Top

CardioVascular and Interventional Radiology

Published in:

01-08-2016 | Technical Note

First Human Experience with Directly Image-able Iodinated Embolization Microbeads

Authors: Elliot B. Levy, Venkatesh P. Krishnasamy, Andrew L. Lewis, Sean Willis, Chelsea Macfarlane, Victoria Anderson, Imramsjah MJ van der Bom, Alessandro Radaelli, Matthew R. Dreher, Karun V. Sharma, Ayele Negussie, Andrew S. Mikhail, Jean-Francois H. Geschwind, Bradford J. Wood

Published in: CardioVascular and Interventional Radiology | Issue 8/2016

Abstract

Purpose

To describe first clinical experience with a directly image-able, inherently radio-opaque microspherical embolic agent for transarterial embolization of liver tumors.

Methodology

LC Bead LUMI™ is a new product based upon sulfonate-modified polyvinyl alcohol hydrogel microbeads with covalently bound iodine (~260 mg I/ml). 70–150 μ LC Bead LUMI™ iodinated microbeads were injected selectively via a 2.8 Fr microcatheter to near complete flow stasis into hepatic arteries in three patients with hepatocellular carcinoma, carcinoid, or neuroendocrine tumor. A custom imaging platform tuned for LC LUMI™ microbead conspicuity using a cone beam CT (CBCT)/angiographic C-arm system (Allura Clarity FD20, Philips) was used along with CBCT embolization treatment planning software (EmboGuide, Philips).

Results

LC Bead LUMI™ image-able microbeads were easily delivered and monitored during the procedure using fluoroscopy, single-shot radiography (SSD), digital subtraction angiography (DSA), dual-phase enhanced and unenhanced CBCT, and unenhanced conventional CT obtained 48 h after the procedure. Intra-procedural imaging demonstrated tumor at risk for potential under-treatment, defined as paucity of image-able microbeads within a portion of the tumor which was confirmed at 48 h CT imaging. Fusion of pre- and post-embolization CBCT identified vessels without beads that corresponded to enhancing tumor tissue in the same location on follow-up imaging (48 h post).

Conclusion

LC Bead LUMI™ image-able microbeads provide real-time feedback and geographic localization of treatment in real time during treatment. The distribution and density of image-able beads within a tumor need further evaluation as an additional endpoint for embolization.

Dreher M, Sharma K, Orandi B, Donahue D, Tang Y, Lewis A, Karanian J, Chiesa O, Pritchard W, Wood B. Distribution of image-able beads and doxorubicin following transcatheter arterial chemoembolization. Society of Interventional Radiology annual meeting 2009, San Diego.

Sharma KV, Dreher MR, Tang Y, Pritchard W, Chiesa OA, Karanian J, Perogoy J, Orandi B, Woods D, Donahue D, Esparza J, Jones G, Willis SL, Lewis AL, Wood B. Development of “image-able” beads for transcatheter embolotherapy. J Vasc Interv Radiol. 2010;21:865–76.CrossRefPubMedPubMedCentral

Dreher MR, Sharma KV, Woods DL, Reddy G, Tang Y, Pritchard WF, Chiesa OA, Karanian JW, Esparza JA, Donahue D, Levy EB, Willis SL, Lewis AL, Wood BJ. Radiopaque drug-eluting beads for transcatheter embolotherapy: experimental study of drug penetration and coverage in swine. J Vasc Interv Radiol. 2012;23(2):257–64.CrossRefPubMed

Tacher V, Lin M, Bhagat N, Abi Jaoudeh N, Radaelli A, Noordhoek N, Carelsen B, Wood BJ, Geschwind JF. Dual-phase cone-beam computed tomography to see, reach, and treat hepatocellular carcinoma during drug-eluting beads transarterial chemo-embolization. J Vis Exp. 2013;82:50795. doi:10.3791/50795.PubMed

Johnson CG, Tang Y, Beck A, Dreher MR, Woods DL, Negussie AH, Donahue D, Levy EB, Willis SL, Lewis AL, Wood BJ, Sharma KV. Preparation of radiopaque drug-eluting beads for transcatheter chemoembolization. J Vasc Interv Radiol. 2016;27(1):117–26.CrossRefPubMed

Negussie AH, Dreher MR, Johnson CG, Tang Y, Lewis AL, Storm G, Sharma KV, Wood BJ. Synthesis and characterization of image-able polyvinyl alcohol microspheres for image-guided chemoembolization. J Mater Sci Mater Med. 2015;26(6):198. doi:10.1007/s10856-015-5530-3.CrossRefPubMed

Lewis AL, Dreher MR, O’Byrne V, Grey D, Caine M, Dunn A, Tang Y, Hall B, Fowers KD, Johnson CG, Sharma KV, Wood BJ. DC BeadM1™: towards an optimal transcatheter hepatic tumour therapy. J Mater Sci Mater Med. 2016;27(1):13. doi:10.1007/s10856-015-5629-6.CrossRefPubMed

Tacher V, Duran R, Lin M, Sohn JH, Sharma KV, Wang Z, Chapiro J, Gacchina Johnson C, Bhagat N, Dreher MR, Schäfer D, Woods DL, Lewis AL, Tang Y, Grass M, Wood BJ, Geschwind JF. Multimodality imaging of ethiodized oil-loaded radiopaque microspheres during transarterial embolization of rabbits with VX2 liver tumors. Radiology. 2015;2015:141624.

Duran R, Sharma K, Dreher MR, Ashrafi K, Mirpour S, Lin M, Schernthaner RE, Schlachter TR, Tacher V, Lewis AL, Willis S, den Hartog M, Radaelli A, Negussie AH, Wood BJ, Geschwind JF. A novel inherently radiopaque bead for transarterial embolization to treat liver cancer—a pre-clinical study. Theranostics. 2016;6(1):28–39.CrossRefPubMedPubMedCentral

10.

Suk OhJ, Jong Chun H, Gil Choi B, Giu Lee H. Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma: usefulness of contrast saturation features on cone-beam computed tomography imaging for predicting short-term tumor response. J Vasc Interv Radiol. 2013;24(4):483–9.CrossRef

11.

Gaba RC, Baumgarten S, Omene BO, van Breemen RB, Garcia KD, Larson AC, Omary RA. Ethiodized oil uptake does not predict doxorubicin drug delivery after chemoembolization in VX2 liver tumors. J Vasc Interv Radiol. 2012;23(2):265–73.CrossRefPubMed

12.

Golowa YS, Cynamon J, Reinus JF, Kinkhabwala M, Abrams M, Jagust M, Chernyak V, Kaubisch A. Value of noncontrast CT immediately after transarterial chemoembolization of hepatocellular carcinoma with drug-eluting beads. J Vasc Interv Radiol. 2012;23(8):1031–5.CrossRefPubMed

Title: First Human Experience with Directly Image-able Iodinated Embolization Microbeads
Authors: Elliot B. Levy
Venkatesh P. Krishnasamy
Andrew L. Lewis
Sean Willis
Chelsea Macfarlane
Victoria Anderson
Imramsjah MJ van der Bom
Alessandro Radaelli
Matthew R. Dreher
Karun V. Sharma
Ayele Negussie
Andrew S. Mikhail
Jean-Francois H. Geschwind
Bradford J. Wood
Publication date: 01-08-2016
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 8/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-016-1364-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

First Human Experience with Directly Image-able Iodinated Embolization Microbeads

Abstract

Purpose

Methodology

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methodology

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2016

Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations

A Novel Technique Using a Protection Filter During Fibrin Sheath Removal for Implanted Venous Access Device Dysfunction

Postsurgical Biliary Complications: The Increasingly Important Role of Interventional Radiologists

The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA

Prostatic Artery Embolization After Failed Urological Interventions for Benign Prostatic Obstruction: A Case Series of Three Patients

A Letter to Editor