Clinical application of airway bypass with paclitaxel-eluting stents: early results.
OBJECTIVE
To assess the safety and early clinical results of a multicenter evaluation of airway bypass with paclitaxel-eluting stents for selected patients with severe emphysema.


METHODS
Airway bypass was performed with a fiberoptic bronchoscope in three steps: identification of a blood vessel-free location with a Doppler probe at the level of segmental bronchi, fenestration of the bronchial wall, and placement of a paclitaxel-eluting stent to expand and maintain the new passage between the airway and adjacent lung tissue. All adverse events were recorded, as well as 1- and 6-month pulmonary function tests and dyspnea index.


RESULTS
Thirty-five patients received the airway bypass procedure with a median of 8 stents implanted per patient. At 1-month follow-up, statistically significant differences in residual volume, total lung capacity, forced vital capacity, forced expiratory volume, modified Medical Research Council scale, 6-minute walk, and St George's Respiratory Questionnaire were observed. At the 6-month follow-up, statistically significant improvements in residual volume and dyspnea were demonstrated. One death occurred after bleeding during the procedure. Retrospective analysis revealed that the degree of pretreatment hyperinflation may be an important indicator of which patients achieve the best short- and long-term results.


CONCLUSIONS
The airway bypass procedure reduces hyperinflation and improves pulmonary function and dyspnea in selected patients with severe emphysema. Duration of benefit appears to correlate with the degree of pretreatment hyperinflation. These preliminary clinical results support further evaluation of the procedure.
Cardoso
Paulo F G
PF
Department of Surgery, Division of Thoracic Surgery, Santa Casa de Porto Alegre-Pavilhao Pereira Filho Hospital, Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre, Porto Alegre-RS, Brazil. cardosop@gmail.com
Snell
Gregory I
GI
Hopkins
Peter
P
Sybrecht
Gerhard W
GW
Stamatis
Georgios
G
Ng
Alan W
AW
Eng
Philip
P
D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D016503:Drug Delivery Systems; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D018579:Patient Selection; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015607:Stents; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D017239:Paclitaxel