2023 年 1 巻 2 号 p. 28-41
Hemoptysis is a symptom with a high mortality rate. The in-hospital mortality rate of hospitalized patients with hemoptysis is 5%-9%. Bronchial artery embolization was formerly positioned as an emergency treatment for massive hemoptysis. Nowadays, it has become a standard treatment for elective treatment for chronic recurrent hemoptysis. Despite the high mortality rate, only 2%-8% of hospitalized patients with hemoptysis underwent Bronchial Artery Embolization (BAE). One possible reason is the concern about spinal cord infarction, followed by the shortage of operators specializing in BAE.
The incidence rate of spinal cord infarction was 0.18%, 0.71%, and 0.06% for gelatin sponge, n-butyl-2-cyanoacrylate (NBCA), and coil, respectively, in a nationwide observational study in JAPAN. CIRSE (Cardiovascular and Interventional Radiological Society of Europe) guideline states that BAE by the coil is relatively safe and spinal-protective based on this study.
BAE is primarily performed by radiologists and is a unique intervention targeting various arteries throughout the thorax, often smaller than 2 mm and, in some cases, less than 1 mm. The authors believe that it is essential to increase the number of pulmonologists subspecializing in BAE, like cardiologists and neurosurgeons who perform catheter treatment in their field.
This paper aims to provide a technical and practical Expert Review of BAE by coil for pulmonologists based on our experience at a high-volume center managed by pulmonologists. The authors will also discuss a general narrative review on classifications of hemoptysis and BAE because we are concerned about the extreme international inconsistency in classifying and defining hemoptysis-related matters and will propose some challenging suggestions depending on our experience to rectify this situation.
