Miltiadis Krokidis

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• Associate Professor in Radiology
• Professor (Associate) at National and Kapodistrian University of Athens

Objectives This study aimed to evaluate whether minimum-intensity projection (MinIP) images could predict complications in CT-guided lung biopsies. Methods We retrospectively analyzed 72 procedures from January 2019 to December 2023, categorizing patients by pneumothorax and the severity of hemorrhage (grade 2 or higher). Radiodensity measurements...

Aim of the study This systematic review aims to evaluate the efficacy, safety, and comparative outcomes of endovascular treatments for acute lower limb deep vein thrombosis (DVT), including catheter-directed thrombolysis (CDT), pharmacomechanical thrombectomy (PMT), mechanical thrombectomy, and venous stenting, drawing insights from a diverse range...

Background/Objectives: This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning. Methods: We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pn...

Purpose Engaging in clinical service development is a prerequisite for Interventional Radiology (IR) to prosper as a full clinical discipline. The CIRSE Clinical Services in IR Task Force conducted a survey of CIRSE members worldwide to assess the current status of their clinical practice and to identify areas of practice requiring further support....

Background: This study investigated and compared the efficacy, safety, radiation exposure, and financial compensation of two modalities for percutaneous radiologic gastrostomy (PRG): multislice computed tomography biopsy mode (MS-CT BM)-guided and fluoroscopy-guided (FPRG). The aim was to provide insights into optimizing radiologically assisted gas...

Bariatric surgery may sometimes be challenging and may lead to severe complications. Surgical re-intervention in such cases is not the preferred option due to co-morbidities. When severe bleeding occurs, embolization of the lacerated vessels is the preferred minimal invasive management option and needs to be available if possible. We would like to...

Pulmonary embolism (PE) is a significant contributor to global cardiovascular-related mortality that mainly depends on the severity of the event. The treatment approach for intermediate and high-risk PE remains a topic of debate due to the fine balance between hemodynamic deterioration and bleeding risk. The initial treatment choice for intermediat...

We describe a case of hereditary haemorrhagic telangiectasia where embolization of a pulmonary arteriovenous malformation with micro-coils was performed. The embolization technique that was implemented was initial scaffolding and then packing among the scaffold coils. The chapter also offers an overview of indications for embolization, a pre-interv...

Antiangiogenic agents have been used for many years as a first-line systemic treatment for advanced HCC. Embolization with cytostatic drugs on the other hand is the first-line treatment for intermediate HCC. The two types of drugs have not been combined for intraarterial delivery yet. The loading and release dynamics and the in vitro effect of thei...

Purpose We aimed to compare the diagnostic yield and procedure-related complications of two different types of systems for percutaneous CT-guided lung biopsy. Material and methods All patients with a lung lesion who underwent a CT-guided lung biopsy at our institution, between January 2019 and 2021, were retrospectively analyzed. The inclusion cri...

Background Endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms is an effective, minimally invasive treatment that has been successfully used since the early 1990s, with refined and expanded techniques and tools currently offering excellent outcomes. Due to increased detection of such lesions in recent years, many of wh...

This CIRSE Standards of Practice document is aimed at healthcare professionals (including interventional radiologists) performing endovascular procedures to provide best practices for performing arterial access for interventions. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. This p...

Histological diagnosis is mandatory for the majority of solid lesions in the lungs in order to characterize the lesions but also to assess the response to treatment. Flexible bronchoscopy has a variable and often poor success rate in sampling pulmonary lesions which are not visible endoscopically. Such focal radiological opacities without endobronc...

Endovascular aortic aneurysm repair has changed the management of patients affected by this condition, offering a minimally invasive solution with satisfactory outcomes. Constant evolution of this technology has expanded the use of endovascular devices to more complex cases. The purpose of this review article is to describe the current strategies,...

Background and Aims Life expectancy for adults with spinal muscular atrophy (SMA) has increased significantly and central neuraxial anesthesia remains one of the safest options for this specific category of patients. Patients with SMA have usually been subjected to spine fusion surgeries and suffer from joint contractures and scoliosis. Successful...

Background: Hepatocellular carcinoma (HCC) can be treated by local and regional methods of percutaneous interventional radiological techniques. Indications depend on tumor size, type and stage, as well as patient's condition, liver function and co-morbidities. According to international classification systems such as Barcelona Clinic Liver Cancer...

Objectives To investigate whether lesion imaging features may condition the outcome of CT-guided Lung Biopsy (CTLB) and to develop a scoring system of biopsy outcome prediction. Methods This is a single center retrospective study on 319 CTLBs that were performed in 319 patients (167 males/ 152 females, mean age 68 ± 12.2). Uni- and multivariate an...

The curvelet transform, which represents images in terms of their geometric and textural characteristics, was investigated toward revealing differences between moderate (50%–69%, n = 11) and severe (70%–100%, n = 14) stenosis asymptomatic plaque from B-mode ultrasound. Texture features were estimated in original and curvelet transformed images of a...

Objective There have been concerns about the long term safety of paclitaxel coated devices in the lower limbs. A formal systematic review and meta-analysis of randomised controlled trials (RCTs) was performed to examine the long term risk of major amputation using paclitaxel coated balloons in peripheral arterial disease (PAD). Method This systema...

(1) Introduction and Aim: The aim of this study is to investigate the prognostic value, in terms of response and survival, of CT-based radiomics features for patients with HCC undergoing drug-eluting beads transarterial chemoembolization (DEB-TACE). (2) Materials and Methods: Pre-treatment CT examinations of 50 patients with HCC, treated with DEB-T...

PurposeTo retrospectively analyse complications in endovascular aortic repair (EVAR) interventions and evaluate if the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) complication classification system is appropriate as a standardized classification tool for EVAR patients.Materials and Methods Demographic, procedural and co...

The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50% of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI)...

Giant visceral aneurysms (or pseudoaneurysms) are aneurysmal lesions of the splanchnic vessels that are larger than 5 cm in diameter. As with other visceral aneurysms, treatment may be either surgical or endovascular. Both treatments face challenges given the anatomical complexity of such lesions. However, in the era of novel tools and techniques t...

Endovascular management of small visceral artery aneurysms is an established treatment with satisfactory outcomes. However, when size exceeds 5 cm visceral aneurysms are considered as “giant” (giant visceral artery aneurysms or GVAAs) and management is significantly more complex. Between August 2007 and June 2019 eleven cases of GVAAs that were end...

Purpose To evaluate the long-term clinical efficacy of the Tigris © stent (Gore ©) in femoropopliteal chronic total occlusions (CTOs). Material and Methods This single centre retrospective study included 29 patients treated with 47 Tigris© stents for CTOs. Lesion location, type, length, revascularisation method, smoking status and diabetes were re...

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult...

Background Biliary obstruction due to malignant disease causes debilitating symptoms and palliation of the disease involves placement of biliary stents. Covered self-expanding metal biliary stents may provide a longer patency and a lower risk of complications and dysfunction compared to uncovered stents, making them better for patients’ quality of...

A formal systematic review and study-level meta-analysis of randomized controlled trials investigating treatment of the infrapopliteal arteries with paclitaxel-coated balloons compared with conventional balloon angioplasty for critical limb ischemia (CLI) was conducted. Medical databases and online content were last screened in September 2019. The...

Abstract The presence of endoleaks remains one of the main drawbacks of endovascular repair of abdominal aortic aneurysms leading to the increase of the size of the aneurysmal sac and in most of the cases to repeated interventions. A variety of devices and percutaneous techniques have been developed so far to prevent and treat this phenomenon, incl...

A 63-year-old patient was admitted to intensive treatment unit with biliary sepsis due to a small distal common bile duct stone. Endoscopic retrograde cholangiopancreatography was initially attempted for insertion of a biliary stent but failed due to the presence of a periampullary diverticulum. Referral to interventional radiology for percutaneous...

Objectives: To evaluate whether the preoperative chest radiographic thoracic area in newborn infants with congenital diaphragmatic hernia was related to the length of mechanical ventilation and the total length of stay and whether chest radiographic thoracic area predicted survival to discharge from neonatal care. Design: Retrospective observati...

Percutaneous image-guided thermal ablation is an established form of treatment of small volume hepato-pancreatico-biliary (HPB) tumors with very satisfactory results over the last three decades. Purpose of this article is to offer a brief overview of the history of thermal ablation and the currently available technology that interventional radiolog...

Femoropopliteal atherosclerosis affects a significant percentage of the world population, leading to intermittent claudication and critical limb ischemia. The femoropopliteal segment has a unique set of biomechanical challenges that must be considered and overcome for treatment. The use of stents is a reality and a necessity in peripheral intervent...

Purpose The aim of this study is to identify the micro-mechanical characteristics that define biopsy performance in normal ex vivo animal organs. Materials and methods Three biopsy systems with differences of needle external diameter, tray height and effective tray length were assessed. Sampling was performed in porcine liver and kidneys with comm...

We reviewed the radiographs of 131 infants with congenital diaphragmatic hernia and report that the umbilical venous catheter usually deviates to the ipsilateral and the endotracheal tube to the contralateral side of the defect. The trachea and the umbilical vein, however, can be found on either side of the midline.

Background Several randomized controlled trials (RCTs) have already shown that paclitaxel‐coated balloons and stents significantly reduce the rates of vessel restenosis and target lesion revascularization after lower extremity interventions. Methods and Results A systematic review and meta‐analysis of RCTs investigating paclitaxel‐coated devices i...

Table S1. Design Characteristics of the Included Randomized Controlled Trials* Table S2. Design Characteristics of the Tested Paclitaxel DES and DCB Devices Table S3. Baseline Patient Characteristics of Included Randomized Clinical Trials Table S4. Sensitivity Analyses of Rare Events (Risk Ratio; 95% CI or CrI)41 (R “meta” Package (Version 4.9‐2...

We reviewed the radiographs of 131 infants with congenital diaphragmatic hernia and report that the umbilical venous catheter usually deviates to the ipsilateral and the endotracheal tube to the contralateral side of the defect. The trachea and the umbilical vein, however, can be found on either side of the midline.

A rare postoperative complication of aortic root replacement is pseudoaneurysm formation. Surgical repair may be rather challenging particularly in patients who are elder and with significant comorbidities. Endovascular approach may also be technically demanding, given the high blood velocity and the anatomical challenges of the area of the aortic...

Purpose: The safety of liquid embolics over the conventional coils for the treatment of non-variceal upper gastrointestinal bleeding (UGIB) approach is still unclear. Purpose of this study is to assess the safety of ethylene-vinyl alcohol copolymer (EVOH 6%) over coils in the treatment of UGIB. Materials and methods: All the upper gastrointestin...

Surgical partial nephrectomy is still considered as the "gold standard" for the definitive management of small malignant renal masses, whereas treatment with image-guided percutaneous ablation is still mainly reserved for those patients who cannot undergo nephron-sparing surgical resection due to advanced age, underlying comorbidities or compromise...

Conclusion: Our results suggest that prolonged mechanical ventilation in infants admitted in neonatal intensive care is associated with reduced skeletal muscle mass acquisition. What is Known: • Prolonged mechanical ventilation in adult intensive care patients has been associated with skeletal muscle dysfunction and atrophy. • The cross-sectional...

Background: Covered biliary stents have shown significant effectiveness in the palliative management of patients with malignant biliary disease due to prevention of tumour ingrowth. However, stent dysfunction may still occur due to growth of tumour at the borders of the covered stent (tumour overgrowth). The aim of this study is to assess the effe...

The combination of percutaneous vertebroplasty with radiofrequency ablation (verteblation) has not shown to be an effective measure of pain management in patients with metastatic lesions of the spine. The use of this novel technique has not been previously described in metastatic disease from thyroid cancer. We would like to report our experience a...

Osteoid osteoma (OO) is a benign tumour that can cause severe pain and functional limitation to children and young adults; the treatment of choice is image-guided ablation. Due to the very small size of the lesion, detection and accurate needle placement may be challenging. Computed tomography (CT) offers very detailed imaging of the skeleton and i...

PurposeIntraprocedural distal embolization is an accepted complication of femoropopliteal angioplasty. The purpose of this study is to assess the use of below-the-knee stents in the “bail-out” of conventional methods. Materials and Methods We retrospectively reviewed 1485 of femoropopliteal angioplasties that were performed in our centre in a 4-yea...

Background: Chronic total occlusions (CTOs) are challenging to treat endovascularly. Classic subintimal approach is offering only moderate success rates mainly due of the lack of dedicated crossing catheters. Purpose of this study is to assess the acute procedural success of the use of a novel hydrophilic crossing catheter in the recanalization of...

Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach...

Transradial access for percutaneous coronary and non-coronary intervention has gained worldwide acceptance. This approach has demonstrated less bleeding and vascular events with a reduced in-hospital stay, and an improvement in clinical outcomes when compared to the traditional transfemoral approach. However, this strategy may occasionally lead to...

Percutaneous embolization was introduced in the mid- 70s and is now an established therapeutic procedure in current medical practice. With the use of improved imaging techniques, smaller profile catheters and new tools, embolization boundaries are significantly expanded in the last decades. Detachable coils were initially introduced in neuroradiolo...

AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions. METHODS A systematic review and meta-analysis was performed following the PRISMA process. PubMed (Medline), EMBASE (Excerpta Medical Database), AMED (Allied and Complementary medicine Database), Scopus and online content, were se...

Purpose The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. Materials and Methods This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudica...

Introduction: Polyarteritis Nodosa (PAN) is a systemic vasculitis affecting small and medium size arteries resulting in microaneurysms formation. Bilateral renal aneurysm rupture is a rare and life threatening complication. Although uncommon, PAN has been associated with chronic myelomonocytic leukaemia (CMML). Presentation of case: We report a...

We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent h...

Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, inclu...

Cholangiocarcinoma and pancreatic head cancer are still linked with extremely high 5-year mortality in the western world. The management of such patients is complex and typically requires a multidisciplinary approach in a tertiary care center. Interventional radiology offers minimally invasive, image-guided treatment for a variety of diseases and c...

Background: Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) II guideline, but endovascular solutions also appear to be a valid option in selected patients. The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction o...

We hypothesized that radiographically-assessed hyperinflation in bronchopulmonary dysplasia (BPD) is related to the degree of oxygenation impairment. Our objective was to explore the relation of chest radiographic thoracic area (CRTA) with right-to-left shunt, right shift of the oxyhemoglobin dissociation curve and ventilation/perfusion ratio (VA/Q...

Objectives: To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries. Methods: From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage...

There is a lack of consensus regarding which type of antiplatelet agent should be used in patients with peripheral arterial disease (PAD) and little is known on the advantages and disadvantages of dual antiplatelet therapy. We conducted a systematic review and network meta-analysis of available randomized controlled trials (RCT) comparing different...

Challenging Concepts in Interventional Radiology is a cased-based guide to the most challenging aspects of interventional radiology and endovascular procedures. The 31 Cases have been selected to cover a wide-spectrum of scenarios, from the endovascular repair of thoracic and abdominal aortic aneurysms to the ablation of lung and kidney tumours.

Challenging Concepts in Interventional Radiology is a cased-based guide to the most challenging aspects of interventional radiology and endovascular procedures. The 31 Cases have been selected to cover a wide-spectrum of scenarios, from the endovascular repair of thoracic and abdominal aortic aneurysms to the ablation of lung and kidney tumours.

Challenging Concepts in Interventional Radiology is a cased-based guide to the most challenging aspects of interventional radiology and endovascular procedures. The 31 Cases have been selected to cover a wide-spectrum of scenarios, from the endovascular repair of thoracic and abdominal aortic aneurysms to the ablation of lung and kidney tumours.

Varicocele is the most common treatable cause of male infertility. However, definitive treatment is very challenging, and there is a high recurrence rate after the majority of surgical and percutaneous procedures. A meticulous knowledge of the anatomy and the physiology of the venous plexus of the internal spermatic vein is required to understand t...

Challenging Concepts in Interventional Radiology is a cased-based guide to the most challenging aspects of interventional radiology and endovascular procedures. The 31 Cases have been selected to cover a wide-spectrum of scenarios, from the endovascular repair of thoracic and abdominal aortic aneurysms to the ablation of lung and kidney tumours.

Transradial access has nowadays become a standard of care for percutaneous coronary angiography and intervention. This approach has demonstrated significant reduction in bleeding rate, length of hospital stay, and improvement in clinical outcomes when compared to the traditional transfemoral approach. Due to its advantages this new access is also i...

Background/aim: We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. Description of case: The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in t...

In-stent restenosis remains one of the main drawbacks of stenting the femoropopliteal segment, and leads to stent failure and repeated interventions. A variety of endovascular techniques have been investigated so far to reduce this phenomenon, including plain angioplasty, atherectomy, new stent deployment, cutting balloons and cryoplasty but withou...

The aim of this study was to assess the safety and effectiveness of contrast-enhanced ultrasound (CEUS) on ultrasound guided high intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. Thirty-three patients (37 fibroids) were randomly assigned to two groups: group A (17 patients, 20 fibroids) in which CEUS was used before, during and...

We report a case of an 80-year-old man, who underwent an endovascular repair of an abdominal aortic aneurysm. Surgical access was obtained from both common femoral arteries, and the procedure was uneventful. One month computed tomography (CT) follow-up was without findings. Two months after endovascular aortic aneurysm repair (EVAR), the patient co...

Background: Application of self-expanding metal stents (SEMS) to treat patients suffering from malignant gastroduodenal outlet obstruction (GDOO) is today considered a well-recognized palliative treatment. Use of SEMS has emerged as an attractive alternative to surgical treatment of such patients. Purpose: To report the immediate and the mid-ter...

Within the group of Gastro-Entero-Pancreatic Neuroendocrine tumours (GEP-NETs), several heterogeneous malignancies are included with a variety of clinical manifestations and imaging characteristics. Often these cases are inoperable and minimal invasive treatment offered by image-guided procedures appears to be the only option. Interventional radiol...

Renal locoregional therapy or local ablation therapy, offers a valid solution for patients with small renal tumours that are not suitable surgical candidates. Local ablation techniques are usually performed under imaging guidance and are minimal invasive. However, complications may occur even with this minimal invasive treatment. The most frequen...

Percutaneous cholecystostomy is an established drainage procedure for the management of high-risk patients with acute cholecystitis. However, percutaneous image-guided access to the gallbladder may not be limited to the simple placement of a drain, but may also be used as an alternative approach to the biliary tree through the catheterization of th...

Background: Arteriovenous malformations (AVMs) are communications between an artery and a vein outside the capillary level. This pathologic communication may be either a fistula, a simple communication between a single artery and a dilated vein, or a more complex communication, a nidus of tortuous channels between one or more arteries/arterioles a...

Introduction: In this study we report the results of endovascular techniques for the management of pulmonary artery aneurysms (PAA) and pseudoaneurysms (PAPS). Methods: Cases with massive haemoptysis due to PAA and/or PAPS that were managed by endovascular means were included in the study. Clinical history and procedure details were analysed. Pr...

The risk of in-stent restenosis has been dramatically reduced with the use of thin-strut nitinol and balloon-expandable drug-eluting stents in the peripheral arterial territory. However, the presence of a permanent endovascular device is linked to a series of events that can lead to restenosis and stent thrombosis. Significant advances in the techn...

Several randomized controlled trials (RCTs) have shown the superiority of some of these technologies over balloon angioplasty, but direct comparisons between these treatment options are lacking. The authors conducted a network meta-analysis of RCTs comparing bare nitinol stents, covered nitinol stents, paclitaxel- or sirolimus-eluting stents (PES o...

Endovascular procedures for the management of the superficial femoral (SFA) and popliteal artery disease are increasingly common. Over the past decade, several stent technologies have been established which may offer new options for improved clinical outcomes. This paper reviews the current evidence for SFA and popliteal artery angioplasty and sten...

A systematic review was undertaken to provide a meta-analysis of clinical trials comparing thermal ablation with surgical nephrectomy for small renal tumours. PubMed (MEDLINE), EMBASE, AMED, and Scopus were searched in August 2013 for eligible prospective or retrospective comparative trials following the PRISMA selection process. Thermal ablation w...

To evaluate the long-term clinical outcomes and the negative predictors after the deployment of double-layered stents in malignant esophageal strictures. This is a single-center study of patients who received a double-layered covered stent for the palliation of dysphagia due to malignant esophageal strictures in a 3-year period. 56 patients fulfill...