Implantation of Ultraflex Nitinol Stents in Malignant Tracheobronchial Stenoses

Miyazawa, Teruomi; Yamakido, Michio; Ikeda, Sadao; Furukawa, Kinya; Takiguchi, Yuichi; Tada, Hirohito; Shirakusa, Takayuki

doi:10.1378/chest.118.4.959

Cited by 175 publications

(122 citation statements)

References 19 publications

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“…There is no clear advantage of any type of stent [88,89,91,92,95,[98][99][100][101][102][103][104]. Stents can be used temporarily [92,105] in a multimodality concept of cancer care and as a last palliative measure for end-stage cancer patients [106,107].…”

Section: Clinical Experience and Resultsmentioning

confidence: 99%

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Bolliger¹

2006

European Respiratory Journal

338

276

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Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes. This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment.Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated.In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease.

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Section: Clinical Experience and Resultsmentioning

confidence: 99%

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Bolliger¹

2006

European Respiratory Journal

338

276

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“…The last 5 mm on each end of the partially covered stents are uncovered and hold the stent in place; this type is the most popular (FIGURE 1). They have been used for the treatment of malignant and benign stenoses [25][26][27][28][29]. As the expansion force of the knitted nitinol stent is not very high [24,30], sufficient pre-dilatation is required to accomplish good airway patency.…”

Section: Metallic Stents: Overviewmentioning

confidence: 99%

The use of self-expandable metallic stents in the airways in the adult population

Dutau¹,

Musani

Plojoux³

et al. 2014

Expert Review of Respiratory Medicine

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The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.KEYWORDS: airway stenting . benign airway stenosis . bronchoscopy . central airway obstruction . self-expandable metallic stentDumon was the first physician to place a dedicated and specially designed airway stent in 1987 in Marseille. This dedicated stent consisted of a silicone tube with small studs on the external surface to reduce migration [1]. Consequently, several companies started to develop other airway stents with silicone and metal. In the last 20 years, numerous reports have been published about the use of selfexpanding and balloon expandable metal stents for the treatment of tracheobronchial malignant and benign stenoses, tracheobronchomalacia (TBM), fistulas and dehiscences [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].Self-expandable stents are made of a shapememory alloy, generally nitinol (nickel-titanium). When the stent is released, it expands spontaneously to reach its original shape and diameter. On the other hand, balloon expandable metallic stents (the first generation of airway metallic stents) were made of metal (steel) meshes that did not possess a memory shape. A balloon was then necessary to deploy them. Most of these stents had originally been developed for use in the vascular system but were found to be adequate for placement in the central airways after only minor modifications, if any at all. The latest developments include stents made of shape memory alloys and composite stents made from metals and polymers [17][18][19]. But, so far, the Dumon stent (Tracheobronxane Ò , Novatech, La Ciotat, France) remains the most commonly placed stent worldwide. Dumon stents have been the 'gold standard' for the treatment of benign and malignant airway stenoses over the past 20 years [20,21], with two specific designs: straight and Y-shaped (for disease involving the carina) [22]. By the way, it is interesting to notice that, in the Thoracic Endoscopy Unit of Marseille, where the Dumon stent was conceptualized and used, the percentage of silicone stent placement has dropped from 100% in 2000 to 65% in 2013. The remaining 35% of the stents used are now fully covered, selfexpandable, metallic stents (SEMS). This goes to prove that the Dumon stents are not the ideal stents in all situa...

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“…Nitinol stents are easily deformable when cold and regain their original shape at body temperatures. Their plasticity allows the tracheal diameter to narrow appropriately with cough, aiding mucocilliary clearance [24][25][26]. The most common types of metallic stents are represented in Table 2.…”

Section: Types Of Metallic Stentsmentioning

confidence: 99%

“…There was improvement in clinical, endoscopic examination and pulmonary function on days 1, 30 and 60 after stent placement. Tumor ingrowth and tumor overgrowth were the most commonly observed complications (21 % and 24 % respectively) [25]. These stents were also available with a polyurethane covering that made them useful for endotracheal disease, preventing tumor growth through the stent.…”

Section: Self-expanding Stents (Sems)mentioning

confidence: 99%

Metallic stents in the airway: should we continue to use them and can we remove them?

Michaud

2012

Curr Respir Care Rep

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Metallic stents have proven to be valuable tools for the management of both malignant and benign airway obstruction. Their use has become popular worldwide as has our knowledge of their long-term effects on the airway. It is essential to understand the implications of placing a metallic stent since they are not devoid of potentially significant complications. It is also important to acknowledge that metallic stents are not always easily removed and a lack of familiarity with the complexities of their removal can have serious consequences. In general, their use should be reserved for malignant airway obstruction or in rare cases of benign disease where all other options have been ruled out.

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Implantation of Ultraflex Nitinol Stents in Malignant Tracheobronchial Stenoses

Cited by 175 publications

References 19 publications

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents

The use of self-expandable metallic stents in the airways in the adult population

Metallic stents in the airway: should we continue to use them and can we remove them?

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