Chest
Volume 127, Issue 2, February 2005, Pages 482-487
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Clinical Investigations: Bronchoscopy
Removal of Covered Self-Expandable Metallic Airway Stents in Benign Disorders: Indications, Technique, and Outcomes

https://doi.org/10.1378/chest.127.2.482Get rights and content

Study objectives

To describe the technique and outcome of removal of self-expandable metallic airway stents (SEMAS) in a series of patients who underwent stenting for benign airway stenoses.

Design and setting

A retrospective cohort analysis of patients with benign airway disorders treated with SEMAS between 1997 and 2003, who presented with an indication for stent removal in a tertiary-care hospital, and referral interventional pulmonology clinic.

Patients and methods

During the study period, 49 SEMAS were inserted in 39 patients for treatment of benign airway disorders. Ten of these 39 patients (25.6%), bearing 12 covered stents, presented with an indication for stent removal. Data of these cases were extracted from electronic files kept in our institution archive.

Results

Indications for stent removal included excessive or recurrent granuloma formation (five cases), recurrence of stenosis after stent failure (one case), stent fracture (two cases), and accomplishment of treatment (two cases). In all of these cases, covered versions of SEMAS had been placed either in the trachea or in a main bronchus. In contrast to many previous reports, these stents proved to be absolutely retrievable even if some difficulties were encountered. In all cases, however, removal was successful without major complications. All patients resumed normal spontaneous ventilation postoperatively, and follow-up was uneventful. Average duration of stenting before removal was 16.2 ± 17.5 months (± SD) [range, 1 to 60 months].

Conclusions

We conclude that although placement of SEMAS is assumed to be permanent in patients with benign airway disorders, an indication for stent removal is often observed (25.6% in our series). The covered SEMAS can be effectively and safely removed if needed without major sequelae. Nevertheless, new technical improvements in metallic stent design and materials may help reinforce the concept of a retrievable metallic airway stent, which may offer significant clinical advantages.

Section snippets

Materials and Methods

We retrospectively analyzed data on all patients with benign disorders who received SEMAS between 1997 and 2003. Data were extracted from electronic files of our institution archive.

Forty-nine SEMAS (41 covered Ultraflex stents, 6 uncovered Ultraflex stents, and 2 Wallstents) were inserted by rigid bronchoscopy in the central airways of 39 patients hospitalized for benign airway disorders in our institution. There were 24 male and 15 female patients (mean age, 59 ± 16 years [± SD]; range, 16 to

Results

Ten of the 39 patients (25.6%), all of them bearing covered versions of SEMAS, presented with an indication for stent removal during the follow-up period (5 male and 5 female patients; mean age, 48 ± 15 years; range, 16 to 62 years). Indications for removal included restenosis due to excessive or recurrent granuloma formation impossible to manage with other treatment modalities (five cases), relapse of stenosis after initial treatment due to material fatigue (one case), stent fracture (two

Discussion

The management of patients with tracheobronchial strictures of benign etiology can be quite challenging. There are a large number of patients with lesions not amenable to surgery, or who are considered medically inoperable.2 In these patients, airway stenting may represent the only possible treatment. Silicone prostheses are considered the first choice in benign diseases except in cases where they are judged unsuitable because of airway wall malacia or distal and/or angular stenosis. In such

Conclusion

Although placement of SEMAS is assumed to be permanent in patients with benign airway disorders, an indication for stent removal is often observed (25.6% in our series). The results obtained in our study suggest that covered SEMAS can be both effectively and safely removed if needed without major sequelae. However, removal can be cumbersome in inexperienced hands. Efforts are ongoing to produce better-designed, technically improved, removable airway stents that may be more suitable for

References (25)

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