Transarterial Hepatic Radioembolization Using a Trimmed Tip Modified Pressure Enabled Delivery Catheter

1. Discuss commonly encountered hepatic vascular branching anatomy.
2. Explore the mechanisms of a pressure enabled drug delivery (PEDD) catheter to improve tumor to nontarget ratio and introduce fluid turbulence to overcome laminar flow.
3. Illustrate the utility of a tip trimmed modified PEDD catheter to aid in homogenous particle distribution.

Background: Solid tumors present unique challenges for treatment, through unregulated neovascularization to changes in interstitial fluid pressures, interventionalists are met with varying blood flow characteristics and vascular abnormalities. With personalized dosimetry as the standard of care for transarterial radioembolization, preservation of true hypervascularity ratio is paramount. The described PEDD catheter (TriNav®, TriSalus Life Sciences, Westminster, CO) represents a significant advancement in technology. The catheter is uniquely designed to prevent reflux, create turbulent flow and facilitate antegrade pressure at the terminal end of the catheter through a microvalve design. The current TriNav® model has approximately 5 mm of catheter distal to the microvalve. This extended catheter tip may diminish the ability to overcome laminar flow which can result in undesired preferential injection into a branch vessel limiting the overall homogenous distribution of particles. Particularly in cases with early bifurcating branches, trimming the tip of the catheter to be aligned with the microvalve helps to ensure even particle delivery and preserves the dosimetry calculations which are based on tumor hypervascularity dynamics.

Clinical Findings/Procedure Details:

In a retrospective analysis performed over 18 months, a PEDD catheter was used in 57 cases. Of these cases 19 implemented the trimmed tip method. Improved flow dynamics was observed and evidenced by visualized contrast. In cases with early bifurcating arterial branches a trimmed tip catheter proved to be favorable, particularly regarding antegrade flow dynamics. No evidence of vasospasm or technical failure was observed in any of the 19 trimmed tip catheter cases in keeping with patient safety.

Conclusion and/or Teaching Points:

As devices and technology continue to evolve small changes can result in big impact. Turbulent fluid flow has been proven to increase distribution of particles in solid tumors. Implementing the trimmed tip technique aids in maintaining turbulent flow at the distal end of the catheter and avoids injection into a single feeding vessel, particularly in cases where early bifurcation is observed. This exhibit aims to promote the safety and efficacy of using a trimmed tip TriNav catheter.