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Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization

  • Clinical Investigation
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Abstract

Background

This study was designed to evaluate the utility of dual phase cone beam computed tomography (DP-CBCT) and automatic vessel detection (AVD) software to guide transarterial embolization (TAE) of angiographically challenging arterial bleedings in emergency settings.

Methods

Twenty patients with an arterial bleeding at computed tomography angiography and an inconclusive identification of the bleeding vessel at the initial 2D angiographic series were included. Accuracy of DP-CBCT and AVD software were defined as the ability to detect the bleeding site and the culprit arterial bleeder, respectively. Technical success was defined as the correct positioning of the microcatheter using AVD software. Clinical success was defined as the successful embolization. Total volume of iodinated contrast medium and overall procedure time were registered.

Results

The bleeding site was not detected by initial angiogram in 20 % of cases, while impossibility to identify the bleeding vessel was the reason for inclusion in the remaining cases. The bleeding site was detected by DP-CBCT in 19 of 20 (95 %) patients; in one case CBCT-CT fusion was required. AVD software identified the culprit arterial branch in 18 of 20 (90 %) cases. In two cases, vessel tracking required manual marking of the candidate arterial bleeder. Technical success was 95 %. Successful embolization was achieved in all patients. Mean contrast volume injected for each patient was 77.5 ml, and mean overall procedural time was 50 min.

Conclusions

C-arm CBCT and AVD software during TAE of angiographically challenging arterial bleedings is feasible and may facilitate successful embolization. Staff training in CBCT imaging and software manipulation is necessary.

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Author information

Authors and Affiliations

  1. Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy

    Gianpaolo Carrafiello, Anna Maria Ierardi, Ejona Duka, Chiara Floridi & Giuseppe De Marchi

  2. Philips Healthcare, Best, The Netherlands

    Alessandro Radaelli

  3. Anaesthesia and Palliative Care, University of Insubria, Varese, Italy

    Alessandro Bacuzzi

  4. Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany

    Maximilian de Bucourt

Authors
  1. Gianpaolo Carrafiello
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  2. Anna Maria Ierardi
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  3. Ejona Duka
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  4. Alessandro Radaelli
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  5. Chiara Floridi
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  6. Alessandro Bacuzzi
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  7. Maximilian de Bucourt
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  8. Giuseppe De Marchi
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Corresponding author

Correspondence to Gianpaolo Carrafiello.

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Conflict of interest

Alessandro Radaelli declares his relationship of employee with Philips. The remaining Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study, when possible.

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Carrafiello, G., Ierardi, A.M., Duka, E. et al. Usefulness of Cone-Beam Computed Tomography and Automatic Vessel Detection Software in Emergency Transarterial Embolization. Cardiovasc Intervent Radiol 39, 530–537 (2016). https://doi.org/10.1007/s00270-015-1213-1

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  • DOI: https://doi.org/10.1007/s00270-015-1213-1

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