Clinical Outcomes with Airway Stents for Proximal versus Distal Malignant Tracheobronchial Obstructions

Walser, Eric; Robinson, Brad; Raza, Syed Atif; Özkan, Orhan Ş.; Üstüner, Evren; Zwischenberger, Joseph B.

doi:10.1097/01.rvi.0000124944.58200.d9

Cited by 31 publications

(21 citation statements)

References 12 publications

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“…It is known that survival of patients with untreated malignant CAO is very poor and ranges from 1 to 2 months [16, 17]. Life expectancy in untreated advanced lung cancer is 4 - 5 months [6].…”

Section: Discussionmentioning

confidence: 99%

Our Clinical Experience of Self-Expanding Metal Stent for Malignant Central Airway Obstruction

Verma

Phua

et al. 2017

J Clin Med Res

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BackgroundWe studied the safety, effectiveness, and limitations of airway stenting using self-expanding metal stent (SEMS) in patients with malignant central airway obstruction (CAO).MethodsA retrospective review of records of patients undergoing SEMS placement for malignant CAO during year 2013 - 2014 was done.ResultsSixteen patients (11 males and five females) underwent SEMS placement for malignant CAO. Median (range) age was 66 (54 - 78) years. No perioperative or immediate postoperative complications were seen except acute myocardial infarction (AMI) in one patient. Three patients were transferred to intensive care unit (ICU) for closer monitoring after the procedure and were discharged the next day. All four patients with lung atelectasis on presentation experienced complete re-expansion of the lung post-stenting. The dyspnea was substantially relieved in 14 (87.5%) patients. Two of the three patients who had been intubated were weaned off from the ventilator following stent insertion. Stent patency was maintained until death in all patients except one. Median survival from the date of diagnosis and the date of stent placement in lung cancer, esophageal cancer, and thyroid cancer were 140 (21 - 564) and 85 (15 - 361), 288 (80 - 419) and 61 (60 - 171), and 129 (71 - 187) and 67 (16 - 118) days, respectively. This survival was similar to reported expected survival associated with the underlying malignancy. During follow-up, granulation tissue (n = 1), mucostasis (n = 1), and tumor ingrowth (n = 2) were the most frequently encountered complications.ConclusionSEMSs are safe and effective in reversing respiratory failure caused by malignant CAO, averting premature death, allowing application of cancer targeted therapy, and restoring impending shortened survival to expected life expectancy associated with the underlying malignancy.

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Section: Discussionmentioning

confidence: 99%

Our Clinical Experience of Self-Expanding Metal Stent for Malignant Central Airway Obstruction

Verma

Phua

et al. 2017

J Clin Med Res

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“…[1] However, the complications associated with airway stenting are not uncommon and can occur during the procedure, shortly after the procedure, or over the long term. In addition, some studies [2,3] reported that the complication rate is relatively high, especially with long-term use.…”

Section: Introductionmentioning

confidence: 99%

Chest CT with iterative reconstruction algorithms for airway stent evaluation in patients with malignant obstructive tracheobronchial diseases

Zhang²,

Wang³

et al. 2016

Medicine

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The aim of the study was to investigate the image quality of low-dose CT images with different reconstruction algorithms including filtered back projection (FBP), hybrid iterative reconstruction (HIR), and iterative model reconstruction (IMR) algorithms by comparison of routine dose images with FBP reconstruction, in patients with malignant obstructive tracheobronchial diseases.In total, 60 patients (59 ± 9.3 years, 37 males) with airway stent who are randomly assigned into 2 groups (routine-dose [RD] and low-dose [LD] group, 30 for each) underwent chest CT on a 256-slice CT (RD-group 120 kV, 250 mAs, LD-group 120 kV, 120 mAs). Images were reconstructed with filtered back projection (FBP) algorithm in the RD group, whereas with FBP, HIR and IMR algorithms in the LD group. Effective radiation dose of both groups was recorded. Image-quality assessment was performed by 2 radiologists according to structure demarcation near stents, artifacts, noise, and diagnostic confidence using a 5-point scale (1 [poor] to 5 [excellent]). Image noise and CNR were measured.The effective radiation dose of LD group was reduced 52.7% compared with the RD group (10.8 mSv ± 0.58 vs 5.1 mSv ± 0.26, P = 0.00). LD-IMR images enabled lowest image noise and best subjective image quality scores of all 4 indices, when compared with RD images reconstructed with FBP (RD-FBP) images (all P < 0.05). LD images reconstructed with and with HIR (LD-HIR) images enabled higher score in subjective image quality of artifacts (P < 0.05), whereas it showed no difference in the other subjective image-quality indices and image noise. Significant higher image noise and lower score of subjective image quality were observed in LD-FBP images (all P < 0.05).Both IMR and HIR improved image quality of low-dose chest CT by comparison of routine dose images reconstructed with FBP. Meanwhile, IMR allows further image quality improvement than HIR.

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“…Patients with untreated CAO have bad prognosis with survival ranging from 1 to 2 months [Macha et al 1994;Walser et al 2004]. …”

Section: Discussionmentioning

confidence: 99%

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

Harris

Modi

Alraiyes

et al. 2015

Chest

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Clinical Outcomes with Airway Stents for Proximal versus Distal Malignant Tracheobronchial Obstructions

Cited by 31 publications

References 12 publications

Our Clinical Experience of Self-Expanding Metal Stent for Malignant Central Airway Obstruction

Our Clinical Experience of Self-Expanding Metal Stent for Malignant Central Airway Obstruction

Chest CT with iterative reconstruction algorithms for airway stent evaluation in patients with malignant obstructive tracheobronchial diseases

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

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