SESSION TITLE: Emerging Techniques for Interventional Pulmonary SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: Commercially-available airway stents come in limited shapes and sizes and often poorly fit in patients with complex airways. This can cause a variety of complications including, but not limited to stent occlusion, granulation tissue formation, infection, biofilm, and migration. A patient-specific stent may minimize complications, improve quality of life, and reduce the need for repeated procedures. We describe our initial clinical outcomes with the placement of thirteen patient-specific (PS) silicone stents in four patients with underlying complex airway diseases who had multiple complications associated with commercially-available airway stents METHODS: We retrospectively reviewed charts of all patients who received PS airway stents at Cleveland Clinic under FDA expanded access. Bronchoscopists completed a survey related to their experience with these PS stents, including their ascertainment of stent-related adverse events (AEs) at 24hrs and 30d post-placement RESULTS: A total of 13 patient-specific airway stents were placed in 4 patients. Two patients had Y-stents placed in the mainstem bronchi, with short limbs extending into the lobar airways. One had a Y-tracheobronchial stent, while the other had a combination of both. Twelve out of the thirteen stents placed were reported easier (30.8%) or no difference (61.5%) to load into the rigid bronchoscope, while one was reported harder (7.7%) to load. Out of the nine stents that have been removed, all nine were reported easier (22.2%) or no difference (77.8%) in difficulty to remove. At 24hrs after implantation, adverse events (AEs) were reported in 4 out of 13 stent placements. At 30 days, 7 of 13 stents were associated with AEs; all with a CTCAE (Common Terminology Criteria for Adverse Events) severity of ≤ 3. The bronchoscopists noted that this was a significant improvement in these patients compared to prior treatment with commercially-available stents. Positive or no clinical change was associated with all of the PS stents placed, and the mean duration between bronchoscopies was significantly longer with patient-specific stents than with commercially-available ones (65.6 days vs. 36.6 days, p = 0.004). Furthermore, the common AEs observed with commercially-available stents in these patients were reduced in incidence and severity, allowing for a significant increase in the lifespan of the patient-specific stents (300.2 days vs. 124.0 days, p < .001) CONCLUSIONS: Due to the increase in time to subsequent procedures and the increase in stent-life, PS silicone airway stents have the potential to decrease the total number of bronchoscopic procedures required for a patient. Overall, bronchoscopists report improved outcomes with PS stents compared to commercially-available ones, especially in patients with benign complex airway disease CLINICAL IMPLICATIONS: Patient-specific stents may have a role in patients with complications of standard stents. DISCLOSURES: No relevant relationships by Carlos Aravena Leon, source=Web Response Advisory Committee Member relationship with Intuitive Please note: $5001 - $20000 Added 11/30/2018 by Thomas Gildea, source=Web Response, value=Travel Advisory Committee Member relationship with J&J Ethicon Please note: $5001 - $20000 Added 11/30/2018 by Thomas Gildea, source=Web Response, value=Consulting fee Inventor relationship with NewCOD Please note: $1-$1000 Added 03/15/2019 by Thomas Gildea, source=Web Response, value=Non-yet Investigator relationship with Auris Please note: $5001 - $20000 Added 06/21/2019 by Thomas Gildea, source=Web Response, value=Research funding for trial Employee relationship with New COS Inc Please note: $20001 - $100000 Added 03/18/2019 by Keith Grafmeyer, source=Web Response, value=Salary No relevant relationships by Hanine Inaty, source=Web Response No relevant relationships by Michael Machuzak, source=Web Response No relevant relationships by Sonali Sethi, source=Web Response No relevant relationships by Adrianna Urbas, source=Web Response
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