Temporary distal balloon occlusion for hepatic embolization: a novel technique to treat what cannot be selected.

Purpose: Particle embolotherapy for liver cancers, such as chemoembolization and yttrium-90 radioembolization, depends on microcatheter selection of the treatment vessel for injection of the embolic. Individually selecting vessels with a microcatheter can be time-consuming and difficult, especially when multiple branches are present in the treatment zone. This article describes a technique to perform an "inverse" embolization-protection of the selected vessel and embolization of the unselected vessels-a technique that has not yet been described.

Materials And Methods: Two cases of hepatic chemoembolization that would require subselection of multiple branch vessels using conventional technique are reported. In both cases the proper hepatic artery was selected with a soft, nondissecting neurovascular guide catheter. The nontarget hepatic vessel was selected with a neurovascular microcatheter occlusion balloon, and the balloon was inflated to protect that vessel. Embolization to multiple target vessels was then achieved by way of a single injection through the guide catheter.

Results: Both procedures were technically successful without complication. Postembolization angiography confirmed normal parenchymal enhancement in the protected zone and expected paucity of enhancement in the treated zone.

Conclusion: Temporary distal balloon occlusion is a useful technique to treat multiple artery branches with a single injection in cases where individual selection of the branches is difficult or time-consuming. Further study of this technique is warranted.