Customization of stent design for treating malignant airway stenosis with the aid of three-dimensional printing

Abstract

Background: The treatment of malignant stenosis involving the carina or bronchi is challenging due to complicated anatomy with individual variation, which makes it necessary to customize stents for each patient.Therefore, this study aims to evaluate the feasibility of a novel metallic segmented airway stent customized with the aid of three-dimensional (3D) printing for such cases. Methods:The stents were individually customized with the aid of a 3D printed mold based on computed tomography (CT) images according to the anatomical features of the airway. A segmented design was applied on the junction part of the main stem and the branches to fit the dynamic changes of the carina angle. In 12 patients with airway stenosis caused by malignancies including esophageal cancer (EC) and lung cancer (LC), the stents were implanted. The technical and clinical success of the stenting procedure, Hugh-Jones (HJ) classification, Karnofsky performance status (KPS), and stent-related complications of patients were evaluated. Results:The stenting procedure was technically successful in all patients, and 11 patients showed significant palliation of dyspnea after stenting. The HJ and KPS classification of patients after stent insertion improved significantly compared with those before stenting (P=0.003 and P=0.006, respectively). During follow-up, granulation tissue proliferation and sputum retention were found in two and four patients, respectively.Conclusions: This study shows that the implantation of a novel stent designed with the aid of 3D printing is feasible for relieving dyspnea and improving performance status of patients with inoperable malignant stenosis involving the carina or bronchi.

Intraoperative cone beam computed tomography of tracheal stenting for stenosis and fistula diseases: a retrospective cohort study

“…Our study found that measurements of the diameters and lengths of the central airway based on CBCT images were not significantly different from those obtained with MDCT. Although there were significant differences between CBCT and MDCT in the visibility of the distal bronchus, pulmonary parenchyma, and airway above the upper stent graft, 2 of these 3 anatomical areas were reproduced in a diagnostically relevant way, which resulted in low scores on CBCT images for the visibility of the distal bronchus, pulmonary parenchyma, and airway above the upper stent graft which, in some cases, were outside the imaging field (14,15). Therefore, our results indicate that CBCT provides sufficient image quality to replace MDCT for safety control after stent implantation.…”

“…The technical image quality of CBCT is inferior to that of MDCT (21). However, clinical experience from other centers has demonstrated the usefulness of CBCT imaging to detect complications in various medical contexts, such as during neuro-endovascular procedures (14,(22)(23)(24)(25)(26), showing that it can improve clinical outcomes (27). A new study from Zhou et al (28) showed that CBCT can provide 3D images that enable accurate positioning of the cryoprobe for transbronchial cryobiopsy and interstitial lung disease as well as reduce the risks of pneumothorax and massive bleeding.…”

Mathematical surface function-based design and 3D printing of airway stents

“…On the other hand, one of the strongest aspects of 3D printing technologies is the direct manufacturing of the implants or scaffolds from digital 3D models converted from a DICOM (Digital Imaging and Communications in Medicine) file generated by using medical imaging of a patient. For example, Shan et al [ 30 ] customized airway stents with the aid of 3D printing the models based on computerized tomography (CT) scans. The stent was reported to be technically successful in all 12 patients, and 11 of the patients (91.7%) and showed significant palliation of dyspnea after stenting.…”

Treatment of aerodigestive fistulas with a novel covered metallic Y-shaped segmented airway stent customized with the assistance of 3D printing

“…The prognosis of malignant aerodigestive fistulas caused by esophageal cancer or lung cancer is poor (5,11). For such patients, airway stenting is a palliative option that could alleviate clinical symptoms and improve quality of life by sealing the fistula (14,33). Patients with benign aerodigestive fistulas after esophagectomy have longer expected survival, and thus, the aim of their treatment is complete healing of the fistula (11).…”

“…Advances in 3D printing offer support for designing patient-specific airway stents. A patient-specific airway stent can be created using a 3D printing mold made according to the anatomical information of the airway captured by computed tomography (CT) to fit the individual geometry of the airway (9,(14)(15)(16)(17).…”