{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:13:32Z","timestamp":1783505612138,"version":"3.55.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>N-butyl cyanoacrylate (NBCA) embolisation is an effective technique for rapid haemostasis and tumour devascularisation. However, selection of a single glue dilution requires balancing distal penetration against proximal control, often relying heavily on operator experience. Achieving both deep distribution and stable proximal occlusion can be challenging, particularly in complex lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technique and case presentation<\/jats:title>\n                    <jats:p>We describe a sequential dual-dilution NBCA embolisation technique (\u201cNitoryu\u201d technique), in which a dilute NBCA\u2013lipiodol mixture is first administered to achieve flow-directed distal penetration, followed by injection of a more concentrated mixture to achieve rapid proximal occlusion and stabilisation of the embolic cast. The technique was applied in two cases. In a patient with ruptured hepatocellular carcinoma and coagulopathy, multiple small tumour-feeding arteries and a poorly visualised culprit pseudoaneurysm required deep penetration of dilute glue, followed by proximal occlusion to ensure durable haemostasis. In a second case of bronchial artery pseudoaneurysm causing haemoptysis, a tiny tortuous feeder necessitated very dilute glue for distal delivery, while subsequent proximal embolisation with a more concentrated mixture reduced the risk of reflux and non-target embolisation. In both cases, the sequential approach allowed controlled embolisation with effective distal penetration of glue and stable proximal occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The sequential dual-dilution NBCA embolisation (Nitoryu technique) enables controlled distal penetration and proximal stabilisation, and may improve safety and efficacy in selected cases requiring precise glue delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00732-5","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:15:59Z","timestamp":1783502159000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sequential dual-dilution N-butyl cyanoacrylate embolisation (\u201cNitoryu\u201d technique) for controlled distal penetration and proximal occlusion"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4168-5205","authenticated-orcid":false,"given":"Yi-Wei","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"732_CR1","doi-asserted-by":"publisher","unstructured":"Comby PO, Guillen K, Chevallier O, Lenfant M, Pellegrinelli J, Falvo N, et al. Endovascular use of cyanoacrylate-lipiodol mixture for peripheral embolization: properties, techniques, pitfalls, and applications. J Clin Med. 2021;10(19). https:\/\/doi.org\/10.3390\/jcm10194320.","DOI":"10.3390\/jcm10194320"},{"key":"732_CR2","doi-asserted-by":"publisher","unstructured":"Kidani N, Hirotsune N. NBCA: basic knowledge. J Neuroendovasc Ther. 2025;19(1):2024\u201355. https:\/\/doi.org\/10.5797\/jnet.ra.2024-0055. PubMedPMID:40018282. PubMedCentralPMCID:PMC11864999.","DOI":"10.5797\/jnet.ra.2024-0055"},{"key":"732_CR3","doi-asserted-by":"publisher","unstructured":"Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H, et al. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol. 2014;32(8):500\u201317. https:\/\/doi.org\/10.1007\/s11604-014-0328-7.\u00a0PubMed PMID: 24889662.","DOI":"10.1007\/s11604-014-0328-7"},{"issue":"5","key":"732_CR4","doi-asserted-by":"publisher","DOI":"10.1148\/rg.250122","volume":"46","author":"HC Kim","year":"2026","unstructured":"Kim HC, Miyayama S, Choi JW, Kim DH, Lee M, Hur S, et al. Embolization with N-butyl cyanoacrylate: properties, techniques, applications, and pitfalls. Radiographics. 2026;46(5):e250122. https:\/\/doi.org\/10.1148\/rg.250122.","journal-title":"Radiographics"},{"key":"732_CR5","doi-asserted-by":"publisher","unstructured":"Zi\u0119tarska A, Dobek A, Sawina A, Bia\u0142ek P, Majewski S, Stefa\u0144czyk L. Bronchial artery embolisation in haemoptysis management: a scoping review with emphasis on embolic materials and indications. Adv Respir Med. 2025;93(5):35. https:\/\/doi.org\/10.3390\/arm93050035. PubMedPMID:40981076. PubMedCentralPMCID:PMC12452465.","DOI":"10.3390\/arm93050035"},{"issue":"6","key":"732_CR6","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1007\/s00270-022-03127-wPubMedPMID:35396612;PubMedCentralPMCID:PMC9117352","volume":"45","author":"J Kettenbach","year":"2022","unstructured":"Kettenbach J, Ittrich H, Gaubert JY, Gebauer B, Vos JA. CIRSE standards of practice on bronchial artery embolisation. Cardiovasc Intervent Radiol. 2022;45(6):721\u201332. https:\/\/doi.org\/10.1007\/s00270-022-03127-wPubMedPMID:35396612;PubMedCentralPMCID:PMC9117352.","journal-title":"Cardiovasc Intervent Radiol"},{"key":"732_CR7","doi-asserted-by":"publisher","unstructured":"McGuire LS, Nico E, Hossa J, Tshibangu M, Mehta A, Alaraj A. Refinement of nBCA embolization technique in treatment of metastatic spinal tumors: case series and technical report. Interv Neuroradiol. 2024:15910199241235975. https:\/\/doi.org\/10.1177\/15910199241235975.","DOI":"10.1177\/15910199241235975"},{"issue":"1","key":"732_CR8","doi-asserted-by":"publisher","first-page":"33","DOI":"10.26676\/jevtm.v4i1.114","volume":"4","author":"EM Fumarola","year":"2020","unstructured":"Fumarola EM, Ierardi AM, Piacentino F, Carrafiello G. Glue or onyx: a guide to choice \u2013 tips and techniques. J Endovasc Resusc Trauma Manag. 2020;4(1):33\u20139. https:\/\/doi.org\/10.26676\/jevtm.v4i1.114.","journal-title":"J Endovasc Resusc Trauma Manag"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00732-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00732-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00732-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:15:59Z","timestamp":1783502159000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42155-026-00732-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["732"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00732-5","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"assertion":[{"value":"23 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"According to institutional policy for this retrospective technical note, formal approval by an ethics committee\/IRB was not required. For this type of study formal consent is not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consents for publication were obtained from the patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"81"}}