nitinol and Tracheal-Stenosis

A 59-year-old man, who had been treated for bronchial asthma since 2000, was hospitalized with high fever and productive cough in November 2003. Chest radiography on admission showed consolidations in both lower lung fields, and computed tomography demonstrated anteroposterior narrowing of both main bronchi. A physical examination revealed deformity of auricular cartilage and saddle nose, and we diagnosed him relapsing polychondritis (RP). When he was readmitted 4 months later because of severe tracheobronchial stenosis and respiratory failure he required mechanical ventilation, but it was difficult to wean him from the ventilator. Self-expandable metallic stents were placed in the left main bronchus and the trachea. After the procedure, he was successfully weared from mechanical ventilation. Since airway complications of RP can be fatal, stent implantation should be considered in the management of RP with airway manifestations.

Topics: Alloys; Bronchoscopy; Humans; Male; Middle Aged; Polychondritis, Relapsing; Stents; Trachea; Tracheal Stenosis

Topics: Alloys; Follow-Up Studies; Humans; Lung Transplantation; Palliative Care; Prosthesis Design; Respiratory Tract Diseases; Retrospective Studies; Silicones; Stents; Time Factors; Tracheal Stenosis

To evaluate the potential utility of a self-expandable intratracheal nitinol stent with flared ends for the treatment of tracheal collapse in dogs, endotracheal stenting therapy was performed under fluoroscopic guidance in four dogs with severe tracheal collapse. During the 4 to 7 month followup, after stent implantation, clinical signs, including dyspnea and respiratory distress, dramatically improved in all dogs. The radiographs showed that the implanted stents improved the tracheal collapse, and there were no side effects such as collapse, shortening or migration of the stents. In conclusion, the self-expandable intratracheal nitinol stents provided adequate stability to the trachea and were effective for attenuating the clinical signs associated with severe tracheal collapse.

Topics: Alloys; Animals; Dog Diseases; Dogs; Female; Male; Prosthesis Implantation; Stents; Tracheal Stenosis

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

Tracheal stents can be placed in a narrow position in the human trachea to ensure smooth breathing. And the stent will deform during service by the influence of the physiological environment or random excitations, such as coughing.. This paper divides the vibration into periodic and random vibrations according to the different pressures. And a coupling vibration model was established by analyzing the contact relationship between the stent and the trachea tissue. And this study discusses the influence of tracheal diameter, respiratory pressure, and frequency on the stent vibration characteristics through Ansys simulation. In addition, the nonlinear equations were solved by the Matlab numerical analysis method, which could help analyze the influence of cough intensity on the stability of the tracheal stent system.. The results showed that when tracheal stenosis occurred in the trachea's more significant grade, the trachea stent was more likely to fall off when treated with a tracheal stent. With the increase in respiratory frequency and pressure, the deformation of the tracheal stent is more considerable. Moreover, the frequency of normal cough hardly affects the stability of the stent system, while the excitation force and damping coefficient value greatly influence the system. When the excitation force of the cough exceeds the critical importance of 20 N, the tracheal stent is prone to fall off. This study comprehensively obtained the forced vibration characteristics of the stent under service conditions, which could make up for the shortage of the vibration theory of the stent.. The results can provide a theoretical basis for predicting the possibility of stent loss in clinical treatment.

Topics: Alloys; Humans; Stents; Trachea; Tracheal Stenosis

This study was conducted to determine whether a nitinol stent coated with doxycycline prevents tracheal inflammation and fibrosis in a rabbit.. A nitinol stent coated with doxycycline was designed by us. Twelve rabbits were divided into three groups: normal, control (nondoxycycline-coated stent), and doxycycline-coated stent group. The stents were inserted into the tracheal lumen through the oral cavity. Tracheal granulation was evaluated and graded by laryngoscopy. Histological examinations evaluated the inflammatory response and fibrosis. Real-time polymerase chain reaction (PCR) and Western blot assessed the changes to the extracellular matrix (ECM).. Endoscopic findings showed that the nitinol stent coated with doxycycline resulted in lesser granulation tissue in the trachea than the noncoated stent. Histologic examination further revealed that the doxycycline-coated stent was associated with decreased inflammatory cells and reduced fibrosis, compared to the noncoated stent. In PCR and Western blot, the doxycycline-coated stent showed lower expression of ECM components inducing fibrosis.. A nitinol stent coated with doxycycline showed favorable effects in reducing tracheal inflammation and fibrosis in a rabbit model. Further research is required to study the beneficial effects of local application of doxycycline for prevention of tracheal stenosis.. NA. Laryngoscope, 128:1558-1563, 2018.

Topics: Adjuvants, Immunologic; Alloys; Animals; Anti-Bacterial Agents; Disease Models, Animal; Doxycycline; Fibrosis; Inflammation; Laryngoscopy; Rabbits; RNA, Messenger; Stents; Trachea; Tracheal Stenosis; Transforming Growth Factor beta1; Wound Healing

Bare metal stents may cause complications like fibrous encapsulation, granulation and tracheal stenosis. We investigated the behaviour of three commercially available stents in vivo (rabbits) and in vitro (coculture of those stents with epithelial and fibroblast cell lines). Also, we investigated whether development of tracheal stenosis could be predicted by any biological marker.. The tracheae of 30 rabbits were implanted with either nitinol stents, with or without paclitaxel elution, or a cobalt-based stent. An additional ten rabbits underwent mock implantation (controls). Serial peripheral venous blood samples were taken throughout the study, and several cytokines measured. Animals were euthanized on day 90, with immediate tracheal endoscopy and lavage performed, then necropsy.. Rabbits with cobalt-based stent exhibited more inflammation and the highest stenosis incidence, with reduced survival. Both in vivo and in vitro, this stent induced higher IL-8 levels than nitinol stents. Most important, the presence of stent-induced tracheal stenosis was closely associated to increase in IL-8 expression in blood just 1 day after tracheal stent implantation: a 1·19-fold increase vs. baseline had 83% sensitivity, 83% specificity, 77% positive predictive value, 88% negative predictive value and 83% accuracy to predict development of stenosis.. The cobalt-based stent had the highest incidence of tracheal inflammation and stenosis. On the other hand, the paclitaxel-eluting nitinol stent did not prevent those complications and provoked a marked reaction compared with the bare nitinol stent. Early increase in IL-8 expression in blood after stent implantation could predict development of tracheal stenosis in rabbits.

Topics: Alloys; Animals; Antineoplastic Agents; Cell Line; Drug-Eluting Stents; Epithelial Cells; Female; Fibroblasts; Humans; In Vitro Techniques; Interleukin-8; Kaplan-Meier Estimate; Paclitaxel; Prosthesis Design; Rabbits; Respiratory System; Stents; Tracheal Stenosis; Vitamin B 12

The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS).. Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multi-slice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated.. The DES group had the longest stenosis (20.51±14.08mm vs. 5.84±12.43 and 6.57±6.54mm in NiTi and ST, respectively, day 30; P<.05), and higher granuloma formation on CT (50% of cases). The NiTi group showed the lowest grade of stenosis (2.86±6.91% vs. 11.28±13.98 and 15.54±25.95% in DES and ST, respectively; P<.05). The AP study revealed that the ST group developed intense proliferative reactivity compared to the other groups. In the DES group, a destructive response was observed in 70% of the animals, while the NiTi was the least reactive stent. CT was more effective in detecting wall thickening (positive correlation of 68.9%; P<.001) than granuloma (not significant).. The ST group developed granulomas and significant stenosis. NiTi was the least reactive stent, while DES caused significant lesions that may be related to drug dosage. This type of DES stent is therefore not recommended for the treatment of tracheobronchial stenosis.

Topics: Alloys; Animals; Female; Fluoroscopy; Granuloma; Models, Animal; Multidetector Computed Tomography; Rabbits; Self Expandable Metallic Stents; Steel; Tracheal Diseases; Tracheal Stenosis

Topics: Aged; Alloys; Bronchoscopy; Dyspnea; Follow-Up Studies; Humans; Male; Risk Assessment; Self Expandable Metallic Stents; Severity of Illness Index; Tomography, X-Ray Computed; Tracheal Stenosis; Tracheomalacia; Treatment Outcome

A 25-year-old, female eclectus parrot (Eclectus roratus) presented for dyspnea 3 weeks after anesthesia and surgery for egg yolk coelomitis. Radiography, computed tomography, and tracheoscopy revealed multiple tracheal strictures spanning a length of 2.6 cm in the mid to distal trachea. Histopathologic examination revealed mild fibrosis, inflammation, and hyperplasia consistent with acquired tracheal strictures. Tracheal resection was not considered possible because of the length of the affected trachea. The strictures were resected endoscopically, and repeated balloon dilation under fluoroscopic guidance over the course of 10 months resulted in immediate but unsustained improvement. Computed tomography was used to measure the stenotic area. A 4 × 36-mm, custom-made, nitinol wire stent was inserted into the trachea under fluoroscopic guidance. After stent placement, intermittent episodes of mild to moderate dyspnea continued, and these responded to nebulization with a combination of saline, acetylcysteine, and dexamethasone. Multiple attempts to wean the patient off nebulization therapy and to switch to a corticosteroid-free combination were unsuccessful. The parrot eventually developed complications, was euthanatized, and necropsy was performed. Histologically, the tracheal mucosa had widespread erosion to ulceration, with accumulation of intraluminal exudate and bacteria, severe degeneration of skeletal muscle and tracheal rings, prominent fibrosis, and mild to moderate, submucosal inflammation. Clinicopathologic findings in this case suggested tracheomalacia, which has not been previously described in birds. Custom-made tracheal stents can be used for severe tracheal stenosis in birds when tracheal resection and anastomosis is not possible. Complications of tracheal stent placement in birds may include tracheitis and tracheomalacia. To our knowledge, this is the first report of tracheal stent placement in an avian species.

Topics: Alloys; Animals; Bird Diseases; Female; Parrots; Stents; Tracheal Stenosis; Tracheomalacia

To evaluate the clinical efficacy and safety of radiologic management for the treatment of benign tracheal strictures caused by tracheostomy.. We retrospectively reviewed of 13 patients with benign tracheal stricture caused by tracheostomy that was treated with balloon dilation or stent placement. Balloon dilation had initially been performed. Stent placement was indicated in patients who showed a poor response to balloon dilation. Outcomes were assessed according to the following variables: technical and clinical success, Hugh-Jones classification scale before and after the procedures, and complications.. Balloon dilation and stent placement were technically successful in all patients. Nine of the 13 patients (69 %) showed no response to balloon dilation, and the remaining the four patients showed a positive response to initial balloon dilation. Six of the nine (67 %) patients showed a good response to temporary stent placement and required no further treatment. Mean Hugh-Jones grades improved from 3.6 ± 0.8 to 1.8 ± 1.1 (P < 0.001). During a follow-up period of 2.6-40.8 months (mean 16.5), overall clinical success was achieved in 10 patients (77 %) after a single balloon dilation (n = 4) and temporary stent placement (n = 6). The remaining three patients with clinical failure underwent tracheal resection (n = 3).. Radiologic management can be a safe and effective therapeutic option for treating benign tracheal stricture caused by tracheostomy. Temporary stent placement can be effective in patients with symptoms recurring soon after balloon dilation.

Topics: Adolescent; Adult; Aged; Alloys; Bronchoscopy; Contrast Media; Female; Fluoroscopy; Humans; Iohexol; Male; Middle Aged; Radiography, Interventional; Retrospective Studies; Stents; Tomography, X-Ray Computed; Tracheal Stenosis; Tracheostomy

Placement of self-expandable nitinol stents is useful for the treatment of esophageal and upper gastrointestinal (GI) obstruction. However, complications such as stent migration, tumor overgrowth, and bleeding occur. Although stent migration and tumor overgrowth are well documented in previous studies, the occurrence of bleeding has not been fully evaluated.. To evaluate the incidence, management strategies, and predictors of bleeding after placement of self-expandable nitinol stents in patients with esophageal and upper GI obstruction.. We retrospectively reviewed the medical records and results of computed tomography and endoscopy of 1485 consecutive patients with esophageal and upper GI obstructions who underwent fluoroscopically guided stent placement.. Bleeding occurred in 25 of 1485 (1.7%) patients 0 to 348 days after stent placement. Early stent-related bleeding occurred in 10 patients (40%) and angiographic embolization was used for 5/10. Late bleeding occurred in 15 patients (60%) and endoscopic hemostasis was used for 7/15. Twenty-two of 25 (88%) patients with bleeding had received prior radiotherapy and/or chemotherapy.. Bleeding is a rare complication after placement of expandable nitinol stents in patients with esophageal and upper GI obstruction, but patients with early bleeding may require embolization for control. Care must be exercised on placing stents in patients who have received prior radiotherapy or chemotherapy.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Constriction, Pathologic; Embolization, Therapeutic; Esophageal Stenosis; Esophagoscopy; Female; Fluoroscopy; Gastrointestinal Hemorrhage; Hemostasis, Surgical; Humans; Incidence; Male; Middle Aged; Patient Selection; Prosthesis Design; Retrospective Studies; Risk Factors; Stents; Tomography, X-Ray Computed; Tracheal Stenosis; Treatment Outcome

A study was designed to describe a novel approach to the treatment of tracheal collapse (TC) in dogs using self-expandable nitinol stents. Medical records were reviewed retrospectively for 26 client owned dogs in which nitinol stents were deployed. The entire length of trachea was supported independently of the extent of TC. Two overlapping stents were used instead of one in cases where one stent was not spanning the entire trachea adequately. The diameter of the cranial radiolucent portion of trachea, just behind the cricoid cartilage, was measured as a specific landmark to select the appropriate size of the stent. Two self-expandable nitinol stents were inserted in 9 of 26 dogs; the trachea in the rest of the cases was supported with only one stent. A follow up tracheoscopy was performed in 10 of 26 cases with recurrent clinical signs. Secondary tracheal stenosis in these cases was caused by stent fracture, granuloma or excessive stent shortening. Additional stents were placed successfully to expand the stenotic lumen. A support of the entire trachea may decrease risk of nitinol fracture at the end of the implant. Long term clinical improvement (25 of 26 dogs, 96 %) is comparable with the results of other studies.. Bei 26 Hunden wurde ein Tracheakollaps mit selbst-expandierenden Nitinol Stents behandelt und die Ergebnisse retrospektiv evaluiert. Die Trachea wurde über ihre gesamte Länge unterstützt unabhängig von der Lokalisation des Kollapses. Falls kein Stent mit ausreichender Länge zur Verfügung stand, wurden zwei überlappende Sents gesetzt, um die gesamte Länge der Trachea zu expandieren. Der Durchmesser des Stents wurde anhand des Durchmesseres der Trachea unmittelbar kaudal des Cricoids gewählt. Bei 9 der 26 Patienten wurden zwei überlappende Stents gesetzt. Bei allen anderen Patienten konnte die gesamte Länge der Trachea mit einem Stent unterstützt werden. Bei 10 Patienten wurde eine «second look» Tracheoskopie durchgeführt, da sich erneut klinische Zeichen eines Tracheakollapses zeigten. Eine sekundäre Tracheastenose wurde konstatiert als Folge einer Stentfraktur, Granulation oder einer exzessiven Stentverkürzung. Ein zuätzlicher Stent wurde erfolgreich gesetzt um das eingeengte Lumen zu expandieren. Die Unterstützung der Trachea über die gesamte Länge kann die Bruchgefahr des Nitinols am Ende des Stents vermindern. Die langfristige Verbesserung des klinischen Zustandes in 25 von 26 Fällen (96 %) ist mit Resultaten anderer Studien vergleichbar.. Des stents auto-expansifs en nitinol ont été utilisés pour traiter 26 chiens atteints de collapsus trachéal et les résultats ont été évalués rétrospectivement. La trachée a été renforcée sur toute sa longueur, indépendamment de la localisation du collapsus. Si aucun stent d'une longueur suffisante n'était disponible, on a utilisé deux stents se recouvrant pour dilater l'ensemble de la trachée. Le diamètre du stent a été choisi sur la base du diamètre de la trachée directement caudalement au cricoïde. Chez 9 des 26 patients, on a posé deux stents se recouvrant. Chez tous les autres patients, il a été possible de renforcer la trachée sur toute sa longueur au moyen d'un seul stent. On a procédé chez dix patients à une seconde trachéoscopie, car de nouveaux signes de collapsus trachéal étaient apparus. Une sténose trachéale secondaire a été constatée suite à une fracture du stent, à du tissus de granulation ou à un raccourcissement excessif du stent. Un stent supplémentaire a été placé avec succès, pour dilater la lumière trachéale rétrécie. Le renforcement de la trachée sur toute sa longueur peut diminuer le risque de fracture du stent à son extrémité. L'amélioration clinique à long terme obtenue chez 25 des 26 patients (96 %) est comparable aux résultats d'autres études.. Sono stati retrospettivamente valutati i risultati del trattamento con stent in nitinol autoespandente su 26 cani affetti da collasso tracheale. La trachea è stata sostenuta sulla sua intera lunghezza, indipendentemente dalla posizione del collasso. Nel caso non fosse disponibile uno stent sufficientemente lungo, sono stati usati due stent sovrapposti per giungere all'intera lunghezza della trachea. Il diametro dello stent è stato scelto sulla base del diametro della parte caudale della trachea immediata della cricoide. In 9 pazienti su 26 sono stati usati due stent sovrapposti. Per tutti gli altri pazienti, la lunghezza totale della trachea era supportata da una stent. In 10 pazienti è stata eseguita una tracheoscopia «second look» che ha rilevato di nuovo segni clinici di un collasso tracheale. Una stenosi tracheale secondaria è stata costatata come risultato di una frattura dello stent, granulazione o eccessivo accorciamento dello stent. Uno stent supplementare è stato collocato con successo per espandere il lume ristretto. Il sostegno della trachea lungo l'intera lunghezza può ridurre il rischio di frattura del nitinol alla fine dello stent. Il miglioramento clinico a lungo termine in 25 su 26 casi (96 %) è comparabile con i risultati di altri studi.

Topics: Alloys; Animals; Cough; Dog Diseases; Dogs; Female; Male; Postoperative Complications; Stents; Tracheal Stenosis

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

To reflect on lessons learned placing endotracheal nitinol stents in children.. Case series with chart review.. Tertiary care children's hospital.. All children who underwent nitinol cervical tracheal stenting were included. Records were carefully reviewed for intraoperative and postoperative complications, management choices, outcomes, and factors that influenced results.. Between 1999 and 2011, 7 children underwent 13 stent placements. Median follow-up was 5 years (range, 1-12 years). Six patients underwent stenting as a salvage procedure following open attempts at airway reconstruction. Four patients remain decannulated with their stent in place (median follow-up 7 years). The fifth patient had his stent removed endoscopically after 50 days because it became apparent that his obstruction was primarily laryngeal. The sixth child had his stent removed via a tracheal fissure after 14 months because of recalcitrant subglottic inflammation at the superior stent border. The seventh patient was decannulated for over 2 years but ultimately required tracheotomy replacement because of stenosis with the stent lumen. Complications included stent migration (23%), restenosis (29%), edema (29%), and granulation (57%).. Endotracheal nitinol stents provide a realistic opportunity for decannulation in children for whom other options have failed but should be reserved only as a salvage procedure in severely complicated airways. Our experience has taught valuable lessons about stent indications, sizing, characteristics, and deployment, as well as means to avoid and manage their complications.

Topics: Adolescent; Alloys; Biocompatible Materials; Child; Child, Preschool; Female; Humans; Learning Curve; Male; Prosthesis Implantation; Stents; Tracheal Stenosis; Tracheomalacia; Treatment Outcome; Young Adult

Tracheal neoplasms account for less than 1% of all malignancies. In spite of their low incidence, these tumors represent potentially lethal phenomena. In cases of airway compromise and unresectable disease, the airway may be maintained by repeated bronchoscopic debulkings, and the use of CO(2) laser, silicone Montgomery T-tube and tracheal stents. The use of metallic expandable stents to relieve airway obstruction in advanced tracheal tumors was previously reported. Our aim was to evaluate the use of metallic expandable tracheal stents as a palliative relief from severe airway obstruction in cases of locally advanced, inoperable malignant tracheal tumors. Patients suffering from severe airway obstruction secondary to locally advanced tracheal tumors, who presented to the Otolaryngology Head and Neck Surgery and Chest Diseases Departments at the Main Alexandria University Hospital, Egypt, were included in this study. After endoscopic and radiological evaluation, expandable metallic tracheal stents (SENS; Ultraflex tracheal prosthesis; Boston Scientific Corp, Watertown, MA, USA) were inserted under general anesthesia to relieve airway obstruction. Postoperative follow-up with regard to improvement of respiration, tolerability of the stent and reporting of complications was done. Twelve patients were included, eight males and four females with a mean age of 61 years. Four patients (33.3%) had primary tracheal tumors and eight (66.7%) suffered from tumors infiltrating the trachea from nearby structures. The stent was easily inserted in all patients with no significant intraoperative complications. Postoperatively, the stent was well tolerated and all patients experienced good respiration with significant improvement of respiratory function test results. The most common complication reported was granulation tissue formation. Other complications were displacement of the stent, bad breath, re-growth of tumor tissue at the lower end of the stent and retention of secretions. We concluded that Ultraflex self-expandable stent is a good alternative for palliative relief from airway obstruction in cases of inoperable malignant tracheal tumors. Strict follow-up is mandatory for early detection and management of expected complications.

Topics: Adult; Aged; Airway Obstruction; Alloys; Female; Humans; Male; Middle Aged; Palliative Care; Stents; Tracheal Neoplasms; Tracheal Stenosis

To report bronchoscopic placement of nitinol stents (Vet Stent-Trachea®) for improvement of end-stage clinical signs in dogs with tracheal collapse.. Case series.. Dogs (n = 18).. Medical records (January 1, 2004-October 31, 2008) were searched for dogs with a diagnosis of tracheal collapse; 18 dogs met inclusion criteria. Tracheal diameter was compared before and after stent deployment. Stent dimensions were compared after stent deployment and at radiographic follow-up.. There was a significant difference in the minimum tracheal diameter when initial and post deployment tracheal diameters were compared (P = .003). Stent length was significantly shorter at follow-up when compared to post deployment measurements (P = .004). Owner assessment of outcome was available for all dogs with 11.1% mortality within 60 days. Complications were documented in 9 dogs.. Use of a nitinol stent (Vet Stent-Trachea®) in dogs with end-stage tracheal collapse is associated with a fair to good outcome despite significant temporal stent fore shortening after bronchoscopic placement.

Topics: Alloys; Animals; Dog Diseases; Dogs; Female; Male; Prosthesis Implantation; Retrospective Studies; Stents; Tracheal Diseases; Tracheal Stenosis

The purpose of this study was to evaluate the safety and effectiveness of a barbed silicone-covered retrievable expandable nitinol stent in preventing stent migration in patients with tracheal strictures or fistulas.. Under fluoroscopic guidance, barbed silicone-covered retrievable expandable nitinol stents were placed in 15 patients with tracheal strictures, two patients with fistulas, two patients with combined strictures and fistulas, and one patient with variable extrathoracic airway obstruction. The three pairs of barbs were attached to the external stent surface at the middle of the stent at equal intervals. Technical success, improvement in respiratory status, complications, and related interventions were evaluated.. The technical success rate was 100%, and respiratory status improved or the fistula closed in all 20 patients. Complications included sputum retention (three patients), tumor overgrowth (three patients), pain (one patient), and granulation tissue formation (one patient). No stent migration occurred, even in the three patients without fixed strictures. Four stents subsequently were removed because of complications, and one stent was removed because the patient's condition improved. Stent removal was not difficult and was uneventful. The silicone membranes and barbs of the removed stents were intact.. Use of a barbed silicone-covered retrievable expandable nitinol stent relieves dyspnea and facilitates fistula closure in patients with benign or malignant tracheal strictures or fistulas. The barbed design of the stent is important in preventing migration.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Coated Materials, Biocompatible; Device Removal; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Radiography, Interventional; Silicones; Stents; Tomography, X-Ray Computed; Tracheal Stenosis; Tracheoesophageal Fistula; Treatment Outcome

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

Curative resection is often contraindicated in patients with airway obstruction by aggressive thyroid disease.. To evaluate the safety and clinical effectiveness of covered retrievable self-expandable nitinol stents placed in patients with airway obstruction caused by benign or malignant thyroid disease.. From 1996 to 2009, covered retrievable self-expandable nitinol stents were placed in nine symptomatic patients with malignant (n=7) or benign (n=2) thyroid disease. Improvement in patient respiratory status, complications and their management, and survival data were evaluated. Stents were removed if stent-related complications occurred or the stents were no longer necessary.. A total of 11 stents were successfully placed without procedure-related complications. Improvement of more than one dyspnea grade was seen in eight of nine patients (89%), while the ninth patient underwent intubation due to upper airway swelling. Stent migration, sputum retention, and tumor overgrowth occurred in 27.3% (n=3), 9.1% (n=1), and 9.1% (n=1) of the stents, respectively. A total of six stents were successfully removed because of stent-related complications (n=4) or after total thyroidectomy (n=2). In two patients with benign thyroid goiters, a stable airway was maintained until total thyroidectomy.. Placement of covered retrievable self-expandable nitinol stents was safe and effective in patients with airway obstruction caused by benign or malignant thyroid disease. Stent retrievability was very useful in cases of stent-related complications. In patients with benign thyroid disease, stent placement can serve as an effective bridge to surgery.

Topics: Adult; Aged; Alloys; Bronchoscopy; Coated Materials, Biocompatible; Device Removal; Female; Foreign-Body Migration; Humans; Male; Middle Aged; Stents; Thyroid Diseases; Thyroid Neoplasms; Thyroidectomy; Tracheal Stenosis; Treatment Outcome

To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement.. Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated.. A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p<0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n=4), haemoptysis (n=2), sputum retention (n=7), and tumour overgrowth (n=1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2-197 days).. Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.

Topics: Adult; Aged; Airway Obstruction; Alloys; Bronchi; Bronchography; Device Removal; Epidemiologic Methods; Esophageal Fistula; Esophageal Neoplasms; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Neoplasm Invasiveness; Palliative Care; Radiography, Interventional; Respiratory Tract Fistula; Stents; Tracheal Stenosis; Treatment Outcome

Self-expanding metal, as well as silicon, stents have long been available for use in the airway. Metal stents can be placed using a flexible bronchoscope and are less readily removed. Silicone stents require rigid bronchoscopy and general anesthesia for placement but are removable. Both technologies are prone to complications on a long-term basis. A new self-expanding hybrid stent, the AERO stent (Alveolus, Inc., NC, USA), combines the best features of metal and silicone stents with a completely covered nitinol framework. The potential advantages of a self-expanding hybrid stent include placement using flexible bronchoscopy under conscious sedation, easy removability and a potential reduction in common long-term stent implant complications. This article profiles the AERO device and evaluates stent technology in general.

Topics: Alloys; Catheterization; Cost-Benefit Analysis; Humans; Product Surveillance, Postmarketing; Sensitivity and Specificity; Stents; Tracheal Stenosis

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

Nitinol stents have been used in the treatment of benign tracheal stenosis. A retrospective review of five patients treated at Stobhill Hospital over the last six and a half years is presented. Age at presentation ranged from 17 to 76 years. The minimum follow-up period was 23 months and the maximum was 78 months. All our patients were successfully decannulated, with none requiring recannulation. Four patients developed granulation tissue related to the stent at intervals ranging from three weeks to 41 months post stenting. Topical mitomycin C application has been useful after resection of granulations using the carbon dioxide (CO2) laser. Stent migration occurred in one patient three weeks after insertion. Nitinol stents are easy to insert and effective in the treatment of tracheal stenosis, but can have associated morbidity. Their use should be considered carefully, as insertion should be regarded as permanent. Publications reporting experience and outcome with the use of Nitinol stents in the trachea are reviewed.

Topics: Administration, Topical; Adolescent; Adult; Aged; Alloys; Antibiotics, Antineoplastic; Cartilage Diseases; Female; Foreign-Body Migration; Granuloma, Foreign-Body; Humans; Laser Therapy; Male; Middle Aged; Mitomycin; Patient Satisfaction; Retrospective Studies; Stents; Tracheal Diseases; Tracheal Stenosis; Treatment Outcome

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

Balloon tracheoplasty and temporary placement of a covered retrievable self-expandable metallic stent was successfully undertaken in the treatment of congenital tracheal stenosis from complete cartilaginous rings in an infant. After balloon tracheoplasty and temporary placement of the stent for 5 months, stable airway condition has been maintained for 21 months.

Topics: Alloys; Cartilage; Catheterization; Equipment Design; Follow-Up Studies; Humans; Infant, Newborn; Male; Polyurethanes; Stents; Tracheal Stenosis

Three different internal airway stents were studied in an animal model of tracheomalacia: the Palmaz stent (Johnson & Johnson, Warren, New Jersey) and the NIR stent (Medinol Ltd., Tel Aviv, Israel)--both made of stainless steel in the form of tubular mesh--and the Nitinol stent, made of nickel-titanium formed into a spiral shape. All three stents could be adequately stabilized in the malacic tracheal segment. The Nitinol stent (Medinol Ltd., Tel Aviv, Israel) proved to be less reactive to the tracheal mucosa, demonstrated higher biocompatibility with significantly less granulation tissue formation, and showed superior radial resistance. Extraction of the Nitinol stent also proved to be much smoother. This stent may be the stent of choice in the treatment of tracheo- and bronchomalacia.

Topics: Airway Obstruction; Alloys; Animals; Bronchoscopy; Disease Models, Animal; Prosthesis Design; Stents; Swine; Trachea; Tracheal Diseases; Tracheal Stenosis

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

A 5-year-old castrated male Pomeranian was evaluated because of severe dyspnea and coughing, and a diagnosis of complete, static collapse of the trachea at the thoracic inlet was made. After failure to improve with medical management alone, an endoluminal tracheal stent was placed, which resulted in resolution of signs. Ten weeks after stent placement, the dog underwent tracheal resection and anastomosis because the stent had fractured at the level of the thoracic inlet. One year after surgery, the dog was doing well and required treatment with hydrocodone infrequently. Compared with other surgical treatment options, placement of an endoluminal tracheal stent is a relatively noninvasive intervention that can provide effective relief from the clinical signs associated with tracheal collapse in dogs. Implantation of endoluminal tracheal stents may be associated with complications; therefore, the procedure may best be regarded as a salvage procedure for dogs with end-stage disease that are refractory to appropriate medical management, have extensive collapse of the intrathoracic portion of the trachea, or are poor candidates for surgery.

Topics: Alloys; Animals; Dog Diseases; Dogs; Male; Postoperative Complications; Prosthesis Implantation; Reoperation; Stents; Tracheal Stenosis; Treatment Outcome

We experienced an unacceptably high 21% complication rate with the stainless steel Gianturco stent: a 68-month mean follow-up (range: 37-96 months) of 23 patients revealed three stent fractures and two migrations. Consequently, we began using nitinol mesh stents (Ultraflex) for fibrous stenoses and silicone-covered prostheses (Rush) for proliferative tracheal tumors. The extractable nitinol stent, made from alloy with thermal memory, was palliatively used in 15 patients with fibrous tracheal stenosis; the mean follow-up currently covers 21 months (range: 1-60 months). The silicone-covered prosthesis was used for two patients with inoperable tracheal tumor; follow-up covers 4 months and 2 months, respectively. The prostheses were positioned under visual guidance via the endoscopic approach. The median forced inspiratory volume in 1 s (FIV1) improved from 2.1 l/s (IQR: 0.7-2.4) to 3.2 l/s (IQR: 0.9-3.4) (P=0.018, Wilcoxon signed rank test). The median ratio of peak inspiratory flow (PIF 50%) to peak expiratory flow (PEF 50%) was 1.0 preoperatively (IQR: 0.8-1.5) and 1.8 postoperatively (IQR: 0.6-6.3). Between months 1 and 12, six granulomas developed. Five were treated with antibiotics and steroid aerosol inhalation therapy and one required CO2 laser vaporization. On day 10, one stent migration was observed. The migrated stent was substituted. To date, no stent fracture has been observed. Nitinol and silicone-covered prostheses can be proposed for the palliative treatment of fibrous tracheal stenoses and tracheal tumors, respectively.

Topics: Adult; Aged; Alloys; Equipment Failure; Female; Follow-Up Studies; Humans; Laser Therapy; Male; Middle Aged; Peak Expiratory Flow Rate; Silicones; Stents; Tracheal Stenosis; Treatment Outcome

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

To provide preliminary clinical data regarding endoscopically placed nitinol stents for children with tracheal obstruction as a temporizing measure to allow for trach tube decannulation while awaiting growth to allow for tracheal resection.. This case series describes the experiences of two children (ages 5 and 15) who were dependent upon tracheotomy because of acquired tracheal obstruction. Both patients had combined tracheomalacia and tracheal stenosis. After failing tracheoplasty with rib graft augmentation both patients suffered from extensive tracheal disease, which was too long to allow for immediate tracheal resection.. Endoscopic placement of nitinol stents in the obstructed tracheal segment using fluoroscopic guidance. All tracheotomy tubes were removed immediately after successful stent deployment with the patient still under general anesthesia.. Four stents were placed in total. The first patient's initial stent was too narrow and was, therefore, removed and replaced at a later date with a larger diameter stent. The second patient experienced distal migration of his initial stent requiring stent removal and replacement at a later date. Both patients remain successfully decannulated (follow-up, 25 and 26 months) and are currently living more normal lives as they grow and await tracheal resection.. Preliminary use of nitinol stents for pediatric tracheal obstruction has enabled successful decannulation in two children with complicated airways. Our results with this series of patients suggest that nitinol stents can be safely used in children as a temporizing measure until tracheal resection can be safely performed. With this approach children can live free from the hassles of trach care, social isolation and peer ridicule. Limited pediatric experience exists in the literature about nitinol stents. Thus, our experience with stent selection and placement will help others avoid problems encountered in this initial series.

Topics: Adolescent; Alloys; Bronchoscopy; Child, Preschool; Female; Humans; Male; Stents; Tracheal Stenosis

Tracheal collapse is a common problem that is typically observed in middle-aged and older small-breed dogs. It is a structural, obstructive airway disease with a dynamic component that can affect the intra- and extrathoracic portions of the trachea and mainstem bronchi. Many methods of treatment have been suggested, including medical management and provision of extraluminal and intraluminal support. All techniques used to treat intrathoracic and mainstem bronchial collapse have been associated with major complications or limitations. This report describes the implantation of intraluminal nitinol stents to successfully treat intrathoracic as well as extrathoracic tracheal collapse in a dog. The stents are composed of material that has characteristics similar to those of the trachea; nitinol stents may provide a method of supporting intrathoracic tracheal and mainstem bronchial collapse in dogs.

Topics: Alloys; Animals; Bronchography; Bronchoscopy; Dog Diseases; Dogs; Male; Postoperative Complications; Reoperation; Stents; Trachea; Tracheal Stenosis; Treatment Outcome

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

The use of silicone- or metal stents in stenosis of the distal trachea and the bronchial system is a customary procedure [1-4], for example after tumor invasion or cicatricial stenosis after transplantation. In the proximal part of the trachea, on smaller, short and soft strictures we try to stabilise the trachea by the implantation of rings. Other methods are tracheal plasty or transverse tracheal resectomy [5-7]. In the case of longer or nearer subglottal stenoses the positioning of self-expanding nitinol stents has proven a simple, gentle and well-tolerated alternative procedure even in very serious disorders [1, 8, 9].. These stents can be placed in short narcosis under endoscopic control without great strain on the patient.. We placed nitinol-stents in the proximal part of the trachea in eleven cases. In five cases dyspnoea caused by a tracheal collapse improved. In two further cases a tracheal stenosis with massive granulation tissue and cicatricial pull under an inlaid tracheal cannula was removed and the tracheostoma was closed. In four cases a solid, scarred and cartilaginous stenosis in the area of the cricoid and the upper tracheal rings was widened with laser and later on stented.. Over an observation time of two years no complications showed safe one case in which a directly postoperative dislocation was repositioned quickly. The patients live without restrictions through the tracheal stenosis or a tracheostoma. In the best possible case epithelialization over the metal meshes develops so that a nearly normal mucus transportation is possible [1, 10-12].

Topics: Adult; Aged; Alloys; Female; Follow-Up Studies; Humans; Male; Middle Aged; Stents; Time Factors; Tracheal Stenosis

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

To evaluate the potential utility of a new endoscopically placed expandable tracheal stent in the treatment of benign symptomatic stenoses of the cervical trachea.. Pilot study utilizing a prospectively followed case series.. An initial group of six patients undergoing stent placement was examined with rigid and flexible endoscopy under anesthesia immediately following stent placement and at postoperative 6 to 8 weeks. Subsequently each patient was followed clinically for a minimum of 6 months.. All stents were well tolerated with no observed complications. Immediate reversal of symptomatic airway obstruction without the need for adjunctive tracheotomy was noted in every patient. At 6 weeks, endoscopic confirmation of complete intraluminal mucosalization without formation of any granulation tissue or scar bands within the stented areas was noted in each case.. This preliminary pilot study supports the use of nitinol expandable tracheal stents as an alternative in the treatment of benign symptomatic tracheal stenoses.

Topics: Adult; Alloys; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; 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

To treat inoperable tracheal stenosis by using nitinol endotracheal stent and to solve some problems facing endotracheal stenting with other kinds of stents.. The stent was made of nitinol wire. It can be deformed to smaller size in iced water. With a self-made introducer, the stent was placed in the location of stenosis. After hot water was injected into the introducer, the stent resumed its original form and anchored there itself.. Altogether, 5 patients with severe tracheal stenosis received this treatment. Dyspnea was relieved immediately after implantation of stents in all patients. Long-term follow-up also showed satisfactory results.. Nitinol stent has some remarkable advantages as compared with other tracheal stents. It can be used as a new endoprosthesis in treating narrowed trachea.

Topics: Adult; Aged; Alloys; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Male; Middle Aged; Stents; Tracheal Neoplasms; Tracheal Stenosis

A 57-year-old man was admitted because of dysphagia. Two year earlier, endoscopic ND-YAG laser treatment had been performed for squamous cell carcinoma of the tracheal carina. The esophagus was compressed and narrowed by invasion of lung cancer. After ballooning, under endoscopic and fluoroscopic control, a self-expanding nitinol stent (SENS, Ultraflex, Microvasive) was implanted in the esophagus. Immediately after esophageal prosthesis implantation, severe dyspnea and stridor developed because of tumor strictures in the left main bronchus. Under fluoroscopic and guide-wire control, SENS (Accuflex, Microvasive) was implanted in the tracheobronchial tree. Dyspnea, dysphagia and stridor were markedly improved after placement of two nitinol stents. Highly flexible, knitted, self-expanding nitinol stent is made of a nickel titanium alloy. Although the implantation of SENS in tracheobronchial stenosis has not previously been reported, it should be useful for prevention of airway obstruction.

Topics: Alloys; Carcinoma, Squamous Cell; Esophageal Stenosis; Humans; Lung Neoplasms; Male; Middle Aged; Quality of Life; Stents; Tracheal Stenosis

Temporary or permanent tracheal splinting in pediatric patients may be indicated in tracheomalacia or bronchomalacia, repair of congenital tracheal stenosis, and after tracheal resection. This study presents the results of the development of a new intraluminal airway stent made from titanium alloy, a metal with "shape memory effect". At low temperatures (martensitic state) the titanium alloy stent can be fashioned into a specific shape; then when heated to a higher temperature (austenitic state) the stent alters its shape, only to regain its original shape when recooled to the lower temperature. The stent, connected to a small electric power supply, was introduced into 20 young rabbits with the use of a 2.5 cm rigid bronchoscope. After implantation in the martensitic state the stent was warmed to 40 degrees C, the austenitic state, by an electric current of 1.5 to 3 ampere for 1 to 2 seconds. After a period of 8 to 10 weeks the stent was removed (in its martensitic state) through the same-sized bronchoscope after being cooled with 3 to 4 ml of 80% alcohol solution at 6 degrees C. No signs of airway obstruction developed in any of the animals after implantation or extraction of the stent. The biomechanical properties of the trachea, as shown by strain measurements with the use of incremental forces, showed significant differences between the stented and unstented segments (p < 0.005). The titanium alloy intratracheal stent adequately fulfilled the requirements of a temporary intraluminal airway splint, and because of its unique feature of shape memory effect the stent could be inserted, fixed, and removed easily, even in very small airways.

Topics: Alloys; Animals; Biomechanical Phenomena; Equipment Design; Rabbits; Stents; Temperature; Trachea; Tracheal Diseases; Tracheal Stenosis

A new method used in treatment of tracheal stenosis by means of nitinol alloy intraluminal tracheal stent (Ni-Ti ITS) is introduced. Altogether 7 stents were implanted into tracheas of 7 mongrels each with a model of tracheal stenosis. The observation periods ranged from 2 to 6 months. The experimental results showed: The Ni-Ti ITSs could maintain long term patency without severe infection or obstruction by granulations or secretion. No displacement was found. There were no signs of either generalized or localized corrosion on the surface of stents. The shape memory character remained unchanged. On the basis of animal experimental study, the stents were successfully used in treatment of 2 patients with tracheal stenosis. One was caused by advanced tracheal tumor, the other was due to recurrent anastomotic stricture.

Topics: Adult; Alloys; Animals; Dogs; Female; Humans; Male; Nickel; Stents; Titanium; Tracheal Stenosis

The authors discuss the results of the first experience in the clinical use of nitinol spiral endoprostheses as an artificial supporting framework of the trachea in local destruction of the tracheal cartilages and loss of rigidity of the tracheal wall. Tracheal endoprosthetics was carried out in 6 patients with cicatrical stenoses and tracheomalacia. The causes of possible complications (growth of granulation tissue into the tracheal lumen and displacement of the endoprosthesis) are analysed and the means of their prevention are suggested. It was established that the nithinol spiral endoprosthesis may be covered by epithelialized tracheal mucosa and provide an adequate rigid lumen for the tracheal area devoid of the framework. The diameter of the implanted prosthesis must be 2-3 mm larger than the diameter of the normal tracheal lumen. Temporary introduction of a protector tube into the repaired trachea may shorten the duration of treatment significantly.

Topics: Adult; Alloys; Cartilage Diseases; Cicatrix; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Prostheses and Implants; Trachea; Tracheal Stenosis; Tracheostomy