Abstract

TU ES D A Y: S ci en ti fic S es si on s Purpose: The most common serious complication of Y90 radioembolotherapy (Y90 RE) is gastrointestinal ulceration secondary to extrahepatic microsphere deposition. The conventional method to prevent extrahepatic deposition of Y90 microspheres is the coil occlusion of the origins of hepatoenteric arteries. However, this method of exclusion is not possible in all cases. Redirection of blood flow towards the liver (hepatopetal) within hepatoenteric arteries during Y90 RE delivery could achieve the identical intention of prevention of gastrointestinal microsphere deposition. We present the utility of the creating hepatopetal flow within hepatoenteric arteries with use of the balloon occlusion technique at our institution for Y90 RE. Materials and Methods: Between September 2010December 2012, 62 patients with diagnostic or treatment angiograms with attempted use of the balloon occlusion technique were catalogued. Tumor types included colorectal (18), hepatocellular (22), neuroendocine (17) or other (5). Temporary balloon catheter occlusion of the common hepatic artery was used to transiently create hepatopetal flow within hepatoenteric arteries during both the diagnostic Tc99m MAA (47 patients) and therapeutic Y90 RE (48 patients) delivery. Planar & SPECT nuclear scintigraphy was performed after delivery of the radionuclides. Whole liver, right lobe, left lobe Y90 RE treatments were performed in 40,8 and 2 sessions respectively. Clinical and laboratory follow up at 1, 3 and 6 months and imaging follow up at 3 and 6 months were performed. Results: 50 Y90 RE treatment sessions were performed with use of the balloon technique with either glass (20) or resin (30) microspheres. Post Y90 RE scintigraphy confirmed hepatic only activity. Greater than 80% administration of the prescribed dose of resin microspheres was possible in 22/30 sessions and in 19/20 sessions of glass microspheres. One NCI-CTC grade 2 gastrointestinal ulcer was present at 90 day follow up. Conclusion: Transient common hepatic artery ballooncatheter occlusion provided a reasonably safe, reliable, and reproducible alternative to conventional fibered coil occlusion of patent hepatoenteric arteries to facilitate Tc99m MAA & Y90 RE delivery.

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