Abstract
Purpose
To assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures.
Methods
We report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec.
Results
We obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration.
Conclusions
Tracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated.
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References
Morris CD, Budde JM, Godette KD, et al (2002) Palliative management of malignant airway obstruction. Ann Thorac Surg 74:1928–1933
Katayama A, Konishi T, Hiraishi M, et al (1998) A combination of laser therapy, radiation therapy, and stent placement for the palliation of complete malignant bronchial obstruction. Surg Endosc 12:1419–1423
Sutedja G, Schramel F, van Kralingen K, et al (1995) Stent placement is justifiable in end stage patients with malignant airway tumor. Respiration 62:148–150
Rafanan A, Mehta AC. (2000) Stenting of the tracheobronchial tree. Radiol Clin North Am 38:395–408
Shin JH, Kim SW, Shim TS, et al (2003) Malignant tracheobronchial strictures: Palliation with covered retrievable expandable nitinol stent. J Vasc Interv Radiol 14:1525–1534
Profili S, Meloni GB, Feo CF, et al (2002) Self-expandable metal stents in the management of cervical and/or hypopharyngeal strictures. Clin Radiol 57:1028–1033
Hautmann H, Gamarra F, Pfeifer KJ, et al (2001) Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease: Indications and results. Chest 120:43–49
Shin JH, Song HY, Shim TS (2004) Management of tracheobronchial strictures. Cardiovasc Intervent Radiol 27:314–324
Venuta F, Rendina EA, de Giacomo T, et al (2002) YAG laser resection of lung cancer invading the airway as a bridge to surgery and palliative treatment. Ann Thorac Surg 74:995–998
Sutedja G, Postmus PE (1994) Bronchoscopic treatment of lung tumors. Lung Cancer 11:1–17
Dumon JF (1990) A dedicated tracheobronchial stent. Chest 97:328–332
Nomori H, Horio H, Suemasu K (1999) Dumon stent placement via endotracheal tube. Chest 115:582–583
Monnier P, Mudry A, Stanzel F, et al (1996) The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers: A prospective multicenter study. Chest 110:1133–1135
Song HY, Shim TS, Kang SG et al (1999) Tracheobronchial strictures: Treatment with a polyurethane-covered retrievable expandable nitinol stent. Initial experience. Radiology 213:905–912
Madden BP, Datta S, Chacoropos N (2002) Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology. Ann Thorac Surg 73:938–944
Tan BS, Watkinson AF, Dussek JE, et al (1996) Metallic endoprostheses for malignant tracheobronchial obstruction: Initial experience. Cardiovasc Intervent Radiol 19:91–96
De Mello-Filho FV, Moody Antonio S, Carrau RL (2003) Endoscopically placed metal tracheal stents for the management of complicated tracheal stenosis. Am J Otolaryngol 24:34–40
Stockton PA, Ledson MJ, Hind CRK, et al (2003) Bronchoscopic insertion of Gianturco stents for the palliation of malignant lung disease: 10 year experience. Lung Cancer 42:113–117
Vonk-Noordergraaf A, Postmus PE, Sutedja TG (2001) Tracheobronchial stenting in the terminal care of cancer patients with central airway obstruction. Chest 120:1811–1814
Herth F, Becker HD, LoCicero J, et al (2001) Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy. Chest 119:1910–1912
Tanigawa N, Sawada S, Okuda Y, et al (2000) Assessment of reintervention with tracheobronchial metallic stenting for malignant airway stenoses. Cardiovasc Intervent Radiol 23:490–491
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Profili, S., Manca, A., Feo, C.F. et al. Palliative Airway Stenting Performed Under Radiological Guidance and Local Anesthesia. Cardiovasc Intervent Radiol 30, 74–78 (2007). https://doi.org/10.1007/s00270-006-0027-6
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DOI: https://doi.org/10.1007/s00270-006-0027-6