Self‐Expandable Metallic Stents in Nonmalignant Large Airway Disease

Fortin, Marc; MacEachern, Paul; Hergott, Christopher A.; Chee, Alex; Dumoulin, Elaine; Tremblay, Alain

doi:10.1155/2015/246509

Cited by 16 publications

(13 citation statements)

References 15 publications

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“…Metallic stent is also an alternative choice in benign disease if the patients are poor surgical candidates or the airway is highly tortuous (30,48). SEMS can be introduced via rigid and flexible bronchoscopy.…”

Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 99%

“…In uncovered and partial covered stent, the re-epithelialization and excessive granulation formation in the edges are the most frequent complications, which cause the difficulty in stent removal (48,53). Benign structure airway obstruction prior to stent implantation is independent factor for granulation tissue formation (54).…”

Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 99%

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Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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The diagnosis of central airway tumors is usually challenging because of the vague presentations.Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction. Here, we provide a clinical review of interventional bronchoscopy in diagnoses and management of central airway tumors. Keywords Diagnostic modalities Computed tomographyOnly less than 30% patients with tracheal tumors have been diagnosed via chest radiography (14). Traditional CT scan is more sensitive and can provide information on the extent of airway lesions. Newly developed multidetector CT (MDCT) can accurately detect airway tumor locations, natures, quantities (1). The extra luminal anatomy is also clearly depicted. Thus, MDCT is a rapid and non-invasive method to provide comprehensive information about the extent of disease process before surgery or interventional bronchoscopy (1). Visualization of bronchoscopyBronchoscopy is the mainstay to approaching endobronchial lesion under direct vision. In addition to conventionally white light bronchoscopy, autofluorescence (AFB) and narrow band imaging (NBI) are new visualization techniques of bronchoscopy which can aid detection of bronchial mucosa lesions (15). Although the specificity of AFB is low and similar to white light bronchoscopy, there is no doubt in usefulness of detecting early bronchial mucosal lesion and evaluate the margin of mucosal involvement (16,17). NBI is designed to detect angiogenesis and neovascular lesion. The diagnostic accuracy is increased under NBI bronchoscopy (15). Both of them have superior sensitivity comparing with white light bronchoscopy [3][4][5]. Endobronchial ultrasonography (EBUS) is also helpful in evaluating the extent of airway lesion involvement (14,18). Tissue sampling: forceps versus cryotechnologyForceps biopsy under direct bronchoscopic vision is the most common method to obtain tissue sample from endobronchial lesion. However, the size of tissue sample is limited by the forceps size. Small samples with crush artifacts are probably insufficient for accurate diagnosis. The diagnostic yield is only 85% of conventional forceps biopsy and patients usually have to repeat bronchoscopy (2,3).Cryotechnology has been used as a t...

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Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 99%

Section: Self-expandable Metallic Stents (Sems)mentioning

confidence: 99%

Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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“…LAM, laryngeal mask; ETT, endotracheal tube; RB, rigid bronchoscopy; TIVA-SV, spontaneous ventilation under total intravenous anesthesia. Compared with silicone stent, inserting a Micro-Tech stent is relatively easy (28). In the current study, all stents were successfully inserted without serious procedure-associated complications and immediate and satisfactory effects were achieved.…”

Section: N (Cone-shaped Stent Y-shaped Stent) ----------------------mentioning

confidence: 60%

Application of Micro‑Tech stents in malignant carinal stenosis

et al. 2019

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Malignant carinal stenosis is a disease process that is not always suitable for treatment with a Y-shaped stent. When one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is infeasible. In this complex condition, a cone-shaped stent is selected to maintain the patency of the trachea and the other main bronchus. The efficacy of the bare cone-shaped Micro-Tech stent to treat malignant carinal stenosis was evaluated in the current study. The medical records of 47 patients with malignant carinal stenosis who underwent Micro-Tech stent placement between January 2004 and October 2017 in Beijing Tian Tan Hospital (Beijing, China) were analyzed retrospectively. A total of 47 bare Micro-Tech stents (28 Y-shaped and 19 cone-shaped) were successfully inserted in the patients. Following stent placement, immediate satisfactory results were achieved in all patients, especially an improvement of dyspnea (100%), cough (81.1%) and stridor (100%). The Karnofsky scores were significantly increased (P<0.001), and the American Thoracic Society Dyspnea Index values were significantly decreased (P<0.001). Following a median of 88 days, initial bronchoscopic interventions were performed for tumor overgrowth (84.6%), stent fracture (7.7%) and granulation tissue (7.7%). Restenting was performed in two patients due to tumor progression (n=1) and stent fracture (n=1). Removal of a Y-shaped stent was attempted in one patient, but failed, as the stent had become partly embedded in the airway mucosa. In conclusion, cone-shaped Micro-Tech stent placement maintained tracheal-unilateral main bronchus patency and benefitted patients with malignant carinal stenosis in whom Y-shaped stents were not suitable for insertion.

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“…Selbstexpandierende Metall-Stents werden bei gutartigen Atemwegserkrankung mit Erfolg eingesetzt [8], sind jedoch auch mit Komplikationen im Zusammenhang mit Materialermüdung, Granulation und mukösen Ablagerungen assoziiert, die zu inoperablen Situationen führen können und 2005 Anlass zu einer «Black-Box-Warnung» der FDA gaben [8,9,10]. …”

Section: Introductionunclassified

3D-gedruckte patientenspezifische Silikon-Stents: Nachbeobachtung nach 1 Jahr bei 2 Patienten

2019

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Die Behandlung komplexer gutartiger Atemwegserkrankungen stellt eine große Herausforderung für die interventionelle Pneumologie dar. Stents in den Atemwegen können aus verschiedenen Gründen Komplikationen hervorrufen, unter anderem bei mangelhafter Passung des Stents. Wir berichten hier über das 1-Jahres-Outcome von 2 Patienten mit Atemwegserkrankung im Rahmen einer Granulomatose mit Polyangiitis (Morbus Wegener) mit Beteiligung des linken Hauptbronchus und der sekundären Carina. Bei beiden Patienten hatten systemische Therapien und bronchoskopische Standardverfahren versagt und handelsübliche Atemwegs-Stents zu Komplikationen geführt. Wir beschreiben unsere klinische Erfahrung mit einem erstmals beim Menschen angewandten Ansatz zur Überwindung dieser Probleme: Mittels Computertomographie- (CT-)Bildgebung und 3D-Drucktechnologie stellten wir einen patientenspezifischen Atemwegs-Stent aus Silikon her und implantierten diesen bei den Patienten mit Atemwegserkrankung. Den Bauplan oder das Rezept für den patientenspezifischen Stent erstellten wir anhand von Thorax-CT-Aufnahmen der Patienten in einem proprietären Softwarepaket, das ursprünglich für die orthopädische OP-Planung entwickelt worden war. Die Silikon-Stents wurden angefertigt und implantiert. Die Nachbeobachtung über >1 Jahr nach der Implantation des patientenspezifischen Stents wurde mit den 6 Monaten vor der Implantation verglichen; Kriterien waren die Anzahl klinisch erforderlicher Stent-Wechsel, die Behandlungsdauer und die allgemeine klinische Verbesserung unter standardmäßiger Versorung nach einem Atemwegs-Stenting. Der Vergleich ergab längere Stent-Liegezeit, kürzere Behandlungsdauer sowie Besserung der Symptome laut Patientenauskunft und dadurch geringeren Bedarf an Stent-Wechseln und -Modifikationen. Die Herstellung patientenspezifischer Silikon-Stents mittels 3D-Druck ist mithin durchführbar, und der erste klinische Nachweis der Praxistauglichkeit (Proof of Concept) belegt eine dauerhafte Verbesserung über den einjährigen Nachbeobachtungszeitraum.

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Self‐Expandable Metallic Stents in Nonmalignant Large Airway Disease

Cited by 16 publications

References 15 publications

Central airway tumors: interventional bronchoscopy in diagnosis and management

Central airway tumors: interventional bronchoscopy in diagnosis and management

Application of Micro‑Tech stents in malignant carinal stenosis

3D-gedruckte patientenspezifische Silikon-Stents: Nachbeobachtung nach 1 Jahr bei 2 Patienten

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