Yamashita Yasuyuki

Empiric Transcatheter Arterial Embolization for Massive Bleeding From Duodenal Ulcers: Efficacy and Complications

PURPOSE To evaluate the efficacy and safety of empiric transcatheter arterial embolization (TAE) for patients with massive bleeding from duodenal ulcers. MATERIALS AND METHODS During January 2000 and December 2009, 59 patients with duodenal ulcer bleeding in whom TAE was attempted after endoscopic therapy failed were retrospectively analyzed. The patients were divided into empiric TAE (n = 36) and identifiable TAE (n = 23) groups according to angiographic findings with or without identification of the bleeding sites. The technical and clinical success rate, recurrent bleeding rate, procedure-related complications, and clinical outcomes were evaluated. RESULTS The technical and clinical success rates of TAE were 100% and 83%. The recurrent bleeding rate, clinical success, duodenal stenosis, and 30-day mortality after TAE were not significantly different between the empiric and identifiable TAE groups. CONCLUSIONS A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography.

Dual-region-of-interest bolus-tracking technique for coronary computed tomographic angiography on a 320-row scanner: reduction in the interpatient variability of arterial contrast enhancement

OBJECTIVE We compared the effect of a dual-region-of-interest (ROI) bolus-tracking technique on interpatient variability of arterial contrast enhancement with that of the conventional bolus-tracking technique in coronary computed tomographic angiography (CTA) on a 320-row scanner. METHODS This study included 100 patients who underwent coronary CTA using one of two protocols: (1) 50 patients underwent scanning using a conventional single-ROI bolus-tracking technique (P-single) with an ROI placed in the ascending aorta, and (2) 50 patients underwent scanning using a dual-ROI technique (P-dual) with two ROIs placed in the pulmonary trunk and the ascending aorta. CT attenuation in the ascending aorta and coronary arteries, and the interpatient variability were compared between the two scanning protocols. RESULTS The mean CT attenuation of the ascending aorta and coronary arteries tended to be higher for P-dual than for P-single, but the difference was not significant (p = 0.08-0.30). The interpatient variability of contrast enhancement (SD of the CT attenuation) was significantly smaller for P-dual than for P-single (p < 0.01). CONCLUSION The dual-ROI bolus-tracking technique can reduce interpatient variability of arterial contrast enhancement in coronary CTA on a 320-row scanner. Advances in knowledge: The use of a dual-ROI bolus-tracking technique can provide sufficient and consistent arterial enhancement of coronary CTA.

Percutaneous aspiration embolectomy of superior mesenteric artery using a 5MAX ACE reperfusion catheter

Acute mesenteric ischaemia is a rare abdominal emergency that commonly results in bowel infarction and has a very high mortality rate. Therefore, prompt recognition and treatment are crucial for a successful outcome. A thrombectomy for embolism in the mid portion of the main trunk of the superior mesenteric artery (SMA) is proposed. A near-complete thrombi removal from the main trunk of the SMA was achieved by using a 5MAX ACE reperfusion catheter, which was designed for treating cerebral embolism. This is the first report describing the treatment of acute mesenteric ischaemia using this catheter. Percutaneous aspiration embolectomy with this catheter is a useful modality for recanalization of embolic occlusion of not only the cerebral artery but also the SMA.