Abstract
BackgroundAlthough not standard of care, Cystic Fibrosis patients with recurrent hemoptysis occasionally have coil embolization of bronchial arteries. In the event of recanalization of these arteries in this specific subset of patients, the presence of indwelling coils makes the prospect of conventional particle embolization more difficult, preventing both adequate catheterization of the coiled segment and reflux of the particles.Case presentationIn this report, we describe a case of bronchial artery embolization of a complex Cystic Fibrosis patient with massive hemoptysis from recanalized coiled bronchial arteries utilizing a Scepter Balloon Catheter® (Microvention Terumo, USA) in administration of the liquid embolic agent Onyx® (Medtronic, USA).ConclusionsThe Scepter occlusion balloon catheter allowed for careful placement of the tip within the interstices of the pre-existing coils, allowing for Onyx injection directly into the coil mass without reflux, reconfirming the benefits of Onyx embolization in bronchial artery embolization and providing evidence that the Scepter occlusion balloon catheter should be added to the armamentarium of devices used in complex bronchial artery embolization for Cystic Fibrosis patients with massive hemoptysis.
Highlights
ConclusionsThe Scepter occlusion balloon catheter allowed for careful placement of the tip within the interstices of the pre-existing coils, allowing for Onyx injection directly into the coil mass without reflux, reconfirming the benefits of Onyx embolization in bronchial artery embolization and providing evidence that the Scepter occlusion balloon catheter should be added to the armamentarium of devices used in complex bronchial artery embolization for Cystic Fibrosis patients with massive hemoptysis
Not standard of care, Cystic Fibrosis patients with recurrent hemoptysis occasionally have coil embolization of bronchial arteries
Patients with coils and recurrent hemoptysis may have recanalized arteries making the prospect of conventional particle embolization more difficult due to inability to safely catheterize the coiled segment and retreatment
Summary
Hemoptysis is a common complication of CF, and occurs in approximately 9.1% of patients Sagara et al (Sagara et al 1998) found an exceedingly high recanalization rate in pulmonary AVMs embolized with coils (57%), justifying that this embolization agent should be avoided in patients with life-threatening hemoptysis (Sagara et al 1998), especially in patients with CF who are known to have a higher recurrence rate for hemoptysis In this case, the presence of indwelling recanalized coils in the bronchial artery caused reflux of PVA particles during the attempted embolization of the fourth intercostal artery. The Scepter occlusion balloon catheter allowed for careful placement of the tip within the interstices of the pre-existing coils, allowing for Onyx injection directly into the coil mass without reflux In this example, we reconfirm the benefits of Onyx embolization in BAE, especially in attempts to embolize recanalized coils.
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