In Vitro Investigation of Microcatheter Behavior During Microsphere Injection in Transarterial Radioembolization

Tess Josien Snoeijink; Jan Lucas van der Hoek; Hadi Mirgolbabaee; Tristan Gerard Vlogman; Joey Roosen; Johannes Frank Wilhelmus Nijsen; Erik Groot Jebbink

doi:10.1177/15266028251318953

In Vitro Investigation of Microcatheter Behavior During Microsphere Injection in Transarterial Radioembolization

J Endovasc Ther. 2025 Feb 24:15266028251318953. doi: 10.1177/15266028251318953. Online ahead of print.

Authors

Tess Josien Snoeijink^{1

2}, Jan Lucas van der Hoek², Hadi Mirgolbabaee^{2

3}, Tristan Gerard Vlogman⁴, Joey Roosen¹, Johannes Frank Wilhelmus Nijsen¹, Erik Groot Jebbink²

Affiliations

¹ Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
² Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
³ Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
⁴ Department of Thermal and Fluid Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands.

PMID: 39989304
DOI: 10.1177/15266028251318953

Abstract

Purpose: To experimentally investigate the behavior of a clinically used microcatheter during transarterial radioembolization (TARE) microsphere injection in a successively bifurcating in vitro model.

Materials and methods: A symmetrical phantom was developed which bifurcated 3 times into 8 outlets. A blood-mimicking fluid was pumped through the phantom using a physiological representative waveform. Holmium-165 microspheres were injected in a pulsed manner at 3 different locations using a standard microcatheter and a rigid counterpart with same dimensions as a control. Motion of the catheter was studied with a top- and side-view camera on the phantom. Microspheres were collected at each outlet and their distribution over the 8 outlets was analyzed.

Results: Due to the pulsatile flow in the phantom, strengthened by the pulsatile microsphere injection, the clinical catheter showed maximum displacements of 0.87 mm within a vessel with a diameter of 3.6 mm. This motion resulted in a different microsphere distribution for the clinical catheter compared with the rigid counterpart (75.9% vs 49.4% of the microspheres went to outlet 1-4, respectively).

Conclusion: In this in vitro model, the motion of the clinical catheter affected distribution of microspheres. Since the pulsatile administration of microspheres resulted in increased motion of the clinical catheter, standardizing microsphere administration could be beneficial to reduce interprocedural differences in TARE.

Clinical impact: Our study demonstrated that microsphere distribution during transarterial radioembolization (TARE) is affected by catheter motion. Furthermore, increased catheter motion was observed as a result of the injection profile. Predictive tools such as the contrast CBCT and scout dose use different injection profiles compared to therapeutic TARE injections, potentially altering catheter tip behaviour and microsphere distribution, which could compromise their predictive values. Additionally, current TARE microsphere injection guidelines provide limited details, which may lead to variability across institutes and interventional radiologists. Standardizing injection techniques could reduce catheter motion variability and may facilitate more consistent and predictable microsphere distribution patterns.

Keywords: TARE; distribution; in vitro; microspheres; radioembolization.