Search Results (667)

Background: This study aimed to evaluate associations between baseline clinical status, radiological findings, prior medical history, procedural characteristics, and recanalization success with neurological outcome at discharge (NIHSS) and functional status at 90 days (mRS). Methods: This single-center retrospective study included 100 consecutive patients with acute ischemic stroke treated with MT within 24 h of symptom onset. Clinical data, CT perfusion parameters, comorbidities, prior therapies, and detailed procedural characteristics (including anesthesia type, recanalization grade, blood pressure variability, hemorrhagic transformation, and procedure duration) were analyzed. Nonparametric tests (Mann–Whitney U, Kruskal–Wallis) and Spearman’s rank correlation were applied. Statistical significance was set at p < 0.05. Results: Early ischemic signs on baseline imaging were associated with higher NIHSS scores at discharge and worse 90-day mRS (p < 0.05). Patients undergoing CT perfusion imaging had higher discharge NIHSS. Admission NIHSS showed a moderate positive correlation with discharge NIHSS (rho = 0.367, p = 0.003). Strong correlations were observed between NIHSS at 24 h and discharge NIHSS (rho = 0.802, p < 0.001), as well as between 24 h NIHSS and 90-day mRS (rho = 0.842, p < 0.001). Successful recanalization was significantly associated with long-term outcomes, with mTICI 3 associated with the lowest 90-day mRS scores (p = 0.003). Intraprocedural blood pressure variability, hemorrhagic transformation, infections, and in-hospital complications were all linked to higher 90-day mRS values. Prolonged procedure duration showed a weak but significant correlation with worse 90-day outcome (rho = 0.232, p = 0.020). In contrast, prior comorbidities and pre-stroke therapy were not significantly associated with outcomes. A multivariable binary logistic regression analysis identified only the NIHSS score at 24 h remained as an independent predictor of favorable functional outcome at 90 days. Conclusions: Baseline stroke severity, early neurological evolution, successful reperfusion, procedural hemodynamic stability, and prevention of in-hospital complications are strongly associated with both early neurological recovery and long-term functional outcome after mechanical thrombectomy. Full article

Marfan syndrome (MFS) is characterized by progressive aortic aneurysm formation resulting from mutations in the fibrillin-1 (Fbn1) gene. Although the thoracic aorta is the primary site of pathology, accumulating evidence indicates that vascular dysfunction in MFS extends beyond the aorta to involve multiple arterial beds. Statins have been shown to attenuate aneurysm progression in experimental models of MFS; however, their effects on systemic vascular remodeling and arterial stiffness outside the aorta remain poorly characterized. In this study, we investigated the impact of chronic atorvastatin therapy on vascular structure and hemodynamic function across multiple vascular beds in the Fbn1^C1041G/+^ mouse model of MFS. Male and female control and MFS mice received drinking water with or without atorvastatin (1 g/kg/day) from 4 weeks to 6 months of age, enabling the effects of atorvastatin to be assessed in both healthy and MFS arteries. High-frequency ultrasound imaging was used to assess vascular parameters in the aorta, left common carotid artery (LCCA), and posterior cerebral artery (PCA). Atorvastatin treatment significantly attenuated aortic root dilation in both male and female MFS mice and reduced aortic pulse wave velocity (PWV), indicating improved arterial compliance. In the carotid circulation, atorvastatin significantly reduced LCCA wall thickness and carotid PWV, although carotid wall strain did not improve. Atorvastatin raised both systolic and diastolic blood pressure in male and female MFS mice relative to untreated MFS animals, reaching levels not significantly different from untreated controls in both sexes, while having little effect in healthy controls apart from a rise in female diastolic pressure. In the posterior cerebral artery, peak systolic velocity, a hemodynamic index rather than a direct measure of perfusion, showed similarly sex-dependent changes, increasing in female MFS mice but decreasing further in males after atorvastatin. Collectively, these findings demonstrate that atorvastatin exerts systemic but heterogeneous vascular effects in MFS, improving arterial stiffness and structural remodeling across multiple arterial beds while producing sex-specific hemodynamic responses that warrant further investigation. Full article

Background/Objectives: The use of quantitative neuroimaging to establish objective biomarkers in neurodegenerative diseases (NDD) has attracted increasing interest over the last decade. Advanced magnetic resonance imaging (MRI) such as arterial spin labeling (ASL) and diffusion tensor imaging (DTI), as well as [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET), could provide clinically meaningful biomarkers and may support differential diagnosis. The aim of this investigator-initiated, single-center, retrospective comparative study was to implement a framework for multimodal neuroimaging to evaluate cases with rare NDD, using a methodological approach that integrates metabolic, perfusion, and microstructural parameters from simultaneous FDG-PET/MRI, and to investigate its potential to facilitate diagnosis. Methods: Three patients with pathological motor signs (1f/2m; 63, 73, and 52 years) and 19 control subjects with subjective cognitive deficits (SCDs) underwent combined FDG-PET/MRI with pseudo-continuous ASL and DTI. Standardized uptake values (SUVs), relative cerebral blood flow (rCBF), and fractional anisotropy (FA) were calculated to identify pattern alterations in individual patients based on parameterization mapping. The final diagnosis was corticobasal degeneration (CBD, n = 1) or primary lateral sclerosis (PLS, n = 2). Results: At the individual patient level, disease-specific changes in defined brain regions could be demonstrated and quantified compared to control subjects. All three patients showed significantly decreased FA, primarily along parts of the course of the corticospinal tract (CST). In the patient with CBD, asymmetric SUVR and rCBF decreases were observed, mostly overlapping with motor regions. In the two patients with PLS, SUVR revealed mostly unspecific findings (hypothetically due to a slow progression rate or due to potentially early disease stages), while ASL indicated decreased rCBF primarily overlapping within the motor cortex. Changes at the gray matter level were primarily located adjacent to changes in white matter, as indicated by the multimodal analysis approach using simultaneously acquired FDG-PET/MRI data. Conclusions: According to this proof-of-concept study, multimodal neuroimaging by the combination of quantitative MRI and FDG-PET has the potential to guide differential diagnosis in rare NDDs, especially if clinical diagnosis is not straightforward to achieve. Since particularly early diagnosis remains essential for patient counseling, effective treatment, and clinical management, the present framework appears helpful to be developed further until it aligns and integrates with clinical routine. Full article

Objective: The objective of this study was to investigate the relationship between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced MRI (DCE-MRI) parameters in soft tissue tumors (STTs). Methods: This retrospective study included patients with histopathologically confirmed STTs who underwent both DCE-MRI and IVIM-DWI between March 2022 and February 2024. Patients with prior therapy and lipomatous tumors were excluded. DCE-MRI parameters (K_trans, K_ep, V_e, iAUC) were obtained from pharmacokinetic maps using manually placed regions of interest (ROIs) in the most perfused tumor areas, avoiding necrotic and cystic regions. Corresponding ROIs were applied to IVIM-DWI maps. IVIM parameters (D, D*, f) were calculated using 11 b-values. Results: Twenty-nine patients (mean age, 56 ± 18 years; 14 malignant, 15 benign) were included. Interobserver agreement was excellent for DCE-MRI parameters, whereas IVIM-DWI parameters showed moderate-to-good agreement, with D showing the lowest reproducibility. In malignant tumors, f demonstrated strong positive correlations with K_trans (r = 0.81, p < 0.001) and iAUC (r = 0.79, p < 0.001), both of which remained significant after correction for multiple comparisons. fD* was higher in malignant than in benign lesions in the unadjusted group comparison; however, diagnostic performance was not evaluated in the present study. No significant differences were observed for DCE-MRI parameters between benign and malignant tumors. Conclusions: IVIM-DWI parameters demonstrated associations with DCE-MRI metrics in malignant STTs and may provide complementary information regarding tumor perfusion. However, the findings should be interpreted cautiously because ROI analysis was limited to a single representative slice. Further validation using larger cohorts and volumetric tumor assessment is required. Full article

Background/Objectives: Neutrophil extracellular traps (NETs) contribute to thromboinflammation and microvascular obstruction after ischemic brain injury. Borneol has anti-inflammatory and microcirculation-related pharmacological activities, but its effects on cerebral microcirculatory dysfunction and NET-related changes remain unclear. This study aimed to determine whether borneol attenuates polyethylene microsphere-induced cerebral microcirculatory dysfunction and to examine its association with NET-related markers. Methods: Rat bone marrow-derived neutrophils were stimulated with PMA with or without borneol. Male Sprague–Dawley rats were subjected to polyethylene microsphere-induced cerebral microcirculatory dysfunction and treated intragastrically with borneol (0.1, 0.2, or 0.4 g/kg). NET formation, neurological deficits, hemodynamics, cerebral microvascular perfusion, hemorheology, histopathology, inflammatory and oxidative stress markers, and NET-related molecules were assessed by immunofluorescence, ELISA, quantitative PCR, and Western blotting. Results: Borneol reduced PMA-induced NET formation in vitro. In vivo, borneol improved neurological scores, hemodynamic indices, microvascular perfusion, hemorheological parameters, and histopathological injury. It also reduced serum TNF-α, IL-1β, and ROS, decreased cerebral MPO/CitH3 signals, and downregulated MPO, PADI4/PAD4, CitH3, TNF-α, IL-6, IL-8, ICAM-1, and MIP2. Conclusions: These findings suggest that borneol alleviates polyethylene microsphere-induced cerebral microcirculatory dysfunction, accompanied by reductions in NET-related markers. However, as borneol was administered prophylactically before model induction, these results should be interpreted with caution and do not directly support a post-insult therapeutic application. Full article

Background: The Langendorff isolated heart model remains one of the most widely used experimental platforms for cardiovascular research. However, conventional bubble oxygenation is associated with several limitations, including inefficient gas utilization and incompatibility with protein-containing perfusates due to excessive foam formation. The present study evaluated whether membrane oxygenation could improve myocardial preservation and facilitate the use of a protein-enriched perfusion solution in a constant-pressure Langendorff system. Methods: A total of 48 male Wistar rats were allocated to six experimental groups (n = 8 per group). In the first experimental series, myocardial performance was compared between a conventional bubble oxygenator, a Terumo CAPIOX^® FX05 membrane oxygenator, and a Novalung iLA membrane oxygenator. In the second series, standard Krebs–Henseleit buffer was compared with a bovine serum albumin-enriched perfusate under membrane oxygenation. Hemodynamic parameters, coronary flow, and perfusate pH were assessed throughout a 180 min ischemia–reperfusion protocol. Results: Both membrane oxygenators demonstrated significantly improved myocardial preservation compared with the conventional bubble oxygenator, as evidenced by superior systolic and diastolic function, enhanced coronary flow, and improved overall cardiac performance. No significant differences were observed between the two membrane oxygenators. Membrane oxygenation additionally enabled stable supplementation of the perfusate with bovine serum albumin, which resulted in further improvements in ventricular function and coronary perfusion. Perfusate pH remained comparable among groups. Furthermore, membrane oxygenation reduced Carbozen consumption by approximately 33%, increasing the number of experiments that could be performed using a standard gas cylinder. Conclusions: The present findings suggest that membrane oxygenation may represent a simple and effective refinement of the Langendorff isolated heart model. Beyond improving myocardial preservation, it enables the use of protein-enriched perfusates and substantially reduces gas consumption. These findings support the incorporation of membrane oxygenation into modern Langendorff systems and provide a foundation for the development of more physiologically relevant isolated organ perfusion models. Full article

Congestion is a major driver of symptoms, hospitalization, and adverse outcomes in heart failure (HF), yet its clinical assessment remains challenging. Traditional approaches based on physical examination, biomarkers, and isolated imaging surrogates often fail to capture the complexity of systemic venous congestion and its impact on organ function. In HF, congestion should be interpreted as a multifactorial process resulting from the interaction between intravascular volume burden, venous compliance, cardiac filling pressures, neurohormonal activation, blood volume redistribution, and organ-specific susceptibility. In this context, point-of-care ultrasound has emerged as a promising adjunctive tool for bedside congestion assessment. The Venous Excess Ultrasound (VExUS) score integrates inferior vena cava assessment with Doppler analysis of hepatic, portal, and intrarenal veins, allowing for the evaluation of venous pressure transmission and organ-level congestion. Observational studies suggest that VExUS and related venous Doppler abnormalities correlate with invasive hemodynamic parameters and are associated with acute kidney injury, diuretic response, heart failure hospitalization, and mortality. Serial changes in venous congestion may provide additional information regarding treatment response and clinical trajectory. However, the available evidence remains heterogeneous across acute HF, ambulatory HF, cardiorenal syndrome, and critical care populations, and randomized trials evaluating VExUS-guided management are lacking. Therefore, VExUS should be interpreted as a complementary tool within a multimodal assessment that includes echocardiography, lung ultrasound, biomarkers, renal function, urine output, physical examination, and response to therapy. By integrating fluid burden with venous pressure transmission and organ perfusion, multimodal ultrasound may support more individualized congestion assessment and risk stratification in HF. Full article

Purpose: To investigate the agreement on perfusion parameters derived from two different commercially available solutions for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with prostate cancer (PCa). Methods: A total of 50 patients (mean age, 71.6; range 56–86) who had undergone radical prostatectomy between December 2021 and September 2022 were included in this retrospective study. All patients had undergone DCE-MRI on a single 3T-MR scanner. Tumor segmentation on MR images was performed by two radiologists in consensus after radiologic-pathologic correlation using topographic maps as a reference standard. Subsequently, four perfusion parameters were calculated by dedicated commercially available solutions from two different vendors. Both solutions adopted a population-based arterial input function and an extended Tofts model as the pharmacokinetic model. The perfusion parameters were as follows; volume transfer constant (K^trans), rate constant (k_ep), volume fraction of extravascular extracellular space (v_e), and volume fraction of plasma (v_p). The differences between paired measurements were compared by Bland–Altman analyses and the reproducibility was evaluated using the intraclass correlation coefficient (ICC). Results: The study population consisted of Gleason score (GS) 6 (n = 12), GS 7 (n = 34), GS 8 (n = 1), and GS 9 (n = 3). Significant differences were found for all parameters (p < 0.0001). Mean differences were as follows: K^trans, −0.2102 (95% confidence interval; −0.2687 to −0.1518); k_ep, −0.7632 (−0.9005 to −0.6258); v_e, −0.1507 (−0.2422 to −0.05907); v_p, −0.02929 (−0.03383 to −0.02476). ICCs for average measures were as follows: K^trans, 0.2989 (−0.2355 to 0.6021); k_ep, 0.6883 (0.4507 to 0.8231); v_e, −0.1331 (−0.9967 to 0.3570); v_p, 0.2653 (−0.3106 to 0.5881). Conclusion: All perfusion parameters were significantly different between the two solutions. Therefore, comparison of perfusion parameters across different solutions is not recommended. Full article

Background/Objectives: Although vascular mechanisms are increasingly implicated in the etiology of sudden sensorineural hearing loss (SSNHL), the inability to directly visualize the labyrinthine artery remains a diagnostic obstacle. Sharing embryological and physiological parallels with the inner ear, the eye represents an accessible surrogate organ capable of reflecting systemic microvascular status. This study aimed to evaluate the diagnostic value of ocular hemodynamic and structural parameters in patients with acute unilateral idiopathic SSNHL. Methods: This prospective, comparative, cross-sectional study enrolled 30 patients with acute unilateral idiopathic SSNHL and 25 age and sex matched healthy controls. Three groups were defined: the affected eye, the contralateral eye, and the control eye. Retrobulbar hemodynamics (PSV, EDV, RI, PI) were assessed by color Doppler imaging; peripapillary choroidal thickness, RNFL, GCC+, and macular thickness by swept-source OCT; and macular microvascular perfusion by OCT angiography. Results: End diastolic velocity in the posterior ciliary arteries was significantly reduced in both patient eye groups relative to controls (p < 0.001), while RI and PI were significantly elevated (p = 0.001 and p = 0.004, respectively). Comparable hemodynamic impairment was observed in the ophthalmic artery. Peripapillary choroidal thickness was bilaterally reduced in the inferior and temporal quadrants in both patient groups (p = 0.003 and p = 0.010). No significant difference was detected between affected and contralateral eyes in any parameter. RNFL, GC+, and macular thickness remained comparable across all groups. Conclusions: The bilateral symmetry of hemodynamic impairment and choroidal thinning suggests that SSNHL arises against a background of systemic microvascular disease. The combined use of OCT and color Doppler ultrasonography holds clinical potential as a non-invasive biomarker panel for defining the vascular phenotype of the condition. Full article

Kidney transplantation is the treatment of choice for end-stage renal disease, although delayed graft function remains a frequent early complication with important clinical implications. Because early graft recovery depends on adequate perfusion, careful perioperative volume assessment and hemodynamic optimization are essential. Conventional markers such as interdialytic weight gain and estimated dry weight provide only indirect information on intravascular volume and may lead to pre-transplant misclassification of volume status. Complementary tools, including bioimpedance, natriuretic peptides, and congestion-focused ultrasound, may improve characterization of fluid distribution and hemodynamic stress, but none reliably define effective graft perfusion. Pressure-based parameters remain central to perioperative management; however, mean arterial pressure reflects systemic perfusion pressure and may be preserved despite reduced renal blood flow. Central venous pressure is an imprecise surrogate of intravascular volume and fluid responsiveness, with inconsistent associations with clinical outcomes across studies. In this context, flow-guided strategies based on dynamic indices of fluid responsiveness provide a more direct assessment of circulatory adequacy and have been associated, in selected studies, with improved early graft outcomes. Overall, the evidence supports a multimodal approach integrating volume assessment tools with pressure- and flow-oriented monitoring to optimize graft perfusion and early transplant outcomes. Full article

Background/Objectives: The objective of this study was to evaluate macular perfusion changes after intracameral injection (ICI) of cefuroxime at the end of phacoemulsification. Methods: Patients who underwent routine phacoemulsification were enrolled. Subjects in the case group had ICI 1 mg/0.1 mL cefuroxime at the end of surgery. Using optical coherence tomography angiography (OCT-A), macular perfusions were assessed at T0 (before surgery), T1, T10, T30, and T90 (days after surgery). Perfusion parameters were calculated in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Independent t-tests were used to compare the changes from baseline in each parameter between groups. Results: A total of 33 eyes in the case group and 27 eyes in the control group were enrolled. After surgery, the case group showed a less pronounced reduction in the foveal avascular zone (FAZ) in the DCP at T10 (−0.06 ± 0.23 vs. −0.18 ± 0.18 mm², p = 0.041) and T30 (−0.04 ± 0.20 vs. −0.16 ± 0.24 mm², p = 0.050). At T90, there was no statistically significant difference in the FAZ change in the DCP between the groups. The postoperative changes in the vessel density, skeleton density, and acircularity index of the FAZ in the SCP and DCP, central retinal thickness, and best-corrected visual acuity were similar between the groups in all 3 months. Conclusions: Our findings indicate that intraoperative ICI low-dose cefuroxime is associated with a temporary deceleration in FAZ reduction in the DCP during the first postoperative month. From a personalized medicine perspective, these layer-specific microanatomic variations suggest that, while prophylactic cefuroxime is globally safe—demonstrating no evidence of inducing capillary dropout, aggravating macular thickening, or compromising visual outcomes within this cohort—preoperative and postoperative OCT-A monitoring can serve as an individualized screening framework to track subclinical perfusion dynamics, especially in patients with compromised retinal baselines. Full article

Background/Objectives: The Doppler perfusion index (DPI) quantifies the ratio of arterial to total hepatic blood flow and reflects hepatic hemodynamic balance. Its clinical applicability is limited by insufficient standardization and the absence of clearly defined physiological reference conditions. This study aimed to establish an upper physiological reference limit for the DPI and to assess its dependence on standardized physiological conditions in healthy adults. Methods: In this prospective study, 44 healthy adults underwent Doppler ultrasonography under standardized conditions (fasting/resting, post-exercise, postprandial). Volumetric blood flow was measured in the portal vein and via the proper hepatic artery and, where feasible, the common hepatic artery. The DPI was calculated as the ratio of arterial to total hepatic inflow. Nonparametric statistical methods were applied. Results: After exclusion of participants with non-standard hepatic arterial anatomy, 39 individuals were analyzed. The DPI varied across physiological conditions, reflecting changes in the relative contributions of arterial and portal venous inflow. Under fasting/resting conditions, values based on the proper hepatic artery showed low variability (mean 0.242 ± 0.057) and normal distribution (Shapiro–Wilk p = 0.625). The empirically derived 90th percentile was 0.30. Measurements based on the common hepatic artery were higher and more variable. Conclusions: The DPI is a physiologically dynamic parameter whose clinical use requires standardized measurement conditions. Under defined protocols, a value of approximately 0.30 may be considered an upper physiological reference limit. Standardization of acquisition and use of the proper hepatic artery enable reproducible and interpretable measurements. This provides a methodological basis for further clinical applications, including oncological contexts in which functional alterations of hepatic perfusion may be relevant. Full article

CT perfusion (CTP) is widely used in acute ischemic stroke imaging, particularly for treatment selection beyond conventional time windows. However, automated perfusion maps are not direct measurements of irreversible tissue injury, but estimates shaped by deconvolution strategy, temporal correction, dispersion handling, and software-specific thresholds. This review provides a clinically oriented explanation of how CTP algorithms influence the estimation of ischemic core and hypoperfused tissue. Particular attention is given to singular value decomposition (SVD) methods, Bayesian approaches, and timing parameters, including time to maximum (Tmax), Delay, time to peak (TTP), and mean transit time (MTT). Differences in residue function estimation and threshold definition may generate variable outputs across software platforms, even from the same source dataset. Perfusion thresholds should therefore not be treated as universally interchangeable. CTP findings should be integrated with clinical status, non-contrast CT, CT angiography (CTA), collateral status, occlusion site, and imaging-to-treatment context, serving as decision-support tools rather than isolated measures of tissue viability. Full article

Pulse oximetry is an essential standard monitor in modern anesthetic practice, enabling continuous noninvasive assessment of arterial oxygen saturation and pulse rate throughout the perioperative period. Since its introduction into clinical medicine, pulse oximetry has significantly improved patient safety by facilitating early detection of hypoxemia and physiologic deterioration. Despite its widespread use, clinicians may underrecognize the technical principles, physiologic assumptions, and limitations that influence measurement accuracy. This review provides a perioperative perspective on pulse oximetry, including the physics of photoplethysmography, sensor technologies, and practical considerations for optimal probe placement and signal acquisition. Sources of inaccuracy such as motion artifact, low perfusion states, dyshemoglobinemias, ambient light interference, skin pigmentation, and venous pulsation are discussed in detail. The review further examines perioperative applications across preoperative evaluation, intraoperative monitoring, and postoperative recovery, while also exploring advanced parameters including perfusion index (PI) and pleth variability index (PVI). Emerging innovations such as multi-wavelength systems and artificial intelligence (AI)-enhanced signal analysis are also highlighted. A comprehensive understanding of pulse oximetry allows anesthesiologists to appropriately interpret monitor data, recognize device limitations, and optimize perioperative patient care. Full article

Background: Thromboangiitis obliterans (TAO) is a nonatherosclerotic inflammatory vascular disorder affecting small- and medium-sized vessels, often leading to critical limb ischemia and a high risk of amputation. Conventional medical and surgical treatments remain limited, particularly for advanced diseases. Tibial transverse bone transport (TTT), based on the principles of distraction osteogenesis, has emerged as a novel technique to promote angiogenesis and improve microcirculation. This systematic review evaluated the clinical efficacy and safety of TTT in the management of TAO. Methods: A systematic review was conducted according to the PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar was performed until December 2025. Eligible studies included clinical investigations that evaluated TTT in patients with TAO. Data on patient characteristics, surgical techniques, clinical outcomes, and complications were extracted and analyzed descriptively because of the heterogeneity in study design and reporting. Results: Ten studies involving 368 patients were included in this review. TTT was consistently associated with significant clinical improvement, including pain relief, increased claudication distance, and ulcer healing, which were typically observed within weeks after the procedure. Limb salvage rates were high, with major amputation rates generally ranging from 3.3% to 13.3%. Objective improvements in perfusion parameters have also been reported in several studies. The most common complication was pin-site infection (up to 30%), while fractures, delayed consolidation, and osteomyelitis were less frequent complications. Conclusions: Current evidence suggests that TTT is a promising limb-salvage strategy for TAO and is associated with favorable clinical and functional outcomes, with an acceptable complication profile. However, the available evidence remains limited, partly because of the rarity of TAO and the specialized nature of the TTT procedure. Most available studies are observational, and further high-quality prospective and randomized trials are required to validate the long-term efficacy of this technique. Full article