Embolization of the gastroduodenal artery before selective internal radiotherapy: a prospectively randomized trial comparing standard pushable coils with fibered interlock detachable coils.
The purpose of this study was compare embolization of the gastroduodenal artery (GDA) using standard pushable coils with the Interlock detachable coil (IDC), a novel fibered mechanically detachable long microcoil, in patients scheduled for selective internal radiotherapy (SIRT). Fifty patients (31 male and 19 female; median age 66.6 ± 8.1 years) were prospectively randomized for embolization using either standard coils or IDCs. Procedure time, radiation dose, number of embolization devices, complications, and durability of vessel occlusion at follow-up angiography were recorded. The procedures differed significantly in time (14:32 ± 5:56 min for standard coils vs. 2:13 ± 1:04 min for IDCs; p < 0.001); radiation dose for coil deployment (2479 ± 1237 cGycm² for standard coils vs. 275 ± 268 cGycm² for IDCs; p < 0.001); and vessel occlusion (17:18 ± 6:39 min for standard coils vs. 11:19 ± 7:54 min for IDCs; p = 0.002). A mean of 6.2 ± 1.8 coils (n = 27) were used in the standard coil group, and 1.3 ± 0.9 coils (p < 0.0001) were used in the IDC group (n = 23) because additional pushable coils were required to achieve GDA occlusion in 4 patients. In 2 patients, the IDC could not be deployed through a Soft-VU catheter. One standard coil dislodged in the hepatic artery and was retrieved. Vessel reperfusion was noted in only 1 patient in the standard coil group. Controlled embolization of the GDA with fibered IDCs was achieved more rapidly than with pushable coils. However, vessel occlusion may not be obtained using a single device only, and the use of sharply angled guiding catheters hampered coil pushability.
Dudeck
Oliver
O
Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany. oliver.dudeck@med.ovgu.de
Bulla
Karsten
K
Wieners
Gero
G
Ruehl
Ricarda
R
Ulrich
Gerd
G
Amthauer
Holger
H
Ricke
Jens
J
Pech
Maciej
M
D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000008:administration & dosage / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D013270:Stomach / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol