Prophylactic embolization of the cystic artery before radioembolization: feasibility, safety, and outcomes

Cardiovasc Intervent Radiol. 2011 Aug;34(4):786-92. doi: 10.1007/s00270-010-0021-x. Epub 2010 Nov 11.


Purpose: To evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization.

Materials and methods: Forty-six patients had cystic artery embolization performed immediately before yttrium-90 radioembolization, either by using Gelfoam pledgets (n = 35) or coils (n = 11). Clinical symptomatology during the admission and angiographic findings at 1-month follow-up were retrospectively reviewed. Rates of collateralization or recanalization of the cystic artery were compared, as well as the frequency of postprocedural abdominal pain and need for cholecystectomy.

Results: Technical success was achieved in all patients, and there were no procedural complications related to cystic artery embolization. Of the 11 coil-embolized patients, 5 (45%) demonstrated collateralization of the cystic artery at 1 month, and 1 (9%) demonstrated recanalization of the cystic artery. Of the 35 Gelfoam-embolized cases, 2 (6%) had collateralized at 1 month, and 14 (40%) had recanalized. Two patients (one from each group) had self-limited right upper quadrant pain after the procedure, and one patient in the coil embolization group required cholecystectomy.

Conclusion: Proximal cystic artery embolization is safe and feasible and may be performed during liver-directed embolotherapy to minimize the exposure of the gallbladder to particulate, chemoembolic, or radioembolic agents.

MeSH terms

  • Adult
  • Aged
  • Angiography
  • Carcinoma, Hepatocellular / blood supply
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / therapy*
  • Colorectal Neoplasms / therapy*
  • Embolization, Therapeutic / methods*
  • Feasibility Studies
  • Female
  • Gallbladder / blood supply*
  • Gallbladder / radiation effects*
  • Humans
  • Liver / blood supply
  • Liver Neoplasms / blood supply
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Radiation Injuries / prevention & control*
  • Retrospective Studies
  • Treatment Outcome
  • Yttrium Radioisotopes / administration & dosage*
  • Yttrium Radioisotopes / adverse effects


  • Yttrium Radioisotopes