Management of tracheal obstruction caused by benign or malignant thyroid disease using covered retrievable self-expandable nitinol stents.
BACKGROUND
Curative resection is often contraindicated in patients with airway obstruction by aggressive thyroid disease.


OBJECTIVE
To evaluate the safety and clinical effectiveness of covered retrievable self-expandable nitinol stents placed in patients with airway obstruction caused by benign or malignant thyroid disease.


METHODS
From 1996 to 2009, covered retrievable self-expandable nitinol stents were placed in nine symptomatic patients with malignant (n=7) or benign (n=2) thyroid disease. Improvement in patient respiratory status, complications and their management, and survival data were evaluated. Stents were removed if stent-related complications occurred or the stents were no longer necessary.


RESULTS
A total of 11 stents were successfully placed without procedure-related complications. Improvement of more than one dyspnea grade was seen in eight of nine patients (89%), while the ninth patient underwent intubation due to upper airway swelling. Stent migration, sputum retention, and tumor overgrowth occurred in 27.3% (n=3), 9.1% (n=1), and 9.1% (n=1) of the stents, respectively. A total of six stents were successfully removed because of stent-related complications (n=4) or after total thyroidectomy (n=2). In two patients with benign thyroid goiters, a stable airway was maintained until total thyroidectomy.


CONCLUSIONS
Placement of covered retrievable self-expandable nitinol stents was safe and effective in patients with airway obstruction caused by benign or malignant thyroid disease. Stent retrievability was very useful in cases of stent-related complications. In patients with benign thyroid disease, stent placement can serve as an effective bridge to surgery.
Kim
Won-Kyeong
WK
Department of Internal Medicine, Chuncheon Armed Forces Hospital, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Shin
Ji Hoon
JH
Kim
Jin Hyoung
JH
Song
Jin Woo
JW
Song
Ho-Young
HY
D000328:Adult; D000368:Aged; D000497:Alloys; D001999:Bronchoscopy; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D005260:Female; D005548:Foreign-Body Migration / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects; D013959:Thyroid Diseases / Q000150:complications* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery; D013965:Thyroidectomy; D014135:Tracheal Stenosis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
D000497:Alloys; D020099:Coated Materials, Biocompatible; C013616:nitinol