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

Abstract

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.

Long-term tolerance of a fractured self-expanding metal stent in a patient with adenoid cystic carcinoma

“…Once re-canalized, it's a low grade cancer with 5-year survival of 89% [1]. Although contraindicated in benign CAO due to difficulty in, or complications associated with removal, Self-expanding metal stent (SEMS) have been widely used for recanalization of malignant airway obstruction [2]. Successful placement prevents premature death from suffocation, and allows time for definitive cancer therapy to take effect [2].…”

“…Although contraindicated in benign CAO due to difficulty in, or complications associated with removal, Self-expanding metal stent (SEMS) have been widely used for recanalization of malignant airway obstruction [2]. Successful placement prevents premature death from suffocation, and allows time for definitive cancer therapy to take effect [2]. Such stents have been reported to be safely tolerated in the airways for the median duration of 3.5 years [3].…”

“…Compared to silicon stent, SEMS offers the advantages of lower migration rate, better conformation to irregular airways, and greater ease of placement as it can be placed even via flexible bronchoscopy under moderate sedation [2]. However, its use is associated with complications such as retained secretions, bacterial colonisation of stent, granulation tissue formation, difficult retrieval, high risk of hazardous complication upon attempting removal, and stent fracture [2,4].…”

Failure of expansion of covered self-expanding metal stent during tracheal stenting: Case report

“…[1][2][3] Recanalization of the obstructed airway by a stent has been proven to relieve dyspnoea and delay respiratory failure, allowing definitive therapy for cancer such as chemotherapy or radiotherapy to be carried out. [3][4][5] Where silicone stents are preferred in benign diseases but require rigid bronchoscopy, metal stents inserted via flexible bronchoscopy are a feasible alternative for the recanalization of malignant central airway obstruction with palliative intent. They are deployed either via a balloon-expandable or self-expanding metal stent (SEMS) system, and are available in either uncovered or covered forms.…”

“…SEMS include Walls tent, Gianturco, Ultraflex and Aero. [3] However, complications associated with SEMS are not uncommon and include occlusion by granulation tissue formation, tumour ingrowth, difficult retrieval, stent fracture, migration, haemoptysis and infectious tracheobronchitis. [4,6,7] We report a rare case of failure of expansion of a covered SEMS during tracheal stenting.…”