Tracheal torsion assessed by a computer-generated 3-dimensional image analysis predicts tracheal self-expandable metallic stent fracture.

Abstract

OBJECTIVE:

Self-expandable metallic stents are used to relieve airway stenosis in selected patients; however, fracture of these stents may occur. This analysis aims to investigate the extent of tracheal torsion, assessed by a computed-generated reformatted 3-dimensional tracheal reconstruction from 2-dimensional computed tomographic images in predicting fracture of tracheal self-expandable metallic stents.

METHODS:

From 2001 to 2007, 32 patients (aged 62.8 ± 14.1 years) with benign tracheal diseases received chest computed tomographic evaluation and Ultraflex (Boston Scientific, Natick, Mass) self-expandable metallic stents. The bending angles of the central axis and peripheral wall of the trachea at choke point were measured from the computed-generated 3-dimensional tracheal images.

RESULTS:

Seventeen fractured stents were found among the patients. The median time for stent fracture was 865 days after implantation. Receiver operating characteristic curve analysis revealed that a 19° bending angle of the tracheal central axis (area under the curve, 0.929; 95% confidence interval, 0.847-1.012; P < .001) and a 44° maximal bending angle of the peripheral tracheal wall (area under the curve, 0.918; 95% confidence interval, 0.821-1.012; P < .001) had maximal power in predicting tracheal fracture of self-expandable metallic stents.

CONCLUSIONS:

Three-dimensional tracheal reconstructions from 2-dimensional chest computed tomographic data are useful in assessing the severity of tracheal torsion. Tortuous trachea with a central axis bending angle of 19° or more and peripheral tracheal wall maximal bending angle of 44° or more were associated with a high probability of fracture of the self-expandable metallic stent.

• Authors: Chih-Teng Yu, Chun-Liang Chou, Fu-Tsai Chung, Jei-Tsai Wu, Yuan-Chang Liu, Yun-Hen Liu, Ting-Yu Lin, Shu-Min Lin, Horng-Chuang Lin, Chun-Hua Wang, Han-Pin Kuo, Hao-Cheng Chen, Chien-Ying Liu
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 140 Issue 4 Pg. 769-76 (Oct 2010) ISSN: 1097-685X [Electronic] United States
• PMID: 20579664 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Chemical References

• Metals

Topics

• Aged
• Bronchoscopy
• Chi-Square Distribution
• Female
• Humans
• Imaging, Three-Dimensional
• Kaplan-Meier Estimate
• Male
• Metals
• Middle Aged
• Odds Ratio
• Predictive Value of Tests
• Prosthesis Design
• Prosthesis Failure
• Radiographic Image Interpretation, Computer-Assisted
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Stents
• Taiwan
• Tomography, X-Ray Computed
• Torsion Abnormality (complications, diagnostic imaging)
• Torsion, Mechanical
• Trachea (diagnostic imaging)
• Tracheal Stenosis (complications, diagnostic imaging, therapy)
• Treatment Outcome