French experience of silicone tracheobronchial stenting in children

Abstract

Silicone stents were inserted into the trachea or left main-stem bronchus in 14 children aged 2-69 months (median, 7 months). Indications were as follows: tracheomalacia or airway kinking (7 cases), vascular compression (5 cases), and surgically corrected congenital tracheal stenoses (2 cases). The best results were obtained in tracheomalacia. Overall, 6 cases out of 14 (43%) were considered successful, with a stent placement duration of 3-15 months (median, 7 months). Two cases were considered a technical success, although they were clinical failures. Five cases were considered failures primarily due to stent migration. A retrospective analysis of failures suggests that most of these could have been avoided by the use of larger stents. One patient died of stent obstruction. No wall erosion was observed, and the development of granulation tissue was infrequent. Endoscopic removal of the prostheses was uneventful. The biocompatibility of silicone stents appears to be better than what is reported for metal ones, although the stability of the former is less satisfactory. The present study shows the feasibility of silicone stent placement in infants. These stents should be considered as a possible therapeutic option in certain types of childhood airway disorders, although further studies are required.

ERS statement: interventional bronchoscopy in children

“…• Silicone stents tend to dislocate [129], and deaths due to airway obstruction caused by dislocated stents have been reported [130]. It has been recommended that these stents should not be used in central airways other than after surgery [131].…”

Operative or non-operative treatment of congenital tracheal stenosis: is there something new?

“…Although still controversial, there is increasing experience with airway stenting in children (14)(15)(16)(17). Tracheobronchomalacia and airway stenosis are the most frequent indications for stenting when other therapeutic options have failed or there are no other surgical alternatives.…”

Utility of Pediatric Flexible Bronchoscopy in the Diagnosis and Treatment of Congenital Airway Malformations in Children

“…Fayon [51] treated 14 patients with left bronchomalacia using silicone stents with success in 6 patients (43%) ; one patient died of stent obstruction .With the development of newer types of stents and delivery devices, non surgical insertion and deployment is utilized, most often using special stent delivery device to place the stent precisely at the required location under bronchoscopic visualization.…”

“…Tracheobronchomalacia occurs fairly commonly in patients with congenital cardiovascular abnormalities with an incidence of 20-58%. Mortality may be high in patients with severe tracheobronchomalacia 51] . Bronchomalacia usually occurs in the left mainstem bronchus because of its proximity to the left atrium and left pulmonary artery, abnormal enlargement of which and pulsatility could compress the left main bronchus leading to bronchomalacia.…”