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When facing complex anatomy and difficult vessel sizes, interventional radiologists need solutions and tools that offer simplicity, versatility and dependability—tools like Terumo’s PROGREAT® microcatheters and AZUR™ embolic systems.
“The Terumo AZUR line and PROGREAT portfolios are synonymous with excellence in the interventional radiology space, particularly in the realms of microcatheters and coils,” said Keith Pereira, MD, FSIR, of Saint Louis University. “These products have been a part of my practice since my training over 15 years ago and have become standard due to their exceptional quality and uniquely tailored portfolios.”
“Terumo offers a comprehensive range of solutions that enhance the entire procedural workflow from access to closure, including the radial-to-peripheral product line,” Dr. Pereira said. “The coils and microcatheters are designed to work together, providing a solution for any situation.”
The microcatheters that fit
Terumo’s PROGREAT portfolio is comprised of microcatheters designed to easily navigate tortuous vasculature. It also includes products such as PROGREAT Alpha™ 2.0Fr, a peripheral microcatheter designed for small vessels, as well as the PROGREAT Lambda™ 1.9Fr, which provides the ideal length for radial access in PAE procedures.4
“The PROGREAT line is designed to navigate distal and tortuous anatomy with precision, making them invaluable for procedures involving small vessels, such as liver and pelvic artery embolizations,” said Dr. Pereira, who has been involved in the development of several of Terumo’s newer-generation catheters, including the PROGREAT line.
According to Dr. Pereira, the PROGREAT Alpha microcatheter’s enhanced design not only allows for reliable vessel access, but also precise delivery of embolics, which is critical for complex procedures such as prostatic artery embolization (PAE) or gastrointestinal bleed embolizations. Progreat Alpha has a 2.0 Fr tip that comes in straight, J curve and 70-degree angle options, and lengths including: 110 cm, 130 cm and 150 cm.1
Terumo’s latest microcatheter for embolization, the PROGREAT Lambda 1.9Fr, is specifically designed to access small, distal vessels via radial access, while providing stability for embolic delivery.4
“This is an outstanding microcatheter, especially for PAE, or for access from anywhere in the body where there is a long distance to the treatment point, such as radial access,” said Marcelo S. Guimaraes, MD, MBA, FSIR, professor of surgery and radiology, Vascular Interventional Radiology Division at Medical University of South Carolina. “The tip is not only straight, but has different configurations such as a semi-curved tip, which helps facilitate access tremendously.”
The PROGREAT Lambda has a 165 cm length and a 1.9 Fr tip that also comes in three shapes: straight, 35-degree angle and a triple angle. The tapered inner lumen and shaft design allow for superior flow rates with up to 900 psi. It is also capable of delivering 0.018” detachable coils and microspheres up to 500μm.2,4
“Particularly in PAE procedures, with the Lambda microcatheter, physicians can use the same catheter to not only deliver the microspheres, but also the coils necessary to prevent non-target embolization,” Dr. Guimaraes said. “It’s an incredible technology—with a 1.9 Fr you can not only deliver beads but also embolization with coils.”
Soft packing, long lasting
During these PAE procedures, Dr. Guimaraes often finds himself delivering Terumo’s AZUR coils, a family of embolization products that are designed to work together for a variety of scenarios, from managing aneurysms to navigating vessel occlusions.
The AZUR line utilizes hydrogel, a scaffolding technology that expands up to four or five times its size when in contact with blood and helps eliminate microchannels to avoid reintervention.3,4
“I regularly use the hydrogel-based coils, as they are an integral part of my practice due to their advanced technology and reliable performance,” said Dr. Pereira. “The hydrogel within these coils enhances embolization efficacy by providing durable and lasting occlusion, making them particularly effective in achieving optimal clinical outcomes.”
“What sets these coils apart are their solid gel cores,” Dr. Guimaraes said. “With hollow cores, clots can form inside them and then get reabsorbed, causing the hollow core coil to become unstable and migrate,” he said. With the AZUR coils, the hydrogel-filled cores prevent this.
Dr. Guimaraes said he also finds them easy to use, especially the AZUR HydroPack™ system, a series of packing coils designed to pack tightly behind an anchor coil.
Because the HydroPack coil has no rigid shape, it can adapt to the space as needed and ensure dense packing, while the soft coil design enables smooth and precise delivery.4
“The hydrogel technology is truly a differentiating factor, as you can use less coils to fill up the same space,” Dr. Guimaraes said. “And if you find resistance in one corner of a cavity, you can go to another. As a result, you can fill up that irregular cavity very well and reach good hemostasis and total occlusion of a true aneurysm.”
“The delivery system for the AZUR line is also highly reliable,” Dr. Guimaraes said. “You have a tiny polymer connecting the pusher wire with the embolic agent. Once the physician is in a position to deliver the coil, they only need to connect a handheld device and push an electric discharge that will melt down that polymer and deliver the coil very precisely.”
This makes it easier for an operator to adjust the coil before deploying. In addition to the AZUR HydroPack Peripheral Coil System, the CX and HydroCoil Peripheral Coil Systems all utilize the hydrogel technology and come in a range of sizes from 0.018” to 0.035”, and lengths up to 60 cm. In addition, these coils are compatible with a variety of microcatheter and angiographic catheter sizes.
This versatility allows precision customization, according to Dr. Pereira, enabling him to address complex vascular anatomy and challenging clinical scenarios.
Simple, reliable solutions
Dr. Guimaraes has been involved in the development of several Terumo products, and though he was not part of the development for the PROGREAT or AZUR portfolios, he said he utilizes these products because of his experience with how Terumo develops their solutions.
“Whenever Terumo launches a product, it has been thoroughly tested and extensively investigated,” he said. “I know from my own experience that all necessary time and resources have been put into ensuring the product will be reliable, safe and consistently optimize patient care.”
Dr. Pereira, who is also the program director for the integrated IR residency at Saint Louis University, said he reaches for Terumo’s AZUR and PROGREAT lines when training residents and technologists.
“These tools off er a comprehensive range of solutions that enhance the entire procedural workflow from access to closure, including the radial-to-peripheral product line,” he said. According to Dr. Pereira, their use has simplified procedural planning, expanded IR scope and ensured uniformity within his practice.
For Dr. Pereira, when selecting systems for use, it’s a simple choice: “For anyone seeking to enhance their interventional radiology capabilities with cutting-edge tools, the Terumo AZUR and PROGREAT portfolios are unparalleled.”
References
- Progreat Microcatheters IFU PG34E002-05 Rev.10 Revised 2023-11
- Progreat Lambda Microcatheter IFU 22700BZX00078_US_2_03. Revised 2025-01
- Shimohira M. Reperfusion rates of pulmonary arteriovenous malformations after coil embolization: evaluation with time-resolved MR angiography or pulmonary angiography.” J Vasc Interv Radiol. 2015 (2015): 856-864. doi:10.1016/j.jvir.2015.02.016
- Data on file.
PROGREAT and PROGREAT ALPHA are intended for the infusion of contrast media into all peripheral vessels up to and including the cervical vessels, all vessels in the lower and upper extremities and all coronary vessels. PROGREAT and PROGREAT ALPHA are also intended for drug infusion in intra-arterial therapy and the infusion of embolic materials for hemostasis. PROGREAT and PROGREAT ALPHA should not be used in cerebral vessels.
PROGREAT LAMBDA is intended for the infusion of contrast media, or embolic materials for hemostasis, into the peripheral vasculature, excluding the blood vessels belonging to the central circulatory system. PROGREAT LAMBDA is also indicated for drug infusion in intraarterial therapy in the peripheral vasculature. PROGREAT LAMBDA should not be used in cerebral or coronary vessels.
Disclaimer: This article is sponsored by an SIR Corporate Partner and does not necessarily reflect the views or policies of SIR. SIR assumes no liability, legal, financial or otherwise, for the accuracy of information in this article or the manner in which it is used. The statements made in the column are not intended to set a standard of care and should not be treated as medical advice nor as a substitute for independent, professional judgment.
