Optimizing Prostate Treatment w/ Embolization Strategies w/ Dr. Rastinehad & Dr. Garbett | Ep. 629

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 app https://www.backtable.com/app --- This podcast is supported by an educational grant from Guerbet. --- Timestamps 00:00 - Introduction 03:33 - Typical Referrals and Patient Workup 06:08 - Prostate Sizes and Bladder Necks 12:33 - Radial Versus Femoral Access 16:38 - Ipsilateral Crossing Techniques 17:02 - Preferred Microcatheters 20:32 - Troubleshooting Techniques with Microwires 22:35 - Intra-arterial Medications and Checkpoints 26:01 - Protecting Penile Collaterals 29:47 - Evolution of PAE Technique 32:20 - Liquid Embolics and Dilution Strategies 37:48 - Bead Sizing Considerations 39:59 - Managing Symptoms Post-PAE 48:33 - Repeat PAE Procedures 52:49 - Managing No-Flow After Injection 57:06 - 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 #VI629 #embolization #interventionalradiology #urology