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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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Maruyama M, Araki H, Yoshida R, Ando S, Nakamura M, Yoshizako T, Kaji Y. Steerable-wire technique using high-flow steerable microcatheter and 0.025-inch guidewire. Radiol Case Rep 2023; 18:4231-4234. [PMID: 37766837 PMCID: PMC10520662 DOI: 10.1016/j.radcr.2023.08.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
A high-flow steerable microcatheter has been reported to be useful as a triaxial system. Moreover, the benefits of steerable microcatheters in acute-angle bifurcation vessel insertions and a compact coil-packing technique using intentional folding with a bendable catheter tip have been reported. However, research on the usefulness of a high-flow steerable catheter and 0.025-inch guidewire combination (steerable-wire) technique is lacking. Herein, we report a case of balloon-occluded retrograde transvenous obliteration (BRTO) via the femoral venous approach to illustrate the usefulness of the steerable-wire technique. The steerable-wire technique facilitates the selection of the wire into the target vessel. The steerable-wire can be used instead of the 0.035-inch guidewire, which is versatile as other devices can follow the steerable wire.
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Affiliation(s)
- Mitsunari Maruyama
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
| | - Hisatoshi Araki
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
| | - Rika Yoshida
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
| | - Shinji Ando
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
| | - Megumi Nakamura
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
| | - Yasushi Kaji
- Department of Radiology, Shimane University Faculty of Medicine, P.O. Box 00693-8501, 89-1 Enya cho, Izumo shi, Japan
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Chikamori F, Ito S, Hamada R, Sharma N. Antecubital vein approach of retrograde transvenous obliteration using a steerable triaxial system for portosystemic encephalopathy. Radiol Case Rep 2023; 18:3274-3280. [PMID: 37520392 PMCID: PMC10375380 DOI: 10.1016/j.radcr.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/29/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023] Open
Abstract
We report a case of portosystemic encephalopathy treated by retrograde transvenous obliteration (RTO) with an antecubital vein approach using a steerable triaxial system. A 77-year-old female was referred to our department complaining of dizziness and tremor. Laboratory data showed hyperammonemia. Contrast-enhanced CT and 3D-CT reconstruction images demonstrated an inferior mesenteric vein (IMV)-left common iliac vein shunt and a splenorenal shunt. The former was treated as a responsible shunt. The spleen volume was 212 mL, and the liver volume was 757 mL; giving a spleen/liver volume ratio of 0.3. Partial splenic artery embolization (PSE) was employed to control portal venous pressure. The hepatic venous pressure gradient (HVPG) changed from 13.2 to 9.6 mm Hg and the spleen/liver volume ratio improved from 0.3 to 0.2 by PSE. Two months after PSE, RTO with an antecubital vein approach using a steerable triaxial system was performed. HVPG changed to 12.5 mm Hg after RTO. Contrast-enhanced CT and 3D-CT reconstruction images 3 days after the procedure demonstrated the thrombus in the IMV-left common iliac vein shunt. We conclude that the antecubital vein approach using a steerable triaxial system is a feasible and minimally invasive technique in RTO for portosystemic shunts.
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Ryo Hamada
- Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi, Japan
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Berenstein A, Cabiri O, Broussalis E, Hufnagl C, Killer-Oberpfalzer M. New concept in neurovascular navigation: technical description and preclinical experience with the Bendit 17 and Bendit 21 microcatheters in a rabbit aneurysm model. J Neurointerv Surg 2023; 15:172-175. [PMID: 35292566 PMCID: PMC9872234 DOI: 10.1136/neurintsurg-2022-018644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Endovascular treatment of intracranial vascular diseases, such as aneurysms, is often challenged by unfavorable vascular anatomy. The Bendit Steerable Microcatheter (Bendit Technologies, Tel Aviv, Israel) has bending and torqueing capabilities designed to improve navigation and stability during device delivery, with or without a guidewire. We describe our preclinical experience with the Bendit 17 and Bendit 21 microcatheters in a rabbit aneurysm model. METHODS Bifurcation and side wall aneurysms were created surgically in six New Zealand rabbits. We attempted to navigate Bendit devices through the vasculature and enter the aneurysms without a guidewire. Various positions within the aneurysm were selectively explored. Angiographic imaging was used to visualize catheterization, navigation, vascular manipulations, and placement of coils, stents, and intrasaccular devices. RESULTS We successfully navigated the Bendit microcatheters to all aneurysms without a guidewire. We successfully recanalized a nearly occluded carotid artery and navigated the Bendit through a braided stent. In contrast, we were unable to navigate a comparator device with a guidewire as effectively as the Bendit. Coils were introduced at different locations within the aneurysm and could be pushed, pulled, and repositioned with the Bendit tip. Finally, we used the Bendit to deliver intrasaccular devices designed for terminal aneurysms to treat side wall aneurysms. CONCLUSIONS Bendit's bending and torqueing abilities, combined with its stability in the bent position, enable quick navigation and optimal deployment of devices. Clinical studies are necessary to determine whether these navigation advantages lead to more efficient treatment of intracranial and peripheral aneurysms.
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Affiliation(s)
- Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Erasmia Broussalis
- Institute of Neurointervention, Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Clemens Hufnagl
- Institute of Neurointervention, Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Institute of Neurointervention, Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
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Komada T, Kamomae T, Matsushima M, Hyodo R, Naganawa S. Embolization using patient-specific vascular models created by a 3D printer for difficult cases: a report of two cases. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:477-483. [PMID: 35967941 PMCID: PMC9350560 DOI: 10.18999/nagjms.84.2.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022]
Abstract
With the widespread use of three-dimensional printers, organ models created by these printers are now being used in the medical field for preoperative planning of surgeries. In this article, we report two cases in which embolization was expected to be difficult, and the three-dimensional printer-based vascular modeling was helpful in planning the surgery. The first case involved an aneurysm of the splenic artery. We attempted to embolize the aneurysm but were unable to advance the catheter into the distal artery and discontinued the procedure. The second case was a perianal varicose vein, which was initially treated with percutaneous transhepatic obliteration but was recanalized and required embolization. However, we expected difficulty in selecting the inferior mesenteric vein. In both cases, the vascular models were created using a 3D printer from the patients' computed tomography images. Preoperative planning, including treatment simulation, was based on these models. The time required to print a three-dimensional vascular model was approximately 12 hours at a cost of less than $10 each. Patient-specific vascular models using a three-dimensional printer can be a simple and inexpensive tool that can increase the success of embolization in difficult cases.
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Affiliation(s)
- Tomohiro Komada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Matsushima
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Chatani S, Seki K, Sonoda A, Murakami Y, Tomozawa Y, Fujimoto T, Andoh A, Watanabe Y. Bleeding anorectal varices treated by a direct puncture approach through the greater sciatic foramen: The utility of a steerable microcatheter for reverse catheterization. Radiol Case Rep 2022; 17:1104-1109. [PMID: 35169409 PMCID: PMC8829532 DOI: 10.1016/j.radcr.2022.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Bleeding is less common from anorectal varices than from esophageal varices, but it is potentially life-threatening. Here, we present a case of a woman in her 70s with critical hemorrhage from anorectal varices. The endoscopic approach could not be performed due to the huge variceal formation and the transhepatic approach was also unsuitable due to the presence of portal vein thrombosis and ascites. A direct puncture to the right superior rectal vein was performed through the greater sciatic foramen under computed tomography fluoroscopic guidance. Using a steerable microcatheter, superior rectal veins were bilaterally embolized with a mixture of n-butyl cyanoacrylate and ethiodized oil, and microcoils. Endoscopy and contrast-enhanced computed tomography performed after the procedure confirmed a marked shrinkage of anorectal varices. When endoscopic or any other approaches are difficult, this technique can be a useful alternative therapeutic option.
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Tanaka K, Osuga K, Higashihara H, Kosai S, Kashiwagi E, Nagai K, Hongyo H, Kimura Y, Ono Y, Tomiyama N. Triaxial Micro-balloon System for Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices. Cardiovasc Intervent Radiol 2021; 44:1284-1285. [PMID: 33825063 DOI: 10.1007/s00270-021-02829-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kaishu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan.
| | - Keigo Osuga
- Department of Diagnostic Radiology, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi Takatsuki, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Shinya Kosai
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Eiji Kashiwagi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Keisuke Nagai
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Hidenari Hongyo
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Yasushi Kimura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
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Yamanishi T, Minamiguchi H, Yoshimatsu R, Kajiwara K, Ogi K, Nishimori M, Shimada C, Maeda H, Kariya S, Komori M, Yamagami T. A case of maxillary cancer treated by intra-arterial therapy using a steerable microcatheter. MINIM INVASIV THER 2021; 31:649-652. [PMID: 33412974 DOI: 10.1080/13645706.2020.1866016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report on a 69-year-old man with locally-advanced left maxillary sinus cancer who underwent treatment with intra-arterial chemoradiotherapy. Angiography showed that the main feeding arteries were the left maxillary artery and the ophthalmic artery, arising from the internal carotid artery. Due to acute branching of the ophthalmic artery, conventional microcatheters could not be inserted. Using a steerable microcatheter, we were able to repeatedly administer chemoradiotherapy via the ophthalmic artery. The tumor has mostly disappeared after intra-arterial chemoradiotherapy, and the patient is still alive two years after treatment. A steerable microcatheter is very useful for acute-angled vascular branches.
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Affiliation(s)
- Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan.,Department of Diagnostic Radiology, National Hospital Organization, Kure Medical Center, Kure, Japan
| | - Kenta Ogi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Miki Nishimori
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Chikako Shimada
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hitomi Maeda
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Shinji Kariya
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
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