ArticleJournal of thoracic disease2025
Risk and protective factors of higher-grade intrapulmonary hemorrhage in patients undergoing percutaneous computed tomography-guided microcoil localization before video-assisted thoracoscopic surgery.
Article in Journal of thoracic disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Computed tomography (CT)-guided microcoil localization before video-assisted thoracoscopic surgery (VATS), while generally safe, carries non-negligible risks of intrapulmonary hemorrhage. This study identifies independent predictors of higher-grade hemorrhage (≥ Grade 2) caused by CT-guided microcoil localization to optimize patient selection and procedural planning. Methods: In this retrospective study, 432 consecutive patients [2016-2020] undergoing microcoil localization prior to VATS for solitary pulmonary nodules were analyzed. Hemorrhage severity was graded radiologically (Grade 0-4). Univariate and multivariate logistic regression identified the independent factors associated with higher-grade hemorrhage (≥ Grade 2), with P<0.05 considered significant. Results: Intrapulmonary hemorrhage occurred in 161 of the 432 CT-guided microcoil localizations (37.27%), and higher-grade hemorrhage occurred in 41 of all procedures (9.49%). The logistic regression revealed that repeat insertion [odds ratio (OR) =9.712, P<0.001] was the only risk factor for higher-grade intrapulmonary hemorrhage, while procedure-related pneumothorax (OR =0.159, P=0.005), nodule size (>5-10 mm, OR =0.216, P=0.002; >10 mm, OR =0.349, P=0.04), pleura-microcoil distance (>20-30 mm, OR =0.365, P=0.02), and lung radiodensity along the needle passage [>-900 to -850 Hounsfield unit (HU), OR =0.426, P=0.03; ≤-900 HU, OR =0.273, P=0.009] were protective factors for higher-grade intrapulmonary hemorrhage. Conclusions: Repeat insertion during microcoil localization significantly increases hemorrhage risk, while pneumothorax, larger nodule size (>5 mm), longer pleura-microcoil distance (>20-30 mm) and lower lung density (≤-850 HU) are protective. These findings enable risk-stratified patient management.
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