Stenting at the Flow-limiting Segment in Tracheobronchial Stenosis due to Lung Cancer

Miyazawa, Teruomi; Miyazu, Yuka; Iwamoto, Yasuo; Ishida, Atsuko; Kanoh, Koji; Sumiyoshi, Hiromichi; Doi, Masao; Kurimoto, Noriaki

doi:10.1164/rccm.200312-1784oc

Cited by 88 publications

(29 citation statements)

References 31 publications

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“…Several studies have proved the effectiveness of stents as both palliative and curative treatment of lung cancer; in fact they lead to a significant improvement not only in symptoms and lung function [2,3,4,5,6,7,8,9,10,11], but also in quality of life [12] and survival, if implanted in time [13,14]. …”

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confidence: 99%

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

et al. 2015

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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.

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confidence: 99%

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

et al. 2015

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“…The physiological assessment of the flow-limiting segment is an important indicator to estimate the outcome [2-4]. To date, however, there is no quantitative examination for assessing the perfusion status during interventional bronchoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The positioning of the stent at the flow-limiting segment provides the greatest functional benefit to patients with central airway stenosis [2-4], due to an improvement in the ventilation-perfusion ratio. However, an increase in ventilation within an obstructed lung can fail to result in any improvements in gas exchange if recanalization is not accompanied by an increase in arterial pulmonary blood flow, such as pulmonary artery stenosis and pulmonary thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Perfusion Using Intrabronchial Capnography in Pulmonary Artery Stenosis

Nishine¹,

Muraoka²,

Inoue³

et al. 2018

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Stenting at the flow-limiting segment can improve the ventilation-perfusion ratio in patients with central airway stenosis. However, there is no quantitative examination for assessing the perfusion status during interventional bronchoscopy. Intrabronchial capnography can estimate regional gas exchange by measuring carbon dioxide concentration. We herein report a case of bilateral bronchial stenosis where stenting was able to improve ventilation-perfusion ratio using intrabronchial capnography. A 44-year-old man was admitted to our institution with orthopnea. Chest computed tomography showed an extrinsic compression at the bilateral main bronchus and right pulmonary artery due to a mediastinal mass. After introduction of general anesthesia, arterial oxygen tension suddenly decreased in the supine position. After initial stenting, an increase was seen in ventilation at the right lung; however, a ventilation-perfusion mismatch occurred due to an increase in dead-space ventilation at the right pulmonary artery stenosis. Intrabronchial capnography was an effective modality to confirm the regional perfusion status during interventional bronchoscopy in real time.

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“…The positioning of the stent at the flow-limiting segment provides the greatest functional benefit to patients with central airway stenosis [2-5]. Thus, estimating the location of the flow-limiting segment and airway mechanics is crucial in guiding interventional bronchoscopy.…”

Section: Introductionmentioning

confidence: 99%

“…In regard to physiological assessments, we noticed distinct flow-volume curve patterns specific to the type of obstruction [5]. Although flow-volume curves are widely used in daily clinical settings, they cannot discriminate between the left and right lungs.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Bronchial Obstruction Using Lateral Pressure Measurement during Bronchoscopy

Nishine¹,

Hiramoto²,

Inoue³

et al. 2017

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Background: In patients with bronchial obstruction estimating the location of the maximal obstruction is crucial for guiding interventional bronchoscopy. However, flow-volume curves cannot discriminate between the right and left lungs. Objectives: The aim of this study was to physiologically evaluate bronchial obstruction during interventional bronchoscopy. Methods: We prospectively measured lateral airway pressure (P_lat) at either side of the obstruction using a double-lumen catheter (pressure-pressure [P-P] curve) simultaneously to assess the degree of bronchial obstruction in 22 patients. The shape of the P-P curve was assessed to confirm the site of maximal obstruction. Results: In the experimental study, P_lat was uniform between both bronchi in the normal model. For the unilateral and bilateral obstruction models, a phase shift was only seen for the more obstructed side. In healthy subjects, the angle of the P-P curve was close to 45° and linear in shape. In patients with bronchial obstruction, the angle was much smaller but approached 45° after the bronchoscopic procedure. The degree of bronchial obstruction was significantly correlated with the angle of the P-P curve (r = –0.51, p < 0.01). Dyspnea significantly increased when the airway lumen was obstructed by more than 60% (p < 0.0001), and when the P-P curve appeared loop-shaped (p < 0.01). Conclusions: The shape of the P-P curve could be used to detect the site of maximal obstruction for the optimal positioning of the stent and assess the need for additional procedures in real time in patients with bronchial obstruction.

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Stenting at the Flow-limiting Segment in Tracheobronchial Stenosis due to Lung Cancer

Cited by 88 publications

References 31 publications

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

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

Pulmonary Perfusion Using Intrabronchial Capnography in Pulmonary Artery Stenosis

Assessment of Bronchial Obstruction Using Lateral Pressure Measurement during Bronchoscopy

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