title: Endoscopic removal of metallic airway stents.
abstract: BACKGROUND
  Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period.
  
  
  METHODS
  We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80%) and malignant disease in 5 patients (20%). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications.
  
  
  RESULTS
  Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), re-obstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1).
  
  
  CONCLUSIONS
  Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.
authors.affiliation: Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
authors.forename: William
authors.initials: W
authors.lastname: Lunn
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.forename: Momen
authors.initials: M
authors.lastname: Wahidi
authors.forename: Simon
authors.initials: S
authors.lastname: Ashiku
authors.forename: Robert
authors.initials: R
authors.lastname: Thurer
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D020099:Coated Materials, Biocompatible; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000628:therapy*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible; D008670:Metals