Clinical Outcomes with Airway Stents for Proximal versus Distal Malignant Tracheobronchial Obstructions
Section snippets
Patient Population
Over a 9-year period (1993–2002), 50 patients underwent endobronchial stent procedures at our institution. Thirty-three procedures in 30 patients were performed for malignant airway disease. Institutional review board approval was granted for a retrospective review of this study population composed of 19 men and 11 women with an age range of 38 – 87 years (mean, 59 years). Indications for stent placement were dyspnea/respiratory distress in 27 patients and refractory postobstructive pneumonitis
RESULTS
Twenty-nine of 30 patients (97%) showed an improvement in at least two of three categories after stent placement. One patient did not show improvement after bronchial stent placement and survived only 29 days after the procedure.
Ten patients (33%) showed radiographic improvement, with clearing of infiltrates and improved lung expansion by CT or chest radiography. After airway stent placement, all bronchograms and/or bronchoscopy showed patent stent-implanted segments without residual narrowing.
DISCUSSION
Bronchogenic and esophageal carcinoma are the most frequent causes of MTS, which can result in serious patient morbidity resulting from dyspnea, hemoptysis, or unrelenting obstructive pneumonitis. For good surgical candidates, the treatment of choice remains lobectomy or pneumonectomy. However, patients with advanced thoracic malignancies often have symptomatic tracheobronchial obstruction. External-beam and/or endobronchial radiation therapy is another option for patients with MTS, with some
CONCLUSIONS
A majority (>90%) of patients with MTS show clinical and subjective improvement after tracheobronchial stent placement. However, only one third show immediate postprocedural radiographic improvement, and approximately 10% of patients will experience significant delay (1–2 weeks) before their dyspnea subsides. Clinical response is independent of airway stent location, and distal airway stents provide the same relief of dyspnea and similar survival time as proximal stents. Accordingly,
Acknowledgment
The authors thank Vicki McDowell for her time and effort in preparing this manuscript.
REFERENCES (15)
A dedicated tracheobronchial stent
Chest
(1990)- et al.
Implantation of Ultraflex nitinol stents in malignant tracheobronchial stenoses
Chest
(2000) Malignant tracheal tumors
Mayo Clin Proc
(1993)- et al.
Massive brachiocephalic artery bleeding due to a Gianturco tracheal stent
J Vasc Interv Radiol
(1993) - et al.
Kirekte endoskopie der luft—und speisewege
Stuttgart: Enke
(1915) - et al.
Study on the treatment of tracheobronchial stenosis using expandable metallic stents
J Nippon Med Sch
(2001) - et al.
Symptomatic improvement in dyspnea following tracheobronchial metallic stenting for malignant airway obstruction
Acta Radiol
(2000)
Cited by (30)
Simulation of stent mechanical testing
2022, Cardiovascular and Respiratory BioengineeringPrognostic factors associated with interventional bronchoscopy in lung cancer
2014, Annals of Thoracic SurgeryReply
2011, Annals of Thoracic SurgeryTimely airway stenting improves survival in patients with malignant central airway obstruction
2010, Annals of Thoracic SurgeryCitation Excerpt :While these data have been reported previously [27–33], to date we have found no literature regarding the impact of tracheobronchial stenting on improved survival. Historically, survival of patients with untreated malignant central airway obstruction ranges from 1 to 2 months [20, 21]. Airway stenting with or without radiation therapy results in significant palliation of symptoms in patients with poor performance status (MRC dyspnea score − 5, ECOG − 4) but has no significant survival benefit when compared with historic controls.
Virtual optimization of self-expandable braided wire stents
2009, Medical Engineering and PhysicsManagement of airway involvement of oesophageal cancer using covered retrievable nitinol stents
2009, Clinical RadiologyCitation Excerpt :Although covered stents have several disadvantages, including high migration rate, low mucociliary clearance, and high sputum retention, their removability in patients with stent-related complications makes them, on balance, more advantageous than uncovered.12 Although there have been several studies of airway stent placement in patients with airway involvement of oesophageal cancer,5–10,12–24 little is known about the safety and efficacy of fluoroscopically guided placement of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement. Therefore, the aim of the present study was to evaluate the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with malignant airway stricture and/or ERF.
None of the authors have identified a conflict of interest.