The efficacy, safety, and related factors of bronchial artery embolization for hemoptysis: a systematic review and meta-analysis with subgroup analysis

Background: Bronchial artery embolization (BAE) is a common and important way to manage hemoptysis. This study's purpose was to summarize the efficacy, safety, and related factors of BAE in the treatment of hemoptysis. Methods: From January 2010 to August 2023, a systematic literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases. Original studies with BAE for hemoptysis were included, with no restrictions on language. The outcomes of interest were technical success rate, clinical success rate, recurrence rate, mortality rate, and major complication rate. Pooled proportions with 95% confidence intervals (CIs) were calculated using random-effects models. The Newcastle-Ottawa Scale (NOS) was employed for quality assessment. Factors such as publication year, region, sample size, amount of hemoptysis, etiology, and embolization materials were extracted for subgroup analyses. Additionally, sensitivity analyses and test for publication bias were conducted. Results: A total of 32 studies, including 6,032 patients, met our inclusion criteria. 27 studies were of high quality, while five of moderate quality. The results indicated the prevalence of technical success was 97.2% (95% CI: 95.1-98.8%) and 93.2% (95% CI: 90.3-95.7%) in clinical success. Hemoptysis recurrence and mortality rates after BAE were 24.8% (95% CI: 20.5-29.4%) and 2.3% (95% CI: 1.1-3.8%), respectively. Moreover, the pooled prevalence of major complication was 0.1% (95% CI: 0.0-0.4%). Subgroup analysis revealed that studies published after 2017 demonstrated a higher technical success rate and a lower recurrence rate. Massive hemoptysis showed a higher technical success rate but a lower clinical success rate. BAE also demonstrated superior efficacy in patients with bronchiectasis. The clinical success rate was significantly higher in patients with benign diseases than those with malignancies. Gelatin sponge (GS) showed poor embolization efficacy. N-butyl-2-cyanoacrylate (NBCA) and coils exhibited reduced recurrence rates, while NBCA displayed an even lower recurrence rate than non-absorbable particles. The study by Ishikawa et al. influenced the stability of the pooled major complication rate, and the sensitivity analysis confirmed the robustness of the remaining results. Conclusions: BAE is safe and effective in treating different degrees of hemoptysis caused by benign and malignant lesions. Promising clinical efficacy was observed with NBCA as an embolic material for the treatment of hemoptysis. However, further conclusions should be investigated using evidence-based medicine.