Bronchoscopic guidance of endovascular stenting limits airway compression

Ebrahim, Mohammad; Hagood, James S.; Moore, John W.; El‐Said, Howaida

doi:10.1002/ccd.25772

Cited by 13 publications

(13 citation statements)

References 6 publications

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“…Our results demonstrate that with assistance of procedural bronchoscopy during test angioplasty, immediate and dynamic assessment of the risk of bronchial compression is possible. In a case series of two patients, Ebrahim and colleagues a similar approach during stent angioplasty of the LPA (2 patients) and redilation of previously placed aortic stents (3 procedures in 2 patients)[10]. In this series, bronchoscopy was not technically challenging and not accompanied by any procedure-related adverse events, consistent with previously published series[11–13].…”

Section: Discussionsupporting

confidence: 80%

“…We would advocate pre-procedural CMR, which can measure pulmonary artery flow splits, identify anatomic stenosis, and lay out the relationship of aorta, pulmonary artery, and bronchus with no radiation exposure. This is in lieu of CTA or rotational angiography whose use has been reported by other groups concerned with this complication[10]. Procedural bronchoscopy and test angioplasty has the potential to reduce the need for post-procedural CTA if a stent is deployed.…”

Section: Discussionmentioning

confidence: 99%

“…This is to avoid having to perform subsequent balloon angioplasty in these patients. Though other groups have reported using procedural bronchoscopy to further dilate stents in patients with coarctation [10], there is an inherent issue with this approach. As has been pointed out[14], once a stent has been deployed, there is no opportunity for a test balloon angioplasty.…”

Section: Discussionmentioning

confidence: 99%

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Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty

et al. 2015

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Background Stenosis of the pulmonary arteries frequently occurs during staged palliation of hypoplastic left heart syndrome and variants, often necessitating stent angioplasty. A complication of stent angioplasty is compression of the ipsilateral main-stem bronchus. Following such a case, we re-evaluated our approach to PA stent angioplasty in these patients. Methods The incident case is described. A retrospective observational study of children and adults with superior(SCPC) and/or total cavopulmonary connection(TCPC) undergoing left pulmonary artery (LPA) stent angioplasty between 1/1/2005 and 5/1/2014 and subsequent chest CT was performed to assess the incidence of bronchial compression. The current strategy of employing bronchoscopy to assess bronchial compression during angioplasty is described with short-term results. Results 65 children and adults underwent LPA stent angioplasty. Other than the incident case, none had symptomatic bronchial compression. Of the total study population, 12% had subsequent CT, of which 1 subject had moderate bronchial compression. To date, 7 subjects have undergone angioplasty of LPA stenosis and bronchoscopy. In one case, stent angioplasty was not performed because of baseline bronchial compression, exacerbated during angioplasty. In the rest of cases, mild-moderate compression was seen during angioplasty. Following stent angioplasty, the resultant compression was not worse than that seen on test angioplasty. Conclusion Bronchial compression is a rare complication of stent angioplasty of the pulmonary arteries in children and adults with SCPC/TCPC. Angioplasty of the region of interest with procedural bronchoscopy can help to identify patients at risk of this complication.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty

et al. 2015

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“…We briefly entertained whether compliance testing with simultaneous bronchoscopy as described in other clinical scenarios was worthwhile. However, this maneuver requires crossing the PDA with a wire, which, in our experience, can result in profound cyanosis and hemodynamic instability, especially in patients in whom the PDA is tortuous and/or the sole source of pulmonary blood flow.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Smith

Saul

Goldfarb

et al. 2020

Cathet Cardio Intervent

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Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock-Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0-12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.

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“…Flexible bronchoscopy has been used to guide endovascular stenting decreasing the risk of catastrophic airway compression [5]. Other specialists prefer cross-section imaging such as magnetic resonance imaging or computed tomography (CT) of the chest to better assess the vessel/airway relationship prior to a procedure and interventional planning [6].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of airway segmentation from three-dimensional rotational angiography

et al. 2020

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Bronchoscopic guidance of endovascular stenting limits airway compression

Abstract: In cases at risk for airway compromise, flexible bronchoscopy is a useful tool to guide endovascular stenting. Maximum safe stent diameter can be determined without risking catastrophic airway compression.

Cited by 13 publications

References 6 publications

Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty

Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Feasibility of airway segmentation from three-dimensional rotational angiography

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