superselective

Superselective is a term used in interventional radiology to describe the catheterization of very distal arterial branches using a microcatheter in order to deliver therapy directly to a target lesion. It denotes a higher degree of selectivity than standard selective catheterization and is intended to maximize local treatment while sparing surrounding healthy tissue.

The technique involves obtaining vascular access (commonly via the femoral or radial artery), advancing a guidewire and then a microcatheter into progressively smaller feeding arteries of the target lesion, and confirming flow with angiography. Once the microcatheter is positioned in the distal vessel, the chosen therapeutic or diagnostic agent—such as embolic particles, chemotherapeutic or radiopharmaceuticals—can be delivered under imaging guidance. The goal is precise delivery with minimal non-target exposure.

Common applications include transarterial chemoembolization for hepatocellular carcinoma and other hypervascular liver lesions, selective embolization of tumors or arteriovenous malformations, and preoperative devascularization or uterine fibroid embolization. Superselective techniques are also used to reduce systemic toxicity and preserve function in organs with complex vascular anatomy.

Benefits of superselective catheterization include improved local control of the lesion, reduced damage to normal tissue, and lower risk of systemic side effects. Potential risks are those associated with any endovascular procedure, including vessel injury, non-target embolization, catheter or guidewire complications, and post-embolization syndrome. Its feasibility depends on vascular anatomy and operator expertise.