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Use of a Retrievable Metallic Stent Internally Coated with Silicone to Treat Airway Obstruction. J Vasc Interv Radiol 2008; 19:1208-14. [DOI: 10.1016/j.jvir.2008.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 04/24/2008] [Accepted: 05/02/2008] [Indexed: 11/17/2022] Open
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Bodhey NK, Gupta AK, Neelakandhan KS, Neema PK, Kapilamoorthy TR, Purkayastha S, Thomas B, Krishnamoorthy T, Kesavadas C. Fluoroscopic-guided balloon dilatation and stenting in tracheal stenosis with metallic self-expandable stents and long-term follow-up results. ACTA ACUST UNITED AC 2007; 51:351-7. [PMID: 17635472 DOI: 10.1111/j.1440-1673.2007.01749.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to assess the safety and long-term efficacy of self-expandable stents in the treatment of benign tracheal stenosis. Nine patients (seven men) with tracheal stenosis (including one with fistula) of varied cause were treated by fluoroscopically guided balloon dilatation and stenting with self-expandable metallic stents. The procedure was carried out under topical spray in eight patients and under general anaesthesia in one patient. The patients were followed up for a period ranging between 13 and 60 months. In eight of the nine patients, satisfactory positioning of the stent was achieved at the first instance, with immediate relief of dyspnoea. One patient with innominate artery aneurysm died 16 days after the procedure because of renal failure. At 1 month of follow up, six out of eight (75%) of our live patients were without any respiratory embarrassment. This dyspnoea-free result reached almost 90% by the end of 1 year especially so in the fibrous strictures. Four out of the eight live patients (50%) had cough for 2 months and two (25%) had mild blood-tinged sputum treated by inhalation and mucolytic agents. Secondary intervention was required in one patient at 1 month because of recurrent symptoms. The patient with tracheo-oesophageal fistula required surgical intervention because of fracture of the stent. Fluoroscopically guided balloon dilatation and stenting of the tracheal stenosis is an effective non-surgical therapy resulting in cure of fibrous strictures and palliation in cases of malignancy.
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Affiliation(s)
- N K Bodhey
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Shin JH, Kim SW, Shim TS, Jung GS, Kim TH, Ko GY, Song HY. Malignant tracheobronchial strictures: palliation with covered retrievable expandable nitinol stent. J Vasc Interv Radiol 2004; 14:1525-34. [PMID: 14654487 DOI: 10.1097/01.rvi.0000099525.29957.34] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the safety and clinical effectiveness of a covered retrievable expandable nitinol stent for the treatment of malignant tracheobronchial stricture and/or esophagorespiratory fistula (ERF). MATERIALS AND METHODS With fluoroscopic guidance, stents were placed in 35 symptomatic patients with malignant tracheobronchial stricture and/or ERF in most cases caused by lung or esophageal cancer. The site of stricture was most commonly at the trachea or left main bronchus. If there were complications, the stent was removed with a retrieval set. Nine patients had combined symptomatic ERF. RESULTS A total of 47 tracheobronchial stents were placed and were technically successful and well-tolerated in all patients. Improvement of dyspnea was achieved in 92% of the patients (24 of 26 patients). Associated ERF in nine patients was effectively treated with tracheobronchial stent placement with or without esophageal stent placement. Stent migration, tumor overgrowth, symptomatic sputum retention, and hemoptysis occurred in 17% (6/35), 6% (2/35), 20% (7/35), and 17% (6/35) of patients, respectively. There were no documented cases of tumor ingrowth. Stent removal was performed easily in five patients when stent migration (n = 2), severe pain (n = 1), tumor overgrowth (n = 1), or persistent gastrobronchial fistula (n = 1) developed. All patients died 2 days to 26 weeks (mean, 9.62 weeks) after stent placement because of disease progression (n = 18), pneumonia (n = 9), hemoptysis (n = 5), or unknown cause (n = 3). CONCLUSION Use of a covered retrievable expandable nitinol stent is a safe and effective method for relieving dyspnea. This procedure contributed to improved quality of life for patients with malignant tracheobronchial stricture and/or ERF. Stent retrievability was useful in resolving stent-related complications.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Lee KH, Ko GY, Song HY, Shim TS, Kim WS. Benign tracheobronchial stenoses: long-term clinical experience with balloon dilation. J Vasc Interv Radiol 2002; 13:909-14. [PMID: 12354825 DOI: 10.1016/s1051-0443(07)61774-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the safety and long-term efficacy of balloon dilation in the treatment of benign tracheobronchial stenosis. MATERIALS AND METHODS Balloon dilation was performed under fluoroscopic guidance in 59 consecutive patients with benign tracheobronchial stenosis. Most patients had tuberculosis (48 of 59, 81%). Two to three serial balloon insufflations were performed for 5-180 seconds (mean, 85 sec) with inflation pressures as high as 16 atm with use of 6-20-mm-diameter balloon catheters. Patients with clinical evidence of restenosis underwent repeat balloon dilation. Patients were followed for 12-42 months (mean, 32 mo). RESULTS A total of 101 balloon dilation sessions were performed in 59 patients, with a range of one to four sessions per patient (mean, 1.7 sessions). Initial symptomatic improvement was achieved in 49 (83%) of the 59 patients; however, during the follow-up period, 39 (80%) of the 49 patients experienced recurrence of their symptoms. The primary patency rates at 3, 6, 9, 12, 18, 24, and 32 months were 92%, 60%, 45%, 24%, 20%, 20%, and 20%, respectively. The secondary patency rates at 3, 6, 9, 12, 18, 24, and 32 months were 92%, 87%, 75%, 43%, 43%, 43%, and 43%, respectively. Procedure-related major complications of deep mucosal laceration (n = 2) and bronchospasm (n = 1) occurred in three patients, but they experienced no subsequent problems. CONCLUSION Although the recurrence rate is high during the long-term follow-up period, balloon dilation seems to be a safe primary treatment modality for benign tracheobronchial stenoses and has an acceptable secondary patency rate.
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Affiliation(s)
- Kwang-Hun Lee
- Departments of Diagnostic Radiology and Research, Institute of Radiological Science, Yonesei University College of Medicine,Yong Dong Severance Hospital, Seoul, South Korea
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Dorenbeck U, Seitz J, Völk M, Strotzer M, Lenhart M, Feuerbach S, Link J. Evaluation of arterial bypass grafts of the pelvic and lower extremities with gadolinium-enhanced magnetic resonance angiography: comparison with digital subtraction angiography. Invest Radiol 2002; 37:60-4. [PMID: 11799328 DOI: 10.1097/00004424-200202000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE MRA) with digital subtraction angiography (DSA) in the assessment of patency and stenoses in bypass grafts. METHODS Fifteen patients were examined with both CE MRA and DSA. Fifteen bypass grafts were evaluated by four readers for potential stenosis in five locations. The stenoses were classified in five types: 1 (0% to 24% stenosis), 2 (25% to 49%), 3 (50% to 74%), 4 (75% to 99%), and 5 (occlusion). RESULTS Using both techniques, 70 of 75 evaluated locations (93.3%) were classified identically. This included six stenoses < 50% and six stenoses > 50%, respectively. Four of five overestimations of stenoses were scaled in DSA as stenoses type 1. One stenosis was categorized as type 3 in DSA. Sensitivity for CE MRA for detecting stenoses >or= 25% was 100% and the specificity 90%. Interobserver agreement for all evaluations was 0.77 (Spearman rank correlation test). CONCLUSION In the assessment of low-grade stenosis in bypass grafts, CE MRA overestimates stenoses slightly but yields good results in comparison with DSA.
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Affiliation(s)
- U Dorenbeck
- Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss, Regensburg, Germany.
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Hwang JC, Song HY, Kang SG, Suh JH, Ko GY, Lee DH, Kim TH, Jeong YK, Lee JH. Covered retrievable tracheobronchial hinged stent: an experimental study in dogs. J Vasc Interv Radiol 2001; 12:1429-36. [PMID: 11742020 DOI: 10.1016/s1051-0443(07)61704-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the safety and technical feasibility of the use of a covered retrievable tracheobronchial hinged stent and investigate the histopathologic airway changes after placement and removal of the stent in dogs. MATERIALS AND METHODS The experimental stent was composed of tracheal and bronchial stents that were connected together at their ends. Each stent was woven from a single thread of 0.2-mm-diameter nitinol wire filament in a tubular configuration and covered with polyurethane solution by a dipping method. Drawstrings were attached at the upper end of the tracheal stent for stent removal. Under fluoroscopic guidance, 20 stents were placed at the lower trachea and left main bronchus in 20 dogs and were electively removed 4 weeks (n = 10) or 8 weeks (n = 10) after placement. Ten dogs were killed just after stent removal and the remaining 10 were killed 2 weeks after stent removal. RESULT Stents were successfully placed in all dogs. Pneumonia was observed in three dogs. Stent migration occurred in seven dogs (35%). Except for two cases of stent expectoration, 18 stents were easily removed within a few minutes. There was considerable granulation tissue proliferation and inflammatory reaction in the airways of the dogs that were killed just after stent removal. The pathologic changes of the airways returned to almost-normal conditions 2 weeks after stent removal. CONCLUSION Placement and removal of a covered retrievable tracheobronchial hinged stent seems to be feasible, and histopathologic changes of the airway related to the stents returned to normal 2 weeks after stent removal.
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Affiliation(s)
- J C Hwang
- Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
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Abstract
Endoscopic treatment of endobronchial obstructions is becoming increasingly important. Tracheobronchial stents often are needed in the treatment of obstructions from submucosal or extrabronchial lesions. Tube stents have been available since the early 1960s but are underused because their insertion requires the use of a rigid bronchoscope. With the recent development of metallic stents, interventional radiologists increasingly are involved in the treatment of tracheobronchial obstructions. Metallic stents, easily placed with flexible bronchoscopy, are growing in popularity. All available tracheobronchial stents have been shown in various clinical series to be able to achieve immediate resolution of respiratory symptoms from various tracheobronchial obstructions. A stent's performance, however, should not be based solely on short-term response. Presently, there is no ideal stent because none is free of complications and none are able to consistently maintain life-long patency. Gianturco stents are associated with serious major complications (bronchial perforations and strut fractures) and are no longer recommended for use in the tracheobronchial tree. The Palmaz stent has also fallen into disfavor, because a strong external force, such as a vigorous cough, can recompress it. The Strecker stent can only be used in smaller airways, but may be useful in the accurate stenting of short segment stenoses because it does not foreshorten on deployment. The Wallstent and Ultraflex are our present metallic stents of choice. Both are easy to deploy, available in covered forms, exert adequate radial force, remain relatively stable in position, and have good longitudinal flexibility for use in tortuous airways. Disadvantages include excessive granulation tissue formation and difficulty of removal once the stent has been epithelialized. Metallic stents should be chosen very carefully for use in benign lesions with ongoing active local inflammation or when temporary stenting is needed. In the absence of an ideal stent, technologic advancements will continue. Potential developments include removable metallic stents, biodegradable stents, and chemically and radioactively coated stents. Unquestionably, the expanding stent market will drive scientific research toward the development of the ideal stent. Clearly, physicians need to be ready to assess these technologic advancements.
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Affiliation(s)
- A L Rafanan
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Ohio 44195, USA
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Song HY, Shim TS, Kang SG, Jung GS, Lee DY, Kim TH, Park S, Ahn YM, Kim WS. Tracheobronchial strictures: treatment with a polyurethane-covered retrievable expandable nitinol stent--initial experience. Radiology 1999; 213:905-12. [PMID: 10580974 DOI: 10.1148/radiology.213.3.r99dc02905] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A polyurethane-covered retrievable expandable stent was placed in 13 patients with tracheobronchial strictures. In four patients with benign strictures, the stent was removed with use of a retrieval hook 2-6 months after placement. After stent removal, three of the four patients did not need further treatment. The retrievable stent warrants further investigation in the treatment of tracheobronchial strictures.
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Affiliation(s)
- H Y Song
- Dept of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea.
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Link J, Steffens JC, Brossmann J, Graessner J, Hackethal S, Heller M. Iliofemoral arterial occlusive disease: contrast-enhanced MR angiography for preinterventional evaluation and follow-up after stent placement. Radiology 1999; 212:371-7. [PMID: 10429692 DOI: 10.1148/radiology.212.2.r99au24371] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the efficacy of contrast material-enhanced magnetic resonance (MR) angiography for the diagnosis of peripheral arterial occlusion and follow-up after stent placement. MATERIALS AND METHODS Sixty-seven patients (21 women, 46 men; mean age, 64.6 years) were examined. Digital subtraction angiography and contrast-enhanced MR angiography were performed in 28 patients for preinterventional evaluation of iliofemoral arterial occlusion and in 39 patients for follow-up after stent placement in the iliac or femoral arteries, which had been performed several months before. RESULTS All 24 occlusions were correctly diagnosed with contrast-enhanced MR angiography. Of the 59 stenoses, 36 were greater than 50% and 23 were 50% or less. Sensitivity and specificity for the detection of stenoses greater than 50% were 100% and 83%, respectively. Patency of the different stents was determined correctly with contrast-enhanced MR angiography. Some stents caused signal intensity dropout, which made MR evaluation of stents difficult. Generally, these signal intensity artifacts were most severe in stainless steel stents and mild in some nitinol stents. CONCLUSION Contrast-enhanced MR angiography is comparable to digital subtraction angiography for the detection of stenosis greater than 50% and occlusion in the iliofemoral arteries. Stent patency can be determined, but contrast-enhanced MR angiography is not suitable for stent evaluation owing to signal intensity dropout; however, it provides information about the vascular anatomic areas proximal and distal to the stent.
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Affiliation(s)
- J Link
- Department of Radiology, Christian-Albrechts-University of Kiel, Germany.
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Nakajima Y, Kurihara Y, Niimi H, Konno S, Ishikawa T, Osada H, Kojima H. Efficacy and complications of the Gianturco-Z tracheobronchial stent for malignant airway stenosis. Cardiovasc Intervent Radiol 1999; 22:287-92. [PMID: 10415217 DOI: 10.1007/s002709900390] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe our experience using the Gianturco Z-stent (G-Z stent) for the management of malignant tracheobronchial stenosis, with special reference to complications. METHODS Thirty-six stents were used in 22 patients with 28 lesions. Thirteen patients were grade 5 according to the Hugh-Jones classification. The technical success rates, follow-up results, and complications were reviewed on the basis of the patients' charts and radiographs. RESULTS All stents were successfully placed in the ideal position without procedure-related complications. After the procedure, respiratory status improved in 95% (21/22) of patients, and performance status improved in 77% (17/22). Mean survival after stent placement was 15 weeks. Four patients suffered from increased thick secretions requiring multiple suctioning and aspiration by bronchoscopy. One of these patients died from asphyxiation 2 weeks after placement. Stent disruption and/or migration was observed in six patients. Of these six, four experienced life-threatening hemoptysis; all four had received aggressive anticancer treatment. CONCLUSION G-Z stents are useful for palliation of malignant tracheobronchial obstruction. However, complications of stent strut fracture and migration give cause for concern.
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Affiliation(s)
- Y Nakajima
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, 216-8511 Japan
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Miyayama S, Matsui O, Terayama N, Tatsu H, Yamamoto T, Takashima T. Covered gianturco stents for malignant biliary obstruction: preliminary clinical evaluation. J Vasc Interv Radiol 1997; 8:641-8. [PMID: 9232582 DOI: 10.1016/s1051-0443(97)70624-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of covered Gianturco stents in patients with malignant biliary obstruction. MATERIALS AND METHODS Three types of partially polyurethane-covered stents were implanted in 19 patients with malignant biliary obstruction located distal to the hilar confluence. A transhepatic approach was employed in all but one patient, in whom the stent was placed through a T-tube tract. RESULTS Stent placement was possible in all patients. In 15 patients, the implanted stents were expanded to a mean of 81% of their original diameter. In the remaining four patients, the stents expanded to less than 40% of the original diameter, and balloon dilation and additional bare stent placement were required. All patients except one, who had impairment of liver function due to multiple liver metastases, showed relief of jaundice after stent placement. At follow-up, which ranged from 5 to 57 weeks (mean, 24.7 weeks), one stent (5%) was occluded after 26 weeks due to tumor growth above the upper stent edge, and required secondary intervention. Complications in three patients included stent migration in one (5%) and cholangitis in two (11%). CONCLUSION Preliminary results suggest that placement of covered Gianturco stents is feasible, the complication rate is acceptable, and short-term patency appears promising.
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Affiliation(s)
- S Miyayama
- Department of Diagnostic Radiology, Fukuiken Saisekai Hospital, Japan
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