title: Incidence and risk factors of early arterial blood flow stasis during first radioembolization of primary and secondary liver malignancy using resin microspheres: an initial single-center analysis.
abstract: OBJECTIVE
  To retrospectively determine incidence of early arterial blood flow stasis and its influencing factors during resin-based radioembolization (RE) of liver tumours.
  
  
  METHODS
  Data of patients undergoing resin-based RE from 06/2006-12/2013 were reviewed. Second RE procedures of the same liver lobe were excluded. 90-yttrium dose was calculated according to the body surface area method. Data were categorized according to RE without full dose application because of early stasis and with full dose application. Clinical/procedural characteristics were recorded. Logistic regression was performed to identify associations between clinical/procedural characteristics and early stasis.
  
  
  RESULTS
  362 patients [220 male; mean age 62 years (range 26-90)] underwent 416 RE sessions with early stasis occurring in 103 REs (24.8 %). Highest incidence and degree of stasis were observed in breast cancer metastases [42.6 % (20/47); 55.8 % of mean intended dose administered]. Independent risk factors were: metastasized breast cancer (odds ratio [OR] 2.18, p = 0.02), liver tumour-burden <25 % and 25-50 % (ORs 5.33, 15.64; p < 0.0001), tumour hypovascularity (OR 2.70, p = 0.04), previous bevacizumab therapy (OR 2.79, p = 0.0009) and concurrent chemotherapy (OR 8.69, p < 0.0001).
  
  
  CONCLUSIONS
  Early stasis was observed in 24.8 % of resin-based REs. In the presence of the identified risk factors, extra care should be taken during microsphere administration.
  
  
  CONCLUSIONS
  • Early arterial blood flow stasis is a known problem of resin-based RE. • The study showed that early stasis occurs in 25 % of REs. • Several clinical and procedural factors are associated with early stasis. • In patients at risk extra care should be taken during RE.
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. claus.christian.pieper@ukb.uni-bonn.de.
authors.forename: Claus Christian
authors.initials: CC
authors.lastname: Pieper
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Winfried A
authors.initials: WA
authors.lastname: Willinek
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Hojjat
authors.initials: H
authors.lastname: Ahmadzadehfar
authors.affiliation: Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Essler
authors.affiliation: Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nadal
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Kai E
authors.initials: KE
authors.lastname: Wilhelm
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Hans Heinz
authors.initials: HH
authors.lastname: Schild
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D004617:Embolism / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes
keywords: Brachytherapy; Embolization; Liver; Metastases; Radiotherapy