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Clinical Case Study
#10
LC BeadM1 used for the treatment of a 6cm
HCC via a single artery with concurrent treatment
of a second artery supplying the same tumor
with LC Bead 100-300μm diameter microspheres
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Nathan W Ertel, MD
University of Alabama at Birmingham
Presentation
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A 60-year-old male Cambodian immigrant with a history of Hepatitis B,
Hepatitis C, alcoholism as well as multiple additional comorbidities presented
initially to an outside hospital. An MRI in October 2012 demonstrated an
irregularly enhancing lesion in segment V with a pseudocapsule and foci of
washout. The patient was referred to our facility for further evaluation. The
patient was a Child-Pugh class B-7 with an ECOG performance status of 1.
Our multidisciplinary hepatic tumor conference concurred with the diagnosis
of hepatocellular carcinoma and recommended embolization with LC Bead .
Unfortunately the patient declined any treatment at that time. He returned
in May 2013 at which time a repeat MRI demonstrated interval growth of
the lesion. Embolization was then performed.
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Image 1. Pre-treatment T1 weighted MRI
with contrast demonstrates a moderate size
hypervascular tumor in the right hepatic lobe
Treatment
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The right common femoral artery was accessed and a Simmons 1
catheter was advanced into the aorta. Superior mesenteric arteriography
demonstrated patency of the portal system without hepatic supply. Celiac
arteriography demonstrated a 6cm hypervascular lesion in the right hepatic
lobe consistent with the lesion seen on MRI. Two moderate size arteries
provided all of the visible arterial supply to the tumor. The more inferior
branch was catheterized using a super-selective approach. Arteriography
demonstrated that this vessel supplied the inferior/medial half of the lesion.
Embolization was performed from this location with one vial of LC BeadM1
(70-150 micron diameter beads) mixed with 10ml non-ionic contrast.
The artery was embolized to near stasis with one entire vial. The second artery
supplying the lesion was then catheterized using a super-selective approach.
Arteriography demonstrated that this vessel supplied the superior/lateral
half of the lesion. Embolization was performed from this location with
LC Bead 100-300 micron diameter beads mixed with 10ml non-ionic contrast.
The near stasis endpoint was achieved after injection of 2-3ml of the beadcontrast solution.
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Image 2. Angiography from the proper hepatic
artery demonstrates the hypervascular lesion
supplied from branches of both the anterior and
posterior divisions of the right hepatic artery.
Embolization was performed from the posterior
division with LC BeadM1®. Embolization was
performed from the horizontal branch of the
anterior division supplying the tumor with
LC Bead® 100-300 micron diameter beads
Imagine where we can go.
Clinical Case Study
#10
Outcome
•Post-treatment MRI demonstrated a tiny focus of residual enhancement in the
posterior-lateral portion of the lesion Unfortunately, a small distant satellite
lesion had also developed. Both lesions were subsequently ablated successfully.
Conclusion
• this patient, two similar arteries supplied roughly equivalent arterial
In
supply to a single 6cm HCC lesion. One of the arteries was embolized with
an entire vial of LC BeadM1 . The other artery was embolized to the same
near stasis endpoint, but required only 2-3ml of the LC Bead 100-300 micron
diameter beads. The portion of the lesion treated with LC BeadM1 beads
achieved complete resolution, while the portion treated with LC Bead
100-300 micron diameter beads had a small amount of residual disease.
This case demonstrates increased efficacy of LC BeadM1 for super-selective
embolization. This effect is likely due to a combination of two factors:
(1) LC BeadM1 allowed for embolization of the entire vial of beads, and
(2) LC BeadM1 embolized more distally, increasing ischemia, and increasing
tumor infarction.
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Image 3. Post-treatment T1 weighted MRI post
contrast demonstrates a small amount of residual
enhancement in the superior/lateral portion of the
tumor. The remainder of the tumor is necrotic
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Nathan W Ertel, MD
Physician Profile
• A
cademic Appointment: Assistant Professor, Department of Radiology Director of Operations,
Section of Interventional Radiology, UAB School of Medicine
• Fellowship: Thomas Jefferson Hospital
• Residency: Pennsylvania Hospital, Chief Resident
Ordering Information:
LC BeadM1®
Product Name
Label Color and Size
70-150µm
Volume of Beads
2ml
For more information or to order, please contact:
Biocompatibles, Inc., Five Tower Bridge, Suite 810, 300 Barr Harbor Drive, West Conshohocken, PA, 19428 USA
Phone:
(877) 626-9989
Fax:
(877) 626-9910
Email:
[email protected]
www.btg-im.com
VE020GS
Product Code
LC Bead® and LC BeadM1® Indications:
LC Bead and LC BeadM1 are intended to be used for the embolization of
hypervascular tumors and arteriovenous malformations (AVMs).
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Cautions:
• Do not use if the vial or packaging appear damaged
• Sterile and single use product. Do not reuse
• Select the size and quantity of LC Bead or LC BeadM1 microspheres appropriate
for the pathology to be treated
• Ensure that LC BeadM1 is an appropriate size for the intended vasculature
• Monitor patients carefully for signs of non-target embolization such as hypoxia
or CNS changes
• Consider upsizing LC BeadM1 if angiographic evidence of embolization does
not appear quickly during delivery
For instructions for use, please refer to www.lcbead.com/ifu and
www.lcbeadm1.com/ifu
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LC Bead® and LC BeadM1® are manufactured by Biocompatibles UK Ltd, Chapman
House, Farnham Business Park, Weydon Lane, Farnham, Surrey, GU9 8QL, UK.
LC Bead® and LC BeadM1® are trademarks of Biocompatibles UK Ltd. BTG and the BTG
roundel logo are registered trademarks of BTG International Ltd. Biocompatibles, Inc.
and Biocompatibles UK Ltd are BTG International group companies. © Copyright 2015
Biocompatibles UK Ltd. US-LCBM1-2013-0624a(1).
Embolization with LC Bead and LC BeadM1 microspheres should only be performed
by physicians who have received appropriate interventional occlusion training in the
region intended to be embolized
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Potential Complications:
1. Undesirable reflux or passage of LC Bead or LC BeadM1 into normal arteries
adjacent to the targeted lesion or through the lesion into other arteries or arterial beds,
such as the internal carotid artery, pulmonary, or coronary circulations
2. Non-target embolization
3. Pulmonary embolization
4. Ischemia at an undesirable location
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5. Capillary bed saturation and tissue damage
6. Ischemic stroke or Ischemic infarction
7. Vessel or lesion rupture and hemorrhage
8. Neurological deficits including cranial nerve palsies
9.Vasospasm
10. Death
11.Recanalization
12. Foreign body reactions necessitating medical intervention
13. Infection necessitating medical intervention
14. Clot formation at the tip of the catheter and subsequent dislodgement
Caution:
Federal (USA) law restricts this device to sale by or on order of a physician.
Imagine where we can go.