Temporary Flow Diversion in Oncological Embolization Procedures Using Degradable Starch Microspheres
Francesco Giurazza1, Pierleone Lucatelli2, Fabio Corvino1
1Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy.
Objectives:
This study aims to report on the application of degradable starch microspheres to provide flow diversion by means of temporary embolization of healthy tissues in oncological endovascular procedures when tumor feeding vessels are not selectively accessible.
Methods:
This is a multicenter retrospective analysis of patients undergoing visceral embolization procedures of malignancies. The inclusion criteria were as follows: flow diversion performed by injection of degradable starch microspheres, visceral embolization procedures with unfeasible superselective catheterism of the target, and a malignant pathology. Technical success was defined as complete flow diversion with temporary exclusion of the non-target district from arterial flow, associated with successful embolization of the target. Clinical success was intended as procedural achievement with patient clinical improvement.
Results:
Sixteen patients were included in this analysis. Peripheral embolization procedures were performed in the coeliac visceral district all in oncologic patients, including 4 transarterial radioembolization work-up procedures in patients with hepatocarcinoma, 10 chemioembolization procedures in patients with hepatocarcinoma (8) or cholangiocarcinoma (2), and 2 palliative transarterial embolizations in patients with gastric cancer. Technical success was obtained in 100% of the cases, while clinical success was reached in 87.5%: in two chemioembolization procedures, despite technical success, the procedural clinical benefits were partial, with an incomplete target lesion response. Minor complications occurred in five patients (31.2%).
Conclusions:
In this study, temporary flow diversion with degradable starch microspheres during oncological embolization procedures was safe and effective; this approach is suitable to protect healthy surrounding tissues when vessels feeding the target cannot be selected with the microcatheter.
Insights
Degradable starch microspheres safely and effectively divert blood flow in oncologic embolization when selective vessel access is impossible. This method protects healthy tissues during cancer treatment, achieving high clinical success rates.
Area of Science:
- Interventional Radiology
- Oncology
- Vascular Surgery
Background:
- Selective catheterization of tumor-feeding vessels is crucial in oncologic embolization.
- Challenges arise when superselective catheterism is unfeasible, risking damage to healthy tissues.
- Temporary flow diversion offers a potential solution to protect non-target organs.
Purpose of the Study:
- To evaluate the safety and efficacy of degradable starch microspheres for temporary flow diversion in oncologic embolization.
- To assess the utility of this technique when selective tumor vessel access is not possible.
- To determine the technical and clinical success rates and complication profile.
Main Methods:
- Multicenter retrospective analysis of 16 patients undergoing visceral embolization for malignancies.
- Inclusion criteria: flow diversion with degradable starch microspheres, unfeasible superselective catheterism, and malignant pathology.
- Technical success: complete flow diversion and successful target embolization. Clinical success: procedural achievement and patient improvement.
Main Results:
- 100% technical success in achieving flow diversion.
- 87.5% clinical success rate, with two cases showing partial response.
- Minor complications occurred in 31.2% of patients.
Conclusions:
- Degradable starch microspheres are a safe and effective tool for temporary flow diversion in oncologic embolization.
- This technique is valuable for protecting healthy tissues when target vessels are not selectively accessible.
- The method facilitates embolization in complex oncological cases.
