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Kawabata T, Iguchi T, Matsui Y, Tomita K, Uka M, Umakoshi N, Nagata S, Hiraki T. Arterial embolization via retrograde approach using steerable microcatheter and triaxial system. MINIM INVASIV THER 2024; 33:184-186. [PMID: 38206125 DOI: 10.1080/13645706.2024.2302567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
We report a case of postoperative pseudoaneurysm, successfully treated with selective arterial embolization, using a steerable microcatheter and triaxial system via retrograde approach. A pseudoaneurysm was detected in the dorsal pancreatic artery, a severely narrow and steeply inverted branch of the superior mesenteric artery, making microcatheter insertion via the antegrade approach challenging. However, a steerable microcatheter was advanced beyond the orifice and the tip was reversed, changing the route to retrograde allowing for easy insertion of the microguidewire. Subsequently, a small microcatheter was advanced beyond the pseudoaneurysm into the dorsal pancreatic artery, and arterial embolization was successfully completed without complications.
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Affiliation(s)
- Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Shoma Nagata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Kim DH, Kang UR, Kim YH, Cha JG. Folded-Loop Guidewire Remodeling Technique: Catheterizing Markedly Angulated Branches during Intravascular Embolization. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:418-426. [PMID: 37051382 PMCID: PMC10083636 DOI: 10.3348/jksr.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 02/21/2023]
Abstract
Purpose Practical challenges are encountered in percutaneous intravascular procedures when applied to markedly angulated branching vessels. Herein, we introduced a folded-loop guidewire remodeling technique-the guidewire-shaping technique-to overcome difficult catheterization. Materials and Methods First, the tip of a 0.014-inch micro-guidewire was manually shaped like a pigtail loop. Second, the shaped guidewire was introduced into the microcatheter and was preloaded into the hollow metal introducer for suitability with the microcatheter hub. Gentle rotation of the guidewire after release from the microcatheter can create the preshaped pigtail loop configuration. On pulling back, the loop loosened, the configuration was changed to a small U-shaped tip, and the guidewire tip was easily introduced into the target artery. Results Between December 2019 and January 2022, the described technique was used in 64 patients (male/female, 49/15; mean age, 66.8 ± 9.5 years) for selective arterial embolization, after failed attempts with the conventional selection technique. The technique was successful in 63/64 patients (98%). The indications of embolization include transcatheter arterial chemoembolization, gastrointestinal bleeding, hemoptysis, trauma-induced bleeding, and tumor bleeding. Conclusion The folded-loop guidewire remodeling technique facilitates the catheterization of markedly angulated branching arteries; when usual catheterization method fails.
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Affiliation(s)
- Dong Hyun Kim
- Department of Radiology, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jung Guen Cha
- Department of Radiology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Sawamura H, Onishi Y, Ohno T, Ikeda T, Yamamoto S, Seno H, Nakamoto Y. Selection of the right inferior phrenic artery using a dual-lumen microcatheter in transarterial chemoembolization for hepatocellular carcinoma. Radiol Case Rep 2022; 17:3727-3730. [PMID: 35965934 PMCID: PMC9363968 DOI: 10.1016/j.radcr.2022.07.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022] Open
Abstract
An 88-year-old woman with a history of multiple hepatocellular carcinomas (HCCs) presented with a new HCC in segment seven of the liver. We decided to perform transarterial chemoembolization for HCC. During treatment, the HCC was supplied by the right inferior phrenic artery (IPA), which originated from the proximal part of the left gastric artery with a steep bifurcation angle. Due to the very short distance between the origins of the left gastric artery and right IPA, the microguidewire and microcatheter were unstable in the left gastric artery and easily prolapsed into the celiac artery. Although different types of microcatheters were used, the right IPA could not be selected. Therefore, we used a dual-lumen microcatheter (DLM) to select the right IPA. The DLM stabilized the microguidewire in the left gastric artery, and the right IPA was successfully selected. Subsequently, transarterial chemoembolization was administered using a branch of the right IPA. Given this experience, we will consider using a DLM as an alternative method for selecting an abdominal artery when other techniques are unsuccessful.
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Affiliation(s)
- Hirokazu Sawamura
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yasuyuki Onishi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
- Corresponding author.
| | - Tsuyoshi Ohno
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tomoya Ikeda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuji Yamamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Core JM, Frey GT, Sharma A, Bussone ST, Legout JD, McKinney JM, Lewis AR, Ritchie C, Devcic Z, Paz-Fumagalli R, Toskich BB. Increasing Yttrium-90 Dose Conformality Using Proximal Radioembolization Enabled by Distal Angiosomal Truncation for the Treatment of Hepatic Malignancy. J Vasc Interv Radiol 2020; 31:934-942. [PMID: 32381352 DOI: 10.1016/j.jvir.2019.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/08/2019] [Accepted: 12/22/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate safety and feasibility of improving radiation dose conformality via proximal radioembolization enabled by distal angiosomal truncation where selective administration was not practical. MATERIALS AND METHODS Hepatic malignancies treated via angiosomal truncation between January 2017 and March 2019 were retrospectively evaluated. Thirty-three patients (8 women, 25 men; mean age, 62.2 y; range, 36-78 y) underwent 39 treatments. Of treatments, 74.3% (n = 29) were for hepatocellular carcinomas, 10.2% (n = 4) were for cholangiocarcinomas, and 15.4% (n = 6) were for metastatic tumors (1 colorectal adenocarcinoma, 1 pancreatic adenocarcinoma, 3 melanomas, and 1 endometroid carcinoma). Truncation was achieved using temporary embolic devices including a microvascular plug, detachable coil, gelatin slurry, and balloon microcatheter, after which proximal radioembolization was performed. Range of treatment activity was 0.47-5.75 GBq. Technetium-99m macroaggregated albumin and bremsstrahlung single photon emission computed tomography (CT)/CT threshold analysis was conducted to delineate and compare distribution of activity within the treatment angiosome before and after radioembolization. RESULTS Dosimetric analysis of 14 patients demonstrated a significant reduction in nontarget liver radiation exposure at 5, 20, and 40% thresholds (P = .002, P = .001, and P = .008, respectively). There were no grade 3 or higher adverse events. There was no significant change in Albumin-Bilirubin grade and Eastern Cooperative Oncology Group Performance Status (P = .09 and P = .74) before and 3 months after the procedure. Truncated arteries were patent on subsequent angiography in 11 cases and on MR angiography or CT angiography in 38 of 39 cases. CONCLUSIONS Proximal radioembolization enabled by distal angiosomal truncation is safe and decreases nontarget parenchymal radioembolization dose in cases not amenable to selective administration.
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Affiliation(s)
- Jacob M Core
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224.
| | - Gregory T Frey
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Akash Sharma
- Division of Nuclear Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Steven T Bussone
- Division of Nuclear Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Jordan D Legout
- Division of Body MRI, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - J Mark McKinney
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Andrew R Lewis
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Charles Ritchie
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Zlatko Devcic
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Ricardo Paz-Fumagalli
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
| | - Beau B Toskich
- Division of Vascular and Interventional Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224
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Vollherbst DF, Hohenstatt S, Schönenberger S, Bendszus M, Möhlenbruch MA. WEB as a combined support and embolization device in a giant partially thrombosed donut-shaped aneurysm. J Clin Neurosci 2020; 75:210-212. [PMID: 32209274 DOI: 10.1016/j.jocn.2020.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Giant partially thrombosed aneurysms are challenging lesions for which treatment can be difficult due to their unfavourable anatomical configuration and abnormal flow conditions. CASE DESCRIPTION The patient presented in this report suffered from a symptomatic giant partially thrombosed donut-shaped aneurysm of the left-sided supraophthalmic internal carotid artery. Due to the location and the size of the aneurysm, endovascular treatment was performed. Navigation of the microcatheter-microwire-system distal to the aneurysm for stent deployment was technically not possible due to limited support, caused by the large aneurysm. Therefore, a WEB device was placed in the distal leg of the donut-shaped aneurysm. Additionally to the occlusion of this part of the aneurysm, the WEB device enabled enough support to navigate the microcatheter-microwire-system distal to the aneurysm. After deployment of a flow-diverting stent, coiling of the aneurysm was performed. Follow-up angiography showed complete occlusion of the aneurysm. The patient suffered from severe headaches which were no longer present 6 months after treatment. CONCLUSIONS The WEB intraaneurysmal flow diverter can be effectively used as combined support and embolization device for the treatment of complex aneurysms in selective cases where other catheterization and embolization strategies have failed.
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Affiliation(s)
- Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Sophia Hohenstatt
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany.
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Ryu B, Sato S, Inoue T, Okada Y, Niimi Y. Simmons Angled microguidewire INsertion to the Target (SAINT) technique in neuroendovascular therapy. J Neuroradiol 2019; 48:400-403. [PMID: 31563587 DOI: 10.1016/j.neurad.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/19/2022]
Abstract
Advancing appropriate microcatheters is essential for treatment. However, we still encounter inaccessible arterial branches because of the anatomical arrangement. While many successful techniques regarding microcatheters have been reported, there have been very few reports of microguidewire-shaping techniques. We developed the Simmons-Angled microguidewire INsertion to the Target (SAINT) technique for insertion of the microguidewire into inaccessible arterial branches. The SAINT technique is feasible for selection and insertion into arteries that are inaccessible with conventional methods.
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Affiliation(s)
- Bikei Ryu
- Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan; Department of Neurosurgery, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan.
| | - Shinsuke Sato
- Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan; Department of Neurosurgery, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular therapy, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, 104-8560 Tokyo, Japan
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Shimohira M, Nagai K, Ohta K, Sawada Y, Muto M, Hashizume T, Shibamoto Y. Use of a steerable triaxial system for challenging catheterization. MINIM INVASIV THER 2019; 29:140-145. [DOI: 10.1080/13645706.2019.1606018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Nagai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Muto
- Department of Radiology, Nagoya City East Medical Center, Nagoya, Japan
| | - Takuya Hashizume
- Department of Radiology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Orron DE, Bloom AI, Neeman Z. The Role of Transcatheter Arterial Embolization in the Management of Nonvariceal Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2018; 28:331-349. [PMID: 29933779 DOI: 10.1016/j.giec.2018.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nearly 50 years ago, catheter angiography was introduced as a means of both diagnosing and treating nonvariceal upper gastrointestinal bleeding. Technological advances and innovations have resulted in the introduction of microcatheters that, using a coaxial technique, are capable of selecting third-order arterial branches and of delivering a wide array of embolic agents. This article reviews the imaging diagnosis of nonvariceal upper gastrointestinal bleeding, the techniques of diagnostic and therapeutic angiography, the angiographic appearance of the various etiologies of nonvariceal upper gastrointestinal bleeding, the rationale behind case-specific selection of embolic agents as well as the anticipated outcome of transcatheter arterial embolization.
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Affiliation(s)
- Dan E Orron
- Department of Radiology, Carmel Medical Center, Michal Street, Haifa 34362, Israel
| | - Allan I Bloom
- Department of Radiology, Hadassah University Medical Center, Ein Karem, Jerusalem 91120, Israel
| | - Ziv Neeman
- Medical Imaging Institute, Haemek Medical Center, Izhak Rabin Boulevard, Afula 1834111, Israel.
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Transcatheter arterial embolization for upper gastrointestinal tract bleeding. Wideochir Inne Tech Maloinwazyjne 2017; 12:385-393. [PMID: 29362654 PMCID: PMC5776486 DOI: 10.5114/wiitm.2017.72319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. Aim To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. Material and methods A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. Results The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). Conclusions In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.
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