Allura

The technique has been described in details elsewhere [20 (link)]. In short, embolic particles were injected proximally in the prostate artery and after achieving stasis of the flow, the microcatheter was advanced into the intraprostatic branches. The purpose of initial flow-directed embolization followed by complete occlusion of the microcirculation was to induce a significant infarction. Perioperatively, 5000 units of heparin in bolus were administered followed by 1000–2000 units per hour on the discretion of the operator. Under local anesthesia, a 5F sheath (Fortress, Biotronik) was employed to access the right common femoral artery. The prostate arteries were localized on each hemipelvis and super-selectively catheterized with a 2.0-F microcatheter (Progreat, Terumo Interventional Systems). Before manually injecting 300–500-μm tris-acryl gelatine microspheres (Embosphere, Merit Medical) particles under fluoroscopic guidance, a cone-beam CT (Allura, Phillips) was performed to confirm catheter placement and visualize any aberrant collaterals. Branches not supplying the prostate were protected by coil embolization or by advancing the microcatheter distally to their origin before injection of embolic particle suspension. Every milliliter of particle suspension injected was followed by three milliliters of saline.

Patency was determined at the end of follow-up, per coronary angiography (Philips Allura Xper FD20, Eindhoven, The Netherlands). Access was via the femoral artery, with the internal mammary catheter (6 Fr) introduced in the proximal LIMA. Images were recorded in at least 2 directions and were graded by 2 independent investigators to the FitzGibbon criteria (classes A and B are defined as patent, class O is defined as nonpatent).^{11 (link)}

We used the X-ray system (Philips Allura Xper FD10/10 biplane), which is a cardiac angiography system.

A digital subtraction angiography machine (Allura, Philips, Amsterdam, Netherlands) performed coronary angiography, and angiography images were recorded at 15 frames/s. The field of view (FOV) was 20 cm × 20 cm − 22 cm × 22 cm, the matrix was 512 × 512, the tube current was 500−800 mA, and the tube voltage was 60−120 kV. The non-ionic contrast agent with an iodine content of 350−370 mgI/ml was injected. Before coronary angiography, nitroglycerin was injected into the target vessel to exclude coronary spasms caused by medical devices. An experienced technician using QCA software (Beijing Crealife Technology Co., Ltd., Beijing, China) selected the angiogram in the diastolic period. Meanwhile, the technician analyzed the quantitative coronary angiography values of the target vessels. QCA software automatically delineated the lumen contour of the target vessels, and a manual correction was allowed when the error of measurement existed. An intermediate QCA technician was selected to analyze the QCA; after that, a senior technician verified all data.