Grange Rémi, Habouzit Vincent, Lanoiselee Julien, Leroy Stéphanie, Stacoffe Nicolas, Magand Nicolas, Lutz Noémie, Boutet Claire, Grange Sylvain
Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
Department of Nuclear Medicine, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France.
Quant Imaging Med Surg. 2025 Mar 3;15(3):1963-1976. doi: 10.21037/qims-24-1767. Epub 2025 Feb 26.
N-butyl-cyanoacrylate (NBCA) is seen as a challenging embolization agent to use, requiring a learning curve. The study aims to evaluate the safety, efficacy and impact of operator's experience of NBCA as an embolic agent in emergency transarterial embolization (TAE).
All patients referred to University Hospital of Saint-Etienne who were treated by TAE with NBCA between January 1, 2016 and January 1, 2024 were retrospectively reviewed. The inclusion criteria were all patients ≥18 years old treated by TAE with NBCA. Demographic, biological and angiographic data were recorded. Clinical success was defined as resolution of signs and symptoms of bleeding during the 30-day follow-up period after TAE and without required endoscopic treatment, surgery, or repeat TAE or death of any cause. Predictive factors of early death (≤30 days) were assessed using univariate and multivariate analysis. Outcomes regarding operator's experience (more or less than 3 years in embolization) were reviewed.
During the study inclusion period, 113 patients (75, 66.4% males) for 113 procedures were included. The mean age was 64.1±14.1 years old. Clinical success was achieved in 93 (82.3%) patients. No major complication was recorded. There were 5 (4.4%) early rebleeding requiring 3 (2.7%) repeat TAE. Fifteen (13.3%) patients died within 30 days after the procedure. Operators with <3 years' experience had the same clinical outcomes as more experienced ones (P>0.05). In univariate analysis, hemodynamic instability, hemoglobin level <8 g/dL, and international normalized radio (INR) >1.5 were associated with early death. In multivariate analysis, hemodynamic instability was independently associated with early death [odds ratio (OR) =14.49; 95% confidence interval (CI): 2.33-282.1, P=0.01].
Use of NBCA demonstrates a low rebleeding rate, and safety profile of TAE using NBCA. Operators' experience has no significant impact on clinical outcomes.
氰基丙烯酸正丁酯（NBCA）被视为一种具有挑战性的栓塞剂，使用时需要一个学习过程。本研究旨在评估NBCA作为栓塞剂在急诊经动脉栓塞术（TAE）中的安全性、有效性以及术者经验的影响。
对2016年1月1日至2024年1月1日期间在圣艾蒂安大学医院接受NBCA TAE治疗的所有患者进行回顾性研究。纳入标准为所有接受NBCA TAE治疗的≥18岁患者。记录人口统计学、生物学和血管造影数据。临床成功定义为TAE后30天随访期内出血体征和症状消失，且无需内镜治疗、手术、重复TAE或因任何原因死亡。采用单因素和多因素分析评估早期死亡（≤30天）的预测因素。回顾了关于术者经验（栓塞经验少于或多于3年）的结果。
在研究纳入期间，共纳入113例患者进行113例手术（75例男性，占66.4%）。平均年龄为64.1±14.1岁。93例（82.3%）患者获得临床成功。未记录到严重并发症。有5例（4.4%）早期再出血，其中3例（2.7%）需要重复TAE。15例（13.3%）患者在术后30天内死亡。经验少于3年的术者与经验更丰富的术者临床结局相同（P>0.05）。单因素分析中，血流动力学不稳定、血红蛋白水平<8 g/dL和国际标准化比值（INR）>1.5与早期死亡相关。多因素分析中，血流动力学不稳定与早期死亡独立相关[比值比（OR）=14.49；95%置信区间（CI）：2.33 - 282.1，P = 0.01]。
使用NBCA显示再出血率低，且NBCA TAE具有安全性。术者经验对临床结局无显著影响。
