Bronchial Artery Embolization

Nima Kokabi, MD, FRCRC

Interventional Radiologist

University of North Carolina

Patient presented with shortness of breath and significant epistaxis consistent with history of HHT.
Angiography demonstrated a large bilateral bronchial artery malformation.
Right bronchial artery branch embolized with five fibered detachable coils.
Patient returned 1 month later for embolization of left bronchial artery malformations.
Complete occlusion of left bronchial artery achieved with a single LOBO-3.
Follow-up CTA performed one-month post embolization showed that embolized branches remained occluded and the malformation regressed in size.

Figure 1. Bronchial artery angiography demonstrating: A) large bronchial artery malformations supplied by branches from both the right and left bronchial arteries; B) embolization of the proximal right bronchial artery with 5 detachable fibered coils.

Figure 2. Bronchial artery angiography demonstrating: A) previously coil-embolized right bronchial artery; B) successful LOBO-3 deployment with no contrast flow through the device.

Figure 3. Follow-up CTA at one month post embolization demonstrating occluded bronchial arteries. The right side embolized with coils had significantly greater streak artifact than the left side embolized with LOBO.

The LOBO-3 successfully embolized the left bronchial artery and achieved complete occlusion in 60 seconds with only a single device. Beyond achieving the same result with fewer embolic devices, the artifact created by the LOBO occluder was substantially less than the coil pack on follow-up imaging.