3 f coaxial microcatheter

TACE was performed by doctors with more than 10 years of experience in the procedure under local anesthesia. First, both the superior mesenteric artery and common hepatic artery angiography were performed with a nonionic contrast agent through a 5- or 4-F catheter (COOK) to assess the patency of the portal vein, anatomy, and tumor burden. Second, chemoembolization was performed by selective catheterization of the feeding arteries with a 3-F coaxial microcatheter (Terumo, Tokyo, Japan). For cTACE, a mixture of 50 mg epirubicin was manually emulsified with 5–10 mL lipiodol followed by embolization with absorbable gelatin sponge particles until the blood flow of the feeding arteries was stagnated. For DEB-TACE, 30 mg of epirubicin was dissolved in 2 mL saline and loaded into 100–300 µm DEB (Jiangsu Hengrui Medicine Co., Ltd., Jiangsu, China) and then mixed with nonionic contrast medium. After catheterization into the feeding arteries, the suspended DEBs were administered slowly. Finally, angiography was performed to confirm the complete embolism of the feeding arteries. Repeated TACE would be performed once the CT or MRI imaging showed residual lesions.

Hepatic arteriography was performed with 5-F Yashiro catheter (Cook Inc., Indiana, USA) and 3-F coaxial microcatheter (Terumo, Tokyo, Japan) to select the celiac lobar, segmental, or subsegmental arteries as sequentially as possible, which mainly depended on the location of tumor-feeding arteries (Figure 1B).
One group of patients were treated with CalliSpheres drug-eluting beads (Jiangsu Hengrui Medicine Co. Ltd., Jiangsu, China). Firstly, 80 mg epirubicin powders were dissolved to 20 mg/mL, and mixed with a certain size (100–300 μm or 300–500 μm) dehydrated beads for 30 min. Then, appropriate contrast agents were added before and the drug-eluting beads were infused slowly into the proper hepatic arteries at a rate of 1 mL/min. Postoperative angiography showed complete embolization and inconspicuous tumor staining (Figure 1C).
Conventional TACE with lipiodol was applied to the other group of patients. Initially, the emulsion of 5–20 mL lipiodol and 10–30 mg epirubicin hydrochloride was administered into the feeding arteries, and then followed by vascular stagnation achieved with embolization in absorbable gelatin sponge particles (300–500 μm or 500–700 μm; Alicon medical Co., Hangzhou, China).19 (link)