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Toward Transpulmonary Chemoembolization with Degradable Starch Microspheres: Systematic Analysis of Local and Systemic Effects in a Porcine Model

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Abstract

Purpose

To investigate local and systemic effects of transpulmonary chemoembolization (TPCE) with degradable starch microspheres (DSM) and doxorubicin. The long-term goal is to establish DSM-TPCE as a treatment option for pulmonary malignancies.

Materials and Methods

Nine pigs underwent TPCE of either the right or left lower lobe pulmonary artery (LLPA) and bland embolization (TPE) of the contralateral LLPA. Before the procedures, macroaggregated albumin (MAA) particles were injected into both LLPAs, to exclude systemic shunting. Pulmonary arterial pressure, heart rate and oxygenation were recorded immediately before and at 1, 3, 5 and 10 min after treatment.

To investigate possible nontarget embolization, animals underwent cerebral MRI (cMRI). We killed the animals after a contrast-enhanced chest computed tomography (CT) and performed a pathologic examination at 12 h (3), 24 h (3) and 72 h (3) after treatment.

Results

All experiments were technically successful. Mean injected DSM dose until stasis was similar in TPCE and TPE (4.3 ± 1.4 vs. 4.0 ± 1.4 mL). Pulmonary arterial pressure increased significantly 3 min after treatment (TPE: 17 ± 5 vs. 27 ± 7 mmHg; TPCE: 22 ± 6 vs. 36 ± 8 mmHg). No significant changes in heart rate or peripheral oxygenation levels occurred. We observed no evidence of structural lung damage or permanent perfusion disruption on CT. MAA test injection and cMRI revealed no shunting or nontarget embolization. The pathologic assessment revealed nonspecific local inflammation of the lung parenchyma.

Conclusion

In this large-animal model, TPCE and TPE appear feasible and safe. We observed a mild increase in pulmonary arterial pressure. Nontarget embolization did not occur. TPCE, as well as TPE, did not cause structural damage to the normal lung parenchyma.

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Acknowledgments

Part of this work was presented previously at CIRSE 2017 in Copenhagen (Cardiovasc Intervent Radiol (2017) 40(Suppl 2): 25. https://doi.org/10.1007/s00270-017-1725-y).

Funding

This study was funded by Pharmacept®. Design of the study and collection, analysis and interpretation of data as well as writing of the manuscript were solely performed by the above-mentioned authors.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany

    A. Barabasch, C. K. Kuhl, A. Sander & P. Isfort

  2. Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany

    S. von Stillfried

  3. Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany

    A. Heinzel

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  1. A. Barabasch
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  2. S. von Stillfried
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  3. C. K. Kuhl
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  4. A. Heinzel
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  5. A. Sander
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  6. P. Isfort
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Correspondence to P. Isfort.

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Barabasch, A., von Stillfried, S., Kuhl, C.K. et al. Toward Transpulmonary Chemoembolization with Degradable Starch Microspheres: Systematic Analysis of Local and Systemic Effects in a Porcine Model. Cardiovasc Intervent Radiol 42, 1475–1482 (2019). https://doi.org/10.1007/s00270-019-02246-1

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  • DOI: https://doi.org/10.1007/s00270-019-02246-1

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