Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol.

Purpose: To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total).
Methods: IRB-approved retrospective review of all patients undergoing SIROS injection of y90 Sir-Spheres via TruSelect from 2019 through 2022 at one quaternary-care academic institution, including medical records.
Results: Included were 48 infusions in 25 patients across 11 cancer histologies. Mean planned, delivered, and residual activities were 28 ± 17, 27 ± 17, 1.1 ± 0.56 mCi respectively (mean residual 4.9% ± 2.8%) across flex-dosing precalibrations including 1-day, 2-day, and 3-day SIROS (4/51, 16/51, and 28/51). Mean liver treatment volume was 483 ± 306 ml with target dose mean of 128 ± 26 Gy in non-segmentectomy cases; Radiation segmentectomy was performed in 15/48 (31%). Arterial stasis was documented in 9/48 (19%) of cases. Use of a 3-day precalibrated SIROS dose, use of activity <10 mCi, treatment of smaller liver volumes (<200 ml) and documentation of stasis were associated with higher residual activity ( P  = 0.025, P  = 0.0007, P  = 0.0177, and P  = 0.049, respectively) were associated with higher residuals.
Conclusion: Combining the new technologies of SIROS and the Truselect microcatheter with a double-flush protocol yielded <10% residual in 94% of y90 infusions. Future studies may clarify if the predictors of high residual dose seen here may warrant microcatheter-specific considerations for dosimetry or dose preparation at the Radiopharmacy level.
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