Early Outcomes and Safety of Prostate Embolization with n-Butyl cyanoacrylate Liquid Embolic: A Single-Center Safety and Feasibility Study

Monday, March 6, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 226ABC

Abstract Speaker(s)

David Bamshad, MD

Fellow PGY6
The Mount Sinai Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

NG

Naveen Galla, MD

Resident Physician
Mount Sinai
Jay Sanghvi

Medical Student
Icahn School of Medicine at Mount Sinai
Dan Shilo, MD

Assistant Professor
Mount Sinai
KG

Kirema Garcia-Reyes, MD

Assistant Professor
Mount Sinai
AR

Art Rastinehad, DO

Vice Chair of Urology and Northwell Health System Director for Prostate Cancer
Lenox Hill Hospital
AF

Aaron M. Fischman, MD

Professor of Radiology and Surgery
Mount Sinai Health System

Disclosure(s):

David Bamshad, MD: No financial relationships to disclose

Kirema Garcia-Reyes, MD: No financial relationships to disclose

Purpose: Historically, prostate artery embolization (PAE) has been performed with calibrated microspheres. Liquid adhesive agents such as n-Butyl cyanoacrylate (n-BCA) have several advantages including quick administration and the ability to embolize arteries difficult to catheterize, of particular interest given the small tortuous arteries supplying the prostate. This study aims to assess the feasibility, safety, and short-term efficacy of n-BCA glue embolization for PAE.

Materials and Methods: 32 consecutive patients who underwent PAE with n-BCA from 6/2022 to 10/2022 were retrospectively reviewed. All cases were performed by a single operator with 8 years of experience performing PAE. After catheterization of the main prostatic arteries with a microcatheter, n-BCA was used as the primary embolic with 1:9-1:12 dilution of n-BCA: lipiodol. All cases were performed using transradial access with separate microcatheters for the right and left sides. Embolization endpoint used was complete stasis prior to reflux (Figure 1). Procedural details including fluoroscopy time (FT), air kerma (AK), and dose area product (DAP), as well as pre- and 6-week post-procedural International Prostate Symptom Score (IPSS) and adverse events (AEs), were recorded. Technical success (TS) was defined as successful bilateral embolization.

Results: TS was 97% (31/32), with one procedure failure secondary to the inability to cannulate the right prostatic artery due to severe atherosclerotic stenosis. Median FT was 22.4 minutes (Interquartile range (IQR): 16.8-32.7). Median AK was 744 mGy (IQR: 530-1296). Median DAP was 16.9 mGym2 (IQR: 11.5-23.9). There were no AEs during the procedures or reported at 6-week follow-up. Mean IPSS decreased from 21.0 to 6.0 (↓71.4%, p < 0.001, n=9). For patients with severe lower urinary tract symptoms (IPSS 20-35), the mean IPSS decreased from 26.0 to 6.6 (↓74.6%, p < 0.001, n=5).

Conclusion: The use of n-BCA as the primary embolic for PAE is technically feasible and safe with low radiation doses and significant improvement in IPSS at short-term follow-up. Further investigation with long-term follow-up and prospective comparative analysis is warranted to compare safety and efficacy with other PAE embolic methods.