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Do airway metallic stents for benign lesions confer too costly a benefit?
Andrew L Chan1, Maya M Juarez, Roblee P Allen
1University of California, Davis Medical School, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Sacramento, USA. alchan@ucdavis.edu
Background:
The use of self-expanding metallic stents (SEMAS) in the treatment benign airway obstruction is controversial.
Methods:
To evaluate the safety and efficacy of SEMAS for this indication, we conducted a 10-year retrospective review at our tertiary medical centre.
Results:
Using flexible bronchoscopy, 82 SEMAS (67% Ultraflex, 33% Wallstent) were placed in 35 patients with inoperable lesions, many with significant medical comorbidities (88%). 68% of stents were tracheal, and 83% of patients showed immediate symptomatic improvement. Reversible complications developed in 9% of patients within 24 hrs of stent placement. Late complications (>24 hrs) occurred in 77% of patients, of which 37% were clinically significant or required an interventional procedure. These were mainly due to stent migration (12.2%), fracture (19.5%), or obstructive granulomas (24.4%). The overall granuloma rate of 57% was higher at tracheal sites (59%) than bronchial ones (34%), but not significantly different between Ultraflex and Wallstents. Nevertheless, Wallstents were associated with higher rates of bleeding (5% vs. 30%, p = 0.005) and migration (7% vs. 26%, p = 0.026). Of 10 SEMAS removed using flexible bronchoscopy, only one was associated with incomplete removal of fractured stent wire. Median survival was 3.6 +/- 2.7 years.
Conclusion:
Ill patients with inoperable lesions may be considered for treatment with SEMAS.
