Adjunctive techniques for optimization of ocular hemodynamics in children undergoing ophthalmic artery infusion chemotherapy

Abstract

NCT01466855.

Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications

“…12,15 An additional limitation is lack of data regarding visual outcomes at the end of treatment, which is not well established in this series due to age of patient, location of tumors, and decreasing use of ERG. Our results report ERG data improving or remaining the same at 10 Yamane et al, 11 and Klufas et al 12 Balloon ICA þ ICA Abruzzo et al 13 Balloon ECA þ OA* MMA Bertelli et al 15 and Bracco et al 14 Meningo-ophthalmic* Bertelli et al 15 and Bracco et al 14 MMA-lacrimal artery Klufas et al, 12 Bertelli et al, 15 and Bracco et al 14…”

“…16,17 Abruzzo et al describe the situation when there is robust flow from the OA to the anastomotic branches from the ECA with a potential reduction in the dose of chemotherapy reaching the eye. 13 We assumed this situation to be present when a choroidal blush could not be readily seen with injection of the microcatheter positioned at the OA origin and performed balloon occlusion of the ipsilateral IMA to improve IAC dosage to the affected eye. In keeping with this assumption, the choroidal blush was seen to be easily visible in these patients when the OA was injected during balloon occlusion of the ipsilateral IMA ( Figure 2).…”

Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up

“…Instead of searching and catheterizing the anastomoses between the ECA and the OA, anterograde redirection of the blood flow was achieved by balloon occlusion of the ECA. 18 However, even this approach has drawbacks (puncture of both femoral arteries, 2 catheter-microcatheter systems within the same artery), and its efficacy/safety versus catheterization of the ECA branches still requires validation. Although the use of the ECA and its branches for IAC has been previously reported, 9 An even more adaptable approach for IAC can be applied in extremely selected cases.…”

Reply:

“…1 Anatomic and hemodynamic variations may require the exploration of several possible alternative pathways of intra-arterial drug delivery from the external carotid artery (ECA) 2 or the use of the balloon technique occluding the ICA or the ECA. 3,4 In the specific case addressed by Paruthi et al, we agree that the disappearance of the ophthalmic artery (OA) after ICA occlusion was due to hemodynamic alterations of the blood flow, but we suggest a different interpretation of such changes. In our opinion, the missing OA opacification could likely be the result of a reversal of flow in the OA related to the occlusion of the ICA rather than to the preferential retrograde flow to the posterior circulation through the primitive trigeminal artery.…”