Temporary Reversal of Hepatoenteric Collaterals during 90Y Radioembolization Planning and Administration

• Published in: Current oncology (Toronto) Vol. 29; no. 12; pp. 9582 - 9592
• Main Authors: Habibollahi, Peiman, Odisio, Bruno C., Gurusamy, Varshana, Kuban, Joshua D., Avritscher, Rony, Abdelsalam, Mohamed E., Chasen, Beth A., Murthy, Ravi, Mahvash, Armeen
• Format: Journal Article
• Language: English
• Published: MDPI 06-12-2022; MDPI AG
• Subjects: balloon occlusion; hepatoenteric collaterals; radioembolization
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol29120753

Purpose: This paper aims to evaluate the safety and efficacy of the temporary redirection of blood flow of hepatoenteric collaterals using a balloon catheter in the common hepatic artery (CHA) to prevent the nontarget deposition of 90Y microspheres. Materials and Methods: In this retrospective single-center study of patients who received 90Y radioembolization (RE) from September 2010 to September 2015, diagnostic (67 patients) or treatment (72 patients) angiograms with the attempted use of a balloon catheter in the CHA to temporarily direct blood flow away from the hepatoenteric arteries were analyzed. SPECT/CT nuclear scintigraphy was performed after both diagnosis and treatment. Results: Overall, only 12 hepatoenteric arteries in 11 patients required embolization due to persistent hepatoenteric flow despite the use of the balloon occlusion technique in a total of 86 patients. Physicians performed the 90Y RE using balloon occlusion with glass (n = 22) or resin (n = 50) microspheres. Over 80% administration of the prescribed 90Y dose was accomplished in 34 (67%) resin and 20 (95%) glass microsphere patients. Post-treatment 90Y RE scintigraphy confirmed the absence of extrahepatic activity in all patients. One grade 2 gastrointestinal ulcer was present after 90 days of follow-up. Conclusion: Temporary CHA occlusion with a balloon catheter is a reliable and reproducible alternative to the conventional coil embolization of hepatoenteric arteries during diagnostic Tc-99m macroaggregated albumin and therapeutic 90Y RE delivery.