Reaction Patterns of the Tracheobronchial Wall to Implanted Noncovered Metal Stents

Grewe, Peter; Müller, Klaus; Lindstaedt, Michael; Germing, Alfried; Müller, Anette; Mügge, Andreas; Deneke, Thomas

doi:10.1378/chest.128.2.986

Cited by 18 publications

(11 citation statements)

References 14 publications

(16 reference statements)

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“…Most prior studies used qualitative comparisons of histologic findings [17, 19-21, 23]; only 1 used a scoring system [18]. Whereas descriptive and qualitative scoring methods are useful for providing a conceptual framework for thinking about histologic changes, they are insufficient for rigorous comparative studies.…”

Section: Discussionmentioning

confidence: 99%

“…For comparisons to be valid between animals, a common reference volume of tissue that is not affected by the intervention is needed. Fortunately, cartilage is not destroyed in airway stenting and does not change in volume [18, 19, 21, 23]. Thus, comparing relative volumes that use cartilage volume as the denominator is valid.…”

Section: Discussionmentioning

confidence: 99%

“…Since cartilage volume is not affected by stenting [18, 19, 21, 23], we reported the Vv of each tissue type as a multiple of the VvC in the sample, providing a relative volume for the tissue type and a control reference volume unique to each section. We computed the relative volume of epithelium (VvE/VvC), submucosal connective tissue (VvS/VvC), submucosal glands (VvG/VvC), and smooth muscle (VvM/VvC) in this way.…”

Section: Methodsmentioning

confidence: 99%

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A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent

et al. 2019

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Background: Granulation tissue is a common complication of airway stenting, but no published methods can quantify the volume and type of tissue that develops. Objective: To use design-based stereology to quantify changes in tissue volume and type associated with airway stenting. Methods: We compared drug-eluting stents (DES) filled with gendine to standard silicone stents in pigs in an assessor-blinded randomized trial. Tracheal stents were placed via rigid bronchoscopy. After 1 month, animals were euthanized and necropsies were performed. Antimicrobial effects of the DES were assessed in trachea tissue samples, on the DES surface, and with residual gel from the DES reservoir. Tracheal thickness was measured using orthogonal intercepts. Design-based stereology was used to quantify the volume density of tissues using a point-counting method. The volume of each tissue was normalized to cartilage volume, which is unaffected by stenting. Results: Pigs were randomized to DES (n = 36) or control stents (n = 9). The drug was successfully eluted from the DES, and the stent surface showed antibacterial activity. DES and controls did not differ in tissue microbiology, tracheal thickness, or granulation tissue volume. Compared to nonstented controls, stented airways demonstrated a 110% increase in soft-tissue volume (p = 0.005). Submucosal connective tissue (118%; p < 0.0001), epithelium (70%; p < 0.0001), submucosal glands (47%; p = 0.001), and smooth muscle (41%; p < 0.0001) increased in volume. Conclusion: Stenting doubles the volume of soft tissue in the trachea. Design-based stereology can quantify the tissue changes associated with airway stenting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent

et al. 2019

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“…16,23,24 Histologic studies of stents have shown a nonspecifi c infl ammatory response without foreign-body giant cells. 16,24,25 Presumably, stents with higher migration rates also have a higher degree of motion, putting them at increased risk for developing granulation tissue. This is consistent with our observation that silicone stents have a higher incidence of both migration and granulation.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Infections Increase the Risk of Granulation Tissue Formation Following Airway Stenting in Patients With Malignant Airway Obstruction

Ost

Shah

Lei

et al. 2012

Chest

103

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“…In about a quarter of all patients it becomes clinically significant, especially if bare metal stents are placed (FIGURE 12) [88,89]. Besides granuloma formation, scarring and shrinking is often seen around the edges of the stent.…”

Section: Granulation Tissue Formationmentioning

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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Reaction Patterns of the Tracheobronchial Wall to Implanted Noncovered Metal Stents

Cited by 18 publications

References 14 publications

A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent

A Design-Based Stereologic Method to Quantify the Tissue Changes Associated with a Novel Drug-Eluting Tracheobronchial Stent

Respiratory Infections Increase the Risk of Granulation Tissue Formation Following Airway Stenting in Patients With Malignant Airway Obstruction

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

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