Agid Ronit, Rubinstein Rina, Siegal Tali, Lester Hava, Bokstein Felix, Chisin Roland, Gomori John M
Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1732-5.
The development of new non-ocular-toxic drugs has enabled infraophthalmic chemotherapeutic infusion. We assessed whether streaming occurs with infraophthalmic, high cervical internal carotid artery (ICA) delivery of chemotherapeutic agents by means of conventional angiographic catheters.
Six patients with high-grade gliomas treated with monthly carotid intraarterial chemotherapy were studied. Chemotherapy delivery and distribution was modeled by technetium 99m hexylmethyl-propyleneamine oxine (HMPAO), a first-pass agent. Each patient received 0.5 mCi (18.5 MBq) of (99m)Tc-HMPAO in 50-mL of saline intraarterially in the ICA at the C1-C2 level. Injections were given twice, at two different injection rates: 0.08 mL/s at one therapeutic session and 6 mL/s a month later. The slow injection rate modeled the slowest rate used in the delivery of chemotherapy into the ICA. The higher rate was selected to avoid any possibility of uneven mixing, by replacing intracarotid blood completely and by using a turbulent injection rate that destroys laminar flow and intraarterial streaming. Single photon emission CT (SPECT) was performed 2 hours after injection. For each patient, the corresponding SPECT sections at the two injection rates were compared.
No differences were noted in (99m)Tc-HMPAO distribution between the two injection rates in any of the patients. However, some of the rapid injection rate SPECT scans showed extension of the (99m)Tc-HMPAO uptake into adjacent watershed territories.
There was no evidence, in humans, of substantial streaming during slow infraophthalmic intracarotid injections. Slow rates of infusion are as good as high rates for infraophthalmic intracarotid drug delivery. This is of special importance for drugs that are not tolerated at high injection rates. Moreover, infraophthalmic intracarotid chemotherapeutic infusion does not require special injectors or catheters.
新型无眼毒性药物的研发使得眶下化疗药物输注成为可能。我们评估了通过传统血管造影导管在眶下、高位颈内动脉（ICA）输送化疗药物时是否会发生血流分层。
对6例接受每月颈动脉内化疗的高级别胶质瘤患者进行研究。化疗药物的输送和分布通过锝99m己基甲基丙二胺肟（HMPAO）进行模拟，HMPAO是一种首过剂。每位患者在C1 - C2水平的颈内动脉内以50 mL生理盐水静脉注射0.5 mCi（18.5 MBq）的（99m）Tc - HMPAO。注射进行两次，采用两种不同的注射速率：一次治疗时为0.08 mL/s，一个月后为6 mL/s。慢注射速率模拟了向颈内动脉输送化疗药物时使用的最慢速率。选择较高的速率是为了避免任何不均匀混合的可能性，通过完全替代颈内动脉内的血液，并使用破坏层流和动脉内血流分层的湍流注射速率。注射后2小时进行单光子发射计算机断层扫描（SPECT）。对每位患者，比较两种注射速率下相应的SPECT断层图像。
在任何患者中，两种注射速率下的（99m）Tc - HMPAO分布均未观察到差异。然而，一些快速注射速率的SPECT扫描显示（99m）Tc - HMPAO摄取延伸至相邻的分水岭区域。
在人类中，没有证据表明在眶下颈内动脉缓慢注射期间存在大量血流分层。对于眶下颈内动脉药物输送，缓慢输注速率与快速输注速率一样好。这对于不能耐受高注射速率的药物尤为重要。此外，眶下颈内动脉化疗输注不需要特殊的注射器或导管。
