Abstract
BackgroundLiver tumors are increasingly treated with radioembolization. Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations.Materials and methods A total of 7 experiments were performed in a bench-top model of the hepatic arterial vasculature with recreated hemodynamics. Fluorescent microspheres and clinically used holmium microspheres were administered with a standard microcatheter (SMC) and an anti-reflux catheter (ARC) positioned at the same level along the longitudinal vessel axis. Catheter-related particle flow dynamics were analyzed by reviewing video recordings of UV-light illuminated fluorescent microsphere administrations. Downstream branch distribution was analyzed by quantification of collected microspheres in separate filters for two first-order branches. Mean deviation from a perfectly homogenous distribution (DHD) was used to compare the distribution homogeneity between catheter types.ResultsThe SMC administrations demonstrated a random off-centered catheter position (in 71 % of experiments), and a laminar particle flow pattern with an inhomogeneous downstream branch distribution, dependent on catheter position and injection force. The ARC administrations demonstrated a fixed centro-luminal catheter position, and a turbulent particle flow pattern with a more consistent and homogenous downstream branch distribution. Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047).ConclusionCatheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model. A within-patient randomized controlled trial has been initiated to investigate clinical catheter-related effects during radioembolization treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13046-015-0188-8) contains supplementary material, which is available to authorized users.
Highlights
Liver tumors are increasingly treated with radioembolization
Primary liver tumors and liver metastases affect a great number of cancer patients worldwide, and advanced disease stages are generally associated with poor prognosis [1,2,3,4]
Since liver tumors are van den Hoven et al Journal of Experimental & Clinical Cancer Research (2015) 34:74 almost exclusively vascularized by the hepatic artery, and healthy liver tissue receives the majority of its blood supply from the portal vein, arterial blood flow should preferentially transport the microspheres towards tumorous tissue, where they lodge in the distal vessels surrounding tumors and emit tumoricidal high-energy β-radiation, while relatively sparing healthy liver tissue [11]
Summary
We present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations. A novel catheter type has recently been developed for trans-catheter liver cancer treatments. This anti-reflux catheter (Surefire Infusion System, Surefire Medical Inc., Westminster, Co, USA) features a dynamically expandable tip that prevents reflux of particles in reverse flow conditions, while preserving normal antegrade blood flow [15]. The catheter orifice is fixed in the center of the vessel lumen (centro-luminal position). These marked differences may affect fluid-particle dynamics during microsphere administrations, and have a significant impact on tumor targeting during radioembolization
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