Angiographic evaluation of hepatic arterial injury after cisplatin and Gelfoam–based transcatheter arterial chemoembolization for hepatocellular carcinoma in a 205 patient cohort during a 6-year follow-up

Abstract

Objective: To evaluate the overall and cumulative incidence, degree, interval change and predictors of hepatic arterial injury (HAI) after cisplatin and Gelfoam® (Upjohn, Kalamazoo, MI)-based transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods: A total of 205 patients with HCC who underwent three or more sessions of TACE without additional surgical or local treatment were included. HAI was evaluated at each segment of the hepatic artery using a three-grade scale: 1 (slight wall irregularity), 2 (overt stenosis) and 3 (occlusion). HAI interval change was categorized into three groups: progression, stable state and improvement. Cumulative incidence of HAI was analysed using KaplanMeier method, and predictors of HAI (patient age, sex, portal vein thrombosis and Child-Pugh classification) were analysed by univariate logistic regression. Results: HAI occurred in 50 of the 205 study patients (24.4%). The cumulative incidence of HAI was 16.0% [95% confidence interval (CI), 10.21-21.77] during 5 sessions of TACE, 52.1% (95% CI, 37.83-66.29) during 10 sessions and 68.0% (95% CI, 67.62-88.46) during 15 sessions. Initial HAI was interpreted as grades 1, 2 and 3 in 11 (22.0%), 17 (34.0%) and 22 (44.0%) patients, respectively. When the interval change was assessed in 48 patients with available follow-up TACE, 40 (83.3%) were included in the progression, 2 (4.2%) in the stable state and 6 (12.5%) in the improvement groups. The univariate analysis used to determine the predictors of HAI revealed no significant predictors. Conclusion: In three or more sessions of TACE, the incidence of HAI was 24%. Increasing TACE causes increased incidence of HAI. The initial presentation was most commonly grade 3, and 12.5% of the patients with HAI showed improvement of the HAI grade during follow-up TACE. Advances in knowledge: In patients who underwent three or more sessions of cisplatin and Gelfoam-based TACE, the overall incidence of HAI was 24.4%, and increasing TACE causes increased incidence of HAI.

Midterm Outcomes and Prognostic Factors of Patients Treated Using Microballoon-Occluded Transarterial Chemoembolization with Miriplatin: A Retrospective Study of 37 Cases

“…Miriplatin is an anticancer agent that produces less vascular disease, including the narrowing of vessels and shunt formation, and remains only transiently in the vessels surrounding the tumor vessels, and thus has no major side effects [36][37][38]. However, the rate of vascular damage obtained in this study after B-TACE with miriplatin might be slightly higher than those in previous reports regarding C-TACE with epirubicin and cisplatin [20,39]. We could not prove the lesser degree of vascular damage caused by miriplatin in this study.…”

Balloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center retrospective case control study

“…Of note, the grade 3 AEs (pseudo-aneurysm) observed in the B-TACE subgroup occurred during the learning curve of balloon micro-catheter usage (within the first five cases) [ 10 , 22 ]. It is to be noted that also during DEM-TACE procedures grade 3 hepatic artery injury (defined as occlusions) occurred [8/205 (3.9%) after 2 sessions of TACE] as reported by Suh et al[ 23 ]. Regarding PES, both groups had a similar percentage of incidence (36.4% and 25.2%), and this is in accordance with the existing literature regarding DEM-TACE (range 24.7%-75%)[ 24 ].…”

Balloon Occluded TACE (B-TACE) vs DEM-TACE for HCC. A Single Center Retrospective Case Control Study.

“…Of note, the grade 3 AEs (pseudoaneurysm) observed in the B-TACE subgroup occurred during the learning curve of balloon micro-catheter usage (within the rst ve cases) 8,18 . It is to be noted that also during DEM-TACE procedures grade 3 hepatic artery injury (de ned as occlusions) occurred [8/205 (3.9%) after 2 sessions of TACE] as reported by Suh et al 19 . Regarding PES, both groups had a similar percentage of incidence (36.4% and 25.2%), and this is in accordance with the existing literature regarding DEM-TACE (range 24.7%-75%) 20 .…”