Customized self-expanding bare metal Y stents in the treatment of malignant carinal stenosis: a retrospective analysis

Abstract

Background: Self-expanding Y metal stent insertion is a safe and effective palliative method for malignant lesions involving the lower trachea, tracheal carina, and the main-stem bronchi. However, the length and degree of airway stenosis in different patients tend to vary, which leads to a call for a customized Y stent that could achieve a better treatment effect.Methods: This retrospective analysis included patients who received customized self-expanding bare metallic Y stents for malignant carinal stenosis at Beijing Tiantan Hospital, Capital Medical University between January 2007 and June 2020. CT scans and initial bronchoscopy were performed to provide reliable data for stent selection and size customization. Data on technical success, clinical success, and follow-up were analyzed.Results: A total of 36 patients (26 males and 10 females; median age, 61 years; age range, 30-83 years) were enrolled. Technical success was 97.2% (35/36), while clinical success was 97.2% (35/36). There was no procedure-related mortality. Out of 35 patients, 4 (11.4%) had stent-associated complications that did not affect the procedure of stent insertion. Re-stenosis of the stent due to tumor progression was the main midand long-term stent-related complication (65% and 57.1%, respectively), followed by stent fractures (5% and 14.3%, respectively).Conclusions: The current study described the design and insertion of customized self-expanding bare metal Y-stents and demonstrated the feasibility of their use for maintaining tracheal and main-stem bronchus patency in malignant carinal stenosis. This approach could be used as a bridging method before commencing adjuvant therapy and final palliative therapy for the relief of symptoms.

Hybrid stent in management of malignant airway obstruction with carina esophageal fistula: A case report

“…The complications include restenosis, stent rupture, and esophago tracheal fistula. [ 4 ] Malignant esophagotracheal fistula is a fatal complication of esophageal or bronchial cancer, which may be related to cancer progression and cancer treatment. Malignant protuberant mediastinal fistula is particularly rare, with poor prognosis.…”

“…[ 3 ] There is always a dispute about which kinds of stent is better used to treat MCAO diseases. [ 2 , 4 ] Patients with MCAO involving trachea carina infiltration, or fistula formation are more difficult to treat, and clinical data are not enough at present.…”

“…[3] There is always a dispute about which kinds of stent is better used to treat MCAO diseases. [2,4] Patients with MCAO involving trachea carina infiltration, or fistula formation are more difficult to treat, and clinical data are not enough at present. We herein report a case of Y type covered metallic stent combined with Y type silicone stent in the management of MCAO involving trachea carina esophageal fistula, which provides a clinical basis for the treatment of complex airway diseases.…”

Hybrid stenting with silicone Y stents and metallic stents in the management of severe malignant airway stenosis and fistulas

“…Several studies regarding the use of these SEMS confirm the efficacy of them in reestablishing the stenotic airway or sealing the fistulas (REF). In case of main carinal obstruction of fistula involving main carinal, lower tracheal or proximal main bronchus, metallic or silicone Y-shaped stents are necessary (8). Y-shaped stents consist of a tracheal body and 2 bronchial limbs that imitate the anatomy of the carina.…”

Self-expandable metallic stent with 125I seed strand in malignant biliary obstruction: a self-made delivery system and novel implantation method

“…For now, two main types of stents including plastic stent and SEMS are equally effective for initial relief of extrahepatic biliary obstruction, with high technical success of >90%, and there is broad consensus that metal stents are preferred for patients expected to survive for >4-6 months and plastic stents are preferred for patients with shorter survival, which is the consequence of taking economic efficiency into consideration (10,11). However, tumor ingrowth, epithelial cell hyperplasia, clot accumulation, and sludge formation lead to a 50% stent restenosis rate within 6 months post stent implantation (12)(13)(14). As the stent itself is unable to inhibit tumor progression, the combination of a stent and 125 I seed strand brachytherapy, focused on the underlying malignancies instead of simply addressing biliary stenosis, has attracted our attention (15).…”