An HCC Challenging Chemoembolization

Baseline Central

A 55 year old woman with a HCV-related liver cirrhosis with portal hypertension, thrombocytopenia and low-risk of oesophageal varices bleeding. CT-scan showed three HCC nodules, the biggest in the II hepatic segment. The patient was classified as being in Intermediate stage and scheduled to undergo a TACE cycle in our institute.

Diagnostic

With right common femoral artery access we started inserting a 4F (1.33 mm) sheath and a 4F catheter (Simmons shaped) to catheterize the celiac trunk and the common hepatic artery to perform a diagnostic angiogram. This angiographic image showed a stenosis just after the origin of the common hepatic artery that appear kinked and twisted distally.

TACE

We decided to use an HI-FLO™ Direxion™ microcatheter 0.27" (0.69mm) and the Fathom™-16 micro-guidewire to overcome these anatomical difficulties in order to perform TACE more distally and more superselectively. So the stenosis was easily passed and we were able to catheterized the branch supplying the HCC nodule.

Treatment was performed by injecting 50mg of epirubicin mixed with 10ml of Lipiodol, followed by gelatine sponge

Result

The CT scan after the procedure confirmed the treatment of the nodule with a complete Lipiodol accumulation in the nodule and the absence of persistent disease.

The patient was scheduled to undergo a further TACE cycle in our institute for the remaining nodules.

Study and images courtesy of
Dr. Rita Golfieri – Chief of Radiology Unit and Vice Director of Department of Digestive Disease – Sant’Orsola Malpighi Hospital - Bologna
Dr. Francesco Modestino – Interventional Radiologist – Sant’Orsola Malpighi Hospital - Bologna

Top