Airway stenting for central airway obstruction: a review

Abstract

Central airway obstruction is a serious complication of various diseases, most often malignancy. Malignant etiologies include primary lung cancer as most common though metastases from various other cancers can obstruct the airways as well. Benign etiologies include inflammatory or fibrotic changes due to prior airway interventions (e.g., endotracheal intubation or tracheostomy) or specific autoimmune conditions. Different interventional modalities exist including various electrosurgical or mechanical debulking tools, though these are sometimes insufficient or contraindicated for the purpose of restoration of airway patency. The placement of stents is thus needed in certain particularly complex or refractory cases. Airway stenting requires careful patient selection and stent selection along with a thorough knowledge of relevant anatomy and procedural technique. Indeed, certain clinical presentations are better suited for stent placement and more likely to achieve a symptomatic benefit. Moreover, a variety of stents exist with each having different attributes that may better fit specific conditions. Complications must be managed properly as well. These include stent migration, granulation tissue formation, and stent-related infection which can have clinically significant consequences. In this review, we will discuss airway stenting for central airway obstruction with regard to these various subject areas as well as conclude with discussion of future research directions.

A novel method for precise implantation of tracheal Y-shaped stent

“…Surgery is an effective treatment, but some patients cannot undergo it due to poor performance status or advanced tumors. In such cases, airway stent implantation is a valuable alternative ( 13 , 14 ), which can quickly relieve breathing difficulties and allow for further treatments, and extend the survival time. After successful alleviation of stenosis, the stent can be safely removed, significantly improving the patient’s quality of life ( 15 ).…”

Trachealtumoren

“…Am häufigsten werden beschichtete Nitinol-oder Silikonstents verwendet, um ein Einwachsen des Tumors in den Stent und eine In-Stent-Stenose zu verhindern. Mögliche Komplikationen nach Stentimplantation sind Sekretverhalt, Hypergranulation und Restenosen, die häufig erneute interventionelle Bronchoskopien erforderlich machen [28,29]. Aufgrund der beschriebenen Komplikationen sowie des Risikos der mechanischen Trachealmazeration durch Druckulzeration ist eine längerfristige Stenteinlage vor geplanter kurativer Tumorresektion unbedingt zu vermeiden [30].…”

Airway Stents in Interventional Pulmonology

“…Among the various airway pathologies that may require stent placement, malignant airway obstruction is the most common [5,6]. Most commonly a result of primary lung cancer, airway obstruction can also develop from pulmonary metastases or intrathoracic complications from other malignancies, including lymphoma or breast, esophageal, colon, and renal cell carcinomas [1].…”

“…Airway obstruction generally consists of three main types: intrinsic (or endoluminal), extrinsic (or extraluminal), and mixed obstruction [5,6]. For intrinsic obstructions, which are most commonly a result of endoluminal tumor growth, therapeutic bronchoscopic interventions with the application of various ablative therapies can often provide adequate airway recanalization without stent placement [10][11][12].…”

“…Mixed obstructions, which occur because of a combination of intrinsic and extrinsic compression, typically require a combined approach. This includes various ablative interventions to address the endoluminal component, followed by dilation and stent placement, if needed, to restore airway patency [6]. Figures 1-3 depict examples of airway stenting in malignant airway obstructions.…”