Clinical Experience With a New Removable Tracheobronchial Stent in the Management of Airway Complications After Lung Transplantation

Fernández-Bussy, Sebastián; Akindipe, Olufemi; Kulkarni, Varsha; Swafford, Wendy; Baz, Maher A.; Jantz, Michael A.

doi:10.1016/j.healun.2009.04.014

Cited by 34 publications

(24 citation statements)

References 50 publications

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“…Therapeutic bronchoscopy is increasingly performed to alleviate CAO in patients with malignant and nonmalignant diseases alike, with several small retrospective studies showing improved outcomes with this approach [2,7,8,9,10,11,12,13,14,15,16,17]. However, there are few studies available that have systematically examined the impact of therapeutic bronchoscopy on pulmonary function, dyspnea, and quality of life (QOL) in patients with CAO [3,18,19,20].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

et al. 2015

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Background: Central airway obstruction (CAO) occurs in patients with primary or metastatic lung malignancy and nonmalignant pulmonary disorders and results in significant adverse effects on respiratory function and quality of life. Objectives: The objective of this study was to assess the effect of therapeutic bronchoscopic interventions on spirometry, dyspnea, quality of life, and survival in patients with CAO. Methods: We prospectively studied patients who underwent therapeutic rigid bronchoscopy for CAO. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before the procedure and at follow-up 6-8 weeks after the procedure. Results: Fifty-three patients (24 malignant and 29 nonmalignant CAO), who underwent successful rigid bronchoscopic intervention, were enrolled. Airway stent placement and various debulking techniques including mechanical debridement and heat therapy were used. After bronchoscopy, there was a significant increase in forced vital capacity (2.2 ± 0.91 l before, 2.7 ± 0.80 l after, p = 0.009) and forced expiratory volume at 1 s (1.4 ± 0.60 l before, 1.8 ± 0.67 l after, p = 0.002). The SOBQ score improved from 55.8 ± 30.1 before the procedure to 37.9 ± 27.25 after the procedure (p = 0.002). In the SF-36, there was an improvement in almost all domains, with statistically significant improvement seen in several domains. Benefits were seen independent of the etiology of CAO, site of intervention or stent placement. The patients with malignant CAO, in whom airway patency could not be achieved, had a poor survival. Conclusions: Alleviation of CAO with therapeutic rigid bronchoscopy results in improvement in spirometry, shortness of breath, quality of life, and survival.

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Section: Introductionmentioning

confidence: 99%

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

et al. 2015

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“…Although in recent years the treatment of tracheal stenosis has been improved by means of tracheobronchial stenting technique, acute inflammation and fibrosis of the tracheal wall, 11 in-stent restenosis (ISR), 11,38 trachea obstruction and stent migration 9,13 resulted in a need for further clinical intervention in the stented lesion. 38 The restenosis in airways will occur because of ingrowth of the tumor, granulation and abnormal tissue growth.…”

Section: Introductionmentioning

confidence: 99%

On Studying the Interaction Between Different Stent Models and Rabbit Tracheal Tissue: Numerical, Endoscopic and Histological Comparison

et al. 2015

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Stenting technique is employed worldwide for treating atherosclerotic vessel and tracheal stenosis. Both diseases can be treated by means of metallic stents which present advantages but are affected by the main problem of restenosis of the stented area. In this study we have built a rabbit trachea numerical model and we have analyzed it before and after insertion and opening of two types of commercial stent: a Zilver R Flex T M Stent and a WallStent T M . In experimental parallel work, two types of stent were implanted in 30 New Zealand rabbits divided in two groups of 10 animals corresponding to each stent type and a third group made up of 10 animals without stent. The tracheal wall response was assessed by means of computerized tomography by endoscopy, macroscopic findings and histopathological study 90 days after stent deployment. Three idealized trachea models, one model for each group, were created in order to perform the computational study.The animal model was used to validate the numerical findings and to attempt to find qualitative correlations between numerical and experimental results. Experimental findings such as inflammation, granuloma and abnormal tissue growth, assessed from histomorphometric analyses were compared with derived numerical parameters such as wall shear stress (WSS) and maximum principal stress. The direct comparison of these parameters and the biological response supports the hypothesis that WSS and tensile stresses may lead to a greater tracheal epithelium response within the stented region, with the latter seeming to have the dominant role. This study may be helpful for improving stent design and demonstrates the feasibility offered by in-silico investigated tracheal structural and fluid dynamics.

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“…This experience almost exclusively included malignant airway obstructions (49/52), a situation where second-generation SEMS had previously also performed well. The only available reports of the performance of third-generation SEMS in benign airway disease include a series of 17 patients published by Dooms et al [11] shortly after the appearance on the market of these stents, demonstrating an unacceptable complication rate at 12 weeks (stent migration 60%, stent fracture 15%, stent shriveling 10%) as well as other small series of post lung transplantation anastomotic strictures treated mainly with AERO stents (Merit Medical Systems, South Jordan, UT, USA) [12][13][14] . Our clinical experience with fully covered third-generation SEMS in benign airway stenosis is larger than any other previously published series to our knowledge; hence, we decided to review it to evaluate the safety and efficacy of third-generation SEMS in benign airway disease.…”

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confidence: 99%

Safety and Efficacy of a Fully Covered Self-Expandable Metallic Stent in Benign Airway Stenosis

et al. 2017

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Background: The use of self-expandable metallic stents (SEMS) in benign airway disease was the object of a boxed warning from the United States Food and Drug Administration in 2005 due to the risk of stent-related complications and difficulties associated with their removal. Third-generation fully covered SEMS have been commercialized since this warning and theoretically should not present the same difficulties associated with removal as they cannot become embedded in the airway mucosa. Objectives: We aimed to examine the safety and efficacy of a specific third-generation SEMS, the Silmet stent. Methods: We reviewed the records of all patients treated for benign airway stenosis with third-generation Silmet SEMS from January 2011 to December 2015 at the North Hospital of Marseilles, France. Results: Forty SEMS were inserted in 30 patients over this period. Twenty (50.0%) stents were removed because of stent-related complications after a median of 77.0 ± 96.6 days (migration 32.5%, granulation tissue formation 7.5%, subjective intolerance 5.0%, mucus plugging 2.5%, laryngeal edema 2.5%). There were no cases of stent-related mortality. All complications were managed successfully endoscopically. Thirty-six stents (90.0%) were removed successfully after a median of 122.0 ± 113.2 days without any complications. The clinical success rate of stent treatment was 40.7%. Conclusion: Third-generation SEMS are a safe treatment option for complex benign airway stenosis, but complications requiring stent removal are frequent. Further studies are needed to compare the performance of third-generation SEMS and silicone stents in benign airway stenosis.

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Clinical Experience With a New Removable Tracheobronchial Stent in the Management of Airway Complications After Lung Transplantation

Cited by 34 publications

References 50 publications

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

On Studying the Interaction Between Different Stent Models and Rabbit Tracheal Tissue: Numerical, Endoscopic and Histological Comparison

Safety and Efficacy of a Fully Covered Self-Expandable Metallic Stent in Benign Airway Stenosis

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