Endobronchial stenting in the management of large airway pathology

Abstract

Endobronchial interventions including the deployment of endobronchial stents have a clear role in the management of central airway problems. The use of endobronchial stents has rapidly increased since the first airway stent was developed in the 1960s and with the subsequent manufacture of improved silicone and metallic stents. They provide effective relief for symptoms of intrinsic and extrinsic airway obstruction secondary to a wide range of pathologies including lung cancer, lymphoma, thyroid carcinoma and benign disease such as tracheal strictures and tracheobronchomalacia. Endobronchial stents can also seal defects within the airway including malignant broncho-oesophageal fistulae and posterior wall tracheal tears. They can be placed safely under conscious sedation at flexible bronchoscopy or under general anaesthetic at rigid bronchoscopy. Rigid bronchoscopy under general anaesthesia provided by a multidisciplinary team is safe with few contraindications. Complications of endobronchial stents include infection, granulation tissue formation and metallic stent fracture sometimes requiring removal, although serious life-threatening complications are very rare. Increasing numbers of patients are being referred to specialist centres for airway intervention. This article reviews the history of endobronchial stents, the different stents available, and the indications, outcomes and complications involved in deploying endobronchial stents.

Implantation of Metallic Stent Under Direct Visualization of Flexible Bronchoscope Without Fluoroscopic Guidance on Orotracheal Intubated Patients

“…The etiology contains malignant tumors and benign diseases [12][13] . Procedures of pulmonary intervention, including ablation of argon [14] , laser resection [15] , and stent implantation, are used to treat malignant airway stenosis.…”

Fatal migration of an endobronchial stent into the pulmonary artery

“…Unfortunately, the patient died intraoperatively due to an uncontrollable bleeding. However, endobronchial stenting is a well-established procedure in the management of benign or malign pathologies causing central airway obstruction,1 and endobronchial stents can be placed safely under general anaesthesia by rigid bronchoscopy. Since the development of airway stents in the 1960s, the use of airway stents increased rapidly, but too little is known about major complications 2.…”

Interventional management of tracheobronchial strictures

“…Even in the absence of parenchymal lung disease, ventilatory failure frequently occurs if the obstruction is not relieved. Tracheobronchial obstructions are challenging to manage, particularly in patients unsuitable for curative surgery, with endobronchial intervention having an increasing role in their management [1] . Endobronchial intervention can be performed under local anesthesia by fluoroscopic guidance and/or fiberoptic bronchoscopy, or under general anesthesia using rigid bronchoscopy.…”