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

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 Y microspheres.

Materials And Methods: In this retrospective single-center study of patients who received Y 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 Y RE using balloon occlusion with glass ( = 22) or resin ( = 50) microspheres. Over 80% administration of the prescribed Y dose was accomplished in 34 (67%) resin and 20 (95%) glass microsphere patients. Post-treatment Y 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 Y RE delivery.