Service D'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France.
Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK.
Cardiovasc Intervent Radiol. 2020 Jun;43(6):858-865. doi: 10.1007/s00270-020-02455-z. Epub 2020 Mar 31.
To retrospectively assess the technical feasibility, safety and clinical efficacy of percutaneous MR-guided cryoablation of low-flow vascular malformations (LFVM).
Between July 2013 and May 2019, 9 consecutive patients (5 male; 4 female; mean age 39.4 ± 15.3 years, range 15-68) underwent MR-guided cryoablation of LFVM. Patients were treated due to pain in all cases. Procedural data, complications and clinical results were analyzed.
Technical success defined as complete coverage of the LFVM by the iceball without involvement of nearby non-target thermal-sensitive structures was achieved in 9/9 (100%) cases. Mean procedure time was 122 ± 20 min (range 90-150); 2-6 cryoprobes (mean 3.7 ± 1.2) and 2-4 freezing cycles (mean freezing time 19.8 ± 11.8 min; range 4-40) were applied. No complications were noted. Mean time from the first treatment to the last follow-up was 548 days (range 30-1776). Persistent/recurring pain was noted in 3/9 cases (33%) 30, 133 and 639 days after cryoablation, respectively, and was related in all cases to MR-confirmed local residual/recurring disease. A second cryoablation treatment was performed in these 3 cases with complete pain control at the last available follow-up (153, 25, 91 days, respectively). In the whole population, at mean 161 days (range 25-413) after the last treatment, on the numerical pain rate scale, pain significantly dropped from mean 6.4 ± 2.1 (range 3-9/10) before CA to mean 0.3 ± 0.9 (range 0-3/10) after (p = 0.009).
Percutaneous MR-guided cryoablation is technically feasible, safe and effective for the treatment of symptomatic LFVM.
Level 3b, retrospective cohort study.
回顾性评估经皮磁共振引导下冷冻消融治疗低流量血管畸形（LFVM）的技术可行性、安全性和临床疗效。
2013 年 7 月至 2019 年 5 月，连续 9 例（5 例男性；4 例女性；平均年龄 39.4±15.3 岁，范围 15-68 岁）患者接受了 LFVM 的磁共振引导下冷冻消融治疗。所有患者均因疼痛而接受治疗。分析了手术相关数据、并发症和临床结果。
技术成功定义为冰球完全覆盖 LFVM，且未累及附近的非目标热敏结构，9/9（100%）例均达到此标准。平均手术时间为 122±20 分钟（范围 90-150 分钟）；使用 2-6 个冷冻探针（平均 3.7±1.2 个）和 2-4 个冷冻循环（平均冷冻时间 19.8±11.8 分钟；范围 4-40 分钟）。无并发症发生。从第一次治疗到最后一次随访的平均时间为 548 天（范围 30-1776 天）。冷冻消融后 30、133 和 639 天，分别有 3/9（33%）例患者出现持续性/复发性疼痛，且所有患者的疼痛均与 MRI 证实的局部残留/复发疾病相关。这 3 例患者均接受了第二次冷冻消融治疗，末次随访时疼痛完全缓解（分别为 153、25 和 91 天）。在整个患者群体中，末次治疗后平均 161 天（范围 25-413 天），在数字疼痛评分量表上，疼痛从 CA 前的平均 6.4±2.1（范围 3-9/10）显著降至 CA 后的平均 0.3±0.9（范围 0-3/10）（p=0.009）。
经皮磁共振引导下冷冻消融治疗症状性 LFVM 是一种技术上可行、安全且有效的治疗方法。
3b 级，回顾性队列研究。
