nitinol and Carcinoma--Small-Cell

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

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

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