Kim Alexander Y, Miller Akemi
a Department of Radiology , Medstar Georgetown University Hospital , Washington , DC , USA.
Expert Rev Med Devices. 2016 May;13(5):435-43. doi: 10.1586/17434440.2016.1164594. Epub 2016 Mar 25.
Patients with primary and secondary liver cancers generally have a poor prognosis with limited potentially curative options. Liver-directed, intra-arterial therapies such as selective internal radiotherapy (SIRT) and trans-arterial chemoembolization (TACE) are taking a larger role in the management of these patients. The current standard of therapy is for delivery of SIRT or TACE particles through an end-hole microcatheter. Antireflux microcatheters (ARM) are a novel class of microcatheters designed to enhance intra-arterial therapies. These catheters are designed with a flexible tip at the end of the microcatheter, which partially collapses during systole and expands during diastole, reducing antegrade and retrograde particle reflux while allowing for forward flow. Initially designed to reduce the risk of particle reflux during SIRT, there is evidence that ARMs may lead to improved particle distribution to tumors during SIRT. Furthermore, ARMs improve embolization efficiency which may lead to improved disease response from TACE for patients with hepatocellular carcinoma.
原发性和继发性肝癌患者的预后通常较差,潜在的治愈选择有限。肝脏定向动脉内治疗,如选择性内放射治疗(SIRT)和经动脉化疗栓塞术(TACE),在这些患者的管理中发挥着越来越大的作用。目前的治疗标准是通过端孔微导管输送SIRT或TACE颗粒。抗反流微导管(ARM)是一类新型微导管,旨在增强动脉内治疗效果。这些导管在微导管末端设计有一个柔性尖端,在收缩期部分塌陷,在舒张期扩张,减少顺行和逆行颗粒反流,同时允许向前流动。ARM最初设计用于降低SIRT期间颗粒反流的风险,有证据表明,在SIRT期间,ARM可能会改善颗粒在肿瘤中的分布。此外,ARM提高了栓塞效率,这可能会改善肝细胞癌患者TACE的疾病反应。