The trial will begin enrollment in 2022, and clinical data will be available after enrollment and follow-up.
    CONCLUSIONS: This article describes the aim and design of a multi-center, randomized, open-label trial to compare the safety and efficacy of flow diversion versus traditional endovascular treatment for unruptured cerebral aneurysms ≥7 mm.
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  • 文章类型: Comparative Study
    目的:评估经颈静脉肝内门体分流术(TIPS)有无辅助栓塞治疗心底静脉曲张出血的疗效。
    方法:回顾性研究包括82名患者(54名男性;平均年龄53.9岁;终末期肝病模型平均评分9.3),其在2011年至2015年期间发生心底静脉曲张出血。静脉曲张再出血,静脉曲张的流出道,评估明显的肝性脑病(HE)和术后静脉曲张通畅性。
    结果:92.7%的患者存在胃-肾分流(n=76)。67.1%的患者(n=55)进行了栓塞治疗。TIPS联合栓塞组的1年和2年静脉曲张再出血率显着低于TIPS单独组(3.8%和13.4%vs13.0%和28.0%,分别为;p=0.041)。两组之间在心底静脉曲张通畅性方面没有发现显着差异。明显的HE或存活率(p>0.05)。
    结论:结果表明,TIPS联合栓塞术可以降低心底静脉曲张患者的静脉曲张再出血风险。
    结论:•TIPS联合栓塞治疗可降低心底静脉曲张再出血的风险。•TIPS联合栓塞不能完全闭塞心底静脉曲张。•TIPS联合栓塞不能预防肝性脑病的发展。
    OBJECTIVE: To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with and without adjunctive embolisation in managing cardiofundal varices bleeding.
    METHODS: The retrospective study comprised 82 patients (54 men; mean age 53.9 years; mean Model of End-stage Liver Disease score 9.3) with cardiofundal varices bleeding who underwent TIPS creation from 2011 to 2015. Variceal rebleeding, the outflow tracts of varices, overt hepatic encephalopathy (HE) and post-procedure varices patency were assessed.
    RESULTS: Gastrorenal shunt was present in 92.7% of patients (n = 76). Embolisation was performed in 67.1% of patients (n = 55). The 1- and 2-year variceal rebleeding rates in the TIPS combined with embolisation group were significantly lower than those in the TIPS alone group (3.8% and 13.4% vs 13.0% and 28.0%, respectively; p = 0.041). No significant differences between the two groups were found in the cardiofundal varices patency, overt HE or survival (p > 0.05).
    CONCLUSIONS: The results suggest that TIPS combined with embolisation can reduce the risk of variceal rebleeding for patients with cardiofundal varices.
    CONCLUSIONS: • TIPS combined with embolisation reduces the risk of rebleeding in treating cardiofundal varices. • TIPS combined with embolisation could not completely occlude cardiofundal varices. • TIPS combined with embolisation could not prevent the development of hepatic encephalopathy.
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  • 文章类型: Comparative Study
    OBJECTIVE: The purpose of the study was to compare safety and efficacy outcomes following prostate artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 100-300 versus 300-500 μm tris-acryl gelatin microspheres.
    METHODS: Patients were prospectively treated between August 2011 and June 2013 to receive PAE with 100-300 μm (group A) or 300-500 μm (group B) tris-acryl gelatin microspheres. Patients were followed for a minimum of 12 months and were assessed for changes in International Prostate Symptom Score (IPSS), quality of life (QoL) index, prostate volume determined by magnetic resonance imaging, serum prostate specific antigen (PSA), and maximum urine flow rate (Qmax), as well as any treatment-related adverse events.
    RESULTS: Fifteen patients were included in each group, and PAE was technically successful in all cases. Both groups experienced significant improvement in mean IPSS, QoL, prostate volume, PSA, and Qmax (p < 0.05 for all). The differences observed between the two groups included a marginally insignificant more adverse events (p = 0.066) and greater mean serum PSA reduction at 3 months of follow-up (p = 0.056) in group A.
    CONCLUSIONS: Both 100-300 and 300-500 μm microspheres are safe and effective embolic agents for PAE to treat LUTS-related to BPH. Although functional and imaging outcomes did not differ significantly following use of the two embolic sizes, the greater incidence of adverse events with 100-300 μm microspheres suggests that 300-500 μm embolic materials may be more appropriate.
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