Achievements

Introduction: With robotic bronchoscopy, lung nodules and masses can be biopsied with a lower pneumothorax risk and similar diagnostic yield as CT-guided transthoracic approach. Bleeding risk for both procedures remains low. In patients who had endovascular stenting and are on antiplatelet agents, pre-procedural management of bleeding risk can be challenging, since holding their antiplatelet agents can have severe consequences. Clopidogrel, an oral antiplatelet agent, can be safely continued for many pulmonary procedures, including EBUS-guided lymph node biopsies. The risk of bleeding for patients undergoing robotic bronchoscopy and FNA of lung mass remains unknown Case report: We present a case of a 75-year-old male former smoker with a new right middle lobe lung mass. He has a history of coronary artery disease and recent drug-eluting stent placed for angina. Stopping his clopidogrel was considered too high risk by his cardiologist. Delaying biopsy until clopidogrel could be stopped was also considered deleterious. Admission prior to biopsy, with transition to an IV anti-platelet equivalent (e.g. cangrelor) was considered but deems unfeasible. Ultimately, with patient informed consent, we proceeded with fine-needle aspiration of his mass using the Ion platform while on clopidogrel. A 23G needle was used for a total of 5 passes until ROSE confirmed adequate tissue. Transbronchial biopsies were deferred. There was no bleeding or other complication post-biopsy. Final cytology confirmed non-small cell lung cancer. Conclusion: For patients in whom clopidogrel cannot be safely held, delaying procedure or admission with transition to IV anti-platelet agent can be considered but come with their own unique drawbacks. In our case, the patient successfully underwent FNA of his lung mass while on therapeutic clopidogrel using robotic bronchoscopy. Robotic bronchoscopy and FNA of lung lesions may be considered for patients in whom clopidogrel cannot be held but further studies need assess its safety and broad applicability