Use of the advanced triple coaxial microcatheter system in superselective arterial embolisation for complex interventional cases: an initial experience with the system.

Abstract

Abstract Learning objective: To share our experience in utilizing the triple coaxial (triaxial) system in super-selective cannulation of arteries for complex embolisation procedures. Background: Percutaneous transcatheter selective embolisation is a widely performed for a myriad of oncologic (e.g. trans-arterial chemo- or radio-embolization) and non-oncologic (e.g. for embolization of bleeding and benign conditions such as uterine fibroid and benign prostate hyperplasia) purposes. The cornerstone of such embolisation procedures is to achieve super-selective cannulation of the arterial supply to the tumour/organ preventing the complication of non-target embolisation. However, the presence of tortuous and complex vascular anatomy can pose a major challenge for achieving this goal. Clinical findings/procedural details: The triaxial system utilizes 2 smaller microcatheter telescoped through each other and over a microwire within an angiographic catheter. We have adopted the use of the triaxial system due to its perceived superior torquability and trackability compared to the conventional coaxial system for cases which superselective cannulation is challenging. The triaxial system is also favourable in situations which the inner microcatheter needs to “sacrificed” after administering embolics (e.g. after administering radionuclides in radioembolization, N-butyl cyanoacrylate (NBCA) glue or dimethyl-sulfoxide (DMSO)). Through a case series with procedural details such as fluoroscopic time, contrast administered etc, we hope to illustrate the utility and efficacy of the triaxial system as well as present pitfalls in its usage. Conclusion:The triaxial system is safe for use in embolization procedures and can confer advantages over conventional co-axial system for specific situations.