Innova 3100

Coronary angiography was performed using the General Electric Innova 3100 (Milwaukee, WI, USA) by the femoral approach in multiple angulated views. A standard Judkins technique was used in all the studied individuals with 5F Judkins catheters, and iohexol (350/100 mL) was used as a contrast agent and manually injected intravenously at the same rate of 3–4 mL/s for the left coronary artery and 2–3 mL/s for the RCA. TFC was used to quantitatively evaluate flow rates of each major coronary artery, including the left anterior descending artery (LAD), the left circumflex coronary artery (LCX), and the right coronary artery (RCA), according to the method first described by Gibson et al. [14 (link)]. TFC, recorded at 30 frames per second, was the number of frames from the second the contrast medium first appeared in the ostium of the coronary artery to the second it reached a distal coronary landmark. Because the LAD is usually longer than the LCX and RCA, the TFC of LAD is divided by 1.7 to obtain the corrected TFC of LAD (cLAD). The mean TFC for each subject was the average of TFC of RCA, LCX, and cLAD. The TFC was undertaken by two separate cardiologists and a third observer resolved any disagreement.

The Innova 3100 digital subtraction angiography (DSA) device (General Electric, Fairfield, Connecticut) was used during the operation. Percutaneous transhepatic cholangial drainage (PTCD) was performed by using pigtail catheters (Guangzhou Leadgem Medical Devices Co., Ltd., China). The self-expandable metal stent was purchased from Micro-Tech Co., Ltd (Nanjing, China) and the catheter with various sizes (8 × 40 mm,8 × 60 mm, 8 × 80 mm, 8 × 100 mm, 10 × 40 mm, 10 × 60 mm, 10 × 80 mm, and 10 × 100 mm, as appropriate) was applied. The ¹²⁵I brachytherapy particles (Beijing Atomic Hi-Tech Co., Ltd., China) were cylindrical, with the length of 4.5 mm, the diameter of 0.8 mm, the radioactivity of 33.3 MBq, and the half-life of 59.43 days.

TACE was performed by two interventional radiologists having > 15 years of clinical experience (JW, 19 years of experience; CY, 21 years of experience). All target regions were investigated under the guidance of a diagnostic digital subtraction angiography (GE Innova 3100) using the Seldinger technique. In general, a radiologist placed a sheath introducer in the right common femoral artery, advanced a 5 French (F) angiographic catheter into the common hepatic artery, and advanced a 2.2–2.4 F microcatheter (Asahi Intecc Co. Ltd., Japan) into the feeding hepatic artery. The patients were treated with combined chemotherapy, and the average doses of epirubicin, hydroxycamptothecin, oxaliplatin, and recombinant human interleukin-2 were 50 mg, 20 mg, 50 mg, and 2 million IU, respectively. Furthermore, 350–560-μm gelatin sponge particles (Hangzhou Alicon Pharmaceutical Technology Co.Ltd. Hangzhou, China) and/or average doses of an epirubicin (10 mg) + lipiodol (6 ml; Lipiodol Ultra-Fluide; Guerbet, France) mixture were also used. The total volume of the lipiodol emulsion was determined based on the tumor size and the achievement of stagnant flow in the tumor-feeding artery, as observed in procedural fluoroscopy.