title: Endotracheal nitinol stents: lessons from the learning curve.
abstract: OBJECTIVE
  To reflect on lessons learned placing endotracheal nitinol stents in children.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  All children who underwent nitinol cervical tracheal stenting were included. Records were carefully reviewed for intraoperative and postoperative complications, management choices, outcomes, and factors that influenced results.
  
  
  RESULTS
  Between 1999 and 2011, 7 children underwent 13 stent placements. Median follow-up was 5 years (range, 1-12 years). Six patients underwent stenting as a salvage procedure following open attempts at airway reconstruction. Four patients remain decannulated with their stent in place (median follow-up 7 years). The fifth patient had his stent removed endoscopically after 50 days because it became apparent that his obstruction was primarily laryngeal. The sixth child had his stent removed via a tracheal fissure after 14 months because of recalcitrant subglottic inflammation at the superior stent border. The seventh patient was decannulated for over 2 years but ultimately required tracheotomy replacement because of stenosis with the stent lumen. Complications included stent migration (23%), restenosis (29%), edema (29%), and granulation (57%).
  
  
  CONCLUSIONS
  Endotracheal nitinol stents provide a realistic opportunity for decannulation in children for whom other options have failed but should be reserved only as a salvage procedure in severely complicated airways. Our experience has taught valuable lessons about stent indications, sizing, characteristics, and deployment, as well as means to avoid and manage their complications.
authors: Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York 10467, USA. gruberb@gmail.com
authors: Bianca
authors: B
authors: Siegel
authors: John P
authors: JP
authors: Bent
authors: Robert F
authors: RF
authors: Ward
mesh_terms: D000293:Adolescent; D000497:Alloys; D001672:Biocompatible Materials; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D019919:Prosthesis Implantation; D015607:Stents; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*; D055090:Tracheomalacia / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000497:Alloys; D001672:Biocompatible Materials; C013616:nitinol