Ep. 629 Optimizing Prostate Treatment with Embolization Strategies with Dr. Art Rastinehad and Dr. Don Garbett

From consult to catheter, success in prostate artery embolization is shaped by a series of decisions that directly impact patient outcomes. In the third installment of our 2026 PAE University series, Dr. Chris Beck is joined again by Dr. Art Rastinehad and Dr. Don Garbett to discuss patient selection, procedural strategies, and practical case-based learnings in prostate artery embolization. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Guerbet. --- Timestamps 00:00 - Introduction03:33 - Typical Referrals and Patient Workup06:08 - Prostate Sizes and Bladder Necks12:33 - Radial Versus Femoral Access16:38 - Ipsilateral Crossing Techniques17:02 - Preferred Microcatheters20:32 - Troubleshooting Techniques with Microwires22:35 - Intra-arterial Medications and Checkpoints26:01 - Protecting Penile Collaterals29:47 - Evolution of PAE Technique32:20 - Liquid Embolics and Dilution Strategies37:48 - Bead Sizing Considerations39:59 - Managing Symptoms Post-PAE48:33 - Repeat PAE Procedures52:49 - Managing No-Flow After Injection57:06 - Case Studies --- More about this episode The discussion begins with consultation frameworks, focusing on imaging modalities and symptom scoring systems used to determine candidacy for PAE. Scenarios in which PAE may be less suitable, such as patients with high bladder neck anatomy, are also addressed alongside alternative management considerations. The conversation then transitions to procedural planning, including arterial access (radial versus femoral), workflow efficiencies to reduce operator fatigue, and preferred device selection such as microcatheters, microwires, and adjunctive vasodilators.Technical challenges encountered during PAE are explored in detail, including management of collateral vessels and avoidance of non-target embolization through techniques such as coil protection and flow modulation. The role of liquid embolics is also discussed, with emphasis on dilution strategies that vary based on operator technique. Post-procedural care is then reviewed, including assessment of symptom response, expectations for clinical outcomes, and criteria for repeat embolization in select patients. The episode concludes with three case studies highlighting procedural decision-making in complex scenarios, emphasizing recognition of anatomic variants and strategies to address intra-procedural challenges. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app