Percutaneous Transtracheal Approach for Endobronchial Stenting

Benign tracheobronchial strictures: long-term results and factors affecting airway patency after temporary stent placement

OBJECTIVE

The purpose of our study was to evaluate long-term results and identify factors affecting airway patency after temporary placement of a covered, retrievable nitinol stent for benign tracheobronchial strictures.

MATERIALS AND METHODS

Polyurethane or polytetrafluoroethylene (PTFE)-covered retrievable expandable nitinol stents were placed fluoroscopically in 24 patients with benign tracheobronchial strictures. Improvement in respiratory status and complications were evaluated. Maintained patency of airway after temporary stenting was calculated and compared between the 2- and 6-month stenting groups. Factors for maintained patency after temporary stenting were evaluated.

RESULTS

A total of 30 stents were successfully placed and well tolerated in 24 patients. Tissue hyperplasia, stent migration, and bronchial obstruction of the left upper lobe occurred in 36.7%, 13.3%, and 3.3% of patients, respectively. All stents were successfully removed electively either 2 (n = 12) or 6 (n = 12) months after placement or when complications occurred (n = 6). During the follow-up period (mean, 24 months), dyspnea recurred in 15 of the 24 patients. The 6-month stenting group showed a lower recurrence rate (41.7% vs 83.3%, p = 0.045) and a better mean maintained patency (39.7 +/- 7.8 vs 9.4 +/- 5.4 months, p = 0.001) than the 2-month stenting group. Multivariate analysis showed that duration of stent placement (p = 0.002) and the occurrence of tissue hyperplasia (p = 0.026) were associated with maintained patency after temporary stenting.

CONCLUSION

Temporary placement of a covered, retrievable, expandable nitinol stent may be a safe and effective treatment for benign tracheobronchial strictures during the period the stent is in place. A high symptomatic recurrence rate of 62.5% was found after stent removal. Shortterm placement of the stent and tissue hyperplasia were associated with decreased airway patency.

Bronchial Catheterization with a TIPS Dilator After Failure of Conventional Technique

OBJECTIVE

A technique is presented for catheterization of an obstructed bronchus when use of a conventional vascular catheter has failed. In some cases, strictures become too stenotic or blunt for passage of a guidewire, making further intervention impossible. We attempted to negotiate a stricture opening using a transjugular intrahepatic portosystemic shunt (TIPS) dilator with a guidewire inside it.

CONCLUSION

The catheterization technique with a TIPS dilator was successful in nine cases in which use of conventional catheters and guidewires had failed.