No Incremental Benefit of Coil-Assisted Over Ethanol Embolization in Unilateral Primary Aldosteronism
Zhi-Qiang Ma, Ning-Peng Liang, Hong-Liang Xiong, Jiao Yang, Zi-Xin Lin, Yi-Fei DongAbstract
Background
Selective adrenal arterial embolization (SAAE) is an alternative treatment for unilateral primary aldosteronism (PA), but its overall success remains variable. We evaluated whether coil-assisted ethanol embolization (Coil-E) improves outcomes compared with ethanol embolization alone in patients undergoing single-vessel SAAE.
Methods
In this retrospective study, patients with unilateral PA who underwent single-vessel SAAE between 2020 and 2021 were categorized into Coil-E and ethanol groups. The primary endpoint was clinical success at 12 months defined according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. Secondary endpoints included biochemical success, changes in 24-hour ambulatory blood pressure (BP), and safety outcomes. Propensity score–based analyses were performed.
Results
Eighty-two patients were included (23 Coil-E, 59 ethanol). At 12 months, complete clinical success occurred in 17.4% vs. 20.3%, partial success in 47.8% vs. 35.6%, and absent success in 34.8% vs. 44.1% (Coil-E vs. ethanol; all P > 0.05). Complete biochemical success occurred in 39.1% vs. 55.9%, whereas absent biochemical success occurred in 34.8% vs. 28.8%. Mean 24-hour systolic/diastolic BP decreased by 21.6/10.1 mmHg in the Coil-E group and 20.5/9.7 mmHg in the ethanol group, with no significant between-group differences. Serum potassium and aldosterone improved in both groups without deterioration in renal function or cortisol levels. No major procedure-related complications occurred. Findings were consistent across adjusted analyses.
Conclusion
Among patients with unilateral PA undergoing single-vessel SAAE, Coil-E was not associated with improved PASO-defined clinical or biochemical success compared with ethanol embolization alone.