Novel use of metallic stent to control post-debulking bleeding in a patient with central airway obstruction

Sivaramakrishnan, Prakash; Mishra, Mayank; Sindhwani, Girish; Sharma, Prakhar

doi:10.1136/bcr-2022-252848

Cited by 3 publications

(4 citation statements)

References 12 publications

(21 reference statements)

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“…There are no objective criteria for when to remove stents. A study done in 2013 in Seoul, South Korea showed that patients stented for more than 12 months had a significantly lower restenosis rate than those with stents for less than 12 months 18 19. Our patient, being an adult man with post-traumatic tracheal stenosis, showed good response to silicone stenting and underwent removal at 2 months, is currently asymptomatic and in regular follow-up.…”

Section: Discussionmentioning

confidence: 56%

“…Stent-related complications include stent migration which may lead to tracheobronchial occlusion, secondary infection due to retention of secretions, stent blockade due to granulation tissue formation, airway erosion and bleeding 18. Other less known complications are stent fracture, difficulty in removal of stent and epithelialisation around the stent.…”

Section: Discussionmentioning

confidence: 99%

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Management of post-traumatic tracheal stenosis with silicone stent placement

Sivaramakrishnan,

Mishra,

Sindhwani

2023

BMJ Case Rep

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Benign airway stenosis often poses a therapeutic challenge and requires a multidisciplinary approach involving interventional pulmonologists and thoracic surgeons. We report the case of a man who presented with thoracic trauma following a road traffic accident. His chest X-ray showed complete collapse of the right lung, while screening flexible bronchoscopy revealed pooled secretions and asymmetric mid-to-lower tracheal stenosis. After thorough clinicoradiological evaluation and multidisciplinary discussion, we proceeded with therapeutic rigid bronchoscopy and silicone stenting of the tracheal stenotic lesion. Post-procedure, the patient improved clinically and also showed radiological improvement. Subsequently, he underwent stent removal and remains in follow-up. While surgery is a definitive modality for management of benign tracheal stenosis, most patients with advanced disease, pneumonia or with poor general condition are unfit to tolerate general anaesthesia or surgery. In such patients, minimally invasive bronchoscopic techniques that are generally safe to perform have led to substantial improvement in symptoms and long-term quality of life.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Management of post-traumatic tracheal stenosis with silicone stent placement

Sivaramakrishnan,

Mishra,

Sindhwani

2023

BMJ Case Rep

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“…Stent placement has also been used to control airway bleeding. When stenting is needed for this indication, it is often in the setting of diffuse bleeding from large areas of airway tumor involvement [22]. In such a scenario, a stent can tamponade a large area of bleeding mucosa to achieve hemostasis more quickly than standard bronchoscopic interventions for bleeding.…”

Section: Indications For Stent Placementmentioning

confidence: 99%

Airway Stents in Interventional Pulmonology

Bashour,

Lazarus

2024

JoR

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Airway stents, first developed in the 1980s, have become fundamental in managing a multitude of airway pathologies and complications within the field of interventional pulmonology. The primary function of an airway stent is to re-establish airway patency and integrity when obstruction, stenosis, anastomotic dehiscence, or fistulae develop as a result of various malignant or benign conditions. Nevertheless, airway stents are foreign bodies that can result in complications. In this review article, we will discuss airway stents and their ongoing role in the management of several malignant and benign diseases. We will describe indications for airway stenting and review the elements that must be taken into consideration for optimal patient and stent selection. Given the prevalence of data regarding therapeutic bronchoscopy and airway stenting in malignant airway obstruction, much of the discussion in this review will focus on stent placement for that indication. We will also review the data as it pertains to safety, efficacy, and complications after stent placement, and conclude with a discussion of the future applications and research avenues related to airway stents.

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“…A much less common indication for stenting is when bleeding control with tamponade of an airway wall is needed. This has been typically done in the setting of diffuse airway wall bleeding such as due to tumor infiltration ( 4 ). Endoluminal ablative therapies can be used but a stent is a rapid intervention that can cover a wide area of disease relatively quickly.…”

Section: Indicationsmentioning

confidence: 99%

Airway stenting for central airway obstruction: a review

Sabath¹,

Casal²

2023

Mediastinum

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Central airway obstruction is a serious complication of various diseases, most often malignancy. Malignant etiologies include primary lung cancer as most common though metastases from various other cancers can obstruct the airways as well. Benign etiologies include inflammatory or fibrotic changes due to prior airway interventions (e.g., endotracheal intubation or tracheostomy) or specific autoimmune conditions. Different interventional modalities exist including various electrosurgical or mechanical debulking tools, though these are sometimes insufficient or contraindicated for the purpose of restoration of airway patency. The placement of stents is thus needed in certain particularly complex or refractory cases. Airway stenting requires careful patient selection and stent selection along with a thorough knowledge of relevant anatomy and procedural technique. Indeed, certain clinical presentations are better suited for stent placement and more likely to achieve a symptomatic benefit. Moreover, a variety of stents exist with each having different attributes that may better fit specific conditions. Complications must be managed properly as well. These include stent migration, granulation tissue formation, and stent-related infection which can have clinically significant consequences. In this review, we will discuss airway stenting for central airway obstruction with regard to these various subject areas as well as conclude with discussion of future research directions.

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Novel use of metallic stent to control post-debulking bleeding in a patient with central airway obstruction

Cited by 3 publications

References 12 publications

Management of post-traumatic tracheal stenosis with silicone stent placement

Management of post-traumatic tracheal stenosis with silicone stent placement

Airway Stents in Interventional Pulmonology

Airway stenting for central airway obstruction: a review

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