Metallic tracheal stents: complications associated with long-term use in the upper airway

The use of metallic airway stents for the treatment of benign airway stenosis is increasingly advocated; however, the long-term safety and efficacy of these devices has not been established. Three case studies involving late but significant proximal tracheal stent complications are reported: 1 related to proximal mechanical stent failure and 2 related to obstructing granulation tissue and stenosis at the proximal stent orifice. Placement of these stents in close proximity to the cricotracheal junction is thought to be primarily responsible for these complications as a result of the excess shearing forces created at the stent-mucosal interface by the differential motion of the stent relative to the rigid subglottic airway and the more distensible trachea. Although the use of metallic stents remains appropriate in cases in which there is a defined and relatively short-term end point for treatment, caution is urged in using them in the proximal trachea for long-term management of benign airway disease.