Abstract
The number of minimally invasive interventional radiology (IR) and interventional cardiology vascular procedures performed increases every year. As the number of vascular procedures increases, the need for advanced technology and innovative devices increases as well. Traditionally, as a general rule, a catheter is used in conjunction with a guidewire in such procedures. The underlying principle of IR is to always use a guidewire prior to any advancement of a catheter. This article describes a revolutionary theory that utilizes a new technology and contradicts this basic principle. Using a steerable microcatheter, a bilateral uterine artery embolization was performed from a wrist access with no guidewire. Furthermore, this technique reduced the procedure time by more than half when compared to standard of care. This technique may be applicable to other IR procedures, which could potentially reduce the time critically ill patients spend in the procedure area outside the intensive care unit.
Highlights
In 1953, Swedish radiologist Sven-Ivar Seldinger developed the Seldinger guidewire catheterization technique, which, with the use of a wire, allows for the placement of a catheter larger than the cannula of the needle used to create the initial vascular access [1]
The rotating-tip steerable microcatheter has the potential to transform the field of interventional radiology (IR) by eliminating the need for a guidewire
With the exception of the microwire used in the radial access set, the entire procedure was performed with a steerable microcatheter without the use of a base catheter, guidewire, or microwire
Summary
In 1953, Swedish radiologist Sven-Ivar Seldinger developed the Seldinger guidewire catheterization technique, which, with the use of a wire, allows for the placement of a catheter larger than the cannula of the needle used to create the initial vascular access [1]. It is well-established that increased procedure time is associated with increased morbidity [3]. With the advent of a steerable microcatheter suitable for vessel selection without a wire, much of the time spent exchanging wires and catheters during procedures could be significantly reduced. The SwiftNINJA steerable microcatheter (Merit Medical Systems, South Jordan, UT, USA) features a 180-degree rotating tip that can be steered by turning a plastic dial on the hub of the catheter This design was originally indicated for the catheterization of difficult and tortuous vessels not amenable to traditional catheterization with a guidewire [7]. Using a peel-away introducer, a 2.4 French 125 cm SwiftNINJA steerable microcatheter (SMC) was advanced directly into the sheath without the use of a base catheter or wire (Figure 2). Hemostasis was obtained with the aid of a radial compression band
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