Progreat lambda

TACE and MWA procedures performed in the same session similar to Roberto Iezzi et.al commenting [19 (link)]. In brief, angiography was performed prior to ablation. All TACE procedures were performed by an experienced physician starting with a routine Seldinger puncture in the arteria cruralis after local anesthesia. A 5 French catheter (Progreat Lambda, Terumo, Japan) was selected to perform arteriography of the celiac and common hepatic artery to identify the tumor and feeders. Afterwards, MWA was performed as described above. CEUS (with sonoview as the enhancing agent) was used to evaluate the completeness of the ablation. If there was a residual tumor, an additional ablation was performed. Subsequently, a microcatheter was used to superselect the tumor-feeding branch and embolization was performed with 1–3 mL of lipiodol, with or without 10 mg of epirubicin (water-in-oil technique was used to mix chemotherapeutic agents and iodized oil which was described in previous study [20 (link)]). Finally, angiography was repeated to evaluate the extent of the lipiodol deposits. The brief procedure was shown in Supplemental Figure S1.

TACE was performed through right femoral artery puncture and cannulation under local anesthesia. Superior mesenteric and common hepatic arteriographies were achieved with a 5-F catheter (Rősch hepatic catheter; Cook) to assess the direction of portal flow, the anatomy of the hepatic artery, tumor size and location, and feeding arteries. Patients underwent cisplatin-based TACE (2 mg/kg body weight) with a 1.7–2.4-F microcatheter (Progreat Lambda, Terumo, Tokyo, Japan; Renegade, Boston Scientific, Cork, Ireland; Carnelian, Tokai Medical Products, Aichi, Japan). A 1:1 emulsion of cisplatin and iodized oil (Lipiodol^®, Laboratoire Guerbet) was infused into the feeding artery. Subsequent embolization was performed with gelatin particles (Upjohn, Kalamazoo, MI, USA) until arterial flow stasis was observed.
Patients were initially followed-up by contrast-enhanced CT or MR imaging and laboratory tests, 1 month after TACE. Subsequent follow-up examinations were repeated every 2–3 months during the first 2 years, and every 3–6 months thereafter until HCC recurrence. Repeated TACE was performed in patients with insufficient responses after a single session of TACE and those with recurrent tumors.