Double Y-stenting for tracheobronchial stenosis

Abstract

The purpose of the present study was to evaluate the feasibility, efficacy and safety of the double Y-stenting technique, by which silicone Y-stents are placed on both the main carina and another peripheral carina, for patients with tracheobronchial stenosis.Under general anaesthesia, using rigid and flexible bronchoscopes, a Dumon TM Y-stent (Novatech, La Ciotat, France) was first placed on the primary right or secondary left carina followed by another Y-stent on the main carina so as to insert the bronchial limb of the stent into the first Y-stent. Patients who underwent double Y-stent placement during 3 yrs and 1 month in a single centre were retrospectively reviewed. In the study period, 93 patients underwent silicone stent placement and 12 (13%) underwent double Y-stent placement (11 for right and one for left bronchus). A combination of Y-stents, 14610610 mm and 16613613 mm in outer diameter, were most frequently used. Dyspnoea was relieved in all patients. Six out of seven patients with supplemental oxygen before stent placement could be discharged without supplemental oxygen. Median survival after stenting was 94.5 days. One pneumothorax and one granuloma formation occurred. Double Y-stent placement for patients with tracheobronchial stenosis was technically feasible, effective and acceptably safe.

Airway stenting in patients requiring intubation due to malignant airway stenosis: a 10-year experience

“…At our institution, we performed all stenting procedures using both rigid and flexible bronchoscopes under general anesthesia in the operating room. For airway stenosis, stenting was performed using a silicone straight stent (DUMON; Novatech, La Ciotat, France), silicone bifurcated stent (DUMON or OKI; Novatech), or self-expandable metal stent (Ultraflex, covered type; Boston Scientific, Natick, MA, USA) after bronchoscopic airway reestablishment using argon plasma coagulation, electrocautery, a CryoProbe, a highpressure balloon, or the bevel of a rigid bronchoscope as previously described (10)(11)(12). After the stent insertion, acetylcysteine nebulization was performed three times daily.…”

Silicone Y-Stent Placement on the Secondary Left Carina

“…Above all, the silicone stent is still one of the gold standards because of its easy removability, customizability, durability and low cost [1,2,3]. Although Dumon Y-stents were originally invented and have been commonly used for the treatment of the main carinal stenosis [13,14], recent studies [6,7,8,9,10] have suggested that they can be used for the stenosis around RC1. However, the main carinal angle differs from the primary right carinal angle, so when we insert a Y-stent on RC1, the proximal and distal orifice of the limbs of the Y-stents must be cut obliquely so that each orifice faces the bronchial lumen but not the bronchial wall [6].…”

“…Therefore, the technique of Y-stenting for LC2 seems to be easier than that for RC1. The right upper lobe bronchus branches off at an acute angle, so the insertion technique of the Y-stent limb into the right upper lobe bronchus is often complicated [6,8,9]. A limitation of the Y-stent for placing it on LC2 may be its large diameter.…”

“…Formerly, there was no ideal stenting for covering the peripheral bifurcation beyond the main carina. However, recent modification of stenting techniques has enabled stenting on the main carina and the carina between the bronchus to the right upper lobe and the bronchus intermedius (primary right carina, RC1 [5]) using a silicone Y-stent [6,7,8,9,10], and a dedicated bifurcated silicone stent [11] is now available for maintaining airway patency of the right main stem bronchus, bronchus intermedius and the right upper lobe bronchus.…”

Changes in the Cross-sectional Area of Pulmonary Small Vessels Assessed via Chest Computed Tomography after Interventional Bronchoscopy in Patients with Airway Obstruction Due to a Malignant Disease

“…Patients suffering from airway obstruction can receive significant relief from life-threatening symptoms via interventional bronchoscopy, and performing interventional bronchoscopy at the exact location of the obstruction can provide the greatest functional benefit to patients [1][2][3][4][5][6][7][8][9][10] . It is essential to improve obstructions, usually using chemotherapy and radiation as the first choice of treatment 11,12) .…”