3:09 PM Abstract No. 63 Balloon occlusion embolization in prostate artery embolization: a single-center evaluation of procedural metrics and clinical outcomes

Abstract

Prostate artery embolization (PAE) is a technically challenging procedure with significant anatomical variation and collateral vessels to surrounding organs. Balloon occlusion (BO) has been proposed as a technique to reduce reflux-mediated nontarget embolization and deliver more embolic particles than would be possible without flow reversal in distal collateral vessels. There has been very limited study of BO in PAE. This study assesses how BO affects technical aspects of PAE and clinical outcomes. 73 patients who underwent PAE from June 2014 to August 2019 were retrospectively reviewed. Bilateral PAE was performed in 17 patients with BO microcatheters and 56 patients with end-hole (EH) microcatheters. Embolization was performed with microspheres ranging from 100 to 300 μm (Embozene, Embospheres) prepared with a 2-mL vial of particles in 15- or 20-mL dilution for the majority of patients. The decision to use BO was based on prostate artery anatomy. Total embolic volume delivered, dose area product (DAP), fluoro time (FT), contrast volume, collateral vessels coiled, International prostate severity score (IPSS), quality of life (QOL), and adverse events (AE) were recorded. For the EH group, mean embolic delivered: 0.78 mL, mean DAP: 651 Gy-cm2, mean FT: 38.5 min, mean contrast used: 135 mL and 9/56 (16%) had collateral vessels coiled. For the BO group, mean embolic delivered: 0.97 mL (P = 0.02), mean DAP: 448 Gy-cm2 (P = NS), mean FT: 28.6 min (P = 0.01), mean contrast used: 112 mL (P = NS), and 3/17 (18%) patients had collateral vessels coiled (P = NS). Over a mean follow-up of 6 weeks, mean IPSS improved from 20.1 to 9.6 (↓52%) and QOL improved from 4.3 to 1.9 (↓56%) in the EH group. In the BO group, mean IPSS improved from 19.1 to 10.2 (↓47%, P = NS) and QOL improved from 3.9 to 1.9 (↓51%, P = NS). No AEs occurred in the BO group. In the EH group, 3 AEs occurred (2 hematuria, 1 penile ulcer). Use of BO microcatheters is safe and associated with lower FT and increased embolic delivery. However, there is no difference in protective coiling rate or short-term clinical outcomes. Further study is warranted with longer follow-up and assessment of the effects of increased embolic delivery using BO.