title: Embolization of parasitized extrahepatic arteries to reestablish intrahepatic arterial supply to tumors before yttrium-90 radioembolization.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Interventional Radiology, H-3646, Stanford University Medical Center, Stanford, CA 94305-5642, USA.
authors.forename: Mohamed H K
authors.initials: MH
authors.lastname: Abdelmaksoud
authors.forename: John D
authors.initials: JD
authors.lastname: Louie
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Hwang
authors.forename: William T
authors.initials: WT
authors.lastname: Kuo
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
authors.forename: David M
authors.initials: DM
authors.lastname: Hovsepian
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002140:California; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes