A 79-year-old man with a history of a solitary hepatocellular carcinoma (HCC) in segment 6 presented to the interventional radiology department for hepatic angiography and preablative embolization (Figure 1A).

After using standard techniques to access the right common femoral artery, a 5-F (1.67-mm) sheath was placed. Subsequently, a selective 4-F (1.33-mm) reverse-curve catheter and a hydrophilic guidewire were used to cannulate the celiac artery. There was difficulty advancing the 4-F (1.33-mm) catheter over the wire and into the common hepatic artery, so it was decided to park the selective catheter at the celiac artery origin and use a microcatheter from there. A 0.027-inch (0.69-mm) Renegade HI-FLO™ Microcatheter and a Fathom®-16 Steerable Guidewire were used to cannulate the right hepatic artery (Figure 1B). The angiogram (contrast injector set for flow rate of 4 mL/s for total volume of 8 mL at pressure of 800 psi [5,516 kPa]) showed the tumor, but there were other areas in question. The microcatheter was exchanged for a 0.027-inch (0.69-mm) Direxion™ Torqueable Microcatheter, and a repeat angiogram (contrast injector set for flow rate of 5.2 mL/s for a total volume of 10 mL at pressure of 1,200 psi [8,274 kPa]) showed innumerable smaller tumors as well (Figure 1C). An intraprocedural decision was made to forego embolization and administer macroaggregated albumin to prepare for yttrium-90 treatment.

DISCUSSION

The higher flow rates and pounds per square inch that the Direxion™ Microcatheter provides completely changed this patient’s management. Had he gone on to ablation, only one of his tumors would have been addressed. By changing his treatment to yttrium-90, all of his tumors were treated, and most had a near-complete treatment response (Figure 1D).

Brian S. Geller, MD, is the Chief of Interventional Radiology and Vice Chairman of Radiology at the University of Florida in Gainesville, Florida. He has disclosed that he received no compensation related to this article and is not a consultant to Boston Scientific Corporation.

Hugh Davis, MD, is a fellow at the University of Florida in Gainesville, Florida. He has disclosed that he received no compensation related to this article and is not a consultant to Boston Scientific Corporation.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.