Embolization Group Research Articles

Effects of Prophylactic Coil Embolization of Pelvic Arteries on Surgical Outcomes in Hemodynamically Stable Patients with Complex Acetabular Fractures.

To investigate the efficacy of prophylactic embolization of the internal iliac artery (IIA) or superior gluteal artery (SGA) before open reduction and internal fixation (ORIF) in reducing intraoperative blood loss (IBL) in hemodynamically stable patients with complex acetabular fractures. A total of 136 patients with complex acetabular fractures were retrospectively included and divided into the prophylactic transcatheter arterial embolization (PTAE) group and non-PTAE group, depending on whether ipsilateral IIA or SGA was embolized using coils within 3 days before ORIF. Demographic characteristics, injury severity score (ISS), fracture classification, and intraoperative and postoperative data were compared between the two groups. Propensity score matching (PSM) was also performed to balance the baseline characteristics of the patients. The determinants of IBL were investigated using multivariate linear regression analysis. The PTAE and non- PTAE groups consisted of 64 and 72 patients, respectively. PSM yielded 43 matched pairs. Post-matching, IBL in the PTAE group was less than that in the non-PTAE group (median [interquartile range], 800 [400-1200] mL vs 1300 [1000-1600] mL, p < 0.001). Furthermore, the PTAE group showed a shorter ORIF duration and lower intraoperative and 24-h postoperative blood transfusion requirements (all p < 0.05). Multivariate analysis revealed that PTAE and the duration of surgery were associated with IBL (PTAE: β = -0.407, p < 0.001; duration of surgery: β = 0.237, p = 0.021). Prophylactic IIA or SGA embolization may be beneficial in reducing IBL during ORIF in hemodynamically stable patients with complex acetabular fractures.

Evaluation of the Effect of Thrombolytic Therapy on Inflammatory Markers in Patients With Acute Pulmonary Embolism.

Acute pulmonary embolism (APE) is a serious cardiovascular condition characterized by high rates of morbidity and mortality, with inflammation playing a significant role in the severity of the disease and patient outcomes. This study aimed to evaluate the effects of thrombolytic therapy on inflammatory markers in patients diagnosed with APE. The study was conducted retrospectively on 138 individuals, 69 with pulmonary embolism and 69 without pulmonary embolism (control), who were admitted to Necmettin Erbakan University between January 2019 and April 2023. Demographic information, C-reactive protein (CRP), white blood cells (WBC), neutrophils, platelets, systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), multi-inflammatory index (MII-1 and MII-2), hemoglobin, and lymphocyte-to-C-reactive protein ratio (LCR) levels of the cases were evaluated. The inflammatory markers were measured before and after thrombolytic therapy. Levels of CRP, WBC, SII, NLR, and MII-1 were significantly increased in the pulmonary embolism group compared to the control group (p<0.05). In contrast, there was a notable decrease in hemoglobin, MII-2, and LCR levels (p<0.05). In the pulmonary embolism group, levels of CRP, WBC, neutrophils, lymphocytes, hemoglobin, SII, NLR, and MII-1 were significantly lower after thrombolytic treatment compared to their levels before the treatment (p<0.05). Conversely, the post-thrombolytic treatment group exhibited significantly higher levels of platelets, PLR, and LCR compared to the pre-thrombolytic treatment group (p<0.05). The findings indicate that novel inflammatory markers, such as SII, NLR, and MII, are elevated in APE and tend to decrease following thrombolytic therapy. This suggests that these markers could be useful for monitoring treatment effectiveness and predicting patient outcomes. However, further research is necessary to confirm their clinical utility.

Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma

BackgroundThe effect of embolization of the middle meningeal artery in patients with subacute or chronic subdural hematoma is uncertain.MethodsWe performed a multicenter, open-label, randomized trial in China, involving patients with symptomatic nonacute subdural hematoma with mass effect. Patients were assigned to undergo burr-hole drainage or receive nonsurgical treatment at the surgeon’s discretion, and patients in each group were then randomly assigned, in a 1:1 ratio, to undergo middle meningeal artery embolization with liquid embolic material or to receive usual care. Patients whose condition warranted craniotomy were excluded. The primary outcome was symptomatic recurrence or progression of subdural hematoma within 90 days after randomization. Secondary outcomes included clinical and imaging outcomes. The main safety outcome was any serious adverse event (including death).ResultsThe analysis included 722 patients, of whom 360 were assigned to the embolization group and 362 to the usual-care group. Burr-hole drainage was performed in 78.3% of the enrolled patients; among the patients who underwent burr-hole drainage, the procedure occurred after embolization in 99.6%. Symptomatic recurrence or progression of subdural hematoma within 90 days occurred in 24 patients (6.7%) in the embolization group and in 36 (9.9%) in the usual-care group (between-group difference, −3.3 percentage points; 95% confidence interval, −7.4 to 0.8; P=0.10). The incidence of serious adverse events was lower in the embolization group than in the usual-care group (6.7% vs. 11.6%, P=0.02).ConclusionsAmong patients with symptomatic nonacute subdural hematoma (of whom 78% underwent burr-hole drainage), middle meningeal artery embolization resulted in a 90-day incidence of symptomatic recurrence or progression similar to that with usual care but was associated with a lower incidence of serious adverse events. (Funded by Shanghai Shenkang Hospital Development Center and others; MAGIC-MT ClinicalTrials.gov number, NCT04700345.)

Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma.

Patients receiving standard treatment for chronic subdural hematoma have a high risk of treatment failure. The effect of adjunctive middle meningeal artery embolization on the risk of treatment failure in this population remains unknown. We randomly assigned patients with symptomatic chronic subdural hematoma to undergo middle meningeal artery embolization as an adjunct to standard treatment (embolization group) or to receive standard treatment alone (control group). Either surgical or nonsurgical standard treatment had been chosen for each patient before randomization. The primary efficacy outcome was a composite of the following events: recurrent or residual chronic subdural hematoma (measuring >10 mm) at 180 days; reoperation or surgical rescue within 180 days; or major disabling stroke, myocardial infarction, or death from neurologic causes within 180 days. The primary safety outcome was a composite of major disabling stroke or death from any cause within 30 days. Among 310 enrolled patients, 149 were randomly assigned to the embolization group and 161 to the control group; 189 patients were to receive surgical standard treatment and 121 nonsurgical standard treatment. The mean age of the patients was 73 years, and 70% were men. In the primary efficacy analysis, a primary-outcome event occurred in 19 of 120 patients (16%) in the embolization group, as compared with 47 of 129 patients (36%) in the control group (odds ratio, 0.36; 95% confidence interval, 0.20 to 0.66; P = 0.001). In the primary safety analysis, 4 of 144 patients (3%) in the embolization group and 5 of 166 patients (3%) in the control group either had a major disabling stroke or died within 30 days. Through 180 days, 12 patients (8%) in the embolization group and 9 patients (5%) in the control group had died, with death from neurologic causes occurring in 1 patient (1%) in the embolization group and in 3 patients (2%) in the control group. Among patients with symptomatic chronic subdural hematoma, adjunctive middle meningeal artery embolization resulted in a lower risk of treatment failure than standard treatment alone, without resulting in an increased incidence of disabling stroke or death in the short term. Further study of longer-term safety outcomes is warranted. (Funded by Balt USA; STEM ClinicalTrials.gov number, NCT04410146.).

Circulating miRNA profiles as predictive biomarkers for aneurysm healing following endovascular treatment: a prospective study

Background Aneurysm treatments are crucial to minimize the rupture risk. The underlying molecular processes mediating cellular remodeling, endothelialization, and aneurysm healing following endovascular treatment are poorly understood. The current study aims to explore circulating miRNA as a treatment and outcome-associated biomarkers in patients undergoing endovascular treatment. Methods Patients undergoing endovascular interventions for unruptured intracranial aneurysms, using either flow diverter placement or coil embolization, were enrolled. Blood samples were collected before the intervention and during a follow-up period between 6 and 18 months. Total mRNA/miRNA was isolated from plasma, followed by RNA-seq analysis. Gene Ontology analysis was used to identify pathways linked to altered miRNA expression. Results Twenty-three patients participated, with 13 (56.5%) undergoing flow diversion and 10 (43.5%) coil embolization. The median follow-up sample collection time was 10.70 months (SEM ± 1.32). No significant differences in angiographic occlusion were noted between intervention groups. Differentially expressed miRNAs were not identified between groups at baseline. However, at follow-up, 39 miRNAs were upregulated and 41 were downregulated, independent of intervention. Notably, three miRNAs (miR-4746-5p, miR-4685-3p, and miR-490-3p) were downregulated in the flow diversion group compared to the coil embolization group. Bioinformatics analysis revealed associations with upregulated fluid shear stress, p53, adherens junction pathways, along with downregulated apoptosis pathways. Conclusions This study suggests that fluid shear stress and apoptosis may influence aneurysm healing or thromboembolic events in flow diverter-treated patients. Further research is warranted to elucidate the functional significance of these findings in treatment outcomes, providing valuable insights for improved patient care in intracranial aneurysm management.

Abstract 094: Embolization of middle meningeal artery for subacute and chronic subdural hematomas using liquid embolic materials and coils: a multistudy comparison

Introduction Chronic subdural hematomas (SDH) are common in older adults due to increased risks of falls, cerebral atrophy, and antithrombotic therapy, leading to higher bleeding risks. Current randomized clinical trials are evaluating the safety and efficacy of middle meningeal artery (MMA) embolization for chronic SDH. These trials, such as EMBOLISE, MAGIC‐MT, and STEM, have reported preliminary promising results using different embolic agents. This study examines the safety and efficacy of MMA embolization using liquid embolic materials and coils at a single institution, comparing outcomes with the aforementioned trials. Methods We conducted a retrospective review of 66 patients who underwent MMA embolization for subacute and chronic SDH at a single institution from February 2021 to March 2024. Data were collected from electronic medical records, including demographics, clinical data, imaging, procedural details, use of antiplatelet or anticoagulation medications, and outcomes at discharge and follow‐up. Patients aged 18 or older with subacute or chronic SDH who underwent MMA embolization were included. Follow‐up assessments were conducted at multiple intervals post‐procedure. Descriptive statistics were used for data analysis. Results The median age of the cohort was 71 years, with a predominance of males (64.71%) and African Americans (54.90%). Eighteen patients had prior SDH interventions, and 62.75% were on antithrombotic therapy before diagnosis. The median time from symptom onset to diagnosis was one day, with most SDHs being traumatic (60.78%). Elective MMA embolizations were performed in 64.71% of cases, primarily using a femoral approach. N‐butyl cyanoacrylate (n‐BCA) was used in 97.37% of procedures, and coils in 27.63%. Complications were rare, with two cases (3.92%) of MMA rupture and access site hematoma. The technical success rate was 97.37%. The median hospital stay was seven days, with most patients discharged home (70.59%). The in‐hospital mortality rate was 1.96%, with seven post‐discharge deaths unrelated to MMA embolization or SDH. The median follow‐up duration was 130 days, with two patients (3.92%) requiring repeat MMA embolization and three (5.88%) needing SDH evacuation. Compared to EMBOLISE, MAGIC‐MT, and STEM trials, our study showed a recurrence rate of 9.8% for all patients, with 6.45% in the MMA embolization alone group and 15% in the surgery with adjunctive MMA embolization group. EMBOLISE reported a 4.10% recurrence rate with surgical evacuation with adjunctive MMA embolization, MAGIC‐MT showed 1.90% recurrence with MMA embolization alone and 4.70% with surgery and adjunctive MMA embolization, and STEM found 19.10% recurrence with MMA embolization alone and 12.30% with surgery with MMA embolization. Discussion Our study suggests that selective distal embolization using n‐BCA is effective, with a low complication rate. Distal embolization may prevent cranial nerve injuries and strokes associated with proximal embolizations. The ongoing trials will provide further insights into optimal embolization sites and agents, and the timing for restarting anticoagulation. Conclusion MMA embolization using liquid embolic materials and coils is a promising treatment for subacute and chronic SDH, with low recurrence and complication rates. Comparison with current trials indicates favorable outcomes. Further research is needed to refine embolization techniques and optimize patient management strategies, potentially revolutionizing chronic SDH treatment.

Dural arteriovenous fistulas at the craniocervical junction: a systematic review and meta-analysis.

The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management. Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes. We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2-64.5), 58.8 years (95%CI: 48.4-69.2), and 63.8 years (95%CI: 60.1-67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3-88.2%) in the microsurgery group and 54.9% (95%CI:30.7-77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7-34.5%) in the embolization group, 11.6% (95%CI:3.8-30.4%) in the microsurgery group, and 7.7% (95%CI:1.1-39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1-80.8%), embolization: 51.9% (95%CI:30.8-72.4%), and conservative: 11.6% (95%CI:4.4-27.4%)]. In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics.

Clinical characteristics and risk factors of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children

Pulmonary embolism is a rare but serious complication in Mycoplasma pneumoniae pneumonia patients, leading to serious sequelae and even death. We aim to retrospectively analyze the clinical features of Mycoplasma pneumoniae pneumonia with pulmonary consolidation in children and to explore the independent risk factors for progression to pulmonary embolism. Clinical data of 207 children with Mycoplasma pneumoniae pneumonia complicated with pulmonary consolidation were collected, and the patients were divided into the pulmonary embolism group (69 patients) and the control group (138 patients). Multivariate logistic regression was used to analyze the risk factors and the predictive efficacy was evaluated by receiver operating characteristic curve. Multivariate logistic regression analysis showed that fever days, D-dimer, immunoglobulin A, chest pain, extra-respiratory symptoms, plastic bronchitis and cutaneous mucosal system complications were the independent risk factors. Fever days ≥ 7.5, D-dimer ≥ 0.895 mg/L, immunoglobulin A ≥ 1.015 g/L, chest pain, extra-respiratory symptoms, plastic bronchitis and cutaneous mucous system complications significantly increased the risk of pulmonary embolism in children with Mycoplasma pneumoniae pneumonia complicated with pulmonary consolidation.

Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I–III: a propensity score matched study

BackgroundArteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable...

Impact of Intraoperative Branch Embolization for Type 2 Endoleak Prevention During Endovascular Abdominal Aortic Repair

Endovascular abdominal aortic repair (EVAR) has a significantly higher revision rate than open repair, primarily due to type 2 endoleak (2EL). Although 2ELs are considered benign, late open conversion (LOC) due to the expansion of the aneurysm diameter of the 2EL is a concern in the mid- and long-term. In this study, we investigated the impact of embolization of the inferior mesenteric artery (IMA) or lumbar artery (LA) at the time of the initial EVAR and its long-term outcomes. Between April 2008 and December 2021, 743 EVAR procedures for abdominal aortic aneurysms were performed at our institution. The patients were divided into 2 groups at the time of initial surgery, namely, 215 and 528 patients in the embolization (Group E) and nonembolization (Group N) groups, respectively. Branch embolization was performed in patients with an IMA diameter ≥3mm and LA diameter ≥2mm on preoperative computed tomography. Re-embolization with EL was performed in patients with a diameter enlargement ≥10mm, and LOC was performed in patients with continued enlargement ≥15mm after re-embolization. The mean follow-up period was 7.0years. The mean number of branch embolizations was 2.3±1.1. Intraoperatively, the operative time, fluoroscopy time, irradiation dose, and contrast medium use were significantly higher in Group E than in Group N. There was a significant difference between the 2 groups regarding shrinkage (Group E versus Group N: 45.6% versus 37.3%; P=0.03) and enlargement (Group E versus Group N: 9.3% vs. 19.5%; P<0.001) of the aneurysm diameter by>5mm after EVAR. In the mid- and long-term, the avoidance rate of 2EL reintervention was significantly lower in Group E at 5years (93.5% vs. 88.6%) and 10years (87.5% vs. 76.4%; P=0.04). LOC prevention was 5years; Group E: 100% vs. 96.9% for Group N and 10years; Group E: 98.8% vs. 92.5% for Group N, significantly lower in Group E (P=0.02). The impact of branch embolization at the time of the initial EVAR is believed to prevent enlargement of the aneurysmal sac and LOC. However, prolonged operation time, increased radiation exposure, and the use of contrast medium have been debated. To improve the long-term results of EVAR, embolisms of both the IMA and LA are required.

The Efficiency of Preoperative Embolization in the Management of Shamblin Type III Carotid Body Tumor: A Single-Center Retrospective Study.

This study aims to determine the efficacy and safety of preoperative embolization in the management of Shamblin type III carotid body tumors (CBT). In this retrospective study, patients with Shamblin type III CBT were included between January 2005 and January 2017. A total of 48 Patients were divided into preoperative embolization (SRE, n = 25) and non-preoperative embolization group (SR, n = 23). Mean surgical time (145.24 ± 19.86 min vs 186.91 ± 17.808 min, P < 0.05) and intraoperative blood loss (271.4 ± 73.001mL vs 380.36 ± 39.822mL, P < 0.05) were markedly reduced in the SRE group compared with SR group. The preoperative tumor volume in the SRE group was larger than that in the SR group, but the volume was similar between the two groups after surgery. The number of tumor residual cases was higher in the SR group. The incidence of complications and duration of hospitalization were comparable between the two groups. This study demonstrates the efficacy of preoperative embolization in reducing the duration of surgery and volume of blood loss during the process of CBT resection. More prospective, well-designed studies are urgently needed to validate the current findings.

Intracranial atherosclerotic disease mechanism indicates poor outcomes of thrombectomy in acute cerebral infarction with large vessel occlusion: A matched cohort study

BackgroundThrombectomy is a standard treatment for acute large vessel occlusion (LVO); however, its effectiveness in treating LVO related to intracranial atherosclerosis disease (ICAD) remains uncertain. This study aimed to compare thrombectomy outcomes in ICAD-related and embolic LVO, focusing on patients with similar symptom severities upon hospital admission. MethodsThis retrospective study was conducted at Jikei University Hospital and Jikei University Kashiwa Hospital between October 2017 and March 2023. Ischemic stroke patients with LVO who underwent thrombectomy were categorized into ICAD and embolism groups based on the occlusion mechanism. Groups were matched using National Institutes of Health Stroke Scale scores at the time of admission. A modified Rankin Scale score of 5 or 6 at 90 days after symptom onset was defined as a devastating outcome. The procedural outcomes and frequency of devastating outcomes were compared between the ICAD and embolism groups. ResultsThe study included 33 matched pairs were included. The ICAD group showed lower rates of successful reperfusion (43 % vs. 82 %, p = 0.001), and longer procedural times (median 88 min vs. 50 min, p < 0.001) than the embolism group. The ICAD group had a significantly higher frequency of devastating outcomes than the non-ICAD group (39 % vs. 15 %, p = 0.027). Multivariate analysis identified ICAD as an independent factor associated with devastating outcomes (OR, 3.804; 95 % confidence interval (95 %CI), 1.148–12.603; p = 0.029). ConclusionIn thrombectomy therapy, reperfusion rates and outcomes are significantly worse in patients with ICAD-LVO than in patients with embolic LVO.

ThP7.4 - Splenic trauma in the West of Scotland: a seven year analysis of management and outcomes

Abstract Aim To evaluate admission characteristics and management of traumatic splenic injuries in the region over a seven-year period and investigate differences in clinical outcomes. Methods Data was obtained from the Scottish Trauma Audit Group (STAG). Retrospective cohort analysis was performed of adult patients who sustained splenic injuries between 2015 and 2022 and received operative (OM), embolization (EM) or conservative management (CM) at a multiple-site single NHS trust in the West of Scotland. Primary outcome was all-cause inpatient mortality, secondary outcomes was length of stay (LOS). Results 129 patients were included. Majority of patients were male (73.6%, n=95). A third (34.1%) underwent OM (n=44), 4.7% underwent EM (n=6) and 61.2% (n=79) were managed conservatively. Median age was highest in the EM group at 61 years, versus 35 and 40 years in OM and CM groups (p=0.039). OM group patients had the highest median admission lactate (3.0) and median H+ ions (48.5) versus the CM group with a median lactate of 2.0 (p=0.050) and H+ of 45.9 (p=0.010). CM failed in 4.8% (n = 4) and required either OM or EM. Overall mortality was 3.9%, and exclusively observed in the CM group. Longest median LOS was observed in the EM group (17 days), versus 10 and 9 days in OM and CM groups (p=0.207). Conclusion Mortality from splenic injury in the region is low. Patients who were shocked on admission were more likely to be managed operatively. Few patients were managed with embolisation, but this cohort had a significantly longer LOS.

Outcome of early versus late primary embolization in ruptured brain arteriovenous malformations.

To determine whether patients with a ruptured brain arteriovenous malformation (rBAVM) would benefit from an early embolization. rBAVM treated first by embolization between March 2002 and May 2022 were included. Embolization was defined early (Group 1) when performed within 10 days postbleeding. If later, embolization was considered late (Group 2). Demographic and rBAVM data were compared between the groups. High-risk bleeding components and reasons for deferring embolization were retrieved. Primary endpoint was rebleeding. Secondary endpoints were good functional outcome (FO, modified Rankin Scale mRS ≤ 2) and angiographic occlusion. Predictors of rebleeding and FO were determined by multivariate analysis. 105 patients were recruited (N = 34 in Group 1; N = 71 in Group 2). No rebleeding was noted before, during or after the first embolization session in the early embolization group. Late embolization depended on missed diagnosis and referral pattern. Eleven patients (10.5%) suffered a rebleeding, of whom N = 3 before embolization (only in Group 2), N = 5 periembolization (N = 2 at the second embolization session in Group 1) and N = 3 spontaneous more than 30 days postembolization. More high-risk components were embolized in Group 1 (19/34; 55.9 vs 17/71; 23.9%; p = .011). Rebleeding rates, FO at last FU (90.9% vs 74.3%) and occlusion rates (80.8% vs 88.5%) did not differ between the groups. Glasgow coma scale ≤ 8 predicted rebleeding, rebleeding correlated with poor FO. Early embolization did prevent rebleeding. The overall rebleeding risk was linked to bleeding before late embolization and bleeding at the second embolization. Rebleeding predicted the final FO.

Middle meningeal artery embolization following surgical evacuation of symptomatic chronic subdural hematoma improves outcomes, interim results of a prospective randomized trial

BackgroundOutcomes after surgical treatment of chronic subdural hematoma (cSDH) remain undesirable in a significant proportion of patients. We aimed to show the role of middle meningeal artery (MMA) embolization and to demonstrate its benefits. MethodsThirty-five patients with symptomatic cSDH were enrolled in a prospective randomized trial following evacuation surgery. Participants were randomized to embolization or control group (expectant management following surgical evacuation without embolization). Patients were followed throughout their hospitalization and outpatient follow-ups. The main goals of this planned interim analysis were to assess neurological outcome and resource utilization. ResultsThe groups were comparable in terms of sex, age and follow-up retention rates. Side(s) of intervention(s) and hematoma size were similar. There was no statistical difference in neurological examination improvement at discharge, but at follow-up, we observed a decline in neurologic exam in the control group (p = 0.03). Control group participants required more re-interventions (p = 0.02) and were followed in clinic and during related readmissions for longer (p = 0.02). The number of imaging studies obtained in relation to the disease management was higher in the control group (p = 0.01). ConclusionsOur results suggest a beneficial role for the addition of MMA embolization to surgical intervention in the treatment of symptomatic chronic subdural hematoma. Neurological outcomes were significantly better in the embolization group. This contributed to less need for follow-up, re-interventions, and imaging studies.

Reduced Incidence of Pneumothorax and Chest Tube Placement following Transthoracic CT-Guided Lung Biopsy with Gelatin Sponge Torpedo Track Embolization: A Propensity Score-Matched Study.

Objectives: To evaluate the effectiveness of track embolization using gelatin sponge torpedo in reducing the incidence of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy. Methods: A retrospective single-center analysis of percutaneous computed tomography (CT)-guided transthoracic lung biopsies was performed between 2017 and 2022. After excluding the patients who received an ultrasound-guided biopsy, combined lung biopsy with ablation, fiducial placement, unsuccessful procedure due to uncooperative patient, and age under 18 years, 884 patients' clinical information was collected (667 without track embolization and 217 with track embolization). The incidence of early and late pneumothorax and chest tube placement were compared between the two groups. Propensity score matching (PSM) was applied to minimize selection bias. Univariable and multivariable analyses were performed to determine risk factors for pneumothorax. Results: After PSM, the baseline differences and all factors that could affect the incidence of pneumothorax were balanced between the track embolization group (217 patients) and the non-track embolization group (217 patients). The incidence rates of early pneumothorax (13.4% vs. 24.0% p = 0.005), late pneumothorax (11.0% vs. 18.0% p = 0.021), and chest tube placement (0.9% vs. 4.6% p = 0.036) were significantly decreased in the track embolization group. However, the success rate of tissue diagnosis yield and length of hospital stay were not significantly different between the two groups. In multivariate analysis, the risk of pneumothorax increased as the fissure was passed (OR = 3.719, p = 0.027). Conclusions: Using track embolization with a gelatin sponge torpedo significantly decreased the incidence of pneumothorax and chest tube placement following percutaneous CT-guided lung biopsy.

Outcomes following heart valve surgery in patients with infective endocarditis and preoperative septic cerebral embolism: insights from the CAMPAIGN study group.

This study aimed to analyse the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis undergoing valve surgery. Retrospective multicentric study based on the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry comprising patients with infective endocarditis who underwent valve surgery between 1994 and 2018 at 6 German centres. Patients were divided into 2 groups for statistical comparison according to the presence or absence of preoperative septic cerebral embolism. Propensity score matching was performed for adjusted comparisons of postoperative outcomes. Primary outcomes were 30-day mortality and estimated 5-year survival. A total of 4917 patients were included in the analysis, 3909 (79.5%) patients without and 1008 (20.5%) patients with preoperative septic cerebral embolism. Patients with preoperative septic cerebral embolism had more baseline comorbidities. Mitral valve endocarditis (44.1% vs 33.0% P < 0.001), large vegetations >10 mm (43.1% vs 30.0%, P < 0.001), and Staphylococcus species infection (42.3% vs 21.3%, P < 0.001) were more frequent in the cerebral embolism group. Among patients with preoperative cerebral embolism, 286 (28.4%) patients had no stroke signs (silent stroke). After matching (1008 matched pairs), there was no statistically significant difference in 30-day mortality (20.1% vs 22.8%; P = 0.14) and 5-year survival (47.8% vs 49.1%; stratified log-rank P = 0.77) in patients with and without preoperative cerebral embolism, respectively. Preoperative septic cerebral embolism in patients with infective endocarditis requiring valve surgery does not negatively affect early or late mortality; therefore, it should not play a major role in deciding if surgery is to be performed.

Preemptive Embolization of Abdominal Aortic Aneurysm Sac Side Branch Arteries Promotes Early Sac Shrinkage after Endovascular Aneurysm Repair 1

The association between the occlusion rate of the side branch arteries branching from the abdominal aortic aneurysm sac and aneurysm sac shrinkage is unclear. We aimed to evaluate the efficacy of preemptive embolization of multiple side branch arteries branching from the abdominal aortic aneurysm sac in early aneurysm sac shrinkage after endovascular aneurysm repair. Patients undergoing endovascular aneurysm repair of abdominal aortic aneurysms, with or without preemptive embolization of multiple side branch arteries, including the inferior mesenteric artery and lumbar arteries, between January 2016 and August 2021, were retrospectively evaluated. Preemptive embolization was introduced at our institution in January 2018 and has been performed in all patients who undergo endovascular aneurysm repair since then. We compared occlusion rates of the side branch arteries, frequency of type 2 endoleaks, changes in aneurysm sac size, percentage of aneurysm sac size decrease, and frequency of reduction in the aneurysm sac diameter by>5mm. The study included 43 patients in the embolization group and 20 in the nonembolization group. Preemptive embolization was successfully performed without any ischemic complications. The total occlusion rate of side branch arteries was significantly higher in the embolization group than in the nonembolization group (70.2% vs. 29.3%, P<0.05). At 24months of follow-up, the type 2 endoleak frequency was significantly lower in the embolization group than in the nonembolization group (6.9% vs. 31.6%, P<0.05). The frequency of reduction in the aneurysm sac diameter by>5mm was significantly higher in the embolization group than in the nonembolization group at 24months (62.1% vs. 31.6% P<0.05). The optimal cutoff value for the total occlusion rate of the side branch arteries to achieve reduction in the aneurysm sac diameter by>5mm at 24months, after endovascular aneurysm repair, was 66.7% in all patients (area under the curve=0.634; sensitivity=62.5%; specificity=70.8%). These findings suggest that occluding 66.7% or more of the side branch arteries may result in early aneurysmal shrinkage. Preemptive embolization of multiple side branch arteries, branching from the abdominal aortic aneurysm sac, may contribute to early aneurysm sac shrinkage; this may serve as a marker for fewer late complications after endovascular aneurysm repair.

Transcatheter Hepatic Artery Embolization Versus Hepatic Artery Perfusion Chemoembolization in the Interventional Treatment of Primary Hepatocellular Carcinoma: Clinical Effect Observation

Objective: To investigate the clinical effect of transcatheter hepatic artery embolization and hepatic artery perfusion chemoembolization on the interventional treatment of primary liver cancer. Methods: Eighty-two primary hepatocellular carcinoma patients who came to the outpatient clinic for treatment from August 2020 to November 2023 were selected as the study subjects. Based on the retrospective analysis, they were divided into 45 cases in the embolization group and 37 cases in the chemoembolization group according to the difference of treatment methods. The embolization group was treated with transcatheter hepatic artery embolization, and the chemoembolization group was treated with hepatic artery perfusion chemoembolization. The clinical efficacy, survival rate, survival quality score, serum tumor markers, and incidence of adverse reactions were observed in the two groups. Results: The clinical efficacy, survival quality score, and serum tumor markers of the chemoembolization group were higher than that of the embolization group, and the incidence of adverse reactions was lower than that of the embolization group, with statistically significant differences (P &lt; 0.05). The survival rate of the chemoembolization group was not statistically significant when compared with that of the embolization group (P &gt; 0.05). Conclusion: In the treatment of primary hepatocellular carcinoma, hepatic artery perfusion chemoembolization is better than transcatheter hepatic artery embolization, which can effectively improve the quality of patients’ survival and reduce the incidence of adverse reactions, and it is worth further popularized in the clinic.

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

This study aimed to assess the safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy (HE) associated with large spontaneous portosystemic shunts (SPSS). Inverse probability of treatment weighting (IPTW) was employed to minimize potential bias. A total of 123 patients were included in this study (34 in the embolization group and 89 in the control group). In the unadjusted cohort, the embolization group demonstrated significantly better liver function, a larger total area of SPSS, and a higher percentage of patients with serum ammonia levels > 60 µmol/L and the presence of hepatocellular carcinoma (HCC) (all P < 0.05). In the IPTW cohort, baseline characteristics were comparable between the two groups (all P > 0.05). Patients in the embolization group exhibited significantly longer HE-free survival compared to the control group in both the unadjusted and IPTW cohorts (both P < 0.05). Subsequent subgroup analyses indicated that patients with serum ammonia level > 60 μmol/L, hepatopetal flow within the portal trunk, the presence of solitary SPSS, a baseline HE grade of II, and the absence of HCC at baseline showed statistically significant benefit from embolization treatment (all P < 0.05). No early procedural complications were observed in the embolization group. The incidence of long-term postoperative complications was comparable to that in the control group (all P > 0.05). Hence, interventional embolization appears to be a safe and effective treatment modality for cirrhotic patients with refractory HE associated with large SPSS. However, the benefits of embolization were discernible only in a specific subset of patients.