Y-Stenting Techniques

Abstract

Y-shaped stents provide treatment for patients with life-threatening central airway obstruction involving lower trachea, main carina, and proximal mainstem bronchi. Tracheobronchial stenoses may result from malignant as well as from benign disorders. The most frequent cause for malignant central airway obstruction is extension of adjacent lung cancer. Because of the epidemic of lung cancer, the incidence of main carinal stenosis may rise. The morbidity due to respiratory distress is significant. Stenting of the airway has been proved to reestablish patency of strictured or compressed central airways. Furthermore, airway stents provide sealing fistulas between trachea or bronchi and esophagus that can be mostly observed in case of esophageal cancer. Stent placement is also a therapeutic option in case of benign disease like strictures or tracheobronchomalacia; however, surgery remains the gold standard in benign airway stenoses.

Generally, Y-stents can be divided into different groups with variable advantages and disadvantages depending mainly on the material they are made from: Y-shaped polymer stents, Y-shaped hybrid stents, and Y-shaped metallic stents. However, the stents provide immediate relief of symptoms; adverse events like granulation tissue formation, secretion, or mucostasis are common. It is important to select the patients prior to airway stenting who will truly benefit from stent implantation. Furthermore, the type of the stent must be carefully selected, considering the biomechanics of the airway obstruction.