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Prostatic Artery Embolization (PAE) Microcatheter Selection
Bryant Schmitz • Jun 21, 2018 • 405 hits
Prostatic artery embolization (PAE) microcatheter and guidewire selection is covered by experts Dr. Ari Isaacson and Dr. Sandeep Bagla for different PAE cases, covering femoral vs. radial and what works well in challenging anatomies. They cover the Terumo Progreat microcatheter, Direxion microcatheter, Merit Maestro microcatheter, Cook Cantata microcatheter, angled microcatheters, & more.
We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
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.
Table of Contents
(1) Prostatic Artery Embolization via Femoral Access
(2) Prostatic Artery Embolization via Radial Access
(3) Balloon Occlusion Can Minimize Nontarget Embolization
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 are either a Progreat microcatheter, a Direxion microcatheter, 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 Microcatheter 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.
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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. Ari Isaacson
Dr. Ari Isaacson is a practicing interventional radiologist with the UNC Department of Radiology in North Carolina.
Dr. Sandeep Bagla
Dr. Sandeep Bagla is a practicing interventional radiologist with the Vascular Institute of Virginia and the president of Prostate Centers USA.
Dr. Michael Barraza
Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.
Cite This Podcast
BackTable, LLC (Producer). (2017, November 18). Ep. 17 – Prostate Artery Embolization [Audio podcast]. Retrieved from https://www.backtable.com
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