Comparison of n-Butyl-2-Cyanoacrylate and Tris-Acryl Microspheres for Bronchial Artery Embolization in Patients with Cystic Fibrosis and Hemoptysis: A Retrospective Cohort Study

Aim: To compare the effectiveness and safety of bronchial artery embolization (BAE) using n-butyl-2-cyanoacrylate (NBCA) versus tris-acryl microspheres in patients with cystic fibrosis. Materials and methods: Fifty-eight patients with severe hemoptysis (>100 mL/24 h) who underwent endovascular embolization between June 2019 and July 2024 were retrospectively analyzed. Patients were divided into two subgroups based on the embolic agent used: NBCA (n = 38) and tris-acryl microspheres (n = 20). Technical success, primary and secondary clinical success, safety, and recurrence rates were evaluated. Potential predictors of recurrence-including the number of pathological arteries identified on CTA, the number and caliber of treated vessels, laterality, and embolized vascular district (bronchial vs. non-bronchial systemic arteries)-were assessed using appropriate univariate tests. Results: Technical success was achieved in all procedures. Primary clinical success was obtained in 57/58 patients (98.3%). During follow-up (mean 42.9 ± 12.3 months), recurrence occurred in 10/58 patients (17.2%), with a significantly higher relapse rate in the microsphere group (10/20, 50%) and no recurrences in the NBCA group (0/38) (p = 0.0005). Most recurrences (7/10) originated from non-bronchial systemic arteries previously embolized with microspheres. No major adverse events were observed. No other variable-including age, number of pathological arteries on CTA, vessel caliber, or laterality-showed a significant association with recurrence. Conclusion: NBCA was associated with lower recurrence rates compared with tris-acryl microspheres. More relapses arose from non-bronchial systemic arteries. Further studies with larger cohorts are needed to confirm these findings and to evaluate additional factors influencing outcomes.