Abstract
Background: Airway stent implantation used in the treatment of benign cicatricial airway stenosis (BCAS) can lead to local granulation and scar formation, resulting in restenosis and treatment failure. Methods: We systematically investigated a paclitaxel-loaded PLGA-coating stent (PLPCS) and analyzed the safety and efficacy of the PLPCS in patients with BCAS. Patients were enrolled from four hospitals in China and observed for six months after implantation, by bronchoscopy performed weekly in the first month and monthly thereafter. The stent was removed immediately upon detection of granulation tissue proliferation, leading to immobility of the stent. Results: Granulation tissue was formed one week after stent implantation, most of which was located at the upper edge of the stent and the narrowest airway in the stent. All stents were removed in three months (mean: 6.51 + 4.67 weeks), with a curative outcome in one case and ineffective results in two. The remaining seven patients developed complications within three months, necessitating early stent removal. The main complication was granulation formation, resulting in difficulty in stent removal. Conclusion: Although PLPCS showed beneficial effects in basic and animal experiments, it cannot prevent airway restenosis in actual practice, mainly due to granulation formation.
Highlights
Benign cicatricial airway stenosis (BCAS) is a form of airway stenosis that is caused by proliferation of scar tissue in the trachea, left and right main bronchus, and/or right middle bronchus and results in dyspnea or even suffocation
Our findings in this study indicated that paclitaxel-loaded Poly(lactic-co-glycolic acid) (PLGA)-coating stent (PLPCS) does not prevent stenosis formation
This is much less than the 100% rate of effectiveness reported for various other treatment methods for benign cicatricial airway stenosis (BCAS), such as balloon-dilation, electric knife, cryotherapy, and topical drugs, for membranous and granulation hyperplasia stenosis
Summary
Benign cicatricial airway stenosis (BCAS) is a form of airway stenosis that is caused by proliferation of scar tissue in the trachea, left and right main bronchus, and/or right middle bronchus and results in dyspnea or even suffocation. We hypothesized that coating a metal stent with paclitaxel through Poly(lactic-co-glycolic acid) (PLGA) would allow for the release of the drug from the PLGA coating to the surrounding tissue, thereby increasing its local concentration and duration of action. This system would preclude the adverse effects of systemic medication, eliminate the need for repeated administration, and help achieve a curative outcome in BCAS. Airway stent implantation used in the treatment of benign cicatricial airway stenosis (BCAS) can lead to local granulation and scar formation, resulting in restenosis and treatment failure. Conclusion: PLPCS showed beneficial effects in basic and animal experiments, it cannot prevent airway restenosis in actual practice, mainly due to granulation formation
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