Tracheobronchial Stents Research Articles

Case report on tracheo-bronchial Stenting: A Rare procedure

In the expanding era of interventional medicine, tracheo-bronchial stenting has emerged as an exigent procedure with new ray of hope. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistula. It plays an important role as a bridge to additional tumor-specific therapies, especially in chemoradiotherapy-naïve patients. Our patient, a 66-year-old lady with history of recurrent oesphageal carcinoma treated with chemotherapy, was suffering from increasing breathlessness with presence of stridor. Tracheo-bronchial stenting (Y-stenting) was done successfully in this patient to relieve her tracheal stenosis as observed in bronchoscopy. We report this case as it highlights the first ever Y-stenting in Bangladesh, might cultivate more feasibilty towards such intervention in different centres. Bangladesh J Medicine 2024; 35: 218-220

Understanding Physician Practices and Preferences Using Vaginal Stents to Prevent Postoperative Vaginal Stenosis in Pediatric and Adolescent Patients

Study ObjectiveThe purpose of this study is to describe practices to prevent vaginal stenosis in pediatric and adolescent patients and to evaluate the strengths and weaknesses of available vaginal stents. MethodsAn online survey was distributed to North American Society for Pediatric and Adolescent Gynecology (NASPAG) members with an optional follow up focus group. Quantitative and qualitative data were synthesized to highlight physician practices and preferences using vaginal stents, strengths and weakness of stents, and ideal stent properties. ResultsTwenty physicians completed at least 50% of the survey and 4 participated in the focus group. Most were pediatric and adolescent gynecology (PAG) specialists (95%) with fellowship training (60%) and experience in managing Müllerian anomalies (80%). Physicians reported they “always” used a vaginal stent when performing vaginoplasty for distal vaginal agenesis with a graft (62.5%) or without a graft (37.5%), and for transverse vaginal septa (57.1%). The most common type of stents used were packed condoms (60%), tracheobronchial stents (40%), Foley catheters (35%), and custom stents (35%). Participants described an ideal vaginal stent as something that would stay in place, cause little discomfort, expand, and come in a variety of lengths. ConclusionsThere are limited vaginal stent options for the PAG population. Participants reported variability in stents used to prevent vaginal stenosis with commonly used vaginal stents having significant weaknesses. Future efforts are needed to identify and develop post-operative clinical guidelines to prevent vaginal stenosis.

3D Printed tracheobronchial stents: personalized medicine in silicone

3D Printed tracheobronchial stents: personalized medicine in silicone

Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective: To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula. Methods: Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected, and all patients underwent tracheal silicone stenting, comparing dyspnea classification and Karnofsky score before and after stenting, and conducting post-treatment follow-up. Results: In 32 patients with tracheoesophageal fistula, dyspnea grading improved from grades III and IV to grades 0 to II. Before treatment, 10 patients (31.06%) were in grade IV, 17 patients (53.12%) were in grade III, and five patients (15.62) were in grade II; after treatment, 13 patients (40.63%) were in grade I, 12 patients (37.50%) were in grade I, and seven patients (21.87%) were in grade 0 (P < 0.05); Karnofsky score (37.52 ± 4.86 before treatment) improved significantly to 71.39 ± 8.24 one week after treatment (P < 0.05). Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent, 11 with silicone 18-14-14 stent, three with silicone Y15-12-12, and seven with silicone stent 16-13-13. Conclusion: Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible, simple, and safe, with reliable near-term efficacy, and is worthy of popularization and application.

Predictors in the treatment of malignant central airway obstruction with silicone stents

PurposeTo examine the role of the silicone stent in palliation of malignant central airway obstruction and identify potential preprocedural predictors for postprocedural outcome.MethodsPatients treated with endoscopic insertion of tracheobronchial silicone stents for malignant central airway obstruction at Aarhus University Hospital from 2012 to 2022 were identified from electronic medical records. Statistical analyses were carried out to identify factors affecting Days Alive and Out of Hospital, complications and overall survival.Results81 patients underwent a total of 90 tracheobronchial stent insertions. Days Alive and Out of Hospital (DAOH) for the first 30 days were affected negatively by urgent intervention, p < 0.001, preprocedural non-invasive respiratory support, p < 0.001, and preprocedural intubation, p = 0.02. Post-procedural oncological treatment was associated with a significant improved DAOH, p = 0.04. Symptomatology and lesion characteristics were not significantly associated with any impact on DAOH. Overall survival was poor (mean survival was 158 days), and only significantly affected by severe degree of dyspnea, p = 0.02, and postprocedural oncological treatment, p < 0.001. Complication where registered in 25.6% of cases within the first 30 days was observed. Procedure-related mortality was 3.7%. Based on chart annotations by an ENT-surgeon, 95% of the patients experienced relief of symptoms following stent insertion.ConclusionsPalliative tracheobronchial airway stenting with silicone stents is found to have a beneficial impact, more research is required for identification of predictors for postprocedural outcome based on preprocedural classifications.

Cryotherapy for the Treatment of Tracheal Stenosis: A Systematic Review.

Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis. Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy'AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis. We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest. Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Effect of Bronchoscopic Spray Cryotherapy and Ultra-low Temperature on Physical Properties of Metallic and Silicone Airway Stents.

Bronchoscopic spray cryotherapy (SCT) is utilized in the field of interventional pulmonology for treating benign and malignant airway stenosis as a standard tool to maintain airway patency. Stent-related complications include tumor overgrowth, granulation tissue, and epithelialization. Thermal ablation can have a limited role in such scenarios due to the risk of airway fire and damage to the existing stent. SCT is a potential therapy using ultra-low temperatures that can allow stents to remain in place during treatment. However, there has been no study demonstrating the safety of SCT on the integrity and physical properties of tracheobronchial stents. We report the results of the first study demonstrating the safety of SCT utilized to treat stent-associated granulation or malignant airway disease. The aim of this study was to demonstrate the effects of SCT on the physical properties of airway stents in an ex vivo environment. Various types of airway stents were subjected to multiple intervals of SCT for up to 30 seconds, and then the cycle was repeated 3 times. After every cycle, we compressed the stents to 60% of their original size, and compression and expansion force data was collected immediately after, at 3-minute and 5-minute intervals, and compared with the baseline readings. There was no significant change in the association between diameter and compression/expansion force, including any derangement in returning to the original diameter or any physical damage to any of the stents even after 3 prolonged SCT sessions of 30 seconds. Our study provides the first evidence that the use of SCT in conjunction with existing silicone/metal stents is feasible and does not cause any physical damage to the stents or alters their ability to maintain the original diameter.

Initial Experience of Endobronchial Silicon Stents from a Tertiary Care Centre in North India

Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign post-intubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

Safety of hybrid bronchial stents in transplant airway complications: a single center experience.

BackgroundTracheobronchial stents are often used to manage lung transplant airway complications. In 2005, the Food and Drug Administration (FDA) issued a warning against the use of metallic stents for benign airway disease. Since that time, fully covered hybrid metallic stents have been developed and are increasingly used due to their ease of insertion and removal. There is limited data to support their safe utilization for transplant airway complications. This is the largest analysis to date of the safety of hybrid metallic stents for transplant airway complications.MethodsWe performed a retrospective study of patients who had covered metallic stents placed for transplant airway complications between April 2016 to April 2021. Information obtained from chart review included demographics, procedure notes and stent data including indication for placement, type, size, location, duration, and complications.ResultsWe identified 50 patients who had a combined 376 stents placed for a total of 15,711 stent days. The most common minor complication and reason for removal was mucus plugging affecting 193 stents.There were only two cases of major stent associated complications. Among minor complications, there was a increased risk of stent fracture with Bonastent® (P=0.04).ConclusionsOur data shows that hybrid metallic stents are a safe intervention for patients with transplant airway complications. Most complications were minor and managed with repeat bronchoscopy. There were only two major complications over a 5-year period. Given the wide spectrum of possible airway complications, further research is needed to determine the optimal use of stents for patients with transplant airway complications.

Vaginal stents: what is working and what is needed to prevent vaginal stenosis in young women

Background: Vaginal stents are used to prevent vaginal stenosis in patients requiring vaginoplasty for vaginal anomalies and strictures. Providers are using a variety of medical devices including foley catheters, condoms with packing, tracheobronchial stents and custom or commercial stents as vaginal stents. The purpose of this study is to describe strengths and weaknesses of available vaginal stents as well explore characteristics for an ideal vaginal stent.

Tracheobronchial stenting in patients with non-resectable tumors complicated by airway stenosis

To study the results and efficiency of tracheobronchial stenting in patients with unresectable tumors complicated by stenosis of central airways. We analyzed the results of tracheobronchial stenting in 23 patients with unresectable tumors complicated by stenosis of central airways between 2016 and 2021. Technical and clinical success rate was 100%. No intraoperative complications were noted. Dyspnea regressed in all patients in early postoperative period. Moreover, there was objective improvement in lung ventilation with increase in lung capacity (from 2.1±0.4 to 2.7±0.5 l; p<0.05), forced expiratory volume (from 1.2±0.5 to 1.8±0.4 l; p<0.05), partial pressure of oxygen in arterial blood (from 47±7.4 to 85±6.3 mm Hg; p<0.05) and arterial oxygen saturation (from 86.1±8.2 to 93.1±5.1%; p<0.05). One patient developed massive bleeding due to tumor decay on the 3rd day after surgery. In 2 patients, stent obturation with a «mucus plug» was observed after 2-3 postoperative days. In 3 months after surgery, 21.8% of patients had disturbances of external respiration accompanied by mild dyspnea due to granulation tissue growth. Stent migration in 3 months after endoscopic stenting was recorded in 1 patient. Three-month mortality was 26.1%. Tracheobronchial stenting is a safe and effective minimally invasive surgical intervention. As a part of palliative care, this procedure improves functional and clinical parameters of pulmonary ventilation and reduces the incidence of complications. Thus, quality of life in patients with unresectable tumors complicated by airway stenosis is improved.

Airway stenting in patients with complex benign tracheobronchial stenosis

Tracheal and bronchial stenting is actively used for cancer and benign airway stenosis. This procedure is common in patients with advanced cancer. Stenting ensures breathing and availability of early chemo- and radiotherapy without the need for tracheostomy. This procedure is less common in patients with benign tracheal stenosis. In this case, isolated tracheal or bronchial stenting is performed. Complex tracheobronchial stenosis is extremely rare and creates significant difficulties. We present 3 cases of tracheobronchial stenting for cicatricial stenosis. In each case, stenosis was dilated with a rigid bronchoscope or balloon dilatation. Then, a silicone stent was installed. Resection with an appropriate anastomosis was contraindicated due to advanced pathological process. Thus stenting was regarded as a palliative operation. The follow-up periods were 9 months, 3 and 10 years. Each patient underwent inhalation therapy, endoscopy and repeated stenting if necessary.

Beware of spurious tracheo-bronchial stents

ObjectiveTo present a case of accidental sheath removal of tracheo-bronchial self-expandable metallic airway stent in a patient with endotracheal tumour. MethodsDesign: Case Report; Setting: Tertiary care hospital; Patient: One. ResultsA 65 years male, follow up case of endotracheal tumor with tracheo-bronchial self-expandable metallic stenting done presented with dry cough and difficulty in breathing since 8–10 days and suddenly coughed out thin whitish paper-like material 2 days back (which later proved as sheath of metallic stent). Direct laryngoscopy with flexible videobronchoscopy was done which showed tracheal stent well placed and intact, coughed out sheath couldn't be replaced back. Procedure was uneventful and patient was discharged in satisfactory condition and is doing well on regular follow up. ConclusionSelf-expandable metallic airway stents (SEMAS) represents a standard method of airways stenting especially when employed for the management of malignant central airway obstruction. Despite the obvious stenting advantages, it may be complicated with stent migration and accidental removal or coughing out of stent especially in high tracheal stenosis. In our case, as a peculiar complication there was accidental removal of the tracheal stent sheath which couldn't be replaced back whereas stent was well in place and intact. We need to be beware of such spurious tracheo-bronchial stents.

Design and manufacturing workflow of a patient specific 3-dimensionally engineered tracheo-bronchial stent

Collapsing airway pathologies, such as vanishing bronchus syndrome, are routinely treated by airway stent implantation. Off-the-shelf stents are appropriate for the treatment of most patients. However, in some cases, these commercially available stents do not fit the patient's airway anatomy sufficient, resulting in a high risk for dislocation and infection. In this article, we present a process for design and manufacturing of patient-specific tracheobronchial stents that allows treatment of patients in whom standard treatment is not appropriate.

A Parametric Tool for Studying a New Tracheobronchial Silicone Stent Prototype: Toward a Customized 3D Printable Prosthesis

The management of complex airway disorders is challenging, as the airway stent placement usually results in several complications. Tissue reaction to the foreign body, poor mechanical properties and inadequate fit of the stent in the airway are some of the reported problems. For this reason, the design of customized biomedical devices to improve the accuracy of the clinical results has recently gained interest. The aim of the present study is to introduce a parametric tool for the design of a new tracheo-bronchial stent that could be capable of improving some of the performances of the commercial devices. The proposed methodology is based on the computer aided design software and on the finite element modeling. The computational results are validated by a parallel experimental work that includes the production of selected stent configurations using the 3D printing technology and their compressive test.

Tracheobronchial stents in patients with malignant airway disease: Finnish tertiary care experience.

Tracheobronchial stenting has an established role in the palliation of malignant central airway obstruction (CAO). The purpose of this study is to describe the experience with self-expanding metal airway stents in 2 tertiary referral centres, covering a third of the population of Finland. Patients referred to and treated with airway stenting for malignant CAO using self-expanding metal-stents were identified from electronic patient records, and data were collected using a structured Endoscopic Lower Airway Management instrument. Statistical analysis to reveal factors affecting patient benefit and survival was carried out. A total of 101 patients (mean age 65.8) and 116 procedures were identified. Procedure-related mortality was rare (3/101 patients) and complications infrequent. The median survival was 2.3 months [95% confidence interval (CI): 1.4-3.1). Stent benefit was not significantly affected by clinical characteristics. Survival was impacted by the use of adjunct procedures [hazard ratio (HR) 0.36, 95% CI: 0.23-0.58, P < 0.001), procedural urgency (HR 0.40; 95% CI: 0.23-0.71, P = 0.002) and post-treatment chemoradiotherapy (HR 0.29, 95% CI: 0.15-0.56, P < 0.001). The beneficial impact observed supports the further use of tracheobronchial stenting in malignant CAO. The use of self-expanding metal stents is encouraged.

Transient maintenance of tracheal patency upon the insertion of a flexible bronchoscope in a patient with an anterior mediastinal mass: a case report

BackgroundPatients with an anterior mediastinal mass are at risk of perioperative respiratory collapse.Case presentationA 74-year-old woman with a large anterior mediastinal mass that led to partial tracheal collapse (shortest diameter, 1.3 mm) was scheduled for tracheobronchial balloon dilation and stent placement under general anesthesia. Although veno-venous extracorporeal membrane oxygenation (V-V ECMO) had been established, maximum flow was limited to 1.6 L/min, and general anesthesia induction was followed by hypoxia probably due to inadequate ventilation. A flexible bronchoscope was inserted through the tracheal lumen that was being compressed by the anterior mass; this not only increased tracheal patency but also enabled positive pressure ventilation and resulted in recovery from hypoxia. Scheduled procedures were successfully performed without complications.ConclusionWe describe a case wherein tracheal patency was transiently maintained by inserting a flexible bronchoscope in a patient with an anterior mediastinal mass.

37. Novel Use of Fully Covered Tracheobronchial Stent for Vaginal Reconstruction

<h3>Background</h3> Vaginal reconstruction can be a complicated procedure with significant need for postoperative dilator therapy completed by the patient. Menstrual suppression can be used to delay surgery in young adolescents but failed suppression or contraindications to medications can lead to early need for surgical intervention before psychologically prepared to participate in dilator therapy. Novel uses of fully covered tracheobronchial stent (FCTBS) in place of immediate postoperative dilator therapy can have advantages in select patients. <h3>Case</h3> Cases selected required complex vaginal repair with physician concern for postoperative dilator therapy challenges either secondary to high obstruction in vaginal canal or patient noncompliance. Case 1: 12 year old with repaired anorectal malformation presented with recurrent hematocolpos after battery foreign body. The obstruction was located adjacent to cervix preventing typical transvaginal Z-plasty anastomosis. Combined abdominal and perineal end to end anastomosis was preformed and FCTBS was placed. Stent removed after 8 weeks with well healing surgical site. Ten year follow up exam and Pap smear revealed only a small ridge at site of repair. Case 2: 14 year old with known single kidney presented with abdominal pain and imaging consistent with obstructed hemivagina ipsilateral renal anomaly. Resection was completed but only a 2cm orifice created due to small nature of the obstructing hemivaginal septum with close proximity to the cervix. FCTBS was placed to prevent stenosis. The stent was removed in four weeks and both cervices were normal. 18 months after surgery, the patient had no dysmenorrhea or recurrence of the hematometra. Case 3: 9 year old with anorectal malformation with history of presumed distal vaginal agenesis repaired in infancy presented with pyocolpos which was incised transvaginally and drain left in place. Once the infection resolved, the lower vagina was <1cm in diameter requiring reconstruction of the lower vagina with placement of buccal graft and insertion of FCTBS. The stent was removed 6 weeks later, and a healthy buccal graft site was present. Two year follow up exam demonstrated a patent vaginal canal with narrowing above the buccal graft location with plan to evaluate after menarche to assess if further revision is needed. <h3>Comments</h3> Novel use of the fully covered tracheobronchial stent has several advantages including decreased immediate need for dilator therapy, bridging high repairs that are difficult to reach with traditional dilators, remains in place without need for anchoring the stent, no concern for tissue in-growth and minimal patient discomfort. Long term follow up demonstrates excellent surgical outcomes in select patients.

Esophagotracheal and esophagobronchial fistulas

Esophagobronchial and esophagotracheal fistulas are rare but complex diseases with aheterogeneous spectrum of underlying etiologies. Common causes are locally advanced tumors of the esophagus and larynx, traumatic perforation from the esophageal or tracheal side as well as postoperative fistulas. The management of esophagotracheal and esophagobronchial fistulas always involves different health care providers and in most cases patients require amultidisciplinary treatment on the intensive care unit. The therapeutic concept primarily depends on the underlying cause, localization and size of the fistula but decision making is also influenced by the severity of the course of sepsis and the extent of the respiratory dysfunction. Endoscopic management with esophageal and/or tracheobronchial stenting is the most common treatment. Surgical reconstructive procedures are predominantly reserved for patients with a treatment refractory fistula or aseptic multiple organ failure. The prognosis is particularly influenced by the underlying disease.