Cone-beam CT could mitigate risk of non-target embolization in the prostatic artery

Sandeep Bagla
Sandeep Bagla

A small study published online ahead of print on 26 August 2013 in the Journal of Vascular and Interventional Radiology (JVIR) suggests that cone-beam CT is a useful technique that can potentially lessen the risk of non-target embolization in prostatic artery embolization.

Prostatic artery embolization is a burgeoning procedure in the field of Interventional Radiology, with research focused on improving safety and evaluating its long term efficacy.

Researchers Sandeep Bagla, Cardiovascular Interventional Radiology, Inova Alexandria Hospital, Alexandria, USA, and colleagues noted that during treatment, it can allow for the interventionalist to identify duplicated prostatic arterial supply or contralateral perfusion, which may be useful when evaluating a treatment failure.

Bagla told Interventional News: “This study is important because the most feared, but rare, complication of non-target embolization could be mitigated with the use of cone beam CT when performing prostatic artery embolization. This offers the interventional radiologist an opportunity to identify possible sources of non-target embolization prior to performing the actual procedure. Modern endovascular units provide rapid and reliable CBCT, which does not add significant time to the procedure and may actually shorten the procedure by improving physician confidence.”

The investigators set out to evaluate the utility of cone-beam computed tomography (CT) in patients who underwent embolization for benign prostatic hyperplasia.

Over a one year period from 2012 to 2013, 15 patients (age range, 59–81 years; mean, 68 years) with moderate- or severe-grade lower urinary tract symptoms, in whom medical management had failed were enrolled in a prospective trial to evaluate prostatic artery embolization.

Bagla et al performed 15 cone-beam CT acquisitions in 11 patients during pelvic angiography. They also noted that digital subtraction angiography was performed in all patients

“Cone-beam CT images were reviewed to assess for sites of potential non-target embolization that impacted therapy. […] Cone-beam CT provided information that impacted treatment in five of 11 patients (46%) by allowing for identification of sites of potential non-target embolization. Duplicated prostatic arterial supply and contralateral perfusion were identified in 21% of patients (three of 11),” the authors noted.