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Gastric Artery Embolization with X-ray-visible Embolic Beads and C-arm Cone Beam CT for Increased Accuracy Clifford R. Weiss MD 1, Paul DiCamillo MD PhD.

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Presentation on theme: "Gastric Artery Embolization with X-ray-visible Embolic Beads and C-arm Cone Beam CT for Increased Accuracy Clifford R. Weiss MD 1, Paul DiCamillo MD PhD."— Presentation transcript:

1 Gastric Artery Embolization with X-ray-visible Embolic Beads and C-arm Cone Beam CT for Increased Accuracy Clifford R. Weiss MD 1, Paul DiCamillo MD PhD 2, Weijie Beh 3,Tza-Huei Wang PhD 4, Hai-Quan Mao PhD 5, Dara L. Kraitchman VMD PhD 2,6 (1)Radiology/Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine (2) Radiology, The Johns Hopkins University School of Medicine (3) Biomedical Engineering, The Johns Hopkins University School of Medicine (4) Mechanical Engineering, The Johns Hopkins University Whiting School of Engineering (5) Materials Science, The Johns Hopkins University Whiting School of Engineering (6) Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine

2 What you’ve just learned! No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

3 What you’ve just learned!

4 Gastroenterology and Endoscopy News: April 2008 | v: 59:04

5

6 What you’ve just learned! Paxton et al, SIR 2012

7 Weight change after bariatric embolization % wt gain % wt loss (relative to untreated animals) Week 4Week 7 untreated Bariatric embolization Paxton et al, SIR 2012

8 Challenges Facing Embolic Therapy Complicated Vascular Anatomy Non-target embolization to spleen / liver / esophagus / pancreas / intestine or “non-fundal” portions of stomach

9 Challenges Facing Embolic Therapy

10 +

11 KNOW WHERE WE’VE BEEN BETTER SEE WHERE WE’RE GOING

12 CT using Conventional Angiography C-arm Cone Beam CT (CBCT) C-arm Cone Beam CT (CBCT) Flat panel angiography 8 s acquisition

13 Barium-sulfate Alginate Check Valve Oleic Acid IPA/ Ca Cl 2 Ca 2+ Prototype Microfluidic Device P alginate >P valve >P oil

14 X-Ray Visible Embolic Beads (XEB) Microfluidic Device Size determined by nozzle size & flow rate Pressurized system prevents clogging of nozzles at high generation rates Scale up by parallelization of device allows production of microbeads at rates of ~1 kHz.

15 XEB Generation

16 SEM of XEBs

17 Fundal Anatomy and Arterial Map

18 Beads: Fabrication Custom made, barium sulfate containing, highly uniform alginate beads (~50 μm) served as the embolic agent in this study. Made with microfluidic devices with pressure controlled flow rates for uniform production

19 Post-embolization CBCT DSA Pre-embolization DSA CBCT Overall Approach Celiac DSA Pathology/Histology Directly Visualized Embo C-Arm Cone Beam CT (CBCT) : DynaCT: AXIOM Artis dFA (Siemens Healthcare, Forchheim, Germany) 8s DSA or DR, 210° rotation, 0.5°/ step, contrast 25% iohexal Repeat for each site

20 Celiac Axis GACE 1, Series 3

21 Approach to Site 1: Avoiding Reflux to Spleen

22 “Fundal Branch” Embolization Pre-embolization Post-embolization

23 Beads are Visible During Delivery

24 GACE 1, Series 7,19, 29 Sagittal Coronal Axial Site 1: C-arm Cone Beam CT Pre Contrast Post

25 “Fundal Branch” CBCT “Fundal Branch” CBCT Pre Contrast Post GACE 1, Series 7,19, 29 Sagittal Coronal Axial

26 “Fundal Branch” CBCT Post Embolization

27 Site 1: Bead are Visible During Delivery GACE 1, Series 11 DSA with beads at 3 frames per second

28 GACE 1, Series 20, 21 Left Gastric?

29 Site 2: C-Arm Cone Beam CT 8 s C-arm CBCT, 25% iohexal at 1cc/sec

30 Right Gastric Embolization Pre Embolization Post Embolization

31 Embolization at Site 3 Pre Embolization Post Embolization DSA with 25% iohexal at 6 frames per second

32 Right Gastric CBCT Right Gastric CBCT Pre Contrast Post S agittal C oronal Axial

33 Procedure Summary S agittal C oronal A xial PrePost “FB” Post RG N= 3 swine

34 CBCT Post Embolization

35 Return to Site #2 to Find Left Gastric

36 Gross Pathology

37 2x 10x Fundus

38 Body 2x 10x

39 Conclusions Combination of XEB and CBCT allows the interventional radiologist to: Better see where they are going See where they have been Allows for complete fundal embolization Better assessment of treatment successes and failures Should allow for “long term” Allow Interventional Radiologist to determine if re-embolization is needed

40 Broader Implications Not only promising for improving Bariatric Arterial Embolization (BAE/BE) Current embolic therapy is growing market: –Hepatocellular Carcinoma –Other Tumors –Uterine Fibroids –Bronchial Artery Embolization


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