Ep. 564 Pressure-Enabled Drug Delivery in HCC & Metastatic Liver Lesions with Dr. Zach Berman

Ep. 564 Pressure-Enabled Drug Delivery in HCC & Metastatic Liver Lesions with Dr. Zach Berman

Can you manipulate blood flow in the tumor microenvironment to optimize drug delivery? In this episode of the BackTable Podcast, interventional oncologist Dr. Zachary Berman (UC San Diego) joins host Dr. Christopher Beck to discuss real-world applications of pressure-enabled drug delivery in locoregional liver-directed therapies like TACE and Y90.---This podcast is supported by:TriSalus Life Scienceshttp://trinavinfusion.com/---SYNPOSISThe 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.---TIMESTAMPS00:00 - Introduction01:39 - The Tumor Microenvironment06:59 - Pressure-Enabled Drug Delivery Explained09:37 - Technical Aspects of Pressure-Enabled Catheters21:48 - Case 1: Grade 3 Neuroendocrine Tumor34:06 - Case 2: Hepatocellular Carcinoma with Tumor and Vein36:01 - Case 3: TACE for Segmental HCC in Decompensated Cirrhosis38:58 - Case 4: Large Heterogenous Cholangiocarcinoma40:40 - Case 5: Lobar Neuroendocrine Tumor42:38 - Case 6: Segmental HCC with Central Necrosis47:52 - Best Practices and Technical Considerations57:52 - Future Directions in Pressure-Directed Embolotherapy59:48 - Conclusion and Final Thoughts---RESOURCESJVIR 2024 Jaroch et al.:https://pubmed.ncbi.nlm.nih.gov/38969336/

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Ep. 517 Complex HCC Patients and the "Grey Zone": What to Do When You Don’t Know What to Do

Ep. 517 Complex HCC Patients and the "Grey Zone": What to Do When You Don’t Know What to Do

Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage ...

14 Helmi 202539min

Ep. 516 Dialysis Procedures: New Tools for Better Outcomes with Dr. Ari Kramer and Dr. Omar Davis

Ep. 516 Dialysis Procedures: New Tools for Better Outcomes with Dr. Ari Kramer and Dr. Omar Davis

Given the challenges that our dialysis patients face, how can we as providers stay sharp with the latest access techniques to help ensure the best possible outcomes? Dr. Omar Davis (interventional nep...

11 Helmi 20251h 12min

Ep. 515 Curative Intent Therapies for HCC: Today and Tomorrow

Ep. 515 Curative Intent Therapies for HCC: Today and Tomorrow

For hepatocellular carcinoma (HCC) patients who are not candidates for liver transplant or resection, lesion ablation can be a curative treatment. With multiple ablation options available and still un...

7 Helmi 202552min

Ep. 514 Deep Sedation in IR: Intro to Ketamine with Dr. Amy Deipolyi

Ep. 514 Deep Sedation in IR: Intro to Ketamine with Dr. Amy Deipolyi

When deep sedation is required, it can be challenging to implement due to the difficulty of scheduling dedicated anesthesia coverage in the IR suite. Dr. Amy Deipolyi (interventional radiologist and D...

4 Helmi 202533min

Ep. 513 Combination Therapy and Clinical trials for Advanced HCC: What They Really Mean

Ep. 513 Combination Therapy and Clinical trials for Advanced HCC: What They Really Mean

In the past five years, the use of immunotherapeutic agents for advanced cancers has emerged as a promising alternative to tyrosine kinase inhibitors and chemotherapy, making it an exciting time to be...

31 Tammi 202547min

Ep. 512 The "Alzate Maneuver”: Flipping Retrograde Access with Dr. Gregg Alzate

Ep. 512 The "Alzate Maneuver”: Flipping Retrograde Access with Dr. Gregg Alzate

Proximity to innovation often gives rise to further innovation. This trend is especially true in interventional radiology. Dr. Gregg Alzate (interventional radiologist in San Diego, California) joins ...

28 Tammi 202549min

Ep. 511 How to Simplify Dosing: Understanding Y-90 Dosimetry from Simple to Complex

Ep. 511 How to Simplify Dosing: Understanding Y-90 Dosimetry from Simple to Complex

Of all the topics covered during interventional radiology training, dosimetry education is often delayed until after IRs enter clinical practice. In this episode, Drs. Tyler Sandow and Sabeen Dhand ho...

24 Tammi 202554min

Ep. 510 Robotics Revolution in Interventional Radiology with Dr. Sean Tutton and Dr. Raj Narayanan

Ep. 510 Robotics Revolution in Interventional Radiology with Dr. Sean Tutton and Dr. Raj Narayanan

Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr....

21 Tammi 202555min

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