Malignant tracheobronchial strictures: palliation with covered retrievable expandable nitinol stent.
OBJECTIVE
To evaluate the safety and clinical effectiveness of a covered retrievable expandable nitinol stent for the treatment of malignant tracheobronchial stricture and/or esophagorespiratory fistula (ERF).


METHODS
With fluoroscopic guidance, stents were placed in 35 symptomatic patients with malignant tracheobronchial stricture and/or ERF in most cases caused by lung or esophageal cancer. The site of stricture was most commonly at the trachea or left main bronchus. If there were complications, the stent was removed with a retrieval set. Nine patients had combined symptomatic ERF.


RESULTS
A total of 47 tracheobronchial stents were placed and were technically successful and well-tolerated in all patients. Improvement of dyspnea was achieved in 92% of the patients (24 of 26 patients). Associated ERF in nine patients was effectively treated with tracheobronchial stent placement with or without esophageal stent placement. Stent migration, tumor overgrowth, symptomatic sputum retention, and hemoptysis occurred in 17% (6/35), 6% (2/35), 20% (7/35), and 17% (6/35) of patients, respectively. There were no documented cases of tumor ingrowth. Stent removal was performed easily in five patients when stent migration (n = 2), severe pain (n = 1), tumor overgrowth (n = 1), or persistent gastrobronchial fistula (n = 1) developed. All patients died 2 days to 26 weeks (mean, 9.62 weeks) after stent placement because of disease progression (n = 18), pneumonia (n = 9), hemoptysis (n = 5), or unknown cause (n = 3).


CONCLUSIONS
Use of a covered retrievable expandable nitinol stent is a safe and effective method for relieving dyspnea. This procedure contributed to improved quality of life for patients with malignant tracheobronchial stricture and/or ERF. Stent retrievability was useful in resolving stent-related complications.
Shin
Ji Hoon
JH
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
Kim
Sang-We
SW
Shim
Tae Sun
TS
Jung
Gyoo-Sik
GS
Kim
Tae-Hyung
TH
Ko
Gi-Young
GY
Song
Ho-Young
HY
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001982:Bronchial Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D015641:Radiography, Interventional; D015607:Stents / Q000009:adverse effects; D014135:Tracheal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol