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Mizandari M, Gotsiridze E, Keshavarz P, Nezami N, Azrumelashvili T, Nejati SF, Habib N, Chiang J, Raman SS. Endoportal Radiofrequency Ablation and Stent Placement in Patients with Portal Vein Tumor Thrombosis from Hepatocellular Carcinoma: A Study on Feasibility and Safety. J Clin Med 2024; 13:2128. [PMID: 38610893 PMCID: PMC11012252 DOI: 10.3390/jcm13072128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer, with 10-40% of cases involving portal vein tumor thrombosis (PVTT), leading to poor outcomes and a short survival. The effectiveness of PVTT treatment in patients with HCC is still controversial. Methods: This prospective dual-center study cohort comprised 60 patients with HCC and PVTT who underwent PVR-EPRFA-ST using a novel intravascular radiofrequency system followed by vascular stent placement across the PVTT stenosed segment under fluoroscopy guidance. Results: PVR-EPRFA-ST was technically and clinically successful in 54/60 (90%) and 37/54 (68.5%) patients, respectively. The mean tumor size, PVTT length, post-ablation luminal diameter, and median duration of the recanalized PV patency were 8.6 ± 3.4 cm, 4.1 ± 2.1 cm, 10.3 ± 1.8 mm, and 13.4 months. Higher technical and clinical success rates were associated with a longer survival (177 ± 17.3 days, HR: 0.3, 95%CI 0.12-0.71, p = 0.04; and 233 ± 18.3 days, HR: 0.14, 0.07-0.27, p < 0.001). A shorter survival was associated with Child-Pugh C (HR: 2.7, p = 0.04), multiple tumors (HR: 1.81, p = 0.03), and PVTT length (HR: 1.16, p = 0.04). Conclusions: PVR-EPRFA-ST was feasible and effective for the treatment of selected patients with PVTT, especially in patients with Child-Pugh A/B, single tumors, or a shorter PVTT length.
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Affiliation(s)
- Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals, Tbilisi 0114, Georgia
| | - Elene Gotsiridze
- Department of Diagnostic & Interventional Radiology, New Hospitals, Tbilisi 0114, Georgia
| | - Pedram Keshavarz
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 10833, USA
- School of Science and Technology, The University of Georgia, Tbilisi 0114, Georgia
| | - Nariman Nezami
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
- Georgetown University School of Medicine, Washington, DC 20007, USA
- Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA
- The Fischell Department of Bioengineering, University of Maryland College Park, College Park, MD 20742, USA
| | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals, Tbilisi 0114, Georgia
| | - Seyed Faraz Nejati
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Nagy Habib
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
| | - Jason Chiang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 10833, USA
| | - Steven S. Raman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 10833, USA
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A novel technique of pulmonary artery banding by means of radiofrequency ablation: An experimental study in rabbits. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:327-333. [PMID: 36303698 PMCID: PMC9580298 DOI: 10.5606/tgkdc.dergisi.2022.22786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/25/2022] [Indexed: 11/21/2022]
Abstract
Background
The aim of this study was to evaluate the efficacy and feasibility of a novel method of narrowing pulmonary arteries with catheter angiography using radiofrequency energy in rabbits.
Methods
A total of nine New Zealand white rabbits weighing 3.0 to 4.2 kg each were utilized in this experimental study. After the location of pulmonary artery was confirmed by echocardiography and angiography, radiofrequency energy was applied by starting with 5 W energy for the first time and increasing by 5 W, if there was no rupture to a maximum of 20 W. Multiple applications of radiofrequency energy with different durations were performed at different levels of the pulmonary artery. Eight weeks later, surviving rabbits were sacrificed. The pulmonary arteries were removed for histological investigation.
Results
Five rabbits remained alive after the experiment. There was a significant correlation between radiofrequency power and the degree of vessel thickness change in the pulmonary artery. The endothelial integrity of the tunica intima was impaired in all groups and the diameter of vessel was thickened by an average of 3.5 times.
Conclusion
The narrowing of the pulmonary artery using radiofrequency energy was successfully performed in a small sample size of experimental animals in this study.
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Wu TT, Li HC, Zheng F, Ao GK, Lin H, Li WM. Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience. Cardiovasc Intervent Radiol 2016; 39:994-1000. [PMID: 26943811 DOI: 10.1007/s00270-016-1317-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device. METHODS We collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated. RESULTS The 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA. CONCLUSIONS Percutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.
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Affiliation(s)
- Tian-Tian Wu
- Hepatobiliary Surgery Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Hu-Cheng Li
- General Surgery Department, The 307th Hospital of PLA, Beijing, 100071, China
| | - Fang Zheng
- Hepatobiliary Surgery Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Guo-Kun Ao
- Radiology Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Hu Lin
- Radiology Department, The 309th Hospital of PLA, Beijing, 100091, China
| | - Wei-Min Li
- Hepatobiliary Surgery Department, The 309th Hospital of PLA, Beijing, 100091, China.
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Foin N, Sen S, Petraco R, Nijjer S, Torii R, Kousera C, Broyd C, Mehta V, Xu Y, Mayet J, Hughes A, Di Mario C, Krams R, Francis D, Davies J. Method for percutaneously introducing, and removing, anatomical stenosis of predetermined severity in vivo: the "stenotic stent". J Cardiovasc Transl Res 2013; 6:640-8. [PMID: 23733543 DOI: 10.1007/s12265-013-9476-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/15/2013] [Indexed: 11/30/2022]
Abstract
Current in vivo models of arterial lesions often lead to unpredictable results in terms of lesion anatomy and hemodynamical significance. This study aimed to evaluate the impact of coronary stenosis using a novel in vivo adjustable stenosis model capable of mimicking advanced human coronary lesions. We developed a series of balloon expandable covered coronary stents with a central restriction, mimicking different intermediate to severe stenosis, and implanted them percutaneously in coronary arteries of eight healthy hybrid Landrace pigs. Optical coherence tomography (OCT) pullbacks and fractional flow reserve (FFR) were acquired along the artery after implantation of the stenotic stents for precise evaluation of anatomy and functional impact. Diameter and area stenosis after deployment of the stenosis implant were, on average, respectively, 54.1 ± 5.9 and 78.4 ± 5.8 % and average FFR value was 0.83 (SD 0.13). There was a low correlation between FFR and MLA evaluated by OCT (r = 0.02, p = 0.94), improved with percentage area stenosis (r = -0.55, p = 0.12), or OCT volumetric evaluation of the stenosis taking into account not only the MLA but also the length of the lesion (r = -0.78, p = 0.01). This study presents a method and proof of concept for percutaneously introducing, and removing, anatomical stenosis of predetermined severity in vivo. Such in vivo model may be used to create and evaluate the impact of focal stenoses on physiological parameters such as FFR.
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Affiliation(s)
- Nicolas Foin
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK.
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The immunologic injury composite with balloon injury leads to dyslipidemia: a robust rabbit model of human atherosclerosis and vulnerable plaque. J Biomed Biotechnol 2012; 2012:249129. [PMID: 22988422 PMCID: PMC3441062 DOI: 10.1155/2012/249129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/25/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022] Open
Abstract
Atherosclerosis is a condition in which a lipid deposition, thrombus formation, immune cell infiltration, and a chronic inflammatory response, but its systemic study has been hampered by the lack of suitable animal models, especially in herbalism fields. We have tried to perform a perfect animal model that completely replicates the stages of human atherosclerosis. This is the first combined study about the immunologic injury and balloon injury based on the cholesterol diet. In this study, we developed a modified protocol of the white rabbit model that could represent a novel approach to studying human atherosclerosis and vulnerable plaque.
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