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Percutaneous intervertebral disc decompression and ablative techniquesMETHOD DEFINITION SUCCESS

RATECOMPLICATIONRATE

AutomatedPercutaneousLumbarDiscectomy

a pneumatically driven, suction-cutting probe within a cannula,removes disc material anteriorto the herniation.

75% 0-9%

Percutaneous LaserDecompression

laser energy vaporizes part ofnucleus pulposus

63-89% 0.5-1%

Intradiscalelectrothermaltherapy

a thermal resistive coilcoagulates the disc tissue withradiant heat

64-75% O.8%

Intervertebral DiscNucleoplasty

non-heat driven process whereplasma energy causesmolecular dissociation anddissolves part of nucleuspulposus creating a series ofintradiscal channels

79% �0.5%

Percutaneous discdecompression

nuclear material extraction isachieved with a mechanicalhigh rotation per minute devicewith spiral tips

60-85% �0.5%

Ozon therapy ozon therapy results inbreakdown of nucleus pulposuswith rapid disappearance ofherniated material

70-78% �0.5%

Discogel gelified ethanol causesdehydration of nucleuspulposus

91.4% �0.5%

References: Kelekis AD, Somon T, Yilmaz H, Bize P,Brountzos EN, Lovblad K, Ruefenacht D, Martin JB. Inter-ventional spine procedures. Eur J Radiol 2005; 55:362–383.

Abstract No. 253

A phase III, open-label study of tenecteplase for im-provement of hemodialysis catheter function: TROPICS4S. Fishbane1, S.L. Milligan2, K.D. Lempert3, J.E. Hertel4,J.B. Wetmore5, M.J. Oliver6, M. Blaney7, B. Gillespie8,J. Jacobs7, S. Begelman7; 1Winthrop University Hospital,Mineola, NY; 2Nephrology Inc., Mishawaka, IN; 3Pro-Medica Health System, Toledo, OH; 4Kidney Care Associ-ates, Augusta, GA; 5University of Kansas Medical Center,Kansas City, KS; 6Sunnybrook Health Sciences Centre,Toronto, ON, Canada; 7Genentech, Inc., South San Fran-cisco, CA; 8Quintiles, Inc., Morrisville, NC.

Purpose: To determine the safety and efficacy of tenect-eplase, a thrombolytic, for the treatment of dysfunctionalhemodialysis (HD) catheters.

Materials and Methods: Patients with cuffed, tunneled HDcatheters and blood flow rate (BFR) �300 mL/min at anarterial pressure of -240 to -280 mmHg received 2 mg/2 mLof open-label tenecteplase in each lumen for a 1-hour int-racatheter dwell. Treatment success was defined as BFR�300 mL/min with a �25 mL/min increase from baselineBFR, without line reversal, 30 minutes prior to and at theend of HD. Patients without treatment success at the end ofthe initial visit received another 2 mg of tenecteplase for anextended-dwell period of up to 72 hours. The primaryefficacy endpoint was the proportion of patients with treat-ment success at the first HD visit. The incidence of alladverse events (AEs), including targeted AEs (intracranialhemorrhage [ICH], major bleeding, embolic events, throm-bosis, catheter-related bloodstream infection [CRBSI], andcatheter-related complications) was recorded from initialtenecteplase administration through the second HD sessionafter final tenecteplase exposure.

Results: Tenecteplase was administered to 223 patients (meanage, 61 years; range, 16-97 years). Following 1-hour-dwelltenecteplase, 76 patients (34%; 95% confidence interval [CI],28%-40%) had treatment success, with a mean (standard de-viation [SD]) increase from baseline BFR of 82 (124) mL/min.Of the 116 patients who received extended-dwell tenecteplase,57 (49%; 95% CI, 40%-58%) had treatment success at the endof the next HD session, with a mean (SD) increase frombaseline BFR of 117 (140) mL/min. Five CRBSIs and one

thrombosis were reported, all of which resolved with treat-

ment. There were no reports of ICH, major bleeding, or em-bolic events.

Conclusion: Tenecteplase administered as a 1-hour dwell or1-hour dwell followed by an extended dwell was associatedwith improved HD catheter function, as measured by BFR.The safety profile of intracatheter tenecteplase was favor-able, with a low incidence of targeted AEs.

Abstract No. 254 EE

Kawasaki disease: CTA and MRI/MRA findings in cor-onary and non-coronary arteriesM.K. Ford, P. Liu; University of Michigan, Ann Arbor, MI.

Learning Objectives: The objective of this educational ex-hibit is to review the current literature on Kawasaki diseaseand to demonstrate its vascular findings and their variousconsequences seen on CTA and MRI/MRA.

Background: Kawasaki disease is a self-limiting vasculitisalmost always seen in young children that affects predomi-nantly mid-sized arteries. As there is no laboratory test for thedisease, the diagnosis is based on clinical symptoms combinedwith physical examination findings, including mucocutaneousabnormalities and lymph node enlargement. The most seriousand well known sequella are due to coronary artery aneuryms.However, aneurysms are also seen in other mid-sized arteriesthroughout the body. The identification and characterization ofthese lesser known aneurysms is important to facilitate appro-priate follow-up and treatment when necessary. In the past,echocardiography and angiography were the imaging modali-ties of choice. While echocardiography is still most commonlyused to follow coronary artery abnormalities, CTA and MRI/MRA are becoming more popular in evaluating coronary andnon-coronary artery aneurysms.

Clinical Findings/Procedure Details: Selected CTA andMRI/MRA cases of patients with a history of Kawasakidisease are presented. Findings including aneurysmal dila-tation of coronary, carotid, vertebral, axillary, iliac, abdom-inal, and extremity arteries are demonstrated. Included arefindings illustrating acute and long-term complications inpatients managed expectantly and operatively. The currentrelevant literature regarding Kawasaki disease is reviewed.

Conclusion and/or Teaching Points: After viewing theexhibit, radiologists should be able to recognize and char-acterize on CTA and MRI/MRA the following in patientswith a history of Kawasaki disease:1. Typical and atypical findings in coronary arteries andtheir complications.2. Typical and atypical findings in non-coronary arteries andtheir complications.3. Long-term follow-up appearance of aneurysms that havebeen managed either expectantly or operatively.

Abstract No. 255

The bumper stitch: A better way to secure tubes?A. Fu, A. Cohen, S. Trerotola; University of PennsylvaniaMedical Center, Philadelphia, PA.

Purpose: Drainage tube dislodgement is a common compli-cation of a commonly performed procedure. Dislodgement ofdrains secured using the traditional “air knot” technique (inwhich a suture in placed into the skin near the drain exit siteand knotted, with the free ends of the knot wrapped around thetube and again tied to secure it) usually occurs due to suture

erosion through the skin, requiring additional visits for resu-

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