Updated: Mar 11, 2019
Prostatic artery embolization (PAE) experts Dr. Ari Isaacson and Dr. Sandeep Bagla discuss their go-to catheters and guidewires for different PAE cases, covering femoral vs. radial and what works well in challenging anatomies.
The BackTable Brief
When performing a PAE procedure via femoral access, Dr. Isaacson and Dr. Bagla typically use a straight Terumo Progreat or an angulated Boston Scientific Direxion microcatheter depending on the prostatic artery anatomy.
For radial access, the Merit Maestro and Cook Cantata are also suitable PAE microcatheters.
Starter guidewires for PAE include the Boston Scientific Fathom-14 and the Terumo Glidewire, escalating to an 0.014 Stryker Transend if needed.
The balloon occlusion capability of the Embolx Sniper catheter may be helpful in minimizing nontarget embolization, but it alters flow and may be better suited for more experienced PAE operators.
Disclaimer: The opinions expressed by the participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Prostatic Artery Embolization via Femoral Access
So Ari, you found the target artery, and you found the angle. What do you typically use to select it?
It depends if you're asking femoral, or radial. My catheters, I tend to use microcatheters, are either Progreat, a Direxion, or a Sniper catheter. Those are the three that I tend to use. My initial wire that I start with is a Fathom-14.
My typical go-to catheter is probably very similar to Ari. The Progreat Catheter 2.4, I may use a 2.0 in very small glands, for example, less than 55 CCs or so. The Direxion catheter I typically use with reverse angled origin prostatic arteries, because it's a very nice, pre-shaped catheter.
As far as go-to wires, I use the double angled Glide wire. I think it works in the majority of cases. If that doesn't work, my secondary wire is an 0.014 Transend wire.
Prostatic Artery Embolization via Radial Access
The first thing is, from radial, you have lesser choices, right? You need a catheter that's at least 150 centimeters. You're looking at a Progreat, a Direxion, there's a Maestro that's available, there's a Cook Cantata, so there are a bunch of different microcatheters that are available for that.
Initially when I started, I really liked the Direxion a lot because of the angulation, obviously, and it helped. I think, since then, I've come to rely more on my wire skills to get into some harder arteries. I'll start with the Progreat, which is straight.
Balloon Occlusion Can Minimize Nontarget Embolization
Okay. I know you guys have provided us with plenty of reading material, and the different wires you can use, including the SwiftNinja, I know Ari, you told me you liked the Sniper catheter to minimize non-target embolization...
As far as from the femoral, I've been using the Sniper a lot lately. This isn't something I recommend, that everyone go out and start using it, cause it is a whole different kind of concept. It's a Balloon Occlusion Catheter. It changes flow. I have some experience with it, so I kind of know what I'm looking for in doing so. I think it's not quite ready for everyone to put their hands on and start using quite yet, but I think there's some potential there, that we could demonstrate some benefit of using Balloon Occlusion for PAE.
Dr. Sandeep Bagla is a practicing interventional radiologist with the Vascular Institute of Virginia.
Dr. Ari Isaacson is a practicing interventional radiologist with the UNC Department of Radiology in North Carolina.
Dr. Michael Barraza is a practicing interventional radiologist with Radiology Alliance in Nashville.
Cite this podcast:
BackTable, LLC (Producer). (2017, November 27). Ep 17 – Prostate Artery Embolizations [Audio podcast]. Retrieved from https://www.backtable.com/podcasts
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