title: Innovation in catheter design for intra-arterial liver cancer treatments results in favorable particle-fluid dynamics.
abstract: BACKGROUND
  Liver tumors are increasingly treated with radioembolization. Here, we present first evidence of catheter design effect on particle-fluid dynamics and downstream branch targeting during microsphere administrations.
  
  
  METHODS
  A total of 7 experiments were performed in a bench-top model of the hepatic arterial vasculature with recreated hemodynamics. Fluorescent microspheres and clinically used holmium microspheres were administered with a standard microcatheter (SMC) and an anti-reflux catheter (ARC) positioned at the same level along the longitudinal vessel axis. Catheter-related particle flow dynamics were analyzed by reviewing video recordings of UV-light illuminated fluorescent microsphere administrations. Downstream branch distribution was analyzed by quantification of collected microspheres in separate filters for two first-order branches. Mean deviation from a perfectly homogenous distribution (DHD) was used to compare the distribution homogeneity between catheter types.
  
  
  RESULTS
  The SMC administrations demonstrated a random off-centered catheter position (in 71 % of experiments), and a laminar particle flow pattern with an inhomogeneous downstream branch distribution, dependent on catheter position and injection force. The ARC administrations demonstrated a fixed centro-luminal catheter position, and a turbulent particle flow pattern with a more consistent and homogenous downstream branch distribution. Quantitative analyses confirmed a significantly more homogeneous distribution with the ARC; the mean DHD was 40.85 % (IQR 22.76 %) for the SMC and 15.54 % (IQR 6.46 %) for the ARC (p = 0.047).
  
  
  CONCLUSIONS
  Catheter type has a significant impact on microsphere administrations in an in-vitro hepatic arterial model. A within-patient randomized controlled trial has been initiated to investigate clinical catheter-related effects during radioembolization treatment.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. a.f.vandenhoven@umcutrecht.nl.
authors.forename: Andor F
authors.initials: AF
authors.lastname: van den Hoven
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. m.lam@umcutrecht.nl.
authors.forename: Marnix G E H
authors.initials: MG
authors.lastname: Lam
authors.affiliation: Department of Mechanical and Aerospace Engineering, North Carolina State University, 911 Oval Drive, Raleigh, North Carolina, 27695, USA. srjernig@ncsu.edu.
authors.forename: Shaphan
authors.initials: S
authors.lastname: Jernigan
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. mbosch@umcutrecht.nl.
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
authors.affiliation: Department of Mechanical and Aerospace Engineering, North Carolina State University, 911 Oval Drive, Raleigh, North Carolina, 27695, USA. gbuckner@ncsu.edu.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Buckner
mesh_terms: D057785:Catheters; D004621:Embolization, Therapeutic; D006801:Humans; D057446:Hydrodynamics; D008113:Liver Neoplasms / Q000188:drug therapy*