Malignant Airway Obstruction and Endobronchial Stent Placement: A Systematic Review on the Efficacy and Safety

Umar, Zaryab; Rasool, Muhammad Haseeb ul; Hosna, Asma U; Parikh, Avish; Ariyaratnam, Jonathan; Sandhu, Jasmine K; Ashfaq, Salman; Ahmed, Nazaakat; Khan, Jawad; Trandafirescu, Theo

doi:10.7759/cureus.40912

Cited by 3 publications

(1 citation statement)

References 40 publications

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“…There are several treatment options, such as surgical intervention and endoscopic treatment including airway stenting [ 4 ]. Although tracheal or endobronchial stent placement has been proven an effective and safe intervention for managing malignant airway obstruction [ 5 ], complications including stent migration, granulation tissue formation, and stent-related infection have to be considered [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of shape and structure of a new 3D-printed personalized bioresorbable tracheal stent on fit and biocompatibility in a rabbit model

Schleich,

Kronen,

Krivitsky

et al. 2024

PLoS ONE

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To date, several types of airway stents are available to treat central airway obstructions. However, the ideal stent that can overcome anatomical, mechanical and microbiological issues is still awaited. In addition, therapeutic effect and self-elimination of these stents are desirable properties, which pose an additional challenge for development and manufacturing. We aimed to create a prototype bioresorbable tracheal stent with acceptable clinical tolerance, fit and biocompatibility, that could be tested in a rabbit model and in the future be further optimized to enable drug-elution and ensure local therapeutic effect. Twenty-one New Zealand White Rabbits received five different types of bioresorbable tracheal stents, 3D-printed from poly(D,L-lactide-co-ε-caprolactone) metacrylates. Various configurations were tested for their functionality and improved until the best performing prototype could undergo detailed in vivo assessment, regarding clinical tolerance, migration and biocompatibility. Previously tested types of 3D printed stents in our preliminary study required improvement due to several problems, mainly related to breakage, unreliable stability and/or migration within the trachea. Abandoned or refined pre-prototypes were not analyzed in a comparative way. The final best performing prototype stent (GSP2 (Group Stent Prototype 2), n = 8) allowed a transoral application mode and showed good clinical tolerance, minimal migration and acceptable biocompatibility. The good performance of stent type GSP2 was attributed to the helix-shaped surface structure, which was therefore regarded as a key-feature. This prototype stent offers the possibility for further research in a large animal model to confirm the promising data and assess other properties such as bioresorption.

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Section: Introductionmentioning

confidence: 99%

Effects of shape and structure of a new 3D-printed personalized bioresorbable tracheal stent on fit and biocompatibility in a rabbit model

Schleich,

Kronen,

Krivitsky

et al. 2024

PLoS ONE

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Lesion-Adaptative Bionic Tracheal Stent with Local Paclitaxel Release for Enhanced Therapy of Tracheal Tumor and Stenosis

Jin,

Fu,

Zhang

et al. 2024

ACS Biomater. Sci. Eng.

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The efficacy of tracheal stents (TSs) in treating malignant tracheal stenosis is often compromised by tumor overgrowth, leading to restenosis and other stent-related complications that conventional chemotherapy and commercial stents fail to adequately address. Drug-loaded tracheal stents have the potential to deliver chemotherapeutics directly to tumors while relieving stenosis, but their effectiveness has yet to be studied in vivo. The design of drug-loaded tracheal stents adapting to lesions to achieve optimal antitumor effects and minimal side effects remains an area worth exploring. In this study, a lesion-adaptive bionic tracheal stent (PTX-TS) designed for the dual purpose of treating tracheal tumors and associated stenosis was developed. This novel PTX-TS was evaluated using an orthotopic rabbit model of malignant tracheal stenosis, newly established in this study. The rabbit lesions were precisely scanned using computed tomography (CT) for 3D reconstruction, enabling the design of a PTX-TS that fit both the tumor and airway dimensions to ensure complete tumor coverage and effective dilation of the stenotic airway. The PTX-TS featured a bilayer structure including a surface layer of PTX/ethylene-vinyl acetate copolymer (EVA) blends for sustained PTX release and an inner layer of polycaprolactone (PCL)/EVA blends for appropriate mechanical performance. The stent was fabricated layer by layer using a custom-built 3D printer, and the drug-loaded surface layer was printed using a novel liquid printing technique developed in our lab, achieving a high drug loading of up to 80%. The dose of the PTX-TS was investigated and set as 7.5 mg/cm 2 , which leads to maximum tissue permeation. With its bionic cross-sectional C-shaped structure, the PTX-TS demonstrated excellent radial flexibility, allowing successful implantation at the lesion site using a specially designed delivery apparatus, where it selfexpanded to relieve stenosis. Additionally, the PTX-TS effectively delivered PTX directly to the tracheal tumor, resulting in superior antitumor efficacy without significant toxicity or complications.

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Advanced Squamous Cell Carcinoma in the Paratracheal Region: Navigating Diagnosis and Comprehensive Treatment Challenges

Grabill,

Louis,

Vivekanandan

et al. 2024

Cureus

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This case of a paratracheal mass emphasizes the importance of early detection and flexibility in the treatment planning for advanced squamous cell carcinoma, especially when logistical challenges impact access to care. A 69-year-old woman presented with a four-month history of progressive dysphagia, significant weight loss, and the recent onset of stridor, suggesting potential airway obstruction. Imaging studies revealed a large heterogeneous mass in the superior mediastinum, extending from the base of the neck into the thoracic inlet. The mass measured approximately 6.9 cm × 3.4 cm, involving the trachea and upper esophagus, causing significant compression and deviation. Additional findings included small hypermetabolic lymph nodes in the mediastinum. The patient underwent bronchoscopy and endoscopy, which revealed narrowing but no intraluminal lesions, indicating external compression by the mass. The pathological examination confirmed well-differentiated squamous cell carcinoma, characterized by keratinization and positive p40 immunostaining, with negative p16 immunostaining, indicating a non-HPV-related etiology. An urgent tracheostomy was performed to secure the airway, which the patient tolerated well. Following this, inpatient chemotherapy with a regimen of Taxotere, Cisplatin, and 5-fluorouracil (TPF) was initiated to manage the tumor and prevent further complications. This case required a multidisciplinary approach to address the patient's complex clinical presentation, including surgical, oncological, and supportive care. As confirmed by imaging, the lack of distant metastasis suggests a potentially better prognosis if effective local control can be achieved. The integrated care provided was essential in managing the patient's immediate and long-term health needs.

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Malignant Airway Obstruction and Endobronchial Stent Placement: A Systematic Review on the Efficacy and Safety

Cited by 3 publications

References 40 publications

Effects of shape and structure of a new 3D-printed personalized bioresorbable tracheal stent on fit and biocompatibility in a rabbit model

Effects of shape and structure of a new 3D-printed personalized bioresorbable tracheal stent on fit and biocompatibility in a rabbit model

Lesion-Adaptative Bionic Tracheal Stent with Local Paclitaxel Release for Enhanced Therapy of Tracheal Tumor and Stenosis

Advanced Squamous Cell Carcinoma in the Paratracheal Region: Navigating Diagnosis and Comprehensive Treatment Challenges

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