Embosphere With or Without Coils in the Treatment of Hemoptysis: A Propensity-Matched Analysis of Recurrence and Safety.

BACKGROUND: BAE has become a well-established, minimally invasive first-line therapy for hemoptysis. Coils may be useful in selected vascular lesions, including pseudoaneurysms and arteriovenous malformations, but their more proximal occlusive effect may limit distal access and could affect later retreatment and whether adding coils to embosphere embolization improves clinical outcomes remains uncertain. We compared recurrence and safety after embosphere-based BAE performed with or without adjunctive coils. METHODS: We retrospectively reviewed all consecutive adult patients who underwent first-time BAE for hemoptysis at our single tertiary care center between January 2019 and December 2024. Patients treated with embosphere were grouped according to whether coils were also deployed. Residual confounding arising from baseline covariate imbalances was mitigated via 1:1 propensity score-based matching, with matched pairs constrained to a caliper of 0.2 standard deviations of the logit of the propensity score. Kaplan-Meier analysis was used to estimate survival without hemoptysis recurrence, and the results were further analyzed based on the cause of hemoptysis. Factors linked to recurrent hemoptysis were evaluated using Cox proportional hazards models. RESULTS: The study cohort included 260 patients (median age, 56 years; 161 women), of whom 82 received embosphere plus coils and 178 received embosphere without coils. Propensity score matching yielded 62 patients in each group. At 1, 3, and 5 years prior to matching, recurrence-free survival stood at 92.6%, 75.0%, and 59.2% in the coil cohort, respectively, compared with 90.9%, 76.0%, and 50.3% in the control cohort (p = 0.979). After matching, the corresponding rates were 91.8%, 73.8%, and 51.8% versus 85.2%, 66.8%, and 40.5% (p = 0.358). Etiology-stratified analyses also showed no significant benefit from coil use after matching (bronchiectasis, p = 0.770; tuberculosis [TB] sequelae, p = 0.868; non-TB and nonbronchiectasis, p = 0.835). The duration of the procedure varied significantly between the groups (p = 0.003), while the rates of complications showed no significant difference (p = 0.181). On multivariable analysis, TB sequelae emerged as an independent predictor of recurrent bleeding, with a hazard ratio (HR) of 1.69 (95% CI 1.20-2.15, p = 0.002). Systemic arterial-pulmonary shunts (SPSs) were also independently tied to recurrence, carrying an HR of 1.52 (95% CI 1.32-3.72, p = 0.048). CONCLUSIONS: In patients undergoing embosphere-based BAE for hemoptysis, adjunctive coils did not improve long-term recurrence-free survival or reduce complications. Coil use was associated with shorter procedure duration.