Assessing the Safety of Y-90 Infusion Through the Right Inferior Phrenic Artery

Researchers assessing the feasibility of infusion of yttrium-90 (Y-90) glass microspheres through the right inferior phrenic artery (RIPA) have found that the procedure may be safe after embolization of a systemic-to-pulmonary shunt identified on C-arm computed tomography (CT).

The study involved 20 patients who underwent Y-90 radioembolization through the RIPA from November 2015 to May 2017. When C-arm CT revealed the systemic-to-pulmonary shunt, polyvinyl alcohol (PVA) particles were administered prophylactically before the Y-90 glass microspheres were administered. The modified Response Evaluation Criteria in Solid Tumors was used to determine tumor response, and retrospective review of follow-up CT scans was performed to determine if there were any pulmonary complications.

Of the patients in the study, 9 (45%) had systemic-to-pulmonary shunts on C-arm CT images of the RIPA. The azygoesophageal branch was identified as the feeder of the systemic-to-pulmonary shunt in 7 patients, and the anterior branch was identified in 2 patients. The glass microsphere infused into the RIPA had a mean activity of 0.49 GBq.

Upon follow-up, no patients had symptomatic radiation pneumonitis or cutaneous complications, though 7 patients had focal atelectasis, focal ground-glass opacity and/or a small amount of pleural effusion. Based on the the modified Response Evaluation Criteria in Solid Tumors, the best tumor response fed by the RIPA was a complete response in 4 patients. Nine patients had a partial response, 2 patients had stable disease, 4 had progressive disease, and 1 was unevaluable.

“The administration of 90Y glass microspheres through the RIPA may be safe after embolization of a systemic-to-pulmonary shunt identified on C-arm CT,” the researchers concluded.

Reference

Kim HC, Kim YJ, Paeng JC, Chung JW. Yttrium-90 radioembolization of the right inferior phrenic artery in 20 patients with hepatocellular carcinoma. J Vasc Interv Radiol. 2018 Jan 17. pii: S1051-0443(17)30922-3. doi: 10.1016/j.jvir.2017.10.010. [Epub ahead of print]