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Safety and Efficacy Assessment of Flow Redistribution by Occlusion of Intrahepatic Vessels Prior to Radioembolization in the Treatment of Liver Tumors

  • Clinical Investigation
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Abstract

We evaluated the feasibility, safety, and efficacy of radioembolization (administered from one or two vascular points) after the redistribution of arterial blood flow in the liver in patients with hepatic neoplasms and arterial anatomic peculiarities (AAP). Twenty-four patients with liver neoplasms and AAP (graded according to Michel’s classification) were included in the study. During pretreatment angiographic planning, all extrahepatic vessels that could feed the tumor were embolized and the intrahepatic vessels occluded in order to redistribute blood flow. The distribution of microspheres was initially assessed by using technetium-99m-labeled macroaggregated albumin (99mTc-MAA) from one of two vascular points before the administration of yttrium-90 (90Y)-radiolabeled resin microspheres. Perfusion of lesions situated in the redistributed segments (L-RS) and nonredistributed segments (L-NRS) were compared by assessing the distribution of 99mTc-MAA by SPECT/CT. Perfusion was graded as normal, reduced, or absent. 90Y resin microspheres were then injected from the same arterial sites as 99mTc-MAA and the tumor response recorded 3 months later. The tumor response in L-RS was compared with that in L-NRS and graded as better, similar, or worse. Among 11 patients with type I AAP in whom mainly vessels in segments I–III or IV were occluded, perfusion of L-RS was graded as similar (n = 7) or reduced (n = 4). Among the remaining 13 patients with AAP types III (n = 3), V (n = 4), VIII (n = 3), and others (n = 3) in which aberrant arteries were occluded, perfusion of L-RS was graded as similar (n = 9), reduced (n = 3), or absent (n = 1). Overall, 99mTc-MAA was present in the L-RS of 95.8% patients and the distribution of 99mTc-MAA in L-RS and L-NRS were graded as similar in 66.6% of patients. Compared with lesions in the L-NRS, tumor response in L-RS was similar in 23 cases and worse in 1 case. No complications were recorded after the administration of 90Y resin microspheres. Redistribution of flow in L-RS is feasible and enables a safe and effective delivery of 90Y resin microspheres that are able to be distributed via intrahepatic collaterals and access the microvasculature of L-RS.

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Authors and Affiliations

  1. Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII nº 36, Pamplona, 31008, Spain

    José I. Bilbao, María J. Herráiz, Carmen Hernández & Antonio Martínez de la Cuesta

  2. Department of Nuclear Medicine, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain

    Puy Garrastachu, Macarena Rodríguez & Javier Arbizu

  3. Department of Internal Medicine-Hepatology, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain

    Mercedes Iñarrairaegui & Bruno Sangro

  4. Department of Oncology, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain

    Javier Rodríguez

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  1. José I. Bilbao
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  2. Puy Garrastachu
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  3. María J. Herráiz
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  4. Macarena Rodríguez
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  5. Mercedes Iñarrairaegui
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  6. Javier Rodríguez
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  7. Carmen Hernández
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  8. Antonio Martínez de la Cuesta
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  9. Javier Arbizu
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  10. Bruno Sangro
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Correspondence to José I. Bilbao.

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Bilbao, J.I., Garrastachu, P., Herráiz, M.J. et al. Safety and Efficacy Assessment of Flow Redistribution by Occlusion of Intrahepatic Vessels Prior to Radioembolization in the Treatment of Liver Tumors. Cardiovasc Intervent Radiol 33, 523–531 (2010). https://doi.org/10.1007/s00270-009-9717-1

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  • DOI: https://doi.org/10.1007/s00270-009-9717-1

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