Journal of Neuroendovascular Therapy
Online ISSN : 2186-2494
Print ISSN : 1882-4072
ISSN-L : 1882-4072
早期公開論文
早期公開論文の17件中1~17を表示しています
  • Toshinari Meguro, Yuma Tada, Miki Taniguchi, Shuji Hamauchi, Toru Fuku ...
    論文ID: tn.2023-0094
    発行日: 2024年
    [早期公開] 公開日: 2024/03/19
    ジャーナル オープンアクセス 早期公開

    Objective: In recent years, the transradial artery approach has gained prominence and is increasingly employed in neurovascular angiography and therapy due to its safety, reduced complications, and minimal invasiveness. While various venous approaches, including the conventional transfemoral vein approach, exist for procedures such as transvenous embolization, recent reports have highlighted methods involving upper extremity cutaneous veins. However, the practicality and efficacy of these approaches remain unclear.

    Case Presentations: This study presents our experience with three cases of dural arteriovenous fistulas, where transvenous embolization was performed via upper limb cutaneous veins. In all instances, the arteriovenous approach was successfully executed using a single upper extremity, leading to the successful completion of treatment.

    Conclusion: This technique demonstrates significant advantages, not only in terms of its minimal invasiveness but also due to its simplicity and safety. Anticipating broader acceptance in the future, this approach offers a promising avenue for further exploration in neurovascular interventions.

  • Yukitaka Ishida, Toru Umehara, Yoshihiro Yano, Shogo Taniwaki, Hidekaz ...
    論文ID: tn.2023-0099
    発行日: 2024年
    [早期公開] 公開日: 2024/03/19
    ジャーナル オープンアクセス 早期公開
    電子付録

    Objective: Mechanical thrombectomy (MT) is the gold standard treatment for acute ischemic stroke. During these interventions, a thrombus frequently obstructs a guiding catheter. The obstructed guiding catheter should be withdrawn before distal embolism occurs; however, albeit infrequently, the thrombus occludes even a sheath introducer (SI). While conventionally new SI placement is required for continuation of treatment, we propose a viable alternative for recanalization of the occluded SI, termed vacuum-assisted delivery of thrombus (VADT), with a clinical report of our cases. The usefulness of this technique was also evaluated in simulation experiments.

    Case Presentations: The VADT procedure is as follows: 1) insert a peel-away sheath, originally attached to a balloon-guiding catheter (BGC), into the SI to continuously open the hemostatic valve; 2) advance the BGC into the peel-away sheath while applying mechanical aspiration; and 3) remove the peel-away sheath/BGC assembly slowly. In a simulation environment using an artificial thrombus, we repeated the VADT procedure five times and reproducibly achieved SI reopening within only 10–20 seconds. From March 2013 to September 2022, 204 patients were treated with MT at our stroke center and SI occlusion occurred in three patients (1.5%). These events occurred exclusively in patients with extracranial internal carotid artery occlusion. All three patients with SI occlusion underwent successfully thrombus extraction in the SI using the VADT on the first try.

    Conclusion: The results of clinical experience and simulation experiments strongly support VADT as a reliable option for recanalization of an occluded SI.

  • Masatoshi Koga
    論文ID: ra.2024-0001
    発行日: 2024年
    [早期公開] 公開日: 2024/03/13
    ジャーナル オープンアクセス 早期公開

    Antithrombotic therapy plays a crucial role in secondary prevention following ischemic stroke from the acute phase. Numerous trials, along with a meta-analysis, contributed to establishing aspirin as the primary medication for secondary stroke prevention. According to the Cochrane Database of Systematic Review 2022, initiating antiplatelet therapy with aspirin at a dose of 160 mg to 300 mg daily within 48 hours of stroke onset reduces the risk of death or dependency at the end of follow-up. Other antiplatelet drugs, such as clopidogrel, cilostazol, prasugrel, and intravenous ozagrel sodium, are also available within the Japanese Health Care Insurance System. Two pivotal trials from the 2010s underscored the effectiveness and safety of dual antiplatelet therapy (DAPT) using aspirin and clopidogrel, administered for 21 days to 3 months following acute ischemic stroke or transient ischemic attack. However, the extension of DAPT with aspirin and clopidogrel beyond 3 months may result in substantial bleeding risks. Although prasugrel offers a rapid, potent, and consistent inhibition of platelet aggregation and can be used in place of clopidogrel, there is a lack of substantial real-world clinical data on its use in acute ischemic stroke. It is important to recognize that antiplatelet drugs might not be beneficial and could even increase the risk of hemorrhagic events in cardioembolic stroke. In cases of ischemic stroke with nonvalvular atrial fibrillation, direct oral anticoagulants are the primary choice if applicable. Warfarin continues to be the anticoagulant of choice for secondary stroke prevention in patients with mechanical valve replacements. In patients who have undergone intravenous thrombolysis, antithrombotic therapy is generally delayed for up to 24 hours, although there are no definitive guidelines for the period during and immediately after mechanical thrombectomy. This review provides an overview of the current status of antithrombotic therapy for acute ischemic stroke.

  • Seigo Kimura, Masaki Komiyama, Ryokichi Yagi, Fumihisa Kishi, Daiji Og ...
    論文ID: cr.2023-0091
    発行日: 2024年
    [早期公開] 公開日: 2024/03/08
    ジャーナル オープンアクセス 早期公開

    Objective: The double origin of the posterior inferior cerebellar artery (DOPICA) is a rare variant of PICA. Vertebral artery dissecting aneurysm (VADA) with DOPICA is an extremely rare occurrence. Herein, we report a case of VADA located between DOPICA that was successfully treated with endovascular internal trapping.

    Case Presentation: A 48-year-old male, found collapsed at his workplace, was admitted to our hospital for emergency medical assistance. Head CT revealed a subarachnoid hemorrhage (Fisher group 3), and cerebral angiography revealed right VADA with DOPICA. The VADA was located distal to the proximal component of the posterior inferior cerebellar artery (PCPICA) and just proximal to the hypoplastic distal component of PICA (DCPICA). Emergency endovascular internal trapping was performed using a total of 13 coils from the distal end of the VADA to just the distal of the branching point of PCPICA. VADA was not visualized, and antegrade flow through DOPICA to the basilar artery was confirmed. Head magnetic resonance angiography (MRA) showed antegrade flow via DOPICA, and the patient was discharged home on Day 46 with a modified Rankin Scale 0.

    Conclusion: Endovascular internal trapping for VADA with DOPICA was considered useful, especially when VADA is distal to PCPICA and proximal to DCPICA.

  • Kohsuke Teranishi, Ryogo Ikemura, Sho Arai, Yumiko Mitome-Mishima, Tak ...
    論文ID: ra.2023-0086
    発行日: 2024年
    [早期公開] 公開日: 2024/02/22
    ジャーナル オープンアクセス 早期公開

    Treatment for wide-neck bifurcation cerebral aneurysms (WNBAs) is widely performed by endovascular treatment as well as open surgical clipping. However, due to factors such as the shape and size of the aneurysms, as well as the anatomical features of surrounding branch vessels, there are some cases in which simple coiling or conventional adjunctive techniques, such as balloon-assisted or neck bridge stent-assisted coiling, are not sufficient to achieve a satisfactory cure. Against this backdrop, the device known as the Woven EndoBridge (WEB) (MicroVention, Aliso Viejo, CA, USA) was developed and can be deployed directly into the aneurysm for treatment. Over a decade has passed since its development, and it is now used in many countries worldwide. This review provides insights into the evolution of the WEB device from its development to the date of this writing, highlighting the unique features of the device and its treatment indications. Additionally, it discusses the posttreatment course, perspectives on recurrence and retreatment, imaging assessments, and potential off-label use based on numerous studies primarily conducted in Europe and the USA.

  • Kimihiko Orito, Masaru Hirohata, Toshi Abe, Shuichi Tanoue, Motohiro M ...
    論文ID: ra.2023-0090
    発行日: 2024年
    [早期公開] 公開日: 2024/02/22
    ジャーナル オープンアクセス 早期公開

    Remarkable advances have been made in the endovascular treatment of intracranial cerebral aneurysms. These advances include various adjunctive techniques, increased indications for endovascular treatment, and improved treatment results. Furthermore, the number of cerebral aneurysm treatments using flow diverters (FDs) is expected to increase. However, the reported long-term rate of branch artery occlusion after FD treatment has been reported is 15.8%. Moreover, the complete aneurysm obliteration rate is low if normal branches arise from an aneurysm neck or dome. Flow diverter placement for ophthalmic artery, posterior communicating artery, and anterior choroidal artery aneurysms is often difficult because these normal branches often arise from the aneurysm neck or dome. Therefore, in many cases, coil embolization, which can occlude the aneurysm while preserving branch vessels, should be selected. Although not yet established, various adjunctive techniques and other endovascular treatments that can be performed safely have been reported. Treatment must be planned after understanding the advantages and disadvantages of each treatment method.

  • Yu Iida, Taisuke Akimoto, Shigeta Miyake, Ryosuke Suzuki, Wataru Shimo ...
    論文ID: oa.2023-0083
    発行日: 2024年
    [早期公開] 公開日: 2024/02/20
    ジャーナル オープンアクセス 早期公開
    電子付録

    Objectives: The superiority and usefulness of liquid material over particles for embolization have been a topic of debate due to differences in materials and techniques. This study aimed to identify the complications and outcomes associated with both embolization materials.

    Methods: This retrospective multicenter cohort study included 93 patients from an endovascular treatment registry, treated from January 1, 2018 to May 31, 2022. It included patients who underwent preoperative embolization for meningioma, solitary fibrous tumor/hemangiopericytoma, and hemangioblastoma. Data for patient characteristics, procedural factors, complications, and outcomes were collected from medical records.

    Results: A tortuous access route was the only factor independently associated with complications (p = 0.020). Although liquid material was more frequently used for embolization in relatively high-risk conditions, complication rates did not differ significantly between the groups (p = 0.999). In the liquid material group, the tip of the microcatheter could be guided closer to the tumor (p <0.001) using a distal access catheter and flow-guide microcatheters. The subgroup middle meningeal artery embolization had less operative bleeding in the liquid material group (p <0.001), whereas the particles group exhibited less intraoperative blood loss than the liquid material group (p = 0.006).

    Conclusion: The vascular tortuosity of the access route was only associated with complications in preoperative tumor embolization. Liquid material and particles showed no difference in complication rates. The use of particles in embolization may reduce intraoperative bleeding, but not in all cases can it be used safely. Therefore, a thorough understanding of the characteristics of both approaches and their relative advantages in clinical practice is essential to opt for the appropriate material according to the case.

  • Yusuke Takahashi, Takahiro Ono, Junta Moroi, Jun Maruya, Shuntaro Toga ...
    論文ID: oa.2023-0097
    発行日: 2024年
    [早期公開] 公開日: 2024/02/20
    ジャーナル オープンアクセス 早期公開

    Objective: Early intervention with mechanical thrombectomy (MT) is expected to improve the functional outcome in patients with large vessel occlusion (LVO); however, a method for the effective detection of these patients in a prehospital setting and early transport to MT-capable hospitals has not been established. This study aimed to analyze the clinical impact and diagnostic performance of the emergent large vessel occlusion (ELVO) screen and its influence on the transportation time.

    Methods: The emergency medical services (EMS) in one of the secondary medical areas in Akita, Japan, introduced a prehospital triage system employing an ELVO screen and a rotation system of three MT-capable hospitals on December 1, 2021. Patients who were transferred to each of the three hospitals involved in the rotation system according to a predefined priority list from December 2021 to November 2022 were included in the triage group. Patients who underwent MT in the three hospitals before the introduction of the triage system were assigned to the pre-triage group. We compared the transportation time parameters between the two groups and analyzed the performance of the ELVO screen for the diagnosis of LVOs. This study was approved by the institutional review boards of all three hospitals.

    Results: Time parameters were compared between the 37 and 42 patients who underwent MT and had detailed data in the triage (n = 351) and pre-triage (n = 43) groups, respectively. The time from door to puncture tended to decrease in the triage group in all hospitals, with one hospital showing a statistically significant shortening of 14 min (p = 0.018). In the triage group, 209 ELVO screen-positive patients were present, with 60 (28.7%) of these having LVO. The sensitivity, specificity, positive and negative predictive values, and area under the curve of the ELVO screen to detect LVO under the present triage system were 87.0%, 47.2%, 28.7%, 93.7%, and 0.671, respectively.

    Conclusion: The present study demonstrated that the introduction of a triage system may have shortened the time required for MT. ELVO screen may be considered a useful marker for screening LVO in prehospital settings in terms of the sensitivity and negative predictive value; however, further improvement may be necessary to reduce the rate of false positive results.

  • Tetsuya Ioku, Keisuke Imai, Takehiro Yamada, Masanori Cho, Toshi Sai, ...
    論文ID: cr.2023-0081
    発行日: 2024年
    [早期公開] 公開日: 2024/02/15
    ジャーナル オープンアクセス 早期公開

    Objective: Infection after carotid artery stenting (CAS) is rare. We report two dialysis cases of delayed stent infection associated with a carotid dual-layer stent (DLS), which occurred several months after deployment of the stent.

    Case Presentations: Case 1: A 74-year-old man receiving dialysis underwent CAS with DLS. Three months after CAS, the patient developed a high fever, neck pain, and neck swelling. Neck CT and carotid ultrasonography (CUS) indicated an abscess around the inserted DLS. The patient was treated with antibiotic agents and fully recovered. Case 2: A 73-year-old man receiving dialysis underwent CAS with DLS. Two months after CAS, this patient also developed a high fever, neck pain, and neck swelling. Contrast-enhanced neck CT indicated inflammatory effusion with an abscess and a giant infectious pseudoaneurysm. Endovascular stent graft reconstruction was employed urgently under antibiotic therapy to prevent its rupture. However, intracranial hemorrhage occurred postoperatively and left hemiparesis remained.

    Conclusion: Delayed carotid stent infection is a rare but severe complication. The use of a DLS might be avoided during CAS for dialysis cases.

  • Yuya Tanaka, Nobuyuki Fukui, Satohiro Kawade, Rikuo Nishii, Yasuhiro Y ...
    論文ID: cr.2023-0079
    発行日: 2024年
    [早期公開] 公開日: 2024/02/10
    ジャーナル オープンアクセス 早期公開

    Objective: Intraorbital dural arteriovenous fistula (IO-dAVF) is a rare condition, and treatment options vary from case to case. We report a case of transarterial embolization (TAE) for IO-dAVF.

    Case Presentation: A 62-year-old male complained of gradually worsening pain, hyperemia, and visual impairment in the right eye. He did not exhibit diplopia or exophthalmos. Cerebral angiography revealed an arteriovenous fistula in the right orbit. The feeding arteries were the ophthalmic artery (OphA) and the artery of the superior orbital fissure (ASOF), with the superior ophthalmic vein (SOV) as the main draining vein. The venous pathway from the SOV was not clearly visible, and considering the risk of blindness with TAE from the OphA, TAE from the ASOF was performed. Onyx 18 was selected as the liquid embolic material and injected through a microcatheter placed in the internal maxillary artery. Occlusion up to the SOV was achieved, and the shunt flow completely disappeared. Normal blood flow in the OphA was maintained, hyperemia improved, and no complications were observed.

    Conclusion: In cases of IO-dAVF, when transvenous embolization is difficult to perform, TAE using Onyx from the vessel of the external carotid artery system may be preferred over OphA.

  • Jun Haruma, Kenji Sugiu, Yuki Ebisudani, Ryu Kimura, Hisanori Edaki, Y ...
    論文ID: ra.2023-0068
    発行日: 2024年
    [早期公開] 公開日: 2024/01/13
    ジャーナル オープンアクセス 早期公開

    Intracranial artery dissections (IADs), although uncommon, are an important cause of cerebral infarction and subarachnoid hemorrhage (SAH). Some IADs can heal spontaneously after reconstitution of the vessel lumen with excellent prognosis. Meanwhile, others can progress to stroke that requires treatment. The incidence of IAD in the posterior circulation is higher than that in the anterior circulation. Anterior circulation dissections are more likely to develop into ischemia and posterior circulation lesions into hemorrhage. The mortality rate after IAD among patients with SAH is 19%–83%. Further, the mortality rate of IAD without SAH is 0%–3%.

    Patients with SAH commonly undergo surgery or receive neuroendovascular treatment (EVT) to prevent rebleeding. However, the treatment of IADs is empirical in the absence of data from randomized controlled trials. Recently, EVT has emerged and is considered for IADs because of its less invasiveness and perceived low rates of procedure-related morbidity with good efficacy. EVT strategies can be classified into deconstructive (involving sacrifice of the parent artery) and reconstructive (preserving blood flow via the parent vessel) techniques. In particular, the number of reports on reconstructive techniques is increasing. However, a reconstructive technique for ruptured IADs has not yet been established. This review aimed to provide an overview of IADs in the posterior circulation managed with EVT by performing a literature search.

  • Shinya Haryu, Hiroyuki Sakata, Yasushi Matsumoto, Kuniyasu Niizuma, Hi ...
    論文ID: ra.2023-0072
    発行日: 2024年
    [早期公開] 公開日: 2024/01/13
    ジャーナル オープンアクセス 早期公開

    Wide-neck bifurcation aneurysms (WNBAs) are sometimes challenging to treat. During endovascular treatment, it is important to prevent coil deviation and preserve normal vessels. Adjunctive balloon- and stent-assisted techniques have been developed. A meta-analysis of endovascular treatments of WNBAs revealed that only 40% of patients had complete occlusion. Recently, novel devices have been developed to expand the range of treatment options. Flow-diverter stents and intra-aneurysmal flow disruption devices do not require coils; however, coil embolization remains the standard procedure used by many neurointerventionists. This review describes the recent trends in adjunctive techniques for supporting coil embolization for WNBAs. We referred to literature on balloon-assisted techniques, stent-assisted techniques, Y-stenting, PulseRider, Barrel stents, Comaneci temporary stents, pCONUS, and eCLIPs. These reports showed that adequate embolization rates were generally greater than 80%, and the complete occlusion rate was as high as 94.6%. All devices had a relatively high occlusion rate; however, it may be inaccurate to simply compare each device because of the heterogeneity of the studies. It is important to select the best treatment for each individual case by considering not only literature-based efficacy and safety but also patient background, aneurysm characteristics, and operator experience.

  • Kiyofumi Yamada, Hirotoshi Imamura, Saya Ozaki, Akihiro Niwa, Yuji Kus ...
    論文ID: ra.2023-0078
    発行日: 2024年
    [早期公開] 公開日: 2024/01/12
    ジャーナル オープンアクセス 早期公開

    Flow diverter (FD) devices are new-generation stents placed in the parent artery at the aneurysmal neck to obstruct intra-aneurysmal blood flow, thus favoring intra-aneurysmal thrombosis. In Japan, about eight years have passed since health insurance approval was granted for FD devices, and FD placement to treat aneurysms has become widespread. Treatment indications have also been expanded with the introduction of novel devices. At present, three types of FD (Pipeline, FRED, and Surpass Streamline) are available in Japan. This report represents a compilation of available FD technologies and describes the current consensus on this treatment.

  • Naoki Akioka, Naoya Kuwayama, Satoshi Kuroda
    論文ID: ra.2023-0034
    発行日: 2023年
    [早期公開] 公開日: 2023/12/23
    ジャーナル オープンアクセス 早期公開

    The sphenoid wing dural arteriovenous fistulas (DAVFs) are clinically rare. They often present as non-sinus-type arteriovenous fistulas (AVFs) and may be associated with focal neurological deficits, intracranial venous hypertension, and intracranial hemorrhage. These cases are classified as lesser or greater sphenoid wing lesions. We searched the PubMed databases for studies evaluating the clinical presentation, surgical treatment, and endovascular treatment of these lesions and analyzed 37 cases from 22 papers. A total of 17 cases had lesser sphenoid wing AVFs, and the localization of the shunts could be divided into the sinus of the lesser sphenoid wing (SLSW) or the superficial middle cerebral vein (SMCV). Most SLSW AVFs drained into the cavernous sinus, but two cases drained directly into the deep middle cerebral vein via a bridging vein. All cases with shunts directly into the SMCV had reflux into the SMCV with varices. A total of 20 cases had shunts in the greater sphenoid wing, and the localization of the shunts varied, with shunt localization, and venous return morphology dependent on variations in middle fossa venous return. Most cases had shunts in the sphenobasal vein near the foramen ovale. However, some cases had shunts in the superior ophthalmic vein, sphenopetrosal vein, and laterocavernous sinus. Many were associated with cortical venous reflux. These lesions have been treated by surgical ligation of the drainage vein and transarterial or transvenous embolization. Recently, embolization has become the standard treatment for DAVFs due to advances in endovascular techniques. This paper reviewed and discussed the angioarchitecture, clinical presentation, and treatment of these lesions to clarify the characteristics of sphenoid wing DAVFs.

  • Yoichi Morofuji, Minoru Morikawa, Nobutaka Horie, Yuki Matsunaga, Tsuy ...
    論文ID: ra.2023-0023
    発行日: 2023年
    [早期公開] 公開日: 2023/09/05
    ジャーナル オープンアクセス 早期公開

    The clinical manifestations of dural arteriovenous fistulas (dAVFs) are highly variable and dependent on the hemodynamic properties and location of the fistula. The locations of the fistula are numerous and include the cavernous sinus, transverse–sigmoid sinus, superior sagittal sinus, inferior and superior petrosal sinuses, anterior condylar confluence, tentorium, anterior cranial fossa, middle fossa, foramen magnum, cranio-cervical junction, convexity, and spinal cord. These dAVFs can be divided into two types, “sinus type” and “non-sinus type,” based on their communication with dural shunts and cerebral veins. The sinus type involves direct communication between the arterial dural branch and one dural sinus, sometimes leading to recruitment of cortical veins. On the other hand, the non-sinus type is embedded into the dura, with the drainage always involving a cerebral vein and no communication with any sinus. Treatment options for these types of dAVFs differ; sinus-type dAVFs require normally sinus obliteration and occlusion of recruited veins, while non-sinus-type dAVFs require embolization of the drainage vein. Accurately classifying the type of fistula, sinus type or non-sinus type, is critical for developing a proper treatment plan. This review describes clinical characteristics and treatment of those non-sinus-type dAVFs involving unusual locations with illustrative cases.

  • Masafumi Hiramatsu, Tomohiko Ozaki, Rie Aoki, Shinri Oda, Jun Haruma, ...
    論文ID: ra.2023-0019
    発行日: 2023年
    [早期公開] 公開日: 2023/07/12
    ジャーナル オープンアクセス 早期公開

    Dural arteriovenous fistula (dAVF) of the foramen magnum (FM) region is rare. Moreover, the terminology of dAVF is very confusing in this region. In the narrow sense, the FM dAVF is the non-sinus-type dAVF with direct venous reflux to the medulla oblongata or spinal cord via the bridging veins (BVs) of the FM. Previous literature was systematically reviewed to investigate the clinical characteristics, angioarchitecture, and effective treatment of the FM dAVF. From the literature review, almost all the feeders of FM dAVF were dural branches. Spinal pial arteries were rarely involved as the feeder. All lesions had venous reflux to the medulla oblongata via medullary BVs. The FM dAVF is characterized by a significant male predominance and a high incidence of aggressive symptoms. The most common symptom is congestive myelopathy, followed by hemorrhage. The FM dAVF differs from the craniocervical junction (CCJ) arteriovenous fistula (AVF) and is similar to the thoracolumbar spinal dAVF. Direct surgery for the FM dAVF is effective and safe. Endovascular treatment for the FM dAVF may be more effective and has lower complication rates than that for the CCJ AVF.

  • Ichiro Nakagawa, Masashi Kotsugi, Shohei Yokoyama, Ryosuke Maeoka, Tom ...
    論文ID: ra.2023-0018
    発行日: 2023年
    [早期公開] 公開日: 2023/05/26
    ジャーナル オープンアクセス 早期公開

    Anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF) is a rare lesion among cerebral DAVFs. This lesion shows significant bleeding risk because of the angioarchitecture, involving direct leptomeningeal retrograde venous drainage, as a nonsinus-type DAVF. Over the years, direct surgery has been considered the primary treatment for ACF DAVF, offering favorable clinical outcomes compared to a low complete obliteration rate with endovascular treatment and the relatively high risk of blindness due to central retinal artery occlusion with transophthalmic artery embolization. In recent years, however, significant improvements in DSA and 3D reconstruction imaging quality have allowed a much more precise understanding of the angioarchitecture of the shunt and vascular access route. In addition, advances in endovascular devices, including catheters and embolic materials, have facilitated microcatheter navigation into more distal vessels and more reliable closure of the fistulous point. Supported by such technological innovations, endovascular approaches to the treatment of ACF DAVF have been becoming successful first-line treatments. This article reviews the evolution of treatment strategies and the current status of endovascular treatment for ACF DAVF, with a particular focus on transarterial embolization.

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