Management of malignant carinal involvement using ‘side‐by‐side’ method of bilateral self‐expandable metallic stents

Abstract

Central airway obstruction caused by cancer requires urgent interventional pulmonology. Malignant main carinal involvement is one of the most challenging situations, usually treated by rigid bronchoscopic intervention under general anaesthesia. However, these patients tend to be in poor condition due to underlying malignancy. Therefore, less‐invasive strategies are needed. Six patients with lung cancer exhibiting malignant carinal involvement treated using the ‘side‐by‐side’ method of bilateral self‐expandable metallic stents using fibre‐optic bronchoscopy under topical anaesthesia were retrospectively investigated. The median procedure time was 29.5 min (range: 23–38), and the palliation of dyspnoea was achieved in all cases. The median survival time after intervention was 58.5 days (range: 23–172). The cause of death was acute coronary syndrome in two patients, aspiration pneumonia in two, upper gastrointestinal perforation in one, and catheter‐related blood stream infection in one. This strategy was less invasive and suitable for patients with poor performance status.

Clinical outcomes and survival following placement of self‐expandable metallic stents for central airway stenosis and fistula

“…The application of the "side-by-side" method of bilateral SEMSs to malignant carinal involvement has been reported to be less invasive and safer under topical anesthesia in all cases. 13 Although self-expandable bifurcated metallic stents have been reported to cause mucus plugs, 14 we did not experience this complication. To mitigate stent migration, we chose a more suitable larger Ultraflex or added a baloon inside the stent.…”

“…In our results, stent migration (12.5%: 3/24) was more frequent than that (4.7%) reported by Saad et al , 12 but infections and obstructive granulomas were not seen. The application of the “side‐by‐side” method of bilateral SEMSs to malignant carinal involvement has been reported to be less invasive and safer under topical anesthesia in all cases 13 . Although self‐expandable bifurcated metallic stents have been reported to cause mucus plugs, 14 we did not experience this complication.…”