nitinol and Carcinoma--Bronchogenic

To assess the uncovered Ultraflex nitinol stent (Boston Scientific; Natick, MA) for its efficacy and safety.. Between October 1997 and October 1998, we carried out a prospective multicenter study at six hospitals in Japan. Fifty-four Ultraflex stents were inserted in 34 patients with inoperable malignant airway stenosis using a flexible and/or a rigid bronchoscope under fluoroscopic and endoscopic visualization.. Clinical, endoscopic examination, and pulmonary function on days 1, 30, and 60 after stent implantation showed improvement. In 19 patients (56%), stent implantation was performed as an emergency procedure because of life-threatening tracheobronchial obstruction. Immediate relief of dyspnea was achieved in 82% of the patients. The dyspnea index improved significantly after implantation (before vs. days 1, 30, and 60; p<0.001). Significant improvements were observed in obstruction of airway diameter (81+/-15% before vs. 14+/-17% on day 1, 12+/-12% on day 30, and 22+/-28% on day 60; p<0.001). Vital capacity (VC), FEV(1), and peak expiratory flow (PEF) increased significantly after stent implantation: before vs immediately after VC (p<0.01), FEV(1) (p<0.001), and PEF (p<0.05). The main complications were tumor ingrowth (24%) and tumor overgrowth (21%). After coagulation with an Nd-YAG laser or argon plasma coagulation, mechanical coring out using the bevel of a rigid bronchoscope was necessary in patients showing tumor ingrowth or overgrowth. Removal and reposition were possible in case of misplacement. There were no problems with migration and retained secretions. The median survival time of patients was 3 months. The 1-year survival rate was 25.4%.. In this study of the Ultraflex nitinol stent, we have demonstrated that patients were relieved from dyspnea, which contributed to improved quality of life, with minimal complications. This stent can be used safely, even in the subglottic region. Owing to its excellent flexibility and biocompatibility, the stent is also indicated in certain complicated situations, eg, narrow stenosis, hourglass stenosis, curvilinear stenosis, bilateral mainstem bronchial stenoses, and long stenosis of varying diameters.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Biocompatible Materials; Bronchoscopy; Carcinoma, Bronchogenic; Carcinoma, Small Cell; Female; Humans; Lung Neoplasms; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Prospective Studies; Prosthesis Design; Prosthesis Implantation; Respiratory Function Tests; Safety; Stents; Tracheal Stenosis

One of the major problems in end-stage bronchotracheal cancer is stenosis of the upper airways, either due to luminal ingrowth of the tumor or mucus plugging. Airway stents that suppress tumor ingrowth and sustain mucociliary transport can alleviate these problems in end-stage bronchial cancer. We evaluated different types of polymeric covers for a tissue engineered airway stent. The distinguishing feature of this stent concept is that respiratory epithelial cells can grow on the luminal surface of the stent which facilitates mucociliary clearance. To facilitate growth of epithelial cells at the air-liquid interface of the stent, we developed a polyurethane cover that allows transport of nutrients to the cells. Nonwoven polycarbonate urethane (PCU) covers were prepared by a spraying process and evaluated for their porosity and glucose permeability. Respiratory epithelial cells harvested from sheep trachea were cultured onto the selected PCU cover and remained viable at the air-liquid interface when cultured for 21days. Lastly, we evaluated the radial force of a PCU-covered nitinol stent, and showed the PCU covers did not adversely affect the mechanical properties of the stents for their intended application in the smaller bronchi. These in vitro data corroborate the design of a novel airway stent for palliative treatment of bronchotracheal stenosis by combination of stent-technology with tissue-engineered epithelial cells.

Topics: Alloys; Animals; Bronchi; Carcinoma, Bronchogenic; Cells, Cultured; Constriction, Pathologic; Epithelial Cells; Equipment Design; Glucose; Permeability; Polycarboxylate Cement; Polyurethanes; Porosity; Respiratory System; Sheep; Stents; Tissue Engineering; Trachea

For the purpose to observe the effectiveness of treatment in late stage patients with bronchogenic carcinoma by implanting nitinol alloy endotrachial stent, combined with endobronchial 192 iridium (Ir) and percutaneous radiotherapy.. The nitiol alloy endotrachial stent was put into the site of airway stenosis through a special introducer under direct optical fibrobronchoscopy without the help of X-ray examination nor guided steel-line. 192 Ir was inserted to the site of tumor via bronchofiberscope for endobronchial irradiation combining with percutaneous radiotherapy alternately.. In all 20 patients, 7 cases (35%) were completely cured and 11 cases (55%) showed partial recovery. The other 2 cases, no change or deteriorated. The 90% effective rate was significantly higher than 60% of control group (P < 0.05).. Dyspnea of patients could be immediately relieved after endobronchial stent was inserted. Combined endobronchial and percutaneous radiotherapy obviously alleviated the obstruction caused by trachial or bronchial neoplasms. The results suggested the combined therapy led to much better objective therapeutic effect and symptomatic relief than single percutaneous radiotherapy.

Topics: Aged; Alloys; Antineoplastic Combined Chemotherapy Protocols; Brachytherapy; Bronchi; Carcinoma, Bronchogenic; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Combined Modality Therapy; Cyclophosphamide; Female; Humans; Iridium Radioisotopes; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Prednisone; Procarbazine; Stents; Survival Rate; Treatment Outcome; Vincristine