A small bifurcated self-expanding metallic stent for malignant bronchial fistula or severe stenosis around the upper left carina

Abstract

Background Bifurcated self-expanding metallic stents have mainly been primarily used for the treatment of airway disease around the main carina, but few studies have reported the use of small bifurcated stents to treat malignant bronchial fistula or severe stenosis around the upper left carina. Purpose We aimed to determine the safety, feasibility, and efficacy of small metallic bifurcated stent placement in the upper left carina. Material and Methods Twenty-two patients with malignant bronchial disease were treated with small bifurcated stents. All bifurcated stents were custom-designed according to the measurement of CT measurements and placed under local anesthesia with fluoroscopic guidance. Clinical outcomes and CT imaging data were retrospectively analyzed. Results A total of 27 stents were used in 22 patients, with two stents removed immediately after placement due to stent insufficient dilation and failure of sealing fistula. Twenty patients underwent successful treatment, with a technical success of 90.9%. Thirteen complications were found in 9 (40.9%) patients. Five patients underwent successful stent removal due to failure of sealing fistula (n = 2) or because they were effectively cured (n = 3) during the follow-up period. Ten patients died of cancer, one patient died of chronic renal failure, and one died of myocardial infarction. The one-, three-, and five-year survival rates were 48.0%, 40.0%, and 32.0%, respectively. The median survival was 12.7 months. Conclusion Small bifurcated self-expanding metallic stents are a safe and effective treatment option for malignant bronchial fistula or severe stenosis around the upper left carina, but complications are relatively high. Further prospective studies are needed to evaluate alternative treatment options.

Hybrid stenting with silicone Y stents and metallic stents in the management of severe malignant airway stenosis and fistulas

“…And the complications are similar among two types of the stents in most conditions which included migration, granulation, diminished mucociliary clearance and patient intolerance. Previous studies have reported the complication rate of 16.1-40.9% in re-establishment of airway with Y stents and 31.3-44.4% with SEMS (15)(16)(17).…”

Stents for small airways: current practice

“…All patients have to inhale 0.9 saline with nebulizer four times a day. The stent of this type is not self-expanding and we have to place it correctly the first time and use the inner balloon to expand it with 8-12 bars [22,23]. Afterward maybe the stent can be removed and replaced by a bigger stent (7 × 22 mm iCAST, 10 mm Dumon) after three months in order to avoid the adverse effects of a metallic stent (Figure 3).…”