Abstracts from the current literature By Ripal T. Gandhi, MD, FSIR, and Suvranu Ganguli, MD, FSIR


This column alerts SIR members to abstracts that may have an impact on their practice and how they converse with referring clinicians. If you would like to suggest abstracts you feel should be included, email us at gandhi@baptisthealth.net or suvranu.ganguli@bmc.org.


Hepatology. 2021 Mar;73(3):998-1010. doi: 10.1002/hep.31318.


Liver transplantation following yttrium-90 radioembolization: 15-year experience in 207-patient cohort


Ahmed Gabr, Laura Kulik, Samdeep Mouli, Ahsun Riaz, Rehan Ali, Kush Desai, Ronald A Mora, Daniel Ganger, Haripriya Maddur, Steven Flamm, Justin Boike, Christopher Moore, Bartley Thornburg, Ali Alasadi, Talia Baker, Daniel Borja- Cacho, Nitin Katariya, Daniela P Ladner, Juan Carlos Caicedo, Robert J Lewandowski, Riad Salem


Background and aims: Radioembolization (yttrium-90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver-directed therapy to curative liver transplantation (LT). In this study, we report long-term outcomes of LT for patients with HCC who were bridged/ downstaged by Y90.


Approach and results: Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor-node-metastasis criteria at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM) and time-to-recurrence, were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Univariate and multivariate analyses were performed using a log-rank test and Cox proportional-hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4–10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%) and 53 (26%) patients showed complete, extensive and partial tumor necrosis on histopathology. Three- year, 5-year and 10-year OS rates were 84%, 77% and 60%, respectively. Twenty-four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69–150) months. DSM at 3, 5 and 10 years was 6%, 11% and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive vs. partial tumor necrosis (P < 0.0001). For patients with UNOS T2 treated during the study period, 5.2% dropped out because of disease progression.


Conclusions: Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment before LT.


34 IRQ | SUMMER 2021


JACC Cardiovasc Interv. 2021 Feb 22;14(4):378-385. doi: 10.1016/j. jcin.2020.10.013.


Distal radial artery approach to prevent radial artery occlusion trial


Guering Eid-Lidt, Agustín Rivera Rodríguez, Joaquín Jimenez Castellanos, Julio I Farjat Pasos, Kathia E Estrada López, Jorge Gaspar


Objectives: The aim of this study was to compare the rate of proximal radial artery occlusion (RAO) with Doppler ultrasound between distal and conventional radial access 24 h and 30 days after a transradial coronary procedure.


Background: The use of distal radial access to prevent proximal RAO (PRAO) in the proximal segment at 24 h and 30 days after a procedure, compared with conventional radial access, is unknown.


Methods: This was a prospective, comparative, longitudinal, randomized study. A total of 282 patients were randomized to either proximal radial access (n = 142) or distal radial access (n = 140) to evaluate the superiority of the distal approach in the prevention of PRAO with Doppler ultrasound 24 h and 30 days after a transradial coronary procedure.


Results: In the per protocol analysis, the rates of PRAO at 24 h and 30 days were 8.4% and 5.6% in the proximal group and 0.7% and 0.7% in the distal group, respectively (24 h: odds ratio [OR]: 12.8; 95% confidence interval [CI]: 1.6–100.0; p = 0.002; 30 days: OR: 8.2; 95% CI: 1.0–67.2; p = 0.019). In an intention-to- treat analysis, the 24-h and 30-day rates of PRAO were 8.8% and 6.4% for proximal radial access and 1.2% and 0.6% in the distal radial access group (24 h: OR: 7.4; 95% CI: 1.6–34.3; p = 0.003; 30 days: OR: 10.6; 95% CI: 1.3–86.4; p = 0.007).


Conclusions: Distal radial access prevents RAO in the proximal segment at 24 h and 30 days after the procedure compared with conventional radial access.


JACC Cardiovasc Interv. 2021 Feb 8;14(3):319-329. doi: 10.1016/j. jcin.2020.09.053. Epub 2021 Jan 13.


Indigo aspiration system for treatment of pulmonary embolism: Results of the EXTRACT-PE Trial


Akhilesh K Sista, James M Horowitz, Victor F Tapson, Michael Rosenberg, Mahir D Elder, Brian J Schiro, Suhail Dohad, Nancy E Amoroso David J Dexter, Christopher T Loh, Daniel A Leung, Bruce Kirke Bieneman, Paul E Perkowsk, Michael L Chuang, James F Benenati, EXTRACT-PE Investigators


Objectives: This study sought to prospectively evaluate the safety and efficacy of the Indigo aspiration system in submassive acute pulmonary embolism (PE).


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