CHEST Guidelines-Successful-Late-Removal-of-Endobronchial-Coils

Successful-Late-Removal-of-Endobronchial-Coils_che

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The article describes the first successful removal of endobronchial coils 10 months post-implantation from a patient experiencing persistent thoracic pain. Endobronchial coils, made from shape-memory nitinol, are typically permanent implants used for treating severe emphysema, designed to induce lung volume reduction. While they generally have an acceptable safety profile, adverse events like pneumothorax and thoracic pain can occur. This report highlights a case in a 56-year-old male patient involved in the REVOLENS study, who developed pneumothorax after coil placement and experienced persistent pain due to very distal (subpleural) coil placement. Despite the standard protocol suggesting coils are difficult to remove, the team successfully retracted two coils well after implantation through a bronchoscopic procedure. This minimally invasive technique used general anesthesia, fluoroscopic guidance, and specialized bronchoscopes and instruments. Notably, there were no complications during the removal, such as bleeding or pneumothorax, and the patient reported complete pain relief following the procedure, with no pain reported at the 8-month follow-up. This case suggests that coil removal, although complex, is possible even months after implantation, especially when facilitated by minimal inflammation or fibrotic reactions around the coils. The procedure underscores the potential for treating complications like persistent thoracic pain through a nonsurgical method and suggests the need for cautious placement of coils to avoid similar issues. The article also calls for more extensive study to further elucidate factors that contribute to complications following coil placements.

Keywords

endobronchial coils

coil removal

thoracic pain

emphysema treatment

pneumothorax

bronchoscopic procedure

shape-memory nitinol

REVOLENS study

minimally invasive

lung volume reduction