Progreat microcatheter

Using a transfemoral approach, a 5-F RH catheter (Cook) was used to catheterize the celiac trunk or anatomic variant to gain access to the hepatic arteries, which was achieved with a 2.7-F Progreat microcatheter (Terumo). Diagnostic angiographic runs were obtained on the celiac trunk and proper hepatic and right and left hepatic arteries to define tumor arterial supply. Through the microcatheter, a vial of 100–300 or 300–500μm in size CalliSpheres microspheres (Jiangsu Hengrui Callisyn Biomedical Co., Ltd., Suzhou, China) loaded with 60 mg of pirarubicin or epirubicin were injected to occlude each tumor artery. If tumor staining was still present on repeated imaging after all DEB, 560–710 μm gelatin sponge particles or polyvinyl alcohol (ALICON Pharm SCI & TECH) were added until near-stasis was achieved, defined as the disappearance of tumor stain on angiography. The procedures were conducted by two interventional radiologists with more than 15 years of experience.

All animal experiments were conducted in accordance with the guidelines issued by our Institutional Animal Care and Use Committee (Approval No: 2012-038). Sixty healthy adult domestic male cats weighing 2.8-3.3 kg were anesthetized with an intramuscular injection of ketamine HCl (2.5 mg/kg; Huons, Jechun, Korea) and xylazine (0.125 mg/kg; Bayer Korea, Seoul, Korea). Cats were allowed to breathe ambient air spontaneously during the procedure. Briefly, the right femoral artery was isolated and its distal portion was ligated with 4.0 silk. An 18-guage intravenous catheter was then inserted into the artery proximal to the ligated portion. A 2.2F microcatheter (Progreat microcatheter, Terumo, Tokyo, Japan) equipped with a microguidewire (GT guidewire, Terumo, Tokyo, Japan) was then passed through the intravenous catheter into the lumen of the artery. The tip of the microcatheter was positioned in the right or left common carotid artery at the level of the fourth cervical vertebra under fluoroscopic guidance. Triolein (triglyceride, 1, 2, 3-tri [cis-9-octadecenoyl] glycerol) was supplied by Sigma-Aldrich (St. Louis, MO, USA).

All ⁹⁰Y procedures were performed under local anaesthesia by or under direct supervision of an expert interventional radiologist (GM) and nuclear medicine physician (CD). Previously published work describes the details of the ⁹⁰Y treatment.13 (link) Briefly, patients first underwent a detailed baseline angiogram and embolization of enterohepatic arteries with micro-coils according to the expertise of the interventional radiologist. Technetium-99m-macroaggregated albumin (^99mTC-MAA) was injected in the target vessels and a planar scintigraphy was performed to determine the lung shunt fraction. Two weeks later patients underwent bi-lobar or uni-lobar injection of ⁹⁰Y resin microspheres (SIR spheres, Sirtex Inc, Cosgrove, Australia) under local anaesthesia. The activity of ⁹⁰Y injected in the patient was calculated based on the body surface area method. In patients where it was possible to use the partition model, the partition model was used instead of the body surface area method. Dependent on the site of lesions, the ⁹⁰Y resin microspheres were injected intra-arterially via a micro catheter to the right and left liver lobe (superselective). A Progreat® micro catheter (Terumo, Europe) or an anti-reflux catheter (Surefire Inc., Westminster, CO, USA) was used for injection of the microspheres. Patients received antiemetics and morphine derivates before ⁹⁰Y injection when required.