To evaluate clinical outcome and safety of procedural conscious sedation and analgesia (PCSA) performed by interventional radiologists (IRs) for patients undergoing percutaneous high-dose-rate brachytherapy (HDR-BT) of the liver. This large-scale, monocentric, retrospective study analyzed the safety-profile of PCSA using fentanyl and midazolam in patients undergoing HDR-BT for liver tumors. Medication was administered by trained IRs exclusively responsible for drug administration and cardiorespiratory monitoring. American Association of Anesthesiologists (ASA) status was recorded for all patients. Peri- and post-interventional complications directly or presumably related to PCSA, were assessed. Between 08/2017 and 12/2023, 1062 minimally invasive tumor ablations were performed in 686 patients with: 29.4% hepatocellular carcinoma, 28.7% metastasized colorectal cancer, 6.4% cholangiocarcinoma, metastases from lung cancer (6.1%), pancreatic cancer (4.1%), neuroendocrine tumors (5.1%) and 15.8% other metastases. PCSA-related complications were low (14/1062 procedures, 1.3%). Peri-interventional arrhythmias occurred during 4 procedures (0.4%). One patient (0.09%) experienced severe hypoxemia requiring brief cardiopulmonary resuscitation with return of spontaneous circulation, intubation and ICU-admission. Multivariable regression showed no significant correlations of PCSA-related complications with age, sex, BMI, ASA, chronic obstructive pulmonary disease (COPD), liver cirrhosis or medication doses but a significant correlation of obstructive sleep apnea syndrome (OSAS). No peri- or post-procedural deaths occurred. PCSA can safely be performed by adequately trained IRs with standardised protocols and support from anesthesiologists for emergencies or high-risk-patients. Careful patient selection, hemodynamic monitoring, structured PCSA documentation and immediate availability of anesthesiological support for severe AEs are essential to minimize risks. PCSA in OSAS should be managed by anesthesiologists.
To compare procedural efficiency, hemodynamic stability, analgesic outcomes, and adverse events between interventional radiologist-directed sedation and general anesthesia (GA) for primary percutaneous biliary drainage. This institutional review board-approved retrospective study included consecutive adults undergoing primary biliary drainage between 2021 and 2026. Procedure duration and turnover intervals were derived from procedural imaging timestamps. Pain scores and opioid utilization were recorded for one day before and after procedures. Sedation-related adverse events within 6 h and 30-day complications were assessed. Procedures were analyzed as independent events. Primary outcomes included procedure room turnover times and intraoperative hypotension. Eighty-seven procedures were performed in 75 patients (42 radiologist-directed; 45 GA). Thirty radiologist-directed cases included ketamine. Procedure duration was similar between groups (median 36.5 vs. 43.0 min; p = 0.218), but pre-procedure (median 66 vs. 110 min; p < 0.001) and post-procedure turnover (median 58 vs. 97.5 min; p < 0.001) were shorter for radiologist-directed sedation, representing a combined 84-min reduction. Intraoperative hypotension (nadir systolic blood pressure < 90 mm Hg) occurred in 5/42 (12%; 95% CI 2-22%) radiologist-directed cases versus 31/45 (69%; 95% CI 55-82%) GA cases (p < 0.001). There were no statistically significant differences in postoperative inpatient pain scores, opioid utilization, and 30-day complications and mortality. Findings were consistent in sensitivity analysis restricted to ketamine cases. In this retrospective single-center cohort, radiologist-directed sedation for primary biliary drainage was associated with shorter procedure room turnover and fewer episodes of intraoperative hypotension compared with GA.
To evaluate whether baseline anxiety-depressive symptom burden is associated with 3-month pain response after venous interventions in women with venous-origin chronic pelvic pain related to pelvic venous disorders (PeVD). This single-center observational cohort study was a retrospective analysis of prospectively collected institutional registry data. A total of 103 women with symptomatic PeVD and venous-origin chronic pelvic pain who underwent venous intervention were included. Pain was assessed using a 0-10 numerical rating scale for average pelvic pain, disease-specific quality of life using the Pelvic Varicose Veins Questionnaire (PVVQ), and anxiety-depressive symptoms using the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Outcomes were assessed at baseline and 3 months. Good pain response was defined as a ≥ 50% reduction in VAS score. Spearman correlation, multivariable linear regression, and Firth bias-reduced logistic regression were used. Baseline VAS, PVVQ, BDI, HADS-A, and HADS-D scores were 7.41 ± 0.90, 63.77 ± 11.76, 16.95 ± 8.70, 10.97 ± 3.15, and 8.94 ± 3.55, respectively. Clinically relevant anxiety symptoms (HADS-A ≥ 8), depressive symptoms (HADS-D ≥ 8), and BDI-defined depressive symptoms (BDI ≥ 14) were present in 80 (77.7%), 63 (61.2%), and 61 (59.2%) patients, respectively. At 3 months, VAS decreased to 2.46 ± 2.55, PVVQ to 33.47 ± 17.74, BDI to 8.60 ± 9.55, HADS-A to 4.87 ± 4.79, and HADS-D to 4.90 ± 4.74 (all P < 0.001). Good pain response occurred in 80 patients (77.7%). Baseline BDI correlated with VAS improvement percentage (ρ = - 0.792, 95% CI - 0.855 to - 0.707, P < 0.001). After adjustment for age and baseline VAS, each one-point increase in baseline BDI was associated with a 2.98-percentage-point lower VAS improvement (95% CI - 3.38 to - 2.57, P < 0.001) and higher odds of poor pain response (adjusted OR 1.94, 95% CI 1.21-3.13, P = 0.006). Venous intervention was associated with significant 3-month improvement in pain, disease-specific quality of life, and anxiety-depressive symptoms. Greater baseline depressive symptom burden was associated with less favorable short-term pain response. These findings are exploratory and require validation in multicenter studies with standardized PeVD phenotyping and longer follow-up.
The pathogenesis of Takotsubo syndrome (TTS) is poorly understood, but differences in outcome depending on the triggering factor imply differences in the pathophysiology. Beyond the established trigger-based InterTAK (International Takotsubo Registry) classification, the newly proposed distinction between primary and secondary TTS aims to differentiate emotionally primed heart dysfunction from TTS driven by direct myocardial injury. To explore these potential differences, we utilized cardiovascular magnetic resonance imaging to assess left ventricular function, myocardial edema, and myocardial injury across the InterTAK classification and between primary and secondary TTS. For this multicenter cohort study, 110 patients (95% women, age 66±12 years) from the InterTAK registry were included who received cardiovascular magnetic resonance 3 (interquartile range, 2-5) days after symptom onset. Cardiovascular magnetic resonance included assessment of myocardial function, edema (T2-weighted spin-echo and T2-mapping when available), and late gadolinium enhancement. No significant differences were observed in left ventricular volumes, function, or mass across the 3 InterTAK groups or between primary and secondary TTS. Patients with emotional triggers exhibited significantly larger myocardial edema (72% versus 60% for physical triggers; P<0.01), supported by higher T2-mapping values in a subset of 22 patients with T2-mapping. In multivariable regression, only emotional trigger (P<0.01) and the absence of coronary artery disease (P=0.04) were independently associated with the extent of myocardial edema. Secondary TTS showed a higher prevalence of focal or patchy late gadolinium enhancement (primary 19%, secondary 54%; P<0.01). In multivariable logistic regression, secondary TTS (P<0.01) and early cardiovascular magnetic resonance (P=0.02) were associated with the presence of any late gadolinium enhancement. TTS due to emotional stress is associated with larger myocardial edema, and secondary TTS exhibited late gadolinium enhancement more frequently, indicative of direct myocardial damage. These findings suggest that emotionally primed heart dysfunction and direct myocardial injury contribute to TTS pathophysiology to varying extents, influenced by both the triggering factor and preexisting conditions.
Long-term outcomes of paclitaxel-coated drug-coated balloons (DCBs) in patients with diabetes mellitus (DM) and infrainguinal peripheral arterial disease (PAD) are incompletely defined. In the current study, we evaluated 5-year outcomes in the diabetic cohort of BIOLUX P-III. BIOLUX P-III was a prospective, international, multicenter, post-market, single-arm study evaluating the Passeo-18 Lux DCB in routine practice. Between October 2014 and January 2017, 877 patients with infrainguinal lesions were treated at 47 centers, of whom 418 (47.7%) had DM. The primary clinical endpoint was 6-month freedom from major adverse events (MAEs), defined as freedom from procedure- or device-related death through 30 days, major target-limb amputation, or clinically driven target-lesion revascularization (CD-TLR). The primary performance endpoint was 12-month freedom from CD-TLR. Time-to-event outcomes were analyzed using Kaplan-Meier methods and the Log rank test. Among 877 treated patients, 418 had DM. Follow-up completion was 81.6%, 86.4%, 82.3%, and 31.3% at 6, 12, 24, and 60 months, respectively. At 5 years, freedom from MAE was lower in patients with DM than in those without DM (71.2% vs 74.7%; P = 0.0359), whereas freedom from CD-TLR was similar between groups (79.8% vs 79.6%; P = 0.535). Patients with DM also had lower overall survival (56.3% vs 73.8%; P < 0.0001), lower freedom from major target-limb amputation (92.4% vs 98.8%; P < 0.0001), and lower amputation-free survival (53.0% vs 73.6%; P < 0.0001). In this real-world registry, the Passeo-18 Lux DCB was associated with durable freedom from reintervention through 5 years, with similar CD-TLR rates in patients with and without DM. Patients with DM had poorer long-term survival and limb outcomes. However, these findings should be interpreted in the context of baseline between-group differences and limited 60-month follow-up (ClinicalTrials.gov number, NCT02276313). Peripheral arterial disease is a condition in which the blood vessels supplying the legs become narrowed or blocked. This can reduce blood flow, cause pain when walking, delay wound healing, and in severe cases increase the risk of amputation. People with diabetes are at especially high risk because they often have more severe artery disease and more other health problems that affect the heart, kidneys, and circulation. This study examined the long-term outcomes of a treatment called the Passeo-18 Lux drug-coated balloon in patients with leg artery disease. A drug-coated balloon is used during angioplasty to open narrowed arteries and deliver a medicine called paclitaxel to the artery wall to help reduce re-narrowing. We analyzed 877 patients treated in routine clinical practice, including 418 patients with diabetes, and followed outcomes for up to 5 years. We found that the need for repeat treatment of the same artery was similar in patients with and without diabetes. This suggests that the device performed well at the level of the treated artery over the long term. However, patients with diabetes had worse overall outcomes, including lower survival, higher rates of major amputation, and lower amputation-free survival. These findings suggest that, although the drug-coated balloon may provide durable treatment of the target lesion, long-term outcomes in patients with diabetes are also strongly influenced by the severity of their underlying disease and by other medical conditions. The results highlight the importance of not only restoring blood flow, but also providing ongoing wound care, diabetes management, cardiovascular risk reduction, and close multidisciplinary follow-up. The study has limitations. It was an observational registry rather than a randomized trial, the analyses were not adjusted for all baseline differences between groups, and follow-up was incomplete at 5 years. For these reasons, the findings should be interpreted with caution.
Hybrid operating rooms have been increasingly adopted in trauma centers to enable integrated surgical and endovascular care in hemorrhagic emergencies, but practical guidance on their operational implementation from the interventional radiology perspective remains limited. We describe our experience implementing a trauma hybrid operating room at an American College of Surgeons-verified Level I trauma center, addressing room design, zoning for rapid transitions between laparotomy and angioembolization, a mobile supply cart, and a pre-embolization checklist. We outline a training approach centered on radiation safety, sterility during procedural transitions, and simulation-based interdisciplinary coordination and discuss key implementation challenges, local activation criteria, and strategies to ensure timely access. This report focuses on operational design; institutional process metrics and clinical outcomes were not included. However, these operational lessons may be relevant to other centers seeking to develop or refine trauma hybrid operating room programs.
Enlarged perivascular spaces (EPVSs) in the basal ganglia (BG-EPVS) are an important marker of cerebral small vessel disease (cSVD), and EPVS in the centrum semiovale (CSO-EPVS) are part of the diagnostic criteria for cerebral amyloid angiopathy. We aimed to investigate associations of EPVS with reduced estimated glomerular filtration rate (eGFR) and glomerular hyperfiltration (higher than normal eGFR), which have scarcely been studied previously. In this cross-sectional study, we used pooled individual patient data from the Microbleeds International Collaborative Network which includes patients with ischemic stroke or transient ischemic attack. We investigated associations of impaired kidney function, defined as an eGFR of 30-60 or <30 mL/minute/1.73 m2, and glomerular hyperfiltration, defined as eGFR above the age-adjusted and sex-adjusted 95th centile, with BG-EPVS and CSO-EPVS severity. EPVS were rated according to a validated 5-point ordinal scale, and combined cSVD burden was rated using a validated 5-point ordinal scale with 1 point assigned for the presence of each of the following: severe white matter hyperintensities, ≥1 cerebral microbleed, ≥1 lacune, and BG-EPVS ≥11. Normal glomerular filtration was defined as eGFR ≥60 without hyperfiltration. We used multivariable ordinal logistic regression models to estimate risk of increased EPVS and cSVD burden severity adjusted for age, sex, and comorbidities. Seven thousand two hundred fifty-four patients (mean age 71 ± 13 years, 43% female) were included in the analysis, 357 with glomerular hyperfiltration, 1,692 with eGFR 30-60, and 256 with eGFR <30. Compared with normal glomerular filtration, hyperfiltration was independently associated with BG-EPVS (adjusted odds ratio [aOR] 1.38, 95% CI 1.11-1.70, p < 0.001) and CSO-EPVS (aOR 1.34, 95% CI 1.08-1.64, p = 0.011). Associations of eGFR 30-60 and eGFR <30 with EPVS were not statistically significant. Compared with normal glomerular filtration, eGFR <30 (aOR 1.27, 95% CI 1.03-1.57) was independently associated with increased cSVD burden, but eGFR 30-60 (aOR 1.06, 95% CI 0.95-1.20) and hyperfiltration (aOR 1.15, 95% CI 0.98-1.34) were not. Glomerular hyperfiltration was independently associated with EPVS severity, in both the basal ganglia and centrum semiovale. eGFR <30 was independently associated with total cSVD burden. A key limitation was a lack of repeated eGFR measurements.
To evaluate efficacy, safety, particle density, and dosimetry of high-specific-activity (HSA) resin-based (RB) Yttrium-90 radiation segmentectomy (Y90-RS) for hepatocellular carcinoma (HCC). All 4- and 5-day pre-calibration (DPC) Y90-RS performed on patients with HCC were retrospectively analyzed at a single-center between July 2023 and May 2025. Tumor response and adverse events (AE) were assessed using mRECIST and CTCAE v5 at 3, 6, and 12-months. Voxel-based dosimetry analysis on post-Y90 SPECT/CT was performed to create tumor dose (TD) volume histograms and particle density (PD) assessment. Receiver Operating Characteristic (ROC) curves were used to evaluate the dose thresholds able to predict a tumor complete response (CR) in relation to TD and PD. Variable differences were assessed with a Mann-Whitney U Test and the Chi-Square tests. Sixty patients (63 tumors) underwent HSA RB Y90-RS (62% 4-DPC). The cohort was 62% male, median age 66 years (IQR, 62-71), with 95% solitary HCC. At 3 months, tumor control was 100% and CR was 79%. Treatment was well tolerated, with only two patients developing grade 3 AEs. The median delivered mean TD was 423 Gy (IQR 316-712), with the CR cohort showing higher mean TD than the incomplete response cohort (546 Gy vs. 299 Gy; p = 0.0003). Tumor PD and Mean TD thresholds predicting 3-month CR were 45,494 microspheres/mL (AUC = 0.80) and 416 Gy (AUC = 0.83), respectively. D95 TD of > 245 Gy was associated with CR (AUC = 0.81). Curative intent ablative Y90-RS of HCC with HSA RB microspheres is efficacious and well tolerated. Mean TD threshold of ≥ 416 Gy and tumor-PD of ≥ 45,494 microspheres/mL were associated with 3-month tumor CR.
Minimal ablative margins (MAM) are critical for local tumour control after microwave ablation, yet their assessment remains subjective. We evaluated whether software improves the precision of ablation margin assessment after liver MWA. In this retrospective study, patients undergoing CT-guided liver MWA between January 2019 and January 2025 were included. Two radiologists (with 4 and 5 years of experience in abdominal imaging) assessed MAM in two steps: first by side-by-side visual comparison of pre- and post-ablation CT using anatomical landmarks, then with dedicated software providing semi-automatic 3D co-registration and margin quantification. Each method included two reading sessions per reader, six weeks apart. Precision was assessed using intraclass correlation coefficients (ICC), Cohen's kappa (κ) for categorical classification (< 5, 5-10, > 10 mm), and Bland-Altman analysis. Sixty-seven patients with 87 liver tumours were included. Visual assessment showed poor reliability, with low intrareader agreement (ICC 0.10 and 0.33) and near-random interreader agreement (κ =  - 0.10; ICC - 0.05), with limits of agreement approaching 17 mm. Software-assisted assessment improved reliability, with higher intrareader ICCs (0.54 and 0.83) and improved interreader agreement (κ = 0.38; ICC = 0.54). Interreader bias decreased from - 2.84 to + 0.91 mm, and limits of agreement narrowed to - 4.10 to + 5.92 mm (p < 0.001). The median absolute interreader difference decreased from 3.0 to 1.0 mm (p < 0.001). Software-assisted assessment improves reliability of MAM evaluation compared with visual methods, but interreader agreement remains only fair-to-moderate; further validation is required before routine clinical adoption.
To provide a systematic review and meta-analysis of studies comparing intravascular ultrasound (IVUS)-guided versus angiography-guided peripheral vascular interventions (PVI) for peripheral arterial disease (PAD). We performed a systematic review and meta-analysis, following PRISMA guidelines, of studies comparing IVUS-guided versus angiography-guided PVI for peripheral arterial disease (PAD). The study was registered in PROSPERO (CRD42024564731). Relevant databases were searched until Dec 2025. Eligible studies reported at least one of the following outcomes: amputation, all-cause mortality, target lesion revascularisation (TLR), restenosis/occlusion, major adverse limb events (MALE), or technical success. Random-effects models with inverse-variance weighting were used to generate pooled effect estimates. Twenty-five studies (23 observational, 2 randomised) including 1,110,593 patients (93,977 IVUS; 1,016,616 angiography) met inclusion criteria. Compared with angiography, IVUS guidance was associated with reduced rates of amputation (RR = 0.75, 95% CI for RR 0.61-0.93), all-cause mortality (RR = 0.86, 95% CI for RR 0.79-0.93), TLR (RR = 0.66, 95% CI for RR 0.48-0.91) and restenosis (RR = 0.74, 95% CI for RR 0.60-0.90). A numerically lower rate of major adverse limb events (MALE) was observed with IVUS guidance, although confidence intervals crossed the null effect (RR 0.66, 95% CI for RR 0.40-1.10). Technical success rates were similar between groups (RR 1.01, 95% CI for RR 1.00-1.01). IVUS-guided PVI was associated with lower rates of amputation, TLR, restenosis, and all-cause mortality compared with angiography alone. However, the available evidence is predominantly observational with low-to-moderate certainty. These findings suggest potential benefit of IVUS-guided intervention in PAD, although further randomised controlled trials are needed.
Purpose To evaluate the preliminary technical development, safety, and feasibility of dynamic contrast-enhanced MR lymphangiography (DCE-MRL) performed with nodal and/or dermal injection of gadopiclenol. Materials and Methods This institutional review board-approved retrospective study included consecutive patients referred to the complex lymphatic disorders clinic who underwent DCE-MRL at 1.5 T with gadopiclenol administered via inguinal nodal and/or interstitial transpedal injection. Technical performance, safety, and feasibility for imaging peripheral and central conducting lymphatic anatomy, flow, and drainage were assessed. Results A total of 23 patients (12 female) underwent DCE-MRL with gadopiclenol. Contrast material was administered via inguinal lymph nodes in all patients (23 of 23, 100%) and via interstitial transpedal injection in one patient (one of 23, 4.3%). No serious or nonserious adverse events were observed (0 of 23). Evaluation of central conducting lymphatic anatomy, flow, and drainage into the central venous system was feasible in all patients (23 of 23), and evaluation of lower extremity superficial lymphatic anatomy was feasible in one patient. Signal contrast increased with flip angle up to approximately 35° at 1.5 T, supporting protocol optimization. Preliminary results suggest a near-optimal flip angle of 35° at 1.5 T, a higher flip angle than when using other gadolinium-based contrast agents. Conclusion Dynamic gadopiclenol-enhanced nodal and pedal MR lymphangiography was safe and feasible for imaging peripheral and central conducting lymphatic anatomy. Keywords: Lymphangiography, MR-Angiography, Lymphatic, MR-Dynamic Contrast Enhanced, MR-Contrast Agent Supplemental material is available for this article. © RSNA, 2026.
Persistent cardiac symptoms are common in post-COVID syndrome, even without structural heart disease. Evidence implicates immune dysregulation, endothelial dysfunction and low-grade cardiovascular inflammation. Yet no targeted treatment exists. Myoflame-19 is a multicenter, double-blind clinical trial of 279 participants with inflammatory cardiac involvement defined by cardiovascular magnetic resonance, randomized 1:1 to losartan plus prednisolone (n = 139) or matching placebos (n = 140) for 16 weeks. The modified intention-to-treat population comprised 124 and 122 participants. The primary endpoint, change in left ventricular (LV) ejection fraction, was neutral: between-group difference 0.74 percentage points (pp), 95%CI -0.14 to 1.62, p = 0.10, unpaired t-test; supportive baseline-adjusted ANCOVA 0.99, 95%CI 0.15-1.83, p = 0.021. Among prespecified secondary endpoints, several symptom and imaging measures showed numerical differences favoring intervention, including Average Symptom Score components (modified Canadian Chest Pain Scale -4.8 pp, 95%CI -17.3 to 7.6; NYHA class -8.1 pp, -20.6 to 4.3; Long COVID symptom burden -7.7 pp, -18.9 to 3.6), native T1 and T2 values (native T1 -2.46 ms, -8.35 to 3.42; native T2 -0.31 ms, -1.16 to 0.53), and LV end-diastolic volume ( + 1.45 ml/m², -0.09 to 3.00); however, confidence intervals included the null value and these findings should be regarded as hypothesis-generating.Treatment was safe and well-tolerated. These findings indicate a neutral treatment effect on the primary endpoint. They inform targeted immunomodulation and design of future trials in post-COVID syndrome and inflammatory cardiac involvement. Trial registration: EudraCT 2022-001682-12; NCT05619653.
To develop expert-consensus recommendations for patient selection, technique and clinical management in genicular artery embolization (GAE) using a Delphi process. A working group developed a 75-statement questionnaire. A panel of musculoskeletal and interventional radiologists (IRs), selected based on clinical experience, scientific expertise and geographic diversity, scored each response using a 10-point Likert-scale across three rounds. Consensus was predefined as ≥ 75% of ratings ≥ 7/10. Twenty-nine IRs completed all three rounds. Consensus inclusion criteria for GAE include knee pain refractory to conservative treatment for ≥ 3 months due to osteoarthritis, tendinopathies or prior knee surgery and recurrent hemarthrosis (median 9[IQR 7-10]; 86% ≥ 7). Pre-procedural assessment should include standardized outcome measures, clinical examination and knee radiographs. Contrast-enhanced MRI is optional for osteoarthritis phenotyping and grading of synovitis, differential diagnosis and outcome prediction (8[7-10]; 79% ≥ 7). Via an ipsilateral antegrade transfemoral access, all visible genicular arteries should be catheterized and embolized upon detection of a hypervascular blush (9[7-10]; 76% ≥ 7). No evidence of superiority of either temporary or permanent embolic agents in terms of safety or efficacy has been demonstrated (10[8-10]; 86% ≥ 7). Structured long-term follow-up is recommended, with clinical success defined as achievement of the minimal clinically important difference or individual patient satisfaction (9[7-10]; 83% ≥ 7). Contralateral or repeat GAE may be considered for bilateral knee pain, insufficient response or pain recurrence (8[7-10]; 76% ≥ 7). This Delphi study establishes expert-derived consensus recommendations for GAE, emphasizing broad indications, patient-tailored technique and an active role of the IR in multidisciplinary longitudinal care.
To compare the efficacy and safety of optical navigation robot-assisted versus conventional CT-guided preoperative localization of pulmonary nodules and to identify predictors of procedure-related pneumothorax and pulmonary hemorrhage. In this retrospective study, 108 patients scheduled for video-assisted thoracoscopic surgery underwent preoperative CT-guided hook-wire localization, either with optical navigation robot assistance (navigation group, n = 53) or conventionally (conventional group, n = 55). Procedural metrics (first-attempt success rate, wire-to-nodule distance, number of CT scans, radiation dose) and complications were compared. Multivariable logistic regression was performed to identify independent factors associated with pneumothorax and pulmonary hemorrhage. The navigation group demonstrated a higher first-attempt success rate (94.34% vs. 80%; P = .03) and a shorter wire-to-nodule distance (4.09 mm vs. 6.40 mm; P = .03) with fewer CT scans required (3.05 vs. 3.20; P = .03), despite a higher radiation dose (172.37 vs. 124.64 mGy·cm; P < .01). Pneumothorax (39.62% vs. 52.73%; P = .17) and pulmonary hemorrhage (24.53% vs. 21.82%; P = .73) rates did not differ significantly. Multivariable analysis identified greater needle depth in the lung (OR: 0.87), greater chest wall thickness traversed (OR: 0.94) and first-attempt success (OR: 0.13) as protective factors against pneumothorax, while needle proximity to a rib (OR: 9.96) was a risk factor. Traversal of pulmonary vessels was the sole risk factor for pulmonary hemorrhage (OR: 11.93). Optical navigation robot-assisted localization improves the precision of preoperative pulmonary nodule marking. The identified predictors of complications-needle proximity to a rib and traversal of pulmonary vessels-constitute actionable targets for procedural optimization. Level 3, Non-controlled retrospective cohort study.
This systematic review and meta-analysis compares the safety and efficacy of atherectomy as a vessel preparation tool prior to balloon angioplasty (ATH + BA) versus balloon angioplasty alone (BA) for the treatment of peripheral arterial disease (PAD). Medline, Embase, CENTRAL, and Clinicaltrials.gov databases were searched for randomized controlled trials (RCTs) comparing ATH + BA versus BA alone in treating PAD. The outcomes analysed included primary patency, technical success, bailout stenting, flow-limiting dissection, clinically driven target lesion revascularization (CD-TLR), distal embolization, arterial perforation, major amputation, and all-cause mortality. A subgroup analysis was done to compare femoropopliteal versus infrapopliteal and plain balloon angioplasty versus drug-coated balloon. Seven RCTs met the inclusion criteria (489 patients). Atherectomy as vessel preparation was associated with reduced rates of bailout stenting (OR: 0.14, 95% CI 0.03-0.67, p = 0.01) and flow-limiting dissection (OR: 0.29, 95% CI 0.10-0.84, p = 0.02). Primary patency (OR: 2.13, 95% CI 1.00-4.50, p = 0.049) and CD-TLR at 6 months (OR: 0.24, 95% CI 0.06-0.96, p = 0.04) results favoured ATH + BA. No significant differences were found in technical success, 12-month primary patency, CD-TLR at 12 months, distal embolization, arterial perforation, major amputation, or all-cause mortality. Subgroup analysis demonstrated a reduction in bailout stenting in femoropopliteal studies (OR: 0.05, 95% CI 0.01-0.21) compared with infrapopliteal studies (OR: 0.86, 95% CI 0.31-2.40). This meta-analysis found that atherectomy as vessel preparation prior to BA reduced bailout stenting, flow-limiting dissections, and 6-month CD-TLR, with improved 6-month patency compared with BA alone. However, these benefits did not translate into improvements in clinical outcomes at 12 months. Larger RCTs are needed to establish the clinical benefit of atherectomy.
To compare the efficacy and safety of predilation-free angioplasty with a scoring paclitaxel-coated balloon catheter versus conventional plain balloon angioplasty for failing arteriovenous access. This prospective multicenter randomized controlled trial enrolled adults with malfunctioning mature arteriovenous fistulas or grafts at nine centers in China between August 21, 2019, and January 4, 2021. Participants were randomly assigned in a 1:1 ratio to predilation-free scoring paclitaxel-coated balloon angioplasty or conventional plain balloon angioplasty. The primary endpoint was 6-month target lesion primary patency. Secondary endpoints included device success, procedural success, clinical success, residual stenosis, 12-month target lesion primary patency, and safety. A total of 219 treated participants were analyzed, including 109 in the scoring paclitaxel-coated balloon group and 110 in the control group. Six-month target lesion primary patency was 78.9% versus 57.3% (center-adjusted absolute difference, 21.2 percentage points; 95% CI 8.1-37.1 percentage points; P = 0.004). Twelve-month target lesion primary patency was 63.5% (66/104) versus 52.4% (55/105) (absolute difference, 11.1 percentage points; 95% CI - 2.2 to 24.4 percentage points; P = 0.1043). Device success, procedural success, clinical success, mortality, adverse events, and serious adverse events did not differ between groups. Acute gain was greater, and residual stenosis was lower with the scoring paclitaxel-coated balloon. Predilation-free angioplasty with a scoring paclitaxel-coated balloon improved a 6-month target lesion primary patency without increasing adverse events in patients with failing arteriovenous access. Level 1, randomized controlled trial.
Endovascular management of descending thoracic aortic disease (aneurysm, acute aortic syndrome and traumatic injury) is an effective, minimally invasive treatment that over the last 20 years has superseded surgical repair and become the standard of care. This CIRSE Standards of Practice document recommends best evidence-based practices for the endovascular management of descending thoracic aortic disease. This includes diagnostic imaging, surveillance, indications for intervention, endovascular treatments, their outcomes, and follow-up. The writing group, established by the CIRSE Standards of Practice Committee, reviewed the literature, and the final recommendations were formulated through consensus. Endovascular treatment has an established role in the successful management of thoracic aortic disease, and this Standards of Practice document provides up-to-date recommendations for its safe performance.
To identify predictors of 30-day mortality and derive a bedside risk score in patients with computed tomography (CT)-proven active bleeding and negative emergency angiography. We retrospectively included consecutive adults with CT-detected active bleeding and negative emergency angiography in a single-center cohort (2012-2026). Univariate analyses (Fisher exact, Mann-Whitney U) were followed by multivariable logistic regression, with a LASSO-penalized model (fivefold cross-validation) performed as sensitivity analysis. A simplified score, Negative Angiography Bleeding-Lethality (NAB-L), was derived from regression coefficients. Discrimination was assessed by area under the receiver operating characteristic curve (AUC) with bootstrap internal validation, calibration by the Hosmer-Lemeshow test, and survival by Kaplan-Meier methods with log-rank comparison. A total of 118 patients were included (median age 67.5 years [IQR 51-78]; 55% male). Thirty-day mortality was 14.4% (17/118) and rebleeding occurred in 33.9% (40/118). Hemoglobin nadir < 8 g/dL (adjusted odds ratio (aOR) 11.44; 95% confidence intervals (CI) 1.45-90.35), arterial lactate > 2 mmol/L (aOR 5.69; 1.27-25.42), and age > 70 years (aOR 3.63; 1.01-13.02) were independently associated with mortality. The NAB-L score (0-5) showed good discrimination (AUC 0.854; 95% CI 0.760-0.941; optimism-corrected 0.816) and adequate calibration (Hosmer-Lemeshow p = 0.946). Mortality rose from 0% (score 0-1) to 56% (score 5). Rebleeding was more frequent in high-risk patients (52% vs. 17%, p = 0.036). CT-positive/angiography-negative bleeding carries substantial early mortality and rebleeding risk. The NAB-L score enables simple early bedside risk stratification but should be considered hypothesis-generating pending external validation.
Artificial intelligence is an increasingly valuable tool in ischemic stroke management. This systematic review and meta-analysis evaluated the effect of artificial intelligence implementation on stroke workflow metrics. PubMed, EMBASE, OpenEvidence, and the Cochrane Central Register of Controlled Trials were searched for studies (2015-2025) evaluating automated large vessel occlusion detection. Pooled mean differences with 95% CIs were calculated for door-to-groin puncture, door-to-first pass, door-to-revascularization, door-to-needle, and door-in-door-out times. Twelve studies met the inclusion criteria: one clinical trial and eleven observational studies. Artificial intelligence was associated with reductions in multiple workflow intervals, including door-to-groin puncture (-17.12 minutes), door-to-first pass (-26.55 minutes), door-to-revascularizationon (-14.55 minutes), door-to-needle (-4.44 minutes), and door-in-door-out time (-36.8 minutes). Overall, AI-based platforms appear to contribute meaningfully to stroke workflow optimization, although randomized controlled trials are still needed to confirm their effectiveness. Level 2c, Systematic review of randomized clinical trials, and observational studies.
To evaluate technical success, diagnostic yield, and complication rates of image-guided percutaneous splenic biopsies based on multicenter registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy. This retrospective multicenter study analyzed image-guided percutaneous splenic biopsies documented in the prospective DeGIR registry between 2018 and 2024. Technical success was defined as needle placement within the target lesion. Diagnostic yield was defined as histologically adequate samples enabling clinical diagnosis. Four hundred splenic biopsies from 92 centers were included. Technical success was achieved in 99.00% of procedures. The complication rate was 5.00%, including 2.50% major complications with no procedure-related deaths. Complication rates were higher for procedures performed under local anesthesia than analgesic sedation (p = 0.042). Histopathological reports were available for 338 procedures, resulting in a diagnostic yield of 90.83%. Diagnostic yield increased with the number of biopsy samples, reaching a maximum with three samples. Procedures performed under analgesic sedation showed a higher diagnostic yield than those under local anesthesia (p = 0.019). Image-guided percutaneous splenic biopsy is a safe and effective diagnostic procedure with high technical success and diagnostic yield. Analgesic sedation and obtaining up to three biopsy samples may improve diagnostic performance without increasing complication rates.