Removal of Retrievable Self-Expandable Metallic Tracheobronchial Stents: An 18-Year Experience in a Single Center.

Abstract

The purpose of the study was to retrospectively evaluate the technical outcomes of removal of retrievable self-expandable metallic stents (REMSs) and identify predictors of technical failure in 81 patients with benign and malignant tracheobronchial strictures. A total of 98 REMSs were removed under fluoroscopic guidance in 81 patients with benign (n=48) or malignant (n=33) tracheobronchial strictures. Primary and secondary technical success rates and complication rate were evaluated. Technical outcomes with regard to underlying diseases were also evaluated. Logistic regression models were constructed to identify predictors of primary technical success. Primary and secondary technical success rates were 86.7 and 94.9%, respectively. Stent removal-related complication rate was 7.1% (7/98) and all were bleeding after stent removal. All bleeding complications were minor and managed conservatively. Primary technical success rate for benign strictures was significantly lower compared with that for malignant strictures (80.9 vs. 97.1%, P=0.029), but secondary technical success rate (93.7 vs. 97.1%, P=0.652) did not differ between the two groups. Granulation tissue formation was identified as an independent predictor of primary technical success (odds ratio 0.249, 95% CI 0.071-0.874, P=0.030). Removal of REMSs in patients with benign and malignant tracheobronchial strictures is safe and technically feasible. Bronchoscopic guidance may be required when the removal using a hook wire fails. The presence of granulation tissue was the negative predictor of primary technical success.