Gastric Artery Embolization with X-ray-visible
Embolic Beads and C-arm Cone Beam CT for
Increased Accuracy
Clifford R. Weiss MD1, Paul DiCamillo MD PhD2, Weijie
Beh3,Tza-Huei Wang PhD4, Hai-Quan Mao PhD5, Dara
L. Kraitchman VMD PhD2,6
(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
What you’ve just learned!
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
What you’ve just learned!
What you’ve just learned!
Gastroenterology and Endoscopy News: April 2008 | v: 59:04
What you’ve just learned!
Paxton et al, SIR 2012
Weight change after bariatric embolization
(relative to untreated animals)
6%
% wt
gain
4%
2%
Week 4
0%
% wt
loss
Week 7
untreated
-2%
-4%
-6%
Bariatric
embolization
-8%
-10%
-12%
Paxton et al, SIR 2012
Challenges Facing Embolic Therapy
• Complicated Vascular
Anatomy
• Non-target embolization
to spleen / liver /
esophagus / pancreas /
intestine or “non-fundal”
portions of stomach
Challenges Facing Embolic Therapy
Challenges Facing Embolic Therapy
+
Challenges Facing Embolic Therapy
BETTER SEE WHERE
WE’RE GOING
KNOW WHERE WE’VE BEEN
CT using Conventional Angiography
C-arm Cone
Beam CT
(CBCT)
• Flat panel
angiography
• 8 s acquisition
Palginate>Pvalve>Poil
Oleic Acid
Prototype
Microfluidic
Device
Check Valve
Barium-sulfate
Alginate
Ca2+ Ca2+
Ca2+
Ca2+
Ca2+
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.
SEM of XEBs
Fundal Anatomy and Arterial Map
Overall Approach
Pre-embolization
Celiac DSA
DSA
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
CBCT
Directly Visualized Embo
Repeat for each site
Post-embolization
CBCT
DSA
Pathology/Histology
Celiac Axis
“Fundal Branch” Embolization
Pre-embolization
Post-embolization
Beads are Visible During
Delivery
“Fundal Branch” CBCT
Sagittal
Coronal
Axial
Pre
Contrast
Post
“Fundal Branch” CBCT
Post Embolization
Left Gastric?
Right Gastric Embolization
Pre Embolization
Post Embolization
Right Gastric CBCT
Sagittal
Coronal
Axial
Pre
Contrast
Post
Procedure Summary
Post “FB”
Post RG
Sagittal
Coronal
Axial
Pre
N= 3 swine
CBCT Post Embolization
Return to Site #2 to Find Left Gastric
Gross Pathology
Fundus
2x
10x
Body
2x
10x
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
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