Fully Covered Self-Expandable Metal Stent in Tracheobronchial Disorders: Clinical Experience

Abstract

Background: The third-generation fully covered self-expandable metallic stent (SEMS) has been developed to solve the problems of difficult removal and in-stent granuloma formation related to the uncovered or partially covered type. There are few written reports about the performance of this type of stents with early encouraging results. Objectives: To report and analyse our experience with the Silmet® stent in the management of malignant and benign tracheobronchial disorders. Methods: We retrospectively reviewed medical records of patients who underwent fully covered SEMS Silmet placement at the Interventional Pulmonology Unit, La Maddalena Cancer Center, Palermo, Italy, between May 2010 and August 2013. Results: Stents were placed in 52 patients with malignant (n = 49) and benign airway obstruction (n = 2) and broncho-oesophageal fistula (n = 1). SEMSs were inserted into the trachea (n = 19), the main bronchi (n = 21) and the peripheral bronchi (n = 31). Besides 1 procedural dislocation, the deployment was successful in all patients with an immediate significant improvement of symptoms (Barthel Index p < 0.001; Medical Research Council score p < 0.001). A radiographic improvement was detected in 48% of patients. The mean follow-up duration was 119 ± 120 days (range 22-549 days). Complications observed were: migration (7.6%), tumour overgrowth (15%), infections (5.7%), granulation tissue formation (3.8%) and mucus plug (3.8%). Conclusions: The Silmet stent is effective, safe and simple to implant and remove. We suggest its use in cases of tight stenoses, in the treatment of small- to medium-caliber airways or in cases of tortuous airways.

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

“…Radiologically, it can present with lobar or complete lung atelectasis. Physiologically, it can manifest as air flow obstruction on spirometry with characteristic changes in flow volume loop (FVL) such as blunting of the expiratory and inspiratory limb of the FVL in case of fixed airway obstruction, or biphasic FVL in case of unilateral mainstem bronchus obstruction [2, 3]. Interventional bronchoscopy with airway stenting by virtue of re-establishment of the patency of the airway provides immediate relief of dyspnea, resolution of radiological and physiological changes, improves functional status, and confers stabilization of clinical condition to allow administration of definitive therapies targeted at cancer [2].…”

Safety and Efficacy of a Fully Covered Self-Expandable Metallic Stent in Benign Airway Stenosis

“…Despite almost a decade of experience with third-generation SEMS, few data have been published on their efficacy, complications, and removability. Marchese et al [10] recently published their experience with 52 patients obtaining clinically significant symptomatic improvement in all but 1 patient with an acceptable complication rate (migration 13.4%, granulation tissue formation 3.8%, infections 5.7%, obstruction due to tumor outgrowth 15.0%) and successful removal in all 7 cases where it was required. This experience almost exclusively included malignant airway obstructions (49/52), a situation where second-generation SEMS had previously also performed well.…”

Emergency cricothyroidotomy following tracheobronchial stenting

“…Complications include stent fracture in deployment, dislocation and failure to deploy 2 12. Long-term use of stents results in increased incidence of complication, most commonly the development of granulation tissue over the stent, stent migration, lower respiratory tract inflammation and infection, mucus plugging and halitosis 2 11–13.…”