Prophylactic Temporary Occlusion of the Cystic Artery Using a Fibered Detachable Coil During 90Y Radioembolization.

Abstract

To address the feasibility of prophylactic temporary occlusion of the cystic artery using a detachable coil during 90Y radioembolization. From January 2012 to October 2016, nine patients underwent temporary occlusion of the cystic artery during 90Y radioembolization. Based on the planning hepatic angiography, a detachable coil was deployed into the cystic artery, which arose from a more distal level (e.g., right anterior hepatic artery) than its usual origin, but the proximal 1cm was left inside the microcatheter. 90Y microspheres were infused proximal to the cystic artery where the 99mTc-MAA had been infused, and then the coil was retrieved. Afterward, the patients underwent PET/CT imaging. Medical records were reviewed, and the differences in the uptake of 99mTc-MAA and 90Y microspheres in the gallbladder were evaluated using Wilcoxon's signed-rank test. Temporary placement of a detachable coil was feasible in all cases. On the angiograms obtained after detachable coil placement, the distal cystic artery and gallbladder were partially identifiable in eight of the nine (88.8%) patients, but fully restored after the removal of the coils in all cases. The proportional uptake of 99mTc-MAA (mean, 4.35%) and 90Y (mean, 0.90%) in the gallbladder was significantly different due to the temporary occlusion of the cystic artery (p=0.004). No clinical complications were identified for three months after the procedure. Temporary occlusion of the cystic artery using a detachable coil appeared to be feasible and effective in reducing 90Y uptake in the gallbladder.