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Zaarour Y, Derbel H, Tran C, Saccentia L, Longère B, Blain M, Amaddeo G, Luciani A, Kobeiter H, Tacher V. Evaluation of a new beads reflux control microcatheter in drug-eluting bead transarterial chemoembolization. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 10:100048. [PMID: 39077730 PMCID: PMC11265494 DOI: 10.1016/j.redii.2024.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/01/2024] [Indexed: 07/31/2024]
Abstract
Rationale and objectives A new microcatheter was recently developed claiming to reduce beads reflux in drug-eluting bead transarterial chemoembolization (DEB-TACE). The aim of this study was to compare the reflux control microcatheter ability versus a standard microcatheter for TACE treatment in patients with hepatocellular carcinoma. Material and methods Patients were prospectively included between November 2017 and February 2022. They received a DEB-TACE treatment with charged radiopaque beads using standard microcatheters or the SeQure reflux control microcatheter (Guerbet, France) and were assigned respectively to a control and a test group. Beads distribution mismatch was evaluated between the targeted territory on treatment planning CBCT and beads' spontaneous opacities on the post-intervention CBCT and the 1-month CT scanner. Results Twenty-three patients (21 men, median age 64 years [12.5 years]) with 37 hepatocellular carcinoma nodules were treated. The control group consisted of 13 patients - 19 nodules, while the test group included ten patients - 18 nodules. Non target embolization (NTE) was found in 20 % (2/10) of patients in the test group and 85 % (11/13) in the control group. NTE involved only an adjacent segment in the test group while it affected the adjacent biliary sector or even the contralateral liver lobe in the control group. No complication linked to NTE was found in the test group, while it led to one case of ischemic cholangitis and another case of biloma in the control group. Conclusion The reflux control microcatheter may be efficient in reducing NTE and thus eventual adverse events in comparison to standard of care end-hole microcatheters.
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Affiliation(s)
- Youssef Zaarour
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - Haytham Derbel
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - Charles Tran
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Laetitia Saccentia
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Benjamin Longère
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Department of Cardiovascular Radiology, Institut Cœur-Poumon, CHU de Lille, 59037 Lille, France
| | - Maxime Blain
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Giuliana Amaddeo
- Department of Hepatology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 94010 Créteil, France
| | - Alain Luciani
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
- Unité Inserm U955, équipe n°18, IMRB, 94010 Créteil, France
| | - Hicham Kobeiter
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
| | - Vania Tacher
- Department of Radiology, CHU Henri-Mondor, Assistance publique – hôpitaux de Paris (AP-HP), 1, rue Gustave-Eiffel, 94010 Créteil, France
- Université Paris-Est Créteil (Upec), 94010 Créteil, France
- Unité Inserm U955, équipe n°18, IMRB, 94010 Créteil, France
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Spiliopoulos S, Moschovaki-Zeiger O, Sethi A, Festas G, Reppas L, Filippiadis D, Kelekis N. An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease. Expert Rev Med Devices 2023; 20:293-302. [PMID: 36825337 DOI: 10.1080/17434440.2023.2185137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Liver-dominant metastatic colorectal cancer is noted in approximately 20%-35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options. AREAS COVERED This is a comprehensive review of novel locoregional treatment technologies, both percutaneous ablation and transcatheter arterial treatments, which can be used to decrease hepatic disease progression in patients with mCRC. Trans-arterial radioembolization is the most recently developed locoregional treatment for metastatic liver disease, and robust evidence has been accumulated over the past years. EXPERT OPINION Image-guided techniques, endovascular and ablative, have gained wide acceptance for the treatment of liver malignancies, in selected patients with non-resectable disease. The optimization of dosimetry and microsphere technological advancement will certainly upgrade the role of liver radioembolization segmentectomy or lobectomy in the upcoming years, due to its curative intent. Also, ablative interventions provide local curative intent, offering significant and sustained local tumor control. Standardization protocols in terms of predictability and reliability using immediate treatment assessment and ablation zone software could further ameliorate clinical outcomes.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Akshay Sethi
- Department of Interventional Radiology, Aberdeen Royal Infirmary Hospital, NHS Grampian, Aberdeen, UK
| | - George Festas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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de Assis AM, Kawakami WY, Moreira AM, Carnevale FC. Prostatic artery embolization using reflux-control microcatheter: prospective experience addressing feasibility. CVIR Endovasc 2022; 5:62. [PMID: 36477441 PMCID: PMC9729574 DOI: 10.1186/s42155-022-00337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of Prostatic Artery Embolization (PAE) using a reflux control microcatheter. MATERIALS AND METHODS This is a prospective, single-center investigation that included 10 patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline, 3-month, and 12-month efficacy endpoints were obtained for all patients and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging (MRI), and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. Complications were assessed using the Cirse classification system. RESULTS Ten patients entered statistical analysis and presented with significant LUTS improvement 12 months after PAE, as follows: mean IPSS reduction of 86.6% (2.8 vs. 20.7, - 17.9, P < 0.001), mean QoL reduction of 79.4% (1.1 vs. 5.4, - 4.3, P < 0.001), mean prostatic volume reduction of 38.4% (69.3 cm3 vs. 112.5 cm3, - 43.2 cm3, P < 0.001), mean peak urinary flow (Qmax) increase of 199.4% (19.9 mL/s vs. 6.6 mL/s, + 13.3 mL/s, P = 0.006) and mean PSA reduction of 50.1% (3.0 ng/mL vs. 6.1 ng/mL, - 3.0 ng/mL, P < 0.001). One patient (10%) needed transurethral resection of the prostate (TURP) after PAE due to a ball-valve effect. One microcatheter (10%) needed to be replaced during PAE due to occlusion. Non-target embolization was not observed in the cohort. CONCLUSION This initial experience suggests that PAE using a reflux control microcatheter is effective and safe for the treatment of LUTS attributed to BPH.
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Affiliation(s)
- André Moreira de Assis
- grid.11899.380000 0004 1937 0722Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, 05403-000 Brazil
| | - Willian Yoshinori Kawakami
- grid.11899.380000 0004 1937 0722Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, 05403-000 Brazil
| | - Airton Mota Moreira
- grid.11899.380000 0004 1937 0722Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, 05403-000 Brazil
| | - Francisco Cesar Carnevale
- grid.11899.380000 0004 1937 0722Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, 05403-000 Brazil
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Guillen K, Comby PO, Salsac AV, Falvo N, Lenfant M, Oudot A, Sikner H, Dencausse A, Laveissiere E, Aho-Glele SL, Loffroy R. X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran ®2 Polymerization: A Rabbit-Model Study. Biomedicines 2022; 10:2625. [PMID: 36289887 PMCID: PMC9599502 DOI: 10.3390/biomedicines10102625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 08/30/2023] Open
Abstract
Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a hypervascular tumor. Adding radiopaque Lipiodol Ultra Fluid® (LUF) modulates glue polymerization and allows fluoroscopic guidance, but few comparative in vivo studies have assessed the impact of the resulting change in glue concentration or of other factors such as target-vessel blood flow. In a rabbit model, we used ex vivo X-ray microtomography to assess the results of in vivo renal-artery embolization by various mixtures of N-butyl cyanoacrylate (NBCA), metacryloxysulfolane, and LUF. Overall, penetration to the superficial interlobular arteries was achieved in about two-thirds of cases and into the capillaries in nearly half the cases, while cast fragmentation was seen in slightly more than half the cases. Greater NBCA dilution and the blocked-blood-flow technique were independently associated with greater distality of penetration. Blocked-blood-flow injection was independently associated with absence of fragmentation, capillary penetration, a shorter cast-to-capsule distance, and higher cast attenuation. A larger mixture volume was independently associated with higher indexed cast ratio and deeper penetration. Finally, microtomography is an adapted tool to assess ex vivo distribution of glue cast.
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Affiliation(s)
- Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| | - Pierre-Olivier Comby
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Anne-Virginie Salsac
- Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Université de Technologie de Compiègne, 60203 Compiègne, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| | - Marc Lenfant
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Alexandra Oudot
- Department of Nuclear Medicine, Plateforme d’Imagerie et de Radiothérapie Préclinique, Georges-François Leclerc Center, 1 Rue Professeur Marion, BP 77980, CEDEX, 21079 Dijon, France
| | - Hugo Sikner
- Department of Nuclear Medicine, Plateforme d’Imagerie et de Radiothérapie Préclinique, Georges-François Leclerc Center, 1 Rue Professeur Marion, BP 77980, CEDEX, 21079 Dijon, France
| | - Anne Dencausse
- R&D, Guerbet Research, CEDEX, 95943 Roissy Charles-de-Gaulle, France
| | | | - Serge Ludwig Aho-Glele
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
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Patel RJ, Cosman BC, Owens EL, Malas MB. Migration of vascular embolisation material from the intravascular space to surrounding interstitial tissues in arteriovenous malformations. BMJ Case Rep 2022; 15:e249406. [PMID: 35606037 PMCID: PMC9125736 DOI: 10.1136/bcr-2022-249406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/03/2022] Open
Abstract
We present the case of a young man active duty in the military who initially presented with pelvic pain and fullness during sexual activity. Extensive workup showed a large pelvic arteriovenous malformation (AVM). He underwent over 10 interventional radiology procedures to embolise his AVM and suffered multiple postoperative complications resulting in exploratory laparotomies, bowel resections and ultimately a colostomy. Six years after his embolisation procedures, he was found on imaging to have gluteal fluid collections with metallic particles, presumed to be migrated Onyx from his angioembolisations as a result of non-target embolisation. Current literature does not document other instances of Onyx material migrating from an intravascular source to interstitial tissue.
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Affiliation(s)
- Rohini J Patel
- Vascular Surgery, University of California San Diego Health System, La Jolla, CA, USA
| | - Bard C Cosman
- General Surgery, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Erik L Owens
- Vascular Surgery, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Mahmoud B Malas
- Vascular Surgery, University of California San Diego Health System, La Jolla, CA, USA
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Bucalau AM, Tancredi I, Verset G. In the Era of Systemic Therapy for Hepatocellular Carcinoma Is Transarterial Chemoembolization Still a Card to Play? Cancers (Basel) 2021; 13:5129. [PMID: 34680278 PMCID: PMC8533902 DOI: 10.3390/cancers13205129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023] Open
Abstract
Conventional transarterial embolization (cTACE) has been proven to be effective for intermediate stage hepatocellular carcinoma (HCC), with a recent systematic review showing an overall survival (OS) of 19.4 months. Nevertheless, due to the rapid development of the systemic therapeutic landscape, the place of TACE is becoming questionable. Is there still a niche for TACE in the era of immunotherapy and combination treatments such as atezolizumab-bevacizumab, which has shown an OS of 19.2 months with excellent tolerance? The development of drug-eluting microspheres (DEMs) has led to the standardization of the technique, and along with adequate selection, it showed an OS of 48 months in a retrospective study. In order to increase treatment selectivity, new catheters have also been added to the TACE arsenal as well as the use of cone-beam CT (CBCT), which provides three-dimensional volumetric images and guidance during procedures. Moreover, the TACE indications have also widened. It may serve as a "bridging therapy" for liver transplantation candidates while they are on the waiting list, and it represents a valuable downstaging tool to transplantation criteria. The aim of this review is to explore the current data on the advancements of TACE and its future place amongst the growing panel of treatments.
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Affiliation(s)
- Ana-Maria Bucalau
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
| | - Illario Tancredi
- Department of Interventional Radiology, Hôpital Erasme, 1070 Brussels, Belgium;
| | - Gontran Verset
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium;
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