Hemoptysis and Pulmonary-Circulation Center, Kishiwada Eishinkai Hospital, Kishiwada, Japan.
Center for Community-based Healthcare Research and Education, Shimane University, Enya-cho 223-8, Zip code, Izumo, 693-8501, Japan.
Eur Radiol. 2019 Feb;29(2):707-715. doi: 10.1007/s00330-018-5637-2. Epub 2018 Jul 19.
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.
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.
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.
Recanalisation was the most common mechanism of recurrent haemoptysis after ssBACE. Our results provide interventionists with indispensable insights.
• 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.
鉴于咯血对患者生活质量造成的重大影响，支气管动脉栓塞术已被全球公认为一线治疗选择之一。由于对于超选择性支气管动脉线圈栓塞术（ssBACE）后复发性咯血的机制知之甚少，本研究旨在对此进行评估。
我们回顾性评估了 2010 年 4 月至 2015 年 12 月期间 57 例连续患者的 299 条与咯血相关的动脉（HRA），这些患者接受了第 2 系列的 ssBACE 治疗复发性咯血。在进行第 2 系列 ssBACE 时，我们使用增强 CT 和电影血管造影来评估复发性咯血的机制。
患者的中位年龄为 69 岁（四分位距 64-74 岁），其中 43.9%为男性。本研究表明：（1）再通是最常见的机制（45.2%），其次是新 HRA 的发展（38.5%）、桥接侧支（14.7%）和传统侧支（1.7%）；（2）这些趋势可以在某些情况下改变，如使用抗血小板或抗凝药物；（3）与小直径 HRA 相比，相对大直径 HRA 更容易再通；（4）第 2 系列 ssBACE 可以成功管理复发性咯血，成功率为 97.7%，无任何重大并发症。
ssBACE 后复发性咯血最常见的机制是再通。我们的结果为介入治疗师提供了不可或缺的见解。
ssBACE 后复发性咯血最常见的机制是再通，其次是新的咯血相关动脉的发展。
这些趋势可以在某些情况下改变，如使用抗血小板或抗凝药物。
第 2 系列超选择性支气管动脉线圈栓塞术可成功治疗复发性咯血，成功率为 97.7%，无任何重大并发症。
