High-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients awaiting liver transplantation

The scarcity of liver grafts in Asia leads to a significant dropout of patients from liver transplant waiting lists, particularly patients with hepatocellular carcinoma and a low model for end-stage liver disease score. In order to reduce dropping out, different bridging therapies are employed. We report the use of high-intensity focused ultrasound ablation as a bridging therapy for a patient with hepatocellular carcinoma of stage two and an extremely low platelet count (20×10 9 /L). The ablation was successful. Blood tests showed that his liver function was similar before and after the treatment. No adhesion was encountered in the liver transplantation performed six months later.

Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion

BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment group.Comparisons were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse events.RESULTS In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627).There were no significant differences between the direct thrombectomy group(16.69±4.91 and 12.12±2.07)and the bridging group(7.13±1.23) and(14.40±0.59)in preoperative NIHSS score and GCS score(P=0.200 and 0.203,respectively).After the operation,the NIHSS scores in both groups were lower than those before the operation,and the GCS scores were higher than those before the operation.There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group(6.91±1.10 and 14.19±0.65)and the bridging group(7.13±1.23 and 14.40±0.59)(P=0.358 and 0.101,respectively).There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group(52.08%)and the bridging group(50.008%)(P=0.838).There was no significant difference in the incidence of adverse events between the direct thrombectomy group(6.25%)and the bridging group(8.33%)(P=0.913).CONCLUSION Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion,achieve good vascular recanalization effects and prognoses,and improve the neurological function of patients.

Different strategies for ultra-early reperfusion therapy in anterior circulation acute ischemic stroke safety and effectiveness of the comparative observation

Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.

High rate of complete histopathological response in hepatocellular carcinoma patients after combined transarterial chemoembolization and stereotactic body radiation therapy

BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor growth.Transarterial chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in LT.However,it remains unclear if one of those treatment options is superior.The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.METHODS In this multicenter retrospective study,27 patients who received liver transplantation for HCC were analyzed.Patients received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver transplantation.Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies.Statistical analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U tests.RESULTS Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and SBRT.There were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor lesions.Strikingly,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.

Combined transarterial chemoembolization and stereotactic body radiation therapy as a bridge therapy to liver transplant for hepatocellular carcinoma

Liver transplant(LT)is the curative treatment for patients with hepatocellular carcinoma(HCC).Bridge therapies are local treatments given to patients on the LT waitlist,to prevent tumor progression and to reduce the dropout rate.Case presentation:We reported a 40-year-old man diagnosed with Barcenola-Clinic Liver Cancer BCLC intermediate stage HCC and Child-Pugh A5 hepatitis B virus cirrhosis who underwent combined bridge therapies to LT.Firstly,the patient received transarterial chemoembolization(TACE)for two times and showed a partial response.Then he underwent stereotactic body radiation therapy(SBRT)with a total dose of 45 Gy in 3 fractions.Three months later,the tumor size and serum protein induced by Vitamin K absence or antagonists-II,alpha fetoprotein levels decreased gradually.In June 2019 a suitable donor was found and his LT was successfully performed.Conclusion:We propose that a combination of TACE and SBRT was feasible as bridge therapy for HCC patients on the LT waitlist.