title: Yttrium-90 resin microsphere radioembolization using an antireflux catheter: an alternative to traditional coil embolization for nontarget protection.
abstract: OBJECTIVE
  Serious complications can result from nontarget embolization during yttrium-90 (Y-90) transarterial radioembolization. Hepatoenteric artery coil embolization has been traditionally performed to prevent nontarget radioembolization. The U.S. Food and Drug Administration-approved Surefire Infusion System (SIS) catheter, designed to prevent reflux, is an alternative to coils. The hypothesis that quantifiable SIS procedural parameters are comparable to coil embolization was tested.
  
  
  METHODS
  Fourteen patients aged 36-79 years with colorectal, neuroendocrine, hepatocellular, and other predominantly bilobar hepatic tumors who underwent resin microsphere Y-90 radioembolization using only the SIS catheter (n = 7) versus only detachable coils (n = 7) for nontarget protection were reviewed retrospectively. Procedure time, fluoroscopy time, contrast dose, radiation dose, and cost were evaluated.
  
  
  RESULTS
  Multivariate analysis identified significant cohort differences in the procedural parameters evaluated (F(10, 3) = 10.39, p = 0.04). Between-group comparisons of the pretreatment planning procedure in the SIS catheter group compared to the coil embolization group demonstrated a significant reduction in procedure time (102.6 vs. 192.1 min, respectively, p = 0.0004), fluoroscopy time (14.3 vs. 49.7 min, respectively, p = 0.0016), and contrast material dose (mean dose of 174.3 vs. 265.0 mL, respectively, p = 0.0098). Procedural parameters were not significantly different between the two groups during subsequent dose delivery procedures. Overall cost of combined first-time radioembolization procedures was significantly less in the SIS group ($4252) compared to retrievable coil embolization ($11,123; p = 0.001).
  
  
  CONCLUSIONS
  The SIS catheter results in a reduction in procedure time, fluoroscopy time, and contrast material dose and may be an attractive cost-effective alternative to detachable coil embolization for prevention of nontarget radioembolization.
authors.affiliation: Radiology Department, University of California San Diego Medical Center, University of California San Diego Health Sciences, 200W Arbor Drive, San Diego, CA, 92103-8756, USA, maud.morshedi@my.rfums.org.
authors.forename: Maud M
authors.initials: MM
authors.lastname: Morshedi
authors.forename: Michael
authors.initials: M
authors.lastname: Bauman
authors.forename: Steven C
authors.initials: SC
authors.lastname: Rose
authors.forename: Steven G
authors.initials: SG
authors.lastname: Kikolski
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods*; D057785:Catheters; D015179:Colorectal Neoplasms / Q000532:radiotherapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000532:radiotherapy*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes