Abstract 186: Intra-Arterial Chemotherapy Opens New Horizons to Neurointerventional Surgeons
Introduction: Intra-arterial chemotherapy (IAC) consists of delivering chemotherapeutic agents precisely into tumor vessels, minimizing systemic toxicity. At our institution, we have utilized this technique to treat children with advanced and extensive retinoblastomas. We assess the safety and efficacy of IAC in a large series of patients, with special emphasis on technique-related complications.
Methods: Between 2010 and 2012, a total of 151 IAC procedures were performed at our institution. The ostium of the ophthalmic artery was superselectively catheterized followed by injection of chemotherapeutic agents in a pulsatile fashion over 30 minutes. Patients were closely observed post-operatively and discharged the same day. Data on procedural safety were prospectively collected.
Results: Catheterization was successful in 98% of the procedures. Technical complications occurred only in 2 cases (1.3%). One patient with anomalous internal carotid artery had a severe spasm during cannulation and the procedure was aborted. He remained neurologically intact post-operatively. Another patient had two asymptomatic tiny foci of diffusion restriction on cerebral magnetic resonance imaging. No patient developed a retroperitoneal hematoma, acute limb ischemia, carotid dissection, or intracerebral hemorrhage. Tumor response was found in 88% of cases with globe salvage in 67%. There was no incident of metastasis, secondary tumor, or death.
Conclusion: With proper technique and instrumentation, IAC can be performed with a technical complication rate as low as 1.3% and a morbidity rate of 0%. Our successful experience with IAC opens new horizons to Neurointerventional Surgeons involved in the care of patients with intracranial malignancies.
- © 2012 by American Heart Association, Inc.