Superselective pulmonary artery embolization (PAE) may offer a safe and effective bailout strategy for patients with persistent haemoptysis following bronchial artery embolization (BAE), according to findings from a prospective case series.
The study, led by Priyanka Naranje (All India Institute of Medical Sciences, Ansari Nagar, India) and colleagues and published in the journal CVIR Endovascular, evaluated outcomes of segmental and subsegmental superselective PAE in patients with recurrent bleeding despite prior embolization. Between January 2022 and July 2024, a total of 50 patients presenting with recurrent haemoptysis after BAE underwent computed tomography (CT) angiography assessment. Where a significant systemic arterial supply was identified, repeat BAE was performed to target recanalised or newly developed vessels, accounting for 34 of the 50 cases.
Among this subgroup, persistent systemic-to-pulmonary shunts (SPS) were identified using CT angiography and diagnostic arteriography in seven patients. These individuals subsequently underwent selective PAE using microcoils. The cohort included four men and three women aged 20–55 years. Underlying pathology was predominantly chronic pulmonary aspergillosis (six patients), with one case attributed to post-tuberculosis sequelae. Most patients had undergone multiple prior BAE procedures, ranging from two to three sessions and involving embolization of between two and eight arteries.
No aneurysms or vascular malformations were identified in the targeted pulmonary artery branches. All patients were receiving appropriate medical therapy for their underlying conditions at the time of intervention. Technical success was defined as complete occlusion of the selected pulmonary artery branch, while clinical success was measured by immediate cessation of haemoptysis and absence of recurrent massive bleeding during follow-up.
Systemic-to-pulmonary shunts were most commonly localised to the left upper lobe (four patients), followed by the left lower lobe, right lower lobe, and right upper lobe (one patient each). Bronchial artery supply was implicated in three cases, while non-bronchial systemic arteries were involved in four cases, with dual vessel supply observed in two patients.
Superselective embolization involved a single pulmonary artery branch in four patients and two branches in the remaining three patients. Technical success was achieved in all cases. Immediate clinical control of haemoptysis was also reported in all patients. One individual experienced mild recurrent haemoptysis at two weeks, which was managed conservatively with antifungal therapy and tranexamic acid.
The authors conclude that superselective PAE represents an effective adjunctive option in carefully selected patients with refractory haemoptysis following BAE, particularly in the presence of persistent systemic-to-pulmonary shunting.
