1
|
Pu CY, Ospina-Delgado D, Kheir F, Avendano CA, Parikh M, Beattie J, Swenson KE, Wilson J, Gangadharan SP, Majid A. Airway Stents for Excessive Central Airway Collapse: A Randomized Controlled Open-label Trial. J Bronchology Interv Pulmonol 2024; 31:e0980. [PMID: 39119872 DOI: 10.1097/lbr.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/26/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Short-term airway stent placement (stent evaluation) has been employed to evaluate whether patients with excessive central airway collapse (ECAC) will benefit from tracheobronchoplasty. Although retrospective studies have explored the impact of stent placement on ECAC, prospective randomized controlled trials are absent. METHODS This was a randomized open-label trial comparing patients receiving airway stent placement and standard medical treatment (intervention group) versus standard medical treatment alone (control group) for ECAC. At baseline, patients' respiratory symptoms, self-reported measures, and functional capabilities were assessed. Follow-up evaluations occurred 7 to 14 days postintervention, with an option for the control group to crossover to stent placement. Follow-up evaluations were repeated in the crossover patients. RESULTS The study enrolled 17 patients in the control group [medical management (MM)] and 14 patients in the intervention group. At follow-up, 15 patients in the MM crossed over to the stent group, resulting in a total of 29 patients in the combined stent group (CSG). Subjectively (shortness of breath and cough), 45% of the CSG exhibited improvement with the intervention compared with just 12% in the MM. The modified St. George Respiratory Questionnaire score in the CSG improved significantly from 61.2 at baseline to 52.5 after stent placement (-8.7, P = 0.04). With intervention, the 6-minute walk test in CSG improved significantly from 364 meters to 398 meters (34 m, P < 0.01). The MM did not show a significant change in the St. George Respiratory Questionnaire score or 6-minute walk test distance. CONCLUSION Short-term airway stent placement in patients with ECAC significantly improves respiratory symptoms, quality of life, and exercise capacity.
Collapse
Affiliation(s)
- Chan Yeu Pu
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
- Department of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Massachusetts General Hospital, Harvard Medical School
| | - Daniel Ospina-Delgado
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
- Department of Pulmonary and Critical Care Medicine, St. Elizabeth's Medical Center, Boston, MA
| | - Fayez Kheir
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Camilo A Avendano
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| | - Mihir Parikh
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| | - Jason Beattie
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| | - Kai E Swenson
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| | - Jennifer Wilson
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| | - Sidharta P Gangadharan
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| | - Adnan Majid
- Department of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center
| |
Collapse
|
2
|
Meyer S, d'Odémont JP, Putz L, Dincq AS, Rondelet B, Ocak S, Pirard L. Subcutaneous fixation model for complex stenting of recurrent laryngotracheal stenosis. BMC Pulm Med 2024; 24:383. [PMID: 39123192 PMCID: PMC11316438 DOI: 10.1186/s12890-024-03197-1] [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: 04/22/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND A straight silicone stent can be used to treat proximal benign tracheal stenosis in non-surgical candidates. However, stent migration is a common complication when placed at a particular location and can lead to major complications. This case series of laryngotracheal stenosis reports a fixation method for straight silicone stents in the subglottic trachea (Stage 3 of the McCaffrey classification). METHODS The medical charts of these patients scheduled for straight silicone stent placement with suture fixation between 2014 and 2020 at the CHU UCL Namur Hospital (Belgium) were retrospectively reviewed. The procedure was performed using a rigid bronchoscope. Details of the procedure were obtained from medical records. RESULTS This case series included six patients (males: 4, females: 2). The median patient age was 59 years. Two suture fixations were placed following previous silicone stent migration episodes, whereas the others were placed proactively to avoid this risk. All fixations were performed by the device Freka® Pexact II ENFIt®, originally developed for gastropexy in endoscopic gastrostomy. The sutures were subcutaneously buried. CONCLUSIONS During the 6-month follow-up period, complications such as fixation issues and stent migration were reported despite the off-label use of the treatment. The straight silicone stent fixation technique used in this case series was simple and effective for securing the stent in upper benign tracheal stenosis.
Collapse
Affiliation(s)
- Sabrina Meyer
- Department of Anesthesiology, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
| | - Jean-Paul d'Odémont
- Department of Pneumology, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
| | - Laurie Putz
- Department of Anesthesiology, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
| | - Anne-Sophie Dincq
- Department of Anesthesiology, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
| | - Benoît Rondelet
- Department of Thoracic surgery, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
| | - Sebahat Ocak
- Department of Pneumology, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium
- Pole of Pneumology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgium
| | - Lionel Pirard
- Department of Pneumology, UCLouvain, CHU UCL Namur (Godinne site), Yvoir, Belgium.
| |
Collapse
|
3
|
Thierry B, Arakelian L, Denoyelle F, Larghero J, Wurtz A. Full circumferential human tracheal replacement: a systematic review. Eur J Cardiothorac Surg 2024; 66:ezae269. [PMID: 38984816 DOI: 10.1093/ejcts/ezae269] [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: 04/10/2024] [Revised: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 07/11/2024] Open
Abstract
Full Circumferential Tracheal Replacement (FCTR) is a surgical challenge, indicated in rare cases of extensive tracheal resection, with no consensus on surgical technique or materials. A systematic review according to PRISMA guidelines was carried out from 2000 to 2022 to identify cases of FCTR, to compare surgical indications, the nature of the tracheal substitutes and their immunological characteristics, surgical replacement techniques and vascularization. Thirty-seven patients, including five children, underwent FCTR surgery using 4 different techniques: thyrotracheal complex allograft (n = 2), aorta (n = 12), autologous surgical reconstruction (n = 19), tissue-engineered decellularized trachea (n = 4). The mean follow-up was 4 years. Of the 15 deceased patients, 10 died of the progression of the initial pathology. For the majority of the teams, particular care was given to the vascularization of the substitute, in order to guarantee long-term biointegration. This included either direct vascularization via vascular anastomosis, or an indirect technique involving envelopment of the avascular substitute in a richly vascularized tissue. Stent placement was standard, except for autologous surgical reconstructions where tracheal caliber was stable. Internal stents were frequently complicated by granulation and stenosis. Although epithelial coverage is essential to limit endoluminal proliferation and act as a barrier, fully functional ciliated airway epithelium did not seem to be necessary. In order to facilitate future comparisons, a standardized clinical trial, respecting regulatory constraints, including routine follow-up with tracheal biomechanics assessment and scheduled biopsies could be proposed. It would help collecting information such as dynamics and mechanisms of tracheal bio-integration and regeneration.
Collapse
Affiliation(s)
- Briac Thierry
- Department of Paediatric Otolaryngology - Head and Neck Surgery, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of biotherapy clinical investigation, INSERM U976, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lousineh Arakelian
- Department of biotherapy clinical investigation, INSERM U976, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of cell therapy, Hôpital St Louis, AP-HP, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology - Head and Neck Surgery, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jérôme Larghero
- Department of biotherapy clinical investigation, INSERM U976, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of cell therapy, Hôpital St Louis, AP-HP, Paris, France
| | - Alain Wurtz
- Emis Platform, Limoges University Hospital, Limoges, France
| |
Collapse
|
4
|
Vikash F, Osayande O, Pang M. Tracheal Stent Ingestion: Unveiling Complications and Innovations in Management. ACG Case Rep J 2024; 11:e01404. [PMID: 39035208 PMCID: PMC11259392 DOI: 10.14309/crj.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/28/2024] [Indexed: 07/23/2024] Open
Abstract
Airway stenting has become integral to the therapeutic endoscopic management of benign and malignant obstructive airway diseases. Despite the increased use of stents, the absence of clear guidelines for surveillance and maintenance poses the potential for unique stent-associated complications. Our case reports a rare incident of tracheal stent dislodgement, leading to its ingestion and unexpected discovery within the stomach. This case serves the purpose of shedding light on a rare yet potentially life-threatening complication and discussing types of stent and characteristics to enhance gastroenterologists' understanding of stent-related challenges and equips them to anticipate and strategize the appropriate course of action.
Collapse
Affiliation(s)
- Fnu Vikash
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Osagiede Osayande
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Maoyin Pang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
5
|
Schleich S, Kronen P, Krivitsky A, Paunović N, Brian CF, Karol AA, Geks A, Bao Y, Leroux JC, von Rechenberg B, Franzen D, Klein K. Effects of shape and structure of a new 3D-printed personalized bioresorbable tracheal stent on fit and biocompatibility in a rabbit model. PLoS One 2024; 19:e0300847. [PMID: 38917158 PMCID: PMC11198857 DOI: 10.1371/journal.pone.0300847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 04/03/2024] [Indexed: 06/27/2024] Open
Abstract
To date, several types of airway stents are available to treat central airway obstructions. However, the ideal stent that can overcome anatomical, mechanical and microbiological issues is still awaited. In addition, therapeutic effect and self-elimination of these stents are desirable properties, which pose an additional challenge for development and manufacturing. We aimed to create a prototype bioresorbable tracheal stent with acceptable clinical tolerance, fit and biocompatibility, that could be tested in a rabbit model and in the future be further optimized to enable drug-elution and ensure local therapeutic effect. Twenty-one New Zealand White Rabbits received five different types of bioresorbable tracheal stents, 3D-printed from poly(D,L-lactide-co-ε-caprolactone) metacrylates. Various configurations were tested for their functionality and improved until the best performing prototype could undergo detailed in vivo assessment, regarding clinical tolerance, migration and biocompatibility. Previously tested types of 3D printed stents in our preliminary study required improvement due to several problems, mainly related to breakage, unreliable stability and/or migration within the trachea. Abandoned or refined pre-prototypes were not analyzed in a comparative way. The final best performing prototype stent (GSP2 (Group Stent Prototype 2), n = 8) allowed a transoral application mode and showed good clinical tolerance, minimal migration and acceptable biocompatibility. The good performance of stent type GSP2 was attributed to the helix-shaped surface structure, which was therefore regarded as a key-feature. This prototype stent offers the possibility for further research in a large animal model to confirm the promising data and assess other properties such as bioresorption.
Collapse
Affiliation(s)
- Sarah Schleich
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Kronen
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Adva Krivitsky
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | - Nevena Paunović
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | | | - Agnieszka Anna Karol
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Anna Geks
- Clinic for Small Animals, Stiftung Tierärztliche Hochschule Hannover, Hanover, Germany
| | - Yinyin Bao
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | - Jean-Christophe Leroux
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Daniel Franzen
- Department of Internal Medicine, Spital Uster, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Karina Klein
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Rozman A, Grabczak EM, George V, Marc Malovrh M, Novais Bastos H, Trojnar A, Graffen S, Tenda ED, Hardavella G. Interventional bronchoscopy in lung cancer treatment. Breathe (Sheff) 2024; 20:230201. [PMID: 39193456 PMCID: PMC11348910 DOI: 10.1183/20734735.0201-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/26/2024] [Indexed: 08/29/2024] Open
Abstract
Interventional bronchoscopy has seen significant advancements in recent decades, particularly in the context of lung cancer. This method has expanded not only diagnostic capabilities but also therapeutic options. In this article, we will outline various therapeutic approaches employed through either a rigid or flexible bronchoscope in multimodal lung cancer treatment. A pivotal focus lies in addressing central airway obstruction resulting from cancer. We will delve into the treatment of initial malignant changes in central airways and explore the rapidly evolving domain of early peripheral malignant lesions, increasingly discovered incidentally or through lung cancer screening programmes. A successful interventional bronchoscopic procedure not only alleviates severe symptoms but also enhances the patient's functional status, paving the way for subsequent multimodal treatments and thereby extending the possibilities for survival. Interventional bronchoscopy proves effective in treating initial cancerous changes in patients unsuitable for surgical or other aggressive treatments due to accompanying diseases. The key advantage of interventional bronchoscopy lies in its minimal invasiveness, effectiveness and favourable safety profile.
Collapse
Affiliation(s)
- Ales Rozman
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Elzbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Mateja Marc Malovrh
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Helder Novais Bastos
- Department of Pulmonology, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Anna Trojnar
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Simon Graffen
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Eric Daniel Tenda
- Dr. Cipto Mangunkusumo National General Hospital, Artificial Intelligence and Digital Health Research Group, The Indonesian Medical Education and Research Institute - Faculty of Medicine Universitas Indonesia (IMERI-FMUI), Jakarta, Indonesia
| | - Georgia Hardavella
- 4th–9th Department of Respiratory Medicine, ‘Sotiria’ Athens’ Chest Diseases Hospital, Athens, Greece
| |
Collapse
|
7
|
Carção A, Cunha-Cabral D, Neves M, Lopes G. Tracheal metallic hybrid stent removal via tracheostomy: an unconventional approach. BMJ Case Rep 2024; 17:e258861. [PMID: 38806399 DOI: 10.1136/bcr-2023-258861] [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] [Indexed: 05/30/2024] Open
Abstract
Increasing use of tracheal expandable metallic hybrid stents will lead to common encounters with these devices in emergency airway management. The presence of these stents qualifies any patient as a challenge when an emergency tracheostomy is needed. We report an unorthodox technique of tracheostomy with concomitant removal of tracheal stent, without any major complications. Although the combined approach with bronchoscopy and tracheostomy has been reported in similar cases, we present a safe procedure when rigid bronchoscopy is not available.
Collapse
Affiliation(s)
- André Carção
- Otorhinolaryngology and Head and Neck Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
- Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Surgery Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Diogo Cunha-Cabral
- Otorhinolaryngology and Head and Neck Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
- Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Surgery Department, Hospital Pedro Hispano, Matosinhos, Portugal
- Anatomy, Universidade do Porto Faculdade de Medicina, Porto, Portugal
| | - Marta Neves
- Otorhinolaryngology and Head and Neck Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
- Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Surgery Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Gustavo Lopes
- Otorhinolaryngology and Head and Neck Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
- Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Surgery Department, Hospital Pedro Hispano, Matosinhos, Portugal
| |
Collapse
|
8
|
Cho RJ, Kadowaki K, Seelig D, Glumac DE, Kent LA, Hunter RC, MacIver RH, Peterson GK, Pandey V, Tanahashi K. To Compare the Effects of a Standard Versus Hydrophilic Polymer Coated Airway Stent in a Porcine Model: A Randomized, Single-Blinded Study. J Bronchology Interv Pulmonol 2024; 31:132-138. [PMID: 37332107 DOI: 10.1097/lbr.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/25/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Stent encrustation with debris and mucostasis is a significant cause of airway injury and comorbidity, leading to ~25% of stent exchanges (1-3). Previous work from our group has shown that the experimental coating can reduce mucous adhesion in bench testing and demonstrated a signal for reducing airway injury and mucostasis in a feasibility study. OBJECTIVES The aim of this study is to continue our inquiry in a randomized, single-blinded multi-animal trial to investigate the degree of airway injury and mucostasis using silicone stents with and without this specialized coating. METHODS We modified commercially available silicone stents with a hydrophilic polymer from Toray Industries. We conducted an in vivo survival study in 6 mainstem airways (3 coated and 3 uncoated) of 3 pigs to compare the degree of airway injury and mucostasis between coated versus noncoated stented airways. Both stents were randomized to either left or right mainstem bronchus. The pathologist was blinded to the stent type. RESULTS We implanted a total of six 14×15 mm silicone stents (1 per mainstem bronchi) into 3 pigs. All animals survived to termination at 4 weeks. All stents were intact; however, 1 uncoated stent migrated out. On average, all the coated stents demonstrated reduced pathology and tissue injury scores (75 vs. 68.3, respectively). The average total dried mucous weight was slightly higher in the coated stents (0.07 g vs. 0.05 g; respectively). CONCLUSION Coated stents had lower airway injury compared with uncoated stents in this study. Of all the stents, 1 uncoated stent migrated out and was not included in the dried mucous weight totals. This could explain the slightly higher mucous weight in the coated stents. Nevertheless, this current study demonstrates promising results in lowering airway injury in stents incorporated with the hydrophilic coating, and future studies, including a larger number of subjects, would be needed to corroborate our findings.
Collapse
Affiliation(s)
- Roy Joseph Cho
- Interventional Pulmonary, Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis MN
| | - Koji Kadowaki
- Advanced Materials Research Laboratories, Toray Industries, Inc, Tokyo, Japan
| | - Davis Seelig
- Department of Veterinary Clinical Sciences, University of Minnesota, MN
| | | | - Leslie A Kent
- Department of Microbiology & Immunology, University of Minnesota Medical School, Minneapolis MN
| | - Ryan C Hunter
- Department of Microbiology & Immunology, University of Minnesota Medical School, Minneapolis MN
| | - Robroy H MacIver
- Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota
| | | | - Vidhu Pandey
- Department of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis MN
| | - Kazuhiro Tanahashi
- Advanced Materials Research Laboratories, Toray Industries, Inc., Tokyo, Japan
| |
Collapse
|
9
|
Chen CX, Amsrala G, Romero AO. Diffuse Large B-cell Lymphoma Presenting as Bronchial Mass. J Bronchology Interv Pulmonol 2024; 31:224-227. [PMID: 38014871 PMCID: PMC10984628 DOI: 10.1097/lbr.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
|
10
|
Kadirvelu L, Sivaramalingam SS, Jothivel D, Chithiraiselvan DD, Karaiyagowder Govindarajan D, Kandaswamy K. A review on antimicrobial strategies in mitigating biofilm-associated infections on medical implants. CURRENT RESEARCH IN MICROBIAL SCIENCES 2024; 6:100231. [PMID: 38510214 PMCID: PMC10951465 DOI: 10.1016/j.crmicr.2024.100231] [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] [Indexed: 03/22/2024] Open
Abstract
Biomedical implants are crucial in providing support and functionality to patients with missing or defective body parts. However, implants carry an inherent risk of bacterial infections that are biofilm-associated and lead to significant complications. These infections often result in implant failure, requiring replacement by surgical restoration. Given these complications, it is crucial to study the biofilm formation mechanism on various biomedical implants that will help prevent implant failures. Therefore, this comprehensive review explores various types of implants (e.g., dental implant, orthopedic implant, tracheal stent, breast implant, central venous catheter, cochlear implant, urinary catheter, intraocular lens, and heart valve) and medical devices (hemodialyzer and pacemaker) in use. In addition, the mechanism of biofilm formation on those implants, and their pathogenesis were discussed. Furthermore, this article critically reviews various approaches in combating implant-associated infections, with a special emphasis on novel non-antibiotic alternatives to mitigate biofilm infections.
Collapse
Affiliation(s)
- Lohita Kadirvelu
- Research Center for Excellence in Microscopy, Department of Biotechnology, Kumaraguru College of Technology, Coimbatore, 641049, Tamil Nadu, India
| | - Sowmiya Sri Sivaramalingam
- Research Center for Excellence in Microscopy, Department of Biotechnology, Kumaraguru College of Technology, Coimbatore, 641049, Tamil Nadu, India
| | - Deepsikha Jothivel
- Research Center for Excellence in Microscopy, Department of Biotechnology, Kumaraguru College of Technology, Coimbatore, 641049, Tamil Nadu, India
| | - Dhivia Dharshika Chithiraiselvan
- Research Center for Excellence in Microscopy, Department of Biotechnology, Kumaraguru College of Technology, Coimbatore, 641049, Tamil Nadu, India
| | | | - Kumaravel Kandaswamy
- Research Center for Excellence in Microscopy, Department of Biotechnology, Kumaraguru College of Technology, Coimbatore, 641049, Tamil Nadu, India
| |
Collapse
|
11
|
Chen X, Wang W, Ye Y, Yang Y, Chen D, He R, Xiao Z, Liu J, Xu T, Cai Y, Feng H, Zhong C, Xiao W, Gu Y, Lu L, Xiong H, Zhang Z, Li S. The Wound Healing of Autologous Regenerative Factor on Recurrent Benign Airway Stenosis: A Canine Experimental and Pilot Study. Respiration 2024; 103:111-123. [PMID: 38342097 DOI: 10.1159/000536007] [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: 07/15/2023] [Accepted: 12/20/2023] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Benign airway stenosis (BAS) is a severe pathologic condition. Complex stenosis has a high recurrence rate and requires repeated bronchoscopic interventions for achieving optimal control, leading to recurrent BAS (RBAS) due to intraluminal granulation. METHODS This study explored the potential of autologous regenerative factor (ARF) for treating RBAS using a post-intubation tracheal stenosis canine model. Bronchoscopic follow-ups were conducted, and RNA-seq analysis of airway tissue was performed. A clinical study was also initiated involving 17 patients with recurrent airway stenosis. RESULTS In the animal model, ARF demonstrated significant effectiveness in preventing further collapse of the injured airway, maintaining airway patency and promoting tissue regeneration. RNA-seq results showed differential gene expression, signifying alterations in cellular components and signaling pathways. The clinical study found that ARF treatment was well-tolerated by patients with no severe adverse events requiring hospitalization. ARF treatment yielded a high response rate, especially for post-intubation tracheal stenosis and idiopathic tracheal stenosis patients. CONCLUSION The study concludes that ARF presents a promising, effective, and less-invasive method for treating RBAS. ARF has shown potential in prolonging the intermittent period and reducing treatment failure in patients with recurrent tracheal stenosis by facilitating tracheal mucosal wound repair and ameliorating tracheal fibrosis. This novel approach could significantly impact future clinical applications.
Collapse
Affiliation(s)
- Xiaobo Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhao Wang
- Translational Research Centre of Regenerative Medicine and 3D Printing of Guangzhou Medical University, Guangdong Province Engineering Research Center for Biomedical Engineering, State Key Laboratory of Respiratory Disease, Department of Orthopaedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongshun Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Huizhou Central People's Hospital, Huizhou, China
| | - Yixi Yang
- Translational Research Centre of Regenerative Medicine and 3D Printing of Guangzhou Medical University, Guangdong Province Engineering Research Center for Biomedical Engineering, State Key Laboratory of Respiratory Disease, Department of Orthopaedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Difei Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ruiting He
- Translational Research Centre of Regenerative Medicine and 3D Printing of Guangzhou Medical University, Guangdong Province Engineering Research Center for Biomedical Engineering, State Key Laboratory of Respiratory Disease, Department of Orthopaedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhulin Xiao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingwei Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingting Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongna Cai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,
| | - Haiqi Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changgao Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqun Xiao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingying Gu
- The Center of Respiratory Pathology, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Liya Lu
- Department of Anesthesiology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hailin Xiong
- Huizhou Central People's Hospital, Huizhou, China
| | - Zhiyong Zhang
- Translational Research Centre of Regenerative Medicine and 3D Printing of Guangzhou Medical University, Guangdong Province Engineering Research Center for Biomedical Engineering, State Key Laboratory of Respiratory Disease, Department of Orthopaedic Surgery, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
12
|
Wu X, Lu G, Luo LC, Wei H, Yi Q, Luo W. Efficacy of airway stenting and nasogastric tube insertion in airway-esophageal fistula patients with airways compromised by advanced malignancy. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13737. [PMID: 38350674 PMCID: PMC10864120 DOI: 10.1111/crj.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Whether airway-compromised airway-esophageal fistula (AEF) patients should undergo combined airway and esophageal stenting is controversial. This study was designed to evaluate the survival prognosis and poststent interventions in AEF patients with airways compromised by advanced malignancy with or without airway stents. METHODS A retrospective analysis of the medical records, survival times, and poststent interventions of 17 patients with or without airway stents was performed. RESULTS The causes of AEF were esophageal cancer (11/17, 64.7%), lung cancer (6/17, 29.4%), and thyroid cancer (1/17, 5.9%). All patients received a nasogastric tube (n = 12) or underwent gastrostomy (n = 5) to resume enteral nutrition. Thirteen patients underwent airway stent insertion (13/17, 76.5%), whereas four patients did not. Four patients with a high risk of stent migration received external stent fixation to the trachea. Three of the patients with stents suffered severe granulation tissue formation and needed repeated bronchoscopy interventions. In the stented group, none of the patients developed stent migration, and the overall median survival time was 9 months, compared with 1.25 months in the nonstented group (P = 0.04). Cox proportional hazards regression revealed that stent insertion, nasogastric tube insertion, and transcatheter bronchial artery chemoembolization were protective factors against death, whereas surgery-related fistula, fistula larger than 2 cm, continued chemotherapy, and age were risk factors for poor survival (P < 0.05). CONCLUSION In airway-compromised AEF patients, airway stents and nasogastric tubes are probably the preferred treatments. Airway stenting is tolerable, and routine weekly poststent bronchoscopy is needed in the first month and depending on respiratory symptoms thereafter.
Collapse
Affiliation(s)
- Xue Wu
- Department of Respiratory and Critical Care MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Department of Respiratory and Critical Care MedicineThe People's Hospital of LeshanLeshanChina
| | - Guangbing Lu
- Department of Critical Care MedicineMeishan Traditional Chinese Medical HospitalMeishanChina
| | - Lin cheng Luo
- Department of Respiratory and Critical Care MedicineThe People's Hospital of LeshanLeshanChina
| | - Hailong Wei
- Department of Respiratory and Critical Care MedicineThe People's Hospital of LeshanLeshanChina
| | - Qun Yi
- Department of Respiratory and Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
- Department of Critical Care MedicineSichuan Cancer HospitalChengduChina
| | - Wei Luo
- Department of Respiratory and Critical Care MedicineThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
- Department of Respiratory and Critical Care MedicineThe People's Hospital of LeshanLeshanChina
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Gesthalter YB, Channick CL. Interventional Pulmonology: Extending the Breadth of Thoracic Care. Annu Rev Med 2024; 75:263-276. [PMID: 37827195 DOI: 10.1146/annurev-med-050922-060929] [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] [Indexed: 10/14/2023]
Abstract
Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive techniques, interventional pulmonologists diagnose and treat pathologies that previously required more invasive options such as surgery. By mitigating procedural risk, interventional pulmonologists have extended the reach of care to a wider pool of vulnerable patients who require therapy. Endoscopic innovations, including endobronchial ultrasound and robotic and electromagnetic bronchoscopy, have enhanced the ability to perform diagnostic procedures on an ambulatory basis. Therapeutic procedures for patients with symptomatic airway disease, pleural disease, and severe emphysema have provided the ability to palliate symptoms. The combination of medical and procedural expertise has made interventional pulmonologists an integral part of comprehensive care teams for patients with oncologic, airway, and pleural needs. This review surveys key areas in which interventional pulmonologists have impacted the care of thoracic disease through bronchoscopic intervention.
Collapse
Affiliation(s)
- Yaron B Gesthalter
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA;
| | - Colleen L Channick
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA;
| |
Collapse
|
15
|
Singh M, Teodorescu DL, Rowlett M, Wang SX, Balcells M, Park C, Bernardo B, McGarel S, Reeves C, Mehra MR, Zhao X, Yuk H, Roche ET. A Tunable Soft Silicone Bioadhesive for Secure Anchoring of Diverse Medical Devices to Wet Biological Tissue. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307288. [PMID: 37865838 DOI: 10.1002/adma.202307288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/21/2023] [Indexed: 10/23/2023]
Abstract
Silicone is utilized widely in medical devices for its compatibility with tissues and bodily fluids, making it a versatile material for implants and wearables. To effectively bond silicone devices to biological tissues, a reliable adhesive is required to create a long-lasting interface. BioAdheSil, a silicone-based bioadhesive designed to provide robust adhesion on both sides of the interface is introduced here, facilitating bonding between dissimilar substrates, namely silicone devices and tissues. The adhesive's design focuses on two key aspects: wet tissue adhesion capability and tissue-infiltration-based long-term integration. BioAdheSil is formulated by mixing soft silicone oligomers with siloxane coupling agents and absorbents for bonding the hydrophobic silicone device to hydrophilic tissues. Incorporation of biodegradable absorbents eliminates surface water and controls porosity, while silane crosslinkers provide interfacial strength. Over time, BioAdheSil transitions from nonpermeable to permeable through enzyme degradation, creating a porous structure that facilitates cell migration and tissue integration, potentially enabling long-lasting adhesion. Experimental results demonstrate that BioAdheSil outperforms commercial adhesives and elicits no adverse response in rats. BioAdheSil offers practical utility for adhering silicone devices to wet tissues, including long-term implants and transcutaneous devices. Here, its functionality is demonstrated through applications such as tracheal stents and left ventricular assist device lines.
Collapse
Affiliation(s)
- Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Debbie L Teodorescu
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, 90048, USA
| | - Meagan Rowlett
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sophie X Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Mercedes Balcells
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Bioengineering Department, Institut Químic de Sarrià, Ramon Llull Univ, Barcelona, Spain, 08017
| | - Clara Park
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Bruno Bernardo
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sian McGarel
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Charlotte Reeves
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- SanaHeal, Inc, Cambridge, MA, 02139, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| |
Collapse
|
16
|
Mondal A, Visner GA, Kaza AK, Dupont PE. A novel ex vivo tracheobronchomalacia model for airway stent testing and in vivo model refinement. J Thorac Cardiovasc Surg 2023; 166:679-687.e1. [PMID: 37156367 PMCID: PMC10524727 DOI: 10.1016/j.jtcvs.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We sought to develop an ex vivo trachea model capable of producing mild, moderate, and severe tracheobronchomalacia for optimizing airway stent design. We also aimed to determine the amount of cartilage resection required for achieving different tracheobronchomalacia grades that can be used in animal models. METHODS We developed an ex vivo trachea test system that enabled video-based measurement of internal cross-sectional area as intratracheal pressure was cyclically varied for peak negative pressures of 20 to 80 cm H2O. Fresh ovine tracheas were induced with tracheobronchomalacia by single mid-anterior incision (n = 4), mid-anterior circumferential cartilage resection of 25% (n = 4), and 50% per cartilage ring (n = 4) along an approximately 3-cm length. Intact tracheas (n = 4) were used as control. All experimental tracheas were mounted and experimentally evaluated. In addition, helical stents of 2 different pitches (6 mm and 12 mm) and wire diameters (0.52 mm and 0.6 mm) were tested in tracheas with 25% (n = 3) and 50% (n = 3) circumferentially resected cartilage rings. The percentage collapse in tracheal cross-sectional area was calculated from the recorded video contours for each experiment. RESULTS Ex vivo tracheas compromised by single incision and 25% and 50% circumferential cartilage resection produce tracheal collapse corresponding to clinical grades of mild, moderate, and severe tracheobronchomalacia, respectively. A single anterior cartilage incision produces saber-sheath type tracheobronchomalacia, whereas 25% and 50% circumferential cartilage resection produce circumferential tracheobronchomalacia. Stent testing enabled the selection of stent design parameters such that airway collapse associated with moderate and severe tracheobronchomalacia could be reduced to conform to, but not exceed, that of intact tracheas (12-mm pitch, 0.6-mm wire diameter). CONCLUSIONS The ex vivo trachea model is a robust platform that enables systematic study and treatment of different grades and morphologies of airway collapse and tracheobronchomalacia. It is a novel tool for optimization of stent design before advancing to in vivo animal models.
Collapse
Affiliation(s)
- Abhijit Mondal
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass.
| | - Gary A Visner
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Aditya K Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Pierre E Dupont
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| |
Collapse
|
17
|
Aravena C, Gildea TR. Patient-specific airway stent using three-dimensional printing: a review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:360. [PMID: 37675337 PMCID: PMC10477630 DOI: 10.21037/atm-22-2878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/19/2022] [Indexed: 09/08/2023]
Abstract
The primary function of an airway stent is to reestablish patency, impeding restenosis, supporting the tracheobronchial wall, or occluding fistulas. But stent-related complications are prevalent and can have devastating consequences. For this reason, stents are considered a last resort when there are no alternatives in treatment. Additionally, commercially available airway stents often poorly fit patients with complex airways, and they can cause various complications. At the end of the 20th century, three-dimensional (3D) printing technology was created. It has been transformative in healthcare and has been used in several applications. One of its first utilizations was the anatomical modeling of body structures that helps preoperative planning. In respiratory medicine, this technology has been essentially used in central airway diseases to produce 3D airway models and to create airway splints and prostheses. In the last decade, it has led to a transformation and allowed progress in personalized medicine, making patient-specific stents for individuals with complex airway problems. A patient-specific stent using 3D printing may minimize complications, improve quality of life, and reduce the need for repeated procedures. This review describes the recent advances in 3D printing technology, its use for developing airway prostheses to treat complex airway diseases, and the current evidence that supports its use.
Collapse
Affiliation(s)
- Carlos Aravena
- Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Thomas R. Gildea
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
18
|
Wayne MT, Ali MS, Wakeam E, Maldonado F, Yarmus LB, Prescott HC, De Cardenas J. Current Practices in Airway Stent Management: A National Survey of US Practitioners. Respiration 2023; 102:608-612. [PMID: 37429267 DOI: 10.1159/000531500] [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: 04/01/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Despite a growing number of tracheobronchial stent types and indications, complications remain frequent, and high-quality evidence on practices to prevent stent-related complications is lacking. Understanding current management practice is a first step to designing prospective studies to assess whether specific practices aimed at mitigating stent-related complications improve patient-centered outcomes. OBJECTIVES In this study, we aimed to understand current management strategies following tracheobronchial stenting. METHOD We performed a nationwide survey of members of the American Association of Bronchology and Interventional Pulmonology (AABIP) and the General Thoracic Surgical Club (GTSC) who place airway stents. The electronic survey captured data on practitioners' demographics, practice setting, airway stent volume, and standard post-stent practices (if any) including the use of medications, mucus clearance devices, surveillance imaging, and surveillance bronchoscopy. RESULTS One hundred thirty-eight physicians completed the survey. Respondents were majority male (75.4%) and had diverse training (50.0% completed interventional pulmonary fellowship; 18.1% thoracic surgery; 31.9% other stent training). Post-stent management strategies varied markedly across respondents; 75.4% prescribe at least one medication to prevent post-stent complications, 52.9% perform routine surveillance bronchoscopy in asymptomatic patients, 26.1% prescribe mucus clearance regimens, 16.7% obtain routine computed tomography scans in asymptomatic patients, and 8.3% routinely replace their stents prior to stent failure. CONCLUSIONS In this national survey of practitioners who place airway stents, there was marked heterogeneity in post-stent management approaches. Further studies are needed to identify which, if any, of these strategies improve patient-centered outcomes.
Collapse
Affiliation(s)
- Max T Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Muhammad Sajawal Ali
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
19
|
Perryman MC, Kraft SM, Kavookjian HL. Laryngotracheal Reconstruction for Subglottic and Tracheal Stenosis. Otolaryngol Clin North Am 2023:S0030-6665(23)00075-0. [PMID: 37268515 DOI: 10.1016/j.otc.2023.04.018] [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: 06/04/2023]
Abstract
Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although endoscopic procedures are effective in opening the airway lumen, open resection and reconstruction can be necessary to reconstitute a functional airway. When resection and anastomosis are insufficient due to extensive length or location of the stenosis, autologous grafts can be used to expand the airway. Future directions in airway reconstruction include tissue engineering and allotransplantation.
Collapse
Affiliation(s)
- Mollie C Perryman
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA
| | - Shannon M Kraft
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA
| | - Hannah L Kavookjian
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA.
| |
Collapse
|
20
|
Aravena C, Mehta AC, Almeida FA, Lamb C, Maldonado F, Gildea TR. Innovation in rigid bronchoscopy-past, present, and future. J Thorac Dis 2023; 15:2836-2847. [PMID: 37324083 PMCID: PMC10267940 DOI: 10.21037/jtd-22-779] [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: 06/06/2022] [Accepted: 03/03/2023] [Indexed: 06/17/2023]
Abstract
German laryngologist Gustav Killian performed the first "Direkte Bronchoskopie" using a rigid bronchoscope to extract a foreign airway body from the right main bronchus over a hundred years ago, transforming the practice of respiratory medicine. The procedure instantaneously became popular throughout the world. Chevalier Jackson Sr from the United States further advanced the instrument, technique, safety, and application. In the 1960s, Professors Harold H. Hopkins and N.S. Kapany introduced optical rods as well as fiberoptics that led Karl Storz to develop the cold light system improving endoluminal illumination, achievements that ushered in the modern era of flexible endoscopy. Several diagnostic and therapeutic procedures became possible such as transbronchial needle biopsy, transbronchial lung biopsy, airway electrosurgery, or cryotherapy. Dr. Jean-François Dumon from France advanced the use of Nd-YAG laser in the endobronchial tree and created the dedicated Dumon silicone stent introducing the whole new field of interventional pulmonology (IP). This major milestone revitalized interest in rigid bronchoscopy (RB). Now, advancements are being made in stenting, instrumentation, and education. RB robotic technology advancements are currently anticipated and can potentially revolutionize the practice of pulmonary medicine. In this review, we describe some of the most substantial advances related to RB from its beginning to the modern era.
Collapse
Affiliation(s)
- Carlos Aravena
- Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Atul C. Mehta
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francisco A. Almeida
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carla Lamb
- Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Boston, MA, USA
| | | | - Thomas R. Gildea
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
21
|
Avasarala SK, Dutau H, Mehta AC. Forbearance with endobronchial stenting: cognisance before conviction. Eur Respir Rev 2023; 32:32/167/220189. [PMID: 36889785 PMCID: PMC10032587 DOI: 10.1183/16000617.0189-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/13/2023] [Indexed: 03/10/2023] Open
Abstract
Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically significant airway stenosis. The list of endobronchial stents available on the market continues to grow. More recently, patient-specific 3D-printed airway stents have been approved for use. Airway stenting should be considered only when all other options have been exhausted. Due to the environment of the airways and the stent-airway wall interactions, stent-related complications are common. Although stents can be placed in various clinical scenarios, they should only be placed in scenarios with proven clinical benefit. The unwarranted placement of a stent can expose the patient to complications with little or no clinical benefit. This article reviews and outlines the key principles of endobronchial stenting and important clinical scenarios in which stenting should be avoided.
Collapse
Affiliation(s)
- Sameer K Avasarala
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hervé Dutau
- Thoracic Oncology, Pleural Disease and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
22
|
Tong X, Jiang Y, Mo F, Sun Z, Wu X, Li Y. A single-tube-braided stent for various airway structures. Front Bioeng Biotechnol 2023; 11:1152412. [PMID: 37008033 PMCID: PMC10060983 DOI: 10.3389/fbioe.2023.1152412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Airway stent has been widely used in airway procedures. However, the metallic and silicone tubular stents are not customized designed for individual patients and cannot adapt to complicated obstruction structures. Other customized stents could not adapt to complex airway structures with easy and standardized manufacturing methods.Object: This study aimed to design a series of novel stents with different shapes which can adapt to various airway structures, such as the “Y” shape structure at the tracheal carina, and to propose a standardized fabrication method to manufacture these customized stents in the same way.Methods: We proposed a design strategy for the stents with different shapes and introduced a braiding method to prototype six types of single-tube-braided stents. Theoretical model was established to investigate the radial stiffness of the stents and deformation upon compression. We also characterized their mechanical properties by conducting compression tests and water tank tests. Finally, a series of benchtop experiments and ex vivo experiments were conducted to evaluate the functions of the stents.Results: The theoretical model predicted similar results to the experimental results, and the proposed stents could bear a compression force of 5.79N. The results of water tank tests showed the stent was still functioning even if suffering from continuous water pressure at body temperature for a period of 30 days. The phantoms and ex-vivo experiments demonstrated that the proposed stents adapt well to different airway structures.Conclusion: Our study offers a new perspective on the design of customized, adaptive, and easy-to-fabricate stents for airway stents which could meet the requirements of various airway illnesses.
Collapse
Affiliation(s)
- Xin Tong
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- School of Mechanical and Electrical Engineering, Xi’an University of Architecture and Technology, Xi’an, China
| | - Yongkang Jiang
- School of Automation, Beijing University of Posts and Telecommunications, Beijing, China
| | - Fei Mo
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhongqing Sun
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiaojun Wu
- School of Mechanical and Electrical Engineering, Xi’an University of Architecture and Technology, Xi’an, China
- *Correspondence: Xiaojun Wu, ; Yingtian Li,
| | - Yingtian Li
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- *Correspondence: Xiaojun Wu, ; Yingtian Li,
| |
Collapse
|
23
|
Aljawad M, Albaqshi A, Qazi S, Madkhali R. Tracheal Stent Migration in a Patient With Tracheomalacia and Tracheoesophageal Fistula: A Rare Case. Cureus 2023; 15:e34560. [PMID: 36879694 PMCID: PMC9985470 DOI: 10.7759/cureus.34560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Tracheomalacia refers to diffuse or segmental tracheal weakness. Most commonly, tracheomalacia develops after prolonged endotracheal intubation or tracheostomy. Surgical management is warranted in symptomatic patients with severe tracheomalacia. Relief of airway obstruction via stenting often provides immediate improvement in both airflow and symptoms. However, stent placement is associated with significant complications. Here, we present the case of a 71-year-old man who was brought to the emergency department with acute respiratory distress. The patient was known to have tracheomalacia with tracheoesophageal fistula. He had multiple medical comorbidities, including longstanding hypertension, diabetes mellitus, and asthma. The patient had a progressive decline in his level of consciousness and was admitted to the intensive care unit for further management. Despite the maximum ventilatory support, the patient did not achieve an adequate oxygenation level. The patient underwent tracheal stent placement by the interventional radiology team. The insertion was unsuccessful despite three attempts. The tracheal stent had migrated into the upper esophagus on the first and second insertion attempts. Because the patient was unstable to tolerate further attempts, the multidisciplinary team recommended the insertion of an esophageal stent to cover the tracheoesophageal fistula. Despite this, the patient continued to have air leakage with progressive worsening of his respiratory condition as he developed multiorgan failure and died. The management of tracheomalacia in the setting of the tracheoesophageal fistula may pose several challenges. The present case highlights an essential complication of stent placement with the stent migrating into the tracheoesophageal fistula, which is an unusual site of migration. A multidisciplinary approach is crucial in the management of difficult cases of tracheomalacia.
Collapse
Affiliation(s)
- Mahdi Aljawad
- Radiology, National Guard Health Affairs, Riyadh, SAU
| | | | - Shahbaz Qazi
- Radiology, National Guard Health Affairs, Riyadh, SAU
| | - Raad Madkhali
- Radiology, National Guard Health Affairs, Riyadh, SAU
| |
Collapse
|
24
|
Lamothe PA, Berkowitz DM, Schimmel ME. A Case of Nitinol Airway Stent Placement in a Patient With Known Nickel Skin Sensitivity With No Local or Systemic Reactions After 6 Months of Follow-up. J Bronchology Interv Pulmonol 2023; 30:83-85. [PMID: 35838198 DOI: 10.1097/lbr.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Pedro A Lamothe
- Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine Emory University School of Medicine, Atlanta, GA
| | | | | |
Collapse
|
25
|
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.
Collapse
|
26
|
Sivaramakrishnan P, Mishra M, Sindhwani G, Sharma P. Novel use of metallic stent to control post-debulking bleeding in a patient with central airway obstruction. BMJ Case Rep 2022; 15:e252848. [PMID: 36316050 PMCID: PMC9628542 DOI: 10.1136/bcr-2022-252848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Bronchoscopy-related bleeding is often encountered and is usually self-limiting or controllable by conservative measures. However, major bleeds can be life threatening for the patient as well as challenging for the physician to manage. There are several methods to achieve adequate haemostasis should a significant airway bleed occur. In this context, we describe a patient who had a post-bronchoscopic debulking bleed which persisted despite use of all available measures, and we deployed a self-expanding metallic stent in an attempt to control it. To the best of our knowledge, this is the first instance of a metallic airway stent being used to control bronchoscopy associated bleeding, though reports of its usage in management of intractable haemoptysis exist in the literature.
Collapse
Affiliation(s)
- Prakash Sivaramakrishnan
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Mayank Mishra
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Girish Sindhwani
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Prakhar Sharma
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| |
Collapse
|
27
|
Yilmaz B, Kara BY. Mathematical surface function-based design and 3D printing of airway stents. 3D Print Med 2022; 8:24. [PMID: 35932364 PMCID: PMC9356489 DOI: 10.1186/s41205-022-00154-8] [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: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) printing is a method applied to build a 3D object of any shape from a digital model, and it provides crucial advantages especially for transferring patient-specific designs to clinical settings. The main purpose of this study is to introduce the newly designed complex airway stent models that are created through mathematical functions and manufactured with 3D printing for implementation in real life. METHODS A mathematical modeling software (MathMod) was used to design five different airway stents. The highly porous structures with designated scales were fabricated by utilizing a stereolithography-based 3D printing technology. The fine details in the microstructure of 3D printed parts were observed by a scanning electron microscope (SEM). The mechanical properties of airway stents with various designs and porosity were compared by compression test. RESULTS The outputs of the mathematical modeling software were successfully converted into 3D printable files and airway stents with a porosity of more than 85% were 3D printed. SEM images revealed the layered topography of high-resolution 3D printed parts. Compression tests have shown that the mathematical function-based design offers the opportunity to adjust the mechanical strength of airway stents without changing the material or manufacturing method. CONCLUSIONS A novel approach, which includes mathematical function-based design and 3D printing technology, is proposed in this study for the fabrication of airway stents as a promising tool for future treatments of central airway pathologies.
Collapse
Affiliation(s)
- Bengi Yilmaz
- Department of Biomaterials, University of Health Sciences Turkey, 34668, Istanbul, Turkey. .,Experimental Medicine Research and Application Center, University of Health Sciences Turkey, 34662, Istanbul, Turkey.
| | - Bilge Yilmaz Kara
- Department of Pulmonary Medicine, Recep Tayyip Erdoğan University School of Medicine, 53020, Rize, Turkey
| |
Collapse
|
28
|
Abia-Trujillo D, Fernandez-Bussy S. Nonmalignant Central Airway Obstruction: Options for Challenging Cases. Semin Respir Crit Care Med 2022; 43:530-535. [PMID: 35728604 DOI: 10.1055/s-0042-1747937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Benign central airway obstruction is commonly referred as nonmalignant central airway obstruction (NMCAO). This is in part related to its lack of benign nature and significant life-quality impairment in patients. It is a pathologic entity with various etiologies and therefore a wide range of therapeutic options are available. Evidence regarding the optimal management that could provide a sustained restoration of airway patency is lacking. The lack of a common pathophysiologic pathway translating into a nonspecific symptom presenting as NMCAO has complicated treatment standardization and subsequently limited solid research to favor of one approach over another one. Our intent is to describe the limited evidence of the most utilized nonsurgical treatment for NMCAO as well as some upcoming promising therapeutic options such as mitomycin C injection, microdebrider, biodegradable stents, radiotherapy, Hybrid Knife, and endoluminal spray cryotherapy. Our goal with this manuscript is to motivate other authors to venture into prospective, multicenter, open-label trials aimed to describe long-term outcomes in patients with NMCAO.
Collapse
Affiliation(s)
- David Abia-Trujillo
- Divisions of Pulmonary, Allergy, Sleep Medicine & Respiratory Services, Mayo Clinic, Jacksonville, Florida
| | - Sebastian Fernandez-Bussy
- Divisions of Pulmonary, Allergy, Sleep Medicine & Respiratory Services, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
29
|
Chen H, Yao Y, Wang S, Liu S, Yang L. Selection of the access channel in bronchoscopic intervention. Expert Rev Respir Med 2022; 16:707-712. [PMID: 35694812 DOI: 10.1080/17476348.2022.2089656] [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
BACKGROUND At present, bronchoscopic intervention has become an important treatment approach for central airway obstruction (CAO). Choosing an appropriate access channel for different patients during this operation has become a research focus. METHODS Data of bronchoscopic interventions in 201 patients with CAO in which one of endotracheal intubation, laryngeal mask, or rigid bronchoscope were used as the only access channel were retrospectively reviewed. RESULTS The total immediate effective rate was 94.1% (398/423), and the main complications related to the access channels included hypoxemia, elevated arterial partial pressure of carbon dioxide, arrhythmia, airway mucosa tear, glottic edema, vocal cord injury, tooth loss, massive bleeding, airway mucosal necrosis, and asphyxia. The incidence of complications was 16.8% (71/423). Glottic edema was the most common complication with an incidence of 7.8% (33/423) and accounted for 46.5% of all complications. Glottic edema only occurred in the laryngeal mask and rigid bronchoscope groups, and the incidence was significantly correlated with the operation time (p < 0.001). Massive bleeding related to the access channel remains the most serious complication. CONCLUSIONS Endotracheal intubation, laryngeal mask, and rigid bronchoscope each have their own advantages and disadvantages. The most appropriate access channel should depend on a comprehensive assessment of the patient.
Collapse
Affiliation(s)
- Hui Chen
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Yang Yao
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Shengyu Wang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Song Liu
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Lin Yang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
30
|
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.
Collapse
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
| | | |
Collapse
|
31
|
Hennessy MM, Moorthy A, Frizelle H, Griffin M, Reidy B, Eaton D, Carton E. Complications of an uncovered metallic tracheal stent managed by veno-venous extracorporeal membrane oxygenation: a case report. BJA OPEN 2022; 2:100011. [PMID: 37588269 PMCID: PMC10430833 DOI: 10.1016/j.bjao.2022.100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/11/2022] [Indexed: 08/18/2023]
Abstract
Airway stents are primarily inserted for the management of airway obstruction associated with an inoperable malignancy and are rarely indicated in benign disease. We outline the complications associated with tracheal stents and describe the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) to facilitate open tracheal surgery in an apnoeic patient who had an uncovered metallic tracheal stent left in place for an inappropriately long period. Computerised tomography imaging of the neck and thorax provided information for operative planning and described of the stent in addition to the extensive granulation tissue at the distal end of the stent. Veno-venous extracorporeal membrane oxygenation was used to facilitate open tracheal surgery, removal of the tracheal stent and formation of a surgical tracheostomy. Prolonged use of an uncovered metallic airway stent in younger patients with benign disease may lead to the stent being difficult to remove. There may be an accumulation of granulation tissue with the risk of airway obstruction.
Collapse
Affiliation(s)
| | - A. Moorthy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - H. Frizelle
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. Griffin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B. Reidy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - D. Eaton
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - E. Carton
- Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
32
|
Seyhan EC, Turan D, Özgül MA, Uğur Chousein E, Özgül G, Çetinkaya E. Use of airway stents to treat malignant tracheobronchial fistulas: Our six-year experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2022; 30:216-226. [PMID: 36168571 PMCID: PMC9473597 DOI: 10.5606/tgkdc.dergisi.2022.20831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/08/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aims to investigate the indications, safety, complications, and long-term outcomes of airway stenting in the treatment of malignant tracheobronchial fistulas. METHODS The medical records of a total of 34 patients (24 males, 10 females; mean age: 55.4+13 years; range, 23 to 76 years) with malignant tracheobronchial fistulas treated with airway stenting between February 2014 and August 2020 were retrospectively analyzed. Data including demographic features, diagnosis, symptoms, treatment, complications and outcomes were recorded. RESULTS Thirty-eight airway stents were inserted in 34 patients with malignant tracheobronchial fistulas, including 19 patients with malignant tracheobronchial esophageal fistulas and 15 patients with bronchopleural fistulas. The clinical success and the technical success rates were 91% and 100%, respectively. No perioperative death or severe complications occurred. Chronic complications (>24 h) occurred in eight (23%) patients with malignant tracheobronchial fistula. Median follow-up was 3.5 (range, 1.4 to 5.5) months in patients with malignant tracheobronchial esophageal fistulas and 18 (range, 9.5 to 26.5) months in patients with bronchopleural fistulas. Mortality rates were 79% and 61%, respectively. CONCLUSION Airway stent insertion provides a secure and effective treatment for patients with malignant tracheobronchial fistulas.
Collapse
Affiliation(s)
- Ekrem Cengiz Seyhan
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Demet Turan
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Mehmet Akif Özgül
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Efsun Uğur Chousein
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Güler Özgül
- Department of Chest Disease, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Türkiye
| | - Erdoğan Çetinkaya
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| |
Collapse
|
33
|
Iravani A, Reddy C. Use of Self-expanding Metallic Y Stent in the United States: First Report. J Bronchology Interv Pulmonol 2022; 29:e23-e25. [PMID: 35318993 DOI: 10.1097/lbr.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Aidin Iravani
- Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonary, Huntsman Cancer Institute University of Utah Health Science Center Salt Lake City, UT
| | | |
Collapse
|
34
|
Barnwell N, Lenihan M. Anaesthesia for airway stenting. BJA Educ 2022; 22:160-166. [PMID: 35531077 PMCID: PMC9073313 DOI: 10.1016/j.bjae.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- N. Barnwell
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. Lenihan
- Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
35
|
Schulze AB, Evers G, Tenk FS, Schliemann C, Schmidt LH, Görlich D, Mohr M. Central airway obstruction treatment with self-expanding covered Y-carina nitinol stents: A single center retrospective analysis. Thorac Cancer 2022; 13:1040-1049. [PMID: 35199949 PMCID: PMC8977163 DOI: 10.1111/1759-7714.14359] [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: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background Central airway obstruction (CAO) is one of the most challenging, potentially lethal complications in malignant and benign respiratory diseases. Worsening dyspnea is also a relevant cause for reduced quality of life in such patients. Here, we present our data on the application of covered, self‐expanding Y‐carina nitinol stents due to benign and malignant diseases. Methods We retrospectively identified 27 patients who had undergone 31 rigid bronchoscopies with implantation of covered Y‐carina nitinol stents over a period of 10 years in order to evaluate indication, clinical course, and outcome. Results Short‐term survival of successfully stented patients with palliative and curative treatment goal did not differ, allowing for diagnosis independent indication. With respect to overall survival, patients with endoluminal obstruction benefited most compared to patients with fistula and/or external compression. Granulation tissue formation (61.3%) and mucus plugging (80.6%) were the most frequent complications. Material defect (6.5%) and migration (3.2%) were rare complications that could be handled by revisional rigid bronchoscopy and stent exchange in some cases. Conclusions Implantation of self‐expanding covered Y‐carina nitinol stents via rigid bronchoscopy is a feasible and safe treatment option for benign and malignant central airway obstruction. Especially in palliative, malignant airway stenosis, stenting might facilitate additional treatment options and optimize dyspnea and eventually quality of life.
Collapse
Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Friederike Sophia Tenk
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pulmonary Medicine and Thoracic Oncology, Klinikum Ingolstadt, Ingolstadt, Germany.,Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische-Wilhelms University Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
36
|
Freitas C, Serino M, Cardoso C, Saleiro S, Vaz AP, Novais-Bastos H, Morais A, Magalhães A, Fernandes G. Predictors of survival and technical success of bronchoscopic interventions in malignant airway obstruction. J Thorac Dis 2022; 13:6760-6768. [PMID: 35070360 PMCID: PMC8743414 DOI: 10.21037/jtd-21-1393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/13/2021] [Indexed: 12/27/2022]
Abstract
Background Malignant airway obstruction (MAO) leads to quality of life impairment and increased mortality. Interventional bronchoscopy allows airway patency restoring, leading to a better survival. We investigated predictors of survival and successful bronchoscopic intervention among MAO patients. Methods This observational prospective study enrolled 100 patients who were newly diagnosed with MAO. Survival was estimated with Kaplan-Meier method and curves compared by log-rank test. Multivariate analyses were performed using Cox proportional hazard models. Univariate and multivariate logistic regression were used for odds ratio calculation. Results A proportion of 73% of the patients were male with a median age was 62.5 years (range, 21–88 years). Lung cancer was the most common primary malignancy (74%). The majority had single (61%), endoluminal (62%) lesions and were classified as grade III in Myer Cotton scale (57%). The most used techniques comprised mechanical debulking (n=81) and laser therapy (n=68). Twenty-two airway stents were placed. While eleven patients were considered untreatable, technical success was achieved in 78%. Haemorrhage was the most common acute complication (16%). No deaths occurred as a result of the procedure. Median global survival was 8 months. Adjusting for age and Eastern Cooperative Oncology Group Performance Status (ECOG), extrinsic compression or mixed airway obstructions [hazard ratio (HR) =2.075; P=0.012], successful bronchoscopic intervention (HR =0.468; P=0.025) and initiation of cancer treatment (HR =0.373; P=0.006) were independent predictors of survival. The absence of distal airway patency on thoracic CT was independently associated with failure of the intervention [odds ratio (OR) =0.013; P<0.001]. Conclusions Interventional bronchoscopy has proven to be an efficient and safe strategy to manage MAO patients. The patients who benefit the most in terms of survival are those with purely endoluminal lesions, in whom technical success was achieved and those whose cancer-specific treatment was initiated. Distal airway patency on thoracic CT predicts the technical success of bronchoscopic intervention.
Collapse
Affiliation(s)
- Cláudia Freitas
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
| | - Mariana Serino
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal
| | - Catarina Cardoso
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal
| | - Sandra Saleiro
- Department of Pulmonology, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto) EPE, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - Ana Paula Vaz
- Department of Pulmonology, Unidade de Saúde Local de Matosinhos - Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Senhora da Hora, Portugal
| | - Hélder Novais-Bastos
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), Instituto de Biologia Molecular e Celular (IBMC), University of Porto, Rua Alfredo Allen, Porto, Portugal
| | - António Morais
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
| | - Adriana Magalhães
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal
| | - Gabriela Fernandes
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
| |
Collapse
|
37
|
Nawashiro A, Tanaka F, Taira A, Shinohara S, Takenaka M, Kuroda K, Shimajiri S. Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer. Surg Case Rep 2022; 8:17. [PMID: 35061129 PMCID: PMC8782972 DOI: 10.1186/s40792-022-01371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Salvage surgery following definitive radiotherapy or systemic treatment has become a feasible treatment option in selected patients with advanced initially unresectable non-small cell lung cancer. Recent clinical trials of neoadjuvant treatment have showed that surgery following immuno-chemotherapy is safely performed. Here, we present the first case of salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced lung large cell carcinoma.
Case presentation
A 44-year male was admitted to our hospital for salvage surgery. Ten months prior to this administration, he had been diagnosed with unresectable large cell carcinoma with malignant pericardial effusion (clinical stage IVA/T3N2M1A; no driver-gene alteration) originating from the right upper lobe (RUL). Due to rapid intrabronchial tumor growth causing severe dyspnea, emergency bronchial stenting in the right main bronchus using an expandable metallic stent had been performed. Thereafter, he had received immuno-chemotherapy with concurrent definitive radiotherapy. Despite dramatic radiographic response, he had suffered from persistent and refractory Pseudomonas aeruginosa lung infection associated with bronchial stent placement. As pericardial effusion had disappeared and no distant metastasis had developed, he was diagnosed with a potentially curable disease and was referred to our hospital. An extended sleeve resection was successfully performed, and pathological sections revealed that pathologic complete response was achieved with immuno-chemo-radiotherapy. The patient received no subsequent treatment, and is alive without tumor recurrence at 8 months after surgery.
Conclusions
Salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced non-small cell lung cancer may be feasible in selected patients, and may be considered as a treatment option to control local disease.
Collapse
|
38
|
Ratwani AP, Davis A, Maldonado F. Current practices in the management of central airway obstruction. Curr Opin Pulm Med 2022; 28:45-51. [PMID: 34720097 DOI: 10.1097/mcp.0000000000000838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Airway obstruction continues to cause substantial pulmonary morbidity and mortality. We present a review of classic, current, and evolving management techniques, highlighting recently published studies on the topic. Recommendations have historically been primarily based on anecdotal experience, case reports, and retrospective studies, but more solid evidence has emerged in the last decade. RECENT FINDINGS Novel endobronchial stents are being developed to mitigate the issues of stent migration, mucus plugging, fracture, and granulation tissue formation. Endobronchial drug delivery has become an active area of translational and clinical research, especially with regards to antineoplastic agents used for malignant airway stenosis. Even classic or updated techniques such as spray cryotherapy, injections of mitomycin-c, and balloon dilation have recently been examined in methodologically sound studies. Finally, recently published data have confirmed that patient breathlessness and quality of life improve significantly with therapeutic airway interventions. A multimodal and multidisciplinary approach to patient care is key to achieving the best outcomes. SUMMARY The treatment of central airway stenosis is often multimodal and should focus on patient-centric factors, taking into account risks and benefits of the procedure, operator, and center expertise, and always occur in the context of a multidisciplinary approach. Evidence-based clinical research is increasingly driving patient management.
Collapse
Affiliation(s)
| | - Andrea Davis
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | |
Collapse
|
39
|
Weinberg AL, Graham DJ, Meyerov DJ, Moshinsky DJA, Aitken DSAA, Spanger DM, Knight DS. Tracheal stent buckling and in-stent stenosis: a case report and proposed airway management algorithm for airway obstruction for patients with tracheal stents. J Cardiothorac Vasc Anesth 2022; 36:3139-3146. [DOI: 10.1053/j.jvca.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
|
40
|
Soriano L, Khalid T, Whelan D, O'Huallachain N, Redmond KC, O'Brien FJ, O'Leary C, Cryan SA. Development and clinical translation of tubular constructs for tracheal tissue engineering: a review. Eur Respir Rev 2021; 30:30/162/210154. [PMID: 34750116 DOI: 10.1183/16000617.0154-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory medicine. The trachea is a 10-11 cm long fibrocartilaginous tube of the lower respiratory tract, with 16-20 tracheal cartilages anterolaterally and a dynamic trachealis muscle posteriorly. Tracheal resection is commonly offered to patients suffering from short-length tracheal defects, but replacement is required when the trauma exceeds 50% of total length of the trachea in adults and 30% in children. Recently, tissue engineering (TE) has shown promise to fabricate biocompatible tissue-engineered tracheal implants for tracheal replacement and regeneration. However, its widespread use is hampered by inadequate re-epithelialisation, poor mechanical properties, insufficient revascularisation and unsatisfactory durability, leading to little success in the clinical use of tissue-engineered tracheal implants to date. Here, we describe in detail the historical attempts and the lessons learned for tracheal TE approaches by contextualising the clinical needs and essential requirements for a functional tracheal graft. TE manufacturing approaches explored to date and the clinical translation of both TE and non-TE strategies for tracheal regeneration are summarised to fully understand the big picture of tracheal TE and its impact on clinical treatment of extensive tracheal defects.
Collapse
Affiliation(s)
- Luis Soriano
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Joint first authors
| | - Tehreem Khalid
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Joint first authors
| | - Derek Whelan
- Dept of Mechanical, Biomedical and Manufacturing Engineering, Munster Technological University, Cork, Ireland
| | - Niall O'Huallachain
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen C Redmond
- National Cardio-thoracic Transplant Unit, Mater Misericordiae University Hospital and UCD School of Medicine, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Cian O'Leary
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
| | - Sally-Ann Cryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland .,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
| |
Collapse
|
41
|
Ruiz LJL, Zhu J, Fitzgerald L, Quinn D, Lach J. Capacitive Sensing for Monitoring Stent Patency in the Central Airway. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5441-5445. [PMID: 34892357 DOI: 10.1109/embc46164.2021.9630965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Central airway obstruction (CAO) is a respiratory disorder characterized by the blockage of the trachea and/or the main bronchi that can be life-threatening. Airway stenting is a palliative procedure for CAO commonly used given its efficacy. However, mucus impaction, secretion retention, and granulation tissue growth are known complications that can counteract the stent's benefits. To prevent these situations, patients are routinely brought into the hospital to check stent patency, incurring a burden for the patient and the health care system, unnecessarily when no problems are found. In this paper, we introduce a capacitive sensor embedded in a stent that can detect solid and colloidal obstructions in the stent, as such obstructions alter the capacitor's dielectric relative permittivity. In the case of colloidal obstructions (e.g., mucus), volumes as low as 0.1 ml can be detected. Given the small form factor of the sensor, it could be adapted to a variety of stent types without changing the standard bronchoscopy insertion method. The proposed system is a step forward in the development of smart airway stents that overcome the limitations of current stenting technology.Clinical Relevance- This establishes the foundation for smart stent technology to monitor stent patency as an alternative to rutinary bronchoscopies.
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Ichinomiya T, Murata H, Sekino M, Yokoyama H, Ogami-Takamura K, Higashijima U, Ashizawa N, Izumikawa K, Machino R, Matsumoto K, Nakaji S, Yoshitomi O, Hara T. Tracheobronchial Stent Insertion Under Venovenous Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease 2019. J Cardiothorac Vasc Anesth 2021; 36:2548-2552. [PMID: 34607762 PMCID: PMC8429073 DOI: 10.1053/j.jvca.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Taiga Ichinomiya
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Murata
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Motohiro Sekino
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruka Yokoyama
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keiko Ogami-Takamura
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ushio Higashijima
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobuyuki Ashizawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shun Nakaji
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Osamu Yoshitomi
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
44
|
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.
Collapse
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.)
| |
Collapse
|
45
|
A Parametric Tool for Studying a New Tracheobronchial Silicone Stent Prototype: Toward a Customized 3D Printable Prosthesis. MATHEMATICS 2021. [DOI: 10.3390/math9172118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of complex airway disorders is challenging, as the airway stent placement usually results in several complications. Tissue reaction to the foreign body, poor mechanical properties and inadequate fit of the stent in the airway are some of the reported problems. For this reason, the design of customized biomedical devices to improve the accuracy of the clinical results has recently gained interest. The aim of the present study is to introduce a parametric tool for the design of a new tracheo-bronchial stent that could be capable of improving some of the performances of the commercial devices. The proposed methodology is based on the computer aided design software and on the finite element modeling. The computational results are validated by a parallel experimental work that includes the production of selected stent configurations using the 3D printing technology and their compressive test.
Collapse
|
46
|
Shan Q, Huang W, Shang M, Wang Z, Xia N, Xue Q, Mao A, Ding X, Wang Z. Treatment of aerodigestive fistulas with a novel covered metallic Y-shaped segmented airway stent customized with the assistance of 3D printing. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1051. [PMID: 34422963 PMCID: PMC8339849 DOI: 10.21037/atm-21-733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/02/2021] [Indexed: 11/12/2022]
Abstract
Background The management of aerodigestive fistula remains challenging. An airway stent that matches well with the individual geometry of the airway is needed for the treatment of the aerodigestive fistula. This study aimed to evaluate the feasibility of a novel covered metallic segmented Y-shaped airway stent customized with the assistance of 3D printing in aerodigestive fistulas involving the carina and distal bronchi and to compare the flexibility of the novel stent with the conventional wholly knitted stent. Methods In the flexibility study, we measured the longitudinal bending force and spring-back force of the segmented stent and wholly knitted stent. Patient-specific stents that were individually customized with the assistance of 3D printing technology were implanted in 26 patients with aerodigestive fistulas. The technical success, clinical success, Karnofsky performance status (KPS), and stent-related complications were recorded. Results The bending force and spring-back force of the segmented stent were significantly lower than those of the wholly knitted stent. Stent deployment was technically successful in all patients. Clinical success was obtained in 21 patients. The KPS of patients after the stenting procedure improved significantly compared with that before stenting (P<0.001). During follow-up, granulation tissue proliferation, sputum retention, stent migration, and intolerance of the stent were found in 2, 5, 1, and 1 patient, respectively. Conclusions The segmented metallic Y-shaped airway stent had greater flexibility than the wholly knitted stent in an ex vivo setting. Implantation of the segmented stent individually customized with the aid of 3D printing is feasible in treating aerodigestive fistulas involving the carina and bronchi distal to the carina.
Collapse
Affiliation(s)
- Qungang Shan
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Shang
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Xia
- Department of Radiology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiwu Mao
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Radiology, Ruijin Hospital/Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
47
|
Marujo F, Gomes FV, Rodrigues F, Flores P. Diagnostic and Treatment Challenge of Left Anomalous Bronchial Artery: A Case of Recurrent Stridor in a 15-Month-Old Boy. Arch Bronconeumol 2021; 57:549-550. [PMID: 35699037 DOI: 10.1016/j.arbr.2020.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/28/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Filipa Marujo
- Pediatric Department, Hospital Dona Estefania, Pediatric University Hospital, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; Centro da Criança e do Adolescente, Hospital CUF Descobertas, Lisbon, Portugal.
| | - Filipe Veloso Gomes
- Interventional Radiology Department, Hospital da Cruz Vermelha, Lisboa, Portugal
| | | | - Pedro Flores
- Centro da Criança e do Adolescente, Hospital CUF Descobertas, Lisbon, Portugal
| |
Collapse
|
48
|
Shan Q, Huang W, Wang Z, Xue Q, Shi Z, Zhou J, Wu Z, Ding X, Mao A, Shang M, Wang Z. Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis. Front Oncol 2021; 11:619781. [PMID: 34381701 PMCID: PMC8350761 DOI: 10.3389/fonc.2021.619781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aims to assess the feasibility of a novel metallic segmented transcordal stent modified with three-dimensional (3D) printing for treating inoperable malignant laryngotracheal stenosis and the tolerability of the stent. Methods This was a retrospective study. The stents were individually customized with the aid of 3D printing model based on the anatomic features of each patient’s airway. The stent was composed of two separate segments that corresponded to the larynx and the upper trachea. The stents were barrel-shaped at the proximal end to prevent migration. The proximal end of the stent was located slightly above the vocal cord. The technical and clinical success of stenting procedure, patient tolerability, and stent-related complications of patients were evaluated. Results Ten patients with dyspnea caused by malignant laryngotracheal stenosis underwent implantation of such stents. Technical and clinical success of the stenting procedure were achieved in all patients. For all patients, basic communication in life could be maintained by speaking softly. During follow-up, one patient showed intolerance to the stent, and the stent was retrieved 2 weeks after stenting. Stent migration was found in one patient, and the position of the stent was readjusted. Granulation tissue proliferation was found in two patients and was treated with cryotherapy by bronchoscopy. There were no deaths associated with stenting. Conclusions The individually customized metallic segmented transcordal stent is feasible and tolerable for patients with inoperable malignant laryngotracheal stenosis. The implantation of this stent may serve as a novel alternative treatment for patients who are not suitable for surgery or tracheotomy.
Collapse
Affiliation(s)
- Qungang Shan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyin Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Shi
- Department of Otolaryngology & Head and Neck Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiwu Mao
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Shang
- Department of Interventional Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Radiology, RuiJin Hospital/Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
49
|
Izhakian S, Wasser WG, Vainshelboim B, Pertzov B, Gorelik O, Kramer MR. Long-term outcomes of metallic endobronchial stents in lung transplant recipients are not affected by bacterial colonization. Interact Cardiovasc Thorac Surg 2021; 32:47-54. [PMID: 33372228 DOI: 10.1093/icvts/ivaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We evaluated associations of endobronchial stenting with airway bacterial colonization, the antimicrobial resistance profile, hospitalizations for pneumonia and survival in lung transplant recipients. METHODS This is a retrospective single-centre study of 582 recipients of lung transplant during 2002-2018. We compared outcomes of 57 patients (9.7%) who received endobronchial stents (intervention group) to a control group of 57 patients without stents who were matched one to one for age, sex, year of transplantation, unilateral/bilateral transplantation and underlying disease. RESULTS For the intervention compared to the control group, airway colonization was more common for Pseudomonas (86% vs 35%, P < 0.001), Acinetobacter (21% vs 7%, P = 0.05), Klebsiella (21% vs 5%, P = 0.02) and Staphylococcus species (11% vs 0%, P = 0.02). The respective proportions of patients with positive bronchoalveolar lavage cultures on the third post-transplantation day, the day of stent insertion and 6-month post-stent insertion were 47.4%, 50.9% and 65.4% for Pseudomonas sp.; 15.8%, 12.3% and 3.8% for Klebsiella sp.; and 8.8%, 5.3% and 5.8% for Acinetobacter sp. The mean number of hospitalizations for pneumonia per patient was higher, without statistical significance, in the intervention than the control group (1.5 ± 1.7 vs 0.9 ± 1.5, P = 0.1). Kaplan-Meier survival curves did not show a statistically significant difference between the intervention group and the entire group without endobronchial stents (n = 525) (P = 0.4). CONCLUSIONS Lung transplant recipients with endobronchial stents were more likely to be colonized with pathologic bacteria and having pneumonia; however, stent placement was not associated with increased long-term mortality with appropriate stent maintenance.
Collapse
Affiliation(s)
- Shimon Izhakian
- Rabin Medical Center, Pulmonary Institute (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Petah Tikva, Israel.,Department of Internal Medicine F, Shamir (Assaf Harofeh) Medical Center (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Zerifin, Israel
| | - Walter G Wasser
- Mayanei Hayeshua Medical Center, Bnei Brak and Rambam Health Care Campus, Haifa, Israel
| | - Baruch Vainshelboim
- Rabin Medical Center, Pulmonary Institute (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Petah Tikva, Israel
| | - Barak Pertzov
- Rabin Medical Center, Pulmonary Institute (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Petah Tikva, Israel
| | - Oleg Gorelik
- Department of Internal Medicine F, Shamir (Assaf Harofeh) Medical Center (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Zerifin, Israel
| | - Mordechai R Kramer
- Rabin Medical Center, Pulmonary Institute (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Petah Tikva, Israel
| |
Collapse
|
50
|
Ni Fhlatharta M, Khan A, Carton E, Redmond KC. Pre-emptive extracorporeal membrane oxygenation to support endobronchial stenting for severe airway obstruction. Eur J Cardiothorac Surg 2021; 59:1345-1346. [PMID: 33225355 DOI: 10.1093/ejcts/ezaa425] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/10/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022] Open
Abstract
Tracheobronchial stent insertion is a common palliative intervention for the management of dynamic airway collapse due to severe tracheobronchomalacia or tracheal compression due to mass effect [1]. Airway stents are usually placed bronchoscopically with or without fluoroscopy. In more complex cases, airway stents are placed using a rigid bronchoscope under general anaesthesia with conventional or jet ventilation. In patients where advancement of a rigid bronchoscope into the distal airway or ventilation through a rigid bronchoscope may be difficult, pre-emptive awake veno-venous extracorporeal membrane oxygenation should be considered. This report is the first publication to describe a novel technique in a series of patients being treated for critical airway obstruction who would otherwise be at risk of respiratory arrest at the induction of anaesthesia.
Collapse
Affiliation(s)
- Meadhbh Ni Fhlatharta
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Asad Khan
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edmund Carton
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Karen C Redmond
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|