On-Site Customization of Silicone Stents: Towards Optimal Palliation of Complex Airway Conditions

Breen, David P.; Dutau, Hervé

doi:10.1159/000205396

Cited by 43 publications

(39 citation statements)

References 47 publications

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“…Silicone stents, developed by DUMON [13], in which mainly the straight and Y-shape stents are available [8], have been widely used in the treatment of airway stenosis, and their efficacy and safety are well-established [14]. The stents can be customised with cutting or in combination for each stenotic airway, and so they are applicable in most cases with central airway stenosis [6]. However, despite the flexible utility of a silicone stent, stenting of the upper lobe bronchus, which a rigid bronchoscope cannot reach directly, has posed a challenging problem.…”

Section: Discussionmentioning

confidence: 99%

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Double Y-stenting for tracheobronchial stenosis

Oki

Sasaki

2012

Eur Respir J

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The purpose of the present study was to evaluate the feasibility, efficacy and safety of the double Y-stenting technique, by which silicone Y-stents are placed on both the main carina and another peripheral carina, for patients with tracheobronchial stenosis.Under general anaesthesia, using rigid and flexible bronchoscopes, a Dumon TM Y-stent (Novatech, La Ciotat, France) was first placed on the primary right or secondary left carina followed by another Y-stent on the main carina so as to insert the bronchial limb of the stent into the first Y-stent. Patients who underwent double Y-stent placement during 3 yrs and 1 month in a single centre were retrospectively reviewed. In the study period, 93 patients underwent silicone stent placement and 12 (13%) underwent double Y-stent placement (11 for right and one for left bronchus). A combination of Y-stents, 14610610 mm and 16613613 mm in outer diameter, were most frequently used. Dyspnoea was relieved in all patients. Six out of seven patients with supplemental oxygen before stent placement could be discharged without supplemental oxygen. Median survival after stenting was 94.5 days. One pneumothorax and one granuloma formation occurred. Double Y-stent placement for patients with tracheobronchial stenosis was technically feasible, effective and acceptably safe.

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Section: Discussionmentioning

confidence: 99%

“…Ideally, the length of the stent should be minimised while covering the whole stenotic region and the shape of the stent should be chosen to fit the anatomical structure of the airway. Of the two main types of airway stents, silicone and metal, silicone stents can be easily customised on-site with cutting or combining to fit the individual stenotic airway [6].…”

mentioning

confidence: 99%

Double Y-stenting for tracheobronchial stenosis

Oki

Sasaki

2012

Eur Respir J

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“…Silicone stents can also be tailored on site to allow ventilation of specific lobes while maintaining its radial force and the patency of the airways. Specially designed instrument allows crafting a window in the wall of the silicone stent for such indications [99], which is impossible in metallic stents.…”

Section: Disadvantagesmentioning

confidence: 99%

The use of self-expandable metallic stents in the airways in the adult population

Dutau¹,

Musani

Plojoux³

et al. 2014

Expert Review of Respiratory Medicine

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The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.KEYWORDS: airway stenting . benign airway stenosis . bronchoscopy . central airway obstruction . self-expandable metallic stentDumon was the first physician to place a dedicated and specially designed airway stent in 1987 in Marseille. This dedicated stent consisted of a silicone tube with small studs on the external surface to reduce migration [1]. Consequently, several companies started to develop other airway stents with silicone and metal. In the last 20 years, numerous reports have been published about the use of selfexpanding and balloon expandable metal stents for the treatment of tracheobronchial malignant and benign stenoses, tracheobronchomalacia (TBM), fistulas and dehiscences [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].Self-expandable stents are made of a shapememory alloy, generally nitinol (nickel-titanium). When the stent is released, it expands spontaneously to reach its original shape and diameter. On the other hand, balloon expandable metallic stents (the first generation of airway metallic stents) were made of metal (steel) meshes that did not possess a memory shape. A balloon was then necessary to deploy them. Most of these stents had originally been developed for use in the vascular system but were found to be adequate for placement in the central airways after only minor modifications, if any at all. The latest developments include stents made of shape memory alloys and composite stents made from metals and polymers [17][18][19]. But, so far, the Dumon stent (Tracheobronxane Ò , Novatech, La Ciotat, France) remains the most commonly placed stent worldwide. Dumon stents have been the 'gold standard' for the treatment of benign and malignant airway stenoses over the past 20 years [20,21], with two specific designs: straight and Y-shaped (for disease involving the carina) [22]. By the way, it is interesting to notice that, in the Thoracic Endoscopy Unit of Marseille, where the Dumon stent was conceptualized and used, the percentage of silicone stent placement has dropped from 100% in 2000 to 65% in 2013. The remaining 35% of the stents used are now fully covered, selfexpandable, metallic stents (SEMS). This goes to prove that the Dumon stents are not the ideal stents in all situa...

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“…Dumon stents can be repositioned, removed, or replaced at any time with ease using standard grabbing rigid forceps. On-site modification of these stents is technically possible [24]. The major complications reported with silicone stents include migration (9.5%), granuloma formation (7.9%), obstruction secondary to secretions (3.6%) [25], and bacterial overgrowth [26].…”

Section: Airway Stentsmentioning

confidence: 99%

“…These stents have a radial force sufficient to render them quite effective in extrinsic airway compression, but still can readily be manipulated and repositioned within the airway without concern [20••]. Techniques do exist to preserve ventilation to lobes covered by an endobronchial stent [24]. It is important to note that the cost of a silicone stent is significantly less than that of a metal self-expandable stent in the order of 1.5-2 times.…”

Section: Airway Stentsmentioning

confidence: 99%

Silicone stents, the rigid bronchoscope, and the standard of care in central airway stenosis

Dutau

Maldonado

Laroumagne

et al. 2012

Curr Respir Care Rep

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Central airway stenoses often represent a therapeutic challenge and require a multidisciplinary approach involving interventional pulmonologists and thoracic surgeons. While surgery is often the preferred definitive modality, advances in bronchoscopic techniques have led to substantial improvements in patient symptoms and longterm quality of life using minimally invasive techniques generally safe when performed by experienced proceduralists. Endobronchial laser therapy, cryotherapy, conventional electrocautery, or argon plasma coagulation and photodynamic therapy have been used successfully. A variety of stents, silicone or self-expandable (covered or non-covered metallic stents), have been used though little significant progress has been achieved since the description of the dedicated airway silicone stents first described by JeanFrancois Dumon in the 1980s. Rigid bronchoscopy remains the method of choice for the treatment of both benign and malignant central airway obstruction, but significant technological advances allow for effective treatments using the flexible bronchoscope. Metallic non-covered stents are generally not recommended, except in selected patients with poor short-term prognosis.

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On-Site Customization of Silicone Stents: Towards Optimal Palliation of Complex Airway Conditions

Cited by 43 publications

References 47 publications

Double Y-stenting for tracheobronchial stenosis

Double Y-stenting for tracheobronchial stenosis

The use of self-expandable metallic stents in the airways in the adult population

Silicone stents, the rigid bronchoscope, and the standard of care in central airway stenosis

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