Airway Stent Placement

Metal Stent Placement

Metal stent placement in the airway is intended to restore airway patency and patient quality of life. With 5-year survival rates of patients with malignant airway disease limited to approximately 15%, the quality of life of patients can often be improved by restoring airway luminal patency during this short life expectancy. Self-expanding metal stents are manufactured in a variety of sizes with and without covering to provide physicians with many options in managing airway obstruction and tracheo-esophageal fistulae.

The Ultraflex™ Tracheobronchial Stent System, a self-expanding metal stent, can be placed via flexible bronchoscopy using a guidewire and can be employed on an outpatient basis under conscious sedation, which may reduce a patient’s hospital stay. The Ultraflex Tracheobronchial Stent System is indicated for use in the treatment of tracheobronchial strictures produced by malignant neoplasms. This stent is contraindicated for use in concurrent fistulae of the tracheobronchial tree unless a covered stent is used; for tracheobronchial obstruction with a luminal diameter which cannot be dilated to and maintained at a minimum of 4mm, or preventing passage of either a rigid or flexible bronchoscope; or in patients for whom bronchoscopic procedures are contraindicated.

Silicone Stent Placement

Silicone stent placement in the airway is another endoprosthesis option for today’s interventionalist. Silicone stents are intended to be used as a measure to restore quality of life for patients with obstructive lung disease.

The Polyflex® Airway Stent, for example, is placed via rigid bronchoscopy. The Polyflex Airway Stent is fully covered and has been designed to reduce in-growth and/or endothelialization of the stent. The Polyflex Airway Stent is indicated for compression or strictures due to tumors (trachea and main bronchus); stenosis of the central airways (such as trachea and main bronchus); tracheo-esophageal fistulae; and airway complications such as anastomosis. It has also been shown that using interventional bronchoscopy techniques in the neoadjuvant setting can improve the functional status of the patient.²

The Polyflex Airway Stent is contraindicated for obstruction of the larynx; narrow or rigid stenoses that cannot be dilated sufficiently; patients for whom endoscopic techniques are contraindicated; and/or patients with blood clotting disorders; and bilateral recurrent laryngeal nerve paresis. There are no contraindications for these stents when placed in life-threatening emergencies.

Another silicone stent option is the Dynamic™ (Y) Stent which consists of a single piece construction bifurcation tube. This stent is designed to simultaneously secure the trachea, left mainstem and right mainstem bronchus. The Dynamic (Y) Stent is intended to maintain patent airways in tracheal stenosis and seal tracheo-esophageal fistulas. The Dynamic (Y) Stent is indicated for use in airway complications such as anastomosis and stenosis following lung transplantation, tracheo-malacia, and tracheo-esophageal fistula. The Dynamic (Y) Stent is contraindicated in laryngeal obstruction, bilateral paralysis of recurrent laryngeal nerve, patent tracheal stoma and when there is a need for artificial ventilation. There are no contraindications for these stents when placed in life-threatening emergencies.

Reference

1. Bolliger CT, Mathur PN(eds): Interventional Bronchoscopy. Prog Respir Res. Basel, Karger, 2000, vol 30, pp 171-186.
2. Chhajed et. al. Annals of Thoracic Surgery, May 2006.