Double Y-Stent Placement for Tracheobronchial Stenosis

Abstract

The silicone stent has been widely used to re-establish airway patency for patients with airway stenosis. The ideal shape of the stent should be well adapted to the tracheobronchial anatomic structures, and its optimal length should cover the entire inner wall of the stenotic airway. Although the silicone Y-stent was developed as a dedicated prosthesis for main carinal stenosis, we often encounter patients with tracheobronchial stenosis that cannot be treated by a single silicone Y-stent. The present study reports 2 cases of malignant disease who underwent double Y-stent placement on the involved carina between the right upper lobe bronchus and the bronchus intermedius as well as on the involved main carina as a unit. The procedure provided successful palliation.

Double Y-stenting for tracheobronchial stenosis

“…To overcome these drawbacks, we reported a technique in which a Dumon Y-stent was placed in RC1 [12]. Afterward, we developed the double Y-stenting technique so as to treat the stenotic airway around both the main carina and RC1 [10]. Double Y-stenting relieved dyspnoea in all cases and six of the seven cases with supplemental oxygen, including one patient requiring mechanical ventilation, were able to discontinue supplemental oxygen.…”

“…The institutional review board of Nagoya Medical Center approved this retrospective study (identifier 2011-437). Some of these patients were previously reported as case reports focused on the stent insertion technique [10].…”

“…However, we often encounter patients with airway stenosis ranging from the trachea to the orifice of the lobar bronchi, which cannot be wholly covered with a single Y-stent. For such cases, we have performed double Y-stenting in which silicone Y-stents are placed on both the main carina and another peripheral carina, such as the one between the bronchus to the right, upper lobe and the bronchus intermedius (primary right carina (RC1)) or the carina between the bronchus to the lingular segment of the left upper-lobe and the left lower-lobe bronchus (secondary left carina (LC2)) [10]. To our knowledge, no data have, so far, been reported on this double Y-stenting procedure, except our case reports focusing on the technical details [10].…”

“…For such cases, we have performed double Y-stenting in which silicone Y-stents are placed on both the main carina and another peripheral carina, such as the one between the bronchus to the right, upper lobe and the bronchus intermedius (primary right carina (RC1)) or the carina between the bronchus to the lingular segment of the left upper-lobe and the left lower-lobe bronchus (secondary left carina (LC2)) [10]. To our knowledge, no data have, so far, been reported on this double Y-stenting procedure, except our case reports focusing on the technical details [10]. In this retrospective study, we investigated the feasibility, efficacy and safety of the double Y-stenting technique for patients with tracheobronchial stenosis.…”

Thin Bronchoscope for Evaluating Stenotic Airways during Stenting Procedures

“…The assessment of lesion location influences the decision as to bronchoscopic management. Since the indication for airway stenting is proximal to the segmental bronchi, stenting is contraindicated if tumor invasion at the level of segmental bronchi is proven on bronchoscopy [20,21]. Assessment of lesion length also provides important information, including selection of the bronchoscopic modality for airway dilatation and choice of stent length.…”