Use of Steroid-Eluting Stents after Endoscopic Repair of Choanal Atresia: A Case Series with Review

Abstract

Objective(s): To describe a single institution’s experience with the use of steroid-eluting stents after endoscopic transnasal repair of choanal atresia. Methods: A case series with review of children who underwent choanal atresia repair at a tertiary children’s hospital from June 2017 to January 2018 was performed. Those who had a mometasone drug-eluting stent (Propel® Mini, Intersect ENT Inc., Palo Alto, CA) placed after primary or secondary choanal atresia repair at our institution were included. The primary outcome measure was need for revision surgery due to stenosis. Postoperative regimens, duration of stenting, and need for return to the operating room (OR) were also assessed. Results: Five patients with a median age of 22 months at the time of repair met inclusion criteria. Two (40%) had bilateral atresia and 3 (60%) had confirmed CHARGE syndrome. A total of 6 mometasone drug-eluting stents were used in the 5 cases. Three patients were reassessed at least once in the OR; however, the majority (57.1%) of postoperative evaluations were able to be performed in the office or bedside setting. The first and last evaluations occurred a mean of 14 and 124 days after surgery, respectively. There were no instances of restenosis, repeat surgical interventions, or stent-related complications noted. Conclusion: Placement of a mometasone drug-eluting stent is a promising method to improve postoperative results and management of choanal atresia repair by limiting the need for repeat anesthetics and OR procedures, as well as the complications of traditional stents.

Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article

“…Post-operative one patient had granulation tissue, but no restenosis was reported among them during the follow-up period. 36 Meleca et al had two unilateral and one bilateral choanal atresia patients, with ages ranging from 8 days-38 months old, with follow-up 6 to 17 months. Although all choana were patent, only one patient showed restenosis, which is treated non-surgical and improved.…”

“…Post-operative one patient had granulation tissue, but no restenosis was reported among them during the follow-up period. 36 …”

Klinisches Management der Choanalatresie

“…Demgegenüber gibt es Hinweise, dass durch den Einsatz Mometason-freisetzender und resorbierbarer Stents Stent-assoziierte Komplikationen seltener auftreten und die Gesamtzahl der operativen Eingriffe, denen sich CA-PatientInnen unterziehen müssen, verringert wird [32,44,45] Auf den lokalen Einsatz des Aminoglykosids Mitomycin C, das mechanistisch über eine Hemmung der Fibroblasten einer Restenosierung vorbeugen und Narbenbildung reduzieren soll, sollte verzichtet werden, da sich in der Literatur keine belastbaren Belege für einen Zusatznutzen in der Versorgung der CA finden [1,29,35].…”

“…Die transnasale endoskopische Herangehensweise gilt als sicherste und effektivste Strategie zur Korrektur der CA. Diese Einschätzung spiegelt sich in der nahezu kompletten Verdrängung der transpalatinalen Resektion aus der operativen Versorgung der CA [8,16,31,32]. Hintergrund der Abwendung von der transpalatinalen Resektion ist neben der Verbesserungen im Bereich endoskopischer Operationssysteme das im Vergleich zur transnasal endoskopischen Herangehensweise deutlich ungünstigere Risikoprofil.…”