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Johnson CM, Luke AS, Jacobsen C, Novak N, Dion GR. State of the Science in Tracheal Stents: A Scoping Review. Laryngoscope 2021; 132:2111-2123. [PMID: 34652817 DOI: 10.1002/lary.29904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Recent material science advancements are driving tracheal stent innovation. We sought to assess the state of the science regarding materials and preclinical/clinical outcomes for tracheal stents in adults with benign tracheal disease. METHODS A comprehensive literature search in April 2021 identified 556 articles related to tracheal stents. One-hundred and twenty-eight full-text articles were reviewed and 58 were included in the final analysis. Datapoints examined were stent materials, clinical applications and outcomes, and preclinical findings, including emerging technologies. RESULTS In the 58 included studies, stent materials were metals (n = 28), polymers (n = 19), coated stents (n = 19), and drug-eluting (n = 5). Metals included nitinol, steel, magnesium alloys, and elgiloy. Studies utilized 10 different polymers, the most popular included polydioxanone, poly-l-lactic acid, poly(d,l-lactide-co-glycolide), and polycaprolactone. Coated stents employed a metal or polymer framework and were coated with polyurethane, silicone, polytetrafluoroethylene, or polyester, with some polymer coatings designed specifically for drug elution. Drug-eluting stents utilized mitomycin C, arsenic trioxide, paclitaxel, rapamycin, and doxycycline. Of the 58 studies, 18 were human and 40 were animal studies (leporine = 21, canine = 9, swine = 4, rat = 3, ovine/feline/murine = 1). Noted complications included granulation tissue and/or stenosis, stent migration, death, infection, and fragmentation. CONCLUSION An increasing diversity of materials and coatings are employed for tracheal stents, growing more pronounced over the past decade. Though most studies are still preclinical, awareness of tracheal stent developments is important in contextualizing novel stent concepts and clinical trials. Laryngoscope, 2021.
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Affiliation(s)
- Christopher M Johnson
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center-San Diego, San Diego, California, U.S.A
| | - Alex S Luke
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A
| | | | - Nicholas Novak
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, U.S.A
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A.,Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A
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Debiane L, Reitzel R, Rosenblatt J, Gagea M, Chavez MA, Adachi R, Grosu HB, Sheshadri A, Hill LR, Raad I, Ost DE. A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent. Respiration 2019; 98:60-69. [PMID: 30799409 DOI: 10.1159/000496152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. OBJECTIVE To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. METHODS We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. RESULTS Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110% increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118%; p < 0.0001), epithelium (70%; p < 0.0001), submucosal glands (47%; p = 0.001), and smooth muscle (41%; p < 0.0001) increased in volume. CONCLUSION Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.
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Affiliation(s)
- Labib Debiane
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruth Reitzel
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mihai Gagea
- Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Miguel A Chavez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Roberto Adachi
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lori R Hill
- Veterinary Medicine and Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA,
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Bi Y, Ren J, Chen H, Bai L, Han X, Wu G. Combined airway and esophageal stents implantation for malignant tracheobronchial and esophageal disease: A STROBE-compliant article. Medicine (Baltimore) 2019; 98:e14169. [PMID: 30653162 PMCID: PMC6370007 DOI: 10.1097/md.0000000000014169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We aimed to evaluate the safety and efficacy of combined airway and esophageal stents under fluoroscopy guidance and local anesthesia for patients with malignant tracheobronchial and esophageal disease. This retrospective analysis included 35 consecutive patients underwent combined stenting from March 2012 to August 2016. All patients underwent chest computed tomography scans before stenting and during follow-up. Thirty-nine airway stents and 43 esophageal covered stents were implanted. The indication of stenting, technical success and postinterventional complications were collected and analyzed. Thirty-nine airway stents and 43 esophageal covered stents were implanted. Stenting failed in 1 airway stent, and 2 esophageal stents, with technology success rates of 97.4% and 95.3%, respectively. No procedure-related death occurred, only 1 patient died from failure of respiration due to esophagotracheal fistula. The median interval between 2 stenting was 13.0 days. Both dyspnea and dysphasia were significantly relieved after stenting. Restenosis after stenting (7.7%) was the most common complication for airway stenting, all these cases required second stenting. Stent migration (7.0%) was the most common complication after esophageal stenting, 1 case had to receive airway stenting and 1 case received replacement of esophageal stent. During follow up, 23 patients were clinically cured, 2 patients were improved in symptoms, and 1 was invalid. Eight deaths were found in total. The 1-year, 3-year, and 5-year survival rates were 82.4%, 78.8%, and 78.8%, respectively. In conclusion, combined airway and esophageal stents implantation under fluoroscopy guidance and local anesthesia are safe and effective for malignant tracheobronchial and esophageal disease.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liangliang Bai
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
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Serrano C, Lostalé F, Rodríguez-Panadero F, de Blas I, Laborda A, Gregorio MAD. Tracheal Self-Expandable Metallic Stents: A Comparative Study of Three Different Stents in a Rabbit Model. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Fu YF, Lv LL, Xu H, Wei N. Double Stent Insertion for Combined Malignant Airway and Esophageal Stenoses: Feasibility, Safety, and Long-Term Outcome. J Laparoendosc Adv Surg Tech A 2016; 26:11-6. [PMID: 26619229 DOI: 10.1089/lap.2015.0169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yu-Fei Fu
- 1 Department of Radiology, Xuzhou Central Hospital , Xuzhou, Jiangsu, China
| | - Lu-Lu Lv
- 1 Department of Radiology, Xuzhou Central Hospital , Xuzhou, Jiangsu, China
| | - Hao Xu
- 2 Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical College , Xuzhou, Jiangsu, China
| | - Ning Wei
- 2 Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical College , Xuzhou, Jiangsu, China
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Tinga S, Thieman Mankin KM, Peycke LE, Cohen ND. Comparison of Outcome After Use of Extra-Luminal Rings and Intra-Luminal Stents for Treatment of Tracheal Collapse in Dogs. Vet Surg 2015; 44:858-65. [DOI: 10.1111/vsu.12365] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | - Noah D. Cohen
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station Texas
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Serrano C, Lostalé F, Rodríguez-Panadero F, Blas ID, Laborda A, de Gregorio MA. Tracheal Self-Expandable Metallic Stents: A Comparative Study of Three Different Stents in a Rabbit Model. Arch Bronconeumol 2015; 52:123-30. [PMID: 26141782 DOI: 10.1016/j.arbres.2015.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/20/2015] [Accepted: 04/20/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS). MATERIAL AND METHODS Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multi-slice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated. RESULTS The DES group had the longest stenosis (20.51±14.08mm vs. 5.84±12.43 and 6.57±6.54mm in NiTi and ST, respectively, day 30; P<.05), and higher granuloma formation on CT (50% of cases). The NiTi group showed the lowest grade of stenosis (2.86±6.91% vs. 11.28±13.98 and 15.54±25.95% in DES and ST, respectively; P<.05). The AP study revealed that the ST group developed intense proliferative reactivity compared to the other groups. In the DES group, a destructive response was observed in 70% of the animals, while the NiTi was the least reactive stent. CT was more effective in detecting wall thickening (positive correlation of 68.9%; P<.001) than granuloma (not significant). CONCLUSIONS The ST group developed granulomas and significant stenosis. NiTi was the least reactive stent, while DES caused significant lesions that may be related to drug dosage. This type of DES stent is therefore not recommended for the treatment of tracheobronchial stenosis.
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Affiliation(s)
- Carolina Serrano
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Fernando Lostalé
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Francisco Rodríguez-Panadero
- Instituto de Biomedicina de Sevilla (IBIS), Hospital Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Ignacio de Blas
- Departamento de Patología Animal, Universidad de Zaragoza, Zaragoza, España
| | - Alicia Laborda
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Miguel Angel de Gregorio
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España; CIBER Bioingeniería, Biomateriales y Nanomedicina (BBN), Zaragoza, España.
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Luffy SA, Chou DT, Waterman J, Wearden PD, Kumta PN, Gilbert TW. Evaluation of magnesium-yttrium alloy as an extraluminal tracheal stent. J Biomed Mater Res A 2013; 102:611-20. [DOI: 10.1002/jbm.a.34731] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 01/28/2013] [Accepted: 03/04/2013] [Indexed: 01/21/2023]
Affiliation(s)
- Sarah A. Luffy
- Department of Surgery, McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Bioengineering, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Da-Tren Chou
- Department of Surgery, McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Bioengineering, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Jenora Waterman
- Department of Animal Sciences; North Carolina Agricultural and Technical State University; Greensboro North Carolina
| | - Peter D. Wearden
- Department of Surgery, McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Bioengineering, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Cardiothoracic Surgery; Children's Hospital of Pittsburgh of UPMC; Pittsburgh Pennsylvania
| | - Prashant N. Kumta
- Department of Surgery, McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Bioengineering, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Chemical and Petroleum Engineering, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Oral Biology, School of Dental Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Thomas W. Gilbert
- Department of Surgery, McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Bioengineering, Swanson School of Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
- Department of Cardiothoracic Surgery; Children's Hospital of Pittsburgh of UPMC; Pittsburgh Pennsylvania
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Brouwer KM, Hoogenkamp HR, Daamen WF, van Kuppevelt TH. Regenerative medicine for the respiratory system: distant future or tomorrow's treatment? Am J Respir Crit Care Med 2012; 187:468-75. [PMID: 23220914 DOI: 10.1164/rccm.201208-1558pp] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Regenerative medicine (RM) is a new field of biomedical science that focuses on the regeneration of tissues and organs and the restoration of organ function. Although regeneration of organ systems such as bone, cartilage, and heart has attracted intense scientific research over recent decades, RM research regarding the respiratory system, including the trachea, the lung proper, and the diaphragm, has lagged behind. However, the last 5 years have witnessed novel approaches and initial clinical applications of tissue-engineered constructs to restore organ structure and function. In this regard, this article briefly addresses the basics of RM and introduces the key elements necessary for tissue regeneration, including (stem) cells, biomaterials, and extracellular matrices. In addition, the current status of the (clinical) application of RM to the respiratory system is discussed, and bottlenecks and recent approaches are identified. For the trachea, several initial clinical studies have been reported and have used various combinations of cells and scaffolds. Although promising, the methods used in these studies require optimization and standardization. For the lung proper, only (stem) cell-based approaches have been probed clinically, but it is becoming apparent that combinations of cells and scaffolds are required to successfully restore the lung's architecture and function. In the case of the diaphragm, clinical applications have focused on the use of decellularized scaffolds, but novel scaffolds, with or without cells, are clearly needed for true regeneration of diaphragmatic tissue. We conclude that respiratory treatment with RM will not be realized tomorrow, but its future looks promising.
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Affiliation(s)
- Katrien M Brouwer
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Durant AM, Sura P, Rohrbach B, Bohling MW. Use of nitinol stents for end-stage tracheal collapse in dogs. Vet Surg 2012; 41:807-17. [PMID: 22957667 DOI: 10.1111/j.1532-950x.2012.01037.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report bronchoscopic placement of nitinol stents (Vet Stent-Trachea®) for improvement of end-stage clinical signs in dogs with tracheal collapse. STUDY DESIGN Case series. SAMPLE POPULATION Dogs (n = 18). METHODS Medical records (January 1, 2004-October 31, 2008) were searched for dogs with a diagnosis of tracheal collapse; 18 dogs met inclusion criteria. Tracheal diameter was compared before and after stent deployment. Stent dimensions were compared after stent deployment and at radiographic follow-up. RESULTS There was a significant difference in the minimum tracheal diameter when initial and post deployment tracheal diameters were compared (P = .003). Stent length was significantly shorter at follow-up when compared to post deployment measurements (P = .004). Owner assessment of outcome was available for all dogs with 11.1% mortality within 60 days. Complications were documented in 9 dogs. CONCLUSIONS Use of a nitinol stent (Vet Stent-Trachea®) in dogs with end-stage tracheal collapse is associated with a fair to good outcome despite significant temporal stent fore shortening after bronchoscopic placement.
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Affiliation(s)
- April M Durant
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN 37996, USA.
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Shin JH, Sung KB, Kim EY, Shin DH, Song HY. A Rat Tracheal Model to Investigate Stent-induced Tissue Hyperplasia: A Pilot Study. J Vasc Interv Radiol 2010; 21:1878-83. [DOI: 10.1016/j.jvir.2010.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 08/08/2010] [Accepted: 09/01/2010] [Indexed: 11/28/2022] Open
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Abstract
Airway obstruction in children is a rare, but difficult clinical problem, with no clear agreement on optimal therapeutic approach. Stenting of the airway has been used successfully in adults, and is an attractive alternative in children. Fundamental differences of pediatric compared to adult use include the benign nature of most stenoses, the narrow and soft airways of children, the required long-term tolerance and adaptation to growth. These differences may significantly alter the therapeutic balance, calling into question the precise role stents play in the treatment of airway obstruction in children. Stent placement can be technically demanding but is not exceedingly difficult. Experience is necessary to select the proper size and type of stent. Metal stents usually achieve airway patency and clinical improvement in the majority of cases, while this is less frequently the case with silicone stents. Some complications such as granulation and secretion retention seem to occur in most children after stent implantation. Unfortunately, severe complications including death have been reported in a significant proportion of children. Stent related mortality can be estimated at 12.9% from published data, but these include complication centered reports. The initial euphoria for airway stents in children has largely abated and most authors agree that they should only be employed in circumstances with no good alternatives. It is crucial that all surgical and medical alternatives are considered and the decision to place a stent is not made because other options are overlooked or not available locally. Stent use in a palliative setting has also been reported and is probably reasonable. Stents will only allow limited adaptation for the growth of pediatric airways by balloon dilatation. All metal stents should be considered as potentially permanent, and removal sometimes may only be possible through a surgical and sometimes risky approach.
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Affiliation(s)
- T Nicolai
- Dr. v. Haunersches Kinderspital, University Childrens Hospital, Munich, Germany.
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Sura PA, Krahwinkel DJ. Self-expanding nitinol stents for the treatment of tracheal collapse in dogs: 12 cases (2001–2004). J Am Vet Med Assoc 2008; 232:228-36. [DOI: 10.2460/javma.232.2.228] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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