Removal of covered self-expandable metallic airway stents in benign disorders - Indications, technique, and outcomes

Study objectives: To describe the technique and outcome of removal of self-expandable metallic airway stents (SEMAS) in a series of patients who underwent stenting for benign airway stenoses. Design and setting: A retrospective cohort analysis of patients with benign airway disorders treated with SEMAS between 1997 and 2003, who presented with an indication for stent removal in a tertiary-care hospital, and referral interventional pulmonology clinic. Patients and methods: During the study period, 49 SEMAS were inserted in 39 patients for treatment of benign airway disorders. Ten of these 39 patients (25.6%), bearing 12 covered stents, presented with an indication for stent removal. Data of these cases were extracted from electronic files kept in our institution archive. Results: Indications for stent removal included excessive or recurrent granuloma formation (five cases), recurrence of stenosis after stent failure (one case), stent fracture (two cases), and accomplishment of treatment (two cases). In all of these cases, covered versions of SEMAS had been placed either in the trachea or in a main bronchus. in contrast to many previous reports, these stents proved to be absolutely retrievable even if some difficulties were encountered. In all cases, however, removal was successful without major complications. All patients resumed normal spontaneous ventilation postoperatively, and follow-up was uneventful. Average duration of stenting before removal was 16.2 +/- 17.5 months (+/- SD) [range, 1 to 60 months]. Conclusions: We conclude that although placement of SEMAS is assumed to be permanent in patients with benign airway disorders, an indication for stent removal is often observed (25.6% in our series). The covered SEMAS can be effectively and safely removed if needed without major sequelae. Nevertheless, new technical improvements in metallic stent design and materials may help reinforce the concept of a retrievable metallic airway stent, which may offer significant clinical advantages.