Management of tracheal obstruction caused by benign or malignant thyroid disease using covered retrievable self-expandable nitinol stents.

Abstract

BACKGROUND:

Curative resection is often contraindicated in patients with airway obstruction by aggressive thyroid disease.

PURPOSE:

To evaluate the safety and clinical effectiveness of covered retrievable self-expandable nitinol stents placed in patients with airway obstruction caused by benign or malignant thyroid disease.

MATERIAL AND METHODS:

From 1996 to 2009, covered retrievable self-expandable nitinol stents were placed in nine symptomatic patients with malignant (n=7) or benign (n=2) thyroid disease. Improvement in patient respiratory status, complications and their management, and survival data were evaluated. Stents were removed if stent-related complications occurred or the stents were no longer necessary.

RESULTS:

A total of 11 stents were successfully placed without procedure-related complications. Improvement of more than one dyspnea grade was seen in eight of nine patients (89%), while the ninth patient underwent intubation due to upper airway swelling. Stent migration, sputum retention, and tumor overgrowth occurred in 27.3% (n=3), 9.1% (n=1), and 9.1% (n=1) of the stents, respectively. A total of six stents were successfully removed because of stent-related complications (n=4) or after total thyroidectomy (n=2). In two patients with benign thyroid goiters, a stable airway was maintained until total thyroidectomy.

CONCLUSION:

Placement of covered retrievable self-expandable nitinol stents was safe and effective in patients with airway obstruction caused by benign or malignant thyroid disease. Stent retrievability was very useful in cases of stent-related complications. In patients with benign thyroid disease, stent placement can serve as an effective bridge to surgery.

• Authors: Won-Kyeong Kim, Ji Hoon Shin, Jin Hyoung Kim, Jin Woo Song, Ho-Young Song
• Journal: Acta radiologica (Stockholm, Sweden : 1987) (Acta Radiol) Vol. 51 Issue 7 Pg. 768-74 (Sep 2010) ISSN: 1600-0455 [Electronic] England
• PMID: 20707660 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Alloys
• Coated Materials, Biocompatible
• nitinol

Topics

• Adult
• Aged
• Alloys
• Bronchoscopy
• Coated Materials, Biocompatible
• Device Removal
• Female
• Foreign-Body Migration (therapy)
• Humans
• Male
• Middle Aged
• Stents (adverse effects)
• Thyroid Diseases (complications, surgery)
• Thyroid Neoplasms (complications, surgery)
• Thyroidectomy
• Tracheal Stenosis (etiology, therapy)
• Treatment Outcome