title: The management of post-intubation tracheal stenoses with self-expandable stents: early and long-term results in 11 cases.
abstract: OBJECTIVE
  The optimal management of post-intubation tracheal stenoses is surgical reconstruction of the airway. Stenting of the trachea using silastic T-tubes or one of the various types of tracheal stents are the alternative ways to surgical reconstruction for the management of post-intubation tracheal stenoses. The early and long-term results of 11 patients with post-intubation tracheal stenosis, who underwent tracheal stenting with self-expandable metallic stents (SEMSs), are presented.
  
  
  METHODS
  Twelve patients (10 men, mean age: 47.8±20.4 years) with post-intubation tracheal stenosis were referred for tracheal stenting with SEMS (2000-2004). In three cases, the upper tracheal stenosis extended within the subglottic larynx. Stenting was successful in 11 patients, while, in one patient with involvement of the subglottic larynx, the attempt to insert the stent failed. Follow-up time varied from 6 to 96 months, and it was made with virtual and fiberoptic bronchoscopy.
  
  
  RESULTS
  Immediate relief of obstructive symptoms was observed in all the 11 patients, where an SEMS was successfully inserted. Stent dislodgement occurred shortly after the procedure in two patients, and it was treated with insertion of a new stent in the first case and a stent-on-stent insertion in the second. Good patency of the stent was observed in three patients for 60-96 months. Three patients with good patency of the stent died from other reasons 24-48 months after stent insertion. Four patients developed obstructive granulation tissue at the ends of the stent after 12-43 months, requiring further treatment with thermal lasers and/or tracheostomy. One patient underwent stent removal and successful laryngotracheal reconstruction 6 months after stent insertion.
  
  
  CONCLUSIONS
  The application of SEMS in post-intubation tracheal stenoses results in immediate improvement of obstructive symptoms without significant perioperative complications. SEMSs have the potential risks of migration and of granulation tissue formation at the end of the stent. SEMS should be applied only in strictly selected patients with post-intubation tracheal stenosis, who are considered unfit for surgery and/or with limited life expectancy.
authors.affiliation: Aristotle University Medical School, AHEPA University Hospital, Department of Thoracic and Cardiovascular Surgery, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Charokopos
authors.forename: Christophoros N
authors.initials: CN
authors.lastname: Foroulis
authors.forename: Efi
authors.initials: E
authors.lastname: Rouska
authors.forename: Maria N
authors.initials: MN
authors.lastname: Sileli
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papadopoulos
authors.forename: Christos
authors.initials: C
authors.lastname: Papakonstantinou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects; D014135:Tracheal Stenosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult