scholarly journals Irreversible electroporation (IRE) in renal cell carcinoma (RCC): a mid-term clinical experience

2021 ◽  
Author(s):  
Tze Min Wah ◽  
James Lenton ◽  
Jonathan Smith ◽  
Paul Bassett ◽  
Satinder Jagdev ◽  
...  
Keyword(s):  
Success Rate ◽  
Renal Cancer ◽  
Tumour Size ◽  
Irreversible Electroporation ◽  
Survival Rates ◽  
Renal Dialysis ◽  
Technical Success ◽  
Ct Guided ◽  
Technical Success Rate

Abstract Objectives To evaluate the safety and efficacy of CT-guided IRE of clinical T1a (cT1a) renal tumours close to vital structures and to assess factors that may influence the technical success and early oncological durability. Methods CT-guided IRE (2015–2020) was prospectively evaluated. Patients’ demographics, technical details/success, Clavien-Dindo (CD) classification of complications (I–V) and oncological outcome were collated. Statistical analysis was performed to determine variables associated with complications. The overall 2- and 3-year cancer-specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates are presented using the Kaplan-Meier curves. Results Thirty cT1a RCCs (biopsy-proven/known VHL disease) in 26 patients (age 32–81 years) were treated with IRE. The mean tumour size was 2.5 cm and the median follow-up was 37 months. The primary technical success rate was 73.3%, where 22 RCCs were completely IRE ablated. Seven residual diseases were successfully ablated with cryoablation, achieving an overall technical success rate of 97%. One patient did not have repeat treatment as he died from unexpected stroke at 4-month post-IRE. One patient had CD-III complication with a proximal ureteric injury. Five patients developed > 25% reduction of eGFR immediately post-IRE. All patients have preservation of renal function without the requirement for renal dialysis. The overall 2- and 3-year CS, LRF and MF survival rates are 89%, 96%, 91% and 87%. Conclusion CT-guided IRE in cT1a RCC is safe with acceptable complications. The primary technical success rate was suboptimal due to the early operator’s learning curve, and long-term follow-up is required to validate the IRE oncological durability. Key Points • Irreversible electroporation should only be considered when surgery or image-guided thermal ablation is not an option for small renal cancer. • This non-thermal technique is safe in the treatment of small renal cancer and the primary technical success rate was 73.3%. • This can be used when renal cancer is close to important structure.

scholarly journals Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jindong Li ◽  
Liangliang Bai ◽  
Xinwei Han ◽  
Jianzhuang Ren
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference

Abstract Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.

scholarly journals Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Hideki Kamada ◽  
Hideki Kobara ◽  
Naohito Uchida ◽  
Kiyohito Kato ◽  
Takayuki Fujimori ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
High Risk Patients ◽  
Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

scholarly journals The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

2020 ◽  
Vol 2020 ◽  
pp. 1-16 ◽  
Author(s):  
Aleksandra Pekacka
Keyword(s):  
Success Rate ◽  
Retention Rate ◽  
Intraarterial Chemotherapy ◽  
Treatment Modalities ◽  
Technical Success ◽  
Secondary Neoplasms ◽  
Systemic Complications ◽  
Technical Success Rate

Introduction. Retinoblastoma is the most common primary intraocular neoplasm in children. With the advances in medicine, the armamentarium of available treatment modalities has grown. Intraarterial chemotherapy is a relatively new treatment method with promising outcomes. The purpose of this literature review is to evaluate its role in the management of retinoblastoma. Methods. A systematic online search was conducted using Ovid Embase and Ovid Medline. The final results included 23 studies. The studies were published between 2011 and 2019. The studies evaluated the technical success rate of IAC, globe salvage rate, and ocular and systemic complications, as well as the occurrence of deaths, metastasis, and secondary neoplasms. In total, 1827 eyes with retinoblastoma were analysed. The follow-up was between 0 and 252 months. Results. Overall globe retention rate ranged from 30% to 100%. Sixteen out of 23 studies reported ocular salvage between 60 and 80%. Eyelid oedema and erythema were the most commonly reported ocular complications following IAC. The most common systemic complications included nausea, vomiting, and neutropenia. Metastases and deaths were reported in 6 out of 23 studies. Three studies reported the development of secondary neoplasms. The technical success rate of IAC procedure ranged from 91% to 100%. Discussion. The studies have shown that IAC is a safe and effective treatment for advanced retinoblastoma, especially group D. It allows to save the globe without compromising patients’ survival. Local and systemic complications are acceptable. The role of IAC in less advanced tumours is yet to be established. Future work should focus on conducting larger prospective studies with longer follow-up. Multiple novel therapies for the management of retinoblastoma are currently being tested, including angiogenic inhibitors and targeted agents. The results seem to be promising. Future advances require a further in-depth understanding of unique genetics of retinoblastoma and complex interactions between tumour cells and their microenvironment.

scholarly journals Long-term outcomes of tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas with tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jianzhuang Li ◽  
Liangliang Bai ◽  
Gang Wu ◽  
Xinwei Han ◽  
...  
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference ◽  
Routine Removal ◽  
Fluoroscopy Guidance

Abstract Background: No study compared the techniques and complications of stent removal under fluoroscopy guidance for tracheal fistula and tracheal stenosis.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Eighty-five patients underwent stent removal for tracheal fistula (TF group), and 67 patients for tracheal stenosis (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4% for tracheal fistula and tracheal stenosis, respectively. Except for the routine removal for half of patients, excessive granulation tissue was the common indications for stent removal, which was found 142.1±25.9 days later for tracheal fistula, and 89.9±15.0 day for tracheal stenosis. The total incidence of complications was 21.1% and 22.4% for tracheal fistula and tracheal stenosis, respectively. One perioperative death of asphyxia was found in TF group, and 2 deaths in TS group. Recurrence of fistula or stenosis requiring stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stent is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference. Recurrence of fistula or stenosis requiring stenting was the most comment complication.

Computed Tomography-Guided Transfissural Coil Localization of Lung Nodules

2019 ◽  
Vol 68 (06) ◽  
pp. 545-548 ◽  
Author(s):  
Feng-Fei Xia ◽  
Yi-Bing Shi ◽  
Tao Wang ◽  
Yu-Fei Fu
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Lung Nodules ◽  
Adenocarcinoma In Situ ◽  
Technical Success ◽  
Invasive Adenocarcinoma ◽  
Ct Guided ◽  
Technical Success Rate

Background The objective of this study was to evaluate the feasibility, safety, and clinical effectiveness of preoperative computed tomography (CT)-guided transfissural coil localization (TFCL) of subfissural lung nodules. Methods Five patients with lung nodules who underwent CT-guided TFCL before video-assisted thoracoscopic surgery between November 2015 and December 2018 were included. Technical success rates of TFCL and wedge resection were assessed, as well complications and pathological results. Results The technical success rate of TFCL was 100%. Two patients experienced parenchymal hemorrhage around the needle path, and two patients experienced asymptomatic pneumothorax after TFCL. The technical success rate of the wedge resection of lung nodules was also 100%. The pathological diagnoses of the five nodules were minimally invasive adenocarcinoma (n = 3), adenocarcinoma in situ (n = 1), and inflammatory nodule (n = 1). Conclusion CT-guided TFCL is a safe and effective method for the preoperative localization of subfissural lung nodules.

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia

2020 ◽  
pp. 026835552097348
Author(s):  
Chang-Ming Wang ◽  
Shi-Lu Zhao ◽  
Qi-Chen Feng ◽  
Shuo Gai ◽  
Xuan Li
Keyword(s):  
Cohort Study ◽  
Radiofrequency Ablation ◽  
Success Rate ◽  
Technical Success ◽  
Technical Success Rate ◽  
Sonographic Evaluation ◽  
Primary Endpoints ◽  
Secondary Endpoints ◽  
One Year

Objectives The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets. Methods Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed. Results The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively ( t= 29.644, P= .000). Conclusions In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.

scholarly journals Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise

2019 ◽  
Vol 25 (5) ◽  
pp. 484-490 ◽  
Author(s):  
Aysun Erbahceci Salik ◽  
Hatem H Selcuk ◽  
Hasanagha Zalov ◽  
Fatih Kilinc ◽  
Musa Cirak ◽  
...  
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
High Grade ◽  
Intracranial Artery ◽  
Technical Success ◽  
Medium Term ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Angioplasty And Stenting

Purpose The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70–99%) stenosis of a major intracranial artery with Enterprise stent. Methods This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70–99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. Results A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6–72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. Conclusion In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

scholarly journals Endovascular Stenting of Extracranial Carotid and Vertebral Artery Dissections: A Systematic Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 856-866 ◽  
Author(s):  
Martin H. Pham ◽  
Rudy J. Rahme ◽  
Omar Arnaout ◽  
Michael C. Hurley ◽  
Richard A. Bernstein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vertebral Artery ◽  
Success Rate ◽  
Artery Dissection ◽  
Endovascular Management ◽  
Review Of The Literature ◽  
Technical Success ◽  
Endovascular Stenting ◽  
Technical Success Rate

Abstract BACKGROUND: Carotid and vertebral artery dissections are a leading cause of stroke in young individuals. OBJECTIVE: To examine the published safety and efficacy of endovascular stenting for extracranial artery dissection. METHODS: We conducted a systematic review of the literature to identify all cases of endovascular management of extracranial carotid and vertebral artery dissections. RESULTS: For carotid dissections, our review yielded 31 published reports including 140 patients (153 vessels). Reported etiologies were traumatic (48%, n = 64), spontaneous (37%, n = 49), and iatrogenic (16%, n = 21). The technical success rate of stenting was 99%, and the procedural complication rate was 1.3%. Mean angiographic follow-up was 12.8 months (range, 2-72 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 10 patients (12 vessels). Etiologies were traumatic (60%, n = 6), spontaneous (20%, n = 2), and iatrogenic (20%, n = 2). There was a 100% technical success rate. The mean angiographic follow-up period was 7.5 months (range, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 months). CONCLUSION: Endovascular management of extracranial arterial dissection continues to evolve. Current experience shows that this treatment option is safe and technically feasible. Prospective randomized trials compared with medical management are needed to further elucidate the role of stenting.

Safety of Transcatheter Arterial Embolization for Visceral Artery Pseudoaneurysms: Incidence of Intraprocedural Rupture

2021 ◽  
Vol 55 (4) ◽  
pp. 361-366
Author(s):  
Masashi Shimohira ◽  
Keiichi Nagai ◽  
Kengo Ohta ◽  
Yusuke Sawada ◽  
Keita Nakayama ◽  
...  
Keyword(s):  
Success Rate ◽  
Transcatheter Arterial Embolization ◽  
Arterial Embolization ◽  
Major Complication ◽  
Visceral Artery ◽  
Technical Success ◽  
Advanced Level ◽  
Technical Success Rate ◽  
A Minor

Introduction: Transcatheter arterial embolization is the first-line treatment for visceral artery pseudoaneurysms (VAPAs); however, the intraprocedural rupture of pseudoaneurysms is an important complication. The present study was performed to evaluate the safety of embolization for VAPAs, including the incidence of intraprocedural rupture. Methods: Among 56 consecutive patients with 57 VAPAs who underwent treatment between April 2009 and October 2020, 46 patients with 47 VAPAs underwent embolization. Complications related to embolization including intraprocedural rupture, the technical success rate, and clinical outcomes were evaluated. Complications that required extended hospitalization, an advanced level of care, or resulted in permanent adverse sequelae or death were classified as major complications, while the remainder were considered to be minor. Technical success was defined as the completion of embolization. Results: The intraprocedural rupture of pseudoaneurysms occurred in 3 out of 47 VAPAs treated with embolization (6%) and resulted in minor complications. One liver abscess requiring drainage was regarded as a major complication (2%). Focal infarction after embolization was observed as a minor complication in 20 cases. Complications occurred in 24 out of 47 cases (51%), comprising one major complication (2%) and 23 minor complications (48%). The technical success rate was 100% (47/47). Fifty-three out of 56 patients (95%) were alive in a median follow-up period of 18 months (range: 2 days-137 months). Conclusions: Embolization is safe and useful for the treatment of VAPAs; however, the intraprocedural rupture of pseudoaneurysms may occur, and, thus, care is needed during this procedure.

Computed Tomography-Guided Trans-scapular Coil Localization for Pulmonary Nodules

2020 ◽  
Author(s):  
Jian-Hua Zhang ◽  
Shi-Qing Zhou ◽  
Feng-Fei Xia ◽  
Tao Wang
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Pulmonary Nodules ◽  
Technical Success ◽  
Ct Guided ◽  
Technical Success Rate ◽  
Preoperative Ct ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background The aim of the study is to evaluate the feasibility, safety, and effectiveness of preoperative computed tomography (CT)-guided trans-scapular coil localization (TSCL) of scapula-blocked pulmonary nodules (PNs). Methods Between November 2015 and May 2020, 11 patients underwent preoperative CT-guided TSCL procedures owing to PN occlusion by scapula. Results A 100% technical success rate was achieved for CT-guided TSCL, with one coil being used for each PN. One patient (9.1%) developed pneumothorax. Successful video-assisted thoracoscopic surgery (VATS)-guided wedge resection of these scapula-blocked PNs was conducted in all patients. Conclusion CT-guided TSCL can be simply and safely used to facilitate successful VATS-guided wedge resection of scapula-blocked PNs.

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