1
|
Gupta R, Miralbés S, Calleja Bonilla A, Naravetla B, Majjhoo AQ, Rayes M, Spiotta AM, Loehr C, Cioltan A, Vollherbst DF, Martínez-Galdámez M, Galván-Fernandez J, Khaldi A, McTaggart RA, Jayaraman MV, Defreyne L, Dhondt E, Vega P, Murias E, Lin E, Chaubal V, Price LL, Liebeskind DS, Möhlenbruch MA. Technique and impact on first pass effect primary results of the ASSIST global registry. J Neurointerv Surg 2024:jnis-2023-021126. [PMID: 38195248 DOI: 10.1136/jnis-2023-021126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Patients treated with mechanical thrombectomy (MT) for acute ischemic strokes from large vessel occlusion (LVO) have better outcomes with effective reperfusion. However, it is unknown which technique leads to better technical and clinical success. We aimed to determine which technique yields the most effective first pass reperfusion during MT. METHODS In a prospective, multicenter global registry we enrolled patients treated with operator preferred MT technique at 71 hospitals from January 2019 to January 2022. Three techniques were assessed: SR Classic with stent retriever (SR) and balloon guide catheter (BGC); SR Combination which employed SR with contact aspiration with or without BGC; and direct aspiration (DA) with or without BGC. The primary outcome was achieving an expanded Thrombolysis In Cerebral Infarction (eTICI) score of 2c or 3 on the first pass, with the primary technique as adjudicated by core lab. The primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2. RESULTS A total of 1492 patients were enrolled. Patients treated with SR Classic or SR Combination were more likely to achieve first pass eTICI 2c or 3 reperfusion (P=0.01). There was no significant difference in mRS 0-2 (P=0.46) or safety endpoints. CONCLUSIONS The use of SR Classic or SR Combination was more likely to achieve first pass eTICI 2c or 3 reperfusion. There were no significant differences in clinical outcomes and safety endpoints.
Collapse
Affiliation(s)
- Rishi Gupta
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | - Salvador Miralbés
- Neuroradiology, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Angel Calleja Bonilla
- Neuroradiology, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | | | | | - Mahmoud Rayes
- McLaren Regional Medical Center, Flint, Michigan, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH, Recklinghausen, Nordrhein-Westfalen, Germany
| | - Andreea Cioltan
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH, Recklinghausen, Nordrhein-Westfalen, Germany
| | | | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
- Interventional Neuroradiology.Radiology Department, Hospital La Luz, Quironsalud, Madrid, Spain
| | - Jorge Galván-Fernandez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain
| | - Ahmad Khaldi
- Neurosurgery, WellStar Health System, Marietta, Georgia, USA
| | | | - Mahesh V Jayaraman
- Diagnostic Imaging, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Luc Defreyne
- Vascular and Interventional Radiology, University Hospital Ghent, Ghent, Belgium
| | - Elisabeth Dhondt
- Vascular and Interventional Radiology, University Hospital Ghent, Ghent, Belgium
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eugene Lin
- Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Varun Chaubal
- Mercy Health Saint Vincent Medical Center, Toledo, Ohio, USA
| | - Lori Lyn Price
- Clinical Affairs, Stryker Neurovascular, Fremont, California, USA
| | - David S Liebeskind
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | | |
Collapse
|
2
|
Hermie L, Biervliet SV, Hoorens A, Cauwenberghe LV, Robberecht E, Defreyne L. Pre-emptive transjugular intrahepatic portosystemic shunt in pediatric cystic fibrosis-related liver disease and portal hypertension: prospective long-term results. Diagn Interv Radiol 2024; 30:55-64. [PMID: 36994654 PMCID: PMC10773179 DOI: 10.4274/dir.2022.221818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/23/2022] [Indexed: 03/31/2023]
Abstract
PURPOSE Portal hypertension (PHT) and its sequelae are the most clinically important manifestations in cystic fibrosis-related liver disease (CFLD). This paper aimed to evaluate the safety and efficacy of a pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) to prevent PHT-related complications in pediatric patients with CFLD. METHODS This was a prospective single-arm study on pediatric patients with CFLD, signs of PHT, and preserved liver function who underwent a pre-emptive TIPS in a single tertiary CF center between 2007 and 2012. The long-term safety and clinical efficacy were assessed. RESULTS A pre-emptive TIPS was performed on seven patients with a mean age of 9.2 years (± standard deviation: 2.2). The procedure was technically successful in all patients, with an estimated median primary patency of 10.7 years [interquartile range (IQR) 0.5-10.7)]. No variceal bleeding was observed during the median follow-up of 9 years (IQR 8.1-12.9). In two patients with advanced PHT and rapidly progressive liver disease, severe thrombocytopenia could not be stopped. Subsequent liver transplantation revealed biliary cirrhosis in both patients. In the remaining patients with early PHT and milder porto-sinusoidal vascular disease, symptomatic hypersplenism did not occur, and liver function remained stable until the end of the follow-up. Inclusion for pre-emptive TIPS was discontinued in 2013 following an episode of severe hepatic encephalopathy. CONCLUSION TIPS is a feasible treatment with encouraging long-term primary patency to avoid variceal bleeding in selected patients with CF and PHT. However, as the progression of liver fibrosis, thrombocytopenia, and splenomegaly is inevitable, the clinical benefits due to pre-emptive placement appear to be minor.
Collapse
Affiliation(s)
- Laurens Hermie
- Ghent University Hospital, Department of Vascular and Interventional Radiology, Gent, Belgium
| | | | - Anne Hoorens
- Ghent University Hospital, Department of Pathology, Gent, Belgium
| | - Lien Van Cauwenberghe
- Ghent University Hospital, Department of Vascular and Interventional Radiology, Gent, Belgium
| | - Eddy Robberecht
- Ghent University Hospital, Department of Pediatrics, Gent, Belgium
| | - Luc Defreyne
- Ghent University Hospital, Department of Vascular and Interventional Radiology, Gent, Belgium
| |
Collapse
|
3
|
Poli S, Mbroh J, Baron JC, Singhal AB, Strbian D, Molina C, Lemmens R, Turc G, Mikulik R, Michel P, Tatlisumak T, Audebert HJ, Dichgans M, Veltkamp R, Hüsing J, Graessner H, Fiehler J, Montaner J, Adeyemi AK, Althaus K, Arenillas JF, Bender B, Benedikt F, Broocks G, Burghaus I, Cardona P, Deb-Chatterji M, Cviková M, Defreyne L, De Herdt V, Detante O, Ernemann U, Flottmann F, García Guillamón L, Glauch M, Gomez-Exposito A, Gory B, Sylvie Grand S, Haršány M, Hauser TK, Heck O, Hemelsoet D, Hennersdorf F, Hoppe J, Kalmbach P, Kellert L, Köhrmann M, Kowarik M, Lara-Rodríguez B, Legris L, Lindig T, Luntz S, Lusk J, Mac Grory B, Manger A, Martinez-Majander N, Mengel A, Meyne J, Müller S, Mundiyanapurath S, Naggara O, Nedeltchev K, Nguyen TN, Nilsson MA, Obadia M, Poli K, Purrucker JC, Räty S, Richard S, Richter H, Schilte C, Schlemm E, Stöhr L, Stolte B, Sykora M, Thomalla G, Tomppo L, van Horn N, Zeller J, Ziemann U, Zuern CS, Härtig F, Tuennerhoff J. Penumbral Rescue by normobaric O = O administration in patients with ischemic stroke and target mismatch proFile (PROOF): Study protocol of a phase IIb trial. Int J Stroke 2024; 19:120-126. [PMID: 37515459 PMCID: PMC10759237 DOI: 10.1177/17474930231185275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
RATIONALE Oxygen is essential for cellular energy metabolism. Neurons are particularly vulnerable to hypoxia. Increasing oxygen supply shortly after stroke onset could preserve the ischemic penumbra until revascularization occurs. AIMS PROOF investigates the use of normobaric oxygen (NBO) therapy within 6 h of symptom onset/notice for brain-protective bridging until endovascular revascularization of acute intracranial anterior-circulation occlusion. METHODS AND DESIGN Randomized (1:1), standard treatment-controlled, open-label, blinded endpoint, multicenter adaptive phase IIb trial. STUDY OUTCOMES Primary outcome is ischemic core growth (mL) from baseline to 24 h (intention-to-treat analysis). Secondary efficacy outcomes include change in NIHSS from baseline to 24 h, mRS at 90 days, cognitive and emotional function, and quality of life. Safety outcomes include mortality, intracranial hemorrhage, and respiratory failure. Exploratory analyses of imaging and blood biomarkers will be conducted. SAMPLE SIZE Using an adaptive design with interim analysis at 80 patients per arm, up to 456 participants (228 per arm) would be needed for 80% power (one-sided alpha 0.05) to detect a mean reduction of ischemic core growth by 6.68 mL, assuming 21.4 mL standard deviation. DISCUSSION By enrolling endovascular thrombectomy candidates in an early time window, the trial replicates insights from preclinical studies in which NBO showed beneficial effects, namely early initiation of near 100% inspired oxygen during short temporary ischemia. Primary outcome assessment at 24 h on follow-up imaging reduces variability due to withdrawal of care and early clinical confounders such as delayed extubation and aspiration pneumonia. TRIAL REGISTRATIONS ClinicalTrials.gov: NCT03500939; EudraCT: 2017-001355-31.
Collapse
Affiliation(s)
- Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Joshua Mbroh
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Jean-Claude Baron
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris, Paris, France
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carlos Molina
- Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Guillaume Turc
- Department of Neurology, Hopital Sainte-Anne, Universite de Paris, Paris, France
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences INSERM U1266 Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Robert Mikulik
- Department of Neurology, St. Anne’s University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Patrik Michel
- Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Heinrich J Audebert
- Department of Neurology and Center for Stroke Research Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
- German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Johannes Hüsing
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
- Landeskrebsregister Nordrhein-Westfalen, Bochum, Germany
| | - Holm Graessner
- Center for Rare Diseases, Eberhard-Karls University, Tubingen, Germany
| | - Jens Fiehler
- Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Eppdata GmbH, Hamburg, Germany
| | - Joan Montaner
- Vall d’Hebron Institut de Recerca, Neurovascular Research Lab, Barcelona, Spain
| | | | | | | | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Frank Benedikt
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ina Burghaus
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Pere Cardona
- Department of Neurology, Hospital University de Bellvitge, Barcelona, Spain
| | - Milani Deb-Chatterji
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Cviková
- Department of Neurology, St. Anne’s University Hospital in Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium
| | - Veerle De Herdt
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Olivier Detante
- Neurology, CHU Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Fabian Flottmann
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Monika Glauch
- Center for Rare Diseases, Eberhard-Karls University, Tubingen, Germany
| | - Alexandra Gomez-Exposito
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospital Regional Universitaire de Nancy, Universite de Lorraine, INSERM U1254, Nancy, France
| | - Sylvie Sylvie Grand
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
- Neuroradiology / MRI Department, CHU Grenoble Alpes, Grenoble, France
| | - Michal Haršány
- Department of Neurology, St. Anne’s University Hospital in Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
- International Clinical Research Centre, St. Anne’s University Hospital in Brno, Brno, Czech Republic
| | - Till Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Olivier Heck
- Neuroradiology / MRI Department, CHU Grenoble Alpes, Grenoble, France
| | | | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Julia Hoppe
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pia Kalmbach
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Martin Köhrmann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Markus Kowarik
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | | | - Loic Legris
- Neurology, CHU Grenoble Alpes, Grenoble, France
- Inserm, U1216, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University, Tubingen, Germany
| | - Steffen Luntz
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Jay Lusk
- Duke University School of Medicine, Durham, NC, USA
| | - Brian Mac Grory
- Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Andreas Manger
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tubingen, Germany
| | | | - Annerose Mengel
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Johannes Meyne
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Susanne Müller
- Department of Neurology, University Hospital of Ulm, Ulm, Germany
| | | | - Olivier Naggara
- Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences INSERM U1266 Universite Paris Cite FHU NeuroVasc, Paris, France
| | - Krassen Nedeltchev
- Department of Neurology, KSA Kantonsspital Aarau and University of Bern, Bern, Switzerland
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | - Maike A Nilsson
- Coordinating Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Michael Obadia
- Department of Neurology and Stroke Center, Hopital fondation Adolphe de Rothschild, Paris, France
| | - Khouloud Poli
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Jan C Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Silja Räty
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Hardy Richter
- Department of Infectiology, Eberhard-Karls-University, Tuebingen, Germany
| | - Clotilde Schilte
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Stöhr
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Benjamin Stolte
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marek Sykora
- Department of Neurology, St. John’s Hospital, Vienna, Austria
| | - Götz Thomalla
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Noel van Horn
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Zeller
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| | - Christine S Zuern
- Department of Cardiology, Universitatsspital Basel, Basel, Switzerland
| | - Florian Härtig
- Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls University, Tubingen, Germany
| | - Johannes Tuennerhoff
- Department of Neurology & Stroke, Eberhard-Karls University, University Hospital, Tubingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tubingen, Germany
| |
Collapse
|
4
|
Zwaenepoel B, Vandewiele K, Peperstraete H, De Ryck F, Vanpeteghem C, Malfait T, Herck I, Vandenberghe W, Van Laethem L, Defreyne L, Van Braeckel E, Depuydt P, Schaubroeck H. Video-assisted thoracic surgery in critically ill COVID-19 patients on venovenous extracorporeal membrane oxygenation. Perfusion 2023; 38:1577-1583. [PMID: 35969115 PMCID: PMC9379594 DOI: 10.1177/02676591221119319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) leads to thoracic complications requiring surgery. This is challenging, particularly in patients supported with venovenous extracorporeal membrane oxygenation (VV-ECMO) due to the need for continuous therapeutic anticoagulation. We aim to share our experience regarding the safety and perioperative management of video-assisted thoracic surgery for this specific population. METHODS Retrospective, single-center study between November 2020 and January 2022 at the ICU department of a 1.061-bed tertiary care and VV-ECMO referral center during the COVID-19 pandemic. RESULTS 48 COVID-19 patients were supported with VV-ECMO. A total of 14 video-assisted thoracic surgery (VATS) procedures were performed in seven patients. Indications were mostly hemothorax (85.7%). In eight procedures heparin was stopped at least 1 h before incision. A total of 10 circuit changes due to clot formation or oxygen transfer failure were required in six patients (85.7%). One circuit replacement seemed related to the preceding VATS procedure, although polytransfusion might be a contributing factor. None of the mechanical complications was fatal. Four VATS-patients (57.1%) died, of which two (50%) immediately perioperatively due to uncontrollable bleeding. All three survivors were treated with additional transarterial embolization. CONCLUSION (1) Thoracic complications in COVID-19 patients on VV-ECMO are common. (2) Indication for VATS is mostly hemothorax (3) Perioperative mortality is high, mostly due to uncontrollable bleeding. (4) Preoperative withdrawal of anticoagulation is not directly related to a higher rate of ECMO circuit-related complications, but a prolonged duration of VV-ECMO support and polytransfusion might be. (5) Additional transarterial embolization to control postoperative bleeding may further improve outcomes.
Collapse
Affiliation(s)
- Bert Zwaenepoel
- Department of Cardiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Korneel Vandewiele
- Department of Perfusion, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Harlinde Peperstraete
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frederic De Ryck
- Department of Thoracic and Vascular
Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Caroline Vanpeteghem
- Department of Anesthesiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Thomas Malfait
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Wim Vandenberghe
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Lien Van Laethem
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Luc Defreyne
- Department of Interventional
Radiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter Depuydt
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Schaubroeck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| |
Collapse
|
5
|
Singfer U, Baert E, Defreyne L. Cerebral Proliferative Angiopathy in a Child, Five Years after an Intraventricular Hemorrhage and Negative Catheter Angiography. J Belg Soc Radiol 2023; 107:55. [PMID: 37546522 PMCID: PMC10402789 DOI: 10.5334/jbsr.3247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 08/08/2023] Open
Abstract
Cerebral proliferative angiopathy (CPA) is a rare cerebrovascular disease comprised of a diffuse network of blood vessels, often spread over several lobes. Due to the presence of normal brain tissue within the malformation, complete resection is not desirable. Several imaging characteristics help to distinguish CPA from brain arteriovenous malformations. We report the case of a patient diagnosed with CPA five years after a spontaneous intraventricular hemorrhage and an initial negative angiogram. Teaching Point The radiologist should be able to differentiate CPA from brain AVM to prevent potentially harmful treatment.
Collapse
Affiliation(s)
- Uri Singfer
- Department of Vascular and Interventional Radiology, Ghent University Hospital, BE
| | - Edward Baert
- Department of Neurosurgery, Ghent University Hospital, BE
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, BE
| |
Collapse
|
6
|
Hermie L, Van Cauwenberghe L, Dhondt E, De Bruyne R, Defreyne L. Transjugular Intrahepatic Portosystemic Shunts in Pediatric Portal Hypertension: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023:S1051-0443(23)00346-9. [PMID: 37196822 DOI: 10.1016/j.jvir.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/08/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To investigate the technical outcome, clinical outcome, and patency of transjugular intrahepatic portosystemic shunt (TIPS) in pediatric portal hypertension (PHT). METHODS A systematic search of MEDLINE/PubMed, EMBASE, Cochrane databases and ClinicalTrials.gov, WHO ICTRP registries was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An a priori protocol was registered at the PROSPERO database. Original full-text articles on pediatric patients (sample size ≥ 5 patients with upper age limit of 21 years) and PHT undergoing TIPS creation for any indication were included. RESULTS Seventeen studies with 284 patients (average-weighted age of 10.1 years) were included with an average-weighted follow-up of 3.6 years. TIPS was technically successful in 93.3% (95%CI, 88.5% - 97.1%) of patients with a major complication rate of 3.2% (95%CI: 0.7 - 6.9) and adjusted hepatic encephalopathy rate of 2.9% (95%CI, 0.6 - 6.3). The pooled 2-year primary and secondary patency rate was respectively 61.8% (95%CI: 50.0 - 72.4) and 99.8% (95%CI: 96.2% - 100.0%). Stent type (P = .002) and age (P = .04) were identified as a significant source of heterogeneity for clinical success. In subgroup analysis, the clinical success rate was respectively 85.9% (95%CI: 77.8 - 91.4) in studies with a majority of covered stents, and 87.6% (95% CI: 74.1 - 94.6) in studies with a median age ≥ 12 years. CONCLUSIONS This systematic review and meta-analysis demonstrates that a TIPS is a feasible and safe treatment for pediatric PHT. To improve clinical outcome and patency on the long term, the use of covered stents should be encouraged.
Collapse
Affiliation(s)
- Laurens Hermie
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium;.
| | - Lien Van Cauwenberghe
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium
| | - Elisabeth Dhondt
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium
| | - Ruth De Bruyne
- Department of Pediatrics, Ghent University Hospital, Belgium
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium
| |
Collapse
|
7
|
Hermie L, Defreyne L. Empirical transarterial embolization in angiographically negative lower gastrointestinal bleeding using vessel tracking and 3D navigation tools: report of 2 patients. CVIR Endovasc 2023; 6:26. [PMID: 37079166 PMCID: PMC10119340 DOI: 10.1186/s42155-023-00372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Recently, an empiric Cone-beam Computed Tomography (CBCT)-guided transarterial embolization (TAE) technique has been investigated for lower gastrointestinal bleeding (LGIB). Although this empirical strategy reduced the rate of rebleeding in hemodynamically unstable patients compared to a 'wait and see' strategy, the specified technique is challenging and time-consuming. CASE PRESENTATION We present two methods to perform a prompt empiric TAE in LGIB when catheter angiography is negative. Based on the pre-procedural Computed Tomography Angiography bleeding site and using vessel detection and navigation software tools that are integrated in contemporary angiosuites, the culprit bleeding artery could be targeted with only one selective intraprocedural CBCT acquisition. CONCLUSION The proposed techniques are promising to reduce procedure time and facilitate the implementation of empiric CBCT-guided TAE in clinical practice when angiography is negative.
Collapse
Affiliation(s)
- Laurens Hermie
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000, Belgium.
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, 9000, Belgium
| |
Collapse
|
8
|
Van Holsbeeck A, Dhondt E, Marrannes J, Claus E, Bonne L, Defreyne L, Maleux G. Coil Embolization of True, Common and Proper, Hepatic Artery Aneurysms: Technique, Safety and Outcome. Cardiovasc Intervent Radiol 2023; 46:480-487. [PMID: 36918422 DOI: 10.1007/s00270-023-03379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE To retrospectively assess the safety and efficacy of coil embolization for catheter-directed true common and proper hepatic artery aneurysm exclusion. MATERIALS AND METHODS Nine consecutive patients (2005-2021) in two university centers presenting with true common and proper hepatic artery aneurysms (> 2 cm in diameter) were treated with 'frontdoor-backdoor' coil embolization. Patients presenting with a hepatic artery pseudoaneurysm, mycotic aneurysm or patients with small (< 2 cm diameter) aneurysms and followed up by imaging were excluded. Technical and clinical success was defined as complete coil-exclusion of the aneurysm on completion angiography and absence of post-embolization adverse events, in particular mass effect or hemorrhage, respectively. Patient characteristics, technical and clinical success, liver function tests and follow-up results were assessed based on the patients' electronic medical records. RESULTS Technical and 30-day clinical success was achieved in all procedures (100%). No major procedural complications were reported. Liver function test values were available in 6/9 patients, showing transient elevation of bilirubin in one patient. No end organ ischemia was reported. The mean clinical follow-up period of the study patients was 72 months (12-168 months). Long-term stable occlusion of the hepatic aneurysms was achieved in 9/9 patients (100%). One patient showed late complication (3 years) with coil migration into a bulbar ulcer, without aneurysm recanalization, however with fatal outcome. CONCLUSION Coil embolization for the endovascular exclusion of true common and proper hepatic artery aneurysms is safe and effective.
Collapse
Affiliation(s)
- A Van Holsbeeck
- Department of Radiology, AZ Sint-Jan Hospital Brugge, Brugge, Belgium.,Department of Radiology, AZ Sint-Lucas Hospital Brugge, Brugge, Belgium
| | - E Dhondt
- Department of Radiology, University Hospital Gent, Ghent, Belgium
| | - J Marrannes
- Department of Radiology, AZ Sint-Jan Hospital Brugge, Brugge, Belgium.,Department of Radiology, AZ Sint-Lucas Hospital Brugge, Brugge, Belgium
| | - E Claus
- Department of Radiology, University Hospital Leuven, Herestraat 49, 3000, Louven, Belgium
| | - L Bonne
- Department of Radiology, University Hospital Leuven, Herestraat 49, 3000, Louven, Belgium
| | - L Defreyne
- Department of Radiology, University Hospital Gent, Ghent, Belgium
| | - G Maleux
- Department of Radiology, University Hospital Leuven, Herestraat 49, 3000, Louven, Belgium.
| |
Collapse
|
9
|
Dhondt E, Lambert B, Hermie L, Huyck L, Vanlangenhove P, Geerts A, Verhelst X, Aerts M, Vanlander A, Berrevoet F, Troisi RI, Van Vlierberghe H, Defreyne L. 90Y Radioembolization versus Drug-eluting Bead Chemoembolization for Unresectable Hepatocellular Carcinoma: Results from the TRACE Phase II Randomized Controlled Trial. Radiology 2022; 303:699-710. [PMID: 35258371 DOI: 10.1148/radiol.211806] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Transarterial chemoembolization (TACE) is the recommended treatment for intermediate hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer guidelines. Prospective uncontrolled studies suggest that yttrium 90 (90Y) transarterial radioembolization (TARE) is a safe and effective alternative. Purpose To compare the efficacy and safety of TARE with TACE for unresectable HCC. Materials and Methods In this single-center prospective randomized controlled trial (TRACE), 90Y glass TARE was compared with doxorubicin drug-eluting bead (DEB) TACE in participants with intermediate-stage HCC, extended to Eastern Cooperative Oncology Group performance status 1 and those with early-stage HCC not eligible for surgery or thermoablation. Participants were recruited between September 2011 and March 2018. The primary end point was time to overall tumor progression (TTP) (Kaplan-Meier analysis) in the intention-to-treat (ITT) and per-protocol (PP) groups. Results At interim analysis, 38 participants (median age, 67 years; IQR, 63-72 years; 33 men) were randomized to the TARE arm and 34 (median age, 68 years; IQR, 61-71 years; 30 men) to the DEB-TACE arm (ITT group). Median TTP was 17.1 months in the TARE arm versus 9.5 months in the DEB-TACE arm (ITT group hazard ratio [HR], 0.36; 95% CI: 0.18, 0.70; P = .002) (PP group, 32 and 34 participants, respectively, in each arm; HR, 0.29; 95% CI: 0.14, 0.60; P < .001). Median overall survival was 30.2 months after TARE and 15.6 months after DEB-TACE (ITT group HR, 0.48; 95% CI: 0.28, 0.82; P = .006). Serious adverse events grade 3 or higher (13 of 33 participants [39%] vs 19 of 36 [53%] after TARE and DEB-TACE, respectively; P = .47) and 30-day mortality (0 of 33 participants [0%] vs three of 36 [8.3%]; P = .24) were similar in the safety groups. At the interim, the HR for the primary end point, TTP, was less than 0.39, meeting the criteria to halt the study. Conclusion With similar safety profile, yttrium 90 radioembolization conferred superior tumor control and survival compared with chemoembolization using drug-eluting beads in selected participants with early or intermediate hepatocellular carcinoma. Clinical trial registration no. NCT01381211 © RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Elisabeth Dhondt
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Bieke Lambert
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Laurens Hermie
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Lynn Huyck
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Peter Vanlangenhove
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Anja Geerts
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Xavier Verhelst
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Maridi Aerts
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Aude Vanlander
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Frederik Berrevoet
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Roberto Ivan Troisi
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Hans Van Vlierberghe
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| | - Luc Defreyne
- From the Departments of Vascular and Interventional Radiology (E.D., L. Hermie, L. Huyck, P.V., L.D.), Gastroenterology and Hepatology (A.G., X.V., M.A., H.V.V.), and General and HPB Surgery and Liver Transplantation (A.V., F.B.), Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; and the Departments of Diagnostic Sciences (B.L.) and Human Structure and Repair (R.I.T.), Ghent University, Ghent, Belgium
| |
Collapse
|
10
|
Dhondt E, Vanlangenhove P, Geboes K, Vandenabeele L, Van Cauwenberghe L, Defreyne L. Correction to: No evidence of improved efficacy of covered stents over uncovered stents in percutaneous palliation of malignant hilar biliary obstruction: results of a prospective randomized trial. Eur Radiol 2020; 30:6965. [DOI: 10.1007/s00330-020-07029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Degrieck B, Defreyne L. Cone-Beam CT-Guided Selective Intralesional Ethanol Injection of the Compressive Epidural Components of Aggressive Vertebral Haemangioma in Progressive and Acute Myelopathy: Report of 2 Cases. J Vasc Interv Radiol 2020; 31:1508-1510. [PMID: 32800666 DOI: 10.1016/j.jvir.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Bert Degrieck
- Department of Vascular and Interventional Radiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| |
Collapse
|
12
|
Claeys W, Defreyne L, Vanlangenhove P, Hoebeke P. PS-7-13 Retrograde Embolization of Cavernous Leakage in Erectile Dysfunction: A Single Center Experience. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
13
|
Dhondt E, Hermie L, Verhelst X, Lambert B, Defreyne L. 4:21 PM Abstract No. 307 Transarterial radioembolization versus drug-eluting beads chemoembolization for treatment of inoperable early and intermediate hepatocellular carcinoma: interim results of the randomized controlled TRACE trial. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
14
|
Dhondt E, Vanlangenhove P, De Man M, Huyck L, Defreyne L. No Advantage of Expanded Polytetrafluoroethylene and Fluorinated Ethylene Propylene–Covered Stents over Uncovered Nitinol Stents for Percutaneous Palliation of Malignant Infrahilar Biliary Obstruction: Results of a Single-Center Prospective Randomized Trial. J Vasc Interv Radiol 2020; 31:82-92. [DOI: 10.1016/j.jvir.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 12/16/2022] Open
|
15
|
Dhondt E, Vanlangenhove P, Van Vlierberghe H, Troisi R, De Bruyne R, Huyck L, Defreyne L. Benign anastomotic biliary strictures untreatable by ERCP: a novel percutaneous balloon dilatation technique avoiding indwelling catheters. Eur Radiol 2018; 29:636-644. [DOI: 10.1007/s00330-018-5526-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/16/2018] [Accepted: 05/03/2018] [Indexed: 02/06/2023]
|
16
|
Singfer U, Defreyne L. Response by Singfer and Defreyne to Letter Regarding Article, “Unruptured Brain Arteriovenous Malformations: Primary ONYX Embolization in ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Patients”. Stroke 2018; 49:e137. [DOI: 10.1161/strokeaha.118.020396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Uri Singfer
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Belgium
| | - Luc Defreyne
- Department of Interventional Neuroradiology, Ghent University Hospital, Belgium
| |
Collapse
|
17
|
Singfer U, Hemelsoet D, Vanlangenhove P, Martens F, Verbeke L, Van Roost D, Defreyne L. Unruptured Brain Arteriovenous Malformations: Primary ONYX Embolization in ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Patients. Stroke 2017; 48:3393-3396. [PMID: 29114088 DOI: 10.1161/strokeaha.117.018605] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In light of evidence from ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations), neurovascular specialists had to reconsider deliberate treatment of unruptured brain arteriovenous malformations (uBAVMs). Our objective was to determine the outcomes of uBAVM treated with primary embolization using ethylene vinyl alcohol (ONYX). METHODS Patients with uBAVM who met the inclusion criteria of ARUBA and were treated with primary Onyx embolization were assigned to this retrospective study. The primary outcome was the modified Rankin Scale score. Secondary outcomes were stroke or death because of uBAVM or intervention and uBAVM obliteration. RESULTS Sixty-one patients (mean age, 38 years) were included. The median observation period was 60 months. Patients were treated by embolization alone (41.0%), embolization and radiosurgery (57.4%), or embolization and excision (1.6%). Occlusion was achieved in 44 of 57 patients with completed treatment (77.2%). Forty-seven patients (77.1%) had no clinical impairment at the end of observation (modified Rankin Scale score of <2). Twelve patients (19.7%) reached the outcome of stroke or death because of uBAVM or intervention. Treatment-related mortality was 6.6% (4 patients). CONCLUSIONS In uBAVM, Onyx embolization alone or combined with stereotactic radiosurgery achieves a high occlusion rate. Morbidity remains a challenge, even if it seems lower than in the ARUBA trial.
Collapse
Affiliation(s)
- Uri Singfer
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Dimitri Hemelsoet
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Peter Vanlangenhove
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Frederic Martens
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Luc Verbeke
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Dirk Van Roost
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Luc Defreyne
- From the Faculty of Medicine and Health Sciences (U.S.), Department of Interventional Neuroradiology (P.V., L.D.), Department of Neurology (D.H.), and Department of Neurosurgery (D.V.R.), Ghent University Hospital, Belgium; and Departments of Neurosurgery (F.M.) and Radiotherapy (L.V.), Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
| |
Collapse
|
18
|
Olivier P, Van Melkebeke D, Honoré PJ, Defreyne L, Hemelsoet D. Cerebral vasospasm in acute porphyria. Eur J Neurol 2017; 24:1183-1187. [DOI: 10.1111/ene.13347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/22/2017] [Indexed: 01/22/2023]
Affiliation(s)
- P. Olivier
- Ghent University Hospital; Ghent Belgium
| | | | | | | | | |
Collapse
|
19
|
Vandenabeele LAM, Dhondt E, Geboes KP, Defreyne L. Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options. Acta Gastroenterol Belg 2017; 80:249-255. [PMID: 29560690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Obstructive jaundice caused by metastatic disease leads to deterioration of general condition and short survival time. Successful decompression can offer symptom control and enable further treatment with chemotherapy, which can improve survival. PATIENTS AND METHODS Ninety-nine percutaneous transhepatic cholangiography (PTC) procedures with metallic stent placement were performed in 93 patients between 2007 and 2013. Files were retrospectively studied and a review of patients' demographics, clinical and laboratory parameters, treatment and survival was performed. Kaplan-Meier survival analysis with log-rank test was done in function of bilirubin level, tumor type and treatment with chemotherapy. RESULTS Hyperbilirubinemia resolved in 73% of procedures. Median survival time after the procedure was 48 (95%CI 34.8 - 61.1) days. If additional chemotherapy was possible, a median survival of 170 (95%CI 88.5 - 251.4) days was noted versus 32 (95%CI 22.4 - 41.5) days without chemotherapy (p < 0.01). Survival rates greatly differed between primary tumor type, with the largest benefit of PTC in colorectal cancer. In 35 % of the procedures minor or more severe complications were noted. The 30-day mortality was 33%, with 3 procedure related deaths. CONCLUSION PTC with metallic stenting can bring symptom relief and enable further treatment with chemotherapy, which can lead to a longer survival time, especially in colorectal cancer. However, in patients in whom palliative stenting failed to resolve the hyperbilirubinemia survival is short.
Collapse
Affiliation(s)
- Lisbeth A M Vandenabeele
- University Hospital of Ghent, Department of Gastroenterology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Elisabeth Dhondt
- University Hospital of Ghent, Department of Interventional Radiology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Karen P Geboes
- University Hospital of Ghent, Department of Gastroenterology, De Pintelaan 185, 9000 Ghent, Belgium
| | - Luc Defreyne
- University Hospital of Ghent, Department of Interventional Radiology, De Pintelaan 185, 9000 Ghent, Belgium
| |
Collapse
|
20
|
Kallmes DF, Brinjikji W, Boccardi E, Ciceri E, Diaz O, Tawk R, Woo H, Jabbour P, Albuquerque F, Chapot R, Bonafe A, Dashti SR, Delgado Almandoz JE, Given C, Kelly ME, Cross DT, Duckwiler G, Razack N, Powers CJ, Fischer S, Lopes D, Harrigan MR, Huddle D, Turner R, Zaidat OO, Defreyne L, Pereira VM, Cekirge S, Fiorella D, Hanel RA, Lylyk P, McDougall C, Siddiqui A, Szikora I, Levy E. Aneurysm Study of Pipeline in an Observational Registry (ASPIRe). Interv Neurol 2016; 5:89-99. [PMID: 27610126 DOI: 10.1159/000446503] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. MATERIALS AND METHODS We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. RESULTS One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). CONCLUSIONS Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months.
Collapse
Affiliation(s)
| | | | - Edoardo Boccardi
- Department of Neuroradiology, Niguarda Ca' Granda Hospital of Milan, Milan, Italy
| | - Elisa Ciceri
- Department of Radiology, Istituto Neurologico Carlo Besta, Milan, Italy
| | - Orlando Diaz
- Department of Radiology, Houston Methodist Hospital, Houston, Tex., USA
| | - Rabih Tawk
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Fla., USA
| | - Henry Woo
- Departments of Neurosurgery at Stony Brook University, Stony Brook, N.Y., USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa., USA
| | | | - Rene Chapot
- Neurointerventional Services, Department of Interventional Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Alain Bonafe
- Department of Radiology, CHU Montpellier, Montpellier, France
| | - Shervin R Dashti
- Department of Neurosurgery, Norton Neuroscience Institute, Norton Healthcare, Louisville, Ky., USA
| | - Josser E Delgado Almandoz
- Department of Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minn., USA
| | - Curtis Given
- Neurointerventional Services, Baptist Health Lexington, Lexington, Ky., USA
| | - Michael E Kelly
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask., Canada
| | - DeWitte T Cross
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
| | - Gary Duckwiler
- Department of Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA
| | - Nasser Razack
- Neurointerventional Associates, P.A., St. Petersburg, Fla., USA
| | - Ciaran J Powers
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Demetrius Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Ill., USA
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama, Birmingham, Ala., USA
| | - Daniel Huddle
- Swedish Medical Center/RIA Neurovascular, Englewood, Colo., USA
| | - Raymond Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, S.C., USA
| | - Osama O Zaidat
- Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA
| | - Luc Defreyne
- Department of Interventional Radiology, Ghent University Hospital, Gent, Belgium
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network and Departments of Medical Imaging and Surgery, University of Toronto, Toronto, Ont., Canada
| | - Saruhan Cekirge
- Department of Radiology, Koru Hospital and Bayindir Hospitals, Ankara, Turkey
| | - David Fiorella
- Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, N.Y., USA
| | - Ricardo A Hanel
- Stroke and Cerebrovascular Surgery, Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, Fla., USA
| | - Pedro Lylyk
- Department of Neurosurgery, Clinica La Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - Cameron McDougall
- Endovascular Neurosurgery, Barrow Neurological Institute, Phoenix, Ariz., USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo Neurosurgery, Buffalo, N.Y., Phoenix, Ariz., USA
| | - Istvan Szikora
- Department of Neurointerventional Services, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Elad Levy
- Department of Neurosurgery, University at Buffalo Neurosurgery, Buffalo, N.Y., Phoenix, Ariz., USA
| |
Collapse
|
21
|
Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E, De Blauwe S, Hemelsoet D, Wiesmann M, Defreyne L. Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough. J Neurointerv Surg 2016; 9:394-398. [PMID: 27036980 DOI: 10.1136/neurintsurg-2016-012290] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment. METHODS We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days. RESULTS PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities <40 HU (for ruling hemorrhage out) and ≥140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%. CONCLUSIONS There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.
Collapse
Affiliation(s)
- Sven Dekeyzer
- Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.,Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.,Institute for Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Bart Lutin
- Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| | - Jeroen De Groote
- Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| | | | | | - Dimitri Hemelsoet
- Department of Neurology, University Hospital (UZ) Ghent, Ghent, Belgium
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| |
Collapse
|
22
|
|
23
|
De Groote J, Snauwaert C, Defreyne L. An unusual case of acute intestinal hemorrhage. Gastroenterology 2015; 148:e10-1. [PMID: 25450073 DOI: 10.1053/j.gastro.2014.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/14/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Jeroen De Groote
- Department of Radiology, Universitair Ziekenhuis, Gent, Belgium; Department of Vascular and interventional Radiology, Universitair Ziekenhuis, Gent, Belgium
| | | | - Luc Defreyne
- Department of Vascular and interventional Radiology, Universitair Ziekenhuis, Gent, Belgium
| |
Collapse
|
24
|
Vanlangenhove P, Dhondt E, Everaert K, Defreyne L. Pathophysiology, diagnosis and treatment of varicoceles: a review. MINERVA UROL NEFROL 2014; 66:257-282. [PMID: 25394405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this article we reviewed the pathophysiology, diagnosis and treatment of varicoceles. The etiology and pathogenesis of varicoceles cannot be explained by one theory. Valve dysfunction, ontogenetic collateral formation and the nutcracker phenomenon seem to act synergistically. Hyperthermia, elevated hydrostatic pressure and antisperm agents are suggested as possible causes for the pathophysiology how varicoceles induce infertility. However the combination of patient's lifestyle, genetic factors and the consequences of reflux into the pampiniform plexus are believed to contribute to the infertility. Although venography stays the gold standard, the combination of physical examination, color Doppler ultrasound and thermography has the highest sensitivity and specificity to diagnose a varicocele. Regarding infertility, we are still searching for strict criteria or grading, to decide which patients with a varicocele may or may not have benefit from treatment. Treatment of varicoceles can be performed by different open surgical or percutaneous techniques. Treatment of varicoceles for infertility or to prevent infertility remains controversial, because the majority of men with varicoceles are still fertile. At the moment, inguinal or subinguinal microscopic surgery gave the highest pregnancy rates, the lowest recurrence and lowest complication rates. But retrograde superselective glue embolization or sclerosing of the ISV are the best percutaneous alternative and can be performed on an outpatient basis under local anesthesia and with faster return to normal activities than surgery.
Collapse
Affiliation(s)
- P Vanlangenhove
- Department of Vascular and Interventional Radiology Ghent University Hospital, Ghent, Belgium -
| | | | | | | |
Collapse
|
25
|
De Beul P, Castelein T, Claikens B, Roelandt W, Lambrecht G, Cool M, Defreyne L, Deboever G. The MDCT-scan as an important tool in the management of relapsing, overt upper gastrointestinal bleeding: letter to the editor. Acta Gastroenterol Belg 2014; 77:439-440. [PMID: 25682638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
26
|
Bonne L, Vanhoenacker P, Defreyne L. Embolization of a Giant Intercostal Aneurysm and Arteriovenous Malformation. Cardiovasc Intervent Radiol 2014; 38:1352-5. [PMID: 25366088 DOI: 10.1007/s00270-014-1007-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Lawrence Bonne
- Department of Radiology, OLV Hospital Aalst-Asse-Ninove, Moorselbaan 164, Aalst, 9300, Belgium.
| | - Piet Vanhoenacker
- Department of Radiology, OLV Hospital Aalst-Asse-Ninove, Moorselbaan 164, Aalst, 9300, Belgium. .,Department of Vascular and Interventional Radiology, University Hospital Ghent, Ghent, Belgium.
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, University Hospital Ghent, Ghent, Belgium.
| |
Collapse
|
27
|
Deprez N, De Herdt V, Vandersteene J, Acou M, Defreyne L, Hemelsoet D. Delayed intravenous thrombolysis based on MRI mismatch in posterior circulation stroke. Acta Neurol Belg 2014; 114:113-5. [PMID: 24399198 DOI: 10.1007/s13760-013-0271-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/12/2013] [Indexed: 11/29/2022]
Abstract
The current time-based approach for patient selection for intravenous (IV) thrombolysis in an acute stroke setting neglects the individual variation of cerebral blood flow impairment. This approach restricts the eligible patient population. In the last decade, advanced imaging and especially MRI diffusion- and perfusion-weighted imaging (DWI-PWI) techniques have been used to select patients for IV thrombolysis outside the current 4.5 h time window. Most of these studies focus on the anterior (carotid artery) cerebral circulation only. We report the case of an acute ischemic stroke due to a dissection of the right vertebral artery and occlusion of the posterior inferior cerebellar artery with good clinical outcome. The patient received IV thrombolysis far beyond the current established time window. This decision was based upon a marked MRI DWI-PWI mismatch zone in the posterior circulation territory.
Collapse
Affiliation(s)
- Nele Deprez
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium,
| | | | | | | | | | | |
Collapse
|
28
|
Seinstra BA, Defreyne L, Lambert B, Lam MGEH, Verkooijen HM, van Erpecum KJ, van Hoek B, van Erkel AR, Coenraad MJ, Al Younis I, van Vlierberghe H, van den Bosch MAAJ. Transarterial radioembolization versus chemoembolization for the treatment of hepatocellular carcinoma (TRACE): study protocol for a randomized controlled trial. Trials 2012; 13:144. [PMID: 22913492 PMCID: PMC3493260 DOI: 10.1186/1745-6215-13-144] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 08/09/2012] [Indexed: 02/08/2023] Open
Abstract
Background Hepatocellular carcinoma is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10 to 15% of hepatocellular carcinoma patients are suitable candidates for treatment with curative intent, such as hepatic resection and liver transplantation. A majority of patients have locally advanced, liver restricted disease (Barcelona Clinic Liver Cancer (BCLC) staging system intermediate stage). Transarterial loco regional treatment modalities offer palliative treatment options for these patients; transarterial chemoembolization (TACE) is the current standard treatment. During TACE, a catheter is advanced into the branches of the hepatic artery supplying the tumor, and a combination of embolic material and chemotherapeutics is delivered through the catheter directly into the tumor. Yttrium-90 radioembolization (90Y-RE) involves the transarterial administration of minimally embolic microspheres loaded with Yttrium-90, a β-emitting isotope, delivering selective internal radiation to the tumor. 90Y-RE is increasingly used in clinical practice for treatment of intermediate stage hepatocellular carcinoma, but its efficacy has never been prospectively compared to that of the standard treatment (TACE). In this study, we describe the protocol of a multicenter randomized controlled trial aimed at comparing the effectiveness of TACE and 90Y-RE for treatment of patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma. Methods/design In this pragmatic randomized controlled trial, 140 patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma, with Eastern Cooperative Oncology Group performance status 0 to 1 and Child-Pugh A to B will be randomly assigned to either 90Y-RE or TACE with drug eluting beads. Patients assigned to 90Y-RE will first receive a diagnostic angiography, followed by the actual transarterial treatment, which can be divided into two sessions in case of bilobar disease. Patients assigned to TACE will receive a maximum of three consecutive transarterial treatment sessions. Patients will undergo structural follow-up for a timeframe of two years post treatment. Post procedural magnetic resonance imaging (MRI) will be performed at one and three months post trial entry and at three-monthly intervals thereafter for two years to assess tumor response. Primary outcome will be time to progression. Secondary outcomes will be overall survival, tumor response according to the modified RECIST criteria, toxicities/adverse events, treatment related effect on total liver function, quality of life, treatment-related costs and cost-effectiveness. Trial registration NCT01381211
Collapse
Affiliation(s)
- Beatrijs A Seinstra
- Department of Radiology, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Seinstra B, Defreyne L, Lambert B, Lam M, Verkooijen L, van Erpecum K, van Hoek B, van Erkel A, Coenraad M, Al Younis I, van Vlierberghe H, van den Bosch M. Abstract No. 377: Transarterial RAdioembolization versus ChemoEmbolization for the treatment of HCC: TRACE trial-an international multicenter randomized controlled trial. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
31
|
Dhondt E, Vanlangenhove P, van Vlierberghe H, Troisi R, Defreyne L. Abstract No. 224: Treatment of benign post-surgery biliary strictures with a 3-fold repeated percutaneous balloon dilatation regimen without long term indwelling catheters. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
32
|
Lambert B, Mertens J, Dhondt E, Seinstra B, Smits M, Colle I, van Vlierberghe H, Troisi R, Defreyne L. Abstract No. 199: Hepatocellular carcinoma (HCC) treatment with radiolabelled lipiodol embolization versus ytrrium-90 radioembolization: comparative survival analysis. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
33
|
van den Ameele J, Sieben A, Van den Broecke C, Boterberg T, Defreyne L, Achten E, Lammens M, Hemelsoet D. Late-onset post-irradiation vasculopathy of the posterior cerebral vasculature. Acta Neurol Belg 2012; 112:101-4. [PMID: 22427301 DOI: 10.1007/s13760-012-0014-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/01/2011] [Indexed: 11/26/2022]
Abstract
Radiotherapy is extensively used in the treatment of malignant tumors of the central nervous system, but may also cause considerable morbidity and mortality, probably through damage to the remarkably vulnerable vascular system. We present two cases of infarction in the posterior cerebral vasculature related to earlier irradiation for a pineal gland tumor. Two patients were irradiated for a pineal gland tumor in young adulthood. Respectively 20 and 35 years later, they presented with a progressive neurological decline, related to early progressive atherosclerosis in the posterior cerebral vasculature. In conclusion, irradiation of the posterior cerebral territory may produce precocious atherosclerosis of posterior circulation vasculature, even decades later. When a progressive clinical decline with accumulating ischemic events is observed, together with signs of atherosclerosis, radiotherapy-related vasculopathy may be considered.
Collapse
Affiliation(s)
- Jelle van den Ameele
- Department of Neurology, Ghent University Hospital 1K12, De Pintelaan 185, 9000 Ghent, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Hoste EAJ, Doom S, De Waele J, Delrue LJ, Defreyne L, Benoit DD, Decruyenaere J. Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive Care Med 2011; 37:1921-31. [PMID: 22048719 DOI: 10.1007/s00134-011-2389-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/29/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE Intensive care unit (ICU) patients frequently undergo contrast-enhanced radiographic examinations, which carries a risk for development of contrast-associated acute kidney injury (CA-AKI). Data on this in ICU patients are scarce. The aim of this study was therefore to evaluate the epidemiology and short- and long-term outcomes of CA-AKI in ICU patients. METHODS A retrospective single-centre cohort study covering the period 1 March 2004 to 31 December 2008 on ICU patients who underwent a radiography examination with parenteral administration of iodinated radio contrast media was conducted. Data analysis included univariate and multivariate analyses of patients with and without CA-AKI. RESULTS A total of 787 ICU patients were included in the study. CA-AKI occurred in 128 (16.3%) and was associated with higher need for RRT [30 (4.6%) vs. 21 (16.4%), p < 0.001], worse kidney function at discharge, longer length of ICU and hospital stay, and higher 28-day and 1-year mortality [28-day: 86 (13.1%) vs. 46 (35.9%), p < 0.001, and 1-year: 158 (24.0%) vs. 71 (55.5%), p < 0.001]. Higher serum creatinine, lower mean arterial pressure, and administration of diuretics and vasoactive therapy were associated with development of CA-AKI in multivariate analysis. After correction for confounders we found that CA-AKI was associated with 28-day mortality in this cohort of ICU patients (odds ratio = 2.742, 95% confidence interval 1.374-5.471). CONCLUSIONS CA-AKI occurred in one out of six ICU patients who underwent a contrast-enhanced radiography examination and was associated with both short-and long-term worse outcomes such as need for RRT, worse kidney function at discharge, increased length of stay in the ICU and hospital, and mortality.
Collapse
Affiliation(s)
- Eric A J Hoste
- Intensive Care Unit, ICU, 2K12 C, Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | | | | | | | | | | | | |
Collapse
|
35
|
Lambert B, Sturm E, Mertens J, Oltenfreiter R, Smeets P, Troisi R, Van Vlierberghe H, Defreyne L. Intra-arterial treatment with 90Y microspheres for hepatocellular carcinoma: 4 years experience at the Ghent University Hospital. Eur J Nucl Med Mol Imaging 2011; 38:2117-24. [DOI: 10.1007/s00259-011-1881-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 07/03/2011] [Indexed: 01/17/2023]
|
36
|
Vanlangenhove P, De Keukeleire K, Everaert K, Van Maele G, Defreyne L. Efficacy and safety of two different n-butyl-2-cyanoacrylates for the embolization of varicoceles: a prospective, randomized, blinded study. Cardiovasc Intervent Radiol 2011; 35:598-606. [PMID: 21638147 DOI: 10.1007/s00270-011-0188-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This was a prospective, randomized, blinded comparative study of the efficacy and safety of two different n-butyl-2-cyanoacrylates (NBCAs) for embolization of varicoceles. METHODS A total of 112 insufficient spermatic veins (left-sided, n=84; right-sided, n=28) that were diagnosed in 83 adult males were prospectively randomized for blinded embolization with NBCA (n=54; Histoacryl, Braun, Germany) or NBCA-MS (n=58; Glubran2, General Enterprise Marketing, Viareggio, Lucca, Italy). Handling, embolic efficacy, and safety of both NBCAs were compared according the fulfillment of a standardized embolization plan, the occlusive effect on the spermatic vein, and the sticking to the microcatheter. Statistical analysis was performed with the Mann-Whitney U test and the Fisher's exact test. RESULTS Patients of both study arms were comparable for age and clinical indication. Spermatic vein characteristics were comparable for varicocele classification and embolization side. Both NBCAs were equally efficient in occluding the spermatic vein and blocking reflux (NBCA, n=54/54, 100% vs. NBCA-MS, n=54/57, 94.7%; P=0.244). The embolization plan could be accomplished in an equal number of veins for both groups (NBCA, n=45/54, 83.3% vs. NBCA-MS, n=41/58, 70.7%; P=0.124). Adhesiveness of the glue to the microcatheter was the same in both NBCA groups (NBCA, n=25/54, 46.3% vs. NBCA-MS, n=29/58, 50%; P=0.71). No glue-related complications were noted. CONCLUSIONS NBCA and NBCA-MS are equally efficient and safe glues for embolization of varicoceles.
Collapse
Affiliation(s)
- Peter Vanlangenhove
- Department of Vascular and Interventional Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | | | | | | | | |
Collapse
|
37
|
Dhondt E, Defreyne L. Abstract No. 61: Percutaneous palliation of malignant infrahilar biliary obstruction with covered versus non covered biliary stents: Results of a prospective randomized trial. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
De Keukeleire K, Vanlangenhove P, Kalala Okito JP, Hallaert G, Van Roost D, Defreyne L. Transarterial embolization with ONYX for treatment of intracranial non-cavernous dural arteriovenous fistula with or without cortical venous reflux. J Neurointerv Surg 2011; 3:224-8. [DOI: 10.1136/jnis.2010.004119] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
39
|
Lambert B, Van Vlierberghe H, Troisi R, Defreyne L. Radionuclide therapy for hepatocellular carcinoma. Acta Gastroenterol Belg 2010; 73:484-488. [PMID: 21299159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Several techniques for radionuclide therapy of hepatocellular carcinoma (HCC) have been developed. In this overview the available radionuclide treatment modalities for HCC are presented, with an emphasis on Yttrium-90 (90Y) microspheres. METHODS We comment on the commercially available products and describe the practical aspects of these treatment modalities. Medical literature was screened for clinical data on these therapies in patients suffering from HCC. The most relevant studies are summarized, focusing on patient selection, safety and outcome. DISCUSSION Randomized trials are still ongoing or recently initialized. These trials will elucidate the role of 90Y-microspheres in relation to biotherapy and chemoembolization for palliative use in patients not amenable to surgery. CONCLUSION Large retrospective or cohort studies proof the safety of 90Y-microspheres for palliative use in HCC patients suffering Child-Pugh A or B7 cirrhosis. Future research will yield more information on its efficacy when compared to chemoembolization or sorafenib. Several groups have reported on the use of selective internal radiation therapy (SIRT) for downstaging patients to surgical curative treatment.
Collapse
Affiliation(s)
- B Lambert
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
| | | | | | | |
Collapse
|
40
|
Lambert B, Mertens J, Sturm EJ, Stienaers S, Defreyne L, D’Asseler Y. 99mTc-labelled macroaggregated albumin (MAA) scintigraphy for planning treatment with 90Y microspheres. Eur J Nucl Med Mol Imaging 2010; 37:2328-33. [DOI: 10.1007/s00259-010-1566-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 07/07/2010] [Indexed: 01/03/2023]
|
41
|
Hendlisz A, Van den Eynde M, Peeters M, Maleux G, Lambert B, Vannoote J, De Keukeleire K, Verslype C, Defreyne L, Van Cutsem E, Delatte P, Delaunoit T, Personeni N, Paesmans M, Van Laethem JL, Flamen P. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol 2010; 28:3687-94. [PMID: 20567019 DOI: 10.1200/jco.2010.28.5643] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Liver dissemination is a major cause of mortality among patients with advanced colorectal cancer. Hepatic intra-arterial injection of the beta-emitting isotope yttrium-90 ((90)Y) bound to resin microspheres (radioembolization) delivers therapeutic radiation doses to liver metastases with minimal damage to adjacent tissues. PATIENTS AND METHODS We conducted a prospective, multicenter, randomized phase III trial in patients with unresectable, chemotherapy-refractory liver-limited metastatic CRC (mCRC) comparing arm A (fluorouracil [FU] protracted intravenous infusion 300 mg/m(2) days 1 through 14 every 3 weeks) and arm B (radioembolization plus intravenous FU 225 mg/m(2) days 1 through 14 then 300 mg/m(2) days 1 through 14 every 3 weeks) until hepatic progression. The primary end point was time to liver progression (TTLP). Cross-over to radioembolization was permitted after progression in arm A. RESULTS Forty-six patients were randomly assigned and 44 were eligible for analysis (arm A, n = 23; arm B, n = 21). Median follow-up was 24.8 months. Median TTLP was 2.1 and 5.5 months in arms A and B, respectively (hazard ratio [HR] = 0.38; 95% CI, 0.20 to 0.72; P = .003). Median time to tumor progression (TTP) was 2.1 and 4.5 months, respectively (HR = 0.51; 95% CI, 0.28 to 0.94; P = .03). Grade 3 or 4 toxicities were recorded in six patients after FU monotherapy and in one patient after radioembolization plus FU treatment (P = .10). Twenty-five of 44 patients received further treatment after progression, including 10 patients in arm A who received radioembolization. Median overall survival was 7.3 and 10.0 months in arms A and B, respectively (HR = 0.92; 95% CI, 0.47 to 1.78; P = .80). CONCLUSION Radioembolization with (90)Y-resin microspheres plus FU is well tolerated and significantly improves TTLP and TTP compared with FU alone. This procedure is a valid therapeutic option for chemotherapy-refractory liver-limited mCRC.
Collapse
Affiliation(s)
- Alain Hendlisz
- Medicine Department, Institut Jules Bordet, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Hallaert GG, De Keukeleire KM, Vanhauwaert DJ, Defreyne L, Van Roost D. Intracranial dural arteriovenous fistula successfully treated by combined open-endovascular procedure. J Neurol Neurosurg Psychiatry 2010; 81:685-9. [PMID: 20176602 DOI: 10.1136/jnnp.2009.174771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Intracranial dural arteriovenous fistulas constitute a rare though potentially devastating disease. Because the arterial (high-pressure) blood flow drains directly into the low-pressure venous system, there is a high risk of bleeding and associated neurological deficit. The classifications by Borden and Cognard underline the correlation between bleeding risk and venous drainage pattern of the fistula. There are different treatment options for this vascular pathology, which always poses a challenge for the physicians involved to offer the optimal treatment for an individual patient. This case report illustrates how combining forces between the neurosurgical and endovascular team benefits outcome. Simultaneously, this contributes to the growing amount of evidence that a new endovascular technique with transarterial ONYX embolisation enables complete obliteration of the vascular malformation.
Collapse
Affiliation(s)
- Giorgio G Hallaert
- Department of Neurosurgery-4K12 IE, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
| | | | | | | | | |
Collapse
|
43
|
Dhondt E, Vanlangenhove P, De Keukeleire K, Van Maele G, Defreyne L. Abstract No. 68: Covered versus non-covered biliary stents in percutaneous palliation of primary malignant biliary obstruction: Results of a prospective randomized trial. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
44
|
Boulanger T, Defreyne L, Fransen H, Wilms G. The topic of stent-assisted coiling (SAC) is very hot. Neuroradiology 2009; 51:577-8; author reply 579-580. [PMID: 19633835 DOI: 10.1007/s00234-009-0573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 07/13/2009] [Indexed: 11/29/2022]
|
45
|
Van De Wiele C, Defreyne L, Peeters M, Lambert B. Yttrium-90 labelled resin microspheres for treatment of primary and secondary malignant liver tumors. Q J Nucl Med Mol Imaging 2009; 53:317-324. [PMID: 19521311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Neither regional nor systemic chemotherapy significantly improve survival in the majority of patients presenting with liver metastases and their median survival is short. While the incidence of hepatocellular (HCC) is increasingly worldwide, the various treatment approaches that hve been developed to treat non-resectable HCC have had minimal or moderate impact on overall survival. SIR-Spheres (SIRS) are commercially available (90)Y-labelled resin microspheres that when selectively injected via the hepatic artery will become trapped in the tumor caplliary bed and will selectively deliver radiation to the tumor whilst sparing normal tissue. In this manuscript, the available literature on the use of SIRS in the clinic is summarized. First, available, predominantly phase I and II studies, on SIRS treatment performed in patients suffering from liver metastases as well as in patients suffering from multinodular asymptomatic unresectable HCC with a well preserved liver function have consistently reported a favourable safety profile for SIRS therapy; only a limited number of patients develop gastrointestinal ulceration or bleeding. Second, most of the studies also reported a high reponse rate to SIRS treatment resulting in increased life expectancy; median survival rates proved consistently higher when compared to historical controls. Finally, in two randomized controlled phase III trials, benefits were demonstrated for SIRS combined with chemotherapy when compared to the chemo-arm alone in patients suffering from colorectal liver metastasis. However, since these reports, novel, potentially more effective chemotherapeutics have been introduced for treating colorectal liver metastasis and the clinical value of (90)Y-Sirspheres when compared to these novel chemotherapeutics warrants confirmation and validation.
Collapse
Affiliation(s)
- C Van De Wiele
- Department of Nuclear Medicine, University Hospital Ghent, Ghent, Belgium.
| | | | | | | |
Collapse
|
46
|
Lambert B, Bacher K, Defreyne L. Rhenium-188 based radiopharmaceuticals for treatment of liver tumours. Q J Nucl Med Mol Imaging 2009; 53:305-310. [PMID: 19521309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Rhenium-188 (188Re) is a high energy beta-emitter with a physical half life of 17 hours. Various 188Re based radiopharmaceuticals were developed to treat liver malignancies. The vast majority of studies focus on patients suffering from hepatocellular carcinoma (HCC). Most radiopharmaceuticals are based on Lipiodol as a vehicle for the rhenium-188. The radiopharmaceutical that was tested clinically in detail is the 188Re-HDD/Lipiodol, developed by the Seoul University. Clinical data derived from several phase I and II studies using 188Re-HDD/Lipiodol suggest an excellent tolerance in patients with Child-Pugh A cirrhosis. A shortcoming in some trials was the occasional low labelling efficiency of 188Re-HDD/Lipiodol. Some newer 188Re based radiopharmaceuticals claim to have consistent high labelling efficiencies, however clinical data for these compounds are scarce or lacking at this moment. Hopefully, phase I clinical data will become available for promising radiopharmaceuticals such as 188Re-SSS-Lipiodol, developed by the group of Rennes, in the upcoming years. In Dresden a very different approach is used. They labelled human serum albumin microspheres with high activities of 188Re. In a small group of patients with liver metastasis and a few HCC patients, treatment proved safe. In the present clinical field, 188Re-based radiopharmaceuticals will have to proof firmly their strength and reliability in large patient groups if they want to compete with the commercially available yttrium-90 microspheres.
Collapse
Affiliation(s)
- B Lambert
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
| | | | | |
Collapse
|
47
|
Van Den Eynde M, Hendlisz A, Peeters M, Defreyne L, Maleux G, Vannoote J, Delatte P, Paesmans M, Van Laethem J, Flamen P. Prospective randomized study comparing hepatic intra-arterial injection of Yttrium-90 resin-microspheres (HAI-Y90) with protracted IV 5FU (5FU CI) versus 5FU CI alone for patients with liver-limited metastatic colorectal cancer (LMCRC) refractory to standard chemotherapy (CT). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4096 Background: Chemorefractory LMCRC has a poor prognosis. We hypothesized a significant improvement of the patient's outcome after internal radiotherapy of the hepatic metastases with HAI-Y90 given along with 5FU CI over 5FU CI alone. Methods: This prospective, multicentric, randomized trial compared arm A: 5FU CI (300 mg/m2 D1–14 q3weeks) with arm B: HAI-Y90 and 5FU CI (225 mg/m2 D1–14 followed by 300 mg/m2 D1–14 q3weeks) until disease progression. Eligibility criteria were: chemo-refractory (5FU, oxaliplatin, irinotecan) LMCRC, PS max 2, normal direct bilirubin, and no lung shunting. Primary endpoint was time to liver progression (TTLP). Secondary endpoints were time to progression (TTP), overall survival (OS) and safety. Cross-over (HAI-Y90 monotherapy) was permitted in arm A after disease progression. Analysis was by intention to treat. To detect an increase in median TTLP from 6 to 18 weeks, 35 local progressions were needed (alpha 5%, power 90%). Distribution of time to events variables was modelled through Cox regression (likelihood ratio tests). Results: Trial randomized 46 patients (pts) of whom 44 were eligible for analysis (23 in arm A and 21 in arm B). Pts’ characteristics in the 2 arms were well balanced. Local progression was documented in 41 pts. Median length of follow-up was 108 weeks. Results are summarized in the table . Treatment was well tolerated with few side effects reported, essentially grade 3 asthenia (5 pts; 22%) in arm A. Most pts (25/44) received further treatment after local progression, including 10 pts with cross-over to HAI-Y90 in arm A, which may explain to some degree the lack of difference in OS. Conclusions: HAI-Y90 with 5FU CI significantly improves TTLP and TTP over 5FU CI alone and is a valid salvage therapeutic option for chemo-refractory LMCRC. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- M. Van Den Eynde
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - A. Hendlisz
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - M. Peeters
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - L. Defreyne
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - G. Maleux
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - J. Vannoote
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - P. Delatte
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - M. Paesmans
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - J. Van Laethem
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| | - P. Flamen
- Institut Jules Bordet Université Libre de Bruxelles, Brussels, Belgium; Universitair Ziekenhuis Gent, Ghent, Belgium; University Hospitals Leuven, Leuven, Belgium; Institut Jules Bordet, Brussels, Belgium; Hopital Universitaire Erasme, Brussels, Belgium
| |
Collapse
|
48
|
Abstract
UNLABELLED Combined embolization and surgical excision as a safe treatment for a high flow superficial upper eyelid anteriovenous malformation. INTRODUCTION Orbital arteriovenous malformations (AVM) may cause significant morbidity including chronic pain and cosmetic disfigurement. These rare lesions require a multidisciplinary approach. A case of an orbital high-flow AVM treated subsequently by an mterventional radiologist and oculoplastic surgeon is presented. MATERIALS AND METHODS Clinical assessment, computed tomography and digital substruction angiography revealed a high-flow AVM. Transvenous and percutaneous embolization was followed by surgical excision. RESULTS A 1.5 cm, slowly growing, compressible pulsating lesion in the left upper eyelid of a 23 year old man was found. Eye motility and ophthalmologic examination were normal. Valsava manoeuvre didn't increase the size. Imaging revealed a high-flow AVM feeded by the arteria temporalis superficialis (itself feeded by the a. supraorbitalis and supratrochlearis). Draining vessels were the superior ophthalmic vein and a superficial lateral orbital vein. This malformation was first embolized. To prevent iatrogenic embolization of the sinus cavernous, the vein draining into the superior ophthalmic was occluded by a transvenous approach, followed by a percutaneous injection with diluted glue (equal amounts of glubran-2 and lipiodol). The remaining low-flow lesion was then safely excised. CONCLUSION High-flow orbital AVM represent a considerable treatment challenge. Good cosmetical and functional outcome was obtained safely by subsequent embolization and surgical excision. When treating these rare malformations it is of the highest importance to coordinate the interdisciplinary efforts.
Collapse
Affiliation(s)
- Christian Decock
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | |
Collapse
|
49
|
Defreyne L, De Schrijver I, Decruyenaere J, Van Maele G, Ceelen W, De Looze D, Vanlangenhove P. Therapeutic decision-making in endoscopically unmanageable nonvariceal upper gastrointestinal hemorrhage. Cardiovasc Intervent Radiol 2008; 31:897-905. [PMID: 18363055 DOI: 10.1007/s00270-008-9320-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Revised: 01/03/2008] [Accepted: 02/05/2008] [Indexed: 01/12/2023]
Abstract
The purpose of this study was to identify endoscopic and clinical parameters influencing the decision-making in salvage of endoscopically unmanageable, nonvariceal upper gastrointestinal hemorrhage (UGIH) and to report the outcome of selected therapy. We retrospectively retrieved all cases of surgery and arteriography for arrest of endoscopically unmanageable UGIH. Only patients with overt bleeding on endoscopy within the previous 24 h were included. Patients with preceding nonendoscopic hemostatic interventions, portal hypertension, malignancy, and transpapillar bleeding were excluded. Potential clinical and endoscopic predictors of allocation to either surgery or arteriography were tested using statistical models. Outcome and survival were regressed on the choice of rescue and clinical variables. Forty-six arteriographed and 51 operated patients met the inclusion criteria. Univariate analysis revealed a higher number of patients with a coagulation disorder in the catheterization group (41.4%, versus 20.4% in the laparotomy group; p = 0.044). With multivariate analysis, the identification of a bleeding peptic ulcer at endoscopy significantly steered decision-making toward surgical rescue (OR = 5.2; p = 0.021). Taking into account reinterventions, hemostasis was achieved in nearly 90% of cases in both groups. Overall therapy failure (no survivors), rebleeding within 3 days (OR = 3.7; p = 0.042), and corticosteroid use (OR = 5.2; p = 0.017) had a significant negative impact on survival. The odds of dying were not different for embolotherapy or surgery. In conclusion, decision-making was endoscopy-based, with bleeding peptic ulcer significantly directing the choice of rescue toward surgery. Unsuccessful hemostasis and corticosteroid use, but not the choice of rescue, negatively affected outcome.
Collapse
Affiliation(s)
- Luc Defreyne
- Department of Interventional Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | | | | | | | | | | | | |
Collapse
|
50
|
De Keukeleire K, Vanlangenhove P, Defreyne L. Evaluation of a neck-bridge device to assist endovascular treatment of wide-neck aneurysms of the anterior circulation. AJNR Am J Neuroradiol 2007; 29:73-8. [PMID: 17928379 DOI: 10.3174/ajnr.a0767] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms with a wide-neck or an unfavorable dome-to-neck ratio may be difficult to treat properly and safely. Our aim was to evaluate the TriSpan neck-bridge device to assist coiling of wide-neck bifurcation aneurysms in the anterior circulation. MATERIALS AND METHODS In 14 patients, we performed 16 TriSpan-assisted coil embolizations with wide-neck bifurcation aneurysms of the anterior circulation. Eleven procedures were indicated for acutely ruptured aneurysms. Five were performed electively for the following: recurrent aneurysm after coil only (n = 1) or after TriSpan-assisted embolization (n = 2), aneurysm remnant after clipping (n = 1), and aneurysm incidentally found (n = 1). Procedural and clinical complications were recorded. Follow-up angiography was performed, and clinical outcomes were assessed by using the modified Rankin Scale score. RESULTS TriSpan-assisted embolization was successful in 15/16 (93.8%) procedures, with complete occlusion in 2/16 (12.5%), near-complete occlusion in 10/16 (62.5%), and incomplete occlusion in 3/16 (18.75%). There were 6 (37.5%) intraprocedural complications: thrombus formation (n = 3), protrusion of a TriSpan loop in the parent artery (n = 1), TriSpan displacement in the aneurysm (n = 1), and tangling of a coil loop in the device (n = 1). Three patients died in the hospital (21.4%). Follow-up angiography or MR angiography was available in 8 (57.1%) patients and showed complete (n = 2), near-complete (n = 2), and incomplete occlusion (n = 4). Long-term clinical outcome was no (n = 4) or minor symptoms (n = 1) and moderate (n = 2), moderately severe (n = 2), or severe handicap (n = 2). CONCLUSION The use of the TriSpan device is feasible in the anterior circulation and can assist treatment of difficult wide-neck bifurcation aneurysms.
Collapse
Affiliation(s)
- K De Keukeleire
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium.
| | | | | |
Collapse
|