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Abstract：
BACKGROUND: Bronchial arterial embolization (BAE) has been accepted as an effective treatment for bronchiectasis-related hemoptysis. However, rare clinical trials compare different sizes of specific embolic agents. This study aims to evaluate whether different Embosphere microsphere sizes change the outcome of BAE.
METHODS: A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis.
RESULTS: Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding.
CONCLUSIONS: For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
METHODS: A retrospective review was conducted on consecutive patients with bronchiectatic hemoptysis who were scheduled to undergo BAE treatment during a period from January 2018 to December 2022. The patients received BAE using microspheres of different sizes: group A patients were treated with 500-750 μm microspheres, and group B patients were treated with 700-900 μm microspheres. The cost of embolic microspheres (Chinese Yuan, CNY), duration of hospitalization, complications, and hemoptysis-free survival were compared between patients in group A and those in group B. A Cox proportional hazards regression model was used to identify predictors of recurrent hemoptysis.
RESULTS: Median follow-up was 30.2 months (range, 20.3-56.5 months). The final analysis included a total of 112 patients (49-77 years of age; 45 men). The patients were divided into two groups: group A (N = 68), which received 500-750 μm Embosphere microspheres, and group B (N = 44), which received 700-900 μm Embosphere microspheres. Except for the cost of embolic microspheres(group A,5314.8 + 1301.5 CNY; group B, 3644.5 + 1192.3 CNY; p = 0.042), there were no statistically significant differences in duration of hospitalization (group A,7.2 + 1.4 days; group B, 8 + 2.4days; p = 0.550), hemoptysis-free survival (group A, 1-year, 2-year, 3-year, 85.9%, 75.8%, 62.9%; group B, 1-year, 2-year, 3-year, 88.4%, 81.2%,59.4%;P = 0.060), and complications(group A,26.5%; group B, 38.6%; p = 0.175) between the two groups. No major complications were observed. The multivariate analysis results revealed that the presence of cystic bronchiectasis (OR 1.61, 95% CI 1.12-2.83; P = 0.001) and systemic arterial-pulmonary shunts (SPSs) (OR 1.52, 95% CI 1.10-2.72; P = 0.028) were independent risk factors for recurrent bleeding.
CONCLUSIONS: For the treatment of BAE in patients with bronchiectasis-related hemoptysis, 500-750 μm diameter Embosphere microspheres have a similar efficacy and safety profile compared to 700-900 μm diameter Embosphere microspheres, especially for those without SPSs or cystic bronchiectasis. Furthermore, the utilization of large-sized (700-900 μm) Embosphere microspheres is associated with the reduced cost of an embolic agent.
摘要：
背景：支气管动脉栓塞（BAE）已被认为是支气管扩张相关咯血的有效治疗方法。然而,罕见的临床试验比较了不同大小的特定栓塞剂。本研究旨在评估不同的Embosphere微球大小是否会改变BAE的结局。
方法：对计划在2018年1月至2022年12月期间接受BAE治疗的连续支气管咯血患者进行回顾性审查。患者使用不同大小的微球接受BAE治疗：A组患者使用500-750μm微球治疗，B组患者给予700～900μm微球治疗。栓塞微球的成本(人民币，CNY),住院时间，并发症,比较A组和B组患者的无咯血生存率。Cox比例风险回归模型用于确定复发性咯血的预测因素。
结果：中位随访时间为30.2个月（范围，20.3-56.5个月）。最终分析包括总共112名患者(49-77岁;45名男性)。将患者分为两组：A组（N=68），收到500-750μmEmbosphere微球，B组（N=44），收到700-900μmEmbosphere微球。除栓塞微球的成本外（A组，5314.8+1301.5元人民币；B组，3644.5+1192.3人民币；p=0.042），住院时间无统计学差异(A组，7.2+1.4天；B组，8+2.4天；p=0.550)，无咯血生存（A组，1年,2年,3年,85.9%,75.8%,62.9%;B组,1年,2年,3年,88.4%,81.2%,59.4%;P=0.060),和并发症(A组，26.5%;B组,38.6%；p=0.175）两组之间。未观察到重大并发症。多因素分析结果显示，囊性支气管扩张（OR1.61，95％CI1.12-2.83；P=0.001）和全身动脉-肺分流（SPS）（OR1.52，95％CI1.10-2.72；P=0.028）是复发性出血的独立危险因素。
结论：对于支气管扩张相关性咯血患者的BAE治疗，与直径700-900μm的Embosphere微球相比，直径500-750μm的Embosphere微球具有相似的功效和安全性，特别是对于那些没有SPS或囊性支气管扩张的人。此外，大尺寸（700-900μm）Embosphere微球的使用与栓塞剂成本的降低有关。
方法：对计划在2018年1月至2022年12月期间接受BAE治疗的连续支气管咯血患者进行回顾性审查。患者使用不同大小的微球接受BAE治疗：A组患者使用500-750μm微球治疗，B组患者给予700～900μm微球治疗。栓塞微球的成本(人民币，CNY),住院时间，并发症,比较A组和B组患者的无咯血生存率。Cox比例风险回归模型用于确定复发性咯血的预测因素。
结果：中位随访时间为30.2个月（范围，20.3-56.5个月）。最终分析包括总共112名患者(49-77岁;45名男性)。将患者分为两组：A组（N=68），收到500-750μmEmbosphere微球，B组（N=44），收到700-900μmEmbosphere微球。除栓塞微球的成本外（A组，5314.8+1301.5元人民币；B组，3644.5+1192.3人民币；p=0.042），住院时间无统计学差异(A组，7.2+1.4天；B组，8+2.4天；p=0.550)，无咯血生存（A组，1年,2年,3年,85.9%,75.8%,62.9%;B组,1年,2年,3年,88.4%,81.2%,59.4%;P=0.060),和并发症(A组，26.5%;B组,38.6%；p=0.175）两组之间。未观察到重大并发症。多因素分析结果显示，囊性支气管扩张（OR1.61，95％CI1.12-2.83；P=0.001）和全身动脉-肺分流（SPS）（OR1.52，95％CI1.10-2.72；P=0.028）是复发性出血的独立危险因素。
结论：对于支气管扩张相关性咯血患者的BAE治疗，与直径700-900μm的Embosphere微球相比，直径500-750μm的Embosphere微球具有相似的功效和安全性，特别是对于那些没有SPS或囊性支气管扩张的人。此外，大尺寸（700-900μm）Embosphere微球的使用与栓塞剂成本的降低有关。
