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1.
Cancer Gene Ther ; 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155611

RESUMO

Effective chimeric antigen receptor-modified T-cell (CAR-T) therapy for liver metastases (LM) will require innovative solutions to ensure efficient delivery and minimization of systemic toxicity. We previously demonstrated the safety of CAR-T hepatic artery infusions (HAI). We subsequently conducted the phase 1b HITM-SIR trial, in which six patients (pts) with CEA+ LM received anti-CEA CAR-T HAIs and selective internal radiation therapy (SIRT). The primary endpoint was safety with secondary assessments of biologic activity. Enrolled pts had a mean LM size of 6.4 cm, 4 pts had >10 LM, and pts received an average of two lines of prior systemic therapy. No grade 4 or 5 toxicities were observed, and there were no instances of severe cytokine-release syndrome (CRS) or neurotoxicity. The mean transduction efficiency was 60.4%. Following CAR-T HAI, reduced levels of GM-CSF-R, IDO, and PD-L1 were detected in LM, and serum CEA levels were stable or decreased in all subjects. Median survival time was 8 months (mean 11, range 4-31). Anti-CEA CAR-T HAI with subsequent SIRT was well tolerated, and biologic responses were demonstrated following failure of conventional therapy. HAI of CAR-T was once again confirmed not to be associated with severe CRS or neurotoxicity.

3.
AJR Am J Roentgenol ; 207(1): 170-6, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27101433

RESUMO

OBJECTIVE: The objective of the study was to determine if time to positive (TTP), defined as the time from the start of (99m)Tc-labeled RBC scanning to the appearance of a radionuclide blush (considered to be a positive finding for acute lower gastrointestinal bleeding [LGIB]), and lag time (LT), defined as the time from the appearance of a radionuclide blush to the start of catheter angiography (CA), affected the yield of CA for the detection of acute LGIB. MATERIALS AND METHODS: TTP and LT were retrospectively evaluated in 120 patients who had positive findings for acute LGIB on (99m)Tc-labeled RBC scanning and subsequently underwent CA for the diagnosis and localization of gastrointestinal bleeding. Two nuclear medicine fellowship-trained radiologists independently reviewed the (99m)Tc-labeled RBC scans. Two fellowship-trained interventional radiologists independently reviewed the angiograms. All data were analyzed using SAS software. RESULTS: When a TTP threshold of ≤ 9 minutes was used, the sensitivity, specificity, positive predictive value, and negative predictive value for a positive CA study were 92%, 35%, 27%, and 94%, respectively. In addition, the odds of detecting bleeding on CA increased 6.1-fold with a TTP of ≤ 9 minutes relative to a TTP of > 9 minutes (p = 0.020). A significant inverse relationship was found between LT and a positive CA study (p = 0.041). CONCLUSION: TTP and LT impact the rate of positive CA studies. A TTP threshold of ≤ 9 minutes allows the detection of almost all patients who would benefit from CA for treatment and allows a reduction in unnecessary negative CA studies. The likelihood of positive findings on CA decreases with a delay in the performance of CA.


Assuntos
Hemorragia Gastrointestinal/diagnóstico por imagem , Cintilografia/métodos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Angiografia , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Sensibilidade e Especificidade , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Fatores de Tempo
4.
Clin Imaging ; 39(5): 759-64, 2015 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25709111

RESUMO

We conducted a pooled analysis of clinical trials comparing intravenous Fenoldopam (FP) with Saline/Placebo/N-acetyl cysteine (NAC) for the prevention of contrast-induced nephropathy (CIN). Five studies were eligible. Quantitative analyses were done with Review Manager (RevMan version 5.2.). A total of 85 out of 353 patients in Fenoldopam group while 73 among 366 in the control group were affected due to CIN. The risk ratio for the development of CIN in the Fenoldopam group was 1.19 compared to the control group. This was not statistically significant. Fenoldopam is no better than Placebo/Saline or NAC in preventing CIN, but more studies are required.


Assuntos
Meios de Contraste/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Fenoldopam/uso terapêutico , Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Humanos
6.
Cardiovasc Intervent Radiol ; 36(3): 567-77, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23483284

RESUMO

PURPOSE: To establish the efficacy and safety of the preclose technique in total percutaneous endovascular aortic repair (PEVAR). METHODS: A systematic literature search of Medline database was conducted for series on PEVAR published between January 1999 and January 2012. RESULTS: Thirty-six articles comprising 2,257 patients and 3,606 arterial accesses were included. Anatomical criteria used to exclude patients from undergoing PEVAR were not uniform across all series. The technical success rate was 94 % per arterial access. Failure was unilateral in the majority (93 %) of the 133 failed PEVAR cases. The groin complication rate in PEVAR was 3.6 %; a minority (1.6 %) of these groin complications required open surgery. The groin complication rate in failed PEVAR cases converted to groin cutdown was 6.1 %. A significantly higher technical success rate was achieved when arterial access was performed via ultrasound guidance. Technical failure rate was significantly higher with larger sheath size (≥20F). CONCLUSION: The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk.


Assuntos
Aneurisma Aórtico/cirurgia , Procedimentos Endovasculares , Implante de Prótese Vascular/métodos , Humanos , Complicações Pós-Operatórias , Fatores de Risco
7.
Semin Intervent Radiol ; 30(3): 225-33, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24436543

RESUMO

Neuroangiography (NA) is an important part of diagnosis and treatment of patients with neurological disease. Although NA may be performed for diagnostic purposes, in many instances NA is performed with the intent to treat. Indications for NA range from extracranial diseases (vertebrobasilar insufficiency from subclavian steal, extracranial carotid stenosis, cavernous-carotid fistula, neck trauma, epistaxis, tumor invasion of the carotid artery, and tumor embolization) to intracranial diseases (nontraumatic subarachnoid hemorrhage, cerebral aneurysms, cerebral arteriovenous malformations, cerebral vasospasm, acute stroke, tumor embolization, and WADA test). Similar to peripheral angiography, appropriate preprocedural assessment and postprocedural care, along with understanding of anatomy, catheter technique, and disease processes, are vital to successful outcomes. This article will review the basic technique, equipment, and patient management in NA. With appropriate skill and knowledge, interventional radiologists can perform NA with safe and successful results.

8.
Semin Intervent Radiol ; 30(3): 234-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24436544

RESUMO

This article is intended to provide a review of clinically relevant neurovascular anatomy. A solid understanding of the vascular anatomy of the brain and spine are essential for the safe and effective performance of neurointerventional radiology. Key concepts to master include collateral pathways and anastomoses between the external and internal carotid circulation, the Circle of Willis as a route to otherwise inaccessible intracranial vascular distributions, and the origin of spinal arterial blood supply. These concepts will be highlighted using clinical angiographic examples with discussion of relevant embryology and pathology as needed.

9.
Semin Intervent Radiol ; 30(3): 278-81, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24436549

RESUMO

Metastases to the vertebral column are often due to hypervascular primary tumors, the most common of which is renal cell carcinoma. Clinical symptoms attributed to vertebral body metastases include localized pain, mechanical instability of the vertebral column, and neurologic deficits resulting from mass effect. Treatment options include targeted radiotherapy, percutaneous vertebral augmentation with or without thermal ablation, and surgical resection with subsequent fusion. Overall, surgical resection of the tumor and stabilization of the vertebral column provide the best prognosis for the patient in terms of symptomatic improvement and long-term survival; however, resection of hypervascular vertebral body metastases can result in significant intraoperative blood loss that can add to the morbidity of the procedure. Preoperative embolization of hypervascular metastases of the vertebral column has been shown to significantly reduce intraoperative blood loss at the time of surgery. The goal of this manuscript is to describe the role of embolization therapy in the management of patients with vertebral body metastases.

10.
Semin Intervent Radiol ; 30(3): 282-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24436550

RESUMO

Acute ischemic stroke is a leading cause of death and the leading cause of disability in the United States. Cerebral neuronal death begins within minutes after threshold values of blood oxygen saturation are crossed. Prompt restoration of oxygenated blood flow into ischemic tissue remains the common goal of reperfusion strategies. This article provides a brief overview of acute ischemic stroke, a summary of the major intra-arterial stroke therapy trials, and comments on current training requirements for the performance of intra-arterial therapies.

11.
Semin Intervent Radiol ; 30(3): 288-96, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24436551

RESUMO

Stroke is the fourth leading cause of death and the number one cause of long-term disability in the United States. Carotid stenosis is an important cause of ischemic strokes, accounting for 20 to 25%. Previous studies have established carotid endarterectomy as standard of care of symptomatic patients with > 50% stenosis and asymptomatic patients with > 60% stenosis; recently, carotid artery stenting has emerged as an alternative treatment for carotid stenosis. Several studies have been published comparing carotid artery stenting with endarterectomy with mixed results. In this article, the authors discuss carotid artery stenting technique, the results from the most recent trials, and future directions.

12.
Semin Intervent Radiol ; 30(3): 307-17, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24436553

RESUMO

Chronic low back pain is a common clinical condition. Percutaneous fluoroscopic-guided interventions are safe and effective procedures for the management of chronic low back pain, which can be performed in an outpatient setting. Interventional radiologists already possess the technical skills necessary to perform these interventions effectively so that they may be incorporated into a busy outpatient practice. This article provides a basic approach to the evaluation of patients with low back pain, as well as a review of techniques used to perform the most common interventions using fluoroscopic guidance.

13.
J Vasc Interv Radiol ; 23(9): 1125-34; quiz 1134, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22920976

RESUMO

Transluminal ablation of renal artery sympathetic nerves has been shown to provide a significant and durable reduction in blood pressure with very low complication rates. Additional publications have documented improvement in insulin sensitivity, obstructive sleep apnea indices, and frequency and severity of congestive heart failure in subgroups undergoing the procedure. This technology may provide effective management of other diseases in which there is autonomic imbalance. Available data are reviewed with the intent to provoke interest within the interventional radiology community in this novel technology, which may allow minimally invasive treatment of many important chronic medical conditions.


Assuntos
Ablação por Cateter , Hipertensão/cirurgia , Artéria Renal/inervação , Simpatectomia/métodos , Animais , Aterosclerose/fisiopatologia , Aterosclerose/cirurgia , Pressão Sanguínea , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/cirurgia , Dislipidemias/fisiopatologia , Dislipidemias/cirurgia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Hipertensão/fisiopatologia , Resistência à Insulina , Obesidade/fisiopatologia , Obesidade/cirurgia , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/cirurgia , Resultado do Tratamento
14.
J Neurointerv Surg ; 3(3): 246-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21990835

RESUMO

BACKGROUND AND PURPOSE: The clinical benefits of intra-arterial thrombolysis for ischemic stroke must be weighed against the risks, including hemorrhagic conversion. SUMMARY OF CASE: A case of angiographically documented hemorrhagic conversion of an ischemic stroke during intra-arterial thrombolysis is presented. Discussion focuses on recognition and management of risk factors for hemorrhagic conversion during performance of stroke thrombolysis. CONCLUSIONS: Recognition and modification of risk factors for hemorrhagic conversion may not prevent this complication during stroke thrombolysis. Identification of the angiographic appearance of hemorrhagic conversion should alert the interventionalist to the likelihood of a poor clinical outcome regardless of vessel patency status.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Terapia Trombolítica/efeitos adversos , Idoso , Angiografia Digital , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X
16.
AJR Am J Roentgenol ; 196(4): W387-93, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21427301

RESUMO

OBJECTIVE: This study aims to evaluate the prevalence, nature, and clinical significance of noncardiac findings (NCFs) at cardiac MRI. MATERIALS AND METHODS: We retrospectively reviewed 240 consecutive, clinically indicated cardiac MRI examinations conducted over a 21-month period. All noncardiac findings (NCFs) were recorded. Those findings that were included in the report impressions were regarded as clinically important (INCF). Electronic medical records and related imaging studies were then reviewed for all patients having INCFs to determine their actual clinical significance. A finding was significant (SNCF) if it was associated with a new diagnosis, treatment, or intervention. The prevalences of findings in the neck, chest, and abdomen were determined. RESULTS: We found 162 NCFs in 104 studies (43%), of which 94 (58%) were INCFs, and 16 (10%) were SNCFs. There was at least one INCF in 65 studies (27%)--67% of which were new--and at least one SNCF in 13 studies (5%). Compared with younger patients, patients 60 years and older were much more likely to have INCFs (43% vs 17%) and SNCFs (12% vs 1%). Overall, 29% of NCFs were in the abdomen, 70% in the chest, and 1% in the neck. The most common INCFs were pleural effusion (n = 26), air-space disease or atelectasis (n = 13), and adenopathy (n = 9). Five new cases of cancer were diagnosed, including lung (n = 2), lymphoma (n = 2), and thyroid (n = 1). CONCLUSION: NCFs are commonly encountered on cardiac MRI studies, many of which are clinically relevant. Proper recognition of NCFs is critical to the comprehensive management of patients referred for cardiac MRI.


Assuntos
Doenças Cardiovasculares/diagnóstico , Achados Incidentais , Imagem por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
17.
Cardiovasc Intervent Radiol ; 34(3): 536-41, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20556384

RESUMO

The design of laser fibers used for endovenous laser ablation (EVLA) in the management of lower-extremity varicose vein disease may affect treatment success. The purpose of this investigation is to report our experience using the gold-tip NeverTouch VenaCure laser fiber (AngioDynamics, Queensbury, NY) and to compare that to our experience with standard bare-tip fibers. A retrospective chart review of 363 consecutive EVLA treatments using the gold-tip laser fiber was performed. Demographic data including patient age, sex, history of previous varicose vein stripping, vein identity, laterality, treatment length, total applied energy in joules (J), use of adjuvant sclerotherapy and ambulatory phlebectomy, treatment-related complications, and treatment failure, which was defined as recanalization of any portion of the treated vein during follow-up as assessed by duplex ultrasound examination-were entered into a spreadsheet. These data were compared with a control group of 471 EVLA treatments performed with a standard bare-tip laser fiber. Data were analyzed using independent-samples Student's t test, chi-square test, and multivariate analysis. Demographic data were similar between the two groups. Treatments with the gold-tip fiber had a failure rate of 11.1%, whereas treatment with a bare-tip fiber had a failure rate of 2.3% during a similar follow-up period. This difference was highly statistically significant (p<0.0001). Multivariate analysis showed fiber type as the most significant factor associated with treatment failure. We conclude that laser fiber design has a significant effect on treatment success in the performance of EVLA.


Assuntos
Terapia a Laser/instrumentação , Perna (Membro)/irrigação sanguínea , Veia Safena , Varizes/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Desenho de Equipamento , Feminino , Humanos , Terapia a Laser/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estudos Retrospectivos , Escleroterapia , Falha de Tratamento , Resultado do Tratamento
18.
J Vasc Interv Radiol ; 21(11): 1755-9, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20888785

RESUMO

Conventional endovascular therapy for acute ischemic stroke includes intraarterial pharmacologic thrombolysis with tissue plasminogen activator (TPA) administration with or without mechanical thrombectomy with a variety of devices. The present report describes two cases of stroke refractory to TPA administration in which successful recanalization was accomplished by the use of a self-expanding intracranial stent. Stent-assisted recanalization may be a viable option for patients with acute ischemic stroke refractory to thrombolysis or thrombectomy.


Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares/instrumentação , Stents , Acidente Vascular Cerebral/terapia , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
20.
J Vasc Interv Radiol ; 19(10): 1449-53, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18760628

RESUMO

PURPOSE: To assess the relationship between energy density and the success of endovenous laser ablation (EVLA) treatment. MATERIALS AND METHODS: A total of 586 EVLAs were performed in a period of 35 months. Retrospective chart review was performed, and data collected included the patients' age, sex, and history of venous stripping procedures, as well as the name, laterality, and length of the treated vein segment(s) and the total energy delivered. Energy density was calculated by dividing total energy delivered (in J) by the length of vein (in cm). Energy density selection was based on the treating interventionalist's preference. Ablated segments were grouped into those treated with less than 60 J/cm, 60-80 J/cm, 81-100 J/cm, and more than 100 J/cm. Failure of EVLA was defined by recanalization of any portion of the treated vein during follow-up as assessed by duplex Doppler ultrasound examination. Failure rates were compared with the chi(2) test and Wilcoxon rank-sum test. RESULTS: A total of 471 segments were included in the analysis with an average follow-up period of 5 months (range, 0.2-28.7 months). Overall, 11 failures were encountered, including four in the group treated with less than 60 J/cm (n = 109; 4%), two in the 60-80-J/cm group (n = 77; 3%), four in the 81-100-J/cm group (n = 169; 3%), and one in the group treated with more than 100 J/cm (n = 116; 1%). There was no statistically significant difference in failure rates among energy density ranges. CONCLUSION: EVLA has a low failure rate that is not affected by energy density.


Assuntos
Terapia a Laser/métodos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Humanos , Pessoa de Meia-Idade , Doses de Radiação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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