Recurrent massive hemoptysis in a patient with cystic fibrosis: balloon assisted Onyx embolization after bronchial artery coil recanalization

Abstract

Background Although 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 presentation In 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). Conclusions 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, 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.

Liquid Embolic Agents for Endovascular Embolization: A Review

“…In 2010, Khalil et al shared their preliminary experience of systemic arterial embolization with Onyx in 15 patients with hemoptysis, where it was controlled in 14 cases [155]. In 2021, Mattay et al described successful Onyx embolization of the bronchial artery in a patient with massive hemoptysis without reflux [156].…”

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

“…Because hypertrophic abnormal vascularization is usually considered the cause of hemoptysis, authors agree that particles can be used for transcatheter embolic treatment. Coils are a good tool too but in case of a super-tortuous vessel could be difficult to reach the peripheral vascular microcirculation [ 41 ]. In case of bronchopulmonary shunt, microparticles or coils may migrate into the pulmonary arteries and in case of bleeding caused by tumor or infectious vascular erosion may not be curative [ 39 ].…”

Society of Chest Imaging and Interventions Consensus Guidelines for the Interventional Radiology Management of Hemoptysis

“…EVOH-based embolizing agents (Onyx) should be used in cases of refractory massive hemoptysis where conventional particle embolization has failed. 50…”