Right bronchopleural fistula treated with a novel, Y-shaped, single-plugged, covered, metallic airway stent

Abstract

Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after pneumonectomy. The incidence of BPF reported in the literature varies from 0.3% to 20%. To determine the feasibility and efficacy of using Y-shaped, single-plugged, covered, metallic stents to treat right bronchopleural fistulas. We have designed a Y-shaped, single-plugged, covered, self-expandable, metallic airway stent to fit the specific anatomy of the right main bronchus. The stent has a main tube and two branches, resembling an inverted "Y". One of the branches is closed (plugged) and bullet-shaped; the other one tubular and open. The entire stent is encased in a nitinol wire mesh. Stent size can be individualized using multislice spiral computed tomography (MSCT) measurements of the airways. Under fluoroscopic guidance, we have implanted 15 Y-shaped stents in 15 patients with right bronchopleural fistulas. Stent insertion was successful in all patients. All fistulas were successfully closed immediately after stent placement. Follow-up was performed for 1-34 months. Positive clinical outcomes were seen in 13 of 15 patients. Two patients died of intractable pulmonary infection and multiorgan failure. The fistula completely healed and the stent could be removed in five patients; however, two of them were left with a small, aseptic, residual right lung cavity. The remaining eight patients are still alive with the stent in situ. The placement of Y-shaped, single-plugged, covered, self-expandable metallic airway stents seems to be a feasible and safe method for the treatment of bronchopleural fistulas involving the right main bronchus. This stent is a promising therapeutic alternative for bronchopleural fistulas involving the right main bronchus.