Adjunctive techniques for optimization of ocular hemodynamics in children undergoing ophthalmic artery infusion chemotherapy.
PURPOSE
To develop a reproducible technique for selective ophthalmic artery infusion chemotherapy (SOAIC) that is technically efficacious in children with unfavorable patterns of ophthalmic artery (OA) flow.


MATERIALS AND METHODS
Initially, all SOAIC was performed with intention to treat using a standard selective OA (microcatheter) infusion technique (sSOAIC). Temporary balloon occlusion (TBO) of the external carotid artery (ECA), a balloon-assisted SOAIC (bSOAIC) technique, was performed only if OA angiography did not show robust and sustained anterograde OA flow. In our more recent experience, all SOAIC was performed with intention to treat by bSOAIC. Verapamil infusion into the OA and internal carotid artery was performed in selected cases. Technical success was defined as delivery of chemotherapeutic agent(s) into the OA with robust and sustained anterograde perfusion. sSOAIC was considered to have failed if converted to bSOAIC.


RESULTS
19 eyes were treated in 17 patients (age 5 months to 16 years) between December 2008 and May 2013. Eighty-three procedures were undertaken and the OA was successfully catheterized in all. Technical success was achieved in 35/41 (85%) sSOAIC cases and 42/42 (100%) bSOAIC cases. TBO of the ECA augmented anterograde OA flow and converted all cases of retrograde OA flow to anterograde. Verapamil further augmented anterograde ocular perfusion during SOAIC. There were no access site complications, strokes, or deaths.


CONCLUSIONS
TBO of the ECA is a safe, effective, and reproducible method for optimizing ocular hemodynamics during SOAIC regardless of baseline OA flow pattern. Verapamil infusion may further favorably modify OA flow.


TRIAL REGISTRATION NUMBER
NCT01466855.
['Abruzzo|Todd A|TA|', 'Geller|James I|JI|', 'Kimbrough|Dale A|DA|', 'Michaels|Samantha|S|', 'Corrêa|Zélia M|ZM|', 'Cornell|Kevin|K|', 'Augsburger|James J|JJ|']
D000293:Adolescent D000970:Antineoplastic Agents D021721:Balloon Occlusion D002342:Carotid Artery, External D002343:Carotid Artery, Internal D002648:Child D002675:Child, Preschool D005134:Eye Neoplasms D005260:Female D006801:Humans D007223:Infant D007261:Infusions, Intra-Arterial D008297:Male D009880:Ophthalmic Artery D017063:Outcome Assessment, Health Care D011859:Radiography D012175:Retinoblastoma D014665:Vasodilator Agents D014700:Verapamil
Balloon Blood Flow Drug Malignant Pediatrics