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McCarty EB, Bertoni D, Patel T, Jaramillo C, Tobey ABJ, Kumta PN, Chi D, Mady LJ. Degrees of Inflammation in the Treatment of Subglottic Stenosis in a Rabbit Model: Histopathological Assessment of a Novel Bioabsorbable Ultra-high Ductility Magnesium Alloy Stent. Int J Pediatr Otorhinolaryngol 2024; 181:111994. [PMID: 38823367 DOI: 10.1016/j.ijporl.2024.111994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/05/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Utilizing a novel histopathological scoring system and subglottic stenosis (SGS) rabbit model, we aimed to compare degrees of inflammation and severity of narrowing in the subglottis between two minimally invasive therapeutic modalities: endoscopic balloon dilation (EBD) alone versus EBD with placement of a bioabsorbable ultra-high ductility magnesium (UHD-Mg) alloy stent. METHODS SGS was induced endoscopically via microsuspension laryngoscopy in 23 New Zealand white rabbits. The control group (n = 11) underwent EBD alone, the study arm (n = 12) underwent EBD with implantation of bioabsorbable UHD-Mg alloy stents. Rabbits were euthanized at 2-, 3-, and 6-weeks after SGS induction, coinciding with wound healing stages. Using Optical Coherence Tomography (OCT), cross-sectional areas of airways were compared to calculate the mean percentage of intraluminal area at sequential time points. A novel histopathological scoring system was used to analyze frozen sections of laryngotracheal complexes. The degree of inflammation was quantified by scoring changes in inflammatory cell infiltration, epithelial ulceration/metaplasia, subepithelial edema/fibrosis, and capillary number/dilation. Univariate analysis was utilized to analyze these markers. RESULTS We found rabbits implanted with the bioabsorbable UHD-Mg alloy stent had statistically significantly higher scores in categories of hyperplastic change (stents vs controls: 1.48 vs 0.46 p < 0.001), squamous metaplasia (22 vs 5 p < 0.001), and neutrophils/fibrin in lumen (31 vs 8, p < 0.001). Rabbits who received EBD alone had higher scores of subepithelial edema and fibrosis (2.70 vs 3.49, p < 0.0256). The stented rabbits demonstrated significantly increased mean percent stenosis by intraluminal mean area compared to controls at 2 weeks (88.56 vs 58.98, p = 0.032), however at all other time points there was no significant difference between intraluminal subglottic stenosis by mean percent stenosis area. DISCUSSION Rabbits with SGS treated with UHD-Mg alloy stents demonstrated histopathologic findings suggestive of lower levels of tracheal fibrosis. This could indicate a reduced tendency towards the development of stenosis when compared to EBD alone. There was not a difference in luminal size between stent and non-stented rabbits at the six-week end point. Histologically, however, overall the use of bioabsorbable UHD-Mg alloy stenting elicited a greater tissue response at the level of the superficial mucosa rather than fibrosis of the lamina propria seen in the stented rabbits. This suggests more favorable healing and less of a tendency towards fibrosis and stenosis even though there may not be a benefit from a luminal size standpoint during this early healing period. Compared to known complications of currently available non-bioabsorbable metal or silicone-based stents, this proof-of-concept investigation highlights the potential use of a novel biodegradable UHD-Mg stent as a therapeutic modality for pediatric SGS.
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Affiliation(s)
- E Berryhill McCarty
- Department of Otolaryngology, University of Pittsburgh Medical Center, 203 Lothrop Street, Eye & Ear Institute, Suite 500, Pittsburgh, PA, 15213, USA.
| | - Dylan Bertoni
- Department of Otolaryngology - Head & Neck Surgery, Sidney Kimmel Medical College, 925 Chestnut Street, 6th Floor, Philadelphia, PA, 19107, USA.
| | - Terral Patel
- Department of Otolaryngology, University of Pittsburgh Medical Center, 203 Lothrop Street, Eye & Ear Institute, Suite 500, Pittsburgh, PA, 15213, USA.
| | - Couger Jaramillo
- Department of Pathology & Laboratory Services, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam, Houston, TX, 78234, USA.
| | - Allison B J Tobey
- Department of Otolaryngology, University of Pittsburgh Medical Center, 203 Lothrop Street, Eye & Ear Institute, Suite 500, Pittsburgh, PA, 15213, USA.
| | - Prashant N Kumta
- Department of Bioengineering, Swanson School of Engineering, 815C Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA; Department of Chemical and Petroleum Engineering, Swanson School of Engineering, 815C Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA; Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, 815C Benedum Hall, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA.
| | - David Chi
- Department of Otolaryngology, University of Pittsburgh Medical Center, 203 Lothrop Street, Eye & Ear Institute, Suite 500, Pittsburgh, PA, 15213, USA.
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh Medical Center, 203 Lothrop Street, Eye & Ear Institute, Suite 500, Pittsburgh, PA, 15213, USA.
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A New Removable Helical Metallic Stent for the Treatment of Tracheomalacia in Children: Study in Pathological Animal Model. J Clin Med 2022; 11:jcm11226757. [PMID: 36431234 PMCID: PMC9695607 DOI: 10.3390/jcm11226757] [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] [Received: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Congenital tracheomalacia is a pathology with no consensus of medical or surgical approach. The permanent nature and the major complications associated with metallic stents have limited their use over the years. The purpose of this study was to evaluate the feasibility of a helical stent design removal. METHODS Ten dogs diagnosed with tracheal collapse and treated with the helical stent were involved in the study. Animals were classified into three groups depending on stent indwelling time. Prior to the removal, endoscopic evaluation was performed to assess endothelization grade, mucous accumulation, and the presence of stenosis. During the removal, bleeding, fracture, or impossibility of removal were noted. After the removal, all macroscopic mucosal changes were recorded. RESULTS Technical success was 100%, without any complications. Complete epithelization of the stent was visualized in 7/10 animals. The removal procedure duration ranged from 2-12 min. At post-removal endoscopy, bleeding or epithelial damage, was visualized in any case. Stent fracture during removal occurred in one animal. CONCLUSIONS The removal of a metallic stent with spiral geometry is feasible, simple, and without complications, regardless of the degree of neo-epithelialization.
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Zou H, Zhang J, Zhan K, Mou XZ, Zhu B. A narrative review of new research progress regarding the use of airway stents in benign airway stenosis. Expert Rev Respir Med 2022; 16:651-659. [PMID: 35793263 DOI: 10.1080/17476348.2022.2099379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Benign airway stenosis is a severe disease that can result in death with improper treatment. Clinicians must know about airway stents to choose the best one in their daily practice. AREAS COVERED PubMed, Embase, and other electronic databases and websites were searched to identify relevant randomized controlled trials and meta-analyses. This review summarizes different types of airway stents and analyzes their advantages and disadvantages. EXPERT OPINION Increasing attention has been given to the indications and prognosis of benign airway stenosis treated with different airway stents. With more investigations and data, better alternatives to silicone stents could be developed in the future.
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Affiliation(s)
- Hai Zou
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Zhang
- Department of Pulmonary and Critical Care Medicine, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kan Zhan
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou, China
| | - Xiao-Zhou Mou
- Key Laboratory of Cancer Molecular Diagnosis and Individualized Therapy of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Biao Zhu
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Sindeeva OA, Prikhozhdenko ES, Schurov I, Sedykh N, Goriainov S, Karamyan A, Mordovina EA, Inozemtseva OA, Kudryavtseva V, Shchesnyak LE, Abramovich RA, Mikhajlov S, Sukhorukov GB. Patterned Drug-Eluting Coatings for Tracheal Stents Based on PLA, PLGA, and PCL for the Granulation Formation Reduction: In Vivo Studies. Pharmaceutics 2021; 13:pharmaceutics13091437. [PMID: 34575513 PMCID: PMC8469052 DOI: 10.3390/pharmaceutics13091437] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 01/25/2023] Open
Abstract
Expandable metallic stent placement is often the only way to treat airway obstructions. Such treatment with an uncoated stent causes granulation proliferation and subsequent restenosis, resulting in the procedure’s adverse complications. Systemic administration of steroids drugs in high dosages slows down granulation tissue overgrowth but leads to long-term side effects. Drug-eluting coatings have been used widely in cardiology for many years to suppress local granulation and reduce the organism’s systemic load. Still, so far, there are no available analogs for the trachea. Here, we demonstrate that PLA-, PCL- and PLGA-based films with arrays of microchambers to accommodate therapeutic substances can be used as a drug-eluting coating through securely fixing on the surface of an expandable nitinol stent. PCL and PLA were most resistant to mechanical damage associated with packing in delivery devices and making it possible to keep high-molecular-weight cargo. Low-molecular-weight methylprednisolone sodium succinate is poorly retained in PCL- and PLGA-based microchambers after immersion in deionized water (only 9.5% and 15.7% are left, respectively). In comparison, PLA-based microchambers retain 96.3% after the same procedure. In vivo studies on rabbits have shown that effective granulation tissue suppression is achieved when PLA and PLGA are used for coatings. PLGA-based microchamber coating almost completely degrades in 10 days in the trachea, while PLA-based microchamber films partially preserve their structure. The PCL-based film coating is most stable over time, which probably causes blocking the outflow of fluid from the tracheal mucosa and the aggravation of the inflammatory process against the background of low drug concentration. Combination and variability of polymers in the fabrication of films with microchambers to retain therapeutic compounds are suggested as a novel type of drug-eluting coating.
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Affiliation(s)
- Olga A. Sindeeva
- Skolkovo Innovation Center, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia
- Correspondence: (O.A.S.); (G.B.S.)
| | - Ekaterina S. Prikhozhdenko
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Igor Schurov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Nikolay Sedykh
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Sergey Goriainov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Arfenya Karamyan
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Ekaterina A. Mordovina
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Olga A. Inozemtseva
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Valeriya Kudryavtseva
- Nanoforce Ltd., School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
| | - Leonid E. Shchesnyak
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Rimma A. Abramovich
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Sergey Mikhajlov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Gleb B. Sukhorukov
- Nanoforce Ltd., School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
- Correspondence: (O.A.S.); (G.B.S.)
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Serrano-Casorran C, Lopez-Minguez S, Rodriguez-Zapater S, Bonastre C, Guirola JA, De Gregorio MA. A new airway spiral stent designed to maintain airway architecture with an atraumatic removal after full epithelization-Research of feasibility and viability in canine patients with tracheomalacia. Pediatr Pulmonol 2020; 55:1757-1764. [PMID: 32407602 DOI: 10.1002/ppul.24816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Surgical management of tracheomalacia is a challenge, with current treatments still presenting numerous complications. In the field of veterinary medicine, this same pathology is present in a significant number of dogs. For this reason, we present an experimental clinical trial performed on canines with tracheobronchomalacia, using a new atraumatic removable tracheal spiral stent (SS). Both implantation procedure and clinical improvement have been analyzed in this study. METHODS In this study, four small dogs, a mean weight of 4.89 kg and body condition scores IV-V, were included. SS was implanted by two different surgical approaches. Image and clinical follow-up have been performed during 90 days. Symptoms were evaluated from 1 to 10 every week. RESULTS This study achieved 100% technical and clinical success. Median tracheal diameters were as follows: cervical 10.85 (3.3), inlet 7.75 (2.1), and carina 7.75 (1.9) mm, and length was 77.5 (26) mm. A 12 × 10 × 100-mm SS was implanted in all cases. Goose honk cough punctuation improved from 8 to 1; also, there were important changes in exercise intolerance, a mean weight loss of 8.76%. The values of modified Karnofsky scale varied from 50 (20) before surgery to 90 (10) after 30 days of surgery. Neither granuloma tissue nor fractures of the prosthesis was observed. CONCLUSION The results in dogs are promising, and a new therapeutic alternative seems to be available for veterinarian field. The similarity of this disease between dogs and newborns suggests that this SS design can also be useful for human trials.
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Affiliation(s)
- Carolina Serrano-Casorran
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Sandra Lopez-Minguez
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Sergio Rodriguez-Zapater
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Cristina Bonastre
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Jose A Guirola
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Interventional Radiology Department, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Miguel A De Gregorio
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Interventional Radiology Department, Lozano Blesa University Hospital, Zaragoza, Spain
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6
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Lopez-Minguez S, Serrano-Casorran C, Guirola JA, Rodriguez-Zapater S, Bonastre C, De Gregorio MA. New tracheal stainless steel stent pilot study: twelve month follow-up in a rabbit model. PeerJ 2019; 7:e7797. [PMID: 31608174 PMCID: PMC6788445 DOI: 10.7717/peerj.7797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background Canine tracheal collapse is a complex airway pathology without promising treatment results. Currently nitinol stents are the best surgical option; however, some professionals are doubting if stent placement is the best option due to the associated complications. Objective Determine the technical feasibility, safety, and long-term follow-up after the implantation of a new tracheal stent designed for canine tracheal collapse. Methods Thirteen healthy, adult female New Zealander rabbits were involved in this pilot study.A new intra-tracheal device (Reference number 902711 patent registered as CasMin-Twine) was implanted in ten animals. Deployment was performed under general anesthesia, making a puncture incision via a 21 Gauge needle in the intra-tracheal space where the stent was introduced with a screwing process. The device was fixed to the tracheal wall with a non-absorbable suture. Computerized Tomography (CT) and an endoscopy to study structural abnormalities were performed after 30, 90 and 365 days after stent placement. Results Technical and clinical success was 100%. There was no significant change in behavior or respiratory disorders. CT studies showed no significant alterations. After the 30 days, 60% of the animals showed partial endothelization in the endoscopy study, and only one animal still presented partial endothelization after 12 months. Mucus accumulation was only present in 40% of cases and classified as low, without respiratory consequences. Only one animal presented a single granuloma at caudal stent tip. Conclusions This new tracheal stent (CasMin-Twine) is an effective and safe procedure with promising results, and also shows the possibility of removing the device after endothelization has been produced. New studies should be carried out to evaluate the effectiveness in patients with tracheomalacia. Clinical Significance/Impact This new product can give veterinarians a new option of treatment for this complicated pathology. Minimizing specific equipment for its deployment, CasMin-Twine will be more accessible for all professionals.
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Affiliation(s)
- Sandra Lopez-Minguez
- University of Zaragoza, GITMI Minimally Invasive Techniques Research Group, Zaragoza, Spain
| | - Carolina Serrano-Casorran
- University of Zaragoza, GITMI Minimally Invasive Techniques Research Group, Zaragoza, Spain.,Animal Pathology, University of Zaragoza, Zaragoza, Spain
| | - Jose A Guirola
- University of Zaragoza, GITMI Minimally Invasive Techniques Research Group, Zaragoza, Spain.,Pediatrics, Radiology and Phisical medicine, University of Zaragoza, Zaragoza, España.,Interventional Radiology Service, Lozano Blesa University Hospital Zaragoza, Spain
| | | | - Cristina Bonastre
- University of Zaragoza, GITMI Minimally Invasive Techniques Research Group, Zaragoza, Spain.,Animal Pathology, University of Zaragoza, Zaragoza, Spain
| | - Miguel Angel De Gregorio
- University of Zaragoza, GITMI Minimally Invasive Techniques Research Group, Zaragoza, Spain.,Pediatrics, Radiology and Phisical medicine, University of Zaragoza, Zaragoza, España.,Interventional Radiology Service, Lozano Blesa University Hospital Zaragoza, Spain
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Abstract
Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.
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Affiliation(s)
- Minh Huynh
- Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
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Thiebes AL, McGrath DJ, Kelly N, Sweeney CA, Kurtenbach K, Gesché VN, Clauser J, O'Brien B, Bruzzi M, McHugh PE, Jockenhoevel S, Cornelissen CG. Comparison of Covered Laser-cut and Braided Respiratory Stents: From Bench to Pre-Clinical Testing. Ann Biomed Eng 2019; 47:1738-1747. [PMID: 31044340 DOI: 10.1007/s10439-019-02278-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Abstract
Lung cancer patients often suffer from severe airway stenosis, the symptoms of which can be relieved by the implantation of stents. Different respiratory stents are commercially available, but the impact of their mechanical performance on tissue responses is not well understood. Two novel laser-cut and hand-braided nitinol stents, partially covered with polycarbonate urethane, were bench tested and implanted in Rhön sheep for 6 weeks. Bench testing highlighted differences in mechanical behavior: the laser-cut stent showed little foreshortening when crimped to a target diameter of 7.5 mm, whereas the braided stent elongated by more than 50%. Testing also revealed that the laser-cut stent generally exerted higher radial resistive and chronic outward forces than the braided stent, but the latter produced significantly higher radial resistive forces at diameters below 9 mm. No migration was observed for either stent type in vivo. In terms of granulation, most stents exerted a low to medium tissue response with only minimal formation of granulation tissue. We have developed a mechanical and in vivo framework to compare the behavior of different stent designs in a large animal model, providing data, which may be employed to improve current stent designs and to achieve better treatment options for lung cancer patients.
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Affiliation(s)
- Anja Lena Thiebes
- Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany
| | - Donnacha J McGrath
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, University Road, Galway, Ireland
| | - Nicola Kelly
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, University Road, Galway, Ireland
| | - Caoimhe A Sweeney
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, University Road, Galway, Ireland
| | - Kathrin Kurtenbach
- Institute for Textile Engineering, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074, Aachen, Germany
| | - Valentine N Gesché
- Institute for Textile Engineering, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074, Aachen, Germany
| | - Johanna Clauser
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Barry O'Brien
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, University Road, Galway, Ireland
| | - Mark Bruzzi
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, University Road, Galway, Ireland
| | - Peter E McHugh
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, University Road, Galway, Ireland
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany.
| | - Christian G Cornelissen
- Department of Biohybrid & Medical Textiles (BioTex), AME - Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany.,Clinic for Pneumology and Internistic Intensive Medicine (Medical Clinic V), Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
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9
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Xue B, Liang B, Yuan G, Zhu L, Wang H, Lu Z, Xu Z. A pilot study of a novel biodegradable magnesium alloy airway stent in a rabbit model. Int J Pediatr Otorhinolaryngol 2019; 117:88-95. [PMID: 30579096 DOI: 10.1016/j.ijporl.2018.10.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To preliminarily investigate the feasibility of bioabsorption tracheal stenting for the therapeutic application of congenital tracheal stenosis (CTS). STUDY DESIGN Experimental research. SETTING Shanghai Children Medical Center, National Children's Medical Center. SUBJECTS AND METHODS Five kinds of magnesium alloys with different compositions were studied in this paper, a patented Mg-Nd-Zn-Zr alloy series namely JDBM (JiaoDa BioMg) and four Mg-Ca-Zn alloys. The cytotoxicity of alloys was evaluated by the MTS ([3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay in rabbit tracheal epithelial cells. Specific magnesium alloys had been immersed in the cell culture medium for 24 h. The tracheal stents that were made of magnesium alloy were implanted into the trachea of New Zealand rabbits and the ablation of the stent was monitored by fiber bronchoscopy. The routine blood examination was conducted prior to and following the stent placement. The rabbits were euthanized following 2-3 months of stenting. H&E staining of the main organs was conducted and the induction of apoptosis of the tracheal tissues was monitored. RESULTS The cytotoxicity of the JDBM magnesium alloy was mild and lower than the remaining 4 alloys. The stents were placed successfully in five animals. The tracheal stents were successfully placed and gradually biodegradated as monitored by fiber bronchoscopy; no significant systemic inflammatory response was noted. No significant differences in the liver and/or kidney function prior to and following stent placement were noted. H&E staining indicated the absence of pathological changes in the trachea, liver, heart and/or kidney tissues. The apoptotic assay indicated that the apoptosis ratio of the tracheal tissues was comparable between rabbits with and without tracheal stenting. CONCLUSION The results suggested the feasibility of bioabsorption stents made of biodegradable magnesium alloys using in patients with tracheal stenosis, especially in infants.
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Affiliation(s)
- Bangde Xue
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China; Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China
| | - Beibei Liang
- Shanghai University of Medicine and Health Sciences, Shanghai, China; Biology Research Center, University of Shanghai for Science and Technology, Shanghai, China
| | - Guangyin Yuan
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Limin Zhu
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China
| | - Hao Wang
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China
| | - Zhaohui Lu
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China.
| | - Zhiwei Xu
- Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Department of Cardiovascular Surgery, Shanghai, China.
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Xu J, Ong HX, Traini D, Byrom M, Williamson J, Young PM. The utility of 3D-printed airway stents to improve treatment strategies for central airway obstructions. Drug Dev Ind Pharm 2018; 45:1-10. [PMID: 30207189 DOI: 10.1080/03639045.2018.1522325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Airway stents are commonly used in the management of patients suffering from central airway obstruction (CAO). CAO may occur directly from airway strictures, obstructing airway cancers, airway fistulas or tracheobronchomalacia, resulting from the weakening and dynamic collapse of the airway wall. Current airway stents are constructed from biocompatible medical-grade silicone or from a nickel-titanium (nitinol) alloy with fixed geometry. The stents are inserted via the mouth during a bronchoscopic procedure. Existing stents have many shortcomings including the development of obstructing granulation tissue in the weeks and months following placement, mucous build up within the stent, and cough. Furthermore, airway stents are expensive and, if improperly sized for a given airway, may be easily dislodged (stent migration). Currently, in Australia, it is estimated that approximately 12,000 patients will develop CAO annually, many of whom will require airway stenting intervention. Of all stenting procedures, the rate of failure is currently reported to be at 22%. With a growing incidence of lung cancer prevalence globally, the need for updating airway stent technology is now greater than ever and personalizing stents using 3D-printing technology may offer the best chance of addressing many of the current limitations in stent design. This review article will assess what represents the gold standard in stent manufacture with regards to treatment of tracheobronchial CAO, the challenges of current airway stents, and outlines the necessity and challenges of incorporating 3D-printing technology into personalizing airway stents today.
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Affiliation(s)
- Jesse Xu
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Hui X Ong
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Daniela Traini
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
| | - Michael Byrom
- d RPA Institute of Academic Surgery , Sydney , NSW , Australia
| | - Jonathan Williamson
- e MO Respiratory and Sleep, Macquarie University Hospital and Clinic , Macquarie University , Sydney , NSW , Australia.,f Respiratory, Sleep and Environmental and Occupational Health (RSEOH) , The Ingham Institute of Applied Medical Research , Sydney , NSW , Australia
| | - Paul M Young
- a Centre for Lung Cancer Research , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,b Respiratory Technology Group , Woolcock Institute of Medical Research , Sydney , NSW , Australia.,c Discipline of Pharmacology, Faculty of Medicine and Health , University of Sydney , Sydney , NSW , Australia
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Yan Z, Liang Y, Fang Y, Yao X, Ma K, Huang F. [Biomechanical study of nickel-titanium three-dimensional memory alloy mesh and autologous bone in treatment of canine tibial plateau collapse fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:722-725. [PMID: 29905052 DOI: 10.7507/1002-1892.201709068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the biomechanical effect of a nickel-titanium (Ni-Ti) three-dimensional memory alloy mesh in treating a canine tibial plateau collapse fracture model and to lay a foundation for further experiments in vivo. Methods Sixteen tibial plateau specimens of 8 adult Beagle dogs were harvested. Twelve specimens were taken to prepare canine tibial plateau collapse fracture models (Schatzker type Ⅲ) and randomly divided into groups A, B, and C, with 4 specimens in each group. Four normal tibia specimens were used as blank control group (group D). In groups A and B, the bone defects were repaired with Ni-Ti three-dimensional shape memory alloy mesh combined with autologous bone and simple autologous bone respectively, and fixed with the lateral plate and screw. In group C, the bone defect was directly fixed with the lateral plate and screw. By using a biomechanical tester, a progressive load (0-1 700 N) was loaded vertically above the femoral condyle. The maximum failure load was recorded and the stiffness was calculated according to the load-displacement curve. Results The maximum failure loads in groups A, B, C, and D were (1 624.72±7.02), (1 506.57±3.37), (1 102.00±1.83), and (1 767.64±24.56) N, respectively; and the stiffnesses were (129.72±20.83), (96.54±27.05), (74.96±17.70), and (169.01±35.62) N/mm, respectively. The maximum failure load and stiffness in group A were significantly higher than those in groups B and C, but which were significantly lower than those in group D ( P<0.05). Conclusion Ni-Ti three-dimensional memory alloy mesh combined with autologous bone can repair the Schatzker type Ⅲ tibial plateau collapse fracture, which has better biomechanical properties than simple autologous bone grafting.
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Affiliation(s)
- Zhaokui Yan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | | | - Yue Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Xiangyu Yao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kunlong Ma
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Abstract
Stents and tubes to maintain the patency of the airways are commonly used for malignant obstruction and are occasionally employed in benign disease. Malignant airway obstruction usually results from direct involvement of bronchogenic carcinoma, or by extension of carcinomas occurring in the esophagus or the thyroid. External compression from lymph nodes or metastatic disease from other organs can also cause central airway obstruction. Most malignant airway lesions are surgically inoperable due to advanced disease stage and require multimodality palliation, including stent placement. As with any other medical device, stents have significantly evolved over the last 50 years and deserve an in-depth understanding of their true capabilities and complications. Not every silicone stent is created equal and the same holds for metallic stents. Herein, we present an overview of the topic as well as some of the more practical and controversial issues surrounding airway stents. We also try to dispel the myths surrounding stent removal and their supposed use only in central airways. At the end, we come to the long-held conclusion that stents should not be used as first line treatment of choice, but after ruling out the possibility of curative surgical resection or repair.
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Affiliation(s)
- Erik Folch
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen Keyes
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Arellano-Orden E, Serrano C, Montes-Worboys A, Sánchez-López V, Laborda A, Lostalé F, Lahuerta C, Rodríguez-Panadero F, de Gregorio MÁ. Stent-induced tracheal stenosis can be predicted by IL-8 expression in rabbits. Eur J Clin Invest 2017; 47:84-92. [PMID: 27873304 DOI: 10.1111/eci.12706] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/18/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bare metal stents may cause complications like fibrous encapsulation, granulation and tracheal stenosis. We investigated the behaviour of three commercially available stents in vivo (rabbits) and in vitro (coculture of those stents with epithelial and fibroblast cell lines). Also, we investigated whether development of tracheal stenosis could be predicted by any biological marker. MATERIALS AND METHODS The tracheae of 30 rabbits were implanted with either nitinol stents, with or without paclitaxel elution, or a cobalt-based stent. An additional ten rabbits underwent mock implantation (controls). Serial peripheral venous blood samples were taken throughout the study, and several cytokines measured. Animals were euthanized on day 90, with immediate tracheal endoscopy and lavage performed, then necropsy. RESULTS Rabbits with cobalt-based stent exhibited more inflammation and the highest stenosis incidence, with reduced survival. Both in vivo and in vitro, this stent induced higher IL-8 levels than nitinol stents. Most important, the presence of stent-induced tracheal stenosis was closely associated to increase in IL-8 expression in blood just 1 day after tracheal stent implantation: a 1·19-fold increase vs. baseline had 83% sensitivity, 83% specificity, 77% positive predictive value, 88% negative predictive value and 83% accuracy to predict development of stenosis. CONCLUSIONS The cobalt-based stent had the highest incidence of tracheal inflammation and stenosis. On the other hand, the paclitaxel-eluting nitinol stent did not prevent those complications and provoked a marked reaction compared with the bare nitinol stent. Early increase in IL-8 expression in blood after stent implantation could predict development of tracheal stenosis in rabbits.
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Affiliation(s)
- Elena Arellano-Orden
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Carolina Serrano
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain
| | - Ana Montes-Worboys
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Verónica Sánchez-López
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Alicia Laborda
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain
| | - Fernando Lostalé
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain
| | - Celia Lahuerta
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain
| | - Francisco Rodríguez-Panadero
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ángel de Gregorio
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Interventional Radiology, Hospital Clinico Universitario, University of Zaragoza, Zaragoza, Spain.,CIBER Bioengineering, Biomaterials and Nanomedicine (BBB), Instituto de Salud Carlos III, Madrid, Spain
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Varela G, Jiménez MF. En la estenosis traqueal benigna nunca deberían emplearse endoprótesis metálicas. Arch Bronconeumol 2016; 52:121-2. [DOI: 10.1016/j.arbres.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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