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The use of microcatheters as a coronary interventional tool for a therapeutic approach to complex coronary interventions like bifurcation lesions, ostial location, tortuous anatomy, angled takeoffs, coronary calcification, and chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is growing among cardiologists across the country. During the treatment of such complex lesions, microcatheters play an essential part of the tool kit with both single-lumen and double-lumen microcatheters (DLMs) having their specific niche areas. The selection of microcatheters involves a detailed understanding of the microcatheter specification, lesion anatomy, lesion location, vessel tortuosity and trajectory, and crossing techniques. The selection of appropriate crossing techniques with different microcatheters increases success rates of PCI, reduces procedural time and contrast use, and lowers the radiation. However, the use of microcatheters and their technicalities have not yet fully realized by many operators and their true scope has not been fully explored. This article discusses and summarizes the thoughts and key opinions of experts in this field.

To evaluate the long-term efficacy and safety of combined ab-interno canaloplasty (ABiC) and gonioscopy-assisted transluminal trabeculotomy (GATT) with the iTrack microcatheter in patients with sustained intraocular pressure (IOP) elevation following intravitreal anti-VEGF or steroid injections. This was a retrospective, single-center study of patients who underwent ABiC and GATT with the iTrack microcatheter between 2017 and 2021 for secondary open-angle glaucoma or ocular hypertension following intravitreal injections. Eligible eyes had a preoperative IOP of ≥18 mmHg while on maximal tolerated medical therapy. Primary outcomes included IOP and glaucoma medication burden. Surgical success was defined using American Academy of Ophthalmology (AAO) criteria. Subgroup analyses were conducted by etiology (anti-VEGF vs steroid-induced). Kaplan-Meier analysis estimated cumulative success rates. Thirty-four eyes from 30 patients were included, with a mean last follow-up of 15.3±9.8 months. Mean IOP was reduced by 46%, from 28.1±6.0 mmHg at baseline to 14.3±5.6 mmHg (p<0.001) at the last follow-up, while the number of medications decreased from 2.79±0.9 to 1.76±1.5 (p=0.001). Surgical success was achieved in 71% of eyes. Medication-free status was reached in 29% of eyes, compared with none at baseline, and 26% achieved IOP ≤15 mmHg without medications. Additional glaucoma procedures were needed in 11.8% of eyes. Combined ABiC and GATT remained effective in eyes receiving post-procedure intravitreal reinjections or prolonged topical steroid use. Kaplan-Meier analysis showed a survival probability above 70% at 25 months. Combined ab-interno canaloplasty and GATT using the iTrack microcatheter is a safe surgical option for selected eyes with sustained IOP elevation following intravitreal injections. The procedure achieved meaningful reductions in IOP and medication use, including in eyes requiring continued intravitreal therapy, supporting a primary surgical effect. Careful patient selection and long-term follow-up remain essential, as a subset of eyes may require additional intervention.

BackgroundVascular angulation at the level of occlusion negatively affects the success of aspiration thrombectomy in patients with acute ischemic stroke (AIS). This study aims to evaluate the efficacy of the aspiration thrombectomy with microcatheter navigation (ATMN) technique in AIS patients where the direct aspiration first pass technique (DAPT) failed due to vascular angulation at the occlusion level.MethodsThe patients admitted to our institution with AIS due to large vessel occlusion and treated with DAPT as a first-line technique between August 2020 and December 2022 were retrospectively evaluated. The feasibility and success of the ATMN technique in patients with DAPT failure were evaluated. Vascular angulation at the occlusion level was measured and compared.Results43 patients were included in the study. Successful revascularization was achieved with DAPT in 29 of 43 patients (67.5%). ATMN technique was performed on 14 of 43 patients (32.5%) after DAPT failure. The ATMN technique achieved a high success rate, with 78.5% (11 out of 14) of patients experiencing successful recanalization. The mean vascular angulation at the occlusion level was significantly increased in patients with sufficient recanalization by DAPT as first-line therapy compared to the patients with insufficient recanalization by DAPT who underwent successful thrombectomy with the ATMN technique (143.5 ± 23.3 vs. 107.6 ± 15.6, p ˂ 0.001).ConclusionThis study’s results showed that the ATMN technique was a useful alternative with a high level of success in stroke patients with vascular angulation in which DAPT failed to achieve sufficient recanalization.

Purpose: The treatment efficacy of the transarterial approach to lung cancer is evaluated. Materials and Methods: A total of 98 patients with advanced lung cancer or recurrent lung cancer after the standard therapies were enrolled retrospectively. The bronchial arteries and mediastinal branches from the subclavian artery were selected by a microcatheter. Immediately after the selective arterial infusion of anti-neoplastic agents, embolization with a spherical embolic material was carried out. Local tumor effects and overall survival were evaluated. Result: The mean reduction rate was 17.9%, with 24.2% for partial remission and with 2.1% for progression disease. The rate of stable disease was 72.6%. The response rate was 25.3%, and the disease control rate was 97.9%. The median survival time (MST) was 11.4 months, the 1-year survival rate was 45.2%, and the 2-year survival rate was 35.6%. Although it is insignificant, the MST for 51 adenocarcinomas was higher than that of 29 squamous cell carcinomas (18.6 months and 9.4 months, respectively). The local extension of tumors related to a better prognosis, though it was not significant. Lymph node metastases and distant metastases were poor prognostic factors. No major complications nor treatment-related mortalities were found in this study. Conclusion: The transarterial treatment for lung cancer should be considered as a treatment option when the other treatments were not indicated both in initial cases and in recurrent cases.

Abstract BACKGROUND Delta-24-RGD, an oncolytic adenovirus, shows promise against glioblastoma. To enhance virus delivery, we recently demonstrated that human bone marrow-derived mesenchymal stem cells loaded with Delta-24-RGD (hMSC-D24) can eradicate glioblastomas in mouse models. There are no studies examining the safety of endovascular selective intra-arterial (ESIA) infusions of MSC-D24 in large animals simulating human clinical situations. OBJECTIVE To perform canine preclinical studies testing the feasibility and safety of delivering increasing doses of hMSCs-D24 via ESIA infusions. METHODS ESIA infusions of hMSC-D24 were performed in the cerebral circulation of 10 normal canines in the target vessels (internal carotid artery [ICA]/P1) via transfemoral approach using commercially available microcatheters. Increasing concentrations of hMSC-D24 or particles (as a positive control) were injected into 1 hemisphere; saline (negative control) was infused contralaterally. Toxicity (particularly embolic stroke) was assessed on postinfusion angiography, diffusion-weighted magnetic resonance imaging, clinical exam, and necropsy. RESULTS ESIA injections were performed in the ICA (n = 7) or P1 (n = 3). In 2 animals injected with particles (positive control), strokes were detected by all assays. Of 6 canines injected with hMSC-D24 through the anterior circulation, escalating dose from 2 × 106 cells/20 mL to 1 × 108 cells/10 mL resulted in no strokes. Two animals had ischemic and hemorrhagic strokes after posterior cerebral artery catheterization. A survival experiment of 2 subjects resulted in no complications detected for 24-h before euthanization. CONCLUSION This novel study simulating ESIA infusion demonstrates that MSCs-D24 can be infused safely at least up to doses of 1 × 108 cells/10 mL (107 cells/ml) in the canine anterior circulation using commercially available microcatheters. These findings support a clinical trial of ESIA infusion of hMSCs-D24.

Optogenetic stimulation has become a promising approach for restoring lost body function. For example, partial restoration of vision has been achieved in a blind patient and preclinical proof-of-concept has been demonstrated for optogenetic hearing restoration. In preparation for clinical translation of hearing restoration, efficient and safe optogenetic modification of spiral ganglion neurons (SGNs) in the mature cochlea remained to be developed. Here, we established microcatheter-based administration of adeno-associated virus (AAV) into of the cochlea of Mongolian gerbils and compared it to the previously developed direct AAV-injection into the spiral ganglion. We probed the potential of AAV-PHP.S to express channelrhodopsins (ChRs) under the control of the human synapsin promotor in mature SGNs of hearing and deafened gerbils. Using the microcatheter approach, but not with the AAV-modiolus injection, we achieved reliable ChR expression in SGN enabling optogenetic stimulation of the auditory pathway in 80% of the treated animals. Yet, the efficiency of SGN transduction was modest with only ~30% ChR-expressing SGNs. Moreover, we encountered off-target expression in hair cells in hearing gerbils in both approaches. We did not detect ChR expression in the central nervous system using microcatheter administration. Comparing optogenetic auditory brainstem responses of gerbils with and without hair cell transduction confirmed that SGNs were the primary site of optogenetic stimulation of the pathway. The AAV.PHP-S microcatheter administration via the round window with pressure relief at the round window is a reliable approach to optogenetically modify the SGNs in order to restore hearing with future optical cochlear implants.

Biliary and pancreatic tract stenosis are hallmark symptoms in pancreaticobiliary diseases, transcending malignancy. Endoscopic techniques are pivotal for biliary/pancreatic drainage; however, challenging scenarios arise when attempting to pass a guidewire (GW) through obstruction. Cholangioscopy-assisted GW placement has proven valuable, but challenges persist in its execution, particularly in maneuvering the GW through cholangioscopy. Therefore, we explored the integration of a 3-Fr microcatheter into cholangioscopy with the aim of enhancing direct visualization and offering a super-selective approach. When GW manipulation under a digital single-operator cholangioscope (D-SOC) guidance was still unsuccessful in a resistant obstruction, the 3-Fr microcatheter was introduced. This technique was performed in 42 individuals for 37 biliary and 5 pancreatic duct drainages, among which there were 19 malignant, 18 benign, and 4 anastomotic obstructions. In all patients, contrast-filled cholangiography in the target area couldn’t be achieved at the pre-microcatheter insertion stage due to obstruction. The technical success rate was 85.7% overall, 89.5% in malignant strictures, 84.2% in benign strictures, and 75.0% in anastomotic obstructions, resulting in a clinical success rate of 78.6%. The use of a 3-Fr microcatheter appears effective for endoscopic drainage performed for obstruction. This technique could pave the way for improved outcomes in patients with pancreaticobiliary diseases.

In the present era, the intricacy of procedures undertaken by a pediatric interventional cardiologist has increased, primarily attributed to dealing with smaller, younger patients with more complex anatomies. To adapt to these smaller and more complex patients, we must adapt our interventions and our equipment to perform these procedures. This article outlines various innovative applications of the SwiftNinja steerable microcatheter within the pediatric cardiac catheterization laboratory.

To study the consistency in outcomes of standalone canaloplasty performed via an ab-interno surgical technique in reducing intraocular pressure (IOP) and number of medications in uncontrolled open-angle glaucoma (OAG) eyes over a 12-month period. This retrospective multicenter case series included patients who underwent standalone canaloplasty via an ab-interno surgical technique using the iTrack microcatheter (Nova Eye, Inc., Fremont, USA) and had preoperative uncontrolled OAG (IOP≥18mmHg) along with no previous glaucoma surgery. The iTrack microcatheter is used to circumnavigate 360° and viscodilate Schlemm's canal. Consistency of IOP and medications reduction on an eye-by-eye basis were evaluated to understand the outcomes in each single eye. Sixty-four eyes of 60 patients (age 71.5±13.4 years) were included. Six eyes (9%) that underwent additional glaucoma surgery were considered a failure and were subsequently excluded from analysis. At 12 months, IOP was reduced in 57 of the 58 (89%) remaining eyes; one eye had the same IOP with a reduced number of medications. Of the 57/58 eyes with a reduced IOP: 44 eyes (69%) required fewer medications; 12 eyes (19%) required the same number of medications. Of these 58 eyes, 78% of eyes had a ≥20% reduction in IOP compared to baseline; 69% eyes had a postoperative IOP ≤15 mmHg, and 86% eyes ≤18 mmHg at 12 months. Forty percent of the eyes were medication-free at 12 months compared to none at baseline. Canaloplasty performed via an ab-interno surgical technique as a standalone procedure consistently reduced IOP and glaucoma medications in almost all eyes.