Division of Interventional Radiology, H-3646, Stanford University Medical Center, Stanford, CA 94305-5642, USA.
J Vasc Interv Radiol. 2011 Oct;22(10):1355-62. doi: 10.1016/j.jvir.2011.06.007.
To perform embolization of parasitized extrahepatic arteries (EHAs) before radioembolization to reestablish intrahepatic arterial supply to large, peripheral tumors, and to evaluate the technical and clinical outcomes of this intervention.
Among 201 patients retrospectively analyzed, embolization of 73 parasitized EHAs in 35 patients was performed. Most embolization procedures were performed during preparatory angiography using large particles and coils. Digital subtraction angiography (DSA), C-arm computed tomography (CT), and technetium-99m macroaggregated albumin ((99m)TcMAA) scintigraphy were used to evaluate the immediate perfusion via intrahepatic collateral channels of target tumor areas previously supplied by parasitized EHAs. Follow-up imaging of differential regional tumor response was used to evaluate microsphere distribution and clinical outcome.
After embolization, reestablishment of intrahepatic arterial supply was confirmed by both DSA and C-arm CT in 94% of territories and by scintigraphy in 96%. In 32% of patients, the differential response of treatment could not be evaluated because of uniform disease progression. However, symmetric regional tumor response in 94% of evaluable patients indicated successful delivery of microspheres to the territories previously supplied by parasitized EHAs.
Reestablishment of intrahepatic arterial inflow to hepatic tumors by embolization of parasitized EHAs is safe and effective and results in successful delivery of yttrium-90 microspheres to tumors previously perfused by parasitized EHAs.
在放射性栓塞前对寄生的肝外动脉（EHAs）进行栓塞，以重新建立对大的、外周肿瘤的肝内动脉供应，并评估该干预的技术和临床结果。
在对 201 例患者进行的回顾性分析中，对 35 例患者的 73 条寄生 EHA 进行了栓塞。大多数栓塞程序都是在使用大颗粒和线圈进行预备性血管造影期间进行的。数字减影血管造影（DSA）、C 臂 CT（C-arm CT）和锝-99m 聚合白蛋白（（99m）TcMAA）闪烁扫描用于评估先前由寄生 EHA 供应的靶肿瘤区域的肝内侧支通道的即时灌注。差异区域肿瘤反应的随访成像用于评估微球的分布和临床结果。
栓塞后，DSA 和 C 臂 CT 均证实 94%的区域和闪烁扫描均证实 96%的区域重新建立了肝内动脉供应。在 32%的患者中，由于疾病的均匀进展，无法评估治疗的差异反应。然而，在可评估的患者中，94%的区域肿瘤反应呈对称，表明微球成功地输送到了先前由寄生 EHA 供应的区域。
通过栓塞寄生的 EHA 重新建立肝内动脉流入肝肿瘤是安全有效的，可导致成功地将钇-90 微球输送到先前由寄生的 EHA 灌注的肿瘤中。
