24 year old with congestive heart failure prior LVAD placement and now presenting with recurrent significant hemoptysis and unknown hypervascular mass in the right lower lobe.
Right intercostal angiogram with a 5fr Mickelson revealed a hypervascular mass and filling of the artery of Adamkiewicz which was at high risk for non-targeted delivery.
A Surefire 5 Fr Axis Specialty catheter was used to access the right intercostal artery. The Surefire Infusion System ST was advanced into the right intercostal artery, past the artery of Adamkiewicz. The Surefire expandable tip was deployed to minimize possible reflux into the spinal artery. Bland embolization was performed with 300-500 μm Embosphere® Microspheres, and 100% of the planned dose was delivered.
The patient’s lower extremity function was assessed throughout the procedure to monitor non-target delivery into the spinal artery, and there was no change in function observed. In post procedure angiography, flow to the hypervascular mass was eliminated while maintaining flow in the anterior radicular artery. The Surefire Infusion System ST enabled bronchial arterial embolization while protecting the artery of Adamkiewicz without any sequelae.
Selective right T6 intercostal arterial injection with 5 French Mickelson shows very hypervascular mass and also faint filling of a vessel with a “hairpin turn” that lies midline thought to be the dominant thoracic anterior radicular artery or also called the “artery of Adamkiewicz” (which supplies the anterior spinal artery).
Embolization with 300-500 μm Embosphere® Microspheres performed with Surefire Infusion System ST through Axis Specialty catheter.
Post embolization angiogram shows elimination of flow to hypervascular mass and persistent filling of the artery of Adamkiewicz.