Olivier Pellerin (Université de Paris, Paris, France) presented on technological updates in the renal space at the Global Embolization Oncology Symposium Technologies meeting (GEST; 18–21 May, New York City, USA). He set out to provide a “broad overview” of radial access, navigation and computed tomography (CT) angiography for the audience.
Pellerin started his presentation by outlining what is necessary for “optimal” renal tumour treatment. He listed among these requirements treatment planning and assessment, the visibility of the tumour, access to the patient intervention site and tumour, the radiation dose to patient and operator, and the procedure morbidity.
Moving on to focus on radial access, Pellerin questioned rhetorically whether the “big push” towards the approach in the last five to 10 years is solely down to industry, or whether it is because it actually offers a “real advantage” when it comes to achieving optimal renal tumour treatment. He made the point that this approach is “widely used and accepted” by cardiologists. The evidence from the last decade comparing femoral with radial access, Pellerin detailed, spans transarterial chemoembolization (TACE), yttrium-90, angioplasty of the superior mesenteric or renal arteries, and renal embolization. This evidence shows that the technical success between the two access approaches is “similar, but it is probably one point to renal access”.
Continuing, Pellerin stated that a radial approach can lower access site complications, based on the existing literature, however, this is “cardiology literature”, he conceded. He then stated that where patient comfort is the concern, radial access is “preferred”, as it only requires “a small puncture under local anaesthesia”. Possible limitations with radial access, Pellerin stipulated, include for procedures where the objective of the intervention is to control a symptom which itself “does not involve the vital prognosis of the patient”, as is the case for uterine artery embolization for symptomatic fibroids, or prostate artery embolization for dysuria management. The choice of vascular access, the speaker set out, “must be guided by a detailed study of risks versus benefit in relation to complications linked to vascular access”. In other words, Pellerin invited the audience to question whether “a haematoma at the puncture site is preferable to a stroke” and similarly, these types of questions “must also be addressed with regard to cancer management”. Whether there is increased morbidity linked to longer procedures has “not yet been studied”, Pellerin added.
Moving on to address navigation, the presenter defined it as “performing the ideal placement of probes based on a predefined trajectory”. Compared to in the past, navigation is “different”, as it has become “more and more stereotactic”, Pellerin noted. Artificial intelligence also assists with needle planning, simulating the ablation zone, and predicting success. It is also possible now to optimise targeting, which means “finding the best option for insertion into the lesion, avoiding critical structures,” Pellerin explained. Robotic arms can also aid in delivery, and there is also confirmation software to help ascertain whether the target has been reached.
Lastly, Pellerin touched on angio-CT which he likened to a Swiss army knife as it “expands your possibilities a lot—you have a very high level of imaging quality”. He then referenced the emerging CT technologies, including spectral CT, which can “totally change the vision of the work we do [by] making possible the comparison of multiple functional parameters”. For example, it can “improve visualisation of lesions to facilitate procedure planning and enable accurate assessment of ablation margins”, while also “characterising tissue to better guide procedures and facilitate clinical decision-making, and analysing quantities such as iodine concentration to help determine procedural success”.