Customized Hinged Covered Metallic Stents for the Treatment of Benign Main Bronchial Stenosis

Han, Xinwei; Al-Tariq, Q.; Zhao, Yanle; Li, Lei; Cheng, Zhe; Wang, Huaqi; Liu, Chao; Jiao, Dechao; Wu, Gang

doi:10.1016/j.athoracsur.2017.01.116

Cited by 23 publications

(16 citation statements)

References 12 publications

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“…Timely and effective treatment can make the atelectasis of the lung ventilated and expiratory dyspnea relieved, and win the opportunity for subsequent treatment 17 . Although SEMSs placement has become an effective method for airway stenosis [2][3][4][5][6] , few reports have described the treatment of atelectasis via SEMSs, except for some case reports. The bronchial stenting and high-frequency percussive ventilation was used for a case of atelectasis induced by extrinsic compression of aortic aneurysm 9 .…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of self-expandable metallic stents for malignant obstructive atelectasis

Zhu

et al. 2020

Sci Rep

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Self-expandable metallic stents (SEMSs) have been widely used in the treatment of malignant central airway obstruction. However, few reports focus on the treatment of atelectasis and how to estimate the prior probability of success via SEMSs placement, This current study aimed to study the safety and effectiveness of SEMSs for the treatment of obstructive atelectasis, and the value of preoperative CT enhancement for ventilation of atelectasis via SEMSs placement. A total of 35 patients with obstructive atelectasis (29 male and 6 female) was included from February 2012 to March 2018. The procedures were performed under fluoroscopic guidance, and bronchoscopic laser resection was performed for severe restenosis cases after SEMSs placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. Thirty-eight SEMSs were successfully implanted in 34 patients, included 29 Y type tracheal stents, 4 small y stents, and 5 straight airway stents. After stenting, 26 cases showed full ventilation, and 3 cases were partially ventilated. The technical success and clinical success was 97.1% and 82.9%, respectively. A higher maximum enhancement CT value was found in patients with full ventilation. Mean follow-up time was 18.8 ± 4.0 months. Eight cases showed restenosis and received endoscopic laser resection, included 1 case underwent removal and 3 cases received second stenting. There were 2 cases of perioperative non-operative death, and 11 cases of post-discharge death (2 cardiac deaths and 9 malignant tumors). The survival rates of 3 months, 1 year and 2 years were 78.6%, 58.5% and 58.5%, respectively. In conclusion, SEMSs placement is safe and effective for obstructive atelectasis, and the preoperative CT enhancement played an important role in estimating the prior probability of success in the treatment of atelectasis via SEMSs placement. Obstructive atelectasis caused by malignant lung or esophageal cancer is a clinical emergency, which is characterized by progressive dyspnea and risk of asphyxiation. Patients often show chronic dyspnea and difficulty to receive surgical resection, chemotherapy, and radiotherapy, thereby resulting in low quality of life and poor prognosis 1. Although SEMSs has been widely used for palliation of airway stenosis, especially malignant central airway obstruction 2-8. At present, few reports have described the treatment of atelectasis via SEMSs placement, except for some case reports 1,9-11. SEMSs implantation can relieve symptoms, improve pulmonary function and stabilize cardiovascular conditions to undertake a successful surgical correction 11. However, stent treatment also brings potential fatal complications, such as stent restenosis caused by tumor or granulation tissue, stent fracture, and stent migration 12-14. Hachiya et al. even reported the potential risk of creating obstructive atelectasis in two cases after stenting 2. Thus it is impo...

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of self-expandable metallic stents for malignant obstructive atelectasis

Zhu

et al. 2020

Sci Rep

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“…Tracheal stent has been widely used clinically for the treatment of tracheal fistula [4][5][6][7] or tracheal stenosis [8][9][10][11][12][13]. However, tracheal stents placement may bring a series of complications, and stent removal sometimes is necessary [23].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, some patients may not be willing to undergo open surgery considering that they are too weak or sick under this circumstance [2]. Since first adoption of self-expanding metal stents to treat bronchial obstruction in 1989 [3], the efficacy and safety of tracheal stent has been proven for the treatment of tracheal fistula [4][5][6][7] or tracheal stenosis [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas with tracheal stenosis

Bai

et al. 2020

Preprint

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Background: No study compared the techniques and complications of stent removal under fluoroscopy guidance for tracheal fistula and tracheal stenosis.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Eighty-five patients underwent stent removal for tracheal fistula (TF group), and 67 patients for tracheal stenosis (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4% for tracheal fistula and tracheal stenosis, respectively. Except for the routine removal for half of patients, excessive granulation tissue was the common indications for stent removal, which was found 142.1±25.9 days later for tracheal fistula, and 89.9±15.0 day for tracheal stenosis. The total incidence of complications was 21.1% and 22.4% for tracheal fistula and tracheal stenosis, respectively. One perioperative death of asphyxia was found in TF group, and 2 deaths in TS group. Recurrence of fistula or stenosis requiring stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stent is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference. Recurrence of fistula or stenosis requiring stenting was the most comment complication.

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“…However, metallic stents show good support and flexibility, can be placed with the help of guide wires, may be less traumatizing and minimize the procedures in cases with a fistula [ 14 ]. Currently, individualized metallic stents are available and can be produce upon request [ 1 , 7 , 21 ]. Metallic large Y stents were designed to be inserted for airway disease at the main carina.…”

Section: Discussionmentioning

confidence: 99%

Metallic small y stent placement at primary right carina for bronchial disease

et al. 2018

BMC Pulm Med

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BackgroundMetallic large Y stent placement has been used mainly for airway disease around the main carina. However, few studies have reported this treatment for bronchial disease around the primary right carina.MethodsTwenty-eight patients were treated by small y stent. All stents were custom-designed and placed under fluoroscopic guidance. Clinical and imaging data were analyzed retrospectively.ResultsThirty-one stents were successfully inserted in 28 patients. Twenty-five patients succeed at the first attempt (89.3%), and 3 patients needed a second attempt. Twelve complications occurred in 10 patients (35.7%). Stent restenosis and sputum retention were the most common complications. Five patients underwent successful stent removal due to complications or cure efficacy. During follow up, 17 patients died of tumors and one died of myocardial infarction. The 1-, 3-, and 5-year survival rates were 49.3, 19.6 and 19.6%, respectively.ConclusionsMetallic small y stent placement is technically feasible, effective and safe for bronchial disease around the primary right carina.

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Customized Hinged Covered Metallic Stents for the Treatment of Benign Main Bronchial Stenosis

Abstract: The described procedure is safe and easy to be performed and avoids the use of intubation, bronchoscopy, and general anesthesia.

Cited by 23 publications

References 12 publications

Clinical outcomes of self-expandable metallic stents for malignant obstructive atelectasis

Clinical outcomes of self-expandable metallic stents for malignant obstructive atelectasis

Long-term outcomes of tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas with tracheal stenosis

Metallic small y stent placement at primary right carina for bronchial disease

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