[A case of a 91-year-old patient with advanced squamous cell lung cancer complicated with renal dysfunction successfully treated with trans-arterial chemo-embolization].

In 2009, a 91-year-old man with renal dysfunction was detected with a small nodule in the left pulmonary field. The nodule was found to have gradually increased in size by April, 2010. A trans-bronchial lung biopsy(TBLB)and computed tomography( CT)revealed squamous cell lung cancer and stage IV (a tumor was found on the right side as well), respectively. Systemic chemotherapy was not administered because of the advanced age of the patient and mild renal dysfunction. We obtained informed consent from the patient and his family before trans-arterial chemo-embolization(TACE)was performed. No side effects were observed either during or after treatment. Although his visits to our hospital stopped, he sought treatment for a cold 8 months after TACE. CT showed 87% shrinkage of the tumor shadow. This method could be a new therapeutic option for non-small cell lung cancer with little side effects, particularly in older patients or those with pulmonary complications.

Erratic coil migration in the bronchus after bronchial artery embolization.

Herein, we report two cases of erratic coil migration from the bronchial artery to the bronchus after bronchial artery embolization (BAE). Neither patient exhibited haemoptysis recurrence, but chest radiographs revealed that part of the coil had disappeared. In Case 1, the patient coughed up the coil 4.5 years after BAE. We performed repeat BAE to minimize the possibility of haemoptysis considering bronchoscopic and angiographic findings. In Case 2, the patient had severe dry cough 2 years after BAE. Chest radiography showed migrated coils in the trachea; bronchoscopy revealed a migrated fragment of the coil protruding from the elevated mucosa. We used a loop cutter to split the coil and then removed it using forceps. Coil migration to the bronchus is an infrequent late-stage complication of super-selective bronchial artery coil embolization, and only one other case has been reported. Accordingly, we propose treatment strategies and speculate on the mechanism of fistula formation.

Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study.

OBJECTIVES: Evidence on the safety and long-term efficacy of super selective bronchial artery embolisation (ssBAE) using platinum coils in patients with haemoptysis is insufficient. The objective of the present study was to evaluate the safety and the 3-year postprocedure haemoptysis-free survival rate of de novo elective ssBAE using platinum coils rather than particles for the treatment of haemoptysis. DESIGN: A single-centre retrospective observational study. SETTING: Hemoptysis and Pulmonary Circulation Center in Japan. PARTICIPANTS: A total of 489 consecutive patients with massive and non-massive haemoptysis who underwent de novo elective ssBAE without malignancy or haemodialysis. INTERVENTIONS: ssBAE using platinum coils. All patients underwent CT angiography before the procedure for identifying haemoptysis-related arteries (HRAs) and for procedural planning. PRIMARY AND SECONDARY OUTCOME MEASURES: The composite of the 3-year recurrence of haemoptysis and mortality from the day of the last ssBAE session. Each component of the primary end point and procedural success defined as successful embolisation of all target HRAs were also evaluated. RESULTS: The median patient age was 69 years, and 46.4% were men. The total number of target vessels was 4 (quartile 2-7), and the procedural success rate was 93.4%. There were 8 (1.6%) major complications: 1 aortic dissection, 2 symptomatic cerebellar infarctions and 5 mediastinal haematoma cases. The haemoptysis-free survival rates were estimated by the Kaplan-Meier analysis at 86.9% (95% CI 83.7% to 90.2%) at 1 year, 79.4% (74.8% to 84.3%) at 2 years and 57.6% (45.1% to 73.4%) at 3 years. Although not statistically significant by the adjusted analysis of variance with multiple imputation of missing variables, cryptogenic haemoptysis tended to show the most favourable outcome and non-tuberculous mycobacterium showed the worst outcome (adjusted p=0.250). CONCLUSIONS: We demonstrated the safety and long-term efficacy of elective ssBAE using platinum coils and established that it can be a valuable therapeutic option for treating patients with haemoptysis.