Customized Tracheobronchial Stenting: An Innovative Approach to Vascular Coil Migration With Life-Threatening Hemoptysis

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

INTRODUCTION: Malignant airway disease is a major source of morbidity and mortality, causing central airway obstruction and life-threatening hemoptysis. Vascular coil embolization is commonly used in the management of severe pulmonary hemorrhage due to primary lung cancer, with rare complications (1). We present a case of malignant broncho-vascular fistula (BVF) formation due to coil migration, managed with the humanitarian use of a customized tracheobronchial stent to mitigate recurrent coil migration and hemoptysis. CASE PRESENTATION: A 42-year-old female with non-small cell lung cancer presented with dyspnea. Imaging showed a large right perihilar mass encasing broncho-vascular structures. Bronchoscopy revealed extensive intrinsic tumor invasion throughout the right bronchial tree, sparing the right lower lobe (RLL). A fully-covered self-expanding metal stent was deployed to preserve the RLL. She later developed recurrent hemoptysis for which she underwent multiple pulmonary and bronchial artery coil embolizations. Months later, she endorsed a foreign body sensation – she had developed a malignant BVF with migration of endovascular coil material into the airways, emanating through the glottis and into the esophagus. She underwent rigid bronchoscopy wherein the coil was cut at the base and removed, however migration recurred 30 days later. A silicone tracheobronchial Y stent was customized by suturing closed the right mainstem bronchial limb - this was deployed to prevent further coil migration and hemoptysis. DISCUSSION: Evidence-based literature guiding the management of malignant BVF with transbronchial migration of vascular embolization coils is lacking, due to the rarity of this complication and associated high mortality. Few case reports describe methods to control hemorrhage and prevent further coil migration, including bronchoscopic removal (2), and surgical resection (3). Our case presents an alternative minimally-invasive strategy in nonoperative candidates, using a customized tracheobronchial stent to produce a functional pneumonectomy. CONCLUSIONS: Customized tracheobronchial stenting is a viable minimally-invasive treatment option in nonsurgical candidates for the management of malignant bronchovascular fistula formation with vascular coil migration and life-threatening hemoptysis. Further investigation into the safety and efficacy of this approach is needed to improve future patient outcomes.

Volume

168

Issue

4S

First Page

6009A

Last Page

6010A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

DOI

10.1016/j.chest.2025.07.3368

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