Stent central airway

Contraindications to the placement of central airway stents are curable malignant tumors. Due to the difficulty in removing metallic stents, these should not be placed in patients with a curable disease. Metallic stents that have been incorporated into the mucosa are extremely difficult to retrieve at endoscopy and surgery. However, in emergency situations with hyperacute airway compression and the need for rapid restoration of adequate pulmonary ventilation, temporary placement of a (preferably) plastic stent may be indicated. 

Appropriate assessment of the location of the tracheal or bronchial obstruction is mandatory to choose the correct stent and to allow proper placement. In the case of a proximal tracheal lesion the distance to the vocal cord has to be assessed and measured. In the case of a distal tracheal lesion the relation to the Carina has to be defined in order to assess whether a single tracheal stent or an additional unilateral or bilateral bronchial stent is required to achieve sufficient luminal diameter in the central airways. In the case of bronchial obstruction, the relation to lobar bronchial orifices has to be analyzed. 

George and colleagues (1992) treated nine patients with malignant central airway obstruction due to tracheal (n=3) or main bronchial ( =6) stenosis with Gianturco stents. All patients suffered from severe dyspnea or asphyxia (four were emergency treatments). All patients had dramatic and rapid reUef of their symptoms after stent insertion. Two patients with intraluminal tumor growth required additional endobronchial measures to control local tumor progression. Patients survived between 3 weeks and 8 months after the intervention. Causes of death were cachexia or pneumonia. 

A large series of 100 Ultraflex stent insertions in 96 patients comes from two experienced airway centers (Herth et al. 2001). In all, 79 stents were placed for malignant incurable central airway diseases, the remaining indications were benign conditions. Of the 96 patients, 90 had high-grade stenoses. Stents... 

Concerning the therapeutic relevance of diagnosing TBM/EDAC, a short-term follow-up study of patients with severe TBM/EDAC undergoing central airway stabilization with silicone stents concluded that the intervention markedly improved dyspnea, health-related quality of life, and functional status in these patients (Ernst et al. 2007). 

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