In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization.

Jorge Aramburu,Junichi Fukamizu,Terumitsu Hasebe,Tomohiro Matsumoto,Makoto Takahashi,Kosuke Tomita,Juan Carlos Ramos,Raúl Antón,Daiki Nozawa,José Ignacio Bilbao,Kouji Ozaki,Bruno Sangro

doi:10.3390/biology10121341

Abstract

Simple SummaryLiver cancer is one of the leading causes of cancer-related deaths worldwide and balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective treatment for liver cancer. However, the hemodynamic alterations that are responsible for the successfulness of the treatment and are produced by the microballoon catheter used during the treatment are not yet well understood. In this study, we developed an in vitro model (IVM) that can simulate B-TACE. We designed clinically relevant experiments, and we obtained clinically realistic results. We conclude that the IVM allows for a visual understanding of a complex phenomenon (i.e., the blood flow redistribution after balloon occlusion) and it could be used as a base for future sophisticated and even patient-specific IVMs; in addition, it could be used to conduct IVM-based research on B-TACE.Background: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. Methods: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. Results: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. Conclusion: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool.

Highlights

Transarterial chemoembolization (TACE) is used to treat patients with primary liver cancer [1], which is the third leading cause of cancer deaths in 2018 [2]
The aim of this study is to present a simple in vitro model (IVM) that replicates a complex phenomenon, i.e., an IVM of the arterial hemodynamics of the liver that includes collateral circulation, to visually study changes in collateral circulation
The purpose of this mathematical model was twofold: it was used to perform a simulation-based sizing of the geometrical characteristics of the IVM to ensure that physiologically realistic flowrates flowed through the IVM, and it was used to perform simulation-based quantitative analyses of pressures and flows in the IVM, which were used to complement the qualitative results observed in the experiments

Summary

Introduction

Transarterial chemoembolization (TACE) is used to treat patients with primary liver cancer [1], which is the third leading cause of cancer deaths in 2018 [2]. Conventional TACE consists of the intraarterial infusion of anticancer agents mixed with lipiodol followed by occluding particles that reduce blood flow and induce tumor necrosis [3]. B-TACE is performed with a microballoon catheter that temporarily occludes the feeding arteries. Compared to conventional TACE, it has been reported that BTACE can improve lipiodol accumulation in tumors, especially when the balloon-occluded arterial stump pressure (BOASP) (i.e., the pressure distal to the catheter tip) is below. Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery.

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