Embosphere microspheres size for bronchial artery embolization in patients with hemoptysis caused by bronchiectasis: a retrospective comparative analysis of 500-750 versus 700-900 μm microspheres.
Bronchiectasis
Embosphere microspheres
Hemoptysis
Hemoptysis recurrence
Size
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
24 Apr 2024
24 Apr 2024
Historique:
received:
27
09
2023
accepted:
16
04
2024
medline:
25
4
2024
pubmed:
25
4
2024
entrez:
24
4
2024
Statut:
epublish
Résumé
Bronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE. A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis. Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding. For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
Sections du résumé
BACKGROUND
BACKGROUND
Bronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE.
METHODS
METHODS
A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis.
RESULTS
RESULTS
Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding.
CONCLUSIONS
CONCLUSIONS
For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
Identifiants
pubmed: 38658883
doi: 10.1186/s12890-024-03019-4
pii: 10.1186/s12890-024-03019-4
doi:
Substances chimiques
Gelatin
9000-70-8
trisacryl gelatin microspheres
0
Acrylic Resins
0
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
203Informations de copyright
© 2024. The Author(s).
Références
Quint JK, Smith MP. Pediatric and adult bronchiectasis: Diagnosis, disease burden and prognosis.[J].Respirology, 2019, 24: 413–422.
Guan WJ, Yuan JJ, Gao YH, et al. [Hemoptysis in adults with bronchiectasis: correlation with disease severity and exacerbation risk].[J]. Zhonghua Jie He He Hu Xi Za Zhi. 2017;40:16–23.
pubmed: 28100357
Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review.[J]. Diagn Interv Radiol. 2017;4:307–17.
doi: 10.5152/dir.2017.16454
Chen J, Chen LA, Liang ZX, et al. Immediate and long-term results of bronchial artery embolization for hemoptysis due to benign versus malignant pulmonary diseases.[J]. Am J Med Sci. 2014;3:204–9.
doi: 10.1097/MAJ.0000000000000226
Chun JY, Morgan R, Belli AM. Radiological management of hemoptysis: a comprehensive review of diagnostic imaging and bronchial arterial embolization.[J].Cardiovasc Intervent Radiol,2010,2:240 – 50.
Kucukay F, Topcuoglu OM, Alpar A, Altay ÇM, Kucukay MB, Ozbulbul NI. Bronchial artery embolization with large Sized (700–900 µm) tris-acryl Microspheres (Embosphere) for massive hemoptysis: long-term results (Clinical Research). Cardiovasc Intervent Radiol. 2018;41(2):225–30.
doi: 10.1007/s00270-017-1818-7
pubmed: 29067512
Corr PD. Bronchial artery embolization for life-threatening hemoptysis using tris-acryl microspheres: short-term result. Cardiovasc Intervent Radiol. 2005 Jul-Aug;28(4):439 – 41. https://doi.org/10.1007/s00270-004-0227-x . PMID: 15959698.
Hwang JH, Kim JH, Park S, Lee KH, Park SH. Feasibility and outcomes of bronchial artery embolization in patients with nonmassive hemoptysis. Respir Res. 2021;22(1):221.
doi: 10.1186/s12931-021-01820-x
pubmed: 34362373
pmcid: 8344225
Fu Z, Li X, Cai F, et al. Microspheres present comparable efficacy and safety profiles compared with polyvinyl alcohol for bronchial artery embolization treatment in hemoptysis patients[. J] J Transl Med. 1970;1:422.
Angle JF, Siddiqi NH, Wallace MJ, et al. Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee.[J]. J Vasc Interv Radiol. 2010;21:1479–86.
doi: 10.1016/j.jvir.2010.06.014
pubmed: 20870162
Reid LM. Reduction in bronchial subdivision in bronchiectasis. Thorax. 1950;5(3):233–47.
doi: 10.1136/thx.5.3.233
pubmed: 14776716
pmcid: 1018338
Ellis HC, Cowman S, Fernandes M, et al. Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort study[. J] Eur Respir J. 2016;2:482–9.
doi: 10.1183/13993003.01312-2015
Hidaka K, Nakamura M, Osuga K, et al. Elastic characteristics of microspherical embolic agents used for vascular interventional radiology.[J]. J Mech Behav Biomed Mater. 2010;7:497–503.
doi: 10.1016/j.jmbbm.2010.05.004
Osuga K, Nakajima Y, Sone M, et al. Transarterial embolization of hypervascular tumors using tris acryl gelatin microspheres (Embosphere): a prospective multicenter clinical trial in Japan[. J] Jpn J Radiol. 2016;5:366–75.
doi: 10.1007/s11604-016-0535-5
Liu J, Shi D,Li L et al. Clinical study on the treatment of Benign Prostatic Hyperplasia by embolization of prostate artery based on Embosphere microspheres and gelatin sponge granules.[J]. J Healthc Eng,2023, 1424021.
Yoon W. Embolic agents used for bronchial artery embolisation in massive hemoptysis.[J]. Expert Opin Pharmacother,2004,2:361–7.
Ishikawa H, Hara M, Ryuge M, et al. Efficacy and safety of superselective bronchial artery coil embolisation for hemoptysis: a single-center retrospective observational study[. J] BMJ Open. 2017;2:e014805.
doi: 10.1136/bmjopen-2016-014805
Woo S, Yoon CJ, Chung JW et al. Bronchial artery embolization to control hemoptysis: comparison of N-butyl-2-cyanoacrylate and polyvinyl alcohol particles.[J].Radiology,2013,2:594–602.
Frood R, Karthik S, Mirsadraee S, et al. Bronchial artery embolisation for massive hemoptysis: Immediate and Long-Term Outcomes-A Retrospective Study.[J]. Pulm Ther. 2020;1:107–17.
doi: 10.1007/s41030-020-00112-x
Yan HT, Lu GD, Liu J, et al. Does the presence of systemic artery-pulmonary circulation shunt during bronchial arterial embolization increase the recurrence of noncancer-related hemoptysis? A retrospective cohort study[. J] Respir Res. 2023;1:119.
doi: 10.1186/s12931-023-02427-0
Walker CM, Rosado-de-Christenson ML,Martínez, -Jiménez S et al. Bronchial arteries: anatomy, function, hypertrophy, and anomalies.[J]. Radiographics,2015,1:32–49.