1. Case-Control Comparison of Conventional End-Hole versus Balloon-Occlusion Microcatheter Prostatic Artery Embolization for Treatment of Symptomatic Benign Prostatic Hyperplasia
- Author
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Raj Ayyagari, Julius Chapiro, Lawrence H. Staib, Jeffrey Pollak, Ralph Devito, Steven Schoenberger, and T. Powell
- Subjects
Male ,Catheters ,Time Factors ,animal structures ,Embosphere Microspheres ,Prostatic Hyperplasia ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Lower Urinary Tract Symptoms ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Adverse effect ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Prostate ,Arteries ,Equipment Design ,Recovery of Function ,Balloon Occlusion ,Middle Aged ,Hyperplasia ,medicine.disease ,Embolization, Therapeutic ,Prostatic artery embolization ,Urodynamics ,Treatment Outcome ,medicine.anatomical_structure ,Balloon occlusion ,030220 oncology & carcinogenesis ,International Prostate Symptom Score ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Artery - Abstract
PURPOSE To compare procedural metrics and clinical improvement for prostatic artery embolization (PAE) performed with a balloon-occlusion (BO) versus end-hole (EH) microcatheter in patients with benign prostatic hyperplasia. MATERIALS AND METHODS Retrospective review was performed of 129 patients undergoing PAE with 100-300 μm Embosphere microspheres from April 2013 through August 2018. Microcatheter selection was nonrandom, based on prostatic artery anatomy. Five technical failures and 5 microcatheter crossover cases were excluded. BO group (n = 46, age 72.8 y ± 9.0, gland volume 184 mL ± 83, 42% in retention) and EH group (n = 73, age 76.0 y ± 9.0, gland volume 190 mL ± 116, 44% in retention) were compared using procedural metrics (excluding 30 EH learning-curve cases); symptomatic improvement at 3, 6, and 12 months after PAE; voiding trial success; and adverse events (reported used Clavien-Dindo classification). RESULTS Procedural and fluoroscopy times were lower in the BO group (n = 46) vs EH group (n = 43) (152.0 min ± 34.0 vs 172.8 min ± 47.9, P < .02; 37.8 min ± 12.9 vs 50.3 min ± 18.9, P < .001). Collaterals coiled, contrast material used, and injected particle volume were similar for both groups (P = NS). International Prostate Symptom Score improvement was similar for BO group (n = 25) (before PAE 23.5 ± 6.5, 12 months after PAE 7.6 ± 6.8) and EH group (n = 30) (before PAE 20.9 ± 5.9, 12 months after PAE 6.6 ± 5.2) (P = NS). Quality-of-life improvements were also similar (BO: before PAE 4.5 ± 1.2, 12 months after PAE 1.4 ± 0.9; EH: before PAE 4.1 ± 1.0, 12 months after PAE 0.9 ± 0.7), as were 12-month postvoid residual improvements, voiding trial failure rates (EH 12%, BO 8%), and adverse event rates (grade II, III: EH 15%, BO 11%) (P = NS for all). CONCLUSIONS BO microcatheter use in PAE did not affect injected particle volume, contrast material use, or protective coiling and did not impact symptomatic improvement, postvoid residual improvement, voiding trial success, or adverse events after PAE. Lower procedure and fluoroscopy times with BO microcatheter were likely due to selection bias.
- Published
- 2019
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