Self-expandable metallic airway stents and flexible bronchoscopy - Long-term outcomes analysis

Study objectives: To report and analyze our 6-year experience with implanting 112 self-expandable metallic stents (SEMSs) using flexible bronchoscopy (FB). Design and setting: Retrospective study, tertiary-care hospital. Patients and methods: The studied population consisted of 82 patients (mean age, 59.1 years; range, 37 to 83 years), who received SEMSs from 1995 to 2001 using Wallstent (Boston Scientific; Galway, Ireland) or Ultraflex (Boston Scientific) stents. Results: The indications for stent placement were airway obstruction caused by neoplasia (lung carcinoma [CA], n = 50), airway complications of lung transplantation (LTx) [n = 11], and miscellaneous benign conditions (BCs) [n = 21]. The most frequent clinical presentations for the airway obstruction were moderate-to-severe dyspnea (80%) and coughing (45%). The median follow-up duration for the CA group was 42.0 days (range, I to 672 days), 329.0 days (range, 35 to 1,540 days) for patients receiving LTx, and 336.0 days (range, 7 to 2,184 days) for the patients with miscellaneous BCs. The observed complications included infection (15.9%), obstructive granulomas (14.6%), and migration (4.7%). The incidence of granulomas was significantly lower in the patients with CA (4.0%) vs LTx and BC groups (17.3% and 33.3% respectively; p = 0.002). All other assessed variables showed no difference between the three analyzed groups. No cases of mucus plugging or fatal hemoptysis were observed. Forty-four patients (53.7%) had no complications related to the SEMS. The incidence of complications was not related to the type of stent (Wallstent or Ultraflex) or SEMS version (covered or uncovered). Fourteen of the 16 patients (87.5%) who were receiving mechanical ventilation could be weaned after the procedure. There were no deaths related to SEMS placement. Conclusions: An SEMS is a safe and effective modality for malignant as well as selected benign airway obstruction. An SEMS is an acceptable therapeutic alternative in patients with central airway obstruction who are not considered good surgical candidates and are receiving mechanical ventilation. Careful patient selection is of outmost importance for a good outcome after airway stenting. Insertion using FB adds to the ease of the procedure.