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Lilburn P, Williamson JP, Phillips M, Tillekeratne N, Ing A, Glanville A, Saghaie T. Tracheobronchial stents: an expanding prospect. Intern Med J 2024; 54:204-213. [PMID: 38140778 DOI: 10.1111/imj.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
The first dedicated tracheobronchial silicone stent was designed by the French pulmonologist Jean-Paul Dumon. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistulae. Silicone stents require rigid bronchoscopy for insertion; however, they are more readily repositioned and removed compared with metallic stents. Metallic stents demonstrate luminal narrowing when loads are applied to their ends, therefore stents should either be reinforced at the ends or exceed the area of stenosis by a minimum of 5 mm. Nitinol, a nickel-titanium metal alloy, is currently the preferred material used for airway stents. Airway stenting provides effective palliation for patients with severe symptomatic obstruction. Drug-eluting and three-dimensional printing of airway stents present promising solutions to the challenges of the physical and anatomical constraints of the tracheobronchial tree. Biodegradable stents could also be a solution for the treatment of nonmalignant airway obstruction.
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Affiliation(s)
- Paul Lilburn
- Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin Phillips
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Nikela Tillekeratne
- MQ Health, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Alvin Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Allan Glanville
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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2
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Fazal ZZ, Ibrahim MB, Saeed MI, Ayesha S, Majeed A. Spontaneous Endoscopic Esophageal Stent Fracture Post-endoscopic Placement: A Case Report. Cureus 2023; 15:e49406. [PMID: 38149152 PMCID: PMC10749889 DOI: 10.7759/cureus.49406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Endoscopic esophageal stent (EES) placement is an important tool for the non-operative management of esophageal pathologies. A rare and infrequently reported complication of EES placement is stent fracture and subsequent migration of the broken fragments. We report a rare case of a spontaneous EES fracture from Pakistan four weeks following its placement for esophageal perforation management, and an uneventful endoscopic retrieval of the fractured stent pieces. The recommended guidelines from available, albeit limited, research literature are also discussed as part of this case report.
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Affiliation(s)
| | | | | | - Syedda Ayesha
- Gastroenterology, Aga Khan University Hospital, Karachi, PAK
| | - Atif Majeed
- Gastroenterology, Aga Khan University Hospital, Karachi, PAK
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3
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Umar Z, Haseeb Ul Rasool M, Hosna AU, Parikh A, Ariyaratnam J, Sandhu JK, Ashfaq S, Ahmed N, Khan J, Trandafirescu T. Malignant Airway Obstruction and Endobronchial Stent Placement: A Systematic Review on the Efficacy and Safety. Cureus 2023; 15:e40912. [PMID: 37496555 PMCID: PMC10366558 DOI: 10.7759/cureus.40912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/28/2023] Open
Abstract
The systematic review aims to evaluate the efficacy and safety of endobronchial stent placement for malignant airway obstruction. A comprehensive search was conducted across multiple databases to identify relevant studies. Cohort studies, randomized controlled trials, and case-control studies examining the outcomes of endobronchial stent placement in patients with malignant airway obstruction were included. Data on pre-treatment evaluation, such as pulmonary function testing, dyspnea severity scoring systems, arterial blood gas parameters, imaging, and degree of obstruction, were also collected. Primary outcomes of interest included post-procedure stenosis, pulmonary function testing evaluation, blood gas parameters, and survival outcomes. Secondary outcomes encompassed improvements in clinical status, dyspnea grade, and procedure-related complications. A total of 27 studies met the inclusion criteria and were included in the systematic review. The included studies demonstrated promising outcomes of endobronchial stent placement in managing malignant airway obstruction. Post-procedure airway diameters, pulmonary function testing, and blood gas parameters improved significantly. Survival outcomes varied among studies. Furthermore, endobronchial stent placement was associated with improvements in clinical status and dyspnea grade. Procedure-related complications ranged from pain, hemoptysis and mucus plugging to stent obstruction, migration and pneumothorax. This systematic review suggests that endobronchial stent placement is an effective and safe intervention for managing malignant airway obstruction. It offers significant improvements in post-procedure stenosis, pulmonary function testing, blood gas parameters, and clinical outcomes. However, further studies with larger sample sizes and standardized reporting are warranted to better evaluate the long-term efficacy and safety of endobronchial stent placement for malignant airway obstruction.
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Affiliation(s)
- Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | | | - Asma U Hosna
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Avish Parikh
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | | | - Jasmine K Sandhu
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | | | - Nazaakat Ahmed
- Internal Medicine, Queens Hospital Center, New York, USA
| | - Jawad Khan
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Theo Trandafirescu
- Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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4
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Shaller BD, Filsoof D, Pineda JM, Gildea TR. Malignant Central Airway Obstruction: What's New? Semin Respir Crit Care Med 2022; 43:512-529. [PMID: 35654419 DOI: 10.1055/s-0042-1748187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
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Affiliation(s)
- Brian D Shaller
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Darius Filsoof
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge M Pineda
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
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5
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Galluccio G, Tramaglino LM, Marchese R, Bandelli GP, Vigliarolo R, Corbetta L. Competence in operative bronchoscopy. Panminerva Med 2019; 61:298-325. [DOI: 10.23736/s0031-0808.19.03602-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Avasarala SK, Freitag L, Mehta AC. Metallic Endobronchial Stents. Chest 2019; 155:1246-1259. [DOI: 10.1016/j.chest.2018.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023] Open
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Khara HS, Diehl DL, Gross SA. Esophageal stent fracture: Case report and review of the literature. World J Gastroenterol 2014; 20:2715-2720. [PMID: 24627608 PMCID: PMC3949281 DOI: 10.3748/wjg.v20.i10.2715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/13/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic esophageal stent placement is widely used in the treatment of a variety of benign and malignant esophageal conditions. Self expanding metal stents (SEMS) are associated with significantly reduced stent related mortality and morbidity compared to plastic stents for treatment of esophageal conditions; however they have known complications of stent migration, stent occlusion, tumor ingrowth, stricture formation, reflux, bleeding and perforation amongst others. A rare and infrequently reported complication of SEMS is stent fracture and subsequent migration of the broken pieces. There have only been a handful of published case reports describing this problem. In this report we describe a case of a spontaneously fractured nitinol esophageal SEMS, and review the available literature on the unusual occurrence of SEMS fracture placed for benign or malignant obstruction in the esophagus. SEMS fracture could be a potentially dangerous event and should be considered in a patient having recurrent dysphagia despite successful placement of an esophageal SEMS. It usually requires endoscopic therapy and may unfortunately require surgery for retrieval of a distally migrated fragment. Early recognition and prompt management may be able to prevent further problems.
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Furukawa K, Ishida J, Yamaguchi G, Usuda J, Tsutsui H, Saito M, Konaka C, Kato H. The role of airway stent placement in the management of tracheobronchial stenosis caused by inoperable advanced lung cancer. Surg Today 2010; 40:315-20. [PMID: 20339985 DOI: 10.1007/s00595-008-4058-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 04/28/2008] [Indexed: 12/17/2022]
Abstract
PURPOSE To our knowledge there is no in-depth report on the benefits of airway stenting, which focuses specifically on patients with inoperable advanced lung cancer causing severe central airway obstruction. We evaluated the role of airway stenting as one aspect of the multidisciplinary management of advanced lung cancer. METHODS We performed airway stenting in 40 lung cancer patients, placing a total of 58 stents. Stenting was done as a final modality in 22 patients with terminal-stage lung cancer (group A). The other 18 patients received additional therapy after stenting (group B), 12 (66.7%) of whom were treatment-naïve on admission. RESULTS The performance status (PS) and Hugh-Jones classification (H-J) scores improved in both groups after stenting: from 3.56 to 2.48 (P = 0.001) and 4.29 to 3.20 (P = 0.004) in group A, and from 3.15 to 1.25 (P < 0.001) and 4.10 to 2.10 (P < 0.001) in group B, respectively. The median survival time and 1-year survival rate after stenting were 1.6 months and 5.1%, respectively, in group A, and 5.6 months and 25.0%, respectively, in group B. CONCLUSIONS Airway stenting followed by adjuvant therapy may improve the survival of treatment-naïve patients with severe symptomatic airway obstruction caused by advanced lung cancer.
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Affiliation(s)
- Kinya Furukawa
- Department of Thoracic Surgery, Tokyo Medical University, Kasumigaura Hospital, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan
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9
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Williamson JP, Phillips MJ, Hillman DR, Eastwood PR. Managing obstruction of the central airways. Intern Med J 2009; 40:399-410. [PMID: 19849741 DOI: 10.1111/j.1445-5994.2009.02113.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20-30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post-obstructive pneumonia and ultimately death. Non-malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre-procedure work-up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.
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Affiliation(s)
- J P Williamson
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Western Australia 6009, Australia.
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10
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Lee KE, Shin JH, Song HY, Kim SB, Kim KR, Kim JH. Management of airway involvement of oesophageal cancer using covered retrievable nitinol stents. Clin Radiol 2008; 64:133-41. [PMID: 19103342 DOI: 10.1016/j.crad.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 07/18/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
Abstract
AIM To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement. MATERIALS AND METHODS Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated. RESULTS A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p<0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n=4), haemoptysis (n=2), sputum retention (n=7), and tumour overgrowth (n=1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2-197 days). CONCLUSION Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.
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Affiliation(s)
- K E Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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12
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Walser EM. Stent placement for tracheobronchial disease. Eur J Radiol 2005; 55:321-30. [PMID: 15913937 DOI: 10.1016/j.ejrad.2005.03.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 12/17/2022]
Abstract
Early treatment for airway stenoses or occlusions involved open repair with the attendant risks of thoracotomy or sternotomy. With the advent of rigid and, more recently, flexible bronchoscopy, the placement of airway stents has come to the forefront in the treatment of benign and malignant tracheobronchial disease. This paper describes the history of surgical and endoluminal treatment of airway disease and discusses the indications and contraindications for airway stent placement. The advantages and limitations of such therapy are reviewed as well as the procedural details and the imaging evaluation and follow-up of patients undergoing endoluminal treatment. Although the placement of tracheobronchial stents is now primarily performed by interventional pulmonologists, imaging anatomically complex airway disease also requires the skills of an accomplished cross-sectional radiologist. Additionally, interventional radiologists using fluoroscopic guidance and alternative access routes to the airways can salvage failed bronchoscopic procedures and primarily treat selected cases. Due to the importance of pre- and post-procedural imaging in these patients, radiologists should be aware of airway anatomy suitable for stent placement and the appearance of various complications of this procedure.
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Affiliation(s)
- Eric M Walser
- Department of Radiology, Rt 0709, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709, USA.
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Raza SA, Walser E, Hernandez A, Ozkan O. Percutaneous Transtracheal Approach for Endobronchial Stenting. AJR Am J Roentgenol 2005; 184:225-6. [PMID: 15615979 DOI: 10.2214/ajr.184.1.01840225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Syed A Raza
- Department of Radiology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709, USA.
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14
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Walser EM, Robinson B, Raza SA, Ozkan OS, Ustuner E, Zwischenberger J. Clinical outcomes with airway stents for proximal versus distal malignant tracheobronchial obstructions. J Vasc Interv Radiol 2004; 15:471-7. [PMID: 15126657 DOI: 10.1097/01.rvi.0000124944.58200.d9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study evaluates the outcome of tracheobronchial stent placement in symptomatic patients with malignant disease. MATERIALS AND METHODS From 1993 to 2002, 30 patients had stents placed for malignant strictures. Five of 30 patients underwent stent placement distal to the mainstem bronchi, 13 received stents in both the proximal and distal airways, and 12 received stents in only the proximal airways. Clinical response and survival were determined from the patients' medical records. A positive clinical response was judged to have occurred if the patient improved in two of these three categories: subjective symptoms (patient-reported), objective signs (clinician-reported), and postprocedural imaging. RESULTS The condition of 29 of 30 patients improved within 4 weeks of stent placement. The mean survival duration after stent placement was 261 days (SD, 395.1 days). The location of stent placement was not associated with significant differences in clinical improvement or survival (P =.51). Eight patients had additional airway segments that were too diffusely involved in which to place a stent or could not be recanalized. Mean survival in this group with incomplete stent placement was significantly reduced at 24.9 days (SD, 23.1 days), compared with 345.5 days (SD, 436 days) for the remaining patients who underwent complete stent placement (P <.05). Four patients lived less than 10 days after the procedure and three patients (75%) had mediastinal invasion. CONCLUSION Tracheobronchial stent placement effectively palliates malignant airway obstruction, and clinical improvement is independent of the location in which the stent is implanted. When patients had diffuse or highly obstructive airway involvement and underwent incomplete stent placement, clinical response was also satisfactory, even though survival was worse. Patients with mediastinal invasion were poor candidates for stent placement as a result of their short survival.
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Affiliation(s)
- Eric M Walser
- Department of Radiology, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0709, USA.
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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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Stockton PA, Ledson MJ, Hind CRK, Walshaw MJ. Bronchoscopic insertion of Gianturco stents for the palliation of malignant lung disease: 10 year experience. Lung Cancer 2003; 42:113-7. [PMID: 14512195 DOI: 10.1016/s0169-5002(03)00247-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Malignant large airway obstruction is life threatening and may not be amenable to urgent radiotherapy. Palliative airway stenting is difficult and traditionally carried out under general anaesthesia and fluoroscopy. We have shown that self expanding Gianturco metal stents can be placed under local anaesthesia using fibreoptic bronchoscopy and direct vision for the treatment of malignant airway tumours, and report our 10 year experience. All referrals for stenting referred to our unit between 1990 and 1999 were included, looking for histological type, number and site of stents, complications of the procedure, other interventions, and survival. One hundred and sixty two patients (average age 64 years, (range 21-89)) had 307 stents inserted during 167 procedures (144 primary lung tumours, 18 secondary malignancy). There were no operative deaths, but three patients developed a pneumothorax, one requiring intercostal drain insertion. Average survival following stent insertion was less for primary lung cancer than for secondary disease (103 vs. 431 days, P<0.001). There were no excess complications in a subgroup of 64 patients treated locally by oncologists, even when stenting was the primary procedure. This technique is useful in palliating life threatening airway obstruction, particularly for secondary cancer, and can be used in any centre undertaking fibreoptic bronchoscopy.
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Affiliation(s)
- P A Stockton
- The Liverpool Lung Cancer Unit, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK
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Gotway MB, Golden JA, LaBerge JM, Webb WR, Reddy GP, Wilson MW, Kerlan RK, Gordon RL. Benign tracheobronchial stenoses: changes in short-term and long-term pulmonary function testing after expandable metallic stent placement. J Comput Assist Tomogr 2002; 26:564-72. [PMID: 12218821 DOI: 10.1097/00004728-200207000-00016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the short- and long-term improvement in airflow dynamics in patients undergoing tracheobronchial stent placement for benign airway stenoses. METHODS Twenty-two patients underwent 34 tracheal and/or bronchial stent placement procedures for benign airway stenoses and had the results of pulmonary function tests available. Stent placement indications included bronchomalacia after lung transplantation (n = 11), postintubation stenoses (n = 6), relapsing polychondritis (n = 2), and 1 each of tracheomalacia, tracheal compression, and histoplasmosis. Six patients underwent more than one stent placement procedure (range: 2-7 procedures). The mean forced expiratory volume in one second (FEV(1) ), forced expiratory flow rate in the midportion of the forced vital capacity curve (FEF(25-75) ), forced vital capacity, and peak flow (PF) rate obtained before stent placement were compared with those immediately after stent placement and with those measurements most remote from stent placement using the paired two-tailed test. RESULTS All patients reported improved respiratory function immediately after stent placement. The mean FEV(1), FEF(25-75), and PF rate improved significantly (p < 0.001, p = 0.002, and p = 0.009, respectively) after stent placement. On long-term follow-up averaging 15 months after stent placement, these parameters declined despite patients' subjective sense of improvement. Segregating the population into transplant and nontransplant airway stenosis etiologies, however, FEF(25-75) and PF rate remained significantly improved (p = 0.045, p = 0.027, respectively), over the long term for the latter. FEV increased after subsequent stent placements for patients receiving multiple stents. CONCLUSION Stent placement for benign tracheobronchial stenoses provides significant immediate improvement in airflow dynamics. Long-term improvement in airflow obstruction may be expected, and additional stent placements may further improve pulmonary function.
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Affiliation(s)
- Michael B Gotway
- Department of Radiology and Pulmonary and Critical Care Medicine, University of California, San Francisco, CA 94110, USA. michael.gotway@radiology, ucsf.edu
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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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Xu X, Tajima H, Ishioh M, Watari J, Miyashita T, Kumazaki T, Ogawa R. Study on the treatment of tracheobronchial stenosis using expandable metallic stents. J NIPPON MED SCH 2001; 68:318-27. [PMID: 11505279 DOI: 10.1272/jnms.68.318] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this study is to clarify the clinical usefulness of Gianturco-Z stent (G-Z stent) for the management of malignant and benign tracheobronchial stenosis. Seventy-three stents were used in 30 patients. In 20 cases, we used the so-called "stent-in-stent" method. Twenty-four patients were grade 5, and 6 were grade 4 according to the Hugh-Jones classification of respiratory status. The technical success rates, clinical condition, respiratory status, blood gas analysis, survival rate, and complications were reviewed on the basis of the patients'medical records and radiographs. All stents were successfully placed in the appropriate position. After the procedure, respiratory status improved in 97% (29/30) of the patients. PaO(2) increased statistically (p<0.05), and PaCO(2) decreased one week after the treatment. Mean survival of 30 patients after stent placement was 123 days. Mean survival in 9 malignant patients treated in combination with radiotherapy (182 days) was statistically longer (p<0.01) than in those treated without radiotherapy (65 days, n=20). The tracheobronchial burn patient who received a combination of stent placement and post operative radiotherapy survived 540 days. No major complications were encountered during or after the procedure. Only 3 minor complications were observed: 1 stent migration, 1 partial rupture of the stent, and 1 stent deformation. G-Z stent treatment with the "stent-in-stent" technique is useful for palliation of malignant and benign tracheobronchial stenosis, and should contribute to improving the quality of life in patients with advanced cancer.
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Affiliation(s)
- X Xu
- Department of Radiology and Center for Advanced Medical Technology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
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21
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Abstract
Interventional Radiology is a technique based medical specialty, using all available imaging modalities (fluoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes. Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides fine needle aspiration. Any pleural, pulmonary or mediastinal fluid or gas collection is amenable to percutaneous pulmonary catheter drainage. Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands. Computed tomography is helpful in pre- and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.
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Affiliation(s)
- B Ghaye
- Dept of Medical Imaging, University Hospital Sart Tilman, Liège, Belgium
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22
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Casiano RR, Numa WA, Nurko YJ. Efficacy of transoral intraluminal Wallstents for tracheal stenosis or tracheomalacia. Laryngoscope 2000; 110:1607-12. [PMID: 11037811 DOI: 10.1097/00005537-200010000-00005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The efficacy and safety of intraluminal Wallstent Endoprosthesis (Boston Scientific/ Medi-Tech, Quincy, MA) placement to restore airway patency in patients with tracheal stenosis or tracheomalacia are unknown. STUDY DESIGN Retrospective review in setting of tertiary, referral, and academic center. METHODS A retrospective review of 13 consecutive patients over a 2-year period who underwent transoral resection of tracheal stenosis and immediate transoral Wallstent placement. One patient had tracheomalacia. All of the patients were considered at high risk for transcervical surgery or had failed prior traditional open procedures. RESULTS The average patient age was 54.2 years, with nine male and four female patients. All had Cotton/Myer stenoses (grades II to IV) with moderate to severe degrees of inspiratory stridor. Four patients were tracheotomy dependent. The length of stenosis varied from 1 to 4 cm. One patient had a 10-cm segment of tracheomalacia. At the time of writing, none of the patients has had a problem with significant migration or extrusion and most of the patients have incorporated the stent well without any short-term obstructive granulation tissue. After a mean follow-up of 15 months (range, 4-24 mo). 10 of the 12 patients with stenosis (83%) have remained free of any inspiratory noise during breathing. The one patient with tracheomalacia also has remained free of symptoms. CONCLUSIONS Transoral Wallstents appear to be safe and may be a reasonable alternative in the restoration of airway patency in select patients with tracheal stenosis or tracheomalacia.
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Affiliation(s)
- R R Casiano
- Department of Otolaryngology, University of Miami School of Medicine, Florida, USA
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Sanderson E, Desai SR. Non‐vascular thoracic intervention. IMAGING 2000. [DOI: 10.1259/img.12.3.120178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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