A conical self-expanding metallic stent for the management of critical complex tracheobronchial malignant stenosis

Fiorelli, Alfonso; Caterino, Umberto; Raucci, Antonio; Santini, Mario

doi:10.1093/icvts/ivw349

Cited by 10 publications

(12 citation statements)

References 4 publications

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“…Increased pulmonary capillary hydrostatic pressure and decreased intraalveolar pressure will result in interstitial and alveolar edema [12,13]. Hypoxemia will initiate a hyperadrenergic state which increases the pulmonary vascular resistance [3,14]. Increased capillary transmural pressures augment the linear endothelial cellular stretch which results in loss of capillary integrity because of mechanical and oxidative stress injury mechanisms [10,12].…”

Section: Resultsmentioning

confidence: 99%

Synthetic Phenylpiperidine Derivative Meperidine as a Trigger for Type I Negative Pressure Pulmonary Edema in General Anesthesia

Baracan¹,

Gavris²,

Poroch³

et al. 2017

Rev. Chim.

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We present a case of type I negative pressure pulmonary edema in a healthy 17-year-old boy who underwent an emergent appendectomy under general anesthesia. The particularity of our case revolves around the administration of meperidine for perioperative shivering, along with other anesthetic risk factors, which may have served as the trigger of type I negative pressure pulmonary edema.We present the pathophysiological mechanisms, the formulation of clinical and paraclinical diagnosis and the principles of intensive care therapy. This was the first such case experienced in our practice, with a remarkable learning opportunity.Negative pressure pulmonary edema (NPPE) is an acute, potentially life threatening, uncommon perioperative pathological entity. Two clinical types have been described: type I NPPE, associated with acute airway obstruction, and type II NPPE, associated with chronic partial upper airway obstruction. An early differential diagnosis between various pulmonary edema conditions in critically ill patients and a prompt recognition of high risk of acute morbidity are crucial in certain circumstances. We present a case of type I NPPE in a healthy 17-year-old boy who underwent an emergent appendectomy under general anesthesia. The particularity of our case revolves around the administration of meperidine, along with other anesthetic risk factors, which may have served as the trigger of NPPE. Experimental part Study case presentationA 17-year-old male patient without medical history presented with acute appendicitis. After evaluation in the emergency department, he was admitted for emergency appendectomy. His preoperative physical examination and laboratory tests were within normal limits except for neutrophilic leukocytosis.Physical status: height (H) = 1.60 m; weight (W) = 50 kg; body mass index (BMI) = 19.53 kg/m 2 ; airway assessment by Mallampati classification of oral opening -Mallampati I.Cardiovascular status: blood pressure (BP) = 117/59 mmHg; heart rate (HR) = 75 bpm; heart auscultationnormal.Respiratory status: chest auscultation was clear bilaterally, without murmurs. His baseline pulse oximetry arterial blood oxygen saturation (SpO 2 ) was 99% on room air, with a fraction of inspired oxygen (FiO 2 ) of 0.21. * email: claudiagavris@yahoo.com, Phone: +40723791322; vlader2000@yahoo.com, Phone: +40723271972 Laboratory blood investigations: hemoglobin (Hgb) = 15.2 g/L; hematocrit (Hct) = 42%; leukocytes (L) = 9,450/ µL (neutrophils = 90%); platelets (PLT) = 221,000/µL; activated partial prothrombine time (aPTT) = 24.4 s; international normalized ratio (INR) = 1.09; serum proteins = 71 g/L; fibrinogen = 3.22 g/L; C-reactive protein (CRP) = 11.3 mg/L; glycemia = 110 mg/dL; serum Na + = 135 mmol/L; serum K + = 4.1 mmol/L; serum Cl -= 98,5 mmol/ L; serum total calcium = 9.43 mg/dL; serum Mg + = 1.81 mg/dL; aspartate aminotrasferase (AST) = 20 U/L; alanine aminotransferase (ALT) = 18 U/L; lactate dehidrogenase (LDH) = 374 U/L; blood urea nitrogen (BUN) = 33.3 mg/ dL; creatinine = 1.06 mg/dL.The patient w...

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Section: Resultsmentioning

confidence: 99%

Synthetic Phenylpiperidine Derivative Meperidine as a Trigger for Type I Negative Pressure Pulmonary Edema in General Anesthesia

Baracan¹,

Gavris²,

Poroch³

et al. 2017

Rev. Chim.

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“…From a technical point of view, we preferred to use a SEMS rather than silicone stent due to presence of severe external compression that caused distortion and obstruction of right main bronchus [6–8]. In addition, the ICI treatment was started two weeks after the endoscopic recanalization, when a complete resolution of atelectasis and pneumonia was achieved as confirmed by improvement of patient’s clinical condition, and by chest CT scan findings.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic central airway recanalization to enable first line pembrolizumab treatment in a PD-L1 strongly positive non-small cell lung cancer: a case report

Fiorelli

Perrotta

Mollica

et al. 2019

J Cardiothorac Surg

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Background Tracheobronchial malignant stenosis is a life-threatening condition which may cause recurrent infections due to lung atelectasis. Despite immunotherapy is less toxic than standard chemotherapy, recurrent lung infections may represent a challenge for this treatment. We report a clinical case of a patient with metastatic squamous cell carcinoma suffering from pulmonary infections due to central airway obstruction who underwent endoscopic recanalization followed by immunotherapy. Case presentation A 64 year-old man was referred to our attention for the management of metastatic squamous cell carcinoma obstructing the right main bronchus with recurrent pulmonary infections. Patient exhibited strong positive PD-L1 expression (> 50%). Advanced disease stage contraindicated surgical treatment. Although therapy with immune check point inhibitors was indicated as first-line treatment, recurrent pulmonary infections made it unfeasible. Therefore, we planned a combined approach including endoscopic recanalization of central airway in order to resolve lung atelectasis, and lung infection followed by immunotherapy treatment with pembrolizumab in order to avoid local and systemic disease progression. Conclusions At 16-week follow-up, the patient was alive in stable disease with improvement of clinical condition and no signs of lung infection.

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“…Only when a unilateral main bronchus is obstructed and cannot be recanalized ( Fig. 2A), or its distal lung tissue is nonfunctional, can a cone-shaped stent insertion be considered (4).…”

Section: Methodsmentioning

confidence: 99%

“…The majority of patients with malignant carinal stenosis are diagnosed in the advanced stages of the disease and cannot undergo surgical resection (3). In these cases, bronchoscopic interventions including stent placements may be the only palliative option for maintaining lumen patency (4). Bronchoscopic interventions are advantageous as they are less invasive and may be suitable for critically ill patients (5).…”

Section: Introductionmentioning

confidence: 99%

“…However, their disadvantages include poor shape-adaptability, difficult placement and secretion retention (8,9). In addition, when one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is not possible (4). Micro-Tech stents (Micro-Tech Co., Ltd., Nanjing, China) are self-expanding metal stents available in different shapes and are individually customizable.…”

Section: Introductionmentioning

confidence: 99%

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Application of Micro‑Tech stents in malignant carinal stenosis

et al. 2019

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Malignant carinal stenosis is a disease process that is not always suitable for treatment with a Y-shaped stent. When one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is infeasible. In this complex condition, a cone-shaped stent is selected to maintain the patency of the trachea and the other main bronchus. The efficacy of the bare cone-shaped Micro-Tech stent to treat malignant carinal stenosis was evaluated in the current study. The medical records of 47 patients with malignant carinal stenosis who underwent Micro-Tech stent placement between January 2004 and October 2017 in Beijing Tian Tan Hospital (Beijing, China) were analyzed retrospectively. A total of 47 bare Micro-Tech stents (28 Y-shaped and 19 cone-shaped) were successfully inserted in the patients. Following stent placement, immediate satisfactory results were achieved in all patients, especially an improvement of dyspnea (100%), cough (81.1%) and stridor (100%). The Karnofsky scores were significantly increased (P<0.001), and the American Thoracic Society Dyspnea Index values were significantly decreased (P<0.001). Following a median of 88 days, initial bronchoscopic interventions were performed for tumor overgrowth (84.6%), stent fracture (7.7%) and granulation tissue (7.7%). Restenting was performed in two patients due to tumor progression (n=1) and stent fracture (n=1). Removal of a Y-shaped stent was attempted in one patient, but failed, as the stent had become partly embedded in the airway mucosa. In conclusion, cone-shaped Micro-Tech stent placement maintained tracheal-unilateral main bronchus patency and benefitted patients with malignant carinal stenosis in whom Y-shaped stents were not suitable for insertion.

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A conical self-expanding metallic stent for the management of critical complex tracheobronchial malignant stenosis

Cited by 10 publications

References 4 publications

Synthetic Phenylpiperidine Derivative Meperidine as a Trigger for Type I Negative Pressure Pulmonary Edema in General Anesthesia

Synthetic Phenylpiperidine Derivative Meperidine as a Trigger for Type I Negative Pressure Pulmonary Edema in General Anesthesia

Endoscopic central airway recanalization to enable first line pembrolizumab treatment in a PD-L1 strongly positive non-small cell lung cancer: a case report

Application of Micro‑Tech stents in malignant carinal stenosis

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