Prostate Artery Embolization With n-Butyl Cyanoacrylate Using Transradial Access: Technical Insights and Early Outcomes

Monday, March 31, 2025

5:05 PM – 5:10 PM CT

Location: Music City Center, 207 CD

Abstract Presenter(s)

Ramita N. Gowda, MPH

Medical Student
St. George's University School of Medicine, United States

Author/Co-author(s)

Jade Lerner, MD (she/her/hers)

Resident
Icahn School of Medicine at Mount Sinai, United States
David Bamshad, MD

Fellow PGY6
The Mount Sinai Hospital, United States
JV

Jenanan Vairavamurthy, MD

Assistant Professor of Radiology
Mount Sinai, United States
Dan Shilo, MD

Assistant Professor
Mount Sinai, United States
KG

Kirema Garcia-Reyes, MD

Assistant Professor
Mount Sinai, United States
Vivian Bishay, MD

Associate Professor
Icahn School of Medicine at Mount Sinai Hospital, United States
RP

Rajesh I. Patel, MD

Assistant Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai, United States
Robert A. Lookstein, MD

Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai, United States
AF

Aaron M. Fischman, MD

Professor of Radiology and Surgery
Mount Sinai Health System, United States

Learning Objectives:

To understand the technical application of n-butyl cyanoacrylate (n-BCA) in prostate artery embolization (PAE).

To explore procedural details of transradial access and microcatheter selection.

To recognize safety measures and outcomes in benign prostatic hyperplasia (BPH) patients treated with n-BCA.

Background:

Prostate artery embolization (PAE) has become a key minimally invasive option for benign prostatic hyperplasia (BPH). The use of n-butyl cyanoacrylate (n-BCA) offers rapid and effective arterial occlusion but requires specific technical considerations to ensure procedural success. This exhibit provides technical insights from a cohort of 231 cases, focusing on microcatheter selection, n-BCA preparation, and transradial access.

Clinical Findings/Procedure Details: Transradial access was employed in 99% (230/231) of cases, offering enhanced patient comfort and procedural efficiency. Microcatheter selection included the Sniper 2.2-Fr balloon occlusion (Embolx), TruSelect 2.0-Fr, and Direxion 2.4/2.8-Fr (Boston Scientific), with choices guided by patient anatomy. Pharmacologic adjuncts, including 2.5 mL of Verapamil and 200 mcg of Nitroglycerin, were used to enhance flow reversal. n-BCA was mixed with ethiodized oil in a 1:10 ratio for controlled delivery. The microcatheter was flushed with dextrose to prevent glue adhesion, and less than 1 mL of embolic was required per side under fluoroscopic guidance. Post-embolization angiography confirmed vascular stasis and excluded non-target embolization.

Conclusion and/or Teaching Points:

PAE with n-BCA is a safe and feasible treatment option for BPH when executed with precise technique. Transradial access enhances patient experience, while meticulous embolic delivery using balloon occlusion microcatheters reduces complications. These technical refinements improve safety and efficacy, providing valuable insights for future procedural standardization.