Myocardial Infarction as a Complication of Bronchial Artery Embolization

Case Report: Ectopic pulmonary embolism as a complication of bronchial artery embolization

Bronchial artery embolization (BAE) is currently the first-line treatment for massive hemoptysis. Previous studies have proven its safety and efficacy, with mild, transient, and reversible complications. This case described a patient with congenital multiple bronchopulmonary fistulas who underwent BAE due to massive hemoptysis. However, due to an overlooked and misdiagnosed atypical fistula, the patient experienced an ectopic pulmonary embolism and subsequently secondary pulmonary infarction. He eventually exhibited a full postoperative recovery following percutaneous catheter-directed embolectomy. This case revealed a type of occult fistula masked by multiple bronchial artery branches, which may be a potential risk factor for an ectopic pulmonary embolism during BAE. We propose that it is crucial to identify abnormal anastomosis, especially atypical fistula, and select appropriate embolization materials during BAE.

Coronary artery-bronchial artery fistula imaging characteristics and its correlation with pulmonary disease severity

Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery-bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2-2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF.

Coronary Embolism: A Systematic Review

BACKGROUND

Coronary embolism is a rare and potentially fatal phenomenon that occurs primarily in patients with valvular heart disease and atrial fibrillation. There is a lack of consensus regarding the diagnosis, treatment, and management of coronary embolism, leaving management at the discretion of the treating physician. Through this review, we aim to establish a better understanding of coronary embolism, and to identify treatment options - invasive and non-invasive - that may be used to manage coronary embolism.

METHODS AND RESULTS

Our systematic review included 147 documented cases of coronary embolism from case reports and case series. The average age of our population was 54.2 ± 17.6 years. The most common causes of coronary embolism included infective endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart valve thrombosis (16.3%). Initial presentation was indistinguishable from an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the diagnosis required a high level of suspicion and evaluation with angiography. Treatment strategies included, but were not limited to, thrombectomy, thrombolysis, balloon angioplasty and stent placement. Myocardial dysfunction on echocardiography was observed in over 80% of patients following coronary embolism. "Good outcomes" were reported in 68.7% of case reports and case series, with a mortality rate of 12.9%.

CONCLUSION

Coronary embolism is an under-recognized etiology of myocardial infarction with the potential for significant morbidity and mortality. To improve outcomes, physicians should strive for early diagnosis and intervention based on the underlying etiology. Thrombectomy may be considered with the goal of rapid restoration of coronary flow.

Bronchial Artery Embolization with Large Sized (700-900 µm) Tris-acryl Microspheres (Embosphere) for Massive Hemoptysis: Long-Term Results (Clinical Research)

PURPOSE

To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere^® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis.

METHODS

One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success.

RESULTS

Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions.

CONCLUSION

Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.