Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases.
Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS) can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS) technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis.
Department of Chest Medicine, Erasme University Hospital, Free University of Brussels, 1070 Brussels, Belgium.
Benjamin
B
Bondue
Department of Chest Medicine, La Reunion University Hospital, Saint Denis, 97400 La Réunion, France.
Pascal
P
Schlossmacher
Department of Chest Medicine, Erasme University Hospital, Free University of Brussels, 1070 Brussels, Belgium.
Christiane
C
Knoop
Department of Chest Medicine, Erasme University Hospital, Free University of Brussels, 1070 Brussels, Belgium.
Isabelle
I
Etienne
Department of Medical Oncology, Erasme University Hospital, Free University of Brussels, 1070 Brussels, Belgium.
Sylvie
S
Luce
Department of Thoracic Surgery, Erasme University Hospital, Free University of Brussels, 1070 Brussels, Belgium.
Youri
Y
Sokolow
Department of Chest Medicine, Erasme University Hospital, Free University of Brussels, 1070 Brussels, Belgium.
Dimitri
D
Leduc