1
|
Yu L, Li X, Lin F, Wan T, Cao Z. Posterior circulation infarction after bronchial artery embolization. Acta Radiol Open 2023; 12:20584601231168968. [PMID: 37089817 PMCID: PMC10116847 DOI: 10.1177/20584601231168968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Bronchial artery embolization is minimally invasive, has a low complication rate, and achieves good hemorrhage control. It is the first-line treatment in hemoptysis patients whom medications are ineffective. Cerebral infarction is a rare complication of bronchial artery embolization, with posterior circulation infarcts being the most common. Possible mechanisms include a neurotoxic reaction to the contrast medium used, bronchial artery-pulmonary shunt, embolus formation, fistula formation between the bronchial artery and the cerebral artery, and so on. To the best of our knowledge, there have been relatively few reports regarding posterior circulation infarcts after BAE, including 14 cases shown in Table 1. 11 patients recovered well after medical treatment, while the other patients did not survive. We report a case of a patient with a large posterior circulation infarct post bronchial artery embolization who developed severe neurological symptoms and died after 3 months of medication. Conclusion: Posterior circulation infarction is a rare but severe complication of bronchial artery embolization, and measures should be taken to prevent its occurrence.
Collapse
Affiliation(s)
- Lei Yu
- Department of Intervention Radiology, Affiliated Sanming First Hospital, Fujian Medical University, Fujian, China
| | - Xionghui Li
- Department of Pulmonology, Affiliated Sanming First Hospital, Fujian Medical University, Fujian, China
| | - Feng Lin
- Department of Neurology, Affiliated Sanming First Hospital, Fujian Medical University, Fujian, China
| | - Tuer Wan
- Department of CT and MRI, Affiliated Sanming First Hospital, Fujian Medical University, Fujian, China
| | - Zhiwei Cao
- Department of Intervention Radiology, Affiliated Sanming First Hospital, Fujian Medical University, Fujian, China
| |
Collapse
|
2
|
Gao F, Xu Y, Fang S. Cerebral infarct after bronchial artery embolization. BJR Case Rep 2019; 5:20180087. [PMID: 31555467 PMCID: PMC6750621 DOI: 10.1259/bjrcr.20180087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 11/29/2022] Open
Abstract
Bronchial artery embolization is an effective and widely used procedure for controlling hemoptysis. Cerebral infarct after bronchial artery embolization is a rare and severe complication. We report two cases of cerebral infarct complicating bronchial artery embolization, most likely due to errant embolic passage through anastomoses with the ipsilateral subclavian artery.
Collapse
Affiliation(s)
- Feng Gao
- The Radiology department, tongji university affiliated shanghai First Maternity and Infant Hospital, shanghai, china
| | - Yali Xu
- The Radiology department, Shanghai Tenth People's Hospital, shanghai, china
| | - Shu Fang
- The DSA department, Shanghai Jiao Tong University School of Medicine Affiliated Renji South Hospital, Shanghai, China
| |
Collapse
|
3
|
Rashad A, Amin M, El-Azim AA, Zidan M, Mahmoud A. Percutaneous transcatheter vascular embolization for life threatening hemoptysis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
4
|
Lu XJ, Zhang Y, Cui DC, Meng WJ, Du LR, Guan HT, Zheng ZZ, Fu NQ, Lv TS, Song L, Zou YH, Lu WL, Fan TY. Research of novel biocompatible radiopaque microcapsules for arterial embolization. Int J Pharm 2013; 452:211-9. [DOI: 10.1016/j.ijpharm.2013.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/09/2013] [Accepted: 05/02/2013] [Indexed: 01/11/2023]
|
5
|
Seki A, Hori S, Sueyoshi S, Hori A, Kono M, Murata S, Maeda M. Transcatheter arterial embolization with spherical embolic agent for pulmonary metastases from renal cell carcinoma. Cardiovasc Intervent Radiol 2013; 36:1527-1535. [PMID: 23430025 DOI: 10.1007/s00270-013-0576-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/12/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE This retrospective study aimed to evaluate the safety and local efficacy of transcatheter arterial embolization (TAE) with superabsorbent polymer microspheres (SAP-MS) in patients with pulmonary metastases from renal cell carcinoma (RCC). METHODS Sixteen patients with unresectable pulmonary metastases from RCC refractory to standard therapy were enrolled to undergo TAE with the purpose of mass reduction and/or palliation. The prepared SAP-MS swell to approximately two times larger than their dry-state size (100-150 μm [n = 14], 50-100 μm [n = 2]). Forty-nine pulmonary nodules (lung n = 22, mediastinal lymph node n = 17, and hilar lymph node n = 10) were selected as target lesions for evaluation. Local tumor response was evaluated 3 months after TAE according to Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). The relationship between tumor enhancement ratio by CT during selective angiography and local tumor response was evaluated. RESULTS The number of TAE sessions per patient ranged from 1 to 5 (median 2.9). Embolized arteries at initial TAE were bronchial arteries in 14 patients (87.5 %) and nonbronchial systemic arteries in 11 patients (68.8 %). Nodule-based evaluation showed that 5 (10.2 %) nodules had complete response, 17 (34.7 %) had partial response, 15 (30.6 %) had stable disease, and 12 (24.5 %) had progressive disease. The response rate was significantly greater in 22 lesions that had a high tumor enhancement ratio than in 27 lesions that had a slight or moderate ratio (90.9 vs. 7.4 %, p = 0.01). Severe TAE-related adverse events did not occur. CONCLUSION TAE with SAP-MS might be a well-tolerated and locally efficacious palliative option for patients with pulmonary metastases from RCC.
Collapse
Affiliation(s)
- Akihiko Seki
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan.
| | - Shinichi Hori
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Satoru Sueyoshi
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Atsushi Hori
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Michihiko Kono
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Shinichi Murata
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| | - Masahiko Maeda
- Department of Radiology, Gate Tower Institute for Image Guided Therapy, 11F, Gate Tower Building, 1-Rinku Ohrai-Kita, Izumisanocity, Osaka, 598-0048, Japan
| |
Collapse
|
6
|
Park JH, Kim DS, Kwon JS, Hwang DH. Posterior circulation stroke after bronchial artery embolization. Neurol Sci 2011; 33:923-6. [PMID: 22124851 DOI: 10.1007/s10072-011-0855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022]
Abstract
We report on a 66-year-old woman with a posterior circulation stroke that occurred after bronchial artery embolization (BAE) due to post-tuberculous bronchiectasis. Stroke is a rare complication of BAE and is usually thought to be caused by inadvertent embolization via a bronchial artery-pulmonary vein shunt. However, the possibility of thromboembolic stroke should be considered, because of the patient's possible underlying anatomical variations or atherothrombosis.
Collapse
Affiliation(s)
- Jong-Ho Park
- Stroke Center, Department of Neurology, Myongji Hospital, Kwandong University College of Medicine, 697-24 Hwajeong-dong, Deokyang-gu, Goyang, Gyeonggi-do 412-270, Korea.
| | | | | | | |
Collapse
|
7
|
Abstract
Hemoptysis is a very common symptom in the practice of pulmonary physicians of India. We present a case of uncontrolled hemoptysis managed with bronchial artery embolization. Bronchial artery embolization is an effective treatment for patients with hemoptysis. Serious complications are rare, but may occur if the arterial supply to other structures is compromised.
Collapse
Affiliation(s)
- Rakesh K Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital, New Delhi, India
| | | | | | | |
Collapse
|
8
|
Ma KFJ, Wong WH, Lui CYD, Cheng LF. Renal and splenic micro-infarctions following bronchial artery embolization with tris-acryl microspheres. Korean J Radiol 2009; 10:97-9. [PMID: 19182511 PMCID: PMC2647174 DOI: 10.3348/kjr.2009.10.1.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A bronchial artery embolization (BAE) is an important therapeutic method used to control acute and chronic hemoptysis. We report a case of multiple micro-infarcts involving both the kidneys and spleen, following a BAE with 500-700 µm crossed-linked tris-acryl microspheres (Embospheres) in a patient with bronchial artery pulmonary vein shunts. The superior penetration characteristics of the microspheres may have resulted in the greater tendency to cross the bronchial artery pulmonary vein shunts, which subsequently caused the systemic infarcts in our patient. We propose the use of larger sized microspheres (700-900 µm), which may aid in avoiding this complication.
Collapse
Affiliation(s)
- Ka-Fai Johnny Ma
- Department of Radiology, Princess Margaret Hospital, Lai King Hill Road, Lai Chi Kok, Kowloon, Hong Kong.
| | | | | | | |
Collapse
|
9
|
Abstract
Haemoptysis varies in significance from trivial to fatal. The most common causes in children are tuberculosis, fungal infections and bronchiectasis of any cause. In populations of European origin, cystic fibrosis is the most common predisposing factor. Chronic or life-threatening haemoptysis requires further investigation. Various forms of treatment are possible, and management is optimized when a multidisciplinary team is available. Bronchial artery embolization (BAE) is effective in controlling haemoptysis in most cases, although recurrent bleeding is not uncommon. BAE is often technically challenging, however, and requires angiographic skills that are not always available in children's hospitals. Although the procedure is usually regarded as relatively safe, complications are not uncommon and may be severe or even fatal.
Collapse
Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London WC1N 3JH, UK.
| | | |
Collapse
|
10
|
Pierucci P, Murphy J, Henderson KJ, Chyun DA, White RI. New Definition and Natural History of Patients With Diffuse Pulmonary Arteriovenous Malformations. Chest 2008; 133:653-61. [DOI: 10.1378/chest.07-1949] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
11
|
Sriram KB, Taylor DJ, Holmes M. Systemic multifocal infarction following bronchial artery embolization with microsphere particles. Intern Med J 2007; 37:734-5. [PMID: 17894775 DOI: 10.1111/j.1445-5994.2007.01462.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Poyanli A, Acunas B, Rozanes I, Guven K, Yilmaz S, Salmaslioglu A, Terzibasioglu E, Cirpin R. Endovascular therapy in the management of moderate and massive haemoptysis. Br J Radiol 2007; 80:331-6. [PMID: 17392400 DOI: 10.1259/bjr/34204483] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to retrospectively evaluate 140 patients with severe (97 massive, 43 moderate) haemoptysis treated by bronchial artery embolisation. Between January 1997 and April 2005, 140 patients (120 males and 20 females, aged 23-71 years) with severe haemoptysis considered surgically inoperable because of limited pulmonary reserve were treated by embolisation. The cause of haemoptysis was tuberculosis in 136 patients and malignancy in four. Embolisation succeeded in controlling haemoptysis immediately after the intervention in 138 patients (98.5%) and at 1 month in 126 patients (90%). Severe haemoptysis recurred in 11 patients with prior massive haemoptysis and 3 patients with prior moderate haemoptysis in a mean time of 3.7 months (1-7 months) after the last intervention. The bleeding source was detected during angiography and embolised in 12 of these patients. Two patients with malignant tumour died because of abundant bleeding, following an asymptomatic period of 30 days. There were no procedure-related major complications. Bronchial artery embolisation is a safe and effective palliative treatment alternative in moderate and massive haemoptysis.
Collapse
Affiliation(s)
- A Poyanli
- Istanbul Medical Faculty, Department of Radiology, Capa 34390, Sehremini, Istanbul, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Pollak JS, Saluja S, Thabet A, Henderson KJ, Denbow N, White RI. Clinical and Anatomic Outcomes after Embolotherapy of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2006; 17:35-44; quiz 45. [PMID: 16415131 DOI: 10.1097/01.rvi.0000191410.13974.b6] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess long-term clinical and imaging results of technically successful pulmonary arteriovenous malformation (AVM) embolization. MATERIALS AND METHODS One hundred fifty-five patients with pulmonary AVMs underwent embolization during a period of 3 years. Recommended follow-up included clinical assessment, helical computed tomography, and physiologic evaluation within 1 year and then every 5 years. RESULTS Hereditary hemorrhagic telangiectasia was present in 148 patients (95%). Four hundred fifteen pulmonary AVMs were occluded during 205 procedures. Clinical follow-up was available in all patients over 3-7 years and imaging follow-up was available in 144 patients (393 lesions) over 1-7 years (mean, 2.9 y). Problems related to pulmonary AVMs occurred in 35 patients (23%) at 42 time points: 22 patients with 23 symptomatic events and 17 patients with 19 asymptomatic events. Symptoms resulted from growth of nonembolized pulmonary AVMs (n = 19), residual embolized pulmonary AVMs (n = 5), or both (n = 2). Symptoms consisted of respiratory manifestations (n = 13), cerebral ischemia (n = 4), brain abscess (n = 5), hemoptysis (n = 3), and seizure (n = 1). Imaging showed pulmonary AVM involution in 97% of embolized lesions and 11 residual lesions (2.8%) in 10 patients (6.9%). These were caused by recanalization (n = 7), presence of an accessory feeding artery (n = 1), pulmonary collateral vessels (n = 1), and bronchial collateral vessels (n = 2). CT detected 10 of the 11 residual lesions. Imaging detected 97 previously small pulmonary AVMs that had enlarged to a significant size in 28 patients (18%), 15 of whom were symptomatic and 13 of whom were asymptomatic. CONCLUSIONS Clinical and anatomic evaluation after pulmonary AVM embolization is important to detect persistent or reperfused lesions and enlarging lesions, with the latter more common. Patients with persistent, reperfused, or enlarging lesions often have symptoms, but a significant minority of patients are asymptomatic. More frequent assessment may improve detection before the onset of symptoms.
Collapse
Affiliation(s)
- Jeffrey S Pollak
- Section of Vascular and Interventional Radiology, Department of Radiology, Yale University School of Medicine, PO Box 208042, 333 Cedar Street, New Haven, Connecticut 06520-8042, USA.
| | | | | | | | | | | |
Collapse
|