An alternative technique of the superselective catheterization of the ophthalmic artery for intra-arterial chemotherapy of the retinoblastoma: retrograde approach through the posterior communicating artery to the ophthalmic artery

Abstract

Introduction: Superselective intra-arterial chemotherapy (IAC) in retinoblastoma has recently become a popular treatment option. In this study, we purposed to investigate the effectiveness of the technique of "retrograde approach through the posterior communicating artery to the ophthalmic artery (OA)" for IAC.

Methods: A total of 12 unilateral retinoblastomas were treated with IAC in 29 sessions from October 2011 to November 2013. Of the 12 patients, 6 were male and 6 were female, with ages ranging from 12 to 72 months with a median age of 27.6 months. Left-to-right ratio for affected eye was 6/6. In the first 4 patients, we used the ipsilateral internal carotid artery (ICA) to reach the OA of the affected globe (10 sessions). Then, we used the vertebral artery, basilary artery, ipsilateral/contralateral P1 segment of the posterior cerebral artery, and ipsilateral/contralateral posterior communicating artery, respectively, to reach inside the OA at next 15 sessions.

Results: At ipsilateral approach, fluoroscopy total time ranged from 16 to 34 min (mean 21.5 min), and the angle between ophthalmic segment of the ICA and proximal segment of the OA was ranged between 34° and 77° with an average angle of 53.4°. At retrograde approach, fluoroscopy total time ranged from 3 to 12 min (mean 7.5 min), and the angle between ophthalmic segment of the ICA and proximal segment of the OA was ranged between 147° and 178° with an average angle of 148.3°.

Conclusion: Retrograde approach makes the IAC procedure easier in retinoblastoma patients and shortens the fluoroscopy time.