Ishikawa Hideo, Hara Masahiko, Ryuge Misaki, Takafuji Jun, Youmoto Mihoko, Akira Masanori, Nagasaka Yukio, Kabata Daijiro, Yamamoto Kouji, Shintani Ayumi
Hemoptysis and Pulmonary-Circulation Center, Kishiwada Eishinkai Hospital, Kishiwada, Japan.
Department of Clinical Epidemiology and Biostatics, Osaka University Graduate School of Medicine, Suita, Japan.
BMJ Open. 2017 Feb 17;7(2):e014805. doi: 10.1136/bmjopen-2016-014805.
Evidence on the safety and long-term efficacy of super selective bronchial artery embolisation (ssBAE) using platinum coils in patients with haemoptysis is insufficient. The objective of the present study was to evaluate the safety and the 3-year postprocedure haemoptysis-free survival rate of de novo elective ssBAE using platinum coils rather than particles for the treatment of haemoptysis.
A single-centre retrospective observational study.
Hemoptysis and Pulmonary Circulation Center in Japan.
A total of 489 consecutive patients with massive and non-massive haemoptysis who underwent de novo elective ssBAE without malignancy or haemodialysis.
ssBAE using platinum coils. All patients underwent CT angiography before the procedure for identifying haemoptysis-related arteries (HRAs) and for procedural planning.
The composite of the 3-year recurrence of haemoptysis and mortality from the day of the last ssBAE session. Each component of the primary end point and procedural success defined as successful embolisation of all target HRAs were also evaluated.
The median patient age was 69 years, and 46.4% were men. The total number of target vessels was 4 (quartile 2-7), and the procedural success rate was 93.4%. There were 8 (1.6%) major complications: 1 aortic dissection, 2 symptomatic cerebellar infarctions and 5 mediastinal haematoma cases. The haemoptysis-free survival rates were estimated by the Kaplan-Meier analysis at 86.9% (95% CI 83.7% to 90.2%) at 1 year, 79.4% (74.8% to 84.3%) at 2 years and 57.6% (45.1% to 73.4%) at 3 years. Although not statistically significant by the adjusted analysis of variance with multiple imputation of missing variables, cryptogenic haemoptysis tended to show the most favourable outcome and non-tuberculous mycobacterium showed the worst outcome (adjusted p=0.250).
We demonstrated the safety and long-term efficacy of elective ssBAE using platinum coils and established that it can be a valuable therapeutic option for treating patients with haemoptysis.
关于使用铂圈进行超选择性支气管动脉栓塞术（ssBAE）治疗咯血患者的安全性和长期疗效的证据不足。本研究的目的是评估使用铂圈而非微粒进行初发性选择性ssBAE治疗咯血的安全性及术后3年无咯血生存率。
单中心回顾性观察研究。
日本咯血与肺循环中心。
共有489例连续的大量和非大量咯血患者，他们接受了初发性选择性ssBAE，且无恶性肿瘤或血液透析情况。
使用铂圈进行ssBAE。所有患者在术前均接受CT血管造影，以识别咯血相关动脉（HRA）并进行手术规划。
自最后一次ssBAE手术之日起3年内咯血复发与死亡的复合情况。还评估了主要终点的每个组成部分以及定义为所有目标HRA成功栓塞的手术成功率。
患者中位年龄为69岁，男性占46.4%。目标血管总数为4条（四分位数2 - 7），手术成功率为93.4%。有8例（1.6%）主要并发症：1例主动脉夹层、2例有症状的小脑梗死和5例纵隔血肿病例。通过Kaplan - Meier分析估计，1年时无咯血生存率为86.9%（95%CI 83.7%至90.2%），2年时为79.4%（74.8%至84.3%），3年时为57.6%（45.1%至73.4%）。尽管通过对缺失变量进行多重插补的方差调整分析无统计学意义，但隐源性咯血往往显示出最有利的结果，非结核分枝杆菌感染显示出最差的结果（调整后p = 0.250）。
我们证明了使用铂圈进行选择性ssBAE的安全性和长期疗效，并确定其可为咯血患者提供有价值的治疗选择。
