Microspheres present comparable efficacy and safety profiles compared with polyvinyl alcohol for bronchial artery embolization treatment in hemoptysis patients

Advanced targeted microsphere embolization for arteriovenous malformations: state-of-the-art and future directions

BACKGROUND

Arteriovenous malformations (AVMs) present a significant therapeutic challenge, as current treatment modalities frequently fail to achieve complete and rapid obliteration and are associated with substantial morbidity in both the short and long term. This underscores the critical need for innovative therapeutic strategies that enable efficient AVM obliteration while minimizing patient risk. The current review aims to comprehensively assess the role of ATME in AVM management, examining its clinical efficacy, associated risks and benefits, and the economic and ethical implications to provide valuable foundation for future studies and guiding development in treatment strategies for AVMs.

RESULTS

Advanced targeted microsphere embolization (ATME) has emerged as a promising therapeutic option, initially developed for the localized treatment of AVMs and unresectable tumors, including liver cancer. By providing targeted delivery, ATME offers potential advantages over conventional approaches in achieving effective local control.

CONCLUSIONS

ATME are safe and effective for vascular disease and cancer. Although evidence for microspheres in AVMs is scarce, results are promising. Future research could refine eligibility criteria, evaluate treatment techniques, and optimize ATME.

The efficacy, safety, and related factors of bronchial artery embolization for hemoptysis: a systematic review and meta-analysis with subgroup analysis

Background

Bronchial artery embolization (BAE) is a common and important way to manage hemoptysis. This study's purpose was to summarize the efficacy, safety, and related factors of BAE in the treatment of hemoptysis.

Methods

From January 2010 to August 2023, a systematic literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases. Original studies with BAE for hemoptysis were included, with no restrictions on language. The outcomes of interest were technical success rate, clinical success rate, recurrence rate, mortality rate, and major complication rate. Pooled proportions with 95% confidence intervals (CIs) were calculated using random-effects models. The Newcastle-Ottawa Scale (NOS) was employed for quality assessment. Factors such as publication year, region, sample size, amount of hemoptysis, etiology, and embolization materials were extracted for subgroup analyses. Additionally, sensitivity analyses and test for publication bias were conducted.

Results

A total of 32 studies, including 6,032 patients, met our inclusion criteria. 27 studies were of high quality, while five of moderate quality. The results indicated the prevalence of technical success was 97.2% (95% CI: 95.1-98.8%) and 93.2% (95% CI: 90.3-95.7%) in clinical success. Hemoptysis recurrence and mortality rates after BAE were 24.8% (95% CI: 20.5-29.4%) and 2.3% (95% CI: 1.1-3.8%), respectively. Moreover, the pooled prevalence of major complication was 0.1% (95% CI: 0.0-0.4%). Subgroup analysis revealed that studies published after 2017 demonstrated a higher technical success rate and a lower recurrence rate. Massive hemoptysis showed a higher technical success rate but a lower clinical success rate. BAE also demonstrated superior efficacy in patients with bronchiectasis. The clinical success rate was significantly higher in patients with benign diseases than those with malignancies. Gelatin sponge (GS) showed poor embolization efficacy. N-butyl-2-cyanoacrylate (NBCA) and coils exhibited reduced recurrence rates, while NBCA displayed an even lower recurrence rate than non-absorbable particles. The study by Ishikawa et al. influenced the stability of the pooled major complication rate, and the sensitivity analysis confirmed the robustness of the remaining results.

Conclusions

BAE is safe and effective in treating different degrees of hemoptysis caused by benign and malignant lesions. Promising clinical efficacy was observed with NBCA as an embolic material for the treatment of hemoptysis. However, further conclusions should be investigated using evidence-based medicine.

Efficacy and safety of particle embolization in bronchial arteries of hemoptysis patients with shunts

AIM

This study assesses the safety and efficacy of particle embolization during bronchial artery embolization (BAE) in patients with shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery.

METHODS

In this retrospective, single-center study, we analyzed 312 BAE procedures performed from June 2020 to April 2023. The patient cohort had shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. We meticulously collected and examined comprehensive data, including clinical characteristics, computed tomography (CT) imaging, and embolization procedural details.

RESULTS

Vascular shunts were identified in 49 patients. The etiologies of hemoptysis included post-TB sequelae (42.8%), bronchiectasis (26.5%), active TB (12.2%), aspergilloma (8.1%), bacterial pneumonia (4.1%), lung cancer (4.1%), and non-tuberculous mycobacterial infection (2%). The technical success rate of the procedures was 98%, with 149 out of 152 identified vessels successfully embolized. All patients experienced cessation or significant reduction of hemoptysis within 24 hours following the procedure. The clinical success rates were 97.9% at one month, 93.9% at six months, and 89.8% at one year. No shunt-related complications were detected.

CONCLUSION

BAE with particle embolization is a safe and effective treatment for hemoptysis, particularly in cases with complex shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery.

The efficacy and safety of combined therapy with endobronchial tamponade and bronchial artery embolization for massive hemoptysis

BACKGROUND

Massive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis.

METHODS

Between March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period.

RESULTS

All patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival.

CONCLUSION

Combination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis.

Bronchial artery chemoembolization with drug-eluting beads versus bronchial artery infusion followed by polyvinyl alcohol particles embolization for advanced squamous cell lung cancer: A retrospective study

PURPOSE

To analyze the efficacy and safety of bronchial arterial embolization (BACE) with drug-eluting beads (DEB) versus bronchial artery infusion (BAI) followed by polyvinyl alcohol (PVA) particle embolization for the treatment of advanced squamous cell lung cancer after the failure of systemic therapy.

METHOD

Thirty-six patients with advanced squamous cell lung cancer who underwent bronchial arterial interventional therapy were included in this retrospective study. The DEB group (n = 20) was treated with nedaplatin and DEB loaded with gemcitabine, and the PVA group (n = 16) BAI with nedaplatin and gemcitabine followed by embolization with PVA particles. The treatment efficacy and complications were analyzed.

RESULTS

The technical success rate was 100 %. The two groups were followed up for a median period of 8.9 months. The mean overall survival (OS) in the DEB group was 12.6 months (95 % CI:9.99-15.21), which was significantly longer than 8.14 months (95 % CI:6.07-10.2) in the PVA group (p = 0.007). The median progression-free survival (PFS) in the DEB group was 4.3 months (95 % CI:2.33-6.27), significantly longer than 3.2 months (95 % CI:2.55-3.85) in the PVA group (p = 0.030). The objective response rate (ORR) six months after the procedure was 50 % in the DEB group and 12.5 % in the PVA group. In the univariate and multivariate analyses, DEB-BACE was an independent prognostic factor for survival. Only grade 1 adverse events like fever, chest pain, and cough were seen.

CONCLUSIONS

DEB-BACE may be a good choice for patients with advanced lung squamous cell carcinoma, as it could prolong OS and PFS without increasing adverse events.

FEASIBILITY STUDY OF LOW TUBE VOLTAGE COMPUTER TOMOGRAPHY ANGIOGRAPHY (CTA) FOR BRONCHIAL ARTERY IMAGING IN PATIENTS WITH HEMOPTYSIS

OBJECTIVE

To investigate the application of low tube voltage computer tomography angiography (CTA) in bronchial artery (BA) imaging in hemoptysis patients.

METHODS

Between January 2017 and December 2021, 119 patients were studied, including 31 in the 80-kV group, 39 in the 100-kV group and 49 in the control group (120 kV). The CT dose index-volume (CTDIvol) (mGy) and effective dose (ED) (mSv) of each group were comparatively analysed. Image quality evaluation included the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and subjective 5-scores.

RESULTS

Statistically significant differences were noted in CTDIvol, ED, SNR, CNR and image quality scores of the groups (P < 0.05). Comparative analysis showed no statistical difference in CTDIvol, ED and image quality scores between the 80- and 100-kV groups.

CONCLUSION

Low tube voltage CTA is useful in BA imaging for hemoptysis patients. Tube voltages of 100 kV have better image quality and lower radiation dose.

A Novel Microcrystalline BAY-876 Formulation Achieves Long-Acting Antitumor Activity Against Aerobic Glycolysis and Proliferation of Hepatocellular Carcinoma

BAY-876 is an effective antagonist of the Glucose transporter type 1 (GLUT1) receptor, a mediator of aerobic glycolysis, a biological process considered a hallmark of hepatocellular carcinoma (HCC) together with cell proliferation, drug-resistance, and metastasis. However, the clinical application of BAY-876 has faced many challenges. In the presence study, we describe the formulation of a novel microcrystalline BAY-876 formulation. A series of HCC tumor models were established to determine not only the sustained release of microcrystalline BAY-876, but also its long-acting antitumor activity. The clinical role of BAY-876 was confirmed by the increased expression of GLUT1, which was associated with the worse prognosis among advanced HCC patients. A single dose of injection of microcrystalline BAY-876 directly in the HCC tissue achieved sustained localized levels of Bay-876. Moreover, the single injection of microcrystalline BAY-876 in HCC tissues not only inhibited glucose uptake and prolonged proliferation of HCC cells, but also inhibited the expression of epithelial-mesenchymal transition (EMT)-related factors. Thus, the microcrystalline BAY-876 described in this study can directly achieve promising localized effects, given its limited diffusion to other tissues, thereby reducing the occurrence of potential side effects, and providing an additional option for advanced HCC treatment.