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Amundsen T, Sørhaug S, Leira HO, Tyvold SS, Langø T, Hammer T, Manstad-Hulaas F, Mattsson E. A new removable airway stent. Eur Clin Respir J 2016; 3:30010. [PMID: 27608269 PMCID: PMC5015637 DOI: 10.3402/ecrj.v3.30010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use.
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Affiliation(s)
- Tore Amundsen
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway.,Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway;
| | - Sveinung Sørhaug
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway.,Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - Håkon Olav Leira
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway.,Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | | | - Thomas Langø
- Department of Medical Technology, SINTEF, Trondheim, Norway.,Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St Olavs Hospital, Trondheim, Norway
| | - Tommy Hammer
- Department of Radiology, St, Olavs Hospital, Trondheim, Norway
| | - Frode Manstad-Hulaas
- Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.,Department of Radiology, St, Olavs Hospital, Trondheim, Norway
| | - Erney Mattsson
- Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.,Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
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Tofts RPH, Lee PM, Sung AW. Interventional pulmonology approaches in the diagnosis and treatment of early stage non small cell lung cancer. Transl Lung Cancer Res 2015; 2:316-31. [PMID: 25806251 DOI: 10.3978/j.issn.2218-6751.2013.10.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
Abstract
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
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Affiliation(s)
- Ryu Peter Hambrook Tofts
- Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY 10003, USA
| | - Peter Mj Lee
- Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY 10003, USA
| | - Arthur Wai Sung
- Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY 10003, USA
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Mitchell PD, Kennedy MP. Bronchoscopic management of malignant airway obstruction. Adv Ther 2014; 31:512-38. [PMID: 24849167 DOI: 10.1007/s12325-014-0122-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Indexed: 12/17/2022]
Abstract
Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through meta stases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.
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Affiliation(s)
- Patrick D Mitchell
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland
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Khan AY, Berkowitz D, Krimsky WS, Hogarth DK, Parks C, Bechara R. Safety of pacemakers and defibrillators in electromagnetic navigation bronchoscopy. Chest 2013; 143:75-81. [PMID: 22922452 DOI: 10.1378/chest.12-0689] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Electromagnetic Navigation Bronchoscopy (ENB) (InReach iLogic system; superDimension Inc) is a relatively new discipline, with promising diagnostic and therapeutic applications in patients with lung lesions. Navigation is performed in a magnetic field and, therefore, has been considered relatively contraindicated in patients with pacemakers and automated implantable cardioverter-defibrillators (AICDs). Potential risks include altering the function and shutting off the device, device damage, lead displacement, and potential overheating. Over the past decade, there has been extensive literature about the safety of pacemakers in either the 1.5-T or 3-T magnetic fields used in current MRI scanners. Although the magnetic field used in ENB is significantly weaker, 0.0001 T or approximately equal to the earth's gravity, its safety in patients with pacemakers is yet to be elucidated. We present our initial experience with ENB in patients with cardiac implanted electrical devices. METHODS Twenty-four procedures in 24 patients with lung lesions and permanent pacemakers were performed. A cardiac electrophysiologist and programmer were present during the procedure. At baseline, the pacers were interrogated, and ECG was recorded. Continuous cardiac monitoring was performed during the procedure, and at the end, the pacer settings and function were reinterrogated to check for any changes. RESULTS The procedures were all successfully concluded. None of the patients suffered any arrhythmias or disruption to their pacemakers' function. CONCLUSION ENB appears to be safe when performed in patients with pacemakers and AICDs. Larger multicenter studies are needed to prove the final safety in this patient population.
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Affiliation(s)
- Ahmed Y Khan
- Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA
| | - David Berkowitz
- Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA
| | - William S Krimsky
- Interventional Pulmonology Program, Medstar Franklin Square Medical Center, Baltimore, MD
| | - D Kyle Hogarth
- Department of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Christopher Parks
- Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA
| | - Rabih Bechara
- Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA; Interventional Pulmonary Program, Cancer Treatment Centers of America at Southeastern Regional Medical Center, Atlanta, GA.
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