Combination Of Embolization Research Articles

Stereotactic radiosurgery alone or combined with embolization for brain arteriovenous malformations: a systematic review and meta-analysis.

OBJECTIVE Embolization of brain arteriovenous malformations (AVMs) prior to stereotactic radiosurgery (SRS) has been reported to negatively affect obliteration rates. The goal of this systematic review and meta-analysis was to compare the outcomes of AVMs treated with embolization plus SRS (E+SRS group) and those of AVMs treated with SRS alone (SRS group). METHODS A literature review was performed using PubMed to identify studies with 10 or more AVM patients and obliteration data for both E+SRS and SRS groups. A meta-analysis was performed to compare obliteration rates between the E+SRS and SRS groups. RESULTS Twelve articles comprising 1716 patients were eligible for analysis. Among the patients with radiological follow-up data, complete obliteration was achieved in 48.4% of patients (330/681) in the E+SRS group compared with 62.7% of patients (613/978) in the SRS group. A meta-analysis of the pooled data revealed that the obliteration rate was significantly lower in the E+SRS group (OR 0.51, 95% CI 0.41-0.64, p < 0.00001). Symptomatic adverse radiation effects were observed in 6.6% (27/412 patients) and 11.1% (48/433 patients) of the E+SRS and SRS groups, respectively. The annual post-SRS hemorrhage rate was 2.0%-6.5% and 0%-2.0% for the E+SRS and SRS groups, respectively. The rates of permanent morbidity were 0%-6.7% and 0%-13.5% for the E+SRS and SRS groups, respectively. CONCLUSIONS Arteriovenous malformation treatment with combined embolization and SRS is associated with lower obliteration rates than those with SRS treatment alone. However, this comparison does not fully account for differences in the initial AVM characteristics in the E+SRS group as compared with those in the SRS group. Further studies are warranted to address these limitations.

Prone Transradial Catheterization for Combined Single-Session Transarterial Embolization and Percutaneous Posterior Approach Cryoablation of Solid Neoplasms.

Transradial access (TRA) has been associated with improved post-procedure hemostasis and patient satisfaction, and decreased hemorrhagic complications, sedation requirements, recovery times, and procedure-related costs when compared with traditional transfemoral catheterization. Supine TRA has been described for the treatment of myocardial infarctions, aortoiliac and femoropopliteal stenoses, and a variety of neoplasms. This original research describes prone transradial catheterization to facilitate combined single-session transarterial embolization and percutaneous cryoablation of solid neoplasms from a posterior approach without repositioning. Prone TRA access, transarterial embolization, and percutaneous cryoablation were successful in all cases described. Mean procedure time was 210min (range: 140-250min). One minor complication, transient bacteremia which responded to antibiotics, was reported. No major complications occurred.

Pipeline embolization device for the treatment of intracranial aneurysms: a preliminary experience

Objective To investigate the clinical application value and technical characteristics of pipeline embolization device(PED)for the treatment of intracranial aneurysms. Methods From December 2014 to December 2015, the clinical data of 20 patients with intracranial aneurysm treated with PED at the Department of Neurosurgeries, Shanghai Punan Hospital of Pudong New District and Donglei Brain Surgeon Group were analyzed retrospectively. Fifteen patients had one aneurysm and 5 had multiple aneurysms. The diameters of 28 aneurysms were 2-33 mm(15.2±9.9 mm). The aneurysm necks of all patients were covered with 1 PED, and 8 of them were treated with the combined aneurysm coil embolization. Results The release of PEDs in all 20 patients was completed successfully. The coverage of aneurysm necks was satisfactory. PEDs were found well adhering to the wall. Immediately after surgery, it showed that contrast agents in aneurysm cavities were obviously detained. Three patients had complications of cerebral hemorrhage after procedure, including 1 died and 1 had hemiparesis at discharge. Eight patients were followed up by digital subtraction angiography(DSA)6 months later, 6 were cured completely, the aneurysm of 1 case was nearly completely occluded, and the size of a large aneurysm did not have obvious change. Two patients had asymptomatic anterior cerebral artery stenosis. The head MRI follow-up revealed that the mass effect of the large and giant intracranial aneurysms were significantly relieved or disappeared. The remaining 11 cases had to be followed up. Conclusions The efficacy of PED for the treatment of large and giant intracranial aneurysms, tandem multiple small aneurysms and intracranial blood blister-like aneurysms is satisfactory. This device has just begun to be applied in clinical practice in China. The complications and long-term efficacy of the large sample case analysis and research are needed. Key words: Intracranial aneurysm; Embolization, therapeutic; Pipeline embolization device

Endovascular Repair of Concomitant Celiac and Splenic Artery Aneurysms Using a Combination of Coil Embolization and Aortic Cuff Stent Graft

Visceral artery aneurysms comprise a small portion of all peripheral vascular aneurysms. Of these, the splenic artery is most commonly affected, while celiac artery involvement is rare. Repair is recommended for symptomatic aneurysms or those exceeding two centimeters in diameter. Most reported repairs for celiac artery aneurysms involve surgical excision with or without bypass grafting, but endovascular treatments are becoming more common. We present a case of a 75 year-old male with proximal celiac and distal splenic artery aneurysms treated with combined percutaneous coil embolization and aortic cuff stent graft placement. The splenic aneurysm sac and proximal splenic artery were coil embolized. Attempts to place a covered stent across the celiac artery aneurysm were unsuccessful from both femoral and brachial approaches. We then coil embolized the celiac artery distal to the aneurysm but proximal to the gastroduodenal branch. Coils were also placed into the celiac artery aneurysm sac and left gastric artery. There was insufficient neck length to place coils into the proximal celiac artery. Consequently, an aortic cuff stent graft was deployed across celiac artery origin to obliterate the inflow. There was no liver dysfunction afterwards due to retrograde flow through a patent gastroduodenal artery.

Endovascular closure of thoracic aortic pseudoaneurysms: A combined device occlusion and coil embolization technique in patients unsuitable for surgery or stenting.

Our aim was to retrospectively evaluate non-stent graft closure of ascending aortic pseudoaneurysms at our center over a 10-year period, and describe a combined device occlusion and coil embolization technique. Aortic pseudoaneurysms (APAs) are a rare complication post cardiothoracic surgery, but can have fatal complications. There is increasing use of percutaneous interventional techniques for occlusion of aortic pseudoaneurysms in patients who are considered unsuitable for surgery. Stent graft deployment may not be possible depending on the specific anatomy and pathology. Retrospective evaluation of the catheter laboratory database was performed at our center and anonymized data was obtained for patients who had nonstent endovascular treatment of APAs. Twelve patients were identified with a mean age of 63 ± 16 years. Seven patients had the combined occlusion and embolization technique, only 1/7 (14.3%) died from complications related to APAs. Five patients had occlusion device only, 3/5 (60%) died of complications related to their APA. The mean survival for the patients who had a combination procedure was 33.2±.22.6 months (range, 1 - 60 months), compared to 2.7 ± 2.6 months with device closure only (note 2 patients had short follow up of <3 months). We evaluate non-stent graft percutaneous closure of APAs in a high-risk patient group and provide data on the use of a novel combined occlusion device and coil embolization technique. We feel this is a viable approach to APA closure in this population but this will require larger clinical studies in the future. © 2016 Wiley Periodicals, Inc.

Treatment methods of residue or recurrence after intracranial aneurysm embolization

Objective To explore how to effectively manage the residual or recurrent intracranial aneurysms after embolization. Methods The treatment methods and clinical efficacy of 36 patients with residual or recurrent intracranial aneurysm after procedure at the Department of Neurosurgery, Tianjin Huanhu Hospital from June 2010 to June 2014 were analyze retrospectively. Among 36 patients, 12 underwent endovascular embolization, 15 underwent surgical clipping directly, and 9 could not be clipped directly were treated by extracranial and intracranial arterial bypass and aneurysm trapping or combined embolization. Results The Glasgow outcome scale (GOS) scores of 36 patients after procedure and at discharge showed that 32 (89%) recovered well, 3 (8%) had severe disability, and 1died (3%). They were followed up for an average of 2 years. Thirty-three patients (92%) recovered well, 2 (6%) had disability. During the follow-up period 3 had recurrent aneurysm, 2 of them were retreated by endovascular intervention, and 1 was treated with craniotomy clipping. Cerebrovascular examination revealed that all the grafts were patent. Conclusions For residual or recurrent intracranial aneurysms after embolization, the determination of treatment method should be based on the clinical status of patients, aneurysmal characteristics, surgical risk, and possibility of rerupture of aneurysms. The safe and effective personalized treatment can be performed in clinical practice by the methods of craniotomy or endovascular interventional therapy, and it will achieve a satisfactory clinical effect. Key words: Intracranial aneurysm; Recurrence; Embolization, therapeutic; Microsurgery

Cesarean scar pregnancy: a systematic review of treatment studies

To study treatment modalities for cesarean scar pregnancies (CSPs), focusing on efficacy and complications in relation to study quality. Systematic review. Not applicable. A total of 2,037 women with CSP. Review of MEDLINE, EMBASE, and Cochrane Library to find studies including five or more women. Data were extracted on primary treatment modality/efficacy, complications, and future fertility. The level of evidence was categorized according to Oxford Centre for Evidence-based Medicine guidelines. Quality was assessed using The Cochrane Collaboration's Risk of Bias Tools for Randomized Controlled Trials and the modified Delphi techniques for case series. Meta-analysis was impossible owing to multifarious treatments. Successful first-line treatment. Complications were hysterectomy, laparotomy, bleeding >1,000mL, or blood transfusion. Fifty-two studies were included: four randomized, controlled trials and 48 case series. Fifteen of the 52 analyzed studies were scored as high quality. Treatment modalities were condensed to 14 different approaches. Combining study quality, level of evidence, efficacy, and safety, five approaches for treating CSP are recommended, depending on availability, severity of patient symptoms, and surgical skills: [1] resection through a transvaginal approach, [2] laparoscopy, [3] uterine artery embolization in combination with dilatation and curettage and hysteroscopy, [4] uterine artery embolization in combination with dilatation and curettage, and [5] hysteroscopy. This review recommends treatment options for CSP in clinical practice, based on efficacy and safety. The literature supports an interventional rather than medical approach. Present recommendations are primarily based on case series. Multicenter, well-designed studies are needed to draw definite conclusions on how to treat CSP.

Efficacy analysis of Onyx embolization in combination with gamma knife surgery for the treatment of intracranial arteriovenous malformation

Objective To investigate the effectiveness and safety of Onyx embolization in combination with gamma knife surgery for the treatment of intracranial arteriovenous malformations (AVMs). Methods A total of 86 patients with AVM admitted to the Neurological intervention Center, Beijing Neurosurgery Institute, Capital Medical University and treated with Onyx embolization in combination with gamma knife surgery from April 2004 to September 2011 were analyzed retrospectively. The related complications and clinical prognosis of embolization were counted and analyzed. During the embolization of AVMs, the combined high risk of bleeding (intracranial aneurysms, hemodynamic aneurysms, and AVM-related arteriovenous fistula) were assessed and embolized. According to the risk factors and embolization or not, the intracranial AVMs with high risk factors were divided into either a targeted embolization group or a non-targeted embolization group. The effect of targeted embolization on hemorrhage risk was assessed. Results The overall annual hemorrhage rate in patients with AVM was 1.66%, and the ruptured AVM was 2.26%, the unruptured AVM was 1.08%, and the annual mortality rate was 0.74%. One of 16 patients with embolization related complications had permanent neurological dysfunction. Twenty-four of 29 patients complicated with intranidal aneurysm underwent targeted embolization; 4 of 5 patients with hemodynamic aneurysm underwent targeted embolization; and 8 of 9 patients with arteriovenous fistula underwent targeted embolization. Chi square test showed that the hemorrhage complications of the targeted embolization group was significantly lower than that of the non-targeted embolization group (P<0.01). Conclusion The targeted embolization in combination with gamma knife surgery may decrease the risk of intracranial AVM hemorrhage, improve clinical prognosis and occur less permanent complications. This method is suitable for the treatment of intracranial AVMs of larger volume and those can not be cured with a single program. Key words: Intracranial arteriovenous malformations; Cerebral angiography; Radiotherapy; Hemorrhage; Postoperative complication

Strategies on the treatment of intracranial arteriovenous malformations

Surgical treatment of intracranial arteriovenous malformation (AVM) is one of the most difficult tasks for neurosurgeons, especially, for patients with large size AVM or AVM at the eloquent and deep location. Recent advent of endovascular treatment and radiosurgery may replace the role of surgery and decrease the difficulty of treatment of AVM to some extend but not all. Surgical excision with or without preoperative embolization remains the main modality of treatment of intracranial AVMs. However, the procedure of embolization itself also carries certain percentage of risk. Selection of this treatment modality needs to be carefully evluated.For small deep seated AVM and small AVM at the eloquent area, radiosurgery is another therapeutic option. However, the efficacy to achieve obliteration of the AVM by radiosurgery is only 60%-70% in general. Combined embolization and radiosurgery has been advocated as an option for treating large complex AVM. However, current treatment results failed to demonstrate any superiority of the result from this combined treatment.Palliative treatment with partial obliteration of the AVM nidus toreduce arteriovenous shunting is considered to be useful for the decrease of the occurrence of steal phenomenon, however, it may also increase shear stress of the abnormal vascular architecture and resulted in increase rate of hemorrhage.From 1989 to 2011, a total of 367 patients with cerebral AVM were treated at the National Taiwan University Hospital and its’ affiliate hospitals. Of these 367 patients, 143 patients underwent microsurgery as the solo treatment and 214 patients received embolization. In the later group, 25 patients had their AVMs cured after one or multiple sessions of endovascular treatment. The other 189 patients in this group, endovascular treatment can only be applied for the reduction of the flow and the size of the AVM. These patients finally underwent microsurgery as the definite treatment. The treatment morbidity was 11% in microsurgical group and 9% inendovascular group. There were 2 mortalities in surgical group (o.6 %) and 2 in endovascular group (0.9 %).Our current selection criteria for different therapeutic modality and surgical strategy for intracranial AVM will be discussed. Surgical treatment of intracranial arteriovenous malformation (AVM) is one of the most difficult tasks for neurosurgeons, especially, for patients with large size AVM or AVM at the eloquent and deep location. Recent advent of endovascular treatment and radiosurgery may replace the role of surgery and decrease the difficulty of treatment of AVM to some extend but not all. Surgical excision with or without preoperative embolization remains the main modality of treatment of intracranial AVMs. However, the procedure of embolization itself also carries certain percentage of risk. Selection of this treatment modality needs to be carefully evluated. For small deep seated AVM and small AVM at the eloquent area, radiosurgery is another therapeutic option. However, the efficacy to achieve obliteration of the AVM by radiosurgery is only 60%-70% in general. Combined embolization and radiosurgery has been advocated as an option for treating large complex AVM. However, current treatment results failed to demonstrate any superiority of the result from this combined treatment. Palliative treatment with partial obliteration of the AVM nidus toreduce arteriovenous shunting is considered to be useful for the decrease of the occurrence of steal phenomenon, however, it may also increase shear stress of the abnormal vascular architecture and resulted in increase rate of hemorrhage. From 1989 to 2011, a total of 367 patients with cerebral AVM were treated at the National Taiwan University Hospital and its’ affiliate hospitals. Of these 367 patients, 143 patients underwent microsurgery as the solo treatment and 214 patients received embolization. In the later group, 25 patients had their AVMs cured after one or multiple sessions of endovascular treatment. The other 189 patients in this group, endovascular treatment can only be applied for the reduction of the flow and the size of the AVM. These patients finally underwent microsurgery as the definite treatment. The treatment morbidity was 11% in microsurgical group and 9% inendovascular group. There were 2 mortalities in surgical group (o.6 %) and 2 in endovascular group (0.9 %). Our current selection criteria for different therapeutic modality and surgical strategy for intracranial AVM will be discussed.

Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients.

ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

Combined Trans-Arterial Coil and Percutaneous Onyx Embolization for Treatment of an Extracranial High-Flow Arteriovenous Malformation

Combined Trans-Arterial Coil and Percutaneous Onyx Embolization for Treatment of an Extracranial High-Flow Arteriovenous Malformation

Combination proximal pulmonary artery coiling and distal embolization induces chronic elevations in pulmonary artery pressure in Swine.

Pulmonary hypertension (PH) is associated with aberrant vascular remodeling and right ventricular (RV) dysfunction that contribute to early mortality. Large animal models that recapitulate human PH are essential for mechanistic studies and evaluating novel therapies; however, these models are not readily accessible to the field owing to the need for advanced surgical techniques or hypoxia. In this study, we present a novel swine model that develops cardiopulmonary hemodynamics and structural changes characteristic of chronic PH. This percutaneous model was created in swine (n=6) by combining distal embolization of dextran beads with selective coiling of the lobar pulmonary arteries (2 procedures per lung over 4 weeks). As controls, findings from this model were compared with those from a standard weekly distal embolization model (n=6) and sham animals (n=4). Survival with the combined embolization model was 100%. At 8 weeks after the index procedure, combined embolization procedure animals had increased mean pulmonary artery pressure (mPA) and pulmonary vascular resistance (PVR) compared to the controls with no effect on left heart or systemic pressures. RV remodeling and RV dysfunction were also present with a decrease in the RV ejection fraction, increase in the myocardial performance index, impaired longitudinal function, as well as cardiomyocyte hypertrophy, and interstitial fibrosis, which were not present in the controls. Pulmonary vascular remodeling occurred in both embolization models, although only the combination embolization model had a decrease in pulmonary capacitance. Taken together, these cardiopulmonary hemodynamic and structural findings identify the novel combination embolization swine model as a valuable tool for future studies of chronic PH.

Effect of Prior Embolization on Cerebral Arteriovenous Malformation Radiosurgery Outcomes: A Case-Control Study.

Embolization before stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVM) has been shown to negatively affect obliteration rates, but its impact on the risks of radiosurgery-induced complications and latency period hemorrhage is poorly defined. To determine, in a case-control study, the effect of prior embolization on AVM SRS outcomes. We evaluated a database of AVM patients who underwent SRS. Propensity score analysis was used to match the case (embolized nidi) and control (nonembolized nidi) cohorts. AVM angioarchitectural complexity was defined as the sum of the number of major feeding arteries and draining veins to the nidus. Multivariate Cox proportional hazards regression analyses were performed on the overall study population to determine independent predictors of obliteration and radiation-induced changes. The matching process yielded 242 patients in each cohort. The actuarial obliteration rates were significantly lower in the embolized (31%, 49% at 5, 10 years, respectively) compared with the nonembolized (48%, 64% at 5, 10 years, respectively) cohort (P = .003). In the multivariate analysis for obliteration, lower angioarchitectural complexity (P < .001) and radiologically evident radiation-induced changes (P = .016) were independent predictors, but embolization was not significant (P = .744). In the multivariate analysis for radiologic radiation-induced changes, lack of prior embolization (P = .009) and fewer draining veins (P = .011) were independent predictors. The effect of prior embolization on AVM obliteration after SRS may be significantly confounded by nidus angioarchitectural complexity. Additionally, embolization could reduce the risk of radiation-induced changes. Thus, combined embolization and SRS may be warranted for appropriately selected nidi.

Abstract T P18: Incidence and Management of Intracranial Wire Perforation During Acute Stroke Endovascular Therapy

BACKGROUND: Wire perforation during endovascular thrombectomy for acute stroke is a rare but devastating complication. Understanding the incidence and mechanism of this adverse event may further identify preventive strategies and improvements in management during perforation. METHODS: Retrospective review of a prospectively maintained database of acute stroke interventions at our institute identified 1035 patients. Of these, 46 patients were noted to have contrast extravastion during the procedure concerning for wire perforation (4%). RESULTS: A majority of the cases involved the anterior circulation (76%). Sites of perforation included: ICA (12), MCA (23), ophthalmic (1), anterior choroidal (2), PCA (4), PICA (1), SCA (1) and vertebral artery (2). Successful hemostasis was achieved with onyx embolization (39%), coil embolization (13%), onyx/coil combined embolization (5%), microcatheter occlusion (2%) and balloon inflation (7%). Thirty one percentage of the cases occurred during intracranial stenting or angioplasty. Despite high rates of mortality (72%), rapid recognition of extravasation and hemostasis led to good outcomes in 9% of patient. CONCLUSION: Intra-procedural wire perforation with leakage of contrast is associated with catheterization of small caliber vessels such as distal MCA branches (M3), anterior choroidal artery and diminutive posterior circulation vessels as well as intracranial angioplasty/stenting. Devastating outcomes can potentially be averted with appropriate hemostatic control.

Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation

ABSTRACT Cesarean scar pregnancy (CSP) is the rarest type of ectopic pregnancy implanted in the myometrium at the site of the previous cesarean section scar. It may lead catastrophic complications like uterine rupture and uncontrollable hemorrhage.4 Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus, preserving the uterus and future fertility. The conservative treatment can be by local and/or systemic administration of methotrexate, dilatation and curettage, excision of trophoblastic tissues (laparoscopy/laparotomy), bilateral internal artery ligation with trophoblastic evacuation and uterine artery embolization7 combined with curettage and/ or methotrexate. We did successful treatment of a viable CSP by systemic injections of methotrexate followed by selective uterine artery embolization in combination with dilatation and curettage. How to cite this article Mehta P, Vishwanath U, Joseph S, Anitha M. Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation. J South Asian Feder Obst Gynae 2015;7(3):143-147.

A rare case of arteriovenous malformation of the upper eyelid

Arteriovenous malformations (AVM's) are serious abnormalities that very rarely affect the eye. They are due to anomalous communications between the arterial and venous systems without any interposing capillaries. Therapeutic management of orbital AVM is not standardized, and it's most essential to strike a balance between spontaneous and iatrogenic risk of any visual loss. Management has to be very patient-specific and includes observation, embolization, surgical excision or a combined preoperative embolization followed by excision. Surgical intervention can also sometimes lead to life-threatening complications like excessive haemorrhage or cardiovascular instability and /or vision threatening complications like retinal vein occlusions. Here we describe an eyelid AVM in a young lady, with a relatively good vision in the affected eye .She was accurately diagnosed and finally after much deliberation involving multiple specialities was offered a combined embolization followed by complete surgical resection, however she declined any active intervention and is now on a regular follow-up

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Role of Combined Embolization and Ablation in Management of Renal Masses

Combination of minimally invasive treatment modalities is being increasingly utilized to improve local tumor control and overall survival. In the liver, the combination of embolization and ablation results in equivalent overall survival and intrahepatic disease progression as surgical resection for lesions smaller than 7 cm. Ablation alone for small renal masses up to 4 cm results in excellent local tumor control and lack of residual enhancement to suggest viable tumor. A small number of studies have been performed combining embolization and ablation, which result in high rates of local tumor control for tumors smaller than 5 cm. Based on this small cohort, combined embolization and ablation may be most indicated for central or mixed tumors where ablation alone suffers from the greatest degree of "heat sink" effect. This article reviews the theory, methods, and outcomes of combining percutaneous ablative and embolic modalities in the treatment of renal masses.

Combined treatment of brain AVMs by Onyx embolization and gamma knife radiosurgery decreased hemorrhage risk despite low obliteration rate.

The effectiveness and risk of cerebral arteriovenous malformations (AVMs) treatment with Onyx embolization combined with Gamma Knife surgery (GKS) were rarely reported. In the present study, we analyzed the radiographic and clinical outcomes of combined Onyx embolization and GKS for cerebral AVMs. A total of 86 patients' clinical outcomes were fully collected. Modalities and complications of the procedure were analyzed as well as the clinical and anatomic outcomes. Risk factors associated with hemorrhage were determined by multivariate analysis. The mean duration of radiological and clinical follow-up was 42 months (12.3-82.5 months) and 57.6 months (12.3-108.9 months), respectively. The total annual hemorrhage rate was 1.66% with 2.26% for ruptured AVMs and 1.08% for unruptured AVMs. The annual mortality rate was 0.4%. The total obliteration rate was 28.2% at follow-up. Clinical deterioration occurred in 4 patients (4.7%). Volume larger than 22 ml, diameter prior GKS larger than 3.5 cm and margin dose less than 16 Gy significantly increased the hemorrhage risk. The post-treatment hemorrhage could be predictable based on AVM's characteristics and treatment approaches. The annual hemorrhage rate was low for both ruptured and unruptured AVMs after combined treatment; however, the total obliteration rate was low. Long-term follow-up and larger population are needed for evaluating the clinical effect for this combined treatment.

Heat shock protein 70 expression and effect of combined transcatheter arterial embolization and radiofrequency ablation in the rabbit VX2 liver tumour model

To evaluate the effects of a combined therapy using transcatheter arterial embolization (TAE) and radiofrequency ablation (RFA) on heat shock protein 70 (HSP70) expression and treatment effects in a rabbit model of VX2 liver tumours. Tumour growth and necrosis rates were evaluated on day 7. Five rabbits were assigned to each group and were killed on days 1, 3, and 7 after treatment. HSP70 expression was detected and quantified by immunohistochemistry, Western blot, and reverse transcription polymerase chain reaction (RT-PCR). Tumour growth rate was significantly decreased and the necrosis rate increased in the TAE + RFA group on day 7 compared with the other groups. HSP70 expression in the TAE group peaked on day 1 and bottomed on days 3 and 7. HSP70 expression in the TAE group was significantly greater than in the control group on days 1, 3, and 7. HSP70 expression was increased on day 1, peaked on day 3, and dropped on day 7 in the RFA and TAE + RFA groups. In the TAE + RFA group, HSP70 expression was significantly greater than in the other groups on days 1, 3, and 7. HSP70 expression in Western blot analysis and HSP70 mRNA peaked on day 3 and dropped on day 7 in the TAE, RFA, and TAE + RFA groups. HSP70 over-expression in residual tumours after TAE + RFA could be attributed to the additive effects of hypoxia and hyperpyrexia generated by TAE combined with RFA.