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Catheter-directed Gastric Artery Chemical Embolization for Modulation of Systemic Ghrelin Levels in a Porcine Model: Initial Experience¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Cardiovascular and Interventional Radiology, Johns Hopkins Medical Institutes, Johns Hopkins Hospital, Blalock 545, 600 N Wolfe St, Baltimore, MD 21287. Received May 8, 2006; revision requested July 6; revision received July 26; accepted August 29; final version accepted December 6. Supported by National Institutes of Health grants 1 K08 EB004348-01 and R01 HL61672. Address correspondence to A.A. (e-mail: aarepal{at}jhmi.edu).

View larger version (80K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Catheter-directed GACE technique. (a) Anteroposterior celiac angiogram shows celiac artery (thick arrow), left gastric artery (thin arrow), and accessory artery (dashed arrow). (b) Anteroposterior angiogram shows superselective catheterization of accessory arteries that supply the gastric fundus (arrow). Morrhuate sodium, 50 mg/mL, with a 5% concentration (American Regent, Shirley, NY) was reconstituted with an equal volume of nonionic contrast agent (iohexol, Omnipaque 140; Amersham, Princeton, NJ). (c) After injection of sclerosant, a dark stain coats the gastric fundus (arrow) at the end of the procedure.

View larger version (131K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Catheter-directed GACE technique. (a) Anteroposterior celiac angiogram shows celiac artery (thick arrow), left gastric artery (thin arrow), and accessory artery (dashed arrow). (b) Anteroposterior angiogram shows superselective catheterization of accessory arteries that supply the gastric fundus (arrow). Morrhuate sodium, 50 mg/mL, with a 5% concentration (American Regent, Shirley, NY) was reconstituted with an equal volume of nonionic contrast agent (iohexol, Omnipaque 140; Amersham, Princeton, NJ). (c) After injection of sclerosant, a dark stain coats the gastric fundus (arrow) at the end of the procedure.

View larger version (128K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Catheter-directed GACE technique. (a) Anteroposterior celiac angiogram shows celiac artery (thick arrow), left gastric artery (thin arrow), and accessory artery (dashed arrow). (b) Anteroposterior angiogram shows superselective catheterization of accessory arteries that supply the gastric fundus (arrow). Morrhuate sodium, 50 mg/mL, with a 5% concentration (American Regent, Shirley, NY) was reconstituted with an equal volume of nonionic contrast agent (iohexol, Omnipaque 140; Amersham, Princeton, NJ). (c) After injection of sclerosant, a dark stain coats the gastric fundus (arrow) at the end of the procedure.

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 2: Mean ghrelin values of low-dose swine (animals A–D) and two control swine at baseline and at weeks 1–4. In control animals, there was no change in mean serum ghrelin values from baseline levels to levels at week 4 (P = .71). In swine that underwent GACE with lower doses (animals A–D), mean levels of postprocedural ghrelin values were significantly increased from baseline levels to levels at week 4 (P = .002). Error bars = standard deviations.

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 3: A, Antighrelin immunohistochemical analysis of control fundus with green fluorescence and 4', 6-diamine-2-phenylindole nuclear staining (blue) reveals abundant ghrelin-positive staining in parietal cells. B, Parietal cells appear normal at hematoxylin-eosin staining. C, Green fluorescence and 4', 6-diamine-2-phenylindole nuclear staining (blue) of morrhuate sodium–treated fundus reveals markedly decreased ghrelin staining. D, Parietal cells of experimental swine are indistinguishable from parietal cells of control swine with hematoxylin-eosin staining. Bar = 100 µm.