Abstract

Transarterial embolization (TAE) is a standard-of-care treatment for tumors in which embolic particles are locally injected via a catheter to occlude blood flow and induce ischemia in the target tissue. Physicians currently rely on subjective visual cues from fluoroscopy in order to determine the procedural endpoint relative to the injection site. This contributes to highly variable treatment outcomes, including the accumulation of embolic particles in healthy tissue, called off-target embolization. To address this concern, we describe a novel, multilumen catheter that 1) measures real-time pressure upstream of the tumor site during TAE injection; and 2) associates that measurement with the volume of embolic particles injected. Using an in vitro silicon vascular model, we characterize the relationship between blood flow, intravascular pressure, and injection pressure. Furthermore, we identify a predictive pressure curve based on the volume of embolic particles injected. This approach has the potential to standardize and optimize TAE, reducing the likelihood of incomplete or off-target embolization, and improving patient outcomes.

References

1.
Bruix
,
J.
, and
Sherman
,
M.
,
2011
, “
Management of Hepatocellular Carcinoma: An Update
,”
Hepatology
,
53
(
3
), pp.
1020
1022
.10.1002/hep.24199
2.
American Cancer Society,
2020
, “
Key Statistics About Liver Cancer
,” American Cancer Society, Atlanta, GA, accessed Oct. 20, 2020, https://www.cancer.org/cancer/liver-cancer/about/what-is-key-statistics.html
3.
Allen
,
M. P.
,
2018
, “
Device and Methods for Transvascular Tumor Embolization With Integrated Flow Regulation
,” US Patent No.
US10130762B2
.https://patents.google.com/patent/US10130762B2
4.
Tsochatzis
,
E. A.
,
Germani
,
G.
, and
Burroughs
,
A. K.
,
2010
, “
Transarterial Chemoembolization, Transarterial Chemotherapy, and Intra-Arterial Chemotherapy for Hepatocellular Carcinoma Treatment
,”
Semin. Oncol.
,
37
(
2
), pp.
89
93
.10.1053/j.seminoncol.2010.03.007
5.
Ahmed
,
M.
,
2014
, “
Image-Guided Tumor Ablation: Standardization of Terminology and Reporting Criteria—a 10-Year Update: Supplement to the Consensus Document
,”
J. Vasc. Interventional Radiology
,
25
(
11
), pp.
1706
1708
.10.1016/j.jvir.2014.09.005
6.
Lewandowski
,
R. J.
,
Sato
,
K. T.
,
Atassi
,
B.
,
Ryu
,
R. K.
,
Nemcek
,
A. A.
,
Kulik
,
L.
,
Geschwind
,
J.
,
Murthy
,
R.
,
Rilling
,
W.
,
Liu
,
D.
,
Bester
,
L.
,
Bilbao
,
J. I.
,
Kennedy
,
A. S.
,
Omary
,
R. A.
, and
Salem
,
R.
,
2007
, “
Radioembolization With 90Y Microspheres: Angiographic and Technical Considerations
,”
Cardiovasc. Interventional Radiology
,
30
(
4
), pp.
571
592
.10.1007/s00270-007-9064-z
7.
Poggi
,
G.
,
Emma
,
P.
,
Riccardi
,
A.
,
Tonini
,
S.
,
Montagna
,
B.
,
Quaretti
,
P.
,
Tagliaferri
,
B.
,
Sottotetti
,
F.
,
Baiardi
,
P.
,
Pagella
,
C.
,
Minoia
,
C.
, and
Bernardo
,
G.
,
2010
, “
Complications of Image-Guided Transcatheter Hepatic Chemoembolization of Primary and Secondary Tumours of the Liver
,”
Anticancer Res.
,
30
(
12
), pp.
5159
5164
.http://ar.iiarjournals.org/content/30/12/5159
8.
Sakamoto
,
I.
,
Aso
,
N.
,
Nagaoki
,
K.
,
Matsuoka
,
Y.
,
Uetani
,
M.
,
Ashizawa
,
K.
,
Iwanaga
,
S.
,
Mori
,
M.
,
Morikawa
,
M.
,
Fukuda
,
T.
,
Hayashi
,
K.
, and
Matsunaga
,
N.
,
1998
, “
Complications Associated With Transcatheter Arterial Embolization for Hepatic Tumors
,”
Radiographics
,
18
(
3
), pp.
605
619
.10.1148/radiographics.18.3.9599386
9.
Rose
,
S. C.
,
Halstead
,
G. D.
, and
Narsinh
,
K. H.
,
2017
, “
Pressure-Directed Embolization of Hepatic Arteries in a Porcine Model Using a Temporary Occlusion Balloon Microcatheter: Proof of Concept
,”
Cardiovasc. Interventional Radiology
,
40
(
11
), pp.
1769
1776
.10.1007/s00270-017-1753-7
10.
Rose
,
S. C.
,
Kikolski
,
S. G.
,
Morshedi
,
M. M.
, and
Narsinh
,
K. H.
,
2015
, “
Feasibility of Intraprocedural Transluminal Hepatic and Femoral Artery Blood Pressure Measurements as an Alternative Embolization Safety Endpoint When Antireflux Devices Are Used During Lobar Chemoembolization
,”
Am. J. Roentgenology
,
205
(
1
), pp.
196
202
.10.2214/AJR.14.13683
11.
Borowski
,
A. M.
,
Frangos
,
A.
,
Mccann
,
J. W.
, and
Brown
,
D. B.
,
2013
, “
Pressure Wire Assessment of Hemodynamic Alterations After Chemoembolization of Hepatocellular Carcinoma
,”
Academic Radiology
,
20
(
8
), pp.
1037
1040
.10.1016/j.acra.2013.02.005
12.
Cortinovis
,
A.
,
Crippa
,
A.
,
Cavalli
,
R.
,
Corti
,
M.
, and
Cattaneo
,
L.
,
2006
, “
Capillary Blood Viscosity in Microcirculation
,”
Clinical Hemorheology Microcirc.
,
35
(
1–2
), pp.
183
192
.https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch921
13.
Šutalo
,
I. D.
,
Lawrence-Brown
,
M. M.
,
Liffman
,
K.
, and
Semmens
,
J. B.
,
2016
, “
Vascular Arterial Haemodynamics
,”
Oxford Textbook of Vascular Surgery
, Oxford University Press, Oxford, UK, pp.
128
133
.
You do not currently have access to this content.