Progressive experience in tracheal stenting with self-expandable stents.
We experienced an unacceptably high 21% complication rate with the stainless steel Gianturco stent: a 68-month mean follow-up (range: 37-96 months) of 23 patients revealed three stent fractures and two migrations. Consequently, we began using nitinol mesh stents (Ultraflex) for fibrous stenoses and silicone-covered prostheses (Rush) for proliferative tracheal tumors. The extractable nitinol stent, made from alloy with thermal memory, was palliatively used in 15 patients with fibrous tracheal stenosis; the mean follow-up currently covers 21 months (range: 1-60 months). The silicone-covered prosthesis was used for two patients with inoperable tracheal tumor; follow-up covers 4 months and 2 months, respectively. The prostheses were positioned under visual guidance via the endoscopic approach. The median forced inspiratory volume in 1 s (FIV1) improved from 2.1 l/s (IQR: 0.7-2.4) to 3.2 l/s (IQR: 0.9-3.4) (P=0.018, Wilcoxon signed rank test). The median ratio of peak inspiratory flow (PIF 50%) to peak expiratory flow (PEF 50%) was 1.0 preoperatively (IQR: 0.8-1.5) and 1.8 postoperatively (IQR: 0.6-6.3). Between months 1 and 12, six granulomas developed. Five were treated with antibiotics and steroid aerosol inhalation therapy and one required CO2 laser vaporization. On day 10, one stent migration was observed. The migrated stent was substituted. To date, no stent fracture has been observed. Nitinol and silicone-covered prostheses can be proposed for the palliative treatment of fibrous tracheal stenoses and tracheal tumors, respectively.
Remacle
Marc
M
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Louvain at Mont-Godinne, Avenue Therasse 1, 5530 Yvoir, Belgium. remacle@orlo.ucl.ac.be
Lawson
Georges
G
Jamart
Jacques
J
Keghian
Jerôme
J
D000328:Adult; D000368:Aged; D000497:Alloys; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D012828:Silicones; D015607:Stents / Q000009:adverse effects*; D014135:Tracheal Stenosis / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
D000497:Alloys; D012828:Silicones; C013616:nitinol