Y-configuration stent combined with iodine-125 seeds strand for the treatment of hepatocellular carcinoma with tumor thrombosis in portal vein branches

RATIONALE Currently, the treatment of hepatocellular carcinoma (HCC) associated with portal vein tumor thrombosis (PVTT) is a challenge. Percutaneous puncture endovascular placement of iodine-125 (I) seeds strand and stent is reported to treat HCC with tumor thrombus effectively. However, it is proved to be only suitable for the main portal vein (MPV) thrombus. PATIENT CONCERNS A 42-year-old male patient was referred to our institution after experiencing right upper abdominal distention without abdominal pain, nausea, or vomiting for 2 weeks. The patient had a history of hepatitis B virus infection over a 20 year period. DIAGNOSIS After a full evaluation, the patient was diagnosed with primary HCC with a tumor thrombus in both main and branch portal veins. INTERVENTIONS We used a Y-configuration stent combined with I seeds strand to treat the tumor thrombus in both main and branch portal veins. OUTCOMES The patient's liver function and the stent patency period were improved. More importantly, the patient had an acceptable survival time. LESSONS A Y-configuration stent makes it possible to treat tumor thrombosis in portal vein branches (PVBs). However, the long-term curative effects of Y-configuration stents need to be verified.