nitinol and Bronchial-Diseases

Topics: Airway Obstruction; Alloys; Bronchial Diseases; Bronchoscopy; Carcinoma, Squamous Cell; Constriction, Pathologic; Humans; Laser Therapy; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Prosthesis Design; Stents; Tomography, X-Ray Computed; Tracheal Stenosis; Treatment Outcome

Topics: Alloys; Bronchial Diseases; Ciliary Motility Disorders; Constriction, Pathologic; Humans; Lung Neoplasms; Mucociliary Clearance; Nasal Mucosa; Palliative Care; Prosthesis Design; Quality of Life; Stents

it is more difficult and carries more risks to place airway stent under local anaesthesia for the patient with severe airway stenosis. The technique and method of domestically made recalled nitinol alloy stent implantation for severe airway stenosis was explored and evaluated.. by using bronchoscopy via larynx mask, trachea intubation, or rigid bronchoscope under general anaesthesia and mechanical ventilation, stents are placed in the airway of patients with severe airway stenosis for which had been difficult to performed under local anaesthesia.. according to the various tracheobronchial lesions of patients, 42 stents were successfully placed in 40 patients, via larynx mask 23 cases, trachea intubation 11 cases, and rigid bronchoscope 6 cases under general anaesthesia and mechanical ventilation. No complications happened. The recalled nitinol alloy stents were placed in trachea 27 cases (membrane covered stent 9 cases), left primary bronchus 8 cases, right primary bronchus to medial segment 2 cases, trachea to left primary bronchus (wedge shaped stent) 5 cases respectively. The airway pressure decreased to normal level and other ventilator parameters also recovered after stents were placed. In most patients, the dyspnea index was improved immediately and the scores decreased from grades IV-V to grades 0-II, with higher scores indicating worse dyspnea.. for patients with severe airway stenosis, it is safer, effective and more comfortable to place the stent via larynx mask, trachea intubation, or rigid bronchoscope under general anaesthesia and mechanical ventilation compared to local anaesthesia and is worth spread and popularization in the future.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Bronchial Diseases; Female; Humans; Male; Middle Aged; Prosthesis Implantation; Stents; Tracheal Stenosis

The potential role of AERO tracheobronchial covered stents in the management of recurrent postinfectious strictures of the bronchus intermedius was studied in three lung transplant recipients. Six devices were inserted. Five of the stents migrated immediately on placement. Buildup of thick mucus was observed in all stents remaining in the airway for longer than 1 week. Strictures recurred in all patients 1, 3, and 5 months after stent deployment. Attempts at stent retrieval were successful for three of five devices. The use of AERO stents may not offer a therapeutic advantage versus balloon dilation of bronchus intermedius strictures in lung transplant recipients.

Topics: Adult; Aged; Airway Obstruction; Alloys; Bronchial Diseases; Bronchoscopy; Catheterization; Coated Materials, Biocompatible; Constriction, Pathologic; Female; Foreign-Body Migration; Humans; Lung Transplantation; Male; Middle Aged; Polyurethanes; Prosthesis Design; Recurrence; Stents; Time Factors; Treatment Outcome

To evaluate the technical success and initial clinical safety and effectiveness of the use of a Y-shaped metallic stent for complex stenoses involving the carina.. Thirty-five consecutive patients with complex tracheobronchial stenoses involving the carina were treated with an integrated self-expandable inverted Y-shaped metallic stent and delivery system. The Y-shaped metallic stents were placed in the tracheobronchial tree with fluoroscopic guidance. Technical success, clinical success, Hugh-Jones classification, and complications were assessed during follow-up.. The delivery of the integrated self-expandable Y-shaped metallic stent in the carinal areas was technically successful and well-tolerated in all patients. Clinical success was achieved in 31 patients (89%) 1-7 days after stent placement; the procedure failed in four patients (11%). The improvement between pre- and postoperative Hugh-Jones classification grade was statistically significant (P<.001). During follow-up (mean follow-up, 192 days+/-169), all stenoses were resolved, and general physical examination of the 31 patents showed improvement with no obvious dyspnea or bleeding. Twenty-one patients were healthy without evidence of dyspnea, and the remaining 14 patients died (mean survival, 189 days+/-172) at the time of this report. The mean and median survival periods were 217 days+/-30 and 215 days+/-108, respectively. The mean and median stent patency periods were 216 days+/-30 and 215 days+/-119, respectively.. Deployment of an integrated, self-expandable inverted Y-shaped metallic stent with the delivery system was a safe and effective procedure for the treatment of complex tracheobronchial stenoses involving the carina.

Topics: Aged; Aged, 80 and over; Alloys; Bronchial Diseases; Constriction, Pathologic; Contrast Media; Female; Fluoroscopy; Humans; Iohexol; Male; Middle Aged; Prosthesis Design; Radiography, Interventional; Stents; Tracheal Stenosis; Treatment Outcome

A metallic stent for tracheobronchial stenosis provides a possible solution for poststenting complications such as sputum retention. We describe our experience with a novel anatomy-conforming metal stent placement at the carina.. A windowed stent was designed to match the tracheobronchial anatomy. The lateral window was used as a passage from the trachea to the contralateral main bronchus.. Six windowed stents were placed in 6 patients (mean age, 52.3 years). Two patients received an additional short straight stent placed in the contralateral bronchus, forming an overall Y stent at the carina. All patients had immediate relief from respiratory distress, and no sputum retention or stent migration occurred during the subsequent treatment period. Follow-up data showed that 4 patients are still alive. One patient died 2 months after stent placement of postradiation hemoptysis, and another died of metastasis 14 months after stent placement.. This anatomy-conforming metal stent has several advantages and its application in carinal stenosis is both effective and safe.

Topics: Adult; Alloys; Bronchial Diseases; Bronchoscopy; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Constriction, Pathologic; Dyspnea; Equipment Design; Female; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Respiratory Insufficiency; Stents; Tomography, X-Ray Computed; Tracheal Neoplasms; Tracheal Stenosis

Topics: Adult; Alloys; Bronchial Diseases; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Constriction, Pathologic; Equipment Design; Female; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Stents; Tracheal Neoplasms; Tracheal Stenosis

To assess the safety and clinical effectiveness of the parallel placement of covered retrievable expandable metallic stents in the palliative treatment of malignant esophageal and tracheobronchial strictures.. Under fluoroscopic guidance, parallel stents were placed in 12 symptomatic patients with both malignant esophageal and tracheobronchial strictures. Seven of these 12 patients also had an esophagorespiratory fistula (ERF) and one patient had an esophagocutaneous fistula. Technical success, clinical improvement, complications, and survival rates were evaluated.. A total of 28 esophageal and airway stents were successfully placed. The grade of dysphagia and dyspnea score significantly decreased after stent placement (P=0.002 and 0.003, respectively). ERF and esophagocutaneous fistula were sealed off in all eight patients after esophageal stent placement; however, the esophagocutaneous fistula reopened 1 month later. Complications included stent migration or expectoration (n=3), tracheal compression by the esophageal stent (n=3), new fistula development due to covering membrane degradation of the esophageal stent (n=1), and symptomatic sputum retention (n=1). Stent removal was easily performed for two stents; one migrated stent and the other with covering membrane degradation. All 12 patients died within the mean survival period of 72.50 days (range 7-375 days).. Parallel placement of covered retrievable expandable metallic stents is safe and effective for the palliative treatment of malignant esophageal and tracheobronchial strictures.

Topics: Adult; Aged; Alloys; Bronchial Diseases; Constriction, Pathologic; Esophageal Fistula; Esophageal Stenosis; Esophagus; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Postoperative Complications; Radiography; Retrospective Studies; Stents; Survival Rate; Trachea; Tracheal Stenosis; Treatment Outcome

To evaluate the safety and clinical effectiveness of placement of covered retrievable expandable metallic stents in seven children with tracheobronchial obstruction.. Using bronchoscopic and fluoroscopic guidance, stent placement was performed in seven children (median age, 12 y; range, 2 mo-14 y). The stents were electively removed 6 months after placement or whenever there were symptom-producing complications. During the follow-up period, technical and clinical success, complications and related reinterventions, and long-term prognosis were retrospectively evaluated.. Stent placement was technically successful for a total of eight stents in all seven patients. Stent removal was also successful for six stents in five patients; two stents were removed electively 6 months after placement, and four stents were removed due to symptom-producing complications. Clinical success defined as ventilator weaning, extubation, or dyspnea improvement was achieved in all patients 1 week after stent placement. A possible infection source in one stent and abundant granulation tissue caused by three stents necessitated removal of four stents in three patients. During the mean follow-up period of 18.7 months (range, 1-31 mo) after stent placement, three patients died due to the progression of underlying cardiopulmonary disease or malignancy. There were no deaths directly related to stent placement or related complications.. Although the findings were based on a small series, placement of covered retrievable expandable metallic stents seems to be safe and effective for the treatment of pediatric tracheobronchial obstruction. Ventilator weaning, extubation, or dyspnea improvement was possible in all patients after stent placement.

Topics: Adolescent; Alloys; Bronchial Diseases; Bronchoscopy; Catheterization; Child; Child, Preschool; Constriction, Pathologic; Device Removal; Female; Fluoroscopy; Humans; Imaging, Three-Dimensional; Infant; Male; Prognosis; Radiography, Interventional; Respiratory Function Tests; Retrospective Studies; Stents; Tomography, X-Ray Computed; Tracheal Stenosis; Treatment Outcome

To evaluate the clinical effectiveness of polytetrafluoroethylene (PTFE)-covered retrievable expandable nitinol stents in tracheobronchial strictures.. With fluoroscopic guidance, PTFE-covered retrievable expandable nitinol stents were placed in 15 symptomatic patients with benign (n = 6) or malignant (n = 9) tracheobronchial strictures. Complications and improvement in respiratory status were evaluated. Stents were removed electively 6 months after placement in benign strictures or if complications occurred. Membrane degradation or separation from the wire mesh was evaluated in removed stents.. A total of 17 stents were successfully placed and were well tolerated in all patients. Sputum retention, stent migration, and tissue hyperplasia occurred in 23.5% (n = 4), 17.6% (n = 3), and 17.6% (n = 3) of stents, respectively. A total of 11 stents were successfully removed electively 6 months after placement (n = 4) or when complications occurred (n = 7). All 11 such stents were removed without difficulty with use of standard techniques, antecedent balloon dilation being necessary in two cases as a result of tissue hyperplasia. No removed stent showed signs of membrane degradation, and two removed stents showed signs of membrane separation from the mesh.. PTFE-covered retrievable expandable nitinol stents were effective in the treatment of tracheobronchial strictures. Stent removal was easy with use of standard techniques, and no removed stent showed evidence of membrane degradation.

Topics: Adolescent; Adult; Aged; Alloys; Bronchial Diseases; Child; Child, Preschool; Constriction, Pathologic; Device Removal; Female; Fluoroscopy; Humans; Infant; Male; Middle Aged; Polytetrafluoroethylene; Radiography, Interventional; Stents; Tracheal Stenosis; Treatment Outcome

To evaluate the efficacy and safety of use of a retrieval hook for removal of retrievable expandable tracheobronchial stents.. With fluoroscopic guidance, a retrieval hook was used to remove 45 retrievable expandable tracheobronchial stents in 31 patients. Indications for stent removal included tissue hyperplasia (n = 16), stent migration (n = 10), stent misplacement (n = 2), tumor overgrowth (n = 2), persistent gastrobronchial fistula (n = 1), and incompletely expanded stent (n = 1). Thirteen stents were electively removed after temporary use. The success rate, causes of failure, and complications related to stent removal with a retrieval hook were analyzed.. Forty-one of 45 stents (91.1%) were successfully removed with a retrieval hook. The following difficulties were encountered: disruption of the polyurethane membrane (n = 3) and an untied drawstring (n = 1). The removal procedure failed in four cases (8.9%) because of excessive tissue hyperplasia (n = 4) in the proximal portion of the stent. The hook wire fractured in two of the four failed cases. The overall complication rate was 4.4% (minor bleeding, n = 2).. For complications with or temporary use of retrievable expandable tracheobronchial stents, removal with a retrievable hook shows promising initial results.

Topics: Adult; Alloys; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Device Removal; Equipment Design; Female; Fluoroscopy; Humans; Male; Middle Aged; Stents; Surgical Instruments; Tracheal Stenosis; Treatment Outcome

Covered retrievable expandable nitinol stents were successfully placed in nine patients with tuberculous bronchial strictures refractory to balloon dilation. Complications included stent migration (n = 1) and tissue hyperplasia at the proximal portion of the stent (n = 2). During the follow-up period (5-52 months), stricture recurred in three of five patients (60%) after temporary stent placement for 2 months, whereas stricture did not recur in the other four patients after temporary stent placement for 6 months. Temporary placement of covered retrievable stents appears to be an effective method for the treatment of patients with tuberculous bronchial strictures refractory to balloon dilation.

Topics: Adolescent; Adult; Alloys; Bronchial Diseases; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Male; Stents; Tuberculosis; Tuberculosis, Pulmonary

To evaluate the safety and clinical effectiveness of a covered retrievable expandable nitinol stent for the treatment of malignant tracheobronchial stricture and/or esophagorespiratory fistula (ERF).. With fluoroscopic guidance, stents were placed in 35 symptomatic patients with malignant tracheobronchial stricture and/or ERF in most cases caused by lung or esophageal cancer. The site of stricture was most commonly at the trachea or left main bronchus. If there were complications, the stent was removed with a retrieval set. Nine patients had combined symptomatic ERF.. A total of 47 tracheobronchial stents were placed and were technically successful and well-tolerated in all patients. Improvement of dyspnea was achieved in 92% of the patients (24 of 26 patients). Associated ERF in nine patients was effectively treated with tracheobronchial stent placement with or without esophageal stent placement. Stent migration, tumor overgrowth, symptomatic sputum retention, and hemoptysis occurred in 17% (6/35), 6% (2/35), 20% (7/35), and 17% (6/35) of patients, respectively. There were no documented cases of tumor ingrowth. Stent removal was performed easily in five patients when stent migration (n = 2), severe pain (n = 1), tumor overgrowth (n = 1), or persistent gastrobronchial fistula (n = 1) developed. All patients died 2 days to 26 weeks (mean, 9.62 weeks) after stent placement because of disease progression (n = 18), pneumonia (n = 9), hemoptysis (n = 5), or unknown cause (n = 3).. Use of a covered retrievable expandable nitinol stent is a safe and effective method for relieving dyspnea. This procedure contributed to improved quality of life for patients with malignant tracheobronchial stricture and/or ERF. Stent retrievability was useful in resolving stent-related complications.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Bronchial Diseases; Constriction, Pathologic; Dyspnea; Esophageal Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Radiography, Interventional; Stents; Tracheal Stenosis; Tracheoesophageal Fistula; Treatment Outcome

Assessment of the therapeutic potential of tracheobronchial stenting for obstructive tracheobronchial disease, in-vivo comparison of different stent types and development of helpful criteria for choosing the suitable stent type.. Prospective case analysis. Between 1993 and 1999 53 stents were implanted into the tracheobronchial system of 39 consecutive patients with benign or malignant airway obstruction. Every single stent (26 Strecker Stents, 18 Wallstents, 6 Accuflex Nitinolstents, 1 Dumon-, 1 Rüsch- and 1 Palmazstent) was recorded in an unified database. Analysis comprised clinical effectiveness, lung function if possible, relevant complications and radiologic follow-up parameters. The probability of their remaining within the tracheobronchial system, of their remaining undislocated and uncompressed was calculated using Kaplan-Meier analysis for three stent types.. Stent placement proved itself to be an effective treatment in 86 % of the patients. Resistance could be normalized in 9/9 patients. Kaplan-Meier analysis clearly revealed a higher probability for the Wall- and Nitinolstent to remain within the tracheobronchial system and to remain uncompressed. Dislocation also occurred more rarely. Explantation of the Wallstent, however, if desired, was much more difficult compared to the Strecker stent. The Wallstent also occasionally led to the formation of granulation tissue especially at the proximal stent end and, as such, required reintervention.. Any of the 3 stent types proved to be an effective therapeutic option in the management of obstructive tracheobronchial disease. Choise of the stent type should be determined through definition of the therapeutic intention. It is useful to distinguish between (a) benign stenosis, (b) malignant stenosis but curative therapeutic situation and (c) malignant stenosis in a palliative therapeutic situation with limited life expectancy. In spite of its superior mechanical properties the Wallstent is rather suited for a palliative situation because explantation may be difficult. The Strecker Stent requires more reinterventions but removal is easy to perform. The Nitinolstent possibly represents a reasonable compromise.

Topics: Adolescent; Adult; Aged; Airway Obstruction; Alloys; Bronchial Diseases; Bronchoscopy; Child; Child, Preschool; Device Removal; Equipment Failure Analysis; Female; Humans; Infant; Lung Neoplasms; Male; Middle Aged; Otorhinolaryngologic Neoplasms; Palliative Care; Patient Care Team; Prosthesis Design; Radiology, Interventional; Stents; Tomography, X-Ray Computed; Tracheal Stenosis

Several types of metal stents are available for the treatment of tracheobronchial stenosis. They can be self-expanding, balloon expandable, covered with a silicone membrane or uncovered. We have used a new self-expanding tracheobronchial nitinol wire stent since 1998, and our results are presented below.. Over a period of two years, 25 patients had a stent in the trachea or bronchus. The stents were inserted while the patients were under general anaesthesia, and flexible bronchoscopy was used. Respiratory function, histopathology, stent data, complications, and mortality were prospectively recorded.. Eighteen patients had a malignant stenosis. Bronchial stenosis following a single lung transplantation (3) was the most frequent reason for a benign stenosis (7). Most of the patients had the stent placed in the trachea (14). All the stent insertions were performed without complications, and respiratory function was immediately improved in all patients except for two. The postoperative complications were inflammatory granuloma (5), stent dislocation (3), delayed expansion (2), stent rupture (1), and stent occlusion caused by retained secretions (1).. The tracheobronchial ultraflex nitinol stent was easy to handle and was troublesome for only a few patients. Nitinol stents are considered to have a good biocompatibility, but 12% of the patients developed inflammatory granulations requiring electroresection.

Topics: Adult; Aged; Alloys; Bronchial Diseases; Coated Materials, Biocompatible; Constriction, Pathologic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Stents; Tracheal Stenosis; Treatment Outcome

Following single lung transplantation, the native lung remains a potential source of morbidity from spontaneous pneumothorax, hyperinflation, bacterial and fungal infection and malignancy. The case of a single lung transplant recipient for idiopathic pulmonary fibrosis who developed a recurrent, non-resolving, spontaneous multiloculated pneumothorax in the native lung following thoracoscopic talc pleurodesis is reported. The pneumothorax ultimately resolved following insertion of a nitinol stent for coexisting bronchostenosis in the transplanted lung. In a single lung transplantation recipient in whom a native lung pneumothorax reoccurs or persists despite appropriate initial management, it may be useful to undertake bronchoscopy to exclude the possibility of bronchostenosis in the transplanted lung.

Topics: Adult; Alloys; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Humans; Lung Transplantation; Lung Volume Measurements; Male; Pleurodesis; Pneumothorax; Recurrence; Stents

The purpose of this study was to evaluate the potential utility of implantation of a nickel-titanium alloy (nitinol) stent for the treatment of malignant or benign tracheobronchial stenosis.. We evaluated 18 patients (14 men and 4 women) who received 24 nitinol stents, between November 1997 and May 2000. All 18 patients had severe dyspnea caused by tracheobronchial stenosis. The underlying condition was malignant disease in 15 patients, and benign tracheal collapse in the other 3 patients.. Implantation of the stent was successfully performed in all patients. Seventeen patients experienced immediate clinical improvement in respiratory symptoms. The remaining 1 patient with a bronchial fistule after lobectomy did not benefit, and died of pneumonia at 16 days after the implantation. In 15 patients, the procedure was performed using a flexible bronchoscope under local anesthesia alone, while the remaining 3 patients needed intravenous sedation. There was no complication resulting from the stent implantation. Among the 3 patients with benign tracheal collapse, 2 patients were alive at 746 and at 401 days after the stent implantation, at the time of this report. One patient with cicatricial stenosis after intubation died of heart failure due to previous myocardial infarction. Among the 15 patients with malignant disease, 4 patients have survived for 177 to 305 days to date, while the other 11 patients have died of primary malignancy with a mean survival duration of 60.2 days.. The nitinol stent was effective in treating malignant or benign tracheobronchial stenosis, and had some remarkable advantages compared with other tracheobronchial stents. In stenting, most procedures can be performed using flexible bronchoscope under local anesthesia.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Anesthesia, Local; Bronchial Diseases; Bronchoscopy; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Stents; Tracheal Neoplasms; Tracheal Stenosis

Topics: Airway Obstruction; Alloys; Bronchial Diseases; Constriction, Pathologic; Foreign-Body Migration; Humans; Stents; Tracheal Stenosis

A polyurethane-covered retrievable expandable stent was placed in 13 patients with tracheobronchial strictures. In four patients with benign strictures, the stent was removed with use of a retrieval hook 2-6 months after placement. After stent removal, three of the four patients did not need further treatment. The retrievable stent warrants further investigation in the treatment of tracheobronchial strictures.

Topics: Adult; Aged; Airway Obstruction; Alloys; Bronchial Diseases; Coated Materials, Biocompatible; Device Removal; Equipment Design; Equipment Failure Analysis; Female; Humans; Male; Middle Aged; Polyurethanes; Stents; Tracheal Stenosis

Silicone and metal stents are available for the treatment of malignant bronchial stenoses. This project sought to compare the self-expanding nitinol Accuflex stent (Boston Scientific Corp; Watertown, Mass) with the passively expandable tantalum Strecker stent (Boston Scientific Corp; Watertown, Mass), both implanted by flexible bronchoscopy under local anesthesia and sedation. In 51 patients with malignant bronchial stenosis, 14 nitinol and 51 tantalum stents were used and stenoses of 75 to 100% were treated. The intervention was successful in all but one patient; a mean patency of 93% was achieved. In the follow-up period, the probability of survival was significantly lower in patients with total bronchus occlusion than in patients with stenotic alterations (44 vs 109 days; p<0.05). In 10 patients, lung function analysis after stent implantation revealed a significant increase in PaO2 (65 vs 71 mm Hg; p<0.01), inspiratory vital capacity (2.5 vs 2.7 L; p<0.05), and FEV1 (1.8 vs 2.0 L; p<0.05). Mucus retention was the main (39%) adverse factor in the early phase after stent implantation, whereas tumor penetration became the most frequent problem (67%) in the later phase. Recanalizing interventions were necessary in 18% of the cases in which tumor penetration occurred. Stent distortion occurred in 12 patients with Strecker and in none with Accuflex stents. In comparison to the Strecker stent, the self-expanding Accuflex stent is preferable owing to its excellent flexibility and faster delivery system. Both types of stents could be sufficiently deployed within the lesion and allowed for highly precise positioning. Furthermore, no general anesthesia was required. The fiberbronchoscopic mode of implantation under sedation is very efficient even for tumor patients with severe impairment of their physical and respiratory condition.

Topics: Alloys; Anesthesia, Local; Bronchial Diseases; Bronchoscopes; Bronchoscopy; Constriction, Pathologic; Equipment Design; Esophageal Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Respiratory Function Tests; Stents; Survival Rate; Tantalum; Time Factors

A 68-year-old man was admitted because of dyspnea. Nine months earlier, he had undergone radiotherapy for esophageal carcinoma. Chest CT scan obtained on admission showed a tumor shadow behind the tracheal carina. Bronchoscopy revealed that the lower trachea and bilateral main bronchi were compressed from the back and narrowed by the esophageal cancer. To maintain the airway, under fluoroscopic and guide-wire control, a self-expanding nitinol stent (SENS, Accuflex, Microvasive) was implanted in the lower trachea and left main bronchus. At the same time, other SENS was similarly implanted in the lower trachea and right main bronchus. During the implantation, the left nitinol stent was connected to the side of the right nitinol stent to form a T-shape. There was little sputum at the joint portion of the stents and the ventilation of both lungs remained adequate. Severe dyspnea markedly improved after placement of two nitinol stents. Knitted SENS is made of a nickel titanium alloy. SENS was formulated for use in the management of biliary obstruction. However, it is highly flexible and easy to implant. So, it is suitable for the treatment of airway obstruction. Although the implantation of SENS in extensive tracheobronchial stenosis has not previously been reported, it should be useful for prevention of airway obstruction.

Topics: Aged; Alloys; Bronchial Diseases; Carcinoma, Squamous Cell; Constriction, Pathologic; Esophageal Neoplasms; Humans; Male; Stents

Stent implantation in malignant bronchial stenoses is a highly effective method of providing symptomatic relief by restoring bronchial patency. Whether an improvement in ventilatory conditions is paralleled by an increase in blood flow and gas exchange has not yet been determined.. Fourteen patients with malignant, high-grade obstruction of bronchi who had metal stent implantation were investigated. Before the intervention and again 8 days afterward, both quantitative technegas ventilation and 99mTc-MAA perfusion scans (V/Q scans) and lung function tests were performed.. Stent implantation was successful in all patients, with a significant reduction in the degree of bronchial stenosis (pre-stent: 93% +/- 1.5%; post-stent: 16% +/- 3.5%). After stent implantation, ventilation scintigraphy revealed an improvement in tracer deposition by 65% (pre-stent: 37% +/- 8%; post-stent: 61% +/- 6%; p < 0.05) within the affected lung. A complementary increase of 71% by perfusion scintigraphy was obtained (pre-stent: 27% +/- 4%; post-stent: 46% +/- 5%; p < 0.01%). Based on scintigraphic criteria, stenting was successful in 93% (n = 13) of all patients. Lung function studies performed after the intervention showed significant improvement in vital capacity (VC, p < 0.01), forced expiratory volume in 1 sec (FEV1, p < 0.05), peak expiratory flow (PEF, p < 0.05), arterial oxygen (PaO2, p < 0.05) and carbon dioxide (PaCO2, p < 0.05) tension, and oxygen saturation (p < 0.05).. Stenting of malignant high-grade bronchial obstructions leads to an increase in bronchial patency and in activity distribution of both ventilation and perfusion scintigraphy of the affected lung, accompanied by significant improvement in lung function parameters.

Topics: Alloys; Bronchial Diseases; Constriction, Pathologic; Equipment Design; Female; Graphite; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Respiratory Function Tests; Sodium Pertechnetate Tc 99m; Stents; Tantalum; Technetium Tc 99m Aggregated Albumin; Ventilation-Perfusion Ratio