Clinical Diagnosis
An 82-year-old male with cryptogenic cirrhosis presented for locoregional therapy of an HCC detected on recent MRI.

Anatomy
The tumor was a 2.2 cm HCC located in segment 3. The patient was initially treated with QuadraSpheres®(Merit Medical) with no significant response. Given its significant portal shunting related to branch portal invasion (visible on initial angiogram), the decision was made to attempt IRE (Irreversible Electroporation) in this location. Thermal ablation was thought to be potentially less effective given its close proximity to large vascular structures. Pre-IRE angiogram was planned for the purpose of Lipiodol® staining to improve targeting under CT guidance. The Surefire® Infusion System ST device was chosen for infusion to improve Lipiodol uptake in the tumor and to prevent reflux of embolic material into the GDA and right gastric artery.

Treatment Plan
Bland Lipiodol embolization with Surefire into the LHA for targeting purposes followed by IRE. A 5 French hydrophilic Terumo glide sheath was introduced through the left radial artery. Celiac access was gained with a 5 French Envoy MPD 100cm guide catheter (Codman Neurovascular). The Surefire ST was advanced over a 0.016” Fathom Guidewire (Boston Scientific) to gain access to the left hepatic artery. The Surefire expandable tip was deployed in the left hepatic artery, and 100% of the intended infusion was achieved.

Target vessel diameter

5mm

Infusion
Lipiodol and 900 micron Embozene® Microspheres (CelaNova Biosciences)

Outcome
An IRE was performed the day after embolization. One month post IRE demonstrated significant lesion necrosis.