Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era.

Authors: Kappel AD, Jha R, Guggilapu S, Smith WJ, Feroze AH, Dmytriw AA, Vicenty-Padilla J, Alcedo Guardia RE, Gessler FA, Patel NJ, Du R, See AP, Peruzzi PP, Aziz-Sultan MA, Bernstock JD

High-grade gliomas (HGGs) have a poor prognosis and are difficult to treat. This review examines the evolving landscape of endovascular therapies for HGGs. Recent advances in endovascular catheter technology and delivery methods allow for super-selective intra-arterial cerebral infusion (SSIACI) with increasing precision. This treatment modality may offer the ability to deliver anti-tumoral therapies directly to tumor regions while minimizing systemic toxicity. However, challenges persist, including blood-brain barrier (BBB) penetration, hemodynamic complexities, and drug-tumor residence time. Innovative adjunct techniques, such as focused ultrasound (FUS) and hyperosmotic disruption, may facilitate BBB disruption and enhance drug penetration. However, hemodynamic factors that limit drug residence time remain a limitation. Expanding therapeutic options beyond chemotherapy, including radiotherapy and immunobiologics, may motivate future investigations. While preclinical and clinical studies demonstrate moderate efficacy, larger randomized trials are needed to validate the clinical benefits. Additionally, future directions may involve endovascular sampling for peri-tumoral surveillance; changes in drug formulations to prolong residence time; and the exploration of non-pharmaceutical therapies, like radioembolization and photodynamic therapy. Endovascular strategies hold immense potential in reshaping HGG treatment paradigms, offering targeted and minimally invasive approaches. However, overcoming technical challenges and validating clinical efficacy remain paramount for translating these advancements into clinical care.

Introduction

Purpose Drug delivery with BBB opening

Study Objective To review and evaluate emerging endovascular therapies for high-grade gliomas—particularly super-selective intra-arterial cerebral infusion—highlighting technical challenges, adjunct delivery strategies, and future research directions.

Disease model high-grade gliomas (HGGs)

Cargo name and characteristics Multiple agents described broadly: traditional chemotherapeutic small molecules; radiation-embedded radiolabeled molecules/particles used in radioembolization (radiotherapeutic agents); immunobiologics/immune-based therapies (protein biologics, antibodies, or cell-based therapies); photosensitizer small molecules for photodynamic therapy; and reformulated drug carriers/nanoparticles designed to prolong intratumoral residence.

Route of administration Super-selective intra-arterial cerebral infusion (endovascular/intra-arterial)

Outcomes and Safety

Summary of Outcomes Endovascular super-selective intra-arterial infusion (SSIACI), potentially combined with focused ultrasound (FUS) or hyperosmotic disruption, can transiently disrupt the blood–brain barrier and enhance intratumoral drug delivery to high-grade gliomas, but tumor drug residence time and clinical efficacy remain limited; no specific FUS parameter sets were tested or reported.

Safety-related matter The review highlights safety concerns including systemic toxicity and hemodynamic complexities that limit drug residence time, and it emphasizes that more research and larger randomized trials are needed to validate clinical benefits and ensure these endovascular approaches are safe for patients.

Brain Region

Visualization unavailable

Ultrasound Parameters

Focal Characteristics Focal depth: None; Focal length: None; Aperture size: None

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