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The Dynamic stent, a bifurcated airway prosthesis facilitating coughing, was clinically evaluated. The stents were inserted bronchoscopically in 135 patients (84 male, 51 female, age 12-90 years, mean 59 years) suffering from compression stenoses, strictures or malacias of the central airways, or tracheo-esophageal fistulas. Extrinsic compression from malignant and semi-malignant tumors was the leading indication for stenting (47.4%), followed by esophago-airway fistulas (22.2%) and post-intubation stenoses (14%). Stent insertion turned out to be very easy and could be performed without complications. The Dynamic stent was well tolerated and gave immediate relief of dyspnea in most cases. Follow-up data, three months after the last implantation revealed that at least 24 patients were still alive with a stent in place and free of complaints. In 27 cases, the stent had been removed after response to treatment. One of these patients received a second in order to seal a fistula, two months after removal of the first one. 85 patients, 79 with malignant, 6 with non-malignant diseases had died, with a mean survival time of 123 days (0 to 611 days). Complications directly attributable to the stent were rare. Two patients who had received the stent to counteract severe tracheal compression from aortic abnormalities died from arrosion and hemoptysis. There were no other severe complications. Cephalad migration occurred in 4/136 inserted stents. The Dynamic stent can be considered feasible, effective, and comparitively safe.

We developed a new insertion technique and designed a forceps device for the placement of bifurcated airway stents; 131 of 142 endoscopically placed tracheobronchial Y-stents were inserted with a forceps and a laryngoscope. For the last 52 stent implantations we used the new stent forceps. It was determined to be a simple and safe method without major complications. In 11 cases alternative techniques had to be used. Technique and device are described in detail.

For the management of severe haemoptysis we have developed a double-lumen, bronchus-blocking catheter that can be introduced through the working channel of a standard fibrebronchoscope. We wondered whether this catheter would be suitable to control pulmonary haemorrhage in clinical practice. Over a period of 36 months, 30 of these catheters were used in 27 patients with moderate and massive pulmonary bleeding from various lesions. Underlying diseases were: malignancies (11), vascular deformities (5), tuberculosis (4), silicosis (2), carcinoids (2), silicosis (2), endometriosis (1), bronchiectasis (1). In 26 cases, the transbronchoscopic balloon tamponade was successful. In one patient, tumour growth close to the carina prevented securing of the balloon and double-lumen tube intubation was required. There were only minor complications attributable to the balloon. With the catheter in place for up to seven days, patients underwent surgery, received radiation, chemotherapy, drug treatment or bronchial arterial embolization. In conclusion, we found this double-lumen, bronchus-blocking device safe and the technique practicable to control pulmonary haemorrhage.

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