title: Bilateral self-expandable metallic stents for lung cancer involving the carina.
abstract: Central airway obstruction needs interventional pulmonology and malignant main carinal involvement is one of the most challenging scenarios requiring rigid bronchoscopic intervention under general anesthesia. However, these patients tend to be in poor condition for such interventions. A 91-year-old male patient with lung cancer accompanied by obstructive pneumonia underwent an Ultraflex self-expandable metallic stent placement in the right mainstem bronchus. The extranodal extension of the carcinoma from mediastinal lymph nodes metastases to the carina was so fast that severe stenosis of the bilateral mainstem bronchi was observed 6 weeks later accompanied by the deterioration of dyspnea. To salvage the carina, bilateral Ultraflex covered stents were placed by "side-by-side" method using fiberoptic bronchoscopy under topical anesthesia. This strategy was quite safe and the time needed for the entire procedure was within 20 min. He never experienced dyspnea thereafter and died of a cardiac sudden death 7 months after the initial stenting.
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center Kyoto, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takeda
authors.affiliation: Division of Thoracic Surgery, Department of General Surgery, Uji Tokushukai Medical Center Kyoto, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Itano
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center Kyoto, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukita
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center Kyoto, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Saitoh
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center Kyoto, Japan.
authors.forename: Sorou
authors.initials: S
authors.lastname: Takeda
keywords: Bilateral self-expandable metallic stents; central airway obstruction; interventional pulmonology; malignant main carinal involvement; side-by-side method