Comparison of Depth of N-butyl Cyanoacrylate Embolic Penetration in Prostate Artery Embolization with Balloon Occlusion Microcatheters versus Conventional End-hole Microcatheters

Purpose: There is evidence that deeper penetration of embolic is associated with improved clinical outcomes after prostate artery embolization (PAE). This study evaluated zone of embolization in PAE with n-butyl cyanoacrylate (n-BCA) for benign prostatic hyperplasia (BPH) using balloon occlusion (BO) microcatheters versus conventional end-hole (EH) microcatheters.

Materials and Methods: A retrospective study of patients who underwent primary PAE with n-BCA for BPH between 6/2022-9/2025 was performed. Patient charts and imaging were reviewed to identify whether a BO or EH microcatheter was used for embolization. Primary outcome was zone of embolization (established by Rastinehad et al; zone 1- embolization of the peripheral capsular arteries; zone 2- embolization of the transitional zone and/or central gland; zone 3- embolization to the midline of the ipsilateral gland). Secondary measures included: if n-BCA crossed the midline and if n-BCA filled a secondary collateral. Each hemiprostate was analyzed independently. Chi-squared and Mann-Whitney U tests were performed to elucidate any association between catheter type and zone of embolization. Chi-squared analysis was performed to evaluate any significant difference between catheter groups and secondary measures.

Results: A total of 868 hemiprostates were embolized in 447 patients who underwent PAE with n-BCA for BPH. Embolization was performed using a BO microcatheter in 46.1% (400/868) of hemiprostate embolizations. Specifically, the Sniper Balloon Occlusion Microcatheter (Embolx, Sunnyvale, CA) was used in 99.5% (398/400) of BO microcatheter cases, and the Scepter C Occlusion Balloon Catheter (MicroVention, Aliso Viejo, CA) was used in 0.5% (2/400) of BO microcatheter cases. EH microcatheters were used in 53.9% (468/868) of hemiprostate embolizations. The type of microcatheter was significantly associated with zone of embolization (p< 0.001). Specifically, zone 3 embolization was achieved in 90.3% (361/400) of cases with BO microcatheters versus 57.3% (268/468) of those with EH microcatheters. There was also a significantly increased likelihood of n-BCA crossing the midline (134/216, 62.0% vs. 82/216, 38.0%; p< 0.001) and filling secondary collaterals (114/175, 65.1% vs. 61/175, 34.9%; p< 0.001) using BO microcatheters as compared with EH microcatheters.

Conclusion: The use of BO microcatheters in PAE for BPH was associated with significantly deeper penetration of n-BCA, as well as a significantly increased likelihood of embolic crossing the midline and filling secondary collaterals.