Feasibility and safety of occlusion balloon microcatheter in superselective arterial embolization

doi:10.3877/cma.j.issn.2095-5782.2023.02.012

Abstract

Abstract:

Superselective arterial intubation technique used in superselective arteriography and embolization can significantly reduce the damage of target organs and improve the therapeutic effect. In clinic, it has been used in the fields of hepatic segment and sub hepatic segment embolization, bronchial artery embolization, prostate artery embolization and other peripheral artery embolization. However, it is still impossible to completely avoid the non-target vascular injury caused by the reflux of embolic substances. With the strong clinical demand, occlusion balloon microcatheter has become an important interventional device to solve such problems. It can significantly reduce the reflux of embolic agents. At present, it has been used in clinical hepatic artery embolization, bronchial artery embolization, prostate artery embolization and other fields. It can make the lesion achieve complete embolization, has high application value, and the incidence of adverse reactions after embolization is very low.

Key words: Superselective arterial embolization, Hepatic artery chemoembolization, Bronchial artery embolization, Occlusion balloon microcatheter

Yanchao Dong, Hongtao Niu. Feasibility and safety of occlusion balloon microcatheter in superselective arterial embolization[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(02): 164-171.

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References 30

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研究者	年代	样本量	栓塞材料	研究终点	并发症
Toshiyuki Irie等	2011	14	碘油	碘油栓塞更致密	未提及
Toshiyuki Irie等	2011	82(B-TACE)，161(TACE)	碘油	并发症发生率	B-TACE：十二指肠出血（n = 1）、胆汁瘤（n = 1）、皮肤坏死（n = 1）、肝段萎缩（n = 1）、膈肌麻痹（n = 5）、需要吗啡控制的剧烈疼痛（n = 5）； TACE：肝功能衰竭和急性肿瘤溶解综合征（n = 2）、胆汁瘤（n = 4）、膈肌麻痹（n = 6）、需要吗啡控制的剧烈疼痛（n = 7）
Tomohiro Matsumoto等	2015	31	碘油	技术成功率：99%	球囊破裂（n = 3），扩张的动脉变形（n = 2）
Pyeong Hwa Kim等	2020	60	碘油	技术成功率100%，ORR 100%（CR 45例，PR 15例），主要并发症发生率为6.7%（4/60），中位TTP为5.3个月（95%CI：4.0~6.9个月）	AST、ALT和总胆红素升高明显
Takeshi Hatanaka等	2018	14	碘油	CR 6例（42.9%）、PR 1例（7.1%）、SD 3例（21.4%）和疾病进展（progressive disease，PD） 7例（28.6%）	未提及
Toru Ishikawa等	2014	51	碘油	6个月时局部复发率为11.1%，12个月时为26.2%	未提及
Hirotaka Arai等	2015	158(B-TACE)，48(TACE)	碘油	B-TACE组靶结节治疗效果（TE）TE4、TE3、TE2及TE1分别为55.1%、38.8%、4.1%和2.0%，c-TACE组TE的分别为39.6%、33.3%、25.0%和2.1%	ALT显著升高，1个月内恢复正常。
Pierleone Lucatelli等	2021	22（B-DEB-TACE），127（DEB-TACE）	载药微球	B-DEB-TACE与DEB-TACE在1个月和3~6个月时的ORR分别为65.7%与62.3%、72.4%与57.4%（P > 0.05）；9~12个月B-DEB-TACE 78.9%明显高于DEB-TACE组53.9%，且B-DEB-TACE组患者肿瘤CR后1年内肿瘤复发时间明显长于DEB-TACE组（278 d vs 219 d）	不良反应发生率无差异
Ana-Maria Bucalau等	2020	24	载药微球	ORR 74.3%	临床药物毒性1/2级25.7%，腹痛17.1%
Pierleone Lucatelli等	2019	22	载药微球	技术成功率100%，1个月和3~6个月的CR率分别为44.8%和52.9%。1个月和3~6个月的PR率分别为55%和4/17，在部分缓解患者中，肿瘤体积减少的平均百分比为64.9% ± 27.3%	不良反应发生率为17%：供血动脉假性动脉瘤、肝脓肿和2例无症状节段性胆道扩张，栓塞后综合征发生率33%
Rita Golfieri等	2021	22（B-TACE），69（B-DEB-TACE），234（c-TACE）	碘油/载药微球	6个月内B-TACE组CR率为59.3%，显著高于non-B-TACE组的41.8%	3级以上不良并发症发生率两组之间无差异
James Meek等	2019	17	Y90栓塞微球	11例CR，6例PR	未提及
Adelchi Saltarelli等	2017	9	Y90栓塞微球	无异位栓塞	未提及
Giulio Eugenio Vallati	2018	1	Y90栓塞微球	3月后病变内坏死部分已经超过70%	未提及

研究者	年代	样本量	栓塞材料	研究终点	并发症
Toshiyuki Irie等	2011	14	碘油	碘油栓塞更致密	未提及
Toshiyuki Irie等	2011	82(B-TACE)，161(TACE)	碘油	并发症发生率	B-TACE：十二指肠出血（n = 1）、胆汁瘤（n = 1）、皮肤坏死（n = 1）、肝段萎缩（n = 1）、膈肌麻痹（n = 5）、需要吗啡控制的剧烈疼痛（n = 5）； TACE：肝功能衰竭和急性肿瘤溶解综合征（n = 2）、胆汁瘤（n = 4）、膈肌麻痹（n = 6）、需要吗啡控制的剧烈疼痛（n = 7）
Tomohiro Matsumoto等	2015	31	碘油	技术成功率：99%	球囊破裂（n = 3），扩张的动脉变形（n = 2）
Pyeong Hwa Kim等	2020	60	碘油	技术成功率100%，ORR 100%（CR 45例，PR 15例），主要并发症发生率为6.7%（4/60），中位TTP为5.3个月（95%CI：4.0~6.9个月）	AST、ALT和总胆红素升高明显
Takeshi Hatanaka等	2018	14	碘油	CR 6例（42.9%）、PR 1例（7.1%）、SD 3例（21.4%）和疾病进展（progressive disease，PD） 7例（28.6%）	未提及
Toru Ishikawa等	2014	51	碘油	6个月时局部复发率为11.1%，12个月时为26.2%	未提及
Hirotaka Arai等	2015	158(B-TACE)，48(TACE)	碘油	B-TACE组靶结节治疗效果（TE）TE4、TE3、TE2及TE1分别为55.1%、38.8%、4.1%和2.0%，c-TACE组TE的分别为39.6%、33.3%、25.0%和2.1%	ALT显著升高，1个月内恢复正常。
Pierleone Lucatelli等	2021	22（B-DEB-TACE），127（DEB-TACE）	载药微球	B-DEB-TACE与DEB-TACE在1个月和3~6个月时的ORR分别为65.7%与62.3%、72.4%与57.4%（P > 0.05）；9~12个月B-DEB-TACE 78.9%明显高于DEB-TACE组53.9%，且B-DEB-TACE组患者肿瘤CR后1年内肿瘤复发时间明显长于DEB-TACE组（278 d vs 219 d）	不良反应发生率无差异
Ana-Maria Bucalau等	2020	24	载药微球	ORR 74.3%	临床药物毒性1/2级25.7%，腹痛17.1%
Pierleone Lucatelli等	2019	22	载药微球	技术成功率100%，1个月和3~6个月的CR率分别为44.8%和52.9%。1个月和3~6个月的PR率分别为55%和4/17，在部分缓解患者中，肿瘤体积减少的平均百分比为64.9% ± 27.3%	不良反应发生率为17%：供血动脉假性动脉瘤、肝脓肿和2例无症状节段性胆道扩张，栓塞后综合征发生率33%
Rita Golfieri等	2021	22（B-TACE），69（B-DEB-TACE），234（c-TACE）	碘油/载药微球	6个月内B-TACE组CR率为59.3%，显著高于non-B-TACE组的41.8%	3级以上不良并发症发生率两组之间无差异
James Meek等	2019	17	Y90栓塞微球	11例CR，6例PR	未提及
Adelchi Saltarelli等	2017	9	Y90栓塞微球	无异位栓塞	未提及
Giulio Eugenio Vallati	2018	1	Y90栓塞微球	3月后病变内坏死部分已经超过70%	未提及

研究者	年代	疾病	样本量	栓塞材料	研究终点	并发症
Mine，Takahiko等	2020	咯血	1	组织胶	止血成功	轻微发热
Ari J Isaacson等	2018	前列腺增生	12	栓塞微球	IPSS降低（15 ± 7）分，生存质量评分降低（4 ± 1）分	无严重并发症，轻度栓塞后反应均在2~5 d内明显消失
Kush Shah等	2020	前列腺增生	10	栓塞微球	术后IPSS从术前的26.5显著降至3个月时的5.1（下降81%），6个月时降至11.0（下降58%）。平均生活质量术前的4.9显著改善到3个月时的1.0（下降80%）和6个月时的2.0（下降60%）	未提及
Rajasekhara Ayyagari等	2018	前列腺增生	1	栓塞微球	1个月IPSS从术前的34下降到12	未提及
Bilhim, Tiago等	2019	前列腺增生	cPAE组（43例）和bPAE组（46例）	栓塞微球	6个月后C-PAE后平均IPSS降低7.58 ±6.88，B-PAE后平均IPSS降低8.30 ± 8.12；C-PAE后平均前列腺体积减少（21.9 ± 51.6）cm³，B-PAE后平均前列腺体积减少（6.15 ± 14.6）cm³；c-PAE后平均PSA降低为（0.9 ± 2.22）ng/mL，bPAE后平均PSA降低为（0.22 ±1.65）ng/mL	C-PAE中阴茎皮肤损伤（n =3）和直肠出血（n = 2）（11.9%，P = 0.01）。未发生重大不良事件
Yusuke Sawada等	2017	肾血管平滑肌脂肪瘤	15	碘油加酒精	技术成功率为93%，临床成功率为100%	严重并发症发生率为0%
Kosuke Tomita等	2020	肾血管平滑肌脂肪瘤	8	碘油加酒精	技术成功率达到100%，临床成功率100%，平均直径缩小率为34%，体积缩小率为77%	血清肌酐浓度和术前和术后估计的肾小球滤过率没有明显变化，也没有重大并发症
Takuji Yamagami等	2018	多囊肾	1	三丙烯酸明胶微球	多囊肾体积缩小，腹胀症状缓解	未提及
Takahiko Mine等	2020	腹主动脉瘤支架后内瘘	2	组织胶	技术成功率达到100%，临床成功率100%	术后严重并发症发生率0%
		胰十二指肠术后出血	1
		腹膜后出血	2
		卵巢恶性肿瘤出血	1

研究者	年代	疾病	样本量	栓塞材料	研究终点	并发症
Mine，Takahiko等	2020	咯血	1	组织胶	止血成功	轻微发热
Ari J Isaacson等	2018	前列腺增生	12	栓塞微球	IPSS降低（15 ± 7）分，生存质量评分降低（4 ± 1）分	无严重并发症，轻度栓塞后反应均在2~5 d内明显消失
Kush Shah等	2020	前列腺增生	10	栓塞微球	术后IPSS从术前的26.5显著降至3个月时的5.1（下降81%），6个月时降至11.0（下降58%）。平均生活质量术前的4.9显著改善到3个月时的1.0（下降80%）和6个月时的2.0（下降60%）	未提及
Rajasekhara Ayyagari等	2018	前列腺增生	1	栓塞微球	1个月IPSS从术前的34下降到12	未提及
Bilhim, Tiago等	2019	前列腺增生	cPAE组（43例）和bPAE组（46例）	栓塞微球	6个月后C-PAE后平均IPSS降低7.58 ±6.88，B-PAE后平均IPSS降低8.30 ± 8.12；C-PAE后平均前列腺体积减少（21.9 ± 51.6）cm³，B-PAE后平均前列腺体积减少（6.15 ± 14.6）cm³；c-PAE后平均PSA降低为（0.9 ± 2.22）ng/mL，bPAE后平均PSA降低为（0.22 ±1.65）ng/mL	C-PAE中阴茎皮肤损伤（n =3）和直肠出血（n = 2）（11.9%，P = 0.01）。未发生重大不良事件
Yusuke Sawada等	2017	肾血管平滑肌脂肪瘤	15	碘油加酒精	技术成功率为93%，临床成功率为100%	严重并发症发生率为0%
Kosuke Tomita等	2020	肾血管平滑肌脂肪瘤	8	碘油加酒精	技术成功率达到100%，临床成功率100%，平均直径缩小率为34%，体积缩小率为77%	血清肌酐浓度和术前和术后估计的肾小球滤过率没有明显变化，也没有重大并发症
Takuji Yamagami等	2018	多囊肾	1	三丙烯酸明胶微球	多囊肾体积缩小，腹胀症状缓解	未提及
Takahiko Mine等	2020	腹主动脉瘤支架后内瘘	2	组织胶	技术成功率达到100%，临床成功率100%	术后严重并发症发生率0%
		胰十二指肠术后出血	1
		腹膜后出血	2
		卵巢恶性肿瘤出血	1

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