Chest
Volume 114, Issue 1, July 1998, Pages 106-109
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Clinical Investigations
Self-expandable Metallic Airway Stent Insertion Employing Flexible Bronchoscopy: Preliminary Results

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We describe 37 patients in whom 52 self-expandable metallic stents were successfully placed using a flexible bronchoscope. Indications for stenting were tracheobronchomalacia (n=13), neoplasia (n=20), and tracheal stenosis (n=4). Airway patency was restored in all patients. Symptoms improved in all but one patient. The median follow-up for all patients and the group of 16 patients alive has been 21 and 69.5 weeks, respectively. Complications have included granulomas and bronchitis. Migration or mucus plugging was not encountered. We conclude that metallic stents can be inserted safely using a flexible bronchoscope. At least in the short term, major complications are uncommon.

Section snippets

Materials and Methods

Patients suspected of having a large airway obstruction underwent FB to confirm the diagnosis and assess the need for stent placement, with or without laser photoresection (LPR). The length of the obstructed segment was measured by withdrawing the tip of the FB from its distal to the proximal end. An estimate of the length as well as the diameter of the corresponding normal airway was also obtained from a three-dimensional CT scan of the chest. Pulmonary function tests (PFTs) were performed as

Results

Between April 1995 and August 1997, we placed 52 stents in 37 patients. There were 24 men and 13 women, with a mean age of 56 years (range, 31 to 94 years). Indications for stenting included symptomatic airway obstruction from tracheobronchomalacia (TBM [n=13]), neoplasia (n=20), and tracheal stenosis (TS [n=6]). Number, size, and location of stent deployment are shown in Table 1.

Of the 37 patients, 19 presented with chronic symptoms (worsening cough or dyspnea) and 18 had acute symptoms (acute

Discussion

The success of metallic stents in the esophagus, biliary, and vascular tree has led to their subsequent use in the tracheobronchial tree. The advantages of the metallic stents are ease of placement, visibility on an ordinary radiograph, dynamic expandability, and preservation of ventilation when placed across lobar orifices.4

The recently introduced Wallstent is an example of an SEMS. Its design provides a characteristic outward radial force, which is exerted uniformly over the tracheobronchial

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Presented at the annual session of the American College of Chest Physicians, New Orleans, October 26–30, 1997.

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