Combination stenting for central airway stenosis

Objectives

Airway stentings for tracheobronchial stenosis have been performed in our institution. We have experienced the patients who underwent insertions of more than two stents using combination of some kind of stents. We demonstrated here the utility of combination stenting for severe endobronchial stenosis from our experiences.

Methods

From 1985 to May 2000, we have experienced 125 cases of stenting for central airway stenosis (malignant: 98 cases, benign: 27 cases). Nd-YAG laser vaporization, balloon dilatation, argon plasma coagulator and/or core out were performed to dilate the bronchial lumen before stentings. T-tube, Dumon stent, self-expandable metallic stent (SEMS) and Dynamic Stent were used. All stentings were performed under a fluoroscope. A rigid bronchoscope was used for all cases of Dumon stent and some cases of SEMS.

Result

The number of combination stentings was 20 cases (male: 14, female: 6) out of 125 cases (16.0%). A total of 45 stents were placed in 20 cases. Mean age was 58.5 years old. Nineteen out of 20 cases were malignant stenosis (lung cancer: 10, esophageal cancer: 6, Mets: 3). Four cases of tracheal-esophageal fistula were observed. One case of benign stenosis was bronchial malacia. The cases of synchronous insertions were 13, metachronous 5, synchronous and metachronous 2. SEMS were frequently selected in 17 out of 20 cases (85.0%) because of its easy procedure (SEMS + SEMS: 8, SEMS + Dumon: 6, SEMS + Dynamic Stent: 2, SEMS + Eso.Stent: 1, Dumon + Dumon: 2, Dynamic + Eso.Stent: 1). Rigid bronchoscope was used for stent insertion in 80.0% (36 out of 45 stents) because of severe and complicated stenosis. Nd-YAG laser was used in 37.8% (17/45 stents). After stenting, chemotherapy and/or radiation could be done in 4 out of 10 cases of lung cancer, in 3 out of 6 cases of esophageal cancer. Improvement of QOL and lung function were obtained after stentings (PS: 3.3–2.0, Hugh-Jones: 4.1–2.7, PO₂: 79.7–84.7 Torr in room air, %VC: 77.6–84.7%, FEV_1.0%:61.0–63.6%, PF: 2.13–2.73 l/s).

Conclusions

Reconstruction of tracheobronchial stenosis by combination stenting was a very useful modality for end stage lung patients with severe central airway stenosis for the purpose of improving pulmonary functions and quality of life. Selection of stents should be done after careful consideration of the characteristics of stents and tracheobronchial stenosis.