Durability of Silicone Airway Stents in the Management of Benign Central Airway Obstruction.

Abstract

The literature is devoid of a comprehensive analysis of silicone airway stenting for benign central airway obstruction (BCAO). With the largest series in the literature to date, we aim to demonstrate the safety profile, pattern of re-intervention, and duration of silicone airway stents. An institutional database was used to identify patients with BCAO who underwent rigid bronchoscopy with dilation and silicone stent placement between 2002 and 2015 at Rush University Medical Center. During the study period, 243 stents were utilized in 63 patients with BCAO. Pure tracheal stenosis was encountered in 71% (45/63), pure tracheomalacia in 11% (7/63), and a hybrid of both in 17% (11/63). Median freedom from re-intervention was 104 (IQR 167) days. Most common indications for re-intervention include mucus accumulation (60%; 131/220), migration (28%; 62/220), and intubation (8%; 18/220). The most common diameters of stent placed were 12mm (94/220) and 14mm (96/220). The most common lengths utilized were 30mm (60/220) and 40mm (77/220). Duration was not effected by stent size when placed for discrete stenosis. However, 14mm stents outperformed 12mm when tracheomalacia was present (157 vs. 37days; p=0.005). Patients with a hybrid stenosis fared better when longer stents were used (60mm stents outlasted 40mm stents 173 vs. 56days; p=0.05). Rigid bronchoscopy with silicone airway stenting is a safe and effective option for the management of benign central airway obstruction. Our results highlight several strategies to improve stent duration.