Mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation: a single-centre retrospective observational study

Abstract

Objectives In recognition of the significant impairment caused by haemoptysis on a patient's quality of life, bronchial artery embolisation has been introduced worldwide as one of the first-line treatment options. Since little evidence is available on the mechanisms of recurrent haemoptysis after super-selective bronchial artery coil embolisation (ssBACE), the purpose of the present study is to evaluate these. Methods We retrospectively evaluated the mechanisms of recurrent haemoptysis using both enhanced computed tomography and cineangiography following ssBACE by reviewing 299 haemoptysis-related arteries (HRAs) in 57 consecutive patients who underwent 2nd series ssBACE for the management of recurrent haemoptysis between April 2010 and December 2015.Results Median age of patients was 69 (interquartile range 64-74) years, and 43.9% were men. This study revealed that (1) recanalisation was the most common mechanism (45.2%) followed by development of new HRA (38.5%), bridging collaterals (14.7%) and conventional collaterals (1.7%); (2) these trends could be modified in several situations such as with antiplatelet or anticoagulant medications; (3) relatively large-diameter HRAs were more likely to recanalise compared with small-diameter HRAs and (4) recurrent haemoptysis could be managed by 2nd series ssBACE with a procedural success rate of 97.7% without any major complications. Conclusions Recanalisation was the most common mechanism of recurrent haemoptysis after ssBACE. Our results provide interventionists with indispensable insights. Key Points • Recanalisation was the most common mechanism of recurrent haemoptysis after super-selective bronchial artery coil embolisation, followed by development of new haemoptysis-related arteries • These trends could be modified in several situations such as with antiplatelet or anticoagulant medications • Recurrent haemoptysis could be managed by 2nd series super-selective bronchial artery coil embolisation with a procedural success rate of 97.7% without any major complications.

Erratic coil migration in the bronchus after bronchial artery embolization

“…If sufficient blood flow persists in the perforated bronchial artery at the site of fistula formation, severe haemoptysis akin to a Dieulafoy's lesion in the stomach is likely. We investigated the mechanism of haemoptysis recurrence after ssBACE and reported that haemoptysis recurrence was caused by the recanalization of embolized arteries in 45.2% cases, new haemoptysis‐related vessels in 38.5% cases, bridging collateral (where the distal part of an embolized artery receives blood directly from the proximal part of the embolized artery itself) in 14.7% cases, and conventional collateral (where the distal part of an embolized artery receives blood from a different vessel) in 1.7% cases . These results suggest that 45.2% of embolized arteries had residual flow, although these data are limited to recurrent haemoptysis cases and cannot be directly extrapolated to the present cases.…”

“…Various embolic agents are used in BAE, including polyvinyl alcohol, n‐butyl‐2‐cyanoacrylate (NBCA) , gelatine sponges, and metallic coils. BAE using coils (super‐selective bronchial artery coil embolization (ssBACE)) is a relatively new method and is regarded safe and effective . We reported 1‐year haemoptysis‐free rate, 2‐year haemoptysis‐free rate, and major complications as 90.4%, 85.9%, and 1.6%, respectively, in our long‐term follow‐up of 489 ssBACE cases .…”

The impact of bronchial artery embolisation on the quality of life of patients with haemoptysis: a prospective observational study

“…Haemoptysis often occurs suddenly and without any prodromal symptoms, such as haemo-sputum [5,10]. Furthermore, patients with haemoptysis experience both acute and chronic decreases in terms of HRQoL [5,11,12]. They typically experience anticipatory anxiety related to their fear of death, which is often strengthened by the sudden onset of haemoptysis and restricted physical activity [3,11].…”

Combined therapy with bronchial artery embolization and tranexamic acid for hemoptysis

“…Although BAE achieves high technical and clinical success rates with immediate cessation of hemoptysis, a number of studies report the recurrence rate to be as high as 10%-55% (7,8). Recurrent bleeding after BAE may result from incomplete embolization, recanalization of embolized vessels, collateral circulation, or underlying disease progression (2,7,9). Relapsing hemoptysis usually requires repeat embolization, resulting in impaired quality of life and substantial financial cost.…”