[Interdisciplinary interventional therapy for tracheobronchial stenosis with modern metal net stents].
OBJECTIVE
Assessment of the therapeutic potential of tracheobronchial stenting for obstructive tracheobronchial disease, in-vivo comparison of different stent types and development of helpful criteria for choosing the suitable stent type.


METHODS
Prospective case analysis. Between 1993 and 1999 53 stents were implanted into the tracheobronchial system of 39 consecutive patients with benign or malignant airway obstruction. Every single stent (26 Strecker Stents, 18 Wallstents, 6 Accuflex Nitinolstents, 1 Dumon-, 1 Rüsch- and 1 Palmazstent) was recorded in an unified database. Analysis comprised clinical effectiveness, lung function if possible, relevant complications and radiologic follow-up parameters. The probability of their remaining within the tracheobronchial system, of their remaining undislocated and uncompressed was calculated using Kaplan-Meier analysis for three stent types.


RESULTS
Stent placement proved itself to be an effective treatment in 86 % of the patients. Resistance could be normalized in 9/9 patients. Kaplan-Meier analysis clearly revealed a higher probability for the Wall- and Nitinolstent to remain within the tracheobronchial system and to remain uncompressed. Dislocation also occurred more rarely. Explantation of the Wallstent, however, if desired, was much more difficult compared to the Strecker stent. The Wallstent also occasionally led to the formation of granulation tissue especially at the proximal stent end and, as such, required reintervention.


CONCLUSIONS
Any of the 3 stent types proved to be an effective therapeutic option in the management of obstructive tracheobronchial disease. Choise of the stent type should be determined through definition of the therapeutic intention. It is useful to distinguish between (a) benign stenosis, (b) malignant stenosis but curative therapeutic situation and (c) malignant stenosis in a palliative therapeutic situation with limited life expectancy. In spite of its superior mechanical properties the Wallstent is rather suited for a palliative situation because explantation may be difficult. The Strecker Stent requires more reinterventions but removal is easy to perform. The Nitinolstent possibly represents a reasonable compromise.
Rieger
J
J
Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München, Germany. jrieger@radin.med.uni-muenchen.de
Linsenmaier
U
U
Hautmann
H
H
Fedorowski
A
A
Huber
R M
RM
Pfeifer
K J
KJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000497:Alloys; D001982:Bronchial Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy; D010166:Palliative Care; D010348:Patient Care Team; D011474:Prosthesis Design; D015642:Radiology, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
D000497:Alloys; C013616:nitinol