Radiofrequency Ablation of Thyroid Nodules: A Long-Term Prospective Study of 24 Patients

Clinical question
Can radiofrequency (RF) ablation serve as an alternative treatment modality for managing benign thyroid nodules with compressive or cosmetic symptomatic complaints?

Take away point
RF ablation of benign symptomatic thyroid nodules is safe and effective. It can be an alternative treatment modality to surgical resection for management.

Reference
Martinez, J. et al. Radiofrequency Ablation of Thyroid Nodules: A Long-Term Prospective Study of 24 Patients. Journal of Vascular and Interventional Radiology (JVIR), Volume 30, Issue 10, 1567-1573.

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Study design
Single arm, prospective, cohort study of 24 Caucasian patients with symptomatic benign single thyroid nodules, undergoing RF ablation, interval follow-up until 36 months after treatment.

Funding source
No reported funding

Setting
Academic hospital, Hospital Universitario de Burgos (HUBU), Spain.






Figure 3
Ultrasound image of a nodule displaying intranodular gas after the “pop” in a successful RF ablation treatment. Vigilance should be directed towards the paratracheal “danger triangle” located near the medial and posterior aspect of the nodule.

Summary

Thyroid nodules are extremely common and the majority of these nodules are benign. A small portion may grow over time and can cause cosmetic issues, local compressive symptoms, and anxiety. Traditional treatment involves surgical resection. Ultrasound-guided, minimally invasive, radiofrequency (RF) ablation in an outpatient setting has become available. Literature remained scarce regarding ablation parameters, safety profile, and long-term efficacy on different nodule compositions.

The authors performed a prospective study of 24 Caucasian patients with solitary symptomatic benign solid, solid predominant, or cystic predominant thyroid nodules undergoing RF ablation with a follow-up period of 36 months. Thyroid Imaging Reporting and Data System grades 1 or 2 nodules with two consecutive Bethesda Category II aspiration results were included. Patients were excluded if presented with contralateral laryngeal nerve palsy, presence of pacemaker, pregnancy, cystic nodules, history of neck external beam radiation, or lack of collaborative capacities. RF ablation was performed with a trans-isthmic approach (except for 1 patient) and the moving-shot technique. 30 W power with 3 minute ablation time was initiated followed by 10 W interval increase every 1 minute until the “pop” of the nodule.

The authors found a total complication rate of 16.67%, including 2 local hematomas and 1 large intra-cystic hematoma as well as a major complication of laryngeal nerve damage. The success rate at 12 months after the procedure was 72.22%. Interval follow-up demonstrated an average decrease in nodular size of 32.98% at 1 month and 68.76% at 12 months. Further changes in nodular sizes were minimal afterwards, measuring 76.84% at the 36-month follow-up. A logarithmic correlation was found between nodular size reduction and time. Sub-group analysis revealed more nodular size reduction of solid nodules within the first 6 months while cystic predominant mixed nodules tend to have a smoother curve of nodular size reduction. No significant correlation with ablation parameters including the number of ablations, ablation power, and ablation time was found.

Commentary

The authors in this study quantified the long-term safety profile and treatment efficacy of RF ablation for the management of benign symptomatic solid or mixed thyroid nodules. Their results also suggested a follow-up timeline of 12 months is adequate given the logarithmic correlation between nodular size reduction and time. Additionally, they found no significant correlation of outcome with ablation parameters. These findings support the notion that RF ablation, with a trans-isthmic approach and moving-shot technique, is a safe and effective treatment for benign symptomatic solid or mixed thyroid nodules. At the same time, the findings also highlight the need for larger prospective clincial trials to substantiate the safety profile and long-term role of RF ablation for thyroid nodule management.

Post author

Ningcheng (Peter) Li, MD, MS
Integrated Interventional Radiology Resident, PGY-3
Department of Interventional Radiology
Oregon Health and Science University, Dotter Interventional Institute
@NingchengLi

Evaluation of Outcomes following Radiofrequency Ablation for Treatment of Parotid Tail Warthin Tumors

Clinical question
Is radiofrequency (RF) ablation safe and efficacious for parotid Warthin tumor ablation?

Take-away point
Warthin tumor ablation could be an option for treatment of Warthin tumors.

Reference
Yu-Chen Tung, et al. Evaluation of Outcomes following Radiofrequency Ablation for Treatment of Parotid Tumors. Journal of Vascular and Interventional Radiology. Oct, 2019: 30; 10, 1574-1580.

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Study design

Retrospective

Funding source

Self-funded or unfunded

Setting

Single-center




Figure 1. Patient 6, a 58-year-old man with a Warthin tumor in the parotid tail area, underwent a preoperative MR imaging evaluation followed by RF ablation using the moving shot technique. (a) Photograph showing assumed facial nerve and branches (yellow lines) and danger zone (red dotted line). RF ablation was performed following the route from the posterior-inferior site of the mandibular angle to avoid damage to the facial nerve. The labels 2a–2d indicate the scan positions from cranial to caudal. (b) Real-time US sagittal oblique image showing the maximum diameter axis of the Warthin tumor. The tip of the electrode was positioned in the deepest and most remote part of the tumor, then sequential ablation was performed by moving the electrode tip backward and forward, from bottom to top. (c) The extent of the ablated zone was determined by the echogenic changes around the electrode. When a hyperechoic zone appeared, the electrode tip was moved backward.

Summary

Warthin tumors are benign parotid tumors that most typically present in middle-age male smokers. Surgery is the current standard of care, however this carries risk associated with anesthesia, iatrogenic complications, and cosmetic defects. Currently, there is some controversy over the need for surgery as malignant transformation is rare. Ablation was proposed as an alternative, and this study aimed to evaluate the efficacy and safety of ultrasound guided RF ablation of parotid Warthin tumors.

7 men with biopsy proven Warthin tumors were treated with RF ablation. Patient’s were included if the tumor was located in the tail of the parotid, the mass was growing and palpable or caused cosmetic concerns, and the patient’s refused surgery. RF ablation was performed using the moving shot technique under local anesthesia. Parotid tumor reduction and cosmetic scale were noted. Average tumoral volume decreased from 14.6 cm3 to 5.3 cm3 1 month post procedure, which was statistically significant. Cosmetic score also demonstrated statistically significant improvement. No peri-procedural complications were noted, however 1 patient experienced parotitis with hematoma 12 days post procedure.

Commentary

While observation of Warthin tumors is reasonable given the low rates of malignant transformation and possible complications of standard surgery, this is limited due to risks associated with observation including variable growth rates, more difficult dissection with larger tumors, and patient anxiety. Ablation may offer a low risk alternative to standard surgery to obviate the need for general anesthesia, lower side effect profile, and smaller incisions. RF ablation is able to be contained to within the tumor capsule. Additionally, with the patient only under local anesthesia, the ablation probe can be immediately relocated with any patient report of pain thus minimizing risk of nerve injury.

This study is limited due to the very small size, retrospective nature, and short follow up. RF ablation is not expected to be comparable to surgery as the ablation is kept within the confines of the tumor and is only possible in parotid tail tumors. However, in locations with diagnostic imaging expertise, and experience with head and neck ablation, RF ablation could be a suitable alternative to select patients who wish to avoid surgery.

Post Author David M Mauro, MD
Assistant Professor
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina

@DavidMauroMD

Chemoembolization Combined with Radiofrequency Ablation for Medium-Sized Hepatocellular Carcinoma: A Propensity-Score Analysis

Clinical question
Compare the effectiveness of combined chemoembolization and RF ablation, chemoembolization alone, and RF ablation alone in the treatment of patients with medium-sized HCC’s (3-5cm in size).

Take away point Large-bore aspiration mechanical thrombectomy is safe with a high technical (100%) and clinical success (88%) rates.

Reference
Chu, Hee Ho et al. Chemoembolization Combined with Radiofrequency ablation for Medium-Sized Hepatocellular Carcinoma: A Propensity-Score Analysis. Journal of Vascular and Interventional Radiology, Volume 30, Issue 10, 1533-43

Click here for abstract

Study design
Single-center, retrospective, cohort study of 538 patients treated between March 2000 – December 2016, with follow up until March 2018

Funding Source
None

Setting
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Figure 2
Flow chart to determine treatment of a single medium-sized (3.1-5.0 cm) HCC. Patients included in this study were unsuitable for surgery or liver transplantation and had one the three treatments.

Summary

Definitive treatment of single medium-sized HCC, according to Barcelona Clinic Liver Cancer (BCLC), is surgical resection. However, this is not always feasible secondary to patient comorbidities and/or tumor location. Radiofrequency (RF) ablation is considered as curative in patients with small (<3cm) HCC’s. However, no such definitive literature exits for single lesions that fall in the medium-size range, between 3-5 cm. Multiple treatment modalities have been used to treat these medium sized lesions including a combination of TACE and RF ablation, TACE alone, and RF alone. The authors performed a retrospective analysis of these treatment types in patients with single medium sized HCC. Additionally they took their data and performed a propensity-score analysis with inverse probability weighting to reduce bias in treatment selection and other confounding variables.

All patients in this study has single medium sized HCC’s and were treated with one of the three therapies. The treatment pathways were chosen as the digression of the interventionist. TACE was performed with a combination of Lipiodol and Cisplatin (1:1 ratio) with a cisplatin dose of 2mg/kg body weight. Gel-foam slurry was infused after administration until arterial stasis was achieved. RF ablation was performed under ultrasound guidance within 2 weeks of chemoembolization (if performed). Of note there were statistically significant differences in the patient population with regards to Child-Pugh class, serum albumin level and tumor size. No major complications were reported as defined by SIR criteria.

The primary endpoint was overall survival (OS) from initial procedure to death. The secondary endpoint was recurrence free survival (RFS), which was determined from initial treatment to recurrence or death. Recurrence included local or distant recurrence and local was defined by a margin of 1 cm.

The mean follow up time for all patients was 59.6 months (SD – 46.9 mo; range: 2-208). Overall survival in combined, chemoembolization-only, and RF-only were 85 mo (95% CI: 51.2-118.8 mo), 56.5 mo (95% CI: 51.7-61.3 mo), and 52.1 mo (95% CI: 40.7-63.5 mo), respectively. Treatment was found to be a significant independent factor associated with OS (P=0.023). During follow up recurrent disease was found in 68.8% of combined group, 78% of the chemoembolization-only group, and 74.8% of the RF-only group. RFS in the combined, chemoembolization-only, and RF-only were 26.5 mo (95% CI: 22-31 mo), 14.1 mo (95% CI: 10.9-17.3 mo), and 14.1 mo (95% CI 9.7-18.5 mo), respectively.

Inverse probability weighting was performed to balance baseline characteristics. The differences in OS remained statistically significant with a P value of 0.022 (Fig 4a). Additionally the differences in RFS values were statistically significant with a P value of 0.002 (Fig 4b).

Commentary

The authors performed a similar study to multiple previous authors, with a much larger patient sample. The findings of this study fit and reinforce all of the current data in treating “unresectable” medium-sized HCC’s. However, the retrospective nature of the study and single center analysis limits its broad applications. Taking this into consideration we now have a larger pool of retrospective data to help reinforce the current trend in treating medium-sized HCC’s. This study provides evidence for future prospective studies to look at this question and help solidify an evolving treatment paradigm.

Post author
Hasnain Hasham, MD
Interventional Radiology Fellow
Dotter Interventional Institute
Oregon Health and Science University, Portland, OR
@irhasham

Midterm outcomes of endovascular repair for Stanford type B aortic dissection with aberrant right subclavian artery

Clinical question
Is complete endovascular repair durable for Type B aortic dissections with aberrant right subclavian artery?

Take away point
Complete endovascular therapy for Type B aortic dissection with aberrant right subclavian artery is a feasible, durable option with positive early- and mid-term outcomes.

Reference
Midterm outcomes of endovascular repair for Stanford type B aortic dissection with aberrant right subclavian artery. Zhang et al. JVIR. 2019;30:1378-1385.

Click here for abstract

Study design
Single institution, single arm retrospective cohort study of 15 patients. 

Funding source
China Medical Board Distinguished Professorship Award and the National Natural Science Foundations of China

Setting
Second Xiangya Hospital, Central South University, Hunan, People’s Republic of China 

Summary 

A treatment algorithm for patients with Stanford Type B aortic dissection with the aberrant right subclavian artery (ARSA) was created based on the distance between the entry tear to the ARSA. If the distance was >15 mm (Type 1), TEVAR would be performed without any technical modifications owing to a favorable proximal landing zone. If the distance was <15 mm but >15 mm existed between the tear and the left subclavian artery (Type 2), the artery supplying the dominant vertebral artery was preserved while the contralateral artery was sacrificed. If <15 mm existed between the tear and left subclavian artery (Type 3), the artery supplying the dominant vertebral artery was preserved while the contralateral artery was sacrificed. In patients with codominant vertebral arteries, the ARSA was preserved in Type 2 patients while both subclavian arteries were preserved in Type 3 patients.

Technical modifications to TEVAR included fenestration for patients with an entry tear on the inner curve of the aorta, chimney (stent-graft preservation dependent on antegrade flow) for preservation of the left subclavian artery from left brachial approach, and periscope/snorkel (stent-graft preservation dependent on retrograde flow) for preservation of the ARSA from femoral approach.

Stent-grafts were oversized to account for concomitant diverticulum of Kommerell to cover the diverticulum without additional embolization of the diverticulum.

Follow-up included clinic visit and CTA at 2 weeks, 3 months, 6 months, and 12 months post-procedure. Mean follow-up was 33 +/- 20 months. There was 100% technical success. No mortalities were noted. No neurologic sequelae were noted. All stent-grafts remained patent with shrinking of the false lumen at 2 weeks.

Commentary

Although this paper is a small series from a single institution, the authors included a relatively high number of patients considering the rarity of this anatomy, which had previously only been described in case reports. Notably, the outcome for this cohort was remarkable with no delayed endoleaks and no clinically significant adverse events. Even with 13 patients undergoing chimney modification for preservation of the left subclavian artery, no delayed Type 1A endoleaks were identified. Whether this can be attributed to the wide variation in the duration of follow-up should be further investigated, since three patients with dominant left vertebral artery had less than 8 months of follow-up.

In the short- and mid-term outcomes of completely endovascular repair appear superior compared to outcomes of hybrid approach, with rates of brachial plexus injury of 12.5% and Type 1A endoleak of 18.8%. This study shows promise for completely endovascular repair although longer-term follow up is needed.

This paper also expands on previously published treatment algorithms for endovascular repair of aortic anatomy in a technically challenging population.


Post Authors 
Eric King, MD
Vascular & Interventional Radiology Fellow
Rush University Medical Center
Chicago, Illinois
@ercking

Sreekumar Madassery, MD
Assistant Professor, Vascular & Interventional Radiology
Director, Advanced Vascular & Interventional Radiology Fellowship
Rush University Medical Center
Rush Oak Park Hospital
Chicago, Illinois
@kmadass, vir_rush

Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique

Clinical question
Is distal radial artery (DRA) access for noncoronary interventional radiology procedures feasible and safe?

Take away point
DRA access is a feasible and safe technique for abdominal interventional radiology embolization procedures. No radial artery occlusion or other major complications were observed in patients who underwent follow-up ultrasound.

Reference
van Dam, Lievay et al. Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique. Journal of Vascular and Interventional Radiology, Volume 30, Issue 8, 1281 - 1285

Click here for abstract

Study design
Retrospective review of 82 punctures in 56 patients.

Funding Source
No reported funding

Setting
Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands






Figure 1. 

Optimal location of distal radial artery access at the deep palmar arch superficial to the scaphoid and trapezium.


Summary
Distal radial artery access has shown to be a safe technique for interventional radiology embolization procedures. The authors performed a retrospective review of 82 DRA procedures in 56 patients. Procedural details and complications were reviewed during the admission and at follow up.

The Barbeau test was used to evaluate radioulnar collateral circulation before the procedure. The preferred puncture site was at the DRA at the anatomical snuffbox (radial fossa). A mixture of 300 μg nitroglycerin and lidocaine 2% was given for analgesia and vasodilation, access was gained with ultrasound guidance using a 21-gauge needle and radial artery sheath, and an anti-spasmolytic mixture of 200 μg nitroglycerin, 2.5 mg verapamil, and 5000 IE heparin was administered. Patent hemostasis was achieved using a Safeguard Radial Compression Device.

Procedures included transarterial chemoembolization, Y-90 pretreatment work up, Y-90 treatment, and hepatic, renal, and splenic artery embolization. The mean number of DRA accesses per patient was 1.46. There was a 97.6% technical success rate. There were 8 minor complications, including 3 hematomas and 1 case of pain without hematoma. All minor complications resolved without treatment. Follow up ultrasound was available after 54 procedures at a mean time of 55 days. Only 1 complication at the DRA was seen on ultrasound. There was 1 case of a non-flow limiting focal dissection, which had resolved on follow up procedure 38 days later.

Commentary
The authors retrospectively reviewed 82 distal radial artery procedures. The results were promising and showed a 97.6% technical success rate without any major complications or cases of radial artery occlusion. Follow up ultrasound imaging provides further reassurance of the safety of DRA access. Access at the distal radial artery, distal to the superficial palmar arch shows theoretical benefit without increased complication. While the data is encouraging, larger patient populations and long term follow up would be helpful to further understand the safety and benefits.

Post Author
Maxwell R. Cretcher, DO
Resident Physician, Integrated Interventional Radiology
Dotter Department of Interventional Radiology
Oregon Health & Science University

Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair

Clinical question
Can we safely perform a zero-contrast procedure relying solely on fusion imaging? What contributes to renal ostia displacement by the insertion of a stiff system during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA)?

Take away point
Sharper angulation between aneurysm neck and sac results in decreased fusion imaging accuracy and precludes EVAR deployment without contrast validation.

Reference
Identification of Parameters Influencing the Vascular Structure Displacement in Fusion Imaging during Endovascular Aneurysm Repair. Lalys F. et al. Journal of Vascular and Interventional Radiology (JVIR), Volume 30, Issue 9, 1386-1392.

Click here for abstract

Study design
Single arm, prospective, cohort study of 50 patients undergoing EVAR.

Funding Source
No reported funding

Setting
Academic hospital, University Rennes, France.





Figure 1
EndoNaut station main screen visualization during an EVAR procedure, with the fusion overlaid on the fluoroscopic image on the left and the corresponding 3D visualization on the right.

Summary

Fusion imaging technology has been shown to decrease contrast usage and radiation dose in both standard and complex endovascular aneurysm repair (EVAR) of abdominal aorta aneurysm (AAA). However, its relevance is limited by deformation of vascular structures after insertion of stiff devices during the procedure. The authors performed a prospective study of 50 patients undergoing EVAR to quantify the displacement of the lowest renal artery ostium and to identify the contributing anatomical parameters.

Patients included in this study were adults undergoing EVAR, who were not open-repair candidates, had AAA diameter greater than 50 mm, or had AAA growth rate greater than 10 mm per year. Patients were excluded if a fenestrated or branched endograft was used, or if the repair was performed for ruptured AAA.

EndoNaut station was used for fusion workflow. Digital subtraction angiogram performed intra-procedurally after insertion of stiff devices but prior to EVAR deployment was compared with the fusion roadmap generated pre-operatively using CT angiography. A large number of anatomical parameters were measured, including tortuosity index, length, diameter, angulation, calcification, thrombus, and distance to spine of the relevant vascular segments. Sharpest angulation, as defined by Van Keulen et al, was also calculated.

Mean displacement of the lowest renal artery ostium was 4.1 ± 2.4 mm (range, 0–11.7 mm), with a left/right displacement of 1.6 ± 1.7 mm (range, 0–6.9 mm) and a craniocaudal displacement of 3.5 ± 2.4 mm (range, 0–11.3 mm). Sharpest angulation between the aneurysmal neck and sac contributed significantly to the accuracy of fusion imaging (p = 0.00001).

Commentary

The authors in this study quantified the degree of renal artery ostia displacement after insertion of stiff devices during EVAR. They further identified the sharpest angulation between the aneurysmal neck and sac as a significant contributor in fusion imaging accuracy. The findings support the need for better fusion imaging technology with semi-automatic intra-procedural adjustments, especially in EVAR cases with significant angulation between the aneurysmal neck and sac. The paper also underlines the importance of small-amount contrast injection prior to EVAR deployment for confirmation of major vascular ostia. Future fusion imaging technology with more adaptive intra-procedural capability, potentially with the assistance of artificial intelligence, should be validated in a similar manner with prospective design and anatomical analysis before we proceed to attempt a zero-contrast EVAR deployment.

Post Author
Ningcheng (Peter) Li, MD, MS
Integrated Interventional Radiology Resident, PGY-3
Department of Interventional Radiology
Oregon Health and Science University, Dotter Interventional Institute
@NingchengLi

Safety and Efficacy of Acute Pulmonary Embolism Treated via Large-Bore Aspiration Mechanical Thrombectomy Using the Inari FlowTriever Device

Clinical question
Is it safe and effective to use the Inari FlowTriever Device in treating acute pulmonary embolism?

Take away point
Large-bore aspiration mechanical thrombectomy is safe with a high technical (100%) and clinical success (88%) rates.

Reference
Wible, Grant C. et al. Safety and Efficacy of Acute Pulmonary Embolism Treated via Large-Bore Aspiration Mechanical Thrombectomy Using the Inari FlowTriever Device. Journal of Vascular and Interventional Radiology, Volume 30, Issue 9, 1370-75

Click here for abstract

Study design
Single center, retrospective, cohort study of 46 patients between March 2018 – March 2019

Funding
One of the authors is a paid consultant for Inari and another receives research support from Inari.

Setting
St. Luke’s Hospital and University of Missouri – Kanas City school of medicine, Kansas City, MO, USA.







Figure 2
CT angiogram of a 68-year-old female with saddle pulmonary embolism (a). Right and left pulmonary angiogram demonstrating large filling defects corresponding to patients know PE (b,c). Post aspiration mechanical thrombectomy angiogram demonstrating significant improvement in pulmonary artery flow (d,e). Back table photographs of aspirated clot using the large-bore Inari device (f).

Summary

The authors performed a retrospective analysis of the Inari FlowTriever device at their institution when treating massive and intermediate-high risk sub-massive pulmonary embolism. They evaluated the technical success and clinical success of the device in the first year of use at their institution. Technical success involved appropriate device positioning and clinical success was defined by angiographic removal of central clot and change in pulmonary artery pressures before and after clot retrieval. Adverse outcomes were defined by the SIR guidelines of endovascular treatment of PE.

Patients included in this study were referred to IR for massive or intermediate-high risk sub-massive PE. No patients were excluded in the timeframe observed and 2 procedure-related adverse outcomes were reported.

All patients had aspiration mechanical thrombectomy with the Inari FlowTriever device with a 100% technical success rate. Pre and post-aspiration mechanical thrombectomy pressures were obtained, except in 4 cases, where the authors experienced failure of the pressure transducer. A 22F sheath was advanced into the suprarenal IVC via the common femoral vein and the 20F Inari aspiration guide catheter (AGC) was advanced over an 0.035 Amplatz wire into the main or lobar pulmonary artery. Aspiration thrombectomy was performed with the assistance of the self-expanding Nitinol discs to facilitate mechanical clot engagement prior to aspiration. This process was repeated several times in multiple pulmonary arteries until angiographic resolution of central clot was achieved.

There were 2 major procedure-related complications. One with intra-procedural hemoptysis requiring in intubation and another with a hematocrit drop of 15%. Both patients recovered and were discharged from the hospital. 2 patients died in the 30 day post-operative period, which the authors attributed to events prior to the procedure – metastatic pancreatic cancer and severe anoxic brain injury.

There was 100% technical success as defined by the authors. Aspiration related intra-procedure blood loss averaged 280ml with a maximum of 520ml resulting in an average hematocrit drop of 4.6% +/- 2.8% per case. Intra-procedural PA pressure decrease was achieved in 37 patients (88%). Average mean PA pressure improved from 33.9 +/- 8.9 mm Hg before to 27.0 +/- 9 mm Hg after, with a decrease of 6.9 mm Hg (P < 0.0001 and CI 5.0-8.8). All patients survived to hospital discharge.

Commentary

The authors evaluated the safety and efficacy of the Inari FlowTriever device at their institution over a one-year period. The findings of this study demonstrate the Inari device can be a treatment alternative in patients who are unable to receive systemic or local TPA in the setting of trauma, recent major surgery or other contraindication. This study only looked at a single centers experience with the device, which is useful in evaluating its success in the other interventional radiology departments. Establishing safety is a promising first step in assessing a new treatment paradigm, though comparison with systemic and local lytic and aspiration treatments is still needed.

Post Author
Hasnain Hasham, MD
Interventional Radiology Fellow
Dotter Interventional Institute
Oregon Health and Science University, Portland, OR
@irhashamz