Techniques in stenting the tracheobronchial tree

Abstract

Endobronchial stents provide a noninvasive alternative to reconstructive surgery or permanent tracheostomy to maintain or restore airway patency. Tracheobronchial stenoses can be due to a variety of benign and malignant diseases, including postintubation stricture and lung cancer. Two main types of airway stents are now available—silicone-based devices and metallic stents. Silicone stents are easily removed if necessary and are predominantly used as a temporizing measure. Unfortunately, they are prone to blockage with mucus plugs and migration. Metallic stents are low-profile, easy to place, and do not migrate. However, they are almost impossible to remove after placement. The authors tend to use shorter balloon-expandable stents for focal bronchial stenoses such as occur posttransplantation, and use the longer, more flexible self-expanding stents for the trachea. Before deployment, all patients have thin-section computed tomography scans and bronchoscopy. Stents are usually inserted under general anesthesia and full intubation. Follow-up bronchoscopy and repeated interventions may be necessary over the long term in patients with benign disease. Stenting is a valuable option in the palliation of severe dyspnea in patients with malignant disease. Endobronchial stents provide a noninvasive alternative to reconstructive surgery or permanent tracheostomy to maintain or restore airway patency. Tracheobronchial stenoses can be due to a variety of benign and malignant diseases, including postintubation stricture and lung cancer. Two main types of airway stents are now available—silicone-based devices and metallic stents. Silicone stents are easily removed if necessary and are predominantly used as a temporizing measure. Unfortunately, they are prone to blockage with mucus plugs and migration. Metallic stents are low-profile, easy to place, and do not migrate. However, they are almost impossible to remove after placement. The authors tend to use shorter balloon-expandable stents for focal bronchial stenoses such as occur posttransplantation, and use the longer, more flexible self-expanding stents for the trachea. Before deployment, all patients have thin-section computed tomography scans and bronchoscopy. Stents are usually inserted under general anesthesia and full intubation. Follow-up bronchoscopy and repeated interventions may be necessary over the long term in patients with benign disease. Stenting is a valuable option in the palliation of severe dyspnea in patients with malignant disease.