Treatment of Benign and Malignant Tracheobronchial Obstruction with Metal Wire Stents: Experience with a Balloon-Expandable and a Self-Expandable Stent Type

Abstract

Over the last few years various types of metal wire stents have been increasingly employed in the treatment of both malignant and benign tracheobronchial obstruction. To date, however, few studies have investigated the in vivo properties of different stent types. We implanted 26 balloon-expandable tantalum Strecker stents (18 patients) and 18 self-expandable Wallstents (16 patients) into the tracheobronchial system of 30 patients with combined stenting in 4 patients. Mean age was 51 years (range: 0.5-79 years). Malignant disease was present in 23 patients, benign disease in seven patients. Both patients and individual stents were monitored clinically and radiographically. The probability of stents remaining within the tracheobronchial system, and of their remaining undislocated and uncompressed was calculated using Kaplan-Meier analysis for both stent types. Average stent follow-up time was 112 days until explantation and 115 days until patients' death or discharge. Kaplan-Meier analysis revealed a higher probability for the Wallstent to remain within the tracheobronchial system. Dislocation and compression occurred more rarely. Explantation, however, if desired, was more difficult compared to the Strecker stent. The Wallstent also led to the formation of granulation tissue, especially at the proximal stent end, frequently requiring reintervention. Both stent types proved to be effective therapeutic options in the management of obstructive tracheobronchial disease. The mechanical properties of the Strecker stent seem to be less favorable compared to the Wallstent but removal is easy. For benign disease, however, the Wallstent reveals limitations due to significant side effects.

Effect of Surface Treatments on Anodic Oxide Film Growth and Electrochemical Properties of Tantalum used for Biomedical Applications

“…Rieger et al [5] implanted several balloon-expandable Ta Strecker stents and self-expandable nitinol Wallstents. They concluded that the Strecker stent displays different mechanical properties with less resistance to the mechanical forces within the tracheobronchial system, but allows easy removal and insertion as compared with the Wallstents in patients with benign lesions or malignant but potentially curable lesions.…”

Fully Covered Self-Expandable Metal Stent in Tracheobronchial Disorders: Clinical Experience

“…Several studies have proved the effectiveness of stents as both palliative and curative treatment of lung cancer; in fact they lead to a significant improvement not only in symptoms and lung function [2,3,4,5,6,7,8,9,10,11], but also in quality of life [12] and survival, if implanted in time [13,14]. …”

Management of Tracheobronchial Stenoses With Endoprostheses: Experience With 103 Patients and 11 Models

“…Endoscopic insertion of airways stents has gained increased popularity over the last decade because of the following: development of diagnostic (interventional pneumology, ENT, interventional radiology) and technical instruments (endoscopy, fibroscopy, computed tomography scan) leading to more accurate diagnosis; improvements in anesthesiologic factors; human (experienced seniors) and technical factors (such as anesthesiology drugs and monitoring); ease and speed of stenting using fibroscopy, suspension laryngoscopy and/or rigid bronchoscopy with or without optics; available and usable procedure for patients with critical health status; endoscopic diagnosis and treatment performed during one surgery: balloon dilation, laser treatment (CO 2 , YAG, KTP, etc) of the stenosis; 9,10 good global tolerance with immediate relief of dyspnea and/or dysphagia in palliative indications (control of intraluminal tumor growth, maintenance of the airway lumen, obturation of TEF); and a low level of complications in the short, medium, and long‐term especially in malignancies. …”

“…endoscopic diagnosis and treatment performed during one surgery: balloon dilation, laser treatment (CO 2 , YAG, KTP, etc) of the stenosis; 9,10 …”