Case study of spleen artery aneurysm embolization utilizing coils and NBCA (n-butyl 2-cyanoacrylate) in conjunction with a novel PTFE-coated microcatheter, featuring 3 patients

A new approach to treating splenic artery aneurysms (SAA) has shown promising results, using a combination of coils and NBCA (N-butyl cyanoacrylate) delivered through a Carry Leon NSX microcatheter.

Three female patients, aged 55, 60, and 80, underwent successful embolization procedures for their SAAs. One of the patients, a 60-year-old woman, was referred to the hospital due to an incidental discovery of the aneurysm during follow-up imaging of hepatic and pancreatic cysts.

The study, which was approved by the ethics committee and had informed consent from all patients, used CO angiography to minimize contrast and preoperative evaluation with noncontrast magnetic resonance angiography (MRA) due to renal dysfunction. The SAA measured 26 × 21 × 22 mm, with an inflow vessel of approximately 8.4 mm and a single outflow vessel of 9.0 mm.

The Carry Leon NSX microcatheter, with its PTFE-coated tip, played a significant role in simplifying the embolization procedure and reducing the number of coils required. This microcatheter has shown promising effectiveness in improving both the safety and efficacy of NBCA embolization procedures.

One of the main challenges with NBCA embolization is the rapid polymerization of the glue, which can cause the microcatheter to adhere to the vessel wall or the embolic cast, raising the risk of catheter entrapment or vessel injury. The PTFE coating on the tip of the Carry Leon NSX microcatheter minimizes this adhesion, allowing for safer catheter retraction after glue injection.

The design and coating of the microcatheter also lend better lubricity and trackability through tortuous vasculature, such as that encountered in splenic artery aneurysms. This facilitates precise distal catheter positioning near or within the aneurysm sac, which is key for targeted embolization.

With improved control and reduced catheter sticking, operators can perform more controlled and accurate NBCA injections. This precision helps prevent reflux or non-target embolization, reducing complications such as ischemia or infarction in adjacent organs.

While direct studies may be limited, reports and case series indicate successful use of PTFE-coated microcatheters like the Carry Leon NSX in complex NBCA embolizations, showing fewer complications related to catheter adhesion and improved technical success rates.

In the case of the 60-year-old woman, the embolization procedure was successful, and postembolization imaging confirmed complete occlusion of the aneurysm. She experienced mild elevations in ALP levels, WBC count, CRP level, and gamma-glutamyl transpeptidase (γGTP) levels, as well as grade 3 renal dysfunction. However, she was discharged after experiencing left-sided abdominal pain and mild splenic infarction, which improved over time. A follow-up MRI confirmed complete occlusion of the aneurysm with a mild splenic infarction.

In conclusion, the Carry Leon NSX microcatheter with a PTFE-coated tip enhances the safety profile of NBCA splenic artery aneurysm embolization by preventing catheter adhesion and enabling controlled delivery, thereby improving procedural efficacy and patient outcomes. However, individual patient anatomy and operator experience remain important factors influencing overall success.

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Case study of spleen artery aneurysm embolization utilizing coils and NBCA (n-butyl 2-cyanoacrylate) in conjunction with a novel PTFE-coated microcatheter, featuring 3 patients