Management of arterial dissections in 12 patients during transarterial chemoembolization and yttrium-90 selective intern
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INTERVENTIONAL RADIOLOGY
Management of arterial dissections in 12 patients during transarterial chemoembolization and yttrium‑90 selective internal radiotherapy for primary and secondary liver tumours Winfred Xi Tai Goh1 · Chow Wei Too2,3 · Kristen Alexa Lee2 · Bien Soo Tan2,3 · Kiang Hiong Tay2,3 · Sivanathan Chandramohan2,3 · Richard Hoau Gong Lo2,3 · Farah Gillan Irani2,3 · Nanda Venkatanarasimha2,3 · Karthikeyan Damodharan2,3 · Kutty Krishnan Pradesh Kumar2 · Kun Da Zhuang2,3 · Jasmine Ming Er Chua2,3 · Ajay Bangaragiri2 · Sum Leong2,3 Received: 4 August 2020 / Revised: 19 September 2020 / Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To describe rates and management strategies of arterial dissections in transarterial chemoembolization (TACE) and Yttrium-90 selective internal radiotherapy (90Y SIRT) for primary and secondary liver tumours. Materials and methods This retrospective review included 1377 hepatic angiographies between May 2010 and June 2015 in a single centre for TACE and 90Y SIRT of liver tumours. The angiogram results, management, treatment outcomes and follow-up angiography/imaging findings were recorded. Results and discussion Twelve cases of arterial dissections (12/1377, 0.87%) were documented. Three dissections (3/633, 0.47%) occurred during TACE, seven (7/449, 1.56%) during pre-treatment planning angiographies (PTPA) for 90Y SIRT, and two (2/249, 0.80%) during the treatment procedure of 90Y SIRT. The preferred management strategy was to manoeuvre past the dissection and complete the procedure, which was achieved in six patients (50%). Angioplasty with stenting was performed in one patient. In three patients, the procedure was held off for up to 3 months to allow the dissection to heal before repeating the procedure. A dissection that occurred during PTPA was detected only when the patient returned for 90Y SIRT. PTPA was immediately repeated for this patient. The last patient opted for sorafenib. Residual 50% stenosis was seen in one patient on follow-up hepatic angiography, but he was otherwise asymptomatic. In the remaining patients, no residual dissection or clinical sequelae was observed on follow-up. Conclusion Arterial dissection is a rare but important complication of transarterial locoregional therapy. Where possible, attempts should be made at completing the therapy. Deferring treatment can be considered as dissections usually heal within 3 months. Level of evidence Level 4, case series. Keywords Arterial dissections · Transarterial therapy · Liver cancer
Introduction For primary and secondary liver tumours not amenable to surgical or ablative therapies, transarterial chemoembolization (TACE) and Yttrium-90 selective internal radiotherapy (90Y SIRT) are transarterial locoregional treatment modalities. In accordance to the Barcelona Clinic Liver * Winfred Xi Tai Goh [email protected] Extended author information available on the last page of the article
Cancer (BCLC) staging criteria for hepatocellu
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