Enhancing procedural decision making with cone beam CT in renal artery embolization

Area of Science:

• Interventional Radiology
• Medical Imaging
• Vascular Surgery

Background:

• Cone-beam computed tomography (CBCT) is a valuable imaging tool in interventional radiology.
• Its application in renal artery embolization (RAE) requires further investigation.
• Effective RAE relies on precise visualization of renal vasculature.

Purpose of the Study:

• To evaluate the role of CBCT in guiding intra-procedural decision-making during RAE.
• To assess the impact of CBCT-derived information on RAE treatment strategies.
• To determine the added value of CBCT compared to conventional angiography.

Main Methods:

• A multicenter retrospective study of 40 patients undergoing CBCT during RAE (January 2019 - January 2023).
• Patients were categorized based on the additional information provided by CBCT: Category 1 (no new info), Category 2 (clarified findings, no plan change), Category 3 (valuable info, plan change).
• Analysis included assessment of vascular anatomy, feeder identification, and treatment modifications.

Main Results:

• CBCT provided no unique information in 10% of cases (Category 1).
• CBCT clarified ambiguous findings and confirmed treatment plans in 47.5% of cases (Category 2).
• CBCT led to treatment plan changes in 42.5% of cases (Category 3), including identification of alternative/additional feeders and optimized embolization extent.

Conclusions:

• CBCT is an efficient tool for intra-procedural decision-making in RAE.
• It provides supplementary imaging information, aiding in confident target vessel identification and superselective embolization.
• CBCT helps prevent non-target embolization and locate previously unidentified feeders, ultimately improving RAE outcomes.