Clinical Evaluation of a New Bifurcated Dynamic Airway Stent: a 5-year Experience with 135 Patients

Abstract

The Dynamic stent, a bifurcated airway prosthesis facilitating coughing, was clinically evaluated. The stents were inserted bronchoscopically in 135 patients (84 male, 51 female, age 12-90 years, mean 59 years) suffering from compression stenoses, strictures or malacias of the central airways, or tracheo-esophageal fistulas. Extrinsic compression from malignant and semi-malignant tumors was the leading indication for stenting (47.4%), followed by esophago-airway fistulas (22.2%) and post-intubation stenoses (14%). Stent insertion turned out to be very easy and could be performed without complications. The Dynamic stent was well tolerated and gave immediate relief of dyspnea in most cases. Follow-up data, three months after the last implantation revealed that at least 24 patients were still alive with a stent in place and free of complaints. In 27 cases, the stent had been removed after response to treatment. One of these patients received a second in order to seal a fistula, two months after removal of the first one. 85 patients, 79 with malignant, 6 with non-malignant diseases had died, with a mean survival time of 123 days (0 to 611 days). Complications directly attributable to the stent were rare. Two patients who had received the stent to counteract severe tracheal compression from aortic abnormalities died from arrosion and hemoptysis. There were no other severe complications. Cephalad migration occurred in 4/136 inserted stents. The Dynamic stent can be considered feasible, effective, and comparitively safe.

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

“…There is no clear advantage of any type of stent [88,89,91,92,95,[98][99][100][101][102][103][104]. Stents can be used temporarily [92,105] in a multimodality concept of cancer care and as a last palliative measure for end-stage cancer patients [106,107].…”

“…The Dynamic stent developed by FREITAG et al [92] (Boston Scientific Corporation, Natlick, MA, USA) is a hybrid stent made from silicone with horseshoe-shaped steel clasps. In their original form, and with individual modifications, they have been successfully used for the sealing of oesophagotracheal fistulas and stump fistulas [92,93]. Other bifurcated prostheses are available from the Hood Company (Hood Laboratories, Decature, GA, USA) and as part of the Dumon set.…”

Imaging guided thoracic interventions

“…Stents are inserted under sedation or anaesthesia, following previous dilatation or laser ablation of the stenosis under uoroscopic and endoscopic control. Two types of endobronchial stents are currently available in the tracheobronchial tree: silicone stents (Dumon, Dynamic, Reynders, and others) [181±183, 186,188,190] and metallic stents, the latter including either balloon expandable stents (Palmaz and Strecker) or selfexpanding stents (Gianturco, Wallstent, Ultra¯ex) [181,182,187,190,192,193,197,198]. Most metallic stents are available in covered and noncovered versions.…”

Reporting of Central Airway Obstruction on Radiology Reports and Impact on Bronchoscopic Airway Interventions and Patient Outcomes

“…These patients underwent multimodality therapy including tumor ablation with laser, APC, and electrocautery, balloon dilation, and airway stenting [Noppen et al 1997;Brichet et al 1999;Mughal et al 2005;Freitag et al 1997;Ost et al 2014;Okiror et al 2015]. Although large, randomized, controlled trials are lacking, retrospective and prospective data show notable improvement in patients' outcome and quality of life with CAO bronchoscopic management [Jeon et al 2006;Ernst et al 2004].…”