Metal airway stent implantation in children: Follow‐up of seven children

Abstract

Long segment malacia of the trachea or main stem bronchi in children is not always suitable for surgical correction; patients may therefore remain ventilator-dependent and/or experience severe obstructive crises. We treated 7 children (ages, 4 months to 9 years) with extreme structural central airway obstruction with stent implantations. Six were mechanically ventilated; 5 had frequent life-threatening obstructive spells requiring deep sedation or paralysis. Diagnoses were: syndrome-associated tracheobronchomalacia (n = 4), malignancy infiltrating the carina (n = 1), congenital tracheal stenosis (n = 1), and tracheobronchial compression by a malpositioned aorta (n = 1). Six tracheal and 13 bronchial stents were endoscopically placed. The prostheses included mesh titan (n = 5), the newer shape memory material nitinol (n = 13), and 1 Y-shaped carina stent. Follow-up was reported for 7 weeks to 72 months. All patients showed marked improvement of their respiratory obstruction. Six children were weaned at least temporarily from ventilation. No significant bleeding, stenosis, or perforation was observed. Seven stents were changed after up to 14 months. Three children are well and at home. In 2 children airway stabilization was successful, but they later died from causes unrelated to stent placement, and 2 children died due to generalized airway disease. Soft metal mesh airway stents can offer a therapeutic option in life-threatening inoperable obstruction of the trachea and main stem bronchi in children.

Cryorecanalization of an Obstructed Bronchial Stent in a 12-Year-Old Boy

“…Although stent implantation is a well established therapy for the treatment of central airway obstruction in adults [2], there is only limited experience in the pediatric age group [3,5,6]. This is due to the fact that the indication for palliative stenting is much more frequent in adults due to the rarity of bronchial malignancies in children.…”

“…This is due to the fact that the indication for palliative stenting is much more frequent in adults due to the rarity of bronchial malignancies in children. Furthermore, bronchial and tracheal stenting for severe airway obstruction in children is considered only if there is no surgical alternative since the former treatment is associated with a significant number of severe disadvantages and complications [5]. These include an absent growth potential [4], interference with mucus clearance, dislocation of the stent, erosion of the bronchial wall, and stent obstruction by the formation of granulation tissue.…”

“…Bronchial obstruction, although rare in infants and children, is associated with significant morbidity and mortality [1,2,3,4,5,6,7]. Stenting of the major airways is a therapeutic option for significant symptomatic bronchial stenosis.…”

Interventional management of tracheobronchial strictures

“…Early investigators used forceps/rotation techniques to remove uncovered expandable metallic stents under general anesthesia [16,17] . In patients in whom the stent was tightly welded to the tracheobronchial wall, however, this removal procedure carried potential risks of mucosal bleeding and airway occlusion during the procedure.…”

Bronchoskopie bei Kindern

“…Mit erheblichen Komplikationen (Granulation, Infektion, Obstruktion, Perforation, Stenose) muss wegen der Kleinheit und Weichheit der kindlichen Atemwege und des Wachstums sowie der notwendigen langen Verweildauer der Stents gerechnet werden, auch wenn die flexiblen Stents neuerer Bauart benutzt werden [12,20]. …”