Airway stents

Abstract

Stents and tubes to maintain the patency of the airways are commonly used for malignant obstruction and are occasionally employed in benign disease. Malignant airway obstruction usually results from direct involvement of bronchogenic carcinoma, or by extension of carcinomas occurring in the esophagus or the thyroid. External compression from lymph nodes or metastatic disease from other organs can also cause central airway obstruction. Most malignant airway lesions are surgically inoperable due to advanced disease stage and require multimodality palliation, including stent placement. As with any other medical device, stents have significantly evolved over the last 50 years and deserve an in-depth understanding of their true capabilities and complications. Not every silicone stent is created equal and the same holds for metallic stents.Herein, we present an overview of the topic as well as some of the more practical and controversial issues surrounding airway stents. We also try to dispel the myths surrounding stent removal and their supposed use only in central airways. At the end, we come to the long-held conclusion that stents should not be used as first line treatment of choice, but after ruling out the possibility of curative surgical resection or repair.

Endobronchial removal of uncovered stent using argon plasma coagulation via fibreoptic bronchoscopy

“…Airway stents have become an important part of bronchial stenosis management due to their feasibility and cost effectiveness. Complications of endobronchial stents largely depend on the type of stent and individual patient response that is amplified by the presence of airway bacterial colonization, infection, and poor bronchial neovascularization post implantation .…”

“…Uncovered endobronchial stent removal can be challenging, especially if it has been in place for a prolonged period of time as granulation tissue forms and the stent becomes embedded into the airway wall due to epithelialization. Embedded metallic stents are usually removed in the operating room, using rigid bronchoscopy and following repeated treatment of granulation tissue and exposing the stent .…”

“…It often requires repeated balloon dilations or endobronchial treatments, including laser ablation, cryotherapy, and possibly endobronchial stent placement . Endobronchial stents, particularly uncovered ones, may have several complications, including excessive granulation tissue that may cause airways obstruction and impaired mucociliary clearance that may lead to further inflammation and subsequent infections .…”

Updates on bronchoscopic management of airway disease

“…Due to the limited evidence in the literature, there is no well‐established guideline on the choice of stents in managing airway diseases . The general consensus is that uncovered metallic stents should not be used when there are other stent options available.…”

A Case of a Temporary Endotracheal Stent for Airway Management in a Patient with Primary Thyroid Lymphoma

“…Currently, a wide range of stent types (such as metal, silicone, self-expanding metal, and hybrid stents) are available for the management of different clinical conditions and their application has been shown to be effective in the treatment of malignant lesions, despite some side effects such as stent migration or malposition, granulation formation, infection, mucoid impaction. 4) Here, we report the recent case of a patient with primary thyroid DLBL who presented with airway compression but was not considered eligible for surgery. Therefore, a temporary tracheal silicone stent was inserted to allow time for chemotherapy to be administered.…”