Episode # 657 • 23 Jun 2026
Advanced Techniques in Y90 Cancer Treatment
What do you do when Y-90 doesn’t deliver the results you expected? In this episode of the 2026 HCC Creator Weekend™, host Dr. Tyler Sandow is joined by Drs. Beau Toskich and Juan Gimenez to discuss the technical challenges and troubleshooting strategies that can make or break a Y-90 radioembolization case. Together, they explore innovative approaches like the PREDATr technique, share tips for reducing complications, and offer guidance on optimizing outcomes for patients with complex liver tumors.
This podcast is supported by an educational grant from Sirtex and Boston Scientific.
Timestamps
00:00 - Introduction
04:24 - Treatment Nonresponse Troubleshooting
06:12 - Navigating Y90 Through Replaced Arteries
09:09 - Mitigating Vasospasm in Embolization
13:31 - What is ‘PREDATr’?
21:12 - Dual Balloon Microcatheter System
23:37 - Gelfoam Techniques and Application
26:06 - Embolization Agents Preferences
36:16 - Concerns with Cystic Artery Treatment and Biliary Stents
42:15 - Prophylactic Antibiotics
44:29 - Utilizing High Lung Shunts
49:28 - Wrap Up and Credits
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More about this episode
The conversation begins with case-based examples of HCC radioembolization, focusing on how to assess treatment response and troubleshoot nonresponsive cases. They discuss how to interpret SPECT findings, identify missed tumor supply with cone-beam CT, and overcome obstacles such as vasospasm, extrahepatic feeders, and challenging arterial anatomy. They introduce the PREDATr technique (proximal radioembolization enabled by distal angiozone truncation) and explain how tools like gelfoam, balloons, and retrievable coils can preserve healthy liver tissue and improve microsphere delivery. The episode also addresses managing biliary stents, using antibiotic prophylaxis, and strategies for handling high lung shunts, making it a practical resource for anyone navigating the complexities of Y-90 treatment.
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