The management of post-intubation tracheal stenoses with self-expandable stents: early and long-term results in 11 cases☆

Charokopos, Nikolaos; Foroulis, Christophoros N.; Rouska, Efi; Sileli, Maria; Papadopoulos, Nikolaos G.; Papakonstantinou, Christos

doi:10.1016/j.ejcts.2010.12.042

Cited by 21 publications

(16 citation statements)

References 19 publications

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“…Surgical airway plasty is strongly recommended for post-intubation stenosis. 5) Long-term therapeutic efficacy of interventional pulmonology procedures, such as placement of a Montgomery T-tube, 6) silicon tracheal stents, 7) and expandable metallic stents, 1) have also been reported. Rea et al 8) reported that although surgical reconstruction is the best option for post-intubation stenosis, it has a high risk for patients, and a permanent T-tube might be the best solution.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

Tsukioka

Takahama

Nakajima

et al. 2016

ATCS

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Background: Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Methods: Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Results: Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with postintubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh-Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Conclusion: Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty.

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Section: Discussionmentioning

confidence: 99%

“…However, repeated procedures are usually required. [1][2][3] This study retrospectively reviewed patients who underwent treatment of benign airway stenosis to investigate the effectiveness of surgical tracheobronchial plasty.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

Tsukioka

Takahama

Nakajima

et al. 2016

ATCS

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“…Despite these recommendations, some authors continue to use SEMS in benign PITTS [52]. We think that the main reason for still using partially covered or uncovered SEMS rather than silicone or fully covered stents, in this situation, is the lack of skills and training in rigid bronchoscopy [53].…”

Section: Benign Airway Stenosis Post-intubation or Post-tracheostomy mentioning

confidence: 99%

“…If a metallic tracheal stent is the only option for a patient, only an experienced physician, well versed in metallic stenting should perform the procedure. If removal is necessary, a physician trained and experienced in removing metallic tracheal stents with rigid bronchoscopy should undertake that [50,51].Despite these recommendations, some authors continue to use SEMS in benign PITTS [52]. We think that the main reason for still using partially covered or uncovered SEMS rather than silicone or fully covered stents, in this situation, is the lack of skills and training in rigid bronchoscopy [53].…”

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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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“…However, some patients are not considered candidates for surgery because of the extent of the stenosis (> 50% of the trachea or multifocal involvement) or because of any surgical contraindication. Endoscopic techniques have been developed as an alternative treatment [12,[18][19][20][21][22][23][24][25][26]. Dilatation, laser photo resection, and stent placement are the mainstay of endoscopic treatment strategy and afford excellent clinical results.…”

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confidence: 99%

Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

Plojoux¹,

Laroumagne²,

Vandemoortele

et al. 2015

The Annals of Thoracic Surgery

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Background. Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management.Methods. Sixty patients with DATS were included. Management decision was made during initial bronchoscopy. When suitable, patients were referred to thoracic surgery for tracheal resection. Posterior localized tracheomalacia was treated with laser photocoagulation of the posterior tracheal wall. Tracheal stents were placed if the stenosis persisted after laser treatment. The choice of stent (straight silicone, hour-glass shaped silicone, Ttube, or fully-covered self-expandable metallic stent) was based on operator's judgment. After 12 to 18 months, stents were removed. If the stenosis persisted after stent removal, surgery was reconsidered. If surgery was not possible, a stent was replaced. In case of satisfactory

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The management of post-intubation tracheal stenoses with self-expandable stents: early and long-term results in 11 cases☆

Cited by 21 publications

References 19 publications

Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

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

Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

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