Transarterial treatment approaches of hepatocellular carcinoma

À côté de la chimioembolisation intra-artérielle hépatique régionale, différentes approches de traitement endovasculaire du carcinome hépatocellulaire sont en cours d’évaluation : chimioembolisation hypersélective ; chimioembolisation par microsphères chargeables ; radioembolisation. Cet article vise à décrire les différentes techniques et à préciser la place de la chimioembolisation dans la stratégie thérapeutique du carcinome hépatocellulaire ainsi que les principaux champs d’investigation clinique pour les techniques plus innovantes.Transarterial regional chemoembolisation is one of the therapeutic options in the palliative treatment of advanced hepatocellular carcinoma. Several other transarterial approaches are under investigation including selective transarterial chemoembolization, embolization with drug-eluting beads, and radioembolisation. The aim of this article is to describe the technical aspects of these techniques and to indicate their indication and/or clinical fields of investigation

Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial.

BACKGROUND A clear patency benefit of a drug-eluting stent (DES) over a bare metal stent (BMS) for treating peripheral artery disease of the femoropopliteal segment has not been definitively demonstrated. The EMINENT study (Trial Comparing Eluvia Versus Bare Metal Stent in Treatment of Superficial Femoral and/or Proximal Popliteal Artery) was designed to evaluate the patency of the Eluvia DES (Boston Scientific, Marlborough, MA), a polymer-coated paclitaxel-eluting stent, compared with BMS for the treatment of femoropopliteal artery lesions. METHODS EMINENT is a prospective, randomized, controlled, multicenter European study with blinded participants and outcome assessment. Patients with symptomatic peripheral artery disease (Rutherford category 2, 3, or 4) of the native superficial femoral artery or proximal popliteal artery with stenosis ≥70%, vessel diameter of 4 to 6 mm, and total lesion length of 30 to 210 mm were randomly assigned 2:1 to treatment with DES or BMS. The primary effectiveness outcome was primary patency at 12 months, defined as independent core laboratory-assessed duplex ultrasound peak systolic velocity ratio ≤2.4 in the absence of clinically driven target lesion revascularization or surgical bypass of the target lesion. Primary sustained clinical improvement was a secondary outcome defined as a decrease in Rutherford classification of ≥1 categories compared with baseline without a repeat velocity ratio ≤2.4 in the absence of clinically driven target lesion revascularization. Health-related quality of life and walking function were assessed. RESULTS A total of 775 patients were randomly assigned to treatment with DES (n=508) or commercially available BMS (n=267). Baseline clinical, demographic, and lesion characteristics were similar between the study groups. Mean lesion length was 75.6±50.3 and 72.2±47.0 mm in the DES and BMS groups, respectively. The 12-month incidence of primary patency for DES treatment (83.2% [337 of 405]) was significantly greater than for BMS (74.3% [165 of 222]; P<0.01). Incidence of primary sustained clinical improvement was greater among patients treated with the DES than among those who received a BMS (83.0% versus 76.6%; P=0.045). The health-related quality of life dimensions of mobility and pain/discomfort improved for the majority of patients in both groups (for 66.4% and 53.6% of DES-treated and for 64.2% and 58.1% of BMS-treated patients, respectively) but did not differ significantly. At 12 months, no statistical difference was observed in all-cause mortality between patients treated with the DES or BMS (2.7% [13 of 474] versus 1.1% [3 of 263]; relative risk, 2.4 [95% CI, 0.69-8.36]; P=0.15). CONCLUSIONS By demonstrating superior 1-year primary patency, the results of the EMINENT randomized study support the benefit of using a polymer-based paclitaxel-eluting stent as a first-line stent-based intervention for patients with symptomatic peripheral artery disease attributable to femoropopliteal disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02921230

OEDEMES AIGUS PULMONAIRES ET STENOSE ARTERIELLE RENALE (RESULTATS A LONG TERME DE L'ANGIOPLASTIE RENALE (DES CARDIOLOGIE))

PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Radioembolization: a new approach for hepatocellular carcinoma

Radio-embolization is a new endovascular technique for the management of hepatic lesions. The intra-arterial super-selective injection of microspheres loaded with a radio-element (Yttrium 90) enables a selective internal radiotherapy at the tumor site. This original technique has been used in the treatment of primary and secondary liver tumours. In patients with HCC in palliative situation, phase 1 and phase 2 trials as well as case series have demonstrated a tumor response rate from 50 to 70% according to RECIST criteria. The global median survival has been found to be 7 to 24 months. In some cases it has been possible to downstage the lesions making the patient eligible to a curative treatment (transplantation or hepatectomy). Considering these promising results, comparison with targeted therapies (i.e. chemo-embolization) is needed. Phase 3 trials are ongoing.La radio-embolisation (RE) est une nouvelle technique endovasculaire innovante de destruction tumorale hépatique. L’injection intra-artérielle hépatique de microsphères chargées d’Yttrium 90 radioactif permet de réaliser une irradiation interne sélective. Cette technique est utilisée dans la prise en charge des cancers primitifs et secondaires du foie. Chez les patients atteints de carcinomes hépatocellulaires (CHC) en situation palliative, les résultats d’étude de phase I, de phase II ou de séries de cas consécutifs ont montré 50 à 70 % de réponse tumorale selon les critères RECIST, avec une médiane de survie globale de 7 à 24 mois. Un certain nombre de patients ont pu bénéficier, au décours de la RE, d’une prise en charge curative (transplantation hépatique, exérèse chirurgicale, radiofréquence). Cette nouvelle approche thérapeutique prometteuse reste insuffisamment comparée aux thérapies ciblées et à la chimioembolisation ; des essais thérapeutiques de phase III sont en cours

Clinical management of renal artery fibromuscular dysplasia

International audienc

Microvascular plug: a new embolic material for hepatic arterial skeletonization

Arterial skeletonization before radioembolization or hepatic artery port catheter placement for chemotherapy is a crucial step to prevent side effects. Coils are commonly used as an embolic material for hepatoenteric arterial occlusion. Herein is reported for the first time the clinical use of a new detachable microvascular plug (MVP) suitable for occlusion of 1-3 mm diameter vessels. The MVP allows vessel embolization even in challenging anatomy such as the right gastric artery. Furthermore, immediate and stable vessel occlusion was observed in our pilot study of 16 MVP placements.status: publishe