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Choi R, Lee M, Choi JW, Kim HC. Safety of Radioembolization via the Cystic Artery in Patients with Hepatocellular Carcinoma and Parasitized Arterial Supply. J Vasc Interv Radiol 2023; 34:1802-1808. [PMID: 37364731 DOI: 10.1016/j.jvir.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of radioembolization through the cystic artery supplying hepatocellular carcinoma (HCC) adjacent to the gallbladder. MATERIALS AND METHODS This retrospective, single-center study included 24 patients who underwent radioembolization via the cystic artery between March 2017 and October 2022. The median tumor size was 8.3 cm (range, 3.4-20.4 cm). Twenty-two (92%) patients had Child-Pugh Class A disease, and 2 (8%) patients had Class B cirrhosis. Technical issues, adverse events, and tumor response were analyzed. RESULTS Infusion of radioactive microspheres was performed from the main cystic artery (n = 6), the deep cystic artery (n = 9), and small feeders from the cystic artery (n = 9). The cystic artery supplied the primary index tumor in 21 patients. The median radiation activity delivered via the cystic artery was 0.19 GBq (range, 0.02-0.43 GBq). The median total radiation activity administered was 4.1 GBq (range, 0.9-10.8 GBq). There was no case of symptomatic cholecystitis requiring invasive intervention. One patient experienced abdominal pain during injection of radioactive microspheres via the cystic artery. Eleven (46%) patients received pain medication during or within 2 days of the procedure. Twelve (50%) patients had gallbladder wall thickening on a 1-month follow-up computed tomography scan. Based on follow-up imaging, 23 (96%) patients showed an objective response (complete or partial response) of the tumor supplied by the cystic artery. CONCLUSION Radioembolization via the cystic artery may be safe in patients with HCC partially supplied by the cystic artery.
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Affiliation(s)
- Rebecca Choi
- Department of Radiology, the Johns Hopkins Hospital, Baltimore, Maryland
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kim HC, Miyayama S, Choi JW, Kim GM, Chung JW. Hepatocellular Carcinoma Supplied by the Inferior Phrenic Artery or Cystic Artery: Anatomic and Technical Considerations. Radiographics 2022; 43:e220076. [DOI: 10.1148/rg.220076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hyo-Cheol Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Shiro Miyayama
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Jin Woo Choi
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Gyoung Min Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
| | - Jin Wook Chung
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea (H.C.K., J.W. Choi, J.W. Chung); Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan (S.M.); and Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (G.M.K.)
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Laidlaw GL, Johnson GE. Recognizing and Managing Adverse Events in Y-90 Radioembolization. Semin Intervent Radiol 2021; 38:453-459. [PMID: 34629713 DOI: 10.1055/s-0041-1735617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transarterial radioembolization using yttrium-90 (Y-90) microspheres is an important therapy in the management of unresectable primary liver tumors or hepatic metastases. While radioembolization is generally well-tolerated, it is not free from adverse events, and familiarity with the prevention and treatment of radioembolization-specific complications is an important component of patient care. This article aims to review radioembolization-specific toxicities stratified by hepatic, extrahepatic, and systemic effects, with a focus on preventing and mitigating radioembolization-induced morbidity.
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Affiliation(s)
- Grace L Laidlaw
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Guy E Johnson
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
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