FRANCISCO CESAR CARNEVALE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina - Médico
19 resultados
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- Effects of Prostatic Artery Embolization on the Dynamic Component of Benign Prostate Hyperplasia as Assessed by Ultrasound Elastography: A Pilot Series(2019) ASSIS, Andre Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; MARCELINO, Antonio Sergio Zafred; CERRI, Luciana Mendes de Oliveira; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoPurposeTo determine the effects of prostatic artery embolization (PAE) on prostaticelasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation.Materials and MethodsThis is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up.ResultsAfter PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, -29.8%, p=0.002) and in m/s (3.75 vs. 4.63, -19.0%, p<0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p<0.05). All eight patients presented with significant LUTS improvement after PAE (p<0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA).ConclusionsFindings described in this study suggest that PAE significantly reduces prostaticEM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.
- Prostatic Tissue Elimination After Prostatic Artery Embolization (PAE): A Report of Three Cases(2017) LEITE, Leandro Cardarelli; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; HARWARD, Sardis Honoria; ANTUNES, Alberto Azoubel; CARNEVALE, Francisco CesarWe report three cases of spontaneous prostatic tissue elimination through the urethra while voiding following technically successful prostatic artery embolization (PAE) as a treatment for lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). All patients were embolized with 100- to 300-mu m microspheres alone or in combination with 300- to 500-mu m microspheres. During follow-up prior to eliminating the tissue fragments, the three patients all presented with intermittent periods of LUTS improvement and aggravation. After expelling the prostatic tissue between 1 and 5 months of follow-up, significant improvements in LUTS and urodynamic parameters were observed in all patients. Urethral obstruction after PAE caused by sloughing prostate tissue is a potential complication of the procedure and should be considered in patients with recurrent LUTS in order to avoid inappropriate management.
- Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications(2021) JR, Ubenicio Silveira Dias; MOURA, Mauricio Ruettimann Liberato de; VIANA, Publio Cesar Cavalcante; ASSIS, Andre Moreira de; MARCELINO, Antonio Sergio Zanfred; MOREIRA, Airton Mota; LEITE, Claudia Costa; CERRI, Giovanni Guido; CARNEVALE, Francisco Cesar; HORVAT, NatallyBenign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as alpha-blockers and 5 alpha-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. (C) RSNA, 2021
- Prostatic Artery Embolization Using Polyethylene Glycol Microspheres: A 1-Year Follow-up Prospective Study Including 30 Patients(2023) PILAN, Bruna Ferreira; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; RODRIGUES, Vanessa Cristina de Paula; ROCHA, Arthur Diego Dias; CARNEVALE, Francisco CesarPurpose: To evaluate safety and effectiveness of prostatic artery embolization (PAE) using polyethylene glycol (PEG) microspheres in patients with moderate-to-severe benign prostatic hyperplasia (BPH).Materials and methods: A single-center, prospective study of 30 patients who underwent PAE from August 2020 to December 2021 using PEG 400-mu m microspheres was conducted. Patient evaluation data using International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA), peak urinary flow rate (Qmax), postvoid residual volume (PVR), and prostate volume (PV) at baseline and 3 and 12 months after PAE were obtained.Results: Bilateral PAE was performed in all patients. One patient had early clinical failure (3.3%) and another presented with lower urinary tract symptoms (LUTSs) recurrence (3.3%) at the 12-month follow-up. Twenty-eight patients (93.3%) experienced significant and durable LUTS improvement. Mean absolute (and relative) improvement at 3 and 12 months were: IPSS, 14.6 points (-69%) for both; QoL, 3.3 points (-70%) and 3.5 points (-74%); Qmax, 6.3 mL/s (+78%) and 8.6 mL/s (+100%); PSA reduction, 1.2 ng/mL (-22%) and 1.0 ng/mL (-15%); PVR reduction, 48 mL (-56%) and 58.2 mL (-49%); PV reduction, 23.4 cm(3) (-29%) and 19.6cm(3) (-25%); (P < .05 for all). No major adverse events were observed. Minor adverse events included urinary tract infection (4/30, 13.3%), prostatic tissue elimination (3/30, 10%), penile punctiform ulcer (1/30, 3.3%), and urinary retention (1/30, 3.3%).Conclusions: PAE using PEG microspheres was observed to be effective with sustained LUTS improvement at the 12-month follow-up. The incidence of urinary infection and prostatic tissue elimination was higher than previously reported for other embolics.
- Prostatic artery embolization using reflux-control microcatheter: prospective experience addressing feasibility(2022) ASSIS, Andre Moreira de; KAWAKAMI, Willian Yoshinori; MOREIRA, Airton Mota; CARNEVALE, Francisco CesarPurposeTo evaluate the efficacy and safety of Prostatic Artery Embolization (PAE) using a reflux control microcatheter. Materials and methodsThis is a prospective, single-center investigation that included 10 patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline, 3-month, and 12-month efficacy endpoints were obtained for all patients and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging (MRI), and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. Complications were assessed using the Cirse classification system. ResultsTen patients entered statistical analysis and presented with significant LUTS improvement 12 months after PAE, as follows: mean IPSS reduction of 86.6% (2.8 vs. 20.7, - 17.9, P < 0.001), mean QoL reduction of 79.4% (1.1 vs. 5.4, - 4.3, P < 0.001), mean prostatic volume reduction of 38.4% (69.3 cm(3) vs. 112.5 cm(3), - 43.2 cm(3), P < 0.001), mean peak urinary flow (Qmax) increase of 199.4% (19.9 mL/s vs. 6.6 mL/s, + 13.3 mL/s, P = 0.006) and mean PSA reduction of 50.1% (3.0 ng/mL vs. 6.1 ng/mL, - 3.0 ng/mL, P < 0.001). One patient (10%) needed transurethral resection of the prostate (TURP) after PAE due to a ball-valve effect. One microcatheter (10%) needed to be replaced during PAE due to occlusion. Non-target embolization was not observed in the cohort. ConclusionThis initial experience suggests that PAE using a reflux control microcatheter is effective and safe for the treatment of LUTS attributed to BPH.
- Advanced image guidance for prostatic artery embolization - a multicenter technical note(2021) CARNEVALE, Francisco Cesar; MCCLURE, Timothy; CADOUR, Farah; VIDAL, Vincent; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; ROCHA, Arthur Diego Dias; REBET, Aya; NUTTING, CharlesBackground Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. Main text This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. Conclusions This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.
- Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay(2017) CARNEVALE, Francisco Cesar; SOARES, Guilherme Rebello; ASSIS, Andre Moreira de; MOREIRA, Airton Mota; HARWARD, Sardis Honoria; CERRI, Giovanni GuidoProstate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.
- Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography(2023) HAJJAR, Ludhmila Abrahao; ANCONA, Marco B.; KALIL FILHO, Roberto; TRESOLDI, Moreno; CALDAS, Jose Guilherme; MONTI, Giacomo; CARNEVALE, Francisco Cesar; COBELLI, Francesco De; ASSIS, Andre Moreira de; CICERI, Fabio; LANDONI, Giovanni; DIJKSTRA, Jouke; MORONI, Francesco; ABIZAID, Alexandre Antonio Cunha; UNGARETTI, Fernanda Willemann; CARMONA, Maria Jose Carvalho; BACKER, Daniel De; POMPILIO, Carlos Eduardo; JR, Fabio S. de Britto; CAMPOS, Carlos M.; ZANGRILLO, Alberto; MONTORFANO, MatteoBackground Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome.Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients.Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 +/- 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 +/- 4.6 mm(2), with stenosis of 60.9 +/- 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 +/- 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 & PLUSMN; 2.6, and the mean thrombus-containing lesion length was 14.1 +/- 13.9 mm. No peri-procedural complications occurred in any of the 13 patients.Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis.
- Role of Ultrasound Elastography in Patient Selection for Prostatic Artery Embolization(2021) ASSIS, Andre Moreira de; MOREIRA, Airton Mota; CARNEVALE, Francisco Cesar; MARCELINO, Antonio Sergio Zafred; ANTUNES, Alberto Azoubel; SROUGI, Miguel; CERRI, Giovanni GuidoPurpose: To determine the effects of prostatic artery embolization (PAE) on prostate elasticity as assessed using ultrasound elastography (US-E) and to describe baseline US-E's potential role in patient selection. Materials and Methods: This was a prospective investigation that included 20 patients undergoing PAE to treat lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). US-E with measurement of the prostatic elastic modulus (EM) and shear wave velocity (SWV) was performed before PAE and at 1-month follow-up. Baseline, 3-month, and 1-year follow-up evaluations included prostate-specific antigen, uroflowmetry, pelvic magnetic resonance imaging, and clinical assessment using the International Prostate Symptom Score (IPSS) and quality of life (QoL) metrics. Results: Seventeen patients entered statistical analysis. US-E showed a significant reduction in mean prostatic EM (34.4 kPa vs 46.3 kPa, similar to 24.7%, P <.0001) and SWV (3.55 m/s vs 4.46 m/s, similar to 20.0%, P <.0001) after PAE. There were moderate positive correlations between baseline EM and 1-year IPSS (R = 0.62, P = .007) and between baseline SWVand 1-year IPSS (R = 0.68, P = .002). Baseline SWV >= 5.59 m/s and baseline EM >= 50.14 kPa were associated with suboptimal IPSS and QoL outcomes after PAE with high degrees of sensitivity (100%) and specificity (69-100%). Conclusions: PAE led to a positive effect on the BPH dynamic component related to prostatic elasticity. There was a moderate positive correlation between baseline prostatic elastographic parameters and 12-month IPSS. Measurement of baseline elastographic characteristics may become useful for the evaluation and selection of patients for PAE.
- Improvements in Irritative Versus Obstructive Symptoms of the International Prostate Symptom Score After Prostatic Artery Embolization in 174 Patients, in a Single Center(2020) MOREIRA, Airton Mota; ASSIS, Andre Moreira de; CARNEVALE, Francisco Cesar; OLIVEIRA, Daniel Simoes; ANTUNES, Alberto AzoubelAim The aim of this study is to compare the improvements in irritative versus obstructive symptoms of the International Prostate Symptom Score (IPSS) after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). Materials and Methods Between 2010 and 2018, 186 patients underwent PAE in a single center and 174 patients were retrospectively selected. The inclusion criteria were symptoms due to BPH, refractory to pharmacological treatment and IPSS >= 8. The mean age of the patients was 63.7 +/- 7.2 years, the mean prostate volume 89.5 +/- 42.5 cm(3), and the mean IPSS 19.0 +/- 6.2 points. Patient data were reviewed at baseline, 3, 12 and 24 months and compared using the ANOVA mixed models and the Tukey's multiple comparison test. Results Obstructive subscores dropped more significantly than irritative subscores (p < 0.0001). The mean decrease in each IPSS item was frequency 2.4 (83%); urgency 0.8 (87%); nocturia 1.3 (49%); incomplete emptying 2.6 (83%); intermittency 2.3 (91%); weak stream 2.9 (82%); straining 1.6 (91%). The area under the curve for baseline obstructive scores was 0.7 (p = 0.006) and 0.59 (p = 0.182) for irritative scores. The most common BPH clinical manifestations include irritative and/or obstructive symptoms, the latter usually more prevalent. The IPSS drop observed after PAE suggests that it acts predominantly over obstructive symptoms (p < 0.0001). Conclusion Although a predominant improvement in obstructive symptoms may be observed after PAE, nocturia complaints may require special attention. The severity of baseline obstructive symptoms may significantly predict clinical outcomes.