Prospective Comparison of Hydrogel-coated Microcoils versus Fibered Platinum Microcoils in the Prophylactic Embolization of the Gastroduodenal Artery before Yttrium-90 Radioembolization

Abstract

PurposeTo prospectively assess the performance of hydrogel-coated versus fibered microcoils in the prophylactic occlusion of the gastroduodenal artery (GDA) before yttrium-90 (90Y) radioembolization. Materials and MethodsA total of 43 patients were randomized to receive fibered microcoils (n = 15), detachable hydrogel-coated microcoils (n = 13), or pushable hydrogel-coated microcoils (n = 15). Numbers of coils used, duration, dose–area product (DAP), contrast agent load, and coil migration were assessed. At the time of yttrium-90 (90Y) radioembolization, persistent GDA occlusion was analyzed. ResultsIn all patients, the embolized GDA was still completely occluded at the time of 90Y radioembolization. Mean numbers of microcoils used per patient were 11.5 (fibered microcoils), 2.9 (detachable hydrocoils), and 5.5 (pushable hydrocoils), with all numbers significantly different (P<.0001). Mean DAPs were 16,283 mGy/cm2±16,545 (standard deviation) for fibered microcoils, 13,786 mGy/cm2±5,990 for detachable hydrocoils, and 35,757 mGy/cm2±74,493 for pushable hydrocoils (P = .87). Mean durations of GDA coil embolization were 20 minutes for fibered microcoils, 25 minutes for detachable hydrocoils, and 32 minutes for pushable hydrocoils (P = .0015). Mean contrast agent loads were 9 mL for fibered microcoils, 11 mL for pushable hydrocoils, and 7 mL for detachable hydrocoils (P = .13). One case of coil migration occurred with each type. ConclusionsHydrogel-coated and fibered microcoils are equally effective for prophylactic occlusion of the GDA before radioembolization. The number of coils used is higher with fibered microcoils compared with pushable and detachable hydrocoils, but the reduced number of hydrocoils comes at the cost of increased procedure duration.