Tracheal stricture and fistula: management with a barbed silicone-covered retrievable expandable nitinol stent.
OBJECTIVE
The purpose of this study was to evaluate the safety and effectiveness of a barbed silicone-covered retrievable expandable nitinol stent in preventing stent migration in patients with tracheal strictures or fistulas.


METHODS
Under fluoroscopic guidance, barbed silicone-covered retrievable expandable nitinol stents were placed in 15 patients with tracheal strictures, two patients with fistulas, two patients with combined strictures and fistulas, and one patient with variable extrathoracic airway obstruction. The three pairs of barbs were attached to the external stent surface at the middle of the stent at equal intervals. Technical success, improvement in respiratory status, complications, and related interventions were evaluated.


RESULTS
The technical success rate was 100%, and respiratory status improved or the fistula closed in all 20 patients. Complications included sputum retention (three patients), tumor overgrowth (three patients), pain (one patient), and granulation tissue formation (one patient). No stent migration occurred, even in the three patients without fixed strictures. Four stents subsequently were removed because of complications, and one stent was removed because the patient's condition improved. Stent removal was not difficult and was uneventful. The silicone membranes and barbs of the removed stents were intact.


CONCLUSIONS
Use of a barbed silicone-covered retrievable expandable nitinol stent relieves dyspnea and facilitates fistula closure in patients with benign or malignant tracheal strictures or fistulas. The barbed design of the stent is important in preventing migration.
Kim
Yong Hee
YH
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Shin
Ji Hoon
JH
Song
Ho-Young
HY
Kim
Jin Hyoung
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D005260:Female; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012828:Silicones; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis / Q000628:therapy*; D014138:Tracheoesophageal Fistula / Q000628:therapy*; D016896:Treatment Outcome
D000497:Alloys; D020099:Coated Materials, Biocompatible; D012828:Silicones; C013616:nitinol