Coil therapy for patients with severe emphysema and bilateral incomplete fissures – effectiveness and complications after 1-year follow-up: a single-center experience

Figures & data

Figure 1 X-ray after bilateral coil implantation.

Table 1 Patient demographics

Characteristics	Baseline
Male/female	40/46
Age, years	64±7
Lung function after bronchodilation with SABA
FEV1, L	0.71±0.21
FEV1, % predicted	27±7
FVC, L	2.09±0.69
FVC, % predicted	62±17
RV, L	6.02±1.39
RV, % predicted	279±52
TLC, L	8.21±1.66
RV/TLC, ratio	74±7
Exercise capacity
6MWT, m	239±91
Dyspnea score
mMRC score	3.2±1

Notes: Data are presented as n (%), mean ± SD, or median (range).

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; mMRC, modified Medical Research Council; 6MWT, 6-minute walk test; RV, residual volume; SABA, short-acting β2-agonists; SD, standard deviation; TLC, total lung capacity.

Figure 2 Patient flowchart.

Table 2 Follow-up data after the first procedure

	Baseline (n=86)	90-day follow-up (n=80)	180-day follow-up (n=62)	365-day follow-up (n=42)	P-value
Pulmonary lung function after bronchodilation with SABA
FEV1, L	0.71±0.21	0.77±0.23 (n=79)*	0.73±0.22 (n=62)	0.70±0.18	<0.001
FEV1, % predicted	27±7	29±8 (n=79)*	28±8 (n=62)	27±6	<0.001
VC, L	2.09±0.69	2.37±0.79 (n=79)*	2.25±0.78 (n=62)*	2.18±0.75	<0.001
VC, % predicted	62±17	70±17 (n=79)*	67±18 (n=62)*	65±18	<0.001
RV, L	6.02±1.39	5.57±1.35 (n=79)*	5.66±1.24 (n=61)*	6.17±1.41 (n=40)	<0.001
RV, % predicted	279±52	253±60 (n=79)*	262±49 (n=61)*	281±51 (n=40)	0.001
TLC, L	8.21±1.66	7.96±1.53 (n=79)	7.99±1.59 (n=61)	8.45±1.82	NS
TLC, % predicted	144±19	139±16 (n=79)*	142±22 (n=61)	148±24	0.01
RV/TLC	74±7	70±9 (n=79)*	71±8 (n=60)*	74±8	<0.001
Exercise capacity
6MWT, m	239±91 (n=79)	275±85 (n=73)*	263±96 (n=54)*	241±90 (n=33)	0.01
Dyspnea perception
mMRC	3.2±1 (n=76)	2.7±1.1 (n=76)*	2.7±1.0 (n=56)*	3±1.2 (n=33)	0.007

Notes: Values are given as mean ± SD. Repeated-measures analysis was used to test for statistical differences with post hoc Bonferroni correction for pairwise comparisons.

* P<0.05 pairwise difference as compared to baseline values with post hoc Bonferroni correction.

Abbreviations: FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; 6MWT, 6-minute walk test; NS, nonsignificant; RV, residual volume; SD, standard deviation; SABA, short-acting β2-agonists; TLC, total lung capacity; VC, vital capacity.

Table 3 Fitted model

Parameters	Intercept	Coefficients
		Time (linear term)	P-value	Time (quadratic term)	P-value
FEV1	0.72	0.011	0.005	−0.001	<0.0001
VC	2.14	0.06	<0.0001	−0.005	<0.0001
RV	6.03	−0.157	<0.0001	0.013	<0.0001
6MWT	242	8.046	<0.0001	−0.600	0.001

Notes: Longitudinal analysis was performed to quantify the patients’ course over time as described by each parameter. Intercepts indicate the value of the respective parameter at time 0. Coefficients indicate the rate of change of each parameter as time passes, with 1 month being the time unit. The P-values indicate the validity of the model.

Abbreviations: FEV₁, forced expiratory volume in 1 second; 6MWT, 6-minute walk test; RV, residual volume; VC, vital capacity.

Figure 3 Lung function after bronchodilation with SABA, exercise tolerance, and perception of dyspnea follow-up graphs after unilateral coil treatment.

Abbreviations: FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; 6MWT, 6-minute walk test; RV, residual volume; SABA, short-acting β2-agonists; TLC, total lung capacity; VC, vital capacity.

Table 4 Follow-up data after the second procedure

	Baseline (n=28)	90-day follow-up (n=24)	180-day follow-up (n=18)	365-day follow-up (n=9)	P-value
Pulmonary lung function after bronchodilation with SABA
FEV1, L	0.67±0.17	0.70±0.15	0.73±0.19	0.63±0.20	NS
FEV1, % predicted	27±5	28±5	28±6	25±4	NS
VC, L	2.04±0.64	2.26±0.62	2.33±0.55	1.90±0.76	NS
VC, % predicted	65±14	72±13	70±13	57±10	NS
RV, L	5.59±0.89	5.28±0.81	5.50±0.99	5.92±1.59	NS
RV, % predicted	265±48	249±29	251±33	281±88	NS
TLC, L	7.65±1.10	7.55±1.16	7.84±1.29	7.83±1.68	NS
TLC, % predicted	141±19	138±14	137±13	140±31	NS
RV/TLC	73±6	70±5	70±5	75±9	NS
Exercise capacity
6MWT, m	270±75 (n=20)	277±65 (n=21)	264±79 (n=11)	261±57 (n=6)	NS
Dyspnea score
mMRC	2.7±1 (n=20)	2.7±1.3 (n=18)	2.0±1.4 (n=9)	3.4±0.9 (n=5)	NS

Notes: Values are given as mean ± SD. Repeated-measures analysis was used to test for statistical differences with post hoc Bonferroni correction for pairwise comparisons.

Abbreviations: FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; 6MWT, 6-minute walk test; NS, nonsignificant; RV, residual volume; SABA, short-acting β2-agonists; SD, standard deviation; TLC, total lung capacity; VC, vital capacity.

Figure 4 Lung function after bronchodilation with SABA, exercise tolerance, and perception of dyspnea follow-up graphs after bilateral coil treatment.

Abbreviations: FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council; 6MWT, 6-minute walk test; RV, residual volume; SABA, short-acting β2-agonists; TLC, total lung capacity; VC, vital capacity.

Table 5 Adverse events in a total of 114 procedures

Adverse events in a total of 114 procedures	0–90 days post-procedure (natural number/%)	90–365 days post-procedure (natural number/%)
Serious adverse events
Mortality	4/3.5	–
Hemoptysis	4/3.51	4/3.51
Pneumothorax treated with chest tube draining	7/6.14	2/1.75
Pneumonia treated with intravenous antibiotics	32/28.1	9/7.9
Hypoxemia	2/1.75	1/0.87
Hypercapnia	5/4.38	3/2.63
Adverse events
Mild hemoptysis	25/22	2/1.75
Pneumothorax without need of chest tube draining	1/0.87	0
Pneumonia treated with oral antibiotics	24/21	29/25.4
COPD exacerbation treated with cortisone	8/18.5	14/12.3
Chest discomfort	6/5.2	0
Cryptogenic organizing pneumonia	1/0.87	1/0.87

Figure 5 CT with infiltrations after coil implantation.

Abbreviation: CT, computed tomography.

Figure 6 Lung autopsy after coil implantation.