Pressure-Enabled Drug Delivery in HCC & Metastatic Liver Lesions

Timestamps

1. 00:00Introduction
2. 01:39The Tumor Microenvironment
3. 06:59Pressure-Enabled Drug Delivery Explained
4. 09:37Technical Aspects of Pressure-Enabled Catheters
5. 21:48Case 1: Grade 3 Neuroendocrine Tumor
6. 34:06Case 2: Hepatocellular Carcinoma with Tumor and Vein
7. 36:01Case 3: TACE for Segmental HCC in Decompensated Cirrhosis
8. 38:58Case 4: Large Heterogenous Cholangiocarcinoma
9. 40:40Case 5: Lobar Neuroendocrine Tumor
10. 42:38Case 6: Segmental HCC with Central Necrosis
11. 47:52Best Practices and Technical Considerations
12. 57:52Future Directions in Pressure-Directed Embolotherapy
13. 59:48Conclusion and Final Thoughts

More about this episode

The conversation begins with an overview of the tumor microvascular environment, focusing on the abnormal nature of the new vessels that feed tumors. They then discuss the genesis of pressure-enabled drug delivery and the theory behind its efficacy. Dr. Berman explains the TriNav catheter’s micro-valve design, its anti-reflux properties, and how these features enhance tumor drug delivery. He walks through his own procedure technique, comparing and contrasting it to standard embolization, and details the utility of pressure-enabled drug delivery in lobar radioembolization and larger tumors. They also explore the benefits of both balloon occlusion and microvalve catheters. Real-world cases—including neuroendocrine tumors, segmental HCC, and more—illustrate the thought process around when to use specialized technologies. The episode wraps up with a discussion of the future implications for this technology in other pathologies, cost considerations, and the potential for enhancing drug delivery with innovative approaches.