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Intrahepatic flow diversion prior to segmental Yttrium-90 radioembolization for challenging tumor vasculature

查看全文 作　　者：Lindsay [1]B.Young;Marcin [2]Kolber;Michael [1]J.King;Mona [3]Ranade;Vivian [1]L.Bishay;Rahul [1]S.Patel;Francis [1]S.Nowakowski;Aaron [1]M.Fischman;Robert [1]A.Lookstein;Edward [1]Kim 高影响力作者 机构地区：[1]Icahn School of Medicine at Mount Sinai Deparmnent of Dignostc,Molecular and lterventionl Radiology,One Gustave L.Levry Place Box 1234,NY,100296574,New York,USA;[2]University of Teras Southwestem Medical Center,Division of Vascular and Inerentional Radiology,5323 Hary Hines Bhvd,Tx,753909316,Dallas,USA;[3]David Geffen School of Medicine at the Univerity of Calfornia-LoS Angeles,Deparment of Itrentionol Radiology,27235 Toumey Road,Suite 1500,Califormia,91355,Valencia,USA高影响力机构 出　　处：《Journal of Interventional Medicine》索引2022年第5卷第2期,共5页高影响力期刊 摘　　要：Background: Hepatic tumors with complex vascular supply or poor relative perfusion are prone to decreased rates of objective response. This is compounded in the setting of Yttrium-90(Y90) transarterial radioembolization(TARE), which is minimally embolic and flow-dependent, relying on high threshold dose for complete response.Objective: We describe our experience with intrahepatic flow diversion(FD) prior to TARE of hepatocellular carcinoma(HCC) with challenging vascular supply.Materials and methods: Between April 2014 and January 2020, 886 cases of coinciding MAA or TARE and bland embolization or temporary occlusion were identified.Intraprocedural embolizations performed for more routine purposes were excluded. FD was performed by bland embolization or temporary occlusion of vessels supplying non-malignant parenchyma in cases where flow was not preferential to target tumor. Lesion characteristics, vascular supply, treatment approach, angiography, and adverse events(AEs) were reviewed. Radiographic response was assessed using mRECIST criteria.Results: 22 cases of FD of focal HCC were identified. Embolics included calibrated microspheres(n = 11), microcoils(n = 4), gelfoam(n = 3), temporary balloon occlusion(n = 2) and temporary deployment of a microvascular plug(n = 1). Post-treatment SPECT-CT dosimetry coverage was concordant with target lesions in all cases. Mean follow-up was 16.7 months(1.4–45 mos). Tumor-specific response per m RECIST was 41% complete response, 50% objective response, and 59% disease control rate. No major adverse events or grade 3/4 hepatotoxicity were reported.Conclusion: Our findings suggest that FD prior to TARE is safe and potentially effective in treating HCC with complex vascular supply or poor tumor perfusion. 关 键 词：EMBOLIZATION routine balloon
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