bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial Viability Assessment
Authors: Dilsizian Vasken , Valenta Ines , Schindler Thomas H. 
Published: November 2015

Abstract
Heart failure may be a consequence of ischemic or non-ischemic cardiomyopathy. Etiologies for LV systolic dysfunction in ischemic cardiomyopathy include; 1) transmural scar, 2) nontransmural scar, 3) repetitive myocardial stunning, 4) hibernating myocardium, and 5) remodeled myocardium. The LV remodeling process, which is activated by the renin-angiotensin system (RAS), stimulates toxic catecholamine actions and matrix metalloproteinases, resulting in maladaptive cellular and molecular alterations5, with a final pathway to interstitial fibrosis. These responses to LV dysfunction and interstitial fibrosis lead to progressive worsening of LV function. Established treatment options for ischemic cardiomyopathy include medical therapy, revascularization, and cardiac transplantation. While there has been continuous progress in the medical treatment of heart failure with beta-blockers, angiotensin-converting enzyme (ACE) inhibition, angiotensin II type 1 receptor (AT1R) blockers, and aldosterone to beneficially influence morbidity and mortality, the 5-years mortality rate for heart failure patients remains as high as 50%. Revascularization procedures include percutaneous transluminal coronary artery interventions (PCI) including angioplasty and endovascular stent placement and coronary artery bypass grafting (CABG). Whereas patents with heart failure due to non-coronary etiologies may best benefit from medical therapy or heart transplantation, coronary revascularization has the potential to improve ventricular function, symptoms, and long term survival, in patients with heart failure symptoms due to CAD and ischemic cardiomyopathy.
Inflammatory and Infiltrative Diseases and Tumors
Authors: Dorbala Sharmila , Nelson Katarina H. 
Published: November 2015

Abstract
This chapter highlights some of the novel clinical radionuclide imaging strategies beyond perfusion imaging including inflammatory diseases, infiltrative diseases and tumors. Targeted molecular imaging techniques to evaluate cardiac amyloidosis as well as myocardial and vascular inflammation are addressed. Clinical 18F-FDG imaging of cardiac sarcoidosis, cardiovascular prosthetic valve and device infections, systemic vasculitis, and tumors are discussed in detail. For each of these pathologies, a concise overview of the disease pathophysiology and management pertinent to understanding of imaging techniques is provided followed by details of imaging including radiotracers, imaging techniques and image interpretation with a reference to societal guidelines. The published data on the utility of radionuclide imaging tests to assess diagnosis, prognosis and to monitor response to therapy are discussed. Clinical scenarios and available societal recommendations on the use of imaging are illustrated. The strengths and limitations of radionuclide techniques are discussed in the context of a comparison to echocardiography, cardiac magnetic resonance imaging, cardiac CT and endomyocardial biopsy. Future directions in imaging and ongoing clinical trials in these areas are listed at the end of each section.
Guidelines and Appropriate Use Criteria
Authors: Marzouka George R. , Otalvaro-Orozco Lynda , Hendel Robert C. 
Published: November 2015

Abstract
Multiple documents have been published regarding the use of radionuclide imaging which attempt to outline the applications of SPECT and PET cardiac imaging and to offer guidance in not only how these techniques are performed but also when these tests should be used. These guidance documents, which include position papers, consensus documents, white papers, clinical practice guidelines (CPG), and appropriate use criteria (AUC) serve a number of purposes and are applicable to various health care providers. The focus of this chapter is on CPG and AUC, as these provide the basis for care optimization and reimbursement decisions and are the most widely accepted documents regarding radionuclide-imaging utilization. Throughout this book, each chapter has focused on the best practice of nuclear cardiology, emphasizing methods that will not only improve image quality but also provide significant clinical value. This chapter will emphasize the selection of patients for radionuclide imaging and focus on how best to use these resources to improve the outcome of patients with known or suspected heart disease.
Radiation Considerations
Authors: Einstein Andrew J. 
Published: November 2015

Abstract
Radiation considerations are an integral part of the practice of nuclear cardiac imaging. Concern regarding radiation has increased in recent years, reflected in statements by many professional societies, and likely attributable both to rapid growth in use of nuclear cardiology as well as high doses received by some nuclear cardiology patients. The fundamental principles of medical radiological protection are justification (ensuring that the right test is performed for the right patient at the right time), optimization (ensuring that the test is performed in the right manner), and dose limitation, which while applicable to healthcare workers is not operative regarding patients. Three "As" facilitate and serve as an organizing principle for justification: awareness, appropriateness, and audit. Awareness incorporates knowledge of the benefits and risks of testing involving radiation and effective communication of these to the patient. Appropriateness in nuclear cardiology can be assessed using the American College of Cardiology's appropriateness criteria. Methods that have been demonstrated to improve appropriateness include using a collaborative learning model, a point-of-order decision support tool, and a multifaceted intervention including threatened loss of insurance coverage. A variety of strategies should be considered for optimization to ensure patient-centered imaging. These including strategic selection of both the protocol, e.g. selecting a stress-first protocol and performing stress-only imaging in patients without a high pre-test probability of abnormal findings on stress imaging, or using PET, and also the administered activity, e.g. by using weight-based dosing and/or software- or hardware-based advances in camera technology. Special considerations are required for pregnant, nursing, and pediatric patients.
Thoracic endoprostheses for type B aortic dissections
Authors: Lioupis Christos , Clough Rachel , Taylor Peter 
Published: November 2015

Abstract
Endovascular treatment of acute complicated type B aortic dissection has become accepted as the first line of treatment. Advantages over open surgical repair include the minimal invasiveness of the procedure, the lack of a thoracotomy, no aortic cross-clamping causing end-organ ischaemia, and no requirement for full anticoagulation. Mortality and morbidity in terms of stroke and paraplegia are less than with open repair, although the long-term durability of endovascular repair is yet to be proven. We present a case of acute complicated type B aortic dissection treated with endovascular repair which resulted in the death of the patient. The reasons for this poor outcome are discussed, and the pitfalls and the ways to avoid them are identified.
Management of endoleaks after thoracic endografts
Authors: Alsafi Ali , Hamady Mo 
Published: November 2015

Abstract
Thoracic aortic aneurysms are a relatively uncommon clinical problem; however, their rupture is associated with high mortality and morbidity, with treatment aiming at reducing this risk. Endovascular repair of thoracic aortic aneurysms (TEVAR) has emerged over the last decade as a viable and increasingly preferred alternative to open surgical repair for thoracic aortic disease, which is increasing in prevalence, especially in an aging population. TEVAR has created a new set of challenges and complications not previously encountered with conventional forms of treatment; one such important complication is endoleaks. This Case discusses the pathogenesis, diagnosis, and management of endoleaks as well as some strategies to reduce their incidence. The discussion of this unique clinical entity includes a case-based discussion of some of the clinical and technical challenges encountered.
Juxtarenal abdominal aortic aneurysms: fenestrations versus chimneys
Authors: Shaida Nadeem , Winterbottom Andrew 
Published: November 2015

Abstract
Limitations of conventional infrarenal endovascular abdominal aortic aneurysm repair (EVAR) include a short infrarenal neck or aneurysmal disease involving the abdominal aortic visceral segment. A number of newer endovascular treatments, including fenestrated EVAR, branched endovascular stent grafts, and chimney stents, have been proposed. We describe one such case treated with a four-vessel fenestrated EVAR and also review the current options available for the treatment of juxtarenal and suprarenal abdominal aortic aneurysm disease.
Management of endoleaks after abdominal aneurysm endovascular repair
Authors: Chung Raymond , Morgan Robert 
Published: November 2015

Abstract
Endoleaks are a common complication of endovascular repair of abdominal aortic aneurysms. Classification is paramount in determining their natural history/propensity for rupture and therefore their clinical management. CT angiography and digital subtraction angiography remains the most common modalities in the detection and characterization of endoleaks (ELs). The majority are amenable to endovascular repair with only a small cohort requiring surgical open conversion. Types I and III ELs, associated with systemic pressurization of the aneurysm sac and therefore increased risk of rupture, are treated early with additional endografts, extender modules, cuffs, balloon remodelling, or the deployment of Palmaz stents. Treatment of type II ELs is reserved for patients who demonstrate sac enlargement. Type II ELs can be embolized by either a percutaneous or a transarterial approach. Type IV ELs resolve spontaneously and do not require further treatment. Type V ELs, also referred to as endotension, can be treated by relining the stent graft with a new endograft. We report the case of a type II EL treated by transarterial embolization with Onyx.
Carotid artery stenting: how to treat restenosis
Authors: Cannavale Alessandro , Fanelli Fabrizio 
Published: November 2015

Abstract
We report a case of a 63-old female who, after previous carotid endarterectomy (CEA) for a transient ischaemic attack (TIA), experienced restenosis which was treated with a balloon-expandable stent. Seven months later an ultrasound colour Doppler (USCD) revealed deformation of the proximal end of the stent, which led to severe in-stent restenosis (ISR). The patient underwent a successful re-intervention by stenting and dilation of the ISR. The management of ISR may be performed by medical therapy, or by an endovascular or surgical approach. Different endovascular techniques are available to treat carotid in-stent restenosis: angioplasty alone, cutting balloon angioplasty (CB), stenting and angioplasty, brachytherapy, drug-eluting stents, or drug-eluting balloons. Each technique can be applied according to the patient’s clinical status and history, supra-aortic vessel anatomy, features of the stent previously implanted, and type of ISR.
SFA endoluminal bypass: the new era of critical limb ischaemia treatment
Authors: Shaw Aidan , Ahmed Irfan 
Published: November 2015

AbstractThe prognosis for patients presenting with critical limb ischaemia (CLI) is poor not only for the limb but also for life. The optimal treatment for patients presenting with CLI is revascularization. Severity and extent of disease, morphology of the lesions, and run-off determine the treatment modalities. Surgical bypass is currently recommended for complex lesions. However, the techniques and technology in endovascular radiology continue to evolve and improve. We describe a case of revascularization of an occluded superficial femoral artery and discuss tips and tricks, such as re-entry devices, as well as the evidence behind the use of angioplasty and stenting, particularly drug-eluting technology.
Below the knee angioplasty: bare versus drug-eluting stents
Authors: Spiliopoulos Stavros , Siablis Dimitrios 
Published: November 2015

Abstract
A 74-year-old patient suffering from critical limb ischaemia underwent percutaneous endovascular revascularization in the interventional radiology department. Baseline symptomatology included severe rest pain not responding to common analgesics, and dry gangrene of the left toe (Rutherford–Becker stage 5). The ankle-brachial index at presentation was 0.60. Selective digital subtraction angiography revealed significant 50–60% tortuous multiple stenoses and one near occlusion, all detected at the proximal segment of the peroneal artery which was the only patent infrapopliteal vessel. The arterial supply of the distal foot was preserved by the distal peroneal collateral network. Direct stenting of the diseased proximal peroneal segment using three sirolimus-eluting stents in an overlapping manner was performed. The total stented length was 94mm. Dual antiplatelet therapy was prescribed for 6 months, followed by monotherapy with clopidogrel 75mg 1 × 1. Complete wound healing and clinical improvement by three stages (Rutherford-Becker stage 2 from stage 5) was detected at one-year follow-up and was sustained throughout a three-year follow-up period. The lesion was patent without any in-stent restenosis at two years angiographic follow-up.
Dialysis access at risk: balloons or stent grafts?
Authors: Spiliopoulos Stavros , Karnabatidis Dimitrios 
Published: November 2015

Abstract
A 34-year-old male was referred to the interventional radiology department with thrombosis of a straight brachiocephalic synthetic haemodialysis graft in upper arm. The haemodialysis access had been created two months previously and the referring physician reported increased venous pressure during haemodialysis, indicating a possible stenosis, during the last two sessionsbefore the thrombotic event. The patient underwent percutaneous haemodialysis access declotting using a combined technique of transcatheter thrombolysis and mechanical thrombectomy. The underlying lesion, detected at the venous anastomosis site, was treated using a 7 × 100mm high-pressure balloon catheter. Thrill was palpable at the end of the procedure. However, no thrill was present the next day and the patient returned for a check fistulogram that demonstrated a significant restenosis of the previously treated anastomotic segment. Subsequent balloon angioplasty was suboptimal and an 8 × 80mm self-expandable covered stent was deployed across the lesion. Antiplatelet therapy with clopidogrel 75mg 1 × 1 was prescribed and the patient entered a monthly monitoring and bimonthly surveillance protocol. At eight months follow-up no clinical signs of failing access were evident and the patient reported excellent dialysis sessions. The six-month fistulogram demonstrated &lt;30% restenosis at the proximal end of the stent.
Epistaxis: which embolic materials to use?
Authors: Jarząbek Magdalena , Trojanowski Piotr , Szczerbo-Trojanowska Małgorzata 
Published: November 2015

Abstract
Although embolization is not considered a first-line treatment for epistaxis, it is widely recognized as being an important therapeutic tool in certain difficult scenarios. We present a case of intractable posterior epistaxis after maxillofacial trauma with isolated nasal septum fracture where conservative therapy was unsuccessful and arterial embolization was performed as a second-line treatment. We will discuss various aspects relating to the diagnosis of epistaxis, types of epistaxis, and alternative treatment methods, with a detailed description of embolization techniques and embolic materials used in different diseases.
Massive haemoptysis: what to embolize?
Authors: Tang Kendrick , Kwok Philip 
Published: November 2015

Abstract
Haemoptysis may hinder oxygen exchange and can be life-threatening if not controlled in time. Contrast CT thorax is preferred over bronchoscopy as the primary investigation for haemoptysis, providing information not only on the site and cause of haemorrhage but also pinpointing the origin of culprit feeder vessel. Percutaneous transcatheter embolization is a safe and effective treatment for massive haemoptysis. The interventional radiologist should be familiar with the bronchial artery anatomy, the catheters, and different types of embolizing agents. Non-bronchial systemic arterial supplies can be the reason for treatment failure. Occasionally, complications may happen and these should be discussed with the patient before the procedure.
Gastrointestinal bleeding: which embolic material to use?
Authors: Ganai Bhaskar , Lee Michael J 
Published: November 2015

Abstract
Gastrointestinal (GI) bleeding is common with an important role for interventional radiology. We describe an unusual case of GI bleeding with examples of different embolic agents that can be employed. For upper GI bleeding, haemostasis can most often be achieved by endoscopy. If this is unsuccessful or there is a recurrence of bleeding, embolization with coils, particles, or liquid embolic agents can be performed. Because of the rich collateral supply, embolization can be focused on larger vessels, such as the gastroduodenal artery. In lower GI bleeding, endoscopy is generally less useful. CT angiography can be used to identify a source of bleeding, followed by embolization with coils. Because of the lack of collateral supply to the lower GI tract, embolization should be very selective.
Uterine fibroid embolization: can fertility be preserved?
Authors: Mailli Leto , Parthipun Aneeta , Ahmed Irfan 
Published: November 2015

Abstract
Uterine fibroid embolization (UFE) is a well-established, safe, and effective treatment for symptomatic fibroids. It has been proved to provide a significant improvement in quality of life, equivalent to that obtained with myomectomy but with a shorter hospital stay and fewer major complications. However, the effects of UFE on preserving fertility remain unclear. At present, myomectomy is considered the only surgical option for women in whom future fertility is desired [1]. Clinicians are facing an increasing predicament as more and more women are considering UFE as a minimally invasive form of treatment [2]. The current case highlights a relatively common but challenging dilemma of a scenario involving a woman with symptomatic fibroids concerned about her fertility and requesting non-surgical treatment.
Postpartum haemorrhage: what is the role of occlusion balloons?
Authors: Das Raj , Belli Anna Maria 
Published: November 2015

Abstract
Post-partum haemorrhage remains a significant cause of maternal morbidity and mortality in childbirth, and interventional radiology now has a crucial role in improving patient outcomes and survival. The prevalence of abnormal placentation is increasing, and with improved ultrasound and MRI detection an increasing number of cases at high risk of post-partum haemorrhage from placenta accreta and percreta are being identified that can benefit from the ’electiveʼ use of prophylactic internal iliac artery occlusion balloons. Prophylactic occlusion balloons in high-risk pregnancies can reduce haemorrhage and promote uterine-conserving surgical techniques. We discuss the technique of occlusion balloon placement, indications, potential complications, and evidence base.
Prostate artery embolization for benign prostate hypertrophy
Authors: Shaw Aidan , Ahmed Irfan , Sabharwal Tarun 
Published: November 2015

Abstract
Prostate artery embolization (PAE) has been performed for intractable haematuria for many years and has most recently come to the forefront as a novel treatment for benign prostate hypertrophy (BPH). PAE has many advantages over surgical treatment options. The current literature for PAE has shown the procedure to be a safe, effective, and minimally invasive treatment option for BPH. We describe a case of PAE and discuss tips and tricks, including pre-operative imaging techniques as well as techniques for optimal visualization of the arteries for successful cannulation.
Tracheobronchial stenting: covered versus uncovered
Authors: Inchingolo Riccardo , Sabharwal Tarun 
Published: November 2015

Abstract
A 67-year old patient with non-operable lung cancer underwent tracheobronchial stenting because of progressive dyspnoea (FEV1 at presentation was 1.03L, which was 44% of the expected value). Pre-procedural CT showed the presence of a central mass involving the left main bronchus and carina and enlarged lymph nodes. CT also confirmed the presence of multiple bone metastases. A kissing stent procedure was performed using covered stents for the left bronchus and uncovered for the right, with significant improvement of the patient’s symptoms. The follow-up CT scan after six months showed tumour in-growth causing severe stenosis of the right stent. Although there was no significant dyspnoea, a new covered stent was placed proximally on the right side to prevent a further occlusion
Early-stage hepatocellular carcinoma: the percutaneous approach
Authors: Hedayati Venus , Peddu Praveen 
Published: November 2015

Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer. The majority of hepatocellular cancers occur in patients with established liver cirrhosis. The most common causes of cirrhosis are alcohol and hepatotrophic viruses. Diagnosis of HCC is made on imaging based on enhancement characteristics. The typical enhancement features, such as arterial hyper-enhancement and washout, are seen in moderately differentiated HCCs. Well differentiated and poorly differentiated tumours can have atypical enhancement and be difficult to diagnose on axial imaging. Early stage HCC constitutes a single lesion or up to three lesions &lt;3cm in diameter without extrahepatic disease. Treatment of early-stage HCC depends on the severity of the background liver disease and the performance status of the patient. Surgical resection and liver transplantation offer the best chance of long-term survival. Percutaneous treatments, such as transarterial chemoembolization (TACE), percutaneous ablation (RFA/microwave), and ethanol injection (PEI) are offered to control disease in those patients on the surgical waiting list or as palliative treatment in those who are unfit for surgery.
Small renal tumours: is radiofrequency ablation better than surgery?
Authors: Krokidis Miltiadis , Adam Andy 
Published: November 2015

Abstract
The main tools in the management of small renal tumours are partial nephrectomy (PN) and percutaneous radiofrequency ablation (RFA). We describe a case where RFA was used for the treatment of a small renal mass with satisfactory long-term results. The case includes an overview of the technique used for RFA, and the current evidence regarding the results of RFA treatment of small renal tumours and the comparison with surgery.
Vertebral augmentation techniques and pain management: is there a role in metastatic disease?
Authors: Orgera Gianluigi , Krokidis Miltiadis , Rossi Michele 
Published: November 2015

Abstract
The management of metastatic spinal disease aims at pain control, maintenance or restoration of neurological function, and stability. Standard treatments are radiation therapy, chemotherapy, and surgery. Technological advances combined with interventional radiology techniques can now offer alternative treatment options which are less invasive for many patients with malignant vertebral body infiltration.Vertebral augmentation (VA) techniques deliver biocompatible cement into the fractured vertebral body via percutaneous needles aiming for an increase in stability. Adjunctive thermal ablation techniques can be used aiming for destruction of sensory nerve fibres and reduction of the size of the lesion. We report a case of an L2 metastasis from a thyroid carcinoma that was successfully treated with a combination of percutaneous vertebroplasty and radiofrequency ablation, and discuss the options of percutaneous vertebral augmentation techniques.