Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Majid, Adnan; Alape, Daniel; Kheir, Fayez; Folch, Erik; Ochoa, Sebastian; Folch, Alejandro; Gangadharan, Sidhu P.

doi:10.1159/000450961

Cited by 36 publications

(59 citation statements)

References 31 publications

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“…Our group and others have used short-term (1-2 weeks) trials with silicone Y-stents and uncovered nitinol stents in an attempt to identify those patients who are more likely to benefit from surgical tracheoplasty (39,40). It is imperative to have a pre-procedural agreement with the patient that the stent(s) will only remain in place for 1-2 weeks given the potential complications of airway stents in benign disease.…”

Section: When the Stent Is Temporarymentioning

confidence: 99%

Airway stents

Folch¹,

Keyes²

2018

Ann. Cardiothorac. Surg.

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141

135

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Stents and tubes to maintain the patency of the airways are commonly used for malignant obstruction and are occasionally employed in benign disease. Malignant airway obstruction usually results from direct involvement of bronchogenic carcinoma, or by extension of carcinomas occurring in the esophagus or the thyroid. External compression from lymph nodes or metastatic disease from other organs can also cause central airway obstruction. Most malignant airway lesions are surgically inoperable due to advanced disease stage and require multimodality palliation, including stent placement. As with any other medical device, stents have significantly evolved over the last 50 years and deserve an in-depth understanding of their true capabilities and complications. Not every silicone stent is created equal and the same holds for metallic stents.Herein, we present an overview of the topic as well as some of the more practical and controversial issues surrounding airway stents. We also try to dispel the myths surrounding stent removal and their supposed use only in central airways. At the end, we come to the long-held conclusion that stents should not be used as first line treatment of choice, but after ruling out the possibility of curative surgical resection or repair.

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Section: When the Stent Is Temporarymentioning

confidence: 99%

Airway stents

Folch¹,

Keyes²

2018

Ann. Cardiothorac. Surg.

Self Cite

141

135

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“…We have recently shown that the short-term USEMAS trial improved respiratory symptoms, quality of life, and exercise capacity with few complications in patients with severe symptomatic ECAC. 28 As such, we currently adopted USEMAS to assess response in patients with severe symptomatic ECAC.…”

Section: Stent Trialmentioning

confidence: 99%

Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Medical and Surgical Treatment

Kheir

Majid

2018

Semin Respir Crit Care Med

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Excessive central airway collapse (ECAC) is characterized by excessive narrowing of the airway lumen during exhalation leading to dyspnea, cough, mucostasis, recurrent respiratory infections, and poor quality of life. Tracheobronchomalacia and excessive dynamic airway collapse are heterogeneous entities of ECAC and are characterized by a diverse nonspecific symptom profile. Although the pathophysiology of airway mechanics as well as morphology in both entities is different, current evidence so far shows no practical benefit in making such distinction since both have similar symptoms and the diagnostic and therapeutic work-ups are the same. The diagnosis of ECAC should be based on dynamic flexible bronchoscopy and/or dynamic computed tomography scan as well as clinical symptoms that are not fully explained by other lung diseases. Initial treatment of symptomatic ECAC includes treatment of coexisting conditions (such as chronic obstructive pulmonary disease, asthma, gastroesophageal reflux disease, and vocal cord dysfunction) and supportive treatment of dynamic central airway collapse (antibiotics for respiratory infections, aggressive therapy, pulmonary physiotherapy, pulmonary rehabilitation, and continuous positive airway pressure). A short-term stent trial in selected patients with severe symptomatic ECAC is needed to assess whether patients will have improvement in symptoms and thus identify patients who will benefit from surgical central airway stabilization. A multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population is essential for optimal outcomes.

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“…Patients undergo physiologic assessment with pulmonary function testing and a 6-minute walk test. Standardized questionnaires are also administered to determine functional status (Karnofsky Performance Scale); symptomatology [modified Medical Research Council (mMRC) dyspnea scale]; and quality of life assessment [respiratory impacted quality of life (St. George Respiratory Questionnaire)] and Cough Specific Quality of Life Questionnaire (CQLQ) (9,16,21,24).…”

Section: Preoperative Evaluation and Stent Trialmentioning

confidence: 99%

“…In some instances, the stent trial may prove inadequate or impossible to complete in patients with unusually large or small airways if correct stent sizes is not available, or in patients in whom their anatomy impedes rigid bronchoscopy for Y-stent placement (e.g., extreme cervical kyphosis). To lessen these potential confounding outcomes, our group recently has piloted the use of uncovered self-expanding metallic stents for short-term trials (24,27). Despite these limitations, a planned shortterm (<2 weeks) stent trial still may yield useful information about those patients with diagnosed TBM who may respond best to surgery.…”

Section: Preoperative Evaluation and Stent Trialmentioning

confidence: 99%