Utilization of a steerable microcatheter and adjunctive techniques for prostatic artery embolization in anatomically challenging vesicoprostatic trunks

Prostatic artery (PA) origination from a common trunk with the superior vesical artery (SVA) is a frequent cause of technical difficulties in PA catheterization for PA embolization (PAE). These difficulties, which substantially increase the operative time, radiation dose, cost, and technical failure rate of PAE, can often be overcome by the utilization of a steerable microcatheter (MC) with a tip that can be manually adjusted at an angle that optimally conforms to the shape and origin of the common vesicoprostatic trunk. Adjunctive techniques that can be applied when the steerable MC fails to engage the PA include: 1) the protective temporary embolization of the SVA so that a permanent embolic can be redirected into the PA; 2) PAE via collaterals between superior vesical branches and the PA; and 3) embolization from a proximal position of the MC near the PA orifice to exploit preferential flow to the PA. In the authors' recent experience, the utilization of a steerable MC with and without adjunctive techniques (in 12 and 23 patients, respectively) resulted in a 35% increase in the technically successful embolization of PAs originating from vesicoprostatic trunks with no significant complications. Familiarization with alternative devices and techniques may substantially improve the technical outcome of PAE in cases with challenging arterial anatomy.