Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse.

Abstract

BACKGROUND:

Patients with severe symptomatic expiratory central airway collapse (ECAC) undergo a stent trial to determine whether they are candidate for tracheobronchoplasty. Most stent trials were done using silicone stents. However, there was a higher number of silicone stent-related complications.

OBJECTIVES:

The aim of this study was to evaluate the safety and efficacy of short-term uncovered self-expanding metallic airway stents (USEMAS) in patients with ECAC.

METHODS:

This was a retrospective review. Baseline measurements were compared to those obtained after 7-14 days. Measurements included: Modified Medical Research Council (mMRC), Cough Quality of Life Questionnaire (CQLQ), spirometry testing, and 6-Minute Walk Test (6MWT). Stent- and procedure-related complications were reported.

RESULTS:

33 patients (median age, 52 years) underwent the USEMAS trial. Presenting symptoms were dyspnea in 100%, intractable cough in 90.3%, recurrent infection in 42.2%, and inability to clear secretions in 21.4%. Dyspnea, cough, and secretion clearance improved in 88, 70, and 57%, respectively. Overall, there was a significant improvement in mMRC (p < 0.001), CQLQ (p = 0.015), and 6MWT (p = 0.015). There was 1 airway infection, 1 stent migration, and 1 pneumothorax. The median duration of USEMAS was 7 days. All stents were removed without any complications. At the time of stent removal, no granulation tissue was observed in 30.9%, and mild granulation tissue was observed in 69.1%.

CONCLUSION:

The short-term USEMAS trial improves respiratory symptoms, quality of life, and exercise capacity with few complications in patients with severe symptomatic ECAC when performed by a multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population.

• Authors: Adnan Majid, Daniel Alape, Fayez Kheir, Erik Folch, Sebastian Ochoa, Alejandro Folch, Sidhu P Gangadharan
• Journal: Respiration; international review of thoracic diseases (Respiration) Vol. 92 Issue 6 Pg. 389-396 ( 2016) ISSN: 1423-0356 [Electronic] Switzerland
• PMID: 27794574 (Publication Type: Journal Article)
• Copyright: © 2016 S. Karger AG, Basel.

Chemical References

• Silicones

Topics

• Adult
• Aged
• Airway Management (instrumentation, methods)
• Bronchoscopy
• Databases, Factual
• Device Removal
• Female
• Humans
• Male
• Middle Aged
• Quality of Life
• Retrospective Studies
• Self Expandable Metallic Stents
• Severity of Illness Index
• Silicones
• Time Factors
• Tomography, X-Ray Computed
• Tracheobronchomalacia (diagnosis, surgery)
• Treatment Outcome