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  • Absorbable gelatin compressed sponge (Gelfoam) embolization of distal external carotid artery branches in intra-arterial chemotherapy for retinoblastoma

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New devices and techniques
Case series
Absorbable gelatin compressed sponge (Gelfoam) embolization of distal external carotid artery branches in intra-arterial chemotherapy for retinoblastoma
  1. Fouad Georges Akkari1,
  2. Christina Stathopoulos2,
  3. Francesco Puccinelli1,
  4. Steven D Hajdu1,
  5. Maja Beck-Popovic3,
  6. Francis L Munier2,
  7. Guillaume Saliou1,
  8. Bruno Bartolini1
  1. 1 Interventional Neuroradiological Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  2. 2 Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
  3. 3 Unit of Pediatric Hematology-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  1. Correspondence to Dr Fouad Georges Akkari, Department of Interventional and Diagnostic Neuroradiology, CHUV, Lausanne, 1011, Switzerland; fouad.g.akkari{at}hotmail.com

Abstract

Background In intra-arterial chemotherapy for retinoblastoma, a backflow from unreachable external carotid artery branches in the ophthalmic artery can be challenging.

Objective To describe a new endovascular technique using Gelfoam pledgets to temporarily occlude distal branches of the external carotid artery to reverse the competitive backflow into the ophthalmic artery in order to perform intra-arterial chemotherapy via the ostium of the ophthalmic artery in selected cases.

Methods We queried our prospectively collected database of 327 consecutive patients treated for retinoblastoma by intra-arterial chemotherapy and identified those employing Gelfoam pledgets. We describe this new technique with emphasis on feasibility and safety.

Results We treated 11 eyes with 14 infusions of intra-arterial chemotherapy using Gelfoam pledgets to occlude the distal branches of the external carotid artery. We report no perioperative complications due to this occlusion technique. At the ophthalmologic follow-up 1 month after the injection of Gelfoam pledgets, all cases showed tumor regression or stable disease. Two injections into the same eye as the rescue intra-arterial chemotherapy infusion resulted in a transient exudative retinal detachment, and one injection in a heavily pretreated case was followed by iris neovascularization and retinal ischemia. None of the pledget injections led to irreversible vision-threatening intraocular complications.

Conclusions Intra-arterial chemotherapy in retinoblastoma using Gelfoam to transiently occlude the distal branches of the external carotid artery and reverse the backflow into the ophthalmic artery seems feasible and safe. Larges series will help to confirm the effectiveness of this new technique.

  • Blood Flow
  • Drug
  • Embolic
  • Orbit
  • Pediatrics

https://doi.org/10.1136/jnis-2023-020206

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    Footnotes

    • Contributors FGA, CS, GS, and BB: drafted the article or revised it critically for important intellectual content. All authors: final approval of the version to be submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.