A Stepwise Embolization Strategy for a Bronchial Arterial Aneurysm: Proximal Coil and Distal Glue with the Optional Use of a Microballoon Occlusion System (original) (raw)

Abstract

Purpose

This study aimed to demonstrate a transcatheter embolization strategy for bronchial artery aneurysms (BAAs) using coils for the proximal lesion and glue (_n_-butyl-2-cyanoacrylate [NBCA]) embolization for the distal lesion with or without the use of a microballoon occlusion catheter.

Materials and Methods

Five patients with BAAs presenting with hemoptysis were enrolled in this study. A bronchial angiogram indicated a mediastinal BAA near the orifice, accompanied by dilated distal branches with or without intrapulmonary BAA. A stepwise procedure was performed. First, the intrapulmonary branches were embolized with glue, with or without the use of a microballoon catheter depending upon the anatomical and local flow hemodynamic conditions. Second, the mediastinal BAA was tightly packed with detachable coils.

Results

Glue embolization of intrapulmonary abnormal branches successfully controlled hemoptysis in all patients; microballoon catheters were used in five of the 10 arteries. The volume embolization ratio of coils within the mediastinal BAA ranged from 28 to 59%, and neither coil compaction nor signs of recanalization were observed during follow-up.

Conclusion

The stepwise embolization procedure with the sequential use of glue (with or without a microballoon occlusion system) and detachable coils may represent a possible endovascular strategy for the treatment of complex BAAs.

Level of Evidence IV

Level 4: Case Series.

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Author notes

  1. Takahiko Mine and Terumitsu Hasebe have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba, 270-1694, Japan
    Takahiko Mine
  2. Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
    Tomohiro Matsumoto, Toshihiko Hayashi, Kosuke Tomita & Terumitsu Hasebe
  3. Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan
    Kimihiko Masuda & Masahiro Kawashima
  4. Department of Respiratory Medicine, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
    Fumio Sakamaki

Authors

  1. Takahiko Mine
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  2. Tomohiro Matsumoto
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  3. Toshihiko Hayashi
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  4. Kosuke Tomita
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  5. Kimihiko Masuda
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  6. Masahiro Kawashima
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  7. Fumio Sakamaki
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  8. Terumitsu Hasebe
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Corresponding author

Correspondence toTakahiko Mine.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest associated with this study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Written informed consent was obtained from all individual participants included in this study.

Electronic supplementary material

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Video 1. B-glue for intrapulmonary bronchial artery aneurysms (BAA). The BAA and the parent vessel were filled with a glue cast. (MP4 19616 kb)

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Mine, T., Matsumoto, T., Hayashi, T. et al. A Stepwise Embolization Strategy for a Bronchial Arterial Aneurysm: Proximal Coil and Distal Glue with the Optional Use of a Microballoon Occlusion System.Cardiovasc Intervent Radiol 41, 1267–1273 (2018). https://doi.org/10.1007/s00270-018-1969-1

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