Application of an advanced steerable microcatheter for challenging arterial embolization in massive hemoptysis

Bronchial artery embolization (BAE) is a safe and effective treatment for hemoptysis, which is caused by diseases such as lung cancer, bronchiectasis, and tuberculosis. In cases of massive hemoptysis, the offending vessel originates from the bronchial artery in more than 90% of cases, and in a few cases, it can originate from nonbronchial arteries. Superselective embolization of complex or rarely affected vessels remains challenging. The SwiftNINJA^® steerable microcatheter (SSM) (Merit Medical) optimizes the navigation of complex vessels through preset tip angles. We present a case of massive hemoptysis caused by lung cancer, in which the offending artery originated from the right thyrocervical trunk, which was at an acute angle (<30°) relative to the right subclavian artery. After conventional microcatheter techniques failed in superselection, the SSM was selected based on the anatomical characteristics of the bleeding vessel during the procedure. By setting the preset angle of its tip, we could quickly and accurately pass it through the right subclavian artery and hook its branch arteries, thereby easily superselecting and embolizing the bleeding vessel. Through the use of SSM, superselection and embolization of difficult angles can be successfully achieved. SSM improves the efficiency of superselective embolization in BAE surgery.