A Novel approach to catheterizing the Left Gastric Artery for bariatric embolization

We present the case of a 45 Y/o morbidly obese male who - unable to lose weight despite extensive lifestyle interventions, presented to us for an experimental procedure known as bariatric embolization. This arterial embolization procedure was performed targeting the left gastric artery with aims to restrict blood flow to the gastric fundus, and lowering serum ghrelin levels. In this case the left gastric artery arose cephalad from the celiac, earlier than where it normally branches; a variation known as a “false tripod”, causing some initial difficulty with selection. We describe how introducing a tertiary curve on the guidewire proved successful. Adapting the guidewire for difficult anatomy is an often a very underutilized skillset for many interventionalists - but led to success in this rather nascent procedure.