Interventional Radiology Research Articles

Lower Gastrointestinal Bleeding (Nonvariceal): Concepts and Technique

AbstractLower gastrointestinal bleeding (LGIB) is defined as bleeding from the GI tract anywhere distal to the ligament of Treitz. It has multiple causes, including colonic diverticula, hemorrhoids, inflammatory bowel disease, and neoplasms. LGIB presents a wide spectrum of clinical manifestations, ranging from acute presentations with massive bleeding to insidious presentations with chronic, low-grade, intermittent bleeding. Although LGIB is less common and generally less severe compared with upper GI bleeding (UGIB), approximately 10 to 15% of cases eventually require endovascular intervention. Because of the unique vascular anatomy and potential complications, it often necessitates more specialized endovascular skills compared with UGIB. Embolization of LGIB carries a higher risk of ischemic complications compared with UGIB, as the superior mesenteric artery and the inferior mesenteric artery have a less rich collateral supply compared with the celiac trunk. The management of LGIB depends on its etiology, location, and severity. A multidisciplinary team approach, including gastroenterologists, surgeons, and interventional radiologists, is vital for achieving the best possible outcomes for these patients. With advances in microcatheter technology and newer embolic agents, interventional radiologist plays an increasingly important role in LGIB. Interventional radiologists managing these patients should have good knowledge of mesenteric arterial anatomy, the properties of different embolic agents, and basic principles of superselective embolization. In this comprehensive review, we discuss how to approach a patient with LGIB and the role of the interventional radiologist in these patients. Furthermore, we delve into endovascular techniques and concepts for superselective embolization and various embolic agents used in LGIB.

Lumen-Apposing Metal Stents in the Management of Complex Pelvic Abscesses

Background: Lumen-apposing metal stents (LAMS) are utilized in a wide range of therapeutic gastrointestinal applications. We present our experience with LAMS-assisted drainage of complex pelvic abscesses at a large safety-net hospital. Methods: EUS-guided LAMS placements for pelvic abscesses from July 2020 to June 2024 were analyzed. Data were collected on patient demographics, procedure indications, fluid collection size, stent characteristics, stent dwell time, and complications. All cases underwent multidisciplinary review with Surgery and Interventional Radiology (IR) prior to LAMS-assisted drainage; all were deemed not amenable to drainage by IR. Results: Eleven patients underwent EUS-guided drainage of complex pelvic abscesses with cautery-enhanced LAMS. Diverticulitis was the most common cause of abscesses (n = 6; 55%). The average time from presentation to drainage was 7 days (1–18). The average abscess size was 7.2 cm (3.9–12.0 cm). The most common LAMS size was 15 mm × 10 mm; each was placed through the left colon and rectum with both technical and clinical success. All abscesses completely resolved with a mean stent dwell time of 28 days (17–42 days). After stent removal, the fistula was not routinely closed. No complications such as stent migration, bleeding, or perforation occurred. There were no recurrences and no patients required additional surgical or IR procedures with a mean follow-up of 25 weeks (SD 35.6). Conclusions: Adequate drainage is the cornerstone of pelvic abscess management, but IR or surgical access can be challenging, with inadequate drainage and prolonged hospitalization leading to significant morbidity. In our experience, EUS-guided, LAMS-assisted drainage provides a safe and effective alternative for managing pelvic abscesses.

Enteral Feeding in Pediatric Patients: Principles and Techniques

AbstractApproximately 40 to 70% of children with chronic medical disease (congenital or acquired respiratory, cardiac, and gastrointestinal disorders) experience feeding difficulties. Enteral feeding in pediatric patients can be administered through orogastric, nasogastric, nasojejunal (NJ), gastrostomy (G) and gastrojejunostomy (GJ) tubes, all of which can be safely placed by the interventional radiologist. This article reviews NJ, G, and GJ tube placement and adjunctive techniques to ensure safe and effective enteral access placement. While feeding can also be performed via a jejunostomy tube, these are less common in children and are typically placed via a surgical approach and will not be discussed in this review. Dose reduction techniques, an important consideration in pediatrics, are also reviewed.

Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2024: imaging immediately after neoadjuvant therapy in soft tissue sarcoma, soft tissue tumor surveillance, and the role of interventional radiology.

An update of the first European Society of Musculoskeletal Radiology (ESSR) consensus on soft tissue tumor imaging in 2015 became necessary due to technical advancements, further insights into specific entities, and the revised WHO classification (2020) and AJCC staging system (2017). The third part of the revised guidelines covers algorithms and techniques beyond initial imaging: (1) Imaging after neoadjuvant therapy in soft tissue sarcoma, (2) sarcoma surveillance, and (3) special aspects, including surveillance of non-malignant entities and the role of interventional radiology. A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by level of agreement (0 to 10) during two iterative rounds that could result in either 'group consensus,' 'group agreement,' or 'lack of agreement.' The three sections contain 47 statements with comments. Group consensus was reached in 91.5%, group agreement in 6.4%, lack of agreement in 2.1%. In sarcoma, imaging immediately after neoadjuvant therapy is pivotal for determining the therapy effects and for resection-planning; surveillance should include imaging at fixed grade- and type-dependent intervals. In general, MRI is the method of choice for loco-regional surveillance of soft tissue sarcomas, and chest CT to assess metastatic disease. Interventional radiology has a role, especially in oligometastatic disease, palliative tumor control and local recurrences. Strategies for standardized soft tissue tumor imaging regarding therapy control, surveillance, and useful interventional procedures are provided. Question An ESSR consensus update on soft tissue tumor imaging regarding surveillance became necessary due to technical advancements, further entity-specific insights, and revised WHO- and AJCC-classifications. Findings Imaging immediately after neoadjuvant therapy in soft tissue sarcoma is pivotal. Post-therapeutic surveillance should include imaging at regular intervals, stratified for tumor grade and type. Clinical relevance The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability, both in individual patients and in future studies on individualized strategies.

Scapholunate advanced collapse of the wrist: a review

Background. Scapholunate advanced collapse (SLAC) is a common type of the wrist osteoarthritis. It is characterized by progressive deformity, instability and arthritis due to chronic dissociation of the scaphoid and lunate bones with chronic scapholunate interosseous ligament (SLIL) injuries. Quite often, in this pathology, it is difficult to alleviate the pain syndrome and preserve the range of motion. The aim of the review — based on the modern literature data, to analyse the concept and pathogenesis of scapholunate advanced collapse, current methods of radiological diagnosis and treatment modalities of the pathology. Methods. The search was performed in eLIBRARY and PubMed databases using the following keywords: scapholunate advanced collapse, SLAC, scapholunate instability, proximal row carpectomy. We selected 86 original articles and reviews out of 110 papers found. The selected ones reveal the issues of pathogenesis, radiological diagnosis and treatment of the pathology. Results. Scapholunate carpal collapse is secondary arthritis of the carpal bones resulting from rupture of the SLIL, which can be traumatic or non-traumatic. Conservative methods of the SLAC treatment can be used in the early stage of arthritis, but there is no data on their effectiveness in the world literature. Surgical treatment methods are varied, the choice depends on the clinical stage of the disease. Conclusions. The efficiency of conservative treatment modalities of the SLAC syndrome has not been proved yet. There is a plenty of surgical treatment methods and their modifications developed to alleviate the pain syndrome and preserve the motion and strength of the wrist grip as far as it is possible. However, the choice of the treatment method depending on the clinical stage of the disease is still problematic. For young active patients especially important is the development of adjuvant techniques aimed to increase the treatment efficiency. To date, there is accumulating evidence of successful use of pyrocarbon implants and arthroscopy techniques in the wrist surgery.

Inferior medial genicular artery pseudoaneurysm after primary total knee arthroplasty: a case report

Background. Small genicular vessel injuries during primary total knee arthroplasty can pass unnoticed during the surgery and present late postoperatively. Case description. We present a 65-year-old female patient, who was admitted three weeks after primary total knee arthroplasty with fresh bleeding from the lower end of the surgical wound. CT angiography showed a pseudoaneurysm of the inferior medial genicular artery which was treated at the same session by coil embolization. Conclusions. A pseudoaneurysm of the inferior medial genicular artery can complicate primary total knee arthroplasty. An interventional radiologist assistance is necessary for diagnosis and management.

Risk factors and comorbidities associated with cardiac arrests and medical emergencies in interventional radiology patients

PurposeTo investigate the incidence, predictors, and outcomes of medical emergencies in patients undergoing IR procedures at a tertiary care center.Materials and methodsSeven-year retrospective review of all medical emergencies in patients undergoing IR procedures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Medical emergencies included Cardiopulmonary arrest (CPA), or emergencies that required activation of the critical care response team (CCRT). Variables included demographics, procedure details and outcome data including complications and 30-day mortality. Multivariate logistic regression analysis was conducted to identify independent predictors of CPA and 30-day mortality.ResultsNinety-four patients (50% male) were included with a median age of 60.5 years. Recent or current ICU admission was recorded in 39 patients (43.8%). Comorbidities included diabetes (50%), hypertension (59.6%), coronary artery disease (25.5%), heart failure (21.5%), ESRD (28.7%), active infection 28 (31%), with ASA3 in 64 patients (68%) and ASA4 in 23 (24.5%).The incidence of CPA and CCRT activation was 0.045% and 0.049%, respectively, among 100,000 patients who underwent IR procedures during the study period. Half the events were with venous procedures, followed by non-vascular (33%) and arterial procedures (10.6%). 30-day mortality was 30.5%. Independent predictors of CPA included pulmonary disease (aOR 16.79, 95% CI 2.334–195.3, p = 0.0097), emergency procedures (aOR 11.63, 95% CI 2.517–72.46, p = 0.0035), general anesthesia (aOR 19.41, 95% CI 1.854–491.8, p = 0.0254), and sedation (aOR 13.04, 95% CI 2.081–118.8, p = 0.0108). Predictors of 30-day mortality were CPA (aOR 9.830, 95% CI 2.439–66.66, p = 0.0045) and hypotension as a complication (aOR 16.81, 95% CI 3.766–122.3, p = 0.0009).ConclusionOur findings highlight the complexity of patients undergoing IR procedures and the importance of identifying high-risk patients to prevent adverse events in the IR setting.

Interventional radiology- Training and career opportunities

Interventional radiology- Training and career opportunities

Robust solutions via optimisation and predictive process monitoring for the scheduling of the interventional radiology procedures

AbstractInterventional radiology (IR) is an increasingly used medical specialty relying on the possibilities offered by medical imaging guidance technologies to perform minimally invasive procedures (both diagnostic and therapeutic) through very small incisions or body orifices. Although the operative context is quite similar to that of the classical operating room (OR) literature, to the best of our knowledge management problems arising in the IR operative context never appeared in the healthcare management literature. This is even more true for studies that combine the OR approach with automatic extraction of information from real hospital health record data as in the present study. Two specific features characterise our case study with respect to the traditional OR literature: due to the Italian legislation, the anaesthetist (usually in a very limited number) must be present for the entire duration of the procedure (), and the IR does not have its own ward but receives inpatients from different wards (). The aim of this paper is to introduce a novel approach to determine a robust solution for our case study problem addressing both features and . Our approach is based on the interplay between optimisation and predictive process monitoring (PPM) models. The obtained results show that the proposed approach produces schedules that achieve higher usage rate, lower overtime and more patients operated on than the original schedule. We also show that the integration of PPM models within the optimisation workflow improves the quality of the output schedule with respect to the standard one‐shot optimisation.

Intracerebral arterial blood pressure in the vasculature distal to large vessel occlusions in patients with ischemic stroke: correlation with clinical and imaging parameters

IntroductionMechanical thrombectomy is a highly effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusions (LVO). However, our understanding of the pathophysiology of AIS is still limited, particularly...

Association of anaesthesia-directed sedation with unplanned discharge to a nursing home following non-ambulatory interventional radiology and endoscopic procedures: a retrospective cohort study.

Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation. We studied adult patients who previously lived independently and underwent a non-ambulatory interventional radiology or gastroenterology procedure under anaesthetist-directed or non-anaesthetist-directed sedation at a large healthcare network. The primary outcomes were postprocedural adverse discharge to a nursing home and postprocedural duration of hospital stay. Among 22,868 patients included, 15,168 (66.3%) and 7700 (33.7%) underwent anaesthetist-directed sedation and non-anaesthetist-directed sedation, respectively. Of all patients receiving anaesthetist-directed sedation, 9.2% experienced adverse discharge to a nursing home compared with 21.3% undergoing non-anaesthetist-directed sedation. Anaesthetist-directed sedation was associated with reduced risk of adverse discharge to a nursing home (adjusted relative risk 0.54, 95%CI 0.45-0.63, p < 0.001, adjusted risk difference -4.6%, 95%CI -5.8 to -3.4, p < 0.001) and a shorter postprocedural duration of hospital stay (median (IQR [range]) 2 (1-6 [0-315]) days vs. 5 (2-12 [0-268]) days; adjusted model estimate 0.84, 95%CI 0.79-0.89, p < 0.001). The lower risk of adverse discharge to a nursing home and shorter duration of hospital stay in patients undergoing anaesthetist-directed sedation was reproduced in an instrumental variable analysis (adjusted risk difference -4.3%, 95%CI -8.4 to -0.1, p = 0.043; and -1.41 days, 95%CI -1.43 to -1.41 days, p < 0.001, respectively). Among patients undergoing anaesthetist-directed sedation the mean (SD) proportion of missing blood pressure measurements was lower (0.7 (4.9) % vs. 8.0 (14.6) %, p < 0.001), which mediated the effect of anaesthetist-directed sedation on adverse discharge. Among patients undergoing a non-ambulatory interventional radiology procedure or a gastrointestinal endoscopy, anaesthetist-directed sedation is associated with a reduced risk of adverse discharge to a nursing home and a shorter duration of hospital stay.

Complications in interventional radiology: early detection and effective intervention strategies.

This narrative review provides a comprehensive overview of complications in interventional radiology (IR), focusing on their aetiology, recognition, and management. As IR procedures continue to evolve and expand, understanding potential adverse events is crucial for improving patient safety and outcomes. The review will summarise various common complications associated with IR-based procedures, including their presentation, aetiology, and management. By consolidating current knowledge on these issues, the review offers valuable insights into minimising risks and enhancing procedural success. This synthesis will aid practitioners' knowledge and ultimately try and ensure safer IR practices and aftercare of patients.

Assessment of external occupational exposure of radiation workers in Jiangsu Province, 2019-2022.

This article analyzes the external occupational radiation exposure distribution and trends among radiation workers in Jiangsu Province. The results show that the total annual collective effective dose for radiation workers in Jiangsu Province from 2019 to 2022 was 24.82 person·Sv, with an average annual effective dose of 0.34mSv over the 4-y period. The average annual effective dose exhibited an initial increase followed by a subsequent decrease, with statistically significant differences (P<.001) between different years. In the medical uses, nuclear medicine and interventional radiology had higher average annual effective doses compared to other categories, at 0.42 and 0.38mSv, respectively (P<.05). In industrial applications, accelerator operation and industrial testing workers had higher average annual effective doses compared to others, at 0.32 and 0.31mSv, respectively (P<.001). Among different levels of medical institutions, secondary hospitals had the highest average annual effective dose (0.38mSv, P<.001). Overall, the average annual effective dose for radiation workers in Jiangsu Province remained relatively low from 2019 to 2022, meeting national standards. However, special attention should still be given to radiation workers in nuclear medicine, interventional radiology, industrial testing, and accelerator operation.

Reliability of a portable toe pressure photoplethysmography device compared to a stationary laser doppler flowmeter.

The study aimed to investigate the reliability of a portable toe pressure (TP) photoplethysmography device (PPG) by comparing it to a stationary laser Doppler flowmeter (LD) used in the Helsinki University Hospital. The study evaluated if lower limb arterial circulation could be reliably evaluated with the portable PPG which is more affordable and mobile than the stationary LD. TPs were measured from 102 toes of 54 patients in the vascular surgery outpatient clinic, vascular surgery ward and interventional radiology recovery ward of Helsinki University Hospital. According to the study protocol TPs were measured twice with the PPG device. If the difference between the values was over 10 mmHg, a third measurement was done and two of the closest values were selected for the final analysis. The lowest value displayed by the PPG device was 30 mmHg. Lower than 30 mmHg values were reported as 25 mmHg in the analysis. The repeatability and reliability of the PPG measurements were compared to the LD with Bland Altman plots. Most patients had rest pain (n = 29) or claudication (n = 9). Prior to TP measurement, 24 patients had undergone lower limb revascularization through either a hybrid (n = 3), open (n = 10) or endovascular (n = 11) procedure. The mean absolute difference between PPG and LD measurement values was 15 mmHg (95% confidence interval 12-18 mmHg). 87.5% of lower limbs with significant arterial insufficiency (TP <60 mmHg with LD, n = 49) had a PPG measurement value of <60 mmHg. Conversely, 84.8% of lower limbs that did not exceed the ischemia criterion of TP ≥60 mmHg with LD had a PPG measurement value of ≥60 mmHg. Mean absolute difference of two consecutive PPG measurement values was 4 mmHg (95% CI 3-5 mmHg). The PPG device is a light and affordable option for the assessment of lower limb arterial circulation in primary health care. It is moderately reliable to exclude significant lower limb arterial insufficiency and may reduce unnecessary referrals to the vascular surgery clinic. The repeatability of the PPG device is satisfactory. However, it requires training to use, and the results must always be interpreted with consideration for the patient's clinical status.

Current Status of the clinical role in Spanish interventional radiology: An online survey among the Spanish Society of Vascular and Interventional Radiology (SERVEI) members

PurposeThis work aims to provide an overview of the current reality of clinical practice in interventional radiology in Spain, evaluating clinical activity, interventional radiologists’ opinion on the importance of playing a proactive clinical role, and the barriers they encounter in doing so. Materials and MethodsThe study was based on an 18-question survey divided into four categories: general aspects, clinical activity, opinion on a proactive clinical role, and barriers. The questionnaire, validated by the Spanish Society of Vascular and Interventional Radiology (SERVEI), was distributed to all members (n = 483) via email. A descriptive statistical analysis was performed. ResultsThe response rate was 26.5% (128/483). A total of 44.5% (57/128) had admitting privileges, 70.3% (90/128) had consultations, 32.8% (42/128) did ward rounds, and 94.5% (121/128) participated in multidisciplinary committees. Most spent just 0%–10% of their workday on clinical activity. A total of 43.7% (56/128) reported providing longitudinal care for their patients. On a Likert scale from 1 to 10, the importance of performing pre-procedural consultations was rated a mean of 8.3 (IQR: 10–8), post-procedural consultations 8.1 (IQR: 10–7), and care during hospitalization 7.7 (IQR: 10–6). The main obstacles were a lack of time/excessive workload and inadequate professional resources. ConclusionsSpanish interventional radiologists demonstrated a clear awareness of the importance of providing longitudinal patient care. However, they reported only partially taking on the clinical responsibilities for the patients they treated.

A setup for live AI support in interventional radiology

Abstract Artificial intelligence (AI) has the potential to support time-critical stroke treatment. In a previous study we demonstrated the feasibility of deep learning based automatic classification for thrombus detection during thrombectomies, a catheter-guided procedure to remove occlusions of cerebral vessels. However, this method has yet to be tested during a live intervention. In this work, we present a setup to integrate AI based support in an angiography suite. A classification PC was connected to the angiography by means of a real-time video connection as well as a research interface for control signals. We found that video conversion in real-time does not affect the classification result in comparison to offline classification of DICOM data. Analyzing 50 video streams of previous cases, the system could classify digital-subtraction angiography (DSA) sequences within 13.3 seconds on average. This processing time can further be reduced to an average of 7.9 seconds with GPU acceleration. Additionally, the system successfully classified two DSA sequences acquired during live thrombectomy, identifying the presence of thrombi in less than 5 seconds. So far, the classification result has only been displayed in the control room of the angiography suite to demonstrate feasibility. In the outlook, however, we also discuss how the result can be displayed directly on the angiography screen.

Management of Placenta Previa in a Jehovah's Witness Patient.

Placenta previa is the partial or complete covering of the internal os of cervix. It is one of the major risk factors for postpartum hemorrhage (PPH), maternal and neonatal morbidity and mortality. A 36-year-old G3P2 Jehovah's Witness female with a gestational age of 36 weeks 6 days and past medical history of chronic hypertension, T2DM, asthma, and past obstetric history of two cesarean sections, large for gestational age babies, and postpartum hemorrhage due to uterine atony, underwent an elective repeat low transverse cesarean section in view of posterior complete placenta previa, complicated by massive postpartum hemorrhage. The patient was immediately transported to the interventional radiology (IR) for uterine artery embolization (UAE) after unsuccessful treatment attempts with uterotonics and JADA system (vacuum induced uterine tamponade). In view of rapidly progressing bleeding, the decision was made for an urgent hysterectomy. Management of postpartum hemorrhage in a Jehovah's Witness patient is particularly complex as these patients refuse administration of blood products and involves medical, ethical, and legal implications.

Ossifying fibroma and juvenile ossifying fibroma: A systematic review on clinical and radiological parameters, treatment modalities and recurrence

Ossifying fibroma (OF) is a rare benign fibro-osseous neoplasm developing mostly in maxillo-facial bones. OF is divided in cemento-ossifying fibroma (COF), juvenile trabecular ossifying fibroma (JTOF) and psammomatoid ossifying fibroma (PSOF). The aim of this systematic review was to synthetize the existing literature on OF, investigating the clinical and radiological parameters related to the different forms of the disease, and to compare the treatment modalities according to their associated recurrence rate. Three databases were searched in March 2024, with an update in September 2024. Eligibility criteria included studies reporting on patients with OF, surgical treatment and follow-up data. Of the 2016 studies identified, 22 were retained after eligibility assessment. A total of 492 patients were included. Most OF presented with painless swelling. COF affected 61.1% of women with a mean age of 29.5, JTOF presented in 55.7% of male children, and PSOF had no predilection for sex with a mean age of 19.5 years. Enucleation and curettage were associated with an elevated recurrence rate in JTOF (12/30) and PSOF (10/16). PSOF (6 cases) and JTOF (15 cases) showed no recurrence with radical surgery. Same recurrence rates in COF were seen for conservative and radical surgery. Although radical surgery seemed to avoid recurrence in JTOF and PSOF, conservative surgery such as enucleation and curettage with additional peripheral ostectomy should be considered primarily to lessen the morbidity induced by radical resection. Close clinical and radiological follow-up should be undertaken to diagnose early recurrence.

Relevance of peripheral inflammation indexes in different collateral circulation for intracranial hemorrhage in acute anterior circulation ischemic stroke patients undergoing endovascular treatment.

Asymptomatic intracranial hemorrhage (aICH) is common after endovascular thrombectomy (EVT). Collateral circulation could modify the association between aICH with functional outcome and we aimed to investigate the impact of systemic inflammation index on 3-month outcome under different collateral circulation. Consecutive patients undertaken EVT were enrolled and classified into non-intracranial hemorrhage (non-ICH), aICH and symptomatic intracranial hemorrhage (sICH) groups according to the neurological status and National Institutes of Health Stroke Scale (NIHSS) changes within 72 hours after EVT. Preoperative collateral status was scored using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Clinical data were collected and analyzed according to the stratification of collateral stratification. Multivariate regression models were constructed to evaluate the influence of systemic inflammation indexes and collateral status on functional outcome. Of 302 patients, 86 (28.5%) developed aICH with 36(11.9%) sICH. Compared to non-ICH patients, there was a significant trend towards higher proportion of poor collateral circulation in patients with aICH, sICH (47.8% vs. 67.2% vs. 94.4%, p <0.001). Spearman's correlation analysis revealed a significant negative correlation of peripheral neutrophil counts, NLR, and SIRI with collateral circulation score. Under poor collateral circulation, neutrophil counts showed a significant positive association with sICH (OR 1.20, 95%CI: 1.07-1.35, p=0.002), but not with aICH. Under good collateral circulation, the inflammation indexes did not show a significant correlation with either ICH. aICH patients with good collateral circulation have good functional outcome comparable to no-ICH patients. Under poor collateral circulation, elevated neutrophil counts may contribute to the conversion from aICH to sICH. Tailored anti-inflammatory therapy has potential to improve the efficacy and safety of EVT.

Impact of the COVID-19 pandemic on diagnostic breast biopsies: a retrospective comparative study

Aims: The purpose of this study is to evaluate and compare the quantity and pathological outcomes of diagnostic breast biopsy procedures performed in our interventional radiology unit before, during, and after the COVID-19 pandemic. This study aims to examine the influence of the COVID-19 pandemic on the quantity of biopsies performed and the rates of detecting malignancies during different time periods. Methods: This retrospective study examined 365 patients who underwent diagnostic breast biopsies between January 2019 and January 2023. The study was approved by the hospital's ethics committee. After excluding 19 patients with inconclusive pathology results, a total of 346 patients were analyzed. Biopsies were performed utilizing 14-18 G tru-cut needles with the assistance of ultrasound guidance. Patients were classified into the following periods: pre-pandemic, pandemic, and post-pandemic. The histopathological findings were categorized as either benign or malignant. Statistical comparisons were conducted using the SPSS software, and a significance level of p&lt;0.05 was used. Results: The average age of the patients was 53.7 ± 15.7 years. Out of the total of 346 biopsies, 165 (47.7%) were determined to be malignant, while 177 (51.2%) were found to be benign. The distribution of biopsies was as follows: 76 (22.0%) were conducted before the pandemic, 13 (3.8%) were conducted during the pandemic, and 257 (74.3%) were conducted after the pandemic. There was a substantial decline in the number of biopsies during the pandemic compared to before the pandemic, and a significant rise in the post-pandemic period compared to both the pandemic and pre-pandemic periods (p=0.024 and p=0.041, respectively). The incidence of malignancies during the post-pandemic period was significantly greater compared to both the pre-pandemic period (p=0.045) and the pandemic period (p=0.027). Conclusion: The COVID-19 pandemic caused substantial disruptions in breast cancer diagnostics, as indicated by a decrease in the number of biopsies performed and delays in the detection of malignancies. Following the pandemic, there was a significant rise in the incidence of malignancies, which can be attributed to the delays in diagnosing and treating these conditions during the pandemic. These findings indicate the significance for stronger healthcare strategies to reduce the effects of future crises on cancer management.