Overcoming the delivery limitation: results of an approach to implanting an integrated self-expanding Y-shaped metallic stent in the carina.
OBJECTIVE
To evaluate the technical success and initial clinical safety and effectiveness of the use of a Y-shaped metallic stent for complex stenoses involving the carina.


METHODS
Thirty-five consecutive patients with complex tracheobronchial stenoses involving the carina were treated with an integrated self-expandable inverted Y-shaped metallic stent and delivery system. The Y-shaped metallic stents were placed in the tracheobronchial tree with fluoroscopic guidance. Technical success, clinical success, Hugh-Jones classification, and complications were assessed during follow-up.


RESULTS
The delivery of the integrated self-expandable Y-shaped metallic stent in the carinal areas was technically successful and well-tolerated in all patients. Clinical success was achieved in 31 patients (89%) 1-7 days after stent placement; the procedure failed in four patients (11%). The improvement between pre- and postoperative Hugh-Jones classification grade was statistically significant (P<.001). During follow-up (mean follow-up, 192 days+/-169), all stenoses were resolved, and general physical examination of the 31 patents showed improvement with no obvious dyspnea or bleeding. Twenty-one patients were healthy without evidence of dyspnea, and the remaining 14 patients died (mean survival, 189 days+/-172) at the time of this report. The mean and median survival periods were 217 days+/-30 and 215 days+/-108, respectively. The mean and median stent patency periods were 216 days+/-30 and 215 days+/-119, respectively.


CONCLUSIONS
Deployment of an integrated, self-expandable inverted Y-shaped metallic stent with the delivery system was a safe and effective procedure for the treatment of complex tracheobronchial stenoses involving the carina.
Han
Xin-Wei
XW
Department of Radiology, the First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Rd, Zhengzhou, Henan Province 450052. hanxinwei@tom.com
Wu
Gang
G
Li
Yong-Dong
YD
Zhang
Qing-Xian
QX
Guan
Sheng
S
Ma
Nan
N
Ma
Ji
J
D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001982:Bronchial Diseases / Q000628:therapy*; D003251:Constriction, Pathologic; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D014135:Tracheal Stenosis / Q000628:therapy*; D016896:Treatment Outcome
D000497:Alloys; D003287:Contrast Media; C013616:nitinol; D007472:Iohexol; C038192:iopromide