Intra-Arterial Chemotherapy as a Treatment for Intraocular Retinoblastoma: Alternatives to Direct Ophthalmic Artery Catheterization

Abstract

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy is a very effective treatment option for intraocular retinoblastoma. However, direct catheterization of the OA is not always possible. The purpose of this work was to report our initial results with intra-arterial chemotherapy for intraocular retinoblastoma when delivery of the drug was not via direct catheterization of the OA.

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

“…The first scenario is a troublesome and unstable catheterization of the OA ostium despite its visualization by selective angiography of the ICA. As previously reported, 9 this situation is usually secondary to a too angulated origin of the OA from the ICA, which makes the catheterization unsteady. In such cases, resuming the balloon technique applied to the ICA has been suggested 9 despite all its drawbacks (ie, the risk of evoking ischemic complications, dilution of the drugs in a volume of blood that is too large, the reduced time of drug perfusion).…”

“…10 Far from it, we believe that the ECA and some of its branches represent potential alternative routes for IAC. In our and in others' experience, 9,16,17 some of these routes have already been used to deliver antitumoral drugs. Our study shows that 16.29% of procedures occurred via 1 of the many alternative pathways previously described and involving branches of the ECA.…”

“…5,9 Failure to catheterize or infuse the OA can be a temporary occurrence, and the procedure can be successfully performed sometime later 8 ; on the other hand, a successful procedure through the OA on 1 or Ͼ1 occasion does not guarantee the same achievement in the following scheduled sessions of IAC. 9 We observed that in a remarkable percentage of children, the technical success of the treatment required different routes of drug infusion, depending on anatomic variants or on temporary hemodynamic variations. In some cases, the route of administration of the drugs had to be changed even within the same procedure so that the antitumoral agents were delivered in part through 1 artery and in part via another one.…”

“…3,5,8 However, in some cases, the procedure is not as straightforward as expected because of difficulties in catheterizing the OA or because angiographic visualization of the OA fails altogether. 5,[7][8][9] Two alternative techniques have been previously proposed in such cases: The first one involves the superselective catheterization of the middle meningeal artery (MMA), provided that an anastomosis between this vessel and the OA allows an acceptable choroidal blush; the second one is to just reapply the balloon technique to the ICA. 5,9 Failure to catheterize or infuse the OA can be a temporary occurrence, and the procedure can be successfully performed sometime later 8 ; on the other hand, a successful procedure through the OA on 1 or Ͼ1 occasion does not guarantee the same achievement in the following scheduled sessions of IAC.…”

“…5,[7][8][9] Two alternative techniques have been previously proposed in such cases: The first one involves the superselective catheterization of the middle meningeal artery (MMA), provided that an anastomosis between this vessel and the OA allows an acceptable choroidal blush; the second one is to just reapply the balloon technique to the ICA. 5,9 Failure to catheterize or infuse the OA can be a temporary occurrence, and the procedure can be successfully performed sometime later 8 ; on the other hand, a successful procedure through the OA on 1 or Ͼ1 occasion does not guarantee the same achievement in the following scheduled sessions of IAC. 9 We observed that in a remarkable percentage of children, the technical success of the treatment required different routes of drug infusion, depending on anatomic variants or on temporary hemodynamic variations.…”