Towards more targeted embolization
The field of embolotherapy is continuously expanding towards new indications, in the last decade towards benign prostate embolization ; more recently towards emborrhoids and muskuloskeletal embolization, with the consequence of making embolization technique more and more demanding.
Aim of embolization procedure is to deliver effective treatment while preserving adjacent tissues/structures. Among embolization principles, targeted and flow-directed embolization are fundamental ones.
The increasing use of microcatheters participated to not only improve targeted embolization but also to maintain maximum blood flow to foster embolics delivery1.
Still, the variability in vascularization anatomy associated to the variability of embolic material that may be used, can make delivery of those embolics a real challenge.
One of the challenges is to avoid Non-Target embolization (NTE) and preserve adjacent tissues. NTE may be minimized by cautious planning and being as targeted as possible. However, presence of small vessels proximal to the target vessel makes it very difficult to control especially when using microspheres that tend to reflux at the tip of the catheter2.
The challenge of Non-Target Embolization (NTE)
- Acute cholecystitis3, 4
- Liver infarction and parenchyma focal
- Spinal cord ischemia (spinal arteries NTE)8
- Dysphagia (esophageal branches NTE)8
- Ischemic colitis8
- Premature menopause (ovarian NTE)5
- Buttock necrosis6
- Labium minora ulceration (internal pudental artery)7
(*in a study examining 51 HCC patients)
Physicians talk about NTE
By the time we can see (contrast) reflux, it is already too late
to prevent NTE
Jafar Golzarian (Minneapolis, MN, USA)
NTE is an under
Irene Bargellini (Pisa, Italy)
Because embolics went off target to embolize the cystic artery,
the patient went to surgery for bilioma inside the peritunum
Thierry de Baere (Villejuif, France)
The patient had transient paraplegia so anti-reflux microcatheters would have
Florian Wolf (Vienna, Austria)
Reduce the risk of
with SeQure®13, 14.
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Full length Physician videos
1 Transcatheter Embolization and Therapy, Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7_1, Springer-Verlag London Ltd. 2010, pp 3-10, http://bit.ly/2tY7rAg
2 Transcatheter Embolization and Therapy, Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-897-7_3, Springer-Verlag London Ltd. 2010, pp 29-31, http://bit.ly/2tY7rAg
3 Safety Profile of Sequential Transcatheter Chemoembolization with DC Bead: Results of 237 Hepatocellular Carcinoma (HCC) Patients. Katerina Malagari, et al. Cardiovasc Intervent Radiol (2011) 34:774–785 DOI 10.1007/s00270-010-0044-3
4 Analysis of Nontarget Embolization Mechanisms During Embolization and Chemoembolization Procedures. Ruben Lopez-Benıtez. Et al. Cardiovasc Intervent Radiol (2009) 32:615–622 DOI 10.1007/s00270-009-9568-9
5 Contrast-enhanced sonography during uterine artery embolization for the treatment of leiomyomas. Marret, H.,et al. (2004) Ultrasound in Obstetrics and Gynecology, 23 (1), pp. 77-79.
6 Buttock necrosis after uterine artery embolization. Dietz, D.M et al. (2004) Obstetrics and Gynecology, 104 (5 PART 2), pp. 1159-1161.
7 Patient presentation and management of labial ulceration following uterine artery embolization. Gonsalves, C., et al. (2007) CardioVascular and Interventional Radiology, 30 (6), pp. 1263-1266
8 Bronchial and Nonbronchial Systemic Artery Embolization for lifethreatening Hemoptysis: A Comprehensive Review. Woong Yoon et al. RadioGraphics 2002; 22:1395–1409. Published online 10.1148/rg.226015180
9 Efficacy and Nontarget Effects of Transarterial Chemoembolization in Bridging of Hepatocellular Carcinoma Patients to Liver Transplantation: A Histopathologic Study. Ulrike Stampfl, MD, et al. J VascIntervRadiol2014;25:1018–1026
10 Acute necrotizing pancreatitis as a fatal complication following DC Bead transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature. Takashi Yamaguchi et al. Molecular and Clinical Oncology 2018; 9: 403-407; DOI: 10.3892/mco.2018.1690
11 Transarterial chemoembolization with DC Bead LUMI™ radiopaque beads for primary liver cancer treatment: Preliminary experience. Aliberti et al. Future Oncology 2017, (25):2243-2252. doi: 10.2217/fon-2017-0364
12 Beads accumulation reports DR-1800178 & TR-026
13 Vessel Flow Dynamic Indication (Beads Reflux) Bench Test report TR-002
14 Usability, Safety and Efficacy of a Novel Microcatheter for Reducing Non-Target Embolization. Michael Tal et al. WCIO 2018 Poster. Animal study.
SEQURE® microcatheters are class IIb medical devices intended for use by interventional radiologists and interventional oncologists for the infusion of contrast media into all peripheral vessels and for drug infusion in intra-arterial therapy, and infusion of embolic materials. They should not be used in cerebral vessels.
For complete information about precautions and optimal usage conditions for these medical devices, we recommend consulting the instructions for use supplied with each device or with your local Guerbet representative(s). Information for use only in countries with applicable health authority registrations. Notified Body: MedCert 0482. Manufacturer: Accurate Medical Therapeutics Ltd. EC Rep: Guerbet. Document creation date: April 2020. SEQURE® microcatheters are registered trademarks of Guerbet Group or its affiliates.