Clinical outcomes and survival following placement of self‐expandable metallic stents for central airway stenosis and fistula

Usuda, Katsuo; Iwai, Shun; Yamagata, Akira; Iijima, Yoshihito; Motono, Nozomu; Takahara, Yutaka; Shinomiya, Shohei; Oikawa, Taku; Mizuno, Shiro; Uramoto, Hidetaka

doi:10.1111/1759-7714.13707

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…The treatment and management of MCAS were very difficult until the time in which specific airway interventions were available, such as electrocautery, cold ablation, mechanical resection, laser, and airway dilatation [ 1 – 5 ]. MCAS can be rapidly resolved in most patients using therapeutic bronchoscopy [ 2 , 6 ]. However, airway restenosis commonly occurs after therapeutic bronchoscopy with the progress of the tumor.…”

Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy

et al. 2021

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Background Therapeutic bronchoscopy is one of the effective methods in the treatment and management of malignant central airway stenosis (MCAS). However, restenosis after therapeutic bronchoscopy frequently occurs and severe restenosis (SR) can be life-threatening. Therefore, this study aimed at investigating the risk factors for SR after therapeutic bronchoscopy. Methods The data of 233 consecutive cases with MCAS who were subjected to therapeutic bronchoscopy between 2015 and 2020 at a tertiary hospital were collected. Patients were divided into SR group and non-SR during 6 months after therapeutic bronchoscopy. Multiple logistic regression analysis was performed to determine the risk factors for SR. Results SR during 6 months after therapeutic bronchoscopy occurred in 39.5% (92/233) of patients. The location and the initial degree of MCAS were associated with SR, as assessed by multiple logistic regression analysis (P < 0.05). The risk of SR after therapeutic bronchoscopy in the left main bronchus, right main bronchus, and right intermediate bronchus increased, compared to the risk when of MCAS was located in the trachea (OR (95% CI) of 8.821 (1.850-25.148), 6.583 (1.791–24.189), and 3.350 (0.831–13.511), respectively). In addition, the initial degree of MCAS was positively associated with an increased risk of SR (OR 1.020; 95% CI 1.006–1.035). Conclusions MCAS located in the left main bronchus, right main bronchus and right intermediate bronchus, as well as the higher initial degree of MCAS were independent risk factors for SR during 6 months after therapeutic bronchoscopy.

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Section: Introductionmentioning

confidence: 99%

RETRACTED ARTICLE: Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy

et al. 2021

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“…Two previous studies have reported that patients with a poor ECOG PS have a short survival time after airway stenting (8,9). In contrast, SEMS placement in patients with a poor ECOG PS has been shown to be effective against malignant airway disorders (10). Another study reported improvements in airway intervention results, especially in patients with an ECOG PS 3-4, but did not include the AERO stent.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of AERO Stent Placement for Malignant Airway Disorder in Patients with a Poor Performance Status

Takigawa,

Sato,

Kudo

et al. 2024

Intern. Med.

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Objective Airway stenting is an established procedure for treating various airway disorders. The AERO stent (Merit Medical Systems, South Jordan, UT, USA) is a fully covered self-expandable metallic stent approved for use in Japan in 2014. However, its effectiveness in treating malignant airway disorders in patients with a poor performance status remains unclear. Therefore, we investigated the safety and efficacy of the AERO stent in patients with malignant airway disorders and a poor performance status. Patients and MethodsWe retrospectively reviewed the medical records of all patients who underwent AERO stent placement at our institute between April 2016 and March 2022, and 21 patients underwent 25 procedures for malignant airway disorders. All AERO stenting procedures were performed using an over-thewire delivery system with flexible and/or rigid bronchoscopy. Results Eighteen of the 21 patients (85.7%) had a poor general condition (Eastern Cooperative Oncology Group performance status 3 or 4). AERO stents were successfully placed in 23 of the 25 procedures and migrated in the remaining 2 cases. Complications occurred in 10 cases, with infection being the most common (3 cases). Fourteen patients (66.6%) showed an improvement in their performance status. In addition, 5 of the 6 intubated patients were extubated following AERO stenting, and 11 patients subsequently received anticancer treatment. ConclusionThe placement of the AERO stent is useful in patients with a poor performance status, including those who are intubated and afflicted with malignant airway disorders.

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“…There are multiple approaches to improve airway stenosis in malignant CAO patients, including mechanical debulking, cryotherapy, thermal therapy, and airway stent implantation (14)(15)(16). The metallic airway stent is a crucial treatment method for malignant airway stenosis, which is part of multimodal approach in malignant CAO patients (17)(18)(19). However, there are some limitations in the implantation procedures of previous stents, which should be implanted under X-ray or rigid/flexible bronchoscope visualization.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are some limitations in the implantation procedures of previous stents, which should be implanted under X-ray or rigid/flexible bronchoscope visualization. This is time-consuming and requires unnecessary radiation exposure and higher technical conditions (16)(17)(18)(19). Our previous pilot study demonstrated the preliminary application of a novel metallic airway stent in CAO patients (13), which could be inserted into the scope of a flexible bronchoscope and be implanted under direct visualization.…”

Section: Discussionmentioning

confidence: 99%

Comparison of operation time, efficacy and safety between through-the-scope stent and over-the-while stent in malignant central airway obstruction: a multi-center randomized control trial

Zeng¹,

Cheng²,

Lv³

et al. 2022

Transl Lung Cancer Res

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Background: Self-expandable metallic (SEM) airway stents are an important approach to treating malignant central airway obstruction (CAO). Standard over-the-while (OTW) stent needs the guidance of a guide-wire. It should be implanted under flouroscopy or the guidance of bronchoscope visualization. In this study, we evaluated the operation time and safety between OTW stent and a novel through-the-scope (TTS) SEM airway stent.Methods: In this multi-center, randomized, parallel-group superiority study, malignant CAO patients were enrolled randomly assigned (2:1) to the TTS stent implantation group (TTS group) or the standard OTW stent group (OTW group) in six sites across China. The entire process of all surgical procedures was recorded by video. Primary endpoint was the operation time of the airway stent implantation and secondary endpoint was the success rate of the stent implantation as well as its efficacy and safety.Results: From May 15, 2017, to December 30, 2018, 148 patients were enrolled from the six sites. We analyzed 134 patients (including 91 patients from the TTS group and 43 patients from the OTW group) according to the per-protocol set. There were no significant differences in the ages, genders, underlying diseases, and stenosis sites between the two groups. The operation time in the TTS group was significantly shorter than that in the OTW group (104±68 vs. 252±111 seconds, P<0.001). Compared to the OTW group, the efficacy of stent implantation (97.80% vs. 90.70%, P=0.093) and rate of first-time successful stent ^ ORCID: 0000-0002-6476-2974. implantation (78.02% vs. 74.42%, P=0.668) were higher in the TTS group, but did not reach statistically significance. The rates of granulation (28.57% vs. 41.86%, P=0.128) and restenosis (15.38% vs. 30.23%, P=0.064) in the TTS group were slightly lower as compared with the OTW group without achieving statistical significance. Conclusions:The TTS stent implantation procedure time was significantly shorter than that of the OTW airway stent with similar efficacy and complications, which might reduce the risk and flexibility of stent implantation.

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Clinical outcomes and survival following placement of self‐expandable metallic stents for central airway stenosis and fistula

Cited by 6 publications

References 26 publications

RETRACTED ARTICLE: Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy

RETRACTED ARTICLE: Association of the location and initial degree of malignant central airway stenosis with the risk of severe restenosis after interventional bronchoscopy

Effectiveness of AERO Stent Placement for Malignant Airway Disorder in Patients with a Poor Performance Status

Comparison of operation time, efficacy and safety between through-the-scope stent and over-the-while stent in malignant central airway obstruction: a multi-center randomized control trial

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