Transcatheter Proximal Coil Blocking with n-Butyl-2-Cyanoacrylate Injection via the Pulmonary Artery Alone for Rasmussen’s Aneurysm

Abstract

Rasmussen’s aneurysm is a peripheral pulmonary artery pseudoaneurysm (PAP) within a tuberculosis cavity. Because it can be perfused from the bronchial and pulmonary arterial circulations, combined embolization via the bronchial and pulmonary arteries is sometimes required. Herein, we present case of a 51-year-old man with Rasmussen’s aneurysm that was successfully treated by proximal coil blocking with n-butyl-2-cyanoacrylate (NBCA) injection via the pulmonary artery alone. With proximal coil blocking, a sufficient amount of NBCA could be injected without unintended reflux of the NBCA cast to the proximal pulmonary artery. To our knowledge, there has been no report that attempted NBCA injection under proximal coil blocking for Rasmussen’s aneurysm. Our treatment approach may be safe and effective for infectious lung disease-related PAP, which has to be treated from the pulmonary artery side.

Liquid Embolic Agents for Endovascular Embolization: A Review

“…In a recent clinical study in 2019, Hassan et al evaluated the efficacy and safety of endovascular embolization of post-tonsillectomy pseudoaneurysm with NBCA glue [50]. In other studies, performed in the same year, the transcatheter embolization of NBCA was successfully used via the pulmonary artery under proximal coil blocking in Rasmussen's aneurysm [51], and NBCA glue for the transcatheter embolization was used as an alternative therapeutic option in the treatment of esophagomediastinal fistula [52].…”

Rasmussen's Aneurysm: A Case Report

“…However, NBCA is a highly operator-dependent material to use and its behavior is difficult to estimate, especially its retrograde flow from the bronchial to the pulmonary artery. Consequently, nontarget embolization can pose dangerous and serious lung ischemic complications [13].…”