Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Hepatocellular carcinoma (HCC) is a malignant tumor that commonly affects cirrhotic patients. For tumors with a Barcelona Clinic Liver Cancer (BCLC) stage B, locoregional therapy is the mainstay of treatment. Transarterial chemoembolization (TACE) utilizes the hepatic arterial network in localizing chemotherapy to the HCC. 80% of HCC cases are primarily supplied by the hepatic artery and most have extrahepatic collaterals from the inferior phrenic artery. This is the first reported case where the gastroduodenal artery (GDA) was the primary and sole blood supply to the HCC. The patient's levels for AST, ALT, hemoglobin, bilirubin, albumin, PT/INR, and platelets were all within normal range. The initial MRI showed a single exophytic tumor located on the caudate lobe. According to the BCLC staging system, the tumor was determined to be in the intermediate stage and TACE was considered to be the appropriate treatment. The right gastroepiploic artery was first occluded with detachable coils. Subsequently, a 150 cm straight 2.9FrSniper balloon microcatheter was introduced into the proximal GDA. TACE was performed using balloon occlusion to redirect blood flow away from the feeder arteries to the duodenum and into the blood supply to the tumor. One-month follow-up MRI scans showed reduction in the size of the HCC.