Our objective is to study the physiology of intraarterial infusions in the carotid artery. A major problem with intracarotid infusions in patients with gliomas is focal injury to the eye and brain. Our hypothesis is that these problems are due to poor mixing of the infusate with blood such that some regions of the target tissue get very high concentrations of the drug which results in infarction of tissue. Other areas may receive suboptimal drug delivery resulting in treatment failure. We demonstrated heterogenous delivery of an intraarterially infused isotope in animal models, and are now studying patients. We hope to eliminate this poor mixing with a specifically engineered infusion pump which injects in a pulsatile manner during the slow blood flow phase of diastole. If drug streaming can be eliminated by this infusion technique, it should permit a convenient and practical means of infusion in the clinic. Although we have used this carotid arterial system and the brain and eye as target organs, the principles established should be generally applicable to other arteries and organs.
