title: Yttrium-90 Radioembolization with Resin Microspheres without Routine Embolization of the Gastroduodenal Artery.
abstract: OBJECTIVE
  To evaluate safety of resin microsphere radioembolization (RE) without prophylactic embolization of the gastroduodenal artery (GDA).
  
  
  METHODS
  Between July 2013 and April 2015, all patients undergoing RE with resin microspheres for liver-dominant metastatic disease were treated without routine embolization of the GDA. Selective embolization of distal hepaticoenteric vessels was performed if identified by digital subtraction angiography, cone-beam computed tomography, or technetium-99m macroaggregated albumin scintigraphy. Resin microspheres were administered using 5% dextrose flush distal to the origin of the GDA in lobar or segmental fashion, with judicious use of an antireflux microcatheter in recognized high-risk situations. Gastrointestinal toxicity was evaluated by the performing physician for at least 3 months.
  
  
  RESULTS
  RE with resin microspheres was performed in 62 patients undergoing 69 treatments. During planning angiography, embolization of 0 or 1 vessel (median, 1; range, 0-4) was performed in 86% of patients, most commonly the right gastric and supraduodenal arteries. Prophylactic embolization of the GDA was performed in only 2 patients (3%). In 6 treatments (9%), adjunctive embolization was required immediately before RE, and an antireflux microcatheter was used in 14% of treatments. Clinical follow-up was available in 60 of 62 patients (median, 134 d; range, 15-582 d). No signs or symptoms of gastric or duodenal ulceration were observed.
  
  
  CONCLUSIONS
  RE using resin microspheres without embolization of the GDA can be performed safely.
authors.affiliation: Division of Interventional Radiology, H-3646 Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642. Electronic address: Thomasjward@gmail.com.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ward
authors.affiliation: Division of Interventional Radiology, H-3646 Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642.
authors.forename: John D
authors.initials: JD
authors.lastname: Louie
authors.affiliation: Division of Interventional Radiology, H-3646 Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D054893:Cone-Beam Computed Tomography; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012117:Resins, Synthetic; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000098:blood supply*; D013668:Technetium Tc 99m Aggregated Albumin / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D012117:Resins, Synthetic; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes