5:27 PM, Abstract No. 239 - Yttrium-90 infusion: incidence and outcomes of delivery system occlusions

To evaluate the incidence, cause, and management of delivery system occlusions during Yttrium-90 (90Y) microsphere infusions and identify techniques to prevent occlusions. We retrospectively reviewed 886 consecutive radioembolization deliveries in 498 patients (mean age 65 years, 299 male) performed between June 2001 and July 2013 at a single academic tertiary care hospital. Procedural details about occlusion events were reviewed in detail. Statistical analysis assessed association between catheter occlusions and patient and procedural characteristics. Eleven occlusions occurred during 886 90Y microsphere deliveries (1.2%). Five occlusions were associated with contained leakage of radioactive material and 1 with a spill. All but one patient completed their treatment the same day, five requiring repeat catheterization. One patient returned a week later to complete treatment. Significantly higher number of occlusions occurred with deliveries of resin (11/492; 2.2%) versus glass (0/394; 0%) microspheres (p=0.002). Occlusions were more likely to occur within the proximal portion of the delivery apparatus (p=0.002). There was no significant relationship to any patient characteristics, and there was no improvement with operator experience. The most common cause of occlusion was resin microsphere delivery device failure. As a result, this delivery device has undergone design modifications. 90Y microsphere delivery device occlusion is uncommon, but does occur with resin microspheres. Understanding causes and how to troubleshoot can limit the incidence and detrimental effects and has led to design improvements.