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CardioVascular and Interventional Radiology

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Open Access 01-10-2011 | Technical Note

Technical Solutions to Ensure Safe Yttrium-90 Radioembolization in Patients With Initial Extrahepatic Deposition of ^99mTechnetium–Albumin Macroaggregates

Authors: M. W. Barentsz, M. A. D. Vente, M. G. E. H. Lam, M. L. J. Smits, J. F. W. Nijsen, B. A. Seinstra, C. E. N. M. Rosenbaum, H. M. Verkooijen, B. A. Zonnenberg, M. A. A. J. Van den Bosch

Published in: CardioVascular and Interventional Radiology | Issue 5/2011

Abstract

Purpose

To evaluate the incidence of extrahepatic deposition of technetium-99m–labeled albumin macroaggregates (^99mTc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton (⁹⁰Y-RE), and to report on technical solutions that can be used to ensure safe delivery of ⁹⁰Y-microspheres in patients with initial extrahepatic deposition.

Materials and Methods

A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with ⁹⁰Y-RE in our institution in 2009, was performed. The angiograms and single-photon emission computed tomography images of all patients were reviewed by an interventional radiologist and a nuclear medicine physician, respectively, to identify and localize extrahepatic deposition of ^99mTc-MAA when present. Subsequently, the technical solutions were used to successfully perform ⁹⁰Y-RE in these patients were evaluated and described.

Results

Extrahepatic deposition of ^99mTc-MAA was observed in 8 of 26 patients (31%). In 7 of 8 patients, a second pretreatment angiography was performed to detect the cause of extrahepatic deposition. The technical solutions to enable safe ⁹⁰Y microspheres delivery included more distal placement of the microcatheter in the proper/right hepatic artery in 4 of 7 (57%) patients; (super)selective catheterization of multiple segmental branches in 2 of 7 (29%); and additional coiling of a newly detected branch in the remaining patient (14%). This was confirmed by a second MAA procedure. ⁹⁰Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (<30 days) were observed.

Conclusion

Extrahepatic deposition of ^99mTc-MAA after pretreatment angiography did occur in 8 of 26 (31%) patients. The technical solutions as presented allowed safe ⁹⁰Y-RE delivery in 25 of 26 (96%) patients.

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Title: Technical Solutions to Ensure Safe Yttrium-90 Radioembolization in Patients With Initial Extrahepatic Deposition of 99mTechnetium–Albumin Macroaggregates
Authors: M. W. Barentsz
M. A. D. Vente
M. G. E. H. Lam
M. L. J. Smits
J. F. W. Nijsen
B. A. Seinstra
C. E. N. M. Rosenbaum
H. M. Verkooijen
B. A. Zonnenberg
M. A. A. J. Van den Bosch
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 5/2011
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-010-0088-4

At a glance: The STEP trials

Springer Medicine

Technical Solutions to Ensure Safe Yttrium-90 Radioembolization in Patients With Initial Extrahepatic Deposition of ^99mTechnetium–Albumin Macroaggregates

Abstract

Purpose

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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