title: A Novel External Carotid Arterial Sheath System for Intra-arterial Infusion Chemotherapy of Head and Neck Cancer.
abstract: OBJECTIVE
  The purpose of this study was to describe a novel system for treating advanced head and neck cancer consisting of an external carotid arterial sheath (ECAS) and a microcatheter to inject drugs retrogradely into multiple feeding arteries through the superficial temporal artery (STA).
  
  
  METHODS
  Four consecutive patients with head and neck cancer that had more than one feeding artery were enrolled in this study. The ECAS was made of polyurethane and surface-coated with heparin resin to prevent thrombus formation, allowing it to remain in place for a prolonged period of time. The ECAS was inserted through the STA, and its tip was placed between the maxillary artery and facial artery. The tumor-feeding arteries were selected using a hooked-shaped microcatheter through the ECAS.
  
  
  RESULTS
  A total of 13 target arteries were selected in the four patients. The microcatheter inserted via the ECAS was used to catheterize ten arteries (five lingual arteries and five facial arteries). The remaining three lingual arteries were directly selected by the catheter without ECAS. All of the target arteries were able to be catheterized superselectively. The technical success rate was 100%. Vascular occlusion, which might have been caused by the ECAS, was observed in one patient. No neurologic toxicities occurred.
  
  
  CONCLUSIONS
  This ECAS system is a new approach for retrograde superselective intra-arterial chemotherapy that covers the entire tumor with anticancer drugs. It has the potential to increase the effectiveness of therapy for advanced head and neck cancer.
  
  
  METHODS
  Level 4, Case Series.
authors.affiliation: Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan. ii-n@clin.medic.mie-u.ac.jp.
authors.forename: Noriko
authors.identifier: http://orcid.org/0000-0003-1526-3738
authors.initials: N
authors.lastname: Ii
authors.affiliation: Department of Radiation Oncology, Ise Red Cross Hospital, 471-2 Funae 1 choume, Ise-shi, Mie, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
authors.affiliation: Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Toyomasu
authors.affiliation: Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Takada
authors.affiliation: Department of Radiation Oncology, Ise Red Cross Hospital, 471-2 Funae 1 choume, Ise-shi, Mie, Japan.
authors.forename: Miwako
authors.initials: M
authors.lastname: Nomura
authors.affiliation: Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sakuma
authors.affiliation: Department of Radiation Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Nomoto
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002342:Carotid Artery, External; D002408:Catheters, Indwelling; D002945:Cisplatin / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D005260:Female; D006493:Heparin; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000295:instrumentation*; D008875:Middle Aged; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000098:blood supply* / Q000188:drug therapy* / Q000473:pathology; D011140:Polyurethanes; D013699:Temporal Arteries
chemical_list: D020099:Coated Materials, Biocompatible; D011140:Polyurethanes; D006493:Heparin; D002945:Cisplatin
keywords: Head and neck cancer; Intra-arterial chemotherapy; New technology/instruments