Temporary Distal Balloon Occlusion for Hepatic Embolization: A Novel Technique to Treat What Cannot be Selected

Abstract

Particle embolotherapy for liver cancers, such as chemoembolization and yttrium-90 radioembolization, depends on microcatheter selection of the treatment vessel for injection of the embolic. Individually selecting vessels with a microcatheter can be time-consuming and difficult, especially when multiple branches are present in the treatment zone. This article describes a technique to perform an "inverse" embolization-protection of the selected vessel and embolization of the unselected vessels-a technique that has not yet beendescribed. Two cases of hepatic chemoembolization that would require subselection of multiple branch vessels using conventional technique are reported. In both cases the proper hepatic artery was selected with a soft, nondissecting neurovascular guide catheter. The nontarget hepatic vessel was selected with a neurovascular microcatheter occlusion balloon, and the balloon was inflated to protect that vessel. Embolization to multiple target vessels was then achieved by way of a single injection through the guide catheter. Both procedures were technically successful without complication. Postembolization angiography confirmed normal parenchymal enhancement in the protected zone and expected paucity of enhancement in the treated zone. Temporary distal balloon occlusion is a useful technique to treat multiple artery branches with a single injection in cases where individual selection of the branches is difficult or time-consuming. Further study of this technique is warranted.