248 - Flow-Directed Catheter Therapies in Yttrium-90 Radioembolization: A Systematic Review and Meta-Analysis

Purpose: Transarterial radioembolization (TARE) with Yttrium-90 microspheres is effective for hepatic malignancies but challenged by non-target delivery. Flow-directed catheter systems (TriNav, Sniper) improve hemodynamic control, enhance microsphere deposition, and may reduce non-target embolization. This meta-analysis evaluates their efficacy, dosimetry, and safety

Materials and Methods: We conducted a PRISMA-based systematic review and meta-analysis (2010–2024) of studies on Y-90 TARE with flow-directed catheters. PubMed, EMBASE, and Cochrane were searched for reports on technical success, tumor response, efficiency, dosimetry, and adverse events. Random-effects models with REML and Hartung-Knapp adjustment were applied, with logit-transformed proportions and heterogeneity assessed using I² and Q. Subgroup and device-specific analyses compared TriNav antireflux systems and Sniper balloon microcatheters

Results: From 119 records, 15 studies met criteria (N=301). Technique-specific analysis showed consistent benefits of flow-directed approaches. Antireflux catheters improved efficiency: fluoroscopy time reduced by 4.2 min (p=0.002), procedure time by 14–90 min (p< 0.001), and radiation by 44% (p=0.04). Dosimetric gains were robust: normal liver exposure decreased by 58% and tumor targeting increased by 68% (p< 0.05). Tumor-to-normal ratios improved twofold on MAA SPECT (p=0.02) and PET (p=0.009). Technical success was high (88.7%, 95% CI 79.2–94.3%). Eleven single-arm studies showed objective response rate of 51.4% (95% CI 35.9–66.6) and disease control rate of 59.1% (95% CI 38.7–76.7). Grade ≥3 adverse events were rare (< 5%) with no technique-specific complications. Device analysis: TriNav (5 studies, n=117) excelled in efficiency and dosimetry, while Sniper (4 studies, n=63) showed complete response 40.9%, objective response 50.0%, disease control 59.1% in HCC, and 100% technical success.

Conclusion: Flow-directed catheter therapies in Y90 TARE are associated with improved dosimetric outcomes and tumor response rates with minimal adverse events. These findings support their routine consideration in complex vascular anatomies or high-risk non-target embolization cases. TriNav and Sniper devices demonstrate complementary clinical advantages, supporting technology selection based on procedural priorities.