Department of Interventional Radiology, American Hospital of Paris, Neuilly-sur-Seine, Paris, France.
Department of Radiology, Hôpital Sud Francilien, Corbeil-Essonnes, France.
Eur Radiol. 2021 Dec;31(12):9150-9160. doi: 10.1007/s00330-021-08063-w. Epub 2021 May 29.
The failure rate following prostate artery embolization (PAE) is around 20%, which may in part result from inadequate embolization. Prostate contrast retention (PCR) adequacy on immediate post-embolization cone-beam CT may provide better assessment of embolization completeness than arterial contrast stasis seen on fluoroscopy alone. The aim of this study was to evaluate outcomes of PAE using PCR adequacy as the procedural endpoint.
A retrospective cohort study of all PAE cases using this technique at a single large volume center was conducted. Following initial embolization of the main prostatic arteries, if PCR was inadequate, additional embolization was performed. Technical success (adequate PCR) was defined as > 75% global prostate gland contrast staining. Clinical success was determined in accordance to CIRSE standards of practice.
One hundred sixty-five patients (mean age 68 ± 8.4 years) underwent PAE from June 2017 to March 2019. Technical and clinical success rates were 98.8% and 96.4% respectively. Clinical success rate was significantly higher in patients with adequate PCR. International Prostate Symptom Scores (IPSS) and Quality of Life (QoL) scores significantly improved at 1-, 3-, 6-, and 12-month follow-up when compared to baseline. Prostate volume (PV) and post-voiding residual bladder volume were significantly reduced at 3, 6, and 12 months in comparison to baseline. Mild (Clavien-Dindo grade I/II) and moderate (grade III) complication rates were 12.1% and 3.6% respectively.
By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.
• By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.
前列腺动脉栓塞术（PAE）后的失败率约为 20%，这在一定程度上可能是由于栓塞不完全所致。即刻栓塞后锥形束 CT 上的前列腺对比保留（PCR）充分性可能比单独透视时观察到的动脉对比停滞提供更好的栓塞完全性评估。本研究旨在评估以 PCR 充分性作为程序终点的 PAE 结果。
对单一大容量中心使用该技术进行的所有 PAE 病例进行回顾性队列研究。在最初栓塞主要前列腺动脉后，如果 PCR 不充分，则进行额外栓塞。技术成功（PCR 充分）定义为 >75%的前列腺整体对比染色。临床成功根据 CIRSE 实践标准确定。
2017 年 6 月至 2019 年 3 月，165 例患者（平均年龄 68±8.4 岁）接受了 PAE。技术和临床成功率分别为 98.8%和 96.4%。在 PCR 充分的患者中，临床成功率显著更高。与基线相比，1、3、6 和 12 个月随访时国际前列腺症状评分（IPSS）和生活质量（QoL）评分显著改善。与基线相比，前列腺体积（PV）和残余膀胱尿量在 3、6 和 12 个月时显著减少。轻度（Clavien-Dindo 分级 I/II）和中度（分级 III）并发症发生率分别为 12.1%和 3.6%。
通过将 PCR 充分性作为指导，确定 PAE 的程序终点，可能实现更完全的栓塞，从而获得更高的临床成功率。
• 通过将 PCR 充分性作为指导，确定 PAE 的程序终点，可能实现更完全的栓塞，从而获得更高的临床成功率。
