Search Results (149)

Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide, requiring rapid reperfusion to minimize damage. Current treatments, including intravenous thrombolysis (IVT) with alteplase (rt-PA) and mechanical thrombectomy (MT), face limitations such as thrombolysis resistance, dosing complexity, and reduced efficacy in large vessel occlusions (LVOs) or fibrin-rich clots. Tenecteplase (TNK), a bioengineered thrombolytic agent with superior pharmacokinetics, simplified administration, and higher fibrin specificity, offers promising advantages over rt-PA, including potential synergy with MT and efficacy against resistant thrombi. Direct oral anticoagulants (DOACs) further complicate AIS management, but evidence suggests that DOAC-treated patients may experience better thrombolysis outcomes due to distinct thrombus characteristics. Advances in imaging now enable precise visualization of vessel occlusion and treatment effects, opening opportunities to refine therapies. Combination approaches targeting fibrin thrombus components may enhance thrombolysis and improve outcomes in resistant cases. Future research should explore TNK’s role in intra-arterial (IA) applications, combination therapies, and its interaction with MT to optimize reperfusion strategies. TNK’s simplified use and promising efficacy position it as a potential breakthrough in AIS management, with the potential to improve functional recovery and reduce treatment complexity. Full article

The use of imaging during percutaneous coronary intervention (PCI) can improve the outcomes by giving key information in every phase of the procedure. It can improve the knowledge of plaque composition thus helping the subsequent technical strategy; it can precisely define the measure of the stent to implant; it can assess in detail the correct positioning of the stent (apposition, expansion, and full coverage of the atherosclerotic plaque); it helps in recognizing the complications that may occur after stenting (e.g., edge dissection or tissue/thrombus protrusion in the stent area). Further, it could help evaluation for both diagnostic and therapeutic purposes of angiographic unknown or questionable findings [e.g., spontaneous coronary artery dissection (SCAD), characterization of mycotic aneurysm and pseudoaneurysm]. In the follow up phase, the use of intracoronary imaging may significantly improve the understanding of the mechanisms leading to the procedural failure. What this review adds is to describe the similarities and differences between intravascular ultrasound (IVUS) and optical coherence tomography (OCT) technologies, to highlight the evidence supporting their utility to improve PCI outcomes, to give practical advice and tools on daily interventional routine, to show a point of view on future perspectives and integration with artificial intelligence (AI). Full article

Objectives: This review aims to review the application of deep learning (DL) techniques in the imaging analysis of abdominal aortic aneurysm (AAA), with a specific focus on the segmentation of intraluminal thrombus (ILT). Methods: A comprehensive literature review was conducted through searches of PUBMED and Web of Science up to September 2025. Only English-language studies applying DL-based networks for ILT segmentation in patients with AAA on computed tomography angiography were included. After screening 664 articles, 22 met the eligibility criteria and were included. The reported methodological frameworks and segmentation performance metrics were extracted for comparison and analysis. Results: Among the studies included, the reported Dice similarity coefficients ranged from 0.81 to 0.93 for 2D networks and from 0.804 to 0.9868 for 3D networks. Notably, 2D Multiview fusion models outperform other 2D approaches, while 3D U-Net remains a strong baseline. Methods using preoperative images demonstrated great applicability for surgical planning, while postoperative segmentation faced challenges related to imaging artifacts caused by stent. Conclusions: This review provides a comprehensive overview of recent DL-based ILT segmentation methods for AAA patients on CTA, offering perspectives for applications in advanced preoperative planning and postoperative surveillance. Despite the promising results, the lack of standardized datasets limits model development and external validation. Future research should address these limitations by focusing on multicenter standardized datasets and seamless integration into clinical workflows. Full article

Conventional whole-blood flow assays for quantifying thrombus formation are typically performed at room temperature and are technically demanding, which limits their translational applicability. We engineered a novel, disposable, mountable, and single-channel microfluidic chip (MC-2S), which is based on the Maastricht chamber (MC) and designed for automated evaluation of platelet function, coagulation and fibrinolysis under physiological conditions. The MC-2S chip allows customizable choices of thrombogenic surfaces, such as collagen and tissue factor. The chip was used in combination with an adapted, 1.3 kg brightfield/fluorescence microscope, operating at physiological temperature (37 °C), and with scripts for automated multicolor analysis of image features. The integrated system enables a robust, rapid, and high-content quantification of the kinetics of thrombus formation and dissolution. In platelet-sensitive mode, MC-2S demonstrated high sensitivity to antiplatelet therapy with aspirin or cangrelor. In coagulation-sensitive mode, it detected the anticoagulant effect of rivaroxaban plus its reversal by andexanet-α. In fibrinolysis-sensitive mode, it monitored tissue-type plasminogen activator-induced thrombus dissolution, inhibited by tranexamic acid. Collectively, the MC-2S platform was found to provide a versatile, physiologically relevant tool for functional hemostasis testing, with high potential for the acute and subacute evaluation of patient blood samples in the context of bleeding disorders, thrombosis risk, and drug monitoring. Full article

Background/Objectives: For surgical candidates with metastatic renal cell carcinoma with a tumor thrombus (mRCC-TT), surgery is cytoreductive nephrectomy with tumor thrombectomy (CN-TT). This is carried out through an open (OCN-TT), laparoscopic (LCN-TT), or robotic (RCN-TT) approach. The purpose of this study was to compare survival outcomes to CN-TT by operative approach. Methods: This was a retrospective analysis of all patients with a diagnosis of mRCC-TT, who underwent CN-TT from a multi-institutional database from 1999–2024. Metastatic locations were qualified as either lung, bone, brain, liver, retroperitoneum, adrenal, paraaortic nodes, or other nodes. Progression was defined as radiographic evidence of recurrence or metastasis not seen on imaging prior to CN-TT. Progression locations were all metastatic locales previously noted plus the nephrectomy bed. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) were calculated. Comparisons were performed between OCN-TT, LCN-TT, and RCN-TT. Results: A total of 131 patients were included in the analysis (97 OCN-TT, 25 LCN-TT, and 9 RCN-TT). The TT level was not different (p-value > 0.05) by approach (p-value > 0.05). Preoperative tumor size, final pathologic tumor subtype, and postoperative tumor size were equivalent between the three surgical approaches (p-value > 0.05). Rates of progression were equivalent as were all locations of disease progression in the study (p-value > 0.05). Median OS was 1.6 years in OCN-TT, 1.5 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.42). Median CSS was 2.1 years in OCN-TT, 3 years in LCN-TT, and 2.5 years in RCN-TT (p-value = 0.86). PFS was 0.8 years in OCN-TT, 1.2 years in LCN-TT, and 1.2 years in RNC-TT (p-value = 0.76). Conclusions: The operative approach does not affect survival outcomes for CN-TT. Surgeon comfort and patient preference should weigh heavily in operative decision making. Full article

Objective: False lumen (FL) thrombosis plays a key role in aortic remodeling after Frozen Elephant Trunk (FET) surgery, yet current imaging assessments are limited to categorical classifications. This study aimed to evaluate an unsupervised artificial intelligence (AI) algorithm based on a variational autoencoder (VAE) for automated, continuous quantification of FL thrombosis using serial computed tomography angiography (CTA). Methods: In this retrospective study, a VAE model was applied to axial CTA slices from 30 patients with aortic dissection who underwent FET surgery. The model encoded each image into a structured latent space, from which a continuous “thrombus score” was developed and derived to quantify the extent of FL thrombosis. Thrombus scores were compared between postoperative and follow-up scans to assess individual remodeling trajectories. Results: The VAE successfully encoded anatomical features of the false lumen into a structured latent space, enabling unsupervised classification of thrombus states. A continuous thrombus score was derived from this space, allowing slice-by-slice quantification of thrombus burden across the aorta. The algorithm demonstrated robust reconstruction accuracy and consistent separation of fully patent, partially thrombosed, and completely thrombosed lumen states without the need for manual annotation. Across the cohort, 50% of patients demonstrated an increase in thrombus score over time, 40% a decrease, and 10% remained unchanged. Despite these individual differences, no statistically significant change in overall thrombus burden was observed at the group level (p = 0.82), emphasizing the importance of individualized longitudinal assessment. Conclusions: The VAE-based method enables reproducible, annotation-free quantification of FL thrombosis and captures patient-specific remodeling patterns. This approach may enhance post-FET surveillance and supports the integration of AI-driven tools into personalized aortic imaging workflows. Full article

Background/Objectives: The relationship between thrombus imaging features and the natural evolution of stroke remains poorly defined. We aimed to investigate the associations between thrombus characteristics on CT and perfusion parameters, as well as subsequent infarct progression, in untreated patients experiencing an anterior circulation acute ischemic stroke (AIS). Methods: This retrospective analysis enrolled 81 untreated patients with AIS who underwent baseline non-contrast CT (NCCT), CT angiography (CTA), CT perfusion (CTP), and a follow-up NCCT. We evaluated the thrombus length, location, and clot burden score (CBS). CTP parameters included the ischemic core, hypoperfused tissue, and penumbra volumes. Infarct growth was the difference between the final infarct volume on a follow-up NCCT and the initial core volume on CTP. Univariate and multivariate regression models were performed. Results: Higher CBS values and shorter thrombi are associated with a reduced ischemic core (coefficients B of −3.9 and 0.88, p < 0.01), diminished hypoperfused tissue (coefficients B of −12.2 and 2.87, p < 0.001), and smaller penumbra volume (coefficients B of −7.9 and 1.99, p < 0.001). More distal occlusions were associated with smaller perfusion deficits. Importantly, a higher CBS and more distal thrombus location were significantly associated with a smaller final infarct volume and infarct growth volume. Conclusions: In untreated AIS patients, a lower thrombus burden (higher CBS, shorter length, distal location) is associated with more favorable baseline perfusion parameters and predicts a slower, less severe natural evolution of AIS. These findings underscore the prognostic value of baseline thrombus characteristics in determining the intrinsic course of a stroke. Full article

Background/Objectives: Eosinophilic myocarditis (EM) is a rare, life-threatening inflammatory cardiomyopathy driven by eosinophil cytotoxicity and extracellular trap formation. Interleukin-5 (IL-5) inhibition may disrupt this pathogenic cascade. We reviewed contemporary evidence on IL-5 blockade in EM and contextualized it with an illustrative case. Methods: We searched PubMed through May 2025 for reports of EM treated with mepolizumab or benralizumab. Inclusion criteria were consistent with prior cohorts: acute cardiac symptoms with biomarker elevation plus abnormalities on transthoracic echocardiography and/or cardiac magnetic resonance imaging (CMR), along with documented IL-5-targeted therapy. We extracted clinical, imaging, biopsy, treatment-timing, and outcome data and included one institutional case. Results: Twenty-one episodes were analyzed (median age, 45 years; 10 men). Underlying conditions included eosinophilic granulomatosis with polyangiitis (10 cases; 48%), hypereosinophilic syndrome (5 cases; 24%), drug reaction with eosinophilia and systemic symptoms (DRESS, 3 cases; 14%), and eosinophilic asthma (3 cases; 14%). Treatments involved mepolizumab in 17 cases (81%) and benralizumab in 4 (19%); 4 patients received “early-start” therapy within 14 days of EM diagnosis. Among the 11 episodes with reported left ventricular ejection fraction (LVEF) at baseline and follow-up, the median baseline LVEF was 40% (range, 30–62), with 10 of 11 (91%) <50%. On follow-up, all 11 patients improved: 4 normalized (≥50%) and 7 improved to 40–49%. CMR (n = 18) demonstrated late gadolinium enhancement in 14 cases (78%), edema in 9 (50%), and intracardiac thrombus in 4 (22%). Endomyocardial biopsy confirmed eosinophilic infiltration in 13 of 15 cases (87%). Outcomes included one death (fulminant DRESS), one recovery following veno-arterial extracorporeal membrane oxygenation, and one successful heart transplantation. Illustrative case: A 24-year-old man on a steroid taper received mepolizumab 300 mg on Day 4. His LVEF improved from 47% to 59% by Day 15, accompanied by biomarker decline and successful steroid tapering. Conclusions: Across published cases and our institutional experience, IL-5–targeted therapy appears safe, steroid-sparing, and associated with rapid ventricular recovery, particularly when initiated early. Although limited, these findings support the need for prospective trials to define the optimal agent, dosing, timing, and integration with standard immunosuppression and anticoagulation. Full article

Background and Clinical Significance: Bladder neoplasms often present with coexisting thrombi and hematuria, appearing as complex intraluminal masses on imaging, and posing a key diagnostic challenge in distinguishing neoplastic tissue from thrombus, to prevent harmful overstaging. Case Presentation: An 82-year-old man with recurrent gross hematuria and urinary disturbances was evaluated by ultrasound, which identified a large endoluminal lesion in the anterior bladder wall. The patient subsequently underwent contrast-enhanced CT using a second-generation dual-layer spectral CT system, which utilizes a dual-layer detector to simultaneously acquire high- and low-energy X-ray data. Conventional CT images confirmed a multifocal, bulky hyperdense lesion along the bladder wall, protruding into the lumen and raising suspicion for a heterogeneous mass, though further characterization was not possible. Spectral imaging enabled the reconstruction of additional maps—such as iodine density, effective atomic number (Z-effective), and electron density—which were used to further characterize these findings. The combination of these techniques clearly demonstrated differences in iodine uptake and tissue composition within the parietal lesions, allowing for a reliable differentiation between neoplastic tissue and intraluminal thrombus. Conclusions: The integration of conventional CT imaging with spectral-derived maps generated in post-processing allowed for accurate and reliable tissue differentiation between bladder neoplasm and thrombus. Spectral imaging holds the potential to prevent tumor overstaging, thereby supporting more appropriate clinical management. The dual-layer technology enables the generation of these maps from every acquisition without altering the scan protocol, thereby having minimal impact on the daily clinical workflow. Full article

Background: A persistent connection between the atria, known as a patent foramen ovale (PFO), is present in approximately 25% of the general population. PFO closure is indicated in patients under 60 years of age who have experienced an embolic stroke of undetermined source (ESUS) or transient ischemic attack (TIA) confirmed by neurological imaging, and in selected cases of peripheral embolism. Follow-up after the procedure is indicated to confirm the position of the occluder, assess the effectiveness of the closure, and evaluate any potential thrombus formation on the device. Methods: We analyzed data from 75 consecutive patients who underwent percutaneous PFO closure procedures and were followed up for at least one year. The procedure was performed under fluoroscopy and transesophageal echocardiography (TEE) guidance, and occluder size selection was made using TEE multiplanar imaging (MPR). All patients had standard transthoracic echocardiography (TTE) at 1 and 6–12 months after the procedure. To assess the long-term efficacy, contrast-enhanced transcranial Doppler (ce-TCD) was performed at 12 months to record high-intensity transient signals (HITSs). Cases with positive ce-TCD had TEE performed. Results: During follow-up evaluations after 1 and 6–12 months (TTE), we did not observe any device dislodgements, thrombi, or residual leaks visible in TTE. ce-TCD detected HITSs in eight patients, prompting additional TEE examinations performed in seven cases. In five out of seven patients, a leak around the occluder was identified, including two patients with grade 2 HITSs. Conclusions: Assessing the effectiveness of PFO occluder placement is crucial for the residual embolic risk and thus the necessity of antithrombotic therapy. Even low grades of HITSs observed in ce-TCD help to identify patients with residual leaks confirmed in TEE. Full article

Background/Aim: Adequate portal inflow is essential for liver graft regeneration following transplantation. Intraoperative portal venography (IOPV) provides real-time assessment of portal vein patency, stenosis, thrombus formation, and portosystemic collaterals. In addition to imaging, portal vein pressure gradient (portal vein pressure minus inferior vena cava pressure) was also measured. This study assessed the impact of IOPV on surgical decision-making and post-transplant outcomes to establish criteria for patient selection. Methods: From November 2016 to November 2024, 34 liver transplant patients with portal inflow insufficiency (flow velocity < 10 cm/s), large shunts (>1 cm), or portal vein thrombosis underwent IOPV. Of the patients, one received deceased donor liver transplantation (DDLT), and the others received living donor liver transplantation (LDLT). Preoperative computed tomography (CT) and ultrasound (US) assessed portal vein patency, thrombus, and shunts. Postoperative US and CT monitored portal flow and graft regeneration. Results: IOPV influenced surgical planning in all cases, leading to shunt ligation or stenting, and improved portal vein flow velocity from 6.3 (IQR, 0–9.0) to 30.8 (IQR, 22.2–36.7) cm/s (p < 0.001). Adequate inflow was achieved in 32 patients, 2 had persistent low flow or occluded flow owing to severe adhesion after transplant and failure to close large collateral veins. Graft regeneration ranged from 104% to 255% within a year. Conclusions: IOPV is a valuable tool in liver transplantation vascular surgery, optimizing surgical strategies and portal inflow. Early integration into routine practice may improve graft outcomes. Further prospective, longitudinal research is needed to refine patient selection and assess long-term benefits. Full article

Background: Accurate localization of internal carotid artery (ICA) occlusion is critical for optimizing endovascular thrombectomy (EVT) strategies. Conventional multiphase CT angiography (mCTA) often omits the carotid bifurcation in delayed phases, limiting differentiation between true cervical ICA occlusion and pseudo-occlusion. Methods: We retrospectively analyzed 56 acute ischemic stroke patients with ICA occlusion who underwent EVT and extended-range mCTA between 2016 and 2020. The scan range of the second and third arterial phases was modified to include the carotid bifurcation. Imaging patterns were evaluated to distinguish bifurcation stenosis with superimposed occlusion from proximal ICA occlusion, and to infer thrombus location by comparing arterial opacification levels across phases. Results: Extended mCTA significantly improved visualization of ICA enhancement patterns in delayed phases (p < 0.001). Cases with bifurcation stenosis showed consistently lower and stable opacification levels across phases, whereas proximal ICA occlusion demonstrated progressive contrast advancement. Distal occlusion, particularly beyond the ophthalmic artery, showed higher opacification. Including the carotid bifurcation increased scan length by ~10%, with acceptable radiation exposure. Conclusions: Incorporating the carotid bifurcation into delayed mCTA phases enhances the ability to differentiate occlusion subtypes and estimate thrombus location. This refined imaging approach enables better EVT planning, including device selection and procedural timing, thereby improving patient outcomes in acute stroke care. Full article

Aim: Hostile aortic neck anatomy—characterized by short neck length, severe angulation, conical shape, and mural thrombus or calcifications—represents a major limitation to the durability and applicability of standard endovascular aneurysm repair (EVAR). In response to these challenges, newer endografts with improved conformability have been developed. This study aimed to evaluate the mid-term outcomes of EVAR using the GORE EXCLUDER Conformable AAA Endoprosthesis (CEXC) (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) in patients with hostile neck anatomy, with specific attention to type III endoleak occurrence, aortic sac remodeling, and maintenance of distal sealing. Methods: A retrospective observational analysis was conducted on 50 consecutive patients treated with the CEXC endograft between October 2019 and September 2023. Patients included had either elective or urgent indications for EVAR and were evaluated preoperatively using CT angiography. Hostile neck criteria were defined according to the 2019 Delphi Consensus. Procedural variables, imaging follow-up, and clinical outcomes were collected. The primary endpoints were technical and clinical success, while secondary outcomes included endoleak rates, aneurysm sac evolution, and reintervention-free survival. Results: Technical success was achieved in 100% of cases, with a clinical success rate of 98%. No type Ia, Ib, or III endoleaks were observed at a median follow-up of 23 months. Sac shrinkage (>5 mm reduction) occurred in 70% of patients, and distal sealing was preserved in 100% of cases. One perioperative death occurred in an emergency setting, and no late reinterventions or aneurysm-related mortalities were reported. The use of intravascular ultrasound (IVUS) and floppy guidewires contributed to precise deployment and sealing in angulated anatomies. Conclusions: The CEXC endograft proved to be a safe and effective option for EVAR in patients with hostile aortic anatomy, ensuring durable proximal and distal sealing, promoting favorable sac remodeling, and preventing type III endoleaks. These findings support the use of CEXC in anatomically complex settings, as long as procedures are meticulously planned and guided by appropriate intraoperative imaging and deployment techniques. Full article

Acute pulmonary embolism (APE) represents a significant cause of morbidity and mortality worldwide, requiring rapid and precise diagnosis and effective therapy strategies. Computed Tomography Pulmonary Angiography (CTPA) is currently the gold standard technique for diagnosing PE; however, it presents some disadvantages, including limited sensitivity in detecting sub-segmental emboli and contrast-related risks. Recent advancements in imaging technologies, including Dual-Energy Computed Tomography (DECT) and Photon Counting (PC), offer improved sensitivity and specificity for APE and perfusion abnormalities detection. Digital Dynamic Radiography (DDR) perfusion imaging represents a novel imaging that allows pulmonary perfusion assessment without contrast medium administration, able to detect anomalies at the patient’s bedside, representing a promising advancement, particularly for critically ill or contrast-allergic patients. In parallel, interventional radiology has become integral to APE management, particularly for high-risk and intermediate–high-risk patients, with evolving intravascular treatment techniques such as catheter-directed thrombolysis, mechanical thrombectomy, and thrombus aspiration. This narrative review provides an overview of the latest developments in APE diagnostic imaging and interventional radiology, contextualizing them within current guideline recommendations for endovascular treatment. Full article

Background: Inherent to the challenge of acute pulmonary embolism (APE), the breadth of presentation ranges from asymptomatic pulmonary emboli to sudden death. Risk stratification of patients with APE is mandatory for determining the appropriate therapeutic management approach. However, the optimal clinically most relevant combination of predictors of death remains to be determined. Radiomics is an emerging discipline in medicine that extracts and analyzes quantitative data from medical images using mathematical algorithms. In APE, these data can reveal thrombus characteristics that are not visible to the naked eye, which may help to more accurately identify patients at higher risk of early clinical deterioration or mortality. We conducted a scoping review to explore the current evidence on the prognostic performance of radiomic models in patients with APE. Methods: PubMed, Web of Science, EMBASE, and Scopus were searched for studies published between January 2010 and April 2025. Eligible studies evaluated the use of radiomics to predict adverse outcomes in patients with APE. The PROSPERO registration number is CRD420251083318. Results: Nine studies were included in this review. There was significant heterogeneity in the methodology for feature selection and model development. Radiomic models demonstrated variable performance across studies. Models that combined radiomic features with clinical data tended to show better predictive accuracy. Conclusions: This scoping review underscores the potential of radiomic models, particularly when combined with clinical data, to improve risk stratification in patients with APE. Full article