Objective To report our early experience in using the steerable ‘Columbus’ guidewire, also known as ‘Drivewire’ in the USA, and its potential applications in neurovascular interventions. Methods Neurointerventions in 36 patients (20 female, 16 male) using the steerable Columbus guidewire were recorded from August 2019 to December 2020 and included a variety of neurovascular procedures: Treatment of aneurysms (n=17), thrombectomy in acute ischemic stroke (n=12), and others (n=7), such as treatment of stenosis and embolization procedures. Immediate follow-up with digital subtraction angiography and tracking of each patient’s clinical outcome was performed. Results In 35 out of 36 cases, the target vessel was reached with Columbus, including advancement of the appropriate microcatheter. In 14 cases, additional wires were used, mainly because of the nature of the procedures (eg, use of multiple wires/buddy wires or exchange maneuvers). In five cases, the Columbus wire was damaged by the operator and had to be replaced. Peri-interventional complications occurred in two patients, neither attributed to the Columbus guidewire. Conclusions The new Columbus neurovascular guidewire has the unique ability to be shaped within the patient. Currently available versions lack torquability compared with other available guidewires but offer tremendous support at the tip, allowing maneuvers which are impossible with other wires on the market.

Introduction Biliodigestive leaks are typically caused by an insufficiency at the surgical anastomosis. Biliodigestive anastomosis (BDA) insufficiencies can lead to bilomas, abscesses and vascular erosion in chronic conditions. Material and methods We performed a retrospective analysis of the medical and radiological records of all patients with biliodigestive insufficiency who received interventional treatment between July 2015 and February 2021. Nine patients (three with unilateral drainage and six with bilateral drainage) were treated with a modified percutaneous transhepatic cholangiodrainage (PTCD). Clinical success was considered after complete resolution of the peribiliary collections, absence of bile within the surgical drains, radiological patency of the BDA (contrast medium flowing properly through the BDA and no signs of leakage) and haemodynamic stability of the patient without signs of sepsis. Results Clinical success was achieved in all nine patients. No patients required revision surgery to repair their BDA. The mean indwelling drainage time was 34.8±16.5 days. The mean number of interventional procedures performed per patient was 6.6±2.0. Conclusion Patients who present with BDA insufficiency may benefit from interventional radiological techniques. Our modified PTCD resolved the BDA leak in all nine cases and should be considered as a valuable option for the treatment of patients with this complication. Our technique demonstrated to be feasible and effective.

Smart angiography suites (SAS) refer to the incorporation of audio-video technology and internet connectivity into the angiography suite to enable bidirectional communication for teleproctoring. Remote streaming support (RESS) is intended to increase patient safety by supporting interventionalists with limited experience or who are practicing in geographically remote areas. The aim of this review is to describe real-life experience of the Tegus system and to share practical tips concerning its use and setup. We describe the platform itself, settings and integration in our angiography suite. We provide technical tips intended to help new and potential users to achieve an optimal experience for both neurointerventionalists and proctors. We describe both elective cases that we have performed with teleproctoring and emergencies. Lastly, we describe a different room setup and software solutions used in live workshops. Use of teleproctoring enabled involvement of proctors in cases where an already experienced interventionalist needed support in the decision-making process concerning the sizing and deployment of devices with which he was familiar only on a basic level. Excellent video feed quality and instant communication enabled optimal preparation and in vivo implantation of those devices without the need for physical proctors’ presence. In emergency cases the system allowed a senior physician to offer support during cases where optimal device sizing is critical. Our usage concept of the rig permitted monitoring of thrombectomy cases by junior physicians. During webinars a remote streaming platform enabled us to conduct workshops that simulated an “on-site” experience as closely as possible during the COVID-19 pandemic.

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm. Video 1 ­:

The aim of this single-center case series is to demonstrate that an ultra-low dose (ULD) can be routinely achieved in the hybrid operating room in standard endovascular aortic repair (EVAR) for infrarenal abdominal aortic aneurysm by adjusting the manufacturer's predefined imaging parameters, hardware configurations and user protocols (including benchmarking). The hybrid operating room manufacturer predefined EVAR software setup of the dose exposure control software (OPTIQ, Siemens Healthineers, Forchheim, Germany) at our university medical center was screened for possible improvements regarding radiation dose application. Tests on a water-equivalent as well as polymethyl methacrylate phantom model to assess the impact of technical settings were performed, including comparison of settings for exposure control software, different magnification, collimation configurations and detector distance. All results were transferred into modified setups for the exposure control software and a new ULD procedure protocol for EVAR. Additionally, to standardize the clinical pathway, the Lucerne EVAR Milestone Approach (LEMA) was introduced including preoperative, perioperative, and postoperative milestones for technical procedure content and dose benchmarking during EVAR. A validation of the new settings including revised software setup, procedure protocol, and applicability of LEMA on a consecutive EVAR case series was conducted. Ten consecutive patients undergoing EVAR for low and medium complexity infrarenal abdominal aortic aneurysm were included. The primary outcome parameter was intraoperative dose area product (DAP, measured in Gy·cm²). Secondary outcomes were median fluoroscopy time (in minutes:seconds), cumulative air kerma (in mGy), clinical success, and occurrence of endoleaks. New ULD settings compared with previous manufacturers standard settings of dose exposure control software reduced DAP for both fluoroscopy (0.0382 Gy·cm²/min vs 0.3 Gy·cm²/min) and angiography (2.36 Gy·cm²/min vs 2.48 Gy·cm²/min). Digital magnification and collimation decreased DAP. Application of the new ULD standard EVAR protocol resulted in a median DAP of 5.6 Gy·cm² (range, 3.54-12.1 Gy·cm²). Median fluoroscopy time was 16 minutes and 32 seconds. Type I endoleaks occurred in no patients (0%), type II in five patients (50%), and type III in no patients (0%). No patient had to undergo reintervention owing to endoleak or absence of diameter shrinkage during the first postoperative year. Revision of the manufacturer-predefined EVAR setup by testing and ensuring optimal imaging parameters and hardware configurations in combination with LEMA enabled performance of ULD standard EVAR procedures routinely without compromising imaging quality.

Background: The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. Methods: An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. Results: After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session. Conclusions: This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. Trial registration: Retrospectively registered