Clinical Characteristics and Technical Outcomes of Microballoon Catheter-assisted Partial Splenic Embolization

<h3>Background/Aim:</h3> Partial splenic embolization (PSE) is an established interventional radiology procedure for portal hypertension. However, in cases of splenomegaly with complex vascular anatomy, guide catheter placement in the splenic artery may be difficult. We aimed to evaluate the clinical characteristics and technical feasibility of microballoon catheter-assisted PSE in such challenging cases. <h3>Patients and Methods:</h3> Among 279 patients who underwent PSE at our institution between November 2007 and March 2026, we retrospectively analyzed 12 patients in whom conventional guide catheter insertion into the main splenic artery was unsuccessful and required microballoon catheter assistance. <h3>Results:</h3> The study population included nine men and three women, with a mean age of 68.9 years. The etiologies of portal hypertension included one case of overlap syndrome (autoimmune hepatitis and primary biliary cirrhosis), one case of hepatitis B-related cirrhosis, three cases of alcoholic cirrhosis, three cases of metabolic dysfunction-associated steatohepatitis-related cirrhosis, and four cases of left-sided portal hypertension. The mean preoperative spleen volume was 619.3±544.9 ml. The mean infarct volume was 337.5±210.2 ml, with a splenic infarction rate of 60.6±14.6%. PSE was successfully performed in all patients. The platelet count increased significantly from 65,000±18,900/μl preoperatively to 183,200±51,500/μl two weeks postoperatively (<i>p</i>&lt;0.001) and was maintained at 102,000/μl at one year. The only complication observed was transient pain during balloon inflation; no major complications, such as abscess formation or aneurysm, were noted. <h3>Conclusion:</h3> Microballoon catheter assistance facilitates stable guide catheter placement in anatomically challenging splenic arteries, enabling safe and effective PSE. This technique may represent a valuable option in difficult cases; however, validation in larger cohorts is required.