First experience with a biodegradable endobronchial stent in a case of bronchomalcia

Abstract

Introduction: Stents are widely used to preserve airways from obstruction. Complications include migration, formation of granuloma and obstruction due to trapped secretions. In this context the use of biodegradable stents might be an alternative. Methods: A 72 years old patient suffering from dyspnea especially on exercise was refered to our Department. The patient9s history included a liver-transplantation related to a cryptogenic cirrhosis in 1994, an oropharyngial carcinoma in 2003 treated with radiation (cervical & supraclavicular) followed by laryngectomy. The patient also suffered from normofrequent atrial fibrillation. Endoscopically there was a breath dependent subtotal stenosis of the left main bronchus (under conscious sedation & awake). The right main bronchus showed a small narrowing. The FEV1 was 0.94 l (37%) and VC 2.17 l (67%). Results: The patient had a history of granulomas in the area of larynectomie. He also had a tracheostomy, therefore a silicon stent was difficult to implant. As a consequence, in this case of benign stenosis we decided to implant a 14 x 30 mm biodegradable polydioxanone stent. The wall tension seemed to be less than with silicon or nitinol stent. In situ the stent did not expand fully and was longer than calculated spaning from the main carina to the partially open ostium of the left upper lob. Fifty days later, the stent was partially bioabsorbed and the in- and expiratory functionality the left main bronchus was open. There were no problem of mucus. The lung functions improved regarding FEV1 1.40 l (55%) and VC 2.79 l (87%). Conclusion: Biodegradable stents are a promising alternative option for the maintainance of the endobronchial lumen.