Aims: To compare the safety and efficacy of TACE using raltitrexed, oxaliplatin and epirubicin wi... more Aims: To compare the safety and efficacy of TACE using raltitrexed, oxaliplatin and epirubicin with 5-fluorouracil, oxaliplatin and epirubicin for patients with unresectable hepatocelluar carcinoma. Results: Median overall survival (OS) was 7.4 months in the raltitrexed group [95% confidence interval (CI): 5.4, 9.4) and 5.8 months in the control group (95% CI: 5.2, 6.4; P = 0.177). The median progression-free survival (PFS) time was significantly higher in the raltitrexed group (3.6 months, 95% CI: 2.8, 4.4) than in the control group (2.6 months, 95% CI: 2.2, 3.0; P = 0.038). The disease control rate (DCR) was higher in the raltitrexed group than in the control group (40% versus 30.4%; P = 0.353). The incidence of adverse events was similar between the two groups. Materials and Methods: From January 2012 to December 2014, 86 patients with unresectable HCC were treated with TACE using the combination of raltitrexed, oxaliplatin and epirubicin (raltitrexed group), and the combination of 5-fluorouracil, oxaliplatin and epirubicin (control group). The primary endpoint was OS, and the secondary endpoints were PFS, DCR and adverse events. Conclusions: Although the study did not meet its primary endpoint, raltitrexed group reach a higher PFS, which suggests that this combination regimen of TACE as alternative may confer some benefits to selected patients.
Introduction The purpose of this study was to evaluate our experience with initial percutaneous t... more Introduction The purpose of this study was to evaluate our experience with initial percutaneous transluminal angioplasty (PTA) ± stenting as valuable options in the acute setting. Methods Between 2003 and 2008, eight patients with abdominal angio-MDCT-scan proven thrombotic AMI benefited from initial PTA ± stenting. We retrospectively assessed clinical and radiological findings and their management. Seven patients presented thrombosis of the superior mesenteric artery, and in one patient both mesenteric arteries were occluded. All patients underwent initial PTA and stenting, except one who had balloon PTA alone. One patient was treated by additional in situ thrombolysis. Results Technical success was obtained in all patients. Three patients required subsequent surgery (37.5%), two of whom had severe radiological findings (pneumatosis intestinalis and/or portal venous gas). Two patients (25%) died: both had NIDD, an ASA score C4, and severe radiologic findings. Satisfactory arterial patency was observed after a follow-up of 15 (range, 11-17) months in five patients who did not require subsequent surgery, four of whom had abdominal guarding but no severe CT scan findings. One patient had an ileocecal stenosis 60 days after the procedure. Conclusions Initial PTA ± stenting is a valuable alternative to surgery for patients with thrombotic AMI even for those with clinical peritoneal irritation signs and/or severe radiologic findings. Early surgery is indicated if clinical condition does not improve after PTA. The decision of a subsequent surgery must be lead by early clinical status reevaluation. In case of underlying atherosclerotic lesion, stenting should be performed after initial balloon dilatation.
ne nouvelle génération de scanographes hélicoïdaux est désormais à notre disposition. Ces machine... more ne nouvelle génération de scanographes hélicoïdaux est désormais à notre disposition. Ces machines autorisent, par la rapidité des acquisitions et l’étendue des volumes explorés, la couverture angioscanographique de la totalité de certains organes et de grandes longueurs de segments artériels en phase artérielle vraie, bouleversant la qualité des explorations et en conséquence les indications radiologiques. La diminution des temps d’acquisition permet d’accéder à une résolution temporelle suffisante pour un examen morphologique de l’aorte thoracique ascendante, mais aussi du cœur. Des procédés associés de synchronisation à l’électrocardiogramme peuvent encore diminuer les artefacts de mouvement. La diminution de l’épaisseur des coupes majore la résolution spatiale et diminue les effets de volume partiel, optimisant la définition anatomique, mais aussi la qualité des reconstructions, en particulier tri-dimensionnelles et notamment des techniques de rendu de volume. Le scanner hélicoï...
The underappreciation of chronic mesenteric ischemia (CMI), diagnostic delays, underdiagnosis and... more The underappreciation of chronic mesenteric ischemia (CMI), diagnostic delays, underdiagnosis and undertreatment, potentially results in fatal acute mesenteric ischemia (AMI). United European Gastroenterology acknowledged the need for a multidisciplinary guideline providing a comprehensive overview and expert agreement, on behalf of gastroenterological and radiological (CIRSE, ESGAR) societies. In this way, 33 recommendations cover the full multidisciplinary spectrum of CMI and needs of all physicians involved. The GRADE ‘‘evidence to decision’’ framework and modified Delphi method were used to reach and express a consensus recently published in published in the United European Gastroenterology Journal [1]. The absence of the classical clinical CMI triad (i.e., postprandial pain, weight loss and abdominal bruit) does not exclude the diagnosis, which is based on a combination of compatible history, significant mesenteric artery (MA) stenosis on radiological imaging and preferably a positive functional test, discussed in an expert multidisciplinary setting by at least a GastroEnterologist, a surgeon and a radiologist. To exclude alternative diagnosis, at least upper GI endoscopy and CTA (imaging test of choice or CE MRA in case of contraindication of CT) must be performed. In symptomatic patients:
Cardiovascular and interventional radiology, Jan 7, 2018
To compare, in an interventional radiology setting, peak skin doses (PSDs) delivered as calculate... more To compare, in an interventional radiology setting, peak skin doses (PSDs) delivered as calculated using a dedicated software tool and as measured using radiochromic film. To assess the utility of this dose calculation software tool in routine clinical practice. First, radiochromic films were positioned on the examination table in the back of an adult anthropomorphic phantom to measure PSD, and X-ray examinations were simulated. Then, films were again positioned in the patient's back for 59 thoracic or abdominopelvic endovascular interventions. The results obtained with the radiochromic films were taken as a reference and were statistically compared with those of the software. With measured PSDs ranging from 100 to 7000 mGy, the median software-film difference was 8.5%. Lin's concordance coefficient was 0.98 [0.97; 0.99] (p < 0.001), meaning that concordance was excellent between the two methods. For the films where PSD exceeded 1000 mGy, the median difference in the meas...
Interventional endoscopic ultrasound (EUS) is a promising novel approach for intravascular interv... more Interventional endoscopic ultrasound (EUS) is a promising novel approach for intravascular interventions. The aim of this study was to assess the feasibility and safety of a EUS-guided intrahepatic portosystemic shunt (EGIPS) with portal pressure gradient measurement in a live porcine model. The left hepatic vein (LHV) or the inferior vena cava (IVC) was punctured with a needle that advanced into the portal vein (PV). A guidewire was then inserted into the PV, and a needle knife was used to create an intrahepatic fistula between LHV and PV. Portal pressure was recorded. The fistula was dilated with a balloon and a biliary metal stent was deployed between LHV and PV under sonographic and fluoroscopic observation. A portocavography validated the patency of the stent. Necropsies were realized after euthanasia. Portosystemic stenting was achieved in 19/21 pigs. Final portocavography confirmed stent patency between PV and LHV or IVC in 17 pigs (efficacy of 81%): Four stents were dysfunct...
Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report ... more Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report of three cases
The aim of this work was to compare the performance of a prototype radioprotection cabin in inter... more The aim of this work was to compare the performance of a prototype radioprotection cabin in interventional neuroradiology, and to assess its suitability for routine use. The radioprotection cabin was a prototype derived from the CATHPAX AF(®) model. Three operators carried out 21 procedures (19 brain arteriographies and 2 embolizations) using the radioprotection cabin and not wearing the usual lead individual protection equipment (IPE), and 17 procedures (16 brain arteriographies and 1 embolization) wearing the standard lead IPE (vest, skirt, thyroid shield and goggles), and not using the radioprotection cabin. In all cases, thermoluminescent dosimeters (TLDs) were positioned at head, trunk, pelvic region, and upper and lower limbs to measure the dose equivalent for Hp(0.07) or Hp(3) that they received, attenuated by either the cabin or the lead IPE. Parallel to these dosimetric measurements, the ergonomics of the protection cabin were appraised by each radiologist after each procedure. The cabin procured an overall reduction of 74% of the dose received on the whole body with Hp(0.07)=0.04 mSv±0.01 (CL=95%) against Hp(0.07)=0.12 mSv±0.04 (CL=95%) for the IPE. Body protection with the cabin was near complete, and close to 100% for the regions not protected by the usual IPE (e.g. the head). We also showed that design weaknesses noted by the operators that hampered procedures (light reflections, reduced hand mobility, awkward access to radioscopy pedal) could be remedied by maker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s improvements to the prototype and minor changes in work habits.
Collection de la Société française d’imagerie cardiaque et vasculaire, 2012
La persistance d’un flux sanguin dans le sac anevrismal constitue l’une des principales preoccupa... more La persistance d’un flux sanguin dans le sac anevrismal constitue l’une des principales preoccupations du traitement endo-vasculaire des anevrismes aortiques. La frequence de ces endo-fuites varie de 15 jusqu’a 50 % pour l’aorte abdominale [1, 2]. La persistance d’une pression systemique au sein du sac anevrismal expose au risque de rupture de l’anevrisme [3].
Objectifs pedagogiques Promouvoir l’utilisation optimale des differentes methodes d’imagerie. Mie... more Objectifs pedagogiques Promouvoir l’utilisation optimale des differentes methodes d’imagerie. Mieux connaitre les contributions actuelles des imageries non invasives pour le diagnostic et la definition des strategies therapeutiques.
Aims: To compare the safety and efficacy of TACE using raltitrexed, oxaliplatin and epirubicin wi... more Aims: To compare the safety and efficacy of TACE using raltitrexed, oxaliplatin and epirubicin with 5-fluorouracil, oxaliplatin and epirubicin for patients with unresectable hepatocelluar carcinoma. Results: Median overall survival (OS) was 7.4 months in the raltitrexed group [95% confidence interval (CI): 5.4, 9.4) and 5.8 months in the control group (95% CI: 5.2, 6.4; P = 0.177). The median progression-free survival (PFS) time was significantly higher in the raltitrexed group (3.6 months, 95% CI: 2.8, 4.4) than in the control group (2.6 months, 95% CI: 2.2, 3.0; P = 0.038). The disease control rate (DCR) was higher in the raltitrexed group than in the control group (40% versus 30.4%; P = 0.353). The incidence of adverse events was similar between the two groups. Materials and Methods: From January 2012 to December 2014, 86 patients with unresectable HCC were treated with TACE using the combination of raltitrexed, oxaliplatin and epirubicin (raltitrexed group), and the combination of 5-fluorouracil, oxaliplatin and epirubicin (control group). The primary endpoint was OS, and the secondary endpoints were PFS, DCR and adverse events. Conclusions: Although the study did not meet its primary endpoint, raltitrexed group reach a higher PFS, which suggests that this combination regimen of TACE as alternative may confer some benefits to selected patients.
Introduction The purpose of this study was to evaluate our experience with initial percutaneous t... more Introduction The purpose of this study was to evaluate our experience with initial percutaneous transluminal angioplasty (PTA) ± stenting as valuable options in the acute setting. Methods Between 2003 and 2008, eight patients with abdominal angio-MDCT-scan proven thrombotic AMI benefited from initial PTA ± stenting. We retrospectively assessed clinical and radiological findings and their management. Seven patients presented thrombosis of the superior mesenteric artery, and in one patient both mesenteric arteries were occluded. All patients underwent initial PTA and stenting, except one who had balloon PTA alone. One patient was treated by additional in situ thrombolysis. Results Technical success was obtained in all patients. Three patients required subsequent surgery (37.5%), two of whom had severe radiological findings (pneumatosis intestinalis and/or portal venous gas). Two patients (25%) died: both had NIDD, an ASA score C4, and severe radiologic findings. Satisfactory arterial patency was observed after a follow-up of 15 (range, 11-17) months in five patients who did not require subsequent surgery, four of whom had abdominal guarding but no severe CT scan findings. One patient had an ileocecal stenosis 60 days after the procedure. Conclusions Initial PTA ± stenting is a valuable alternative to surgery for patients with thrombotic AMI even for those with clinical peritoneal irritation signs and/or severe radiologic findings. Early surgery is indicated if clinical condition does not improve after PTA. The decision of a subsequent surgery must be lead by early clinical status reevaluation. In case of underlying atherosclerotic lesion, stenting should be performed after initial balloon dilatation.
ne nouvelle génération de scanographes hélicoïdaux est désormais à notre disposition. Ces machine... more ne nouvelle génération de scanographes hélicoïdaux est désormais à notre disposition. Ces machines autorisent, par la rapidité des acquisitions et l’étendue des volumes explorés, la couverture angioscanographique de la totalité de certains organes et de grandes longueurs de segments artériels en phase artérielle vraie, bouleversant la qualité des explorations et en conséquence les indications radiologiques. La diminution des temps d’acquisition permet d’accéder à une résolution temporelle suffisante pour un examen morphologique de l’aorte thoracique ascendante, mais aussi du cœur. Des procédés associés de synchronisation à l’électrocardiogramme peuvent encore diminuer les artefacts de mouvement. La diminution de l’épaisseur des coupes majore la résolution spatiale et diminue les effets de volume partiel, optimisant la définition anatomique, mais aussi la qualité des reconstructions, en particulier tri-dimensionnelles et notamment des techniques de rendu de volume. Le scanner hélicoï...
The underappreciation of chronic mesenteric ischemia (CMI), diagnostic delays, underdiagnosis and... more The underappreciation of chronic mesenteric ischemia (CMI), diagnostic delays, underdiagnosis and undertreatment, potentially results in fatal acute mesenteric ischemia (AMI). United European Gastroenterology acknowledged the need for a multidisciplinary guideline providing a comprehensive overview and expert agreement, on behalf of gastroenterological and radiological (CIRSE, ESGAR) societies. In this way, 33 recommendations cover the full multidisciplinary spectrum of CMI and needs of all physicians involved. The GRADE ‘‘evidence to decision’’ framework and modified Delphi method were used to reach and express a consensus recently published in published in the United European Gastroenterology Journal [1]. The absence of the classical clinical CMI triad (i.e., postprandial pain, weight loss and abdominal bruit) does not exclude the diagnosis, which is based on a combination of compatible history, significant mesenteric artery (MA) stenosis on radiological imaging and preferably a positive functional test, discussed in an expert multidisciplinary setting by at least a GastroEnterologist, a surgeon and a radiologist. To exclude alternative diagnosis, at least upper GI endoscopy and CTA (imaging test of choice or CE MRA in case of contraindication of CT) must be performed. In symptomatic patients:
Cardiovascular and interventional radiology, Jan 7, 2018
To compare, in an interventional radiology setting, peak skin doses (PSDs) delivered as calculate... more To compare, in an interventional radiology setting, peak skin doses (PSDs) delivered as calculated using a dedicated software tool and as measured using radiochromic film. To assess the utility of this dose calculation software tool in routine clinical practice. First, radiochromic films were positioned on the examination table in the back of an adult anthropomorphic phantom to measure PSD, and X-ray examinations were simulated. Then, films were again positioned in the patient's back for 59 thoracic or abdominopelvic endovascular interventions. The results obtained with the radiochromic films were taken as a reference and were statistically compared with those of the software. With measured PSDs ranging from 100 to 7000 mGy, the median software-film difference was 8.5%. Lin's concordance coefficient was 0.98 [0.97; 0.99] (p < 0.001), meaning that concordance was excellent between the two methods. For the films where PSD exceeded 1000 mGy, the median difference in the meas...
Interventional endoscopic ultrasound (EUS) is a promising novel approach for intravascular interv... more Interventional endoscopic ultrasound (EUS) is a promising novel approach for intravascular interventions. The aim of this study was to assess the feasibility and safety of a EUS-guided intrahepatic portosystemic shunt (EGIPS) with portal pressure gradient measurement in a live porcine model. The left hepatic vein (LHV) or the inferior vena cava (IVC) was punctured with a needle that advanced into the portal vein (PV). A guidewire was then inserted into the PV, and a needle knife was used to create an intrahepatic fistula between LHV and PV. Portal pressure was recorded. The fistula was dilated with a balloon and a biliary metal stent was deployed between LHV and PV under sonographic and fluoroscopic observation. A portocavography validated the patency of the stent. Necropsies were realized after euthanasia. Portosystemic stenting was achieved in 19/21 pigs. Final portocavography confirmed stent patency between PV and LHV or IVC in 17 pigs (efficacy of 81%): Four stents were dysfunct...
Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report ... more Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report of three cases
The aim of this work was to compare the performance of a prototype radioprotection cabin in inter... more The aim of this work was to compare the performance of a prototype radioprotection cabin in interventional neuroradiology, and to assess its suitability for routine use. The radioprotection cabin was a prototype derived from the CATHPAX AF(®) model. Three operators carried out 21 procedures (19 brain arteriographies and 2 embolizations) using the radioprotection cabin and not wearing the usual lead individual protection equipment (IPE), and 17 procedures (16 brain arteriographies and 1 embolization) wearing the standard lead IPE (vest, skirt, thyroid shield and goggles), and not using the radioprotection cabin. In all cases, thermoluminescent dosimeters (TLDs) were positioned at head, trunk, pelvic region, and upper and lower limbs to measure the dose equivalent for Hp(0.07) or Hp(3) that they received, attenuated by either the cabin or the lead IPE. Parallel to these dosimetric measurements, the ergonomics of the protection cabin were appraised by each radiologist after each procedure. The cabin procured an overall reduction of 74% of the dose received on the whole body with Hp(0.07)=0.04 mSv±0.01 (CL=95%) against Hp(0.07)=0.12 mSv±0.04 (CL=95%) for the IPE. Body protection with the cabin was near complete, and close to 100% for the regions not protected by the usual IPE (e.g. the head). We also showed that design weaknesses noted by the operators that hampered procedures (light reflections, reduced hand mobility, awkward access to radioscopy pedal) could be remedied by maker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s improvements to the prototype and minor changes in work habits.
Collection de la Société française d’imagerie cardiaque et vasculaire, 2012
La persistance d’un flux sanguin dans le sac anevrismal constitue l’une des principales preoccupa... more La persistance d’un flux sanguin dans le sac anevrismal constitue l’une des principales preoccupations du traitement endo-vasculaire des anevrismes aortiques. La frequence de ces endo-fuites varie de 15 jusqu’a 50 % pour l’aorte abdominale [1, 2]. La persistance d’une pression systemique au sein du sac anevrismal expose au risque de rupture de l’anevrisme [3].
Objectifs pedagogiques Promouvoir l’utilisation optimale des differentes methodes d’imagerie. Mie... more Objectifs pedagogiques Promouvoir l’utilisation optimale des differentes methodes d’imagerie. Mieux connaitre les contributions actuelles des imageries non invasives pour le diagnostic et la definition des strategies therapeutiques.
Uploads
Papers by Louis Boyer