Fig. 4

82 year-old female with segment 4a hepatocellular carcinoma. Recent myocardial infarction, treated with angiography and stent placement, thus must remain on aspirin and plavix. Celiac DSA demonstrates trifurcation of common hepatic artery into right hepatic, left hepatic, and gastroduodenal arteries (a). The SwiftNINJA® steerable microcatheter was used to select the left hepatic artery (LHA), and DSA images demonstrate a segment 4 branch artery off of the LGA supplying the tumor, with early arterial enhancement (b). The LHA was selected with the SwiftNINJA® and no guidewire, with time to target vessel selection of 9 s. The steerable microcatheter was used to superselect the branch artery supplying the HCC with prominent tumor enhancement (c). The time from SwiftNINJA® selection from proximal LHA to superselective branch vessel cannulation was 13 s, with no guidewire needed. After superselective transarterial chemoembolization, there was appropriate stasis in the feeding vessel. Total procedure time was 45 min