Self-expanding covered metallic stents as a transition to silicone stent implantation in management of severe post-tuberculosis bronchial stenosis

Abstract

Background and aims: Post-tuberculosis bronchial stenosis (PTBS) is one of the most common complications of tracheobronchial tuberculosis. Silicone stent serves as a major treatment for maintaining airway patency. However, silicone stent placement remains a large challenge in patients with severe cicatricial PTBS. Our objective was to evaluate the efficacy and safety of covered, self-expanding, metallic stents (SEMSs) as a transition to silicone stent implantation for treating severe PTBS. Methods: We retrospectively reviewed the data of patients with severe PTBS who received airway stenting in the First Affiliated Hospital of Guangdong Medical University between September 2015 and May 2019. The types of the stent, intervention procedures, bronchoscopic findings, clinical outcomes and related complications were collected and analyzed. Results: Fifty-eight cases with severe PTBS were included in this study. Thirteen (22.4%) of the patients received bronchial silicone stent implantation immediately after dilations. For the remaining 45 (77.6%) patients, silicone stents could not be deployed after dilations and SEMSs implantation was implemented as a bridge to silicone stenting. The SEMSs were placed for an interval of 28.4 ± 11.1 days. All of the silicone stents were inserted successfully following the removal of SEMSs. No SEMS-related complication occurred. The subgroup analysis showed that patients who received transitional SEMSs had less luminal caliber but fewer transbronchial dilations before silicone stent implantation ( p < 0.05). Conclusion: Covered SEMS placement as a transition to silicone stenting could serve as a feasible procedure to reduce complications and improve the success rate of silicone stent implantation in patients with severe PTBS. The reviews of this paper are available via the supplemental material section.

Application of Bronchoscopic TransParenchymal Nodule Access in tuberculous bronchial occlusion

“…Bronchial scar occlusion caused by bronchial tuberculosis is a serious clinical complication. The commonly used methods for bronchoscopic interventional treatment of bronchial stenosis or occlusion include laser, 14 high‐frequency electrotomy, 15 cryotherapy, 16 balloon dilatation, 17 and stent implantation 18 . But early intervention is still needed for treatment to be effective.…”

“…The commonly used methods for bronchoscopic interventional treatment of bronchial stenosis or occlusion include laser, 14 high‐frequency electrotomy, 15 cryotherapy, 16 balloon dilatation, 17 and stent implantation. 18 But early intervention is still needed for treatment to be effective. The success rate of common techniques in the later stage is relatively low, and the risk is very high, which is easy to induce massive bleeding and endanger the patient's life.…”

Post-tuberculosis tracheobronchial stenosis: long-term follow-up after self-expandable metallic stents placement and development of a prediction score—the Restenosis Score

“…Typically, balloon dilation is the first treatment for PTTS, especially appropriate for annular cicatricial stenosis [ 4 ]. But when this approach fails and many a dilation is required, airway stenting is needed [ 4 , 5 ].…”

Post-Tuberculosis Tracheobronchial Stenosis: Long-Term Follow-Up after Self-Expandable Metallic Stents Placement and development of a prediction score: the Restenosis Score

“…multiple, long segments and poor pulmonary reserves). [4][5] Previous clinical evidences have indicated that silicone stents are a safe and effective treatment for patients with PTTS. [6][7] However, placement of silicone stents needs the auxiliary of rigid bronchoscopy, which promotes the development of self-expanding metallic stents (SEMS).…”