Endoscopic removal of metallic airway stents

Metallic airway stents must be removed when stent-related complications cause airway injury or obstruction. This study compared the techniques and complications associated with endoscopic removal of covered metallic stents (CMSs) and uncovered metallic stents (UCMS).

A retrospective analysis of data from 48 patients with airway disorders treated with 40 CMSs and 18 UCMSs, in whom endoscopic stent removal was indicated between January 2005 and January 2010 was carried out. Procedures were performed under general anesthesia with a rigid bronchoscope or local anesthesia with a flexible bronchoscope. The airway wall of 54 stents was pretreated with argon plasma coagulation and/or cryoablation before stent removal. Balloon dilation, argon plasma coagulation, CO2 cryoablation, or chemotherapy was performed to prevent restenoses after the stent removal in selected patients.

Of the stents, 84.5% (49 of 58) were eventually removed, including 36 CMSs and 13 UCMSs; 4 CMSs and 5 UCMSs could not be removed. Strut fracture was more common in UCMSs (77.8%) than in CMSs (5%; P<0.001). Of patients with CMS, 91.7% underwent successful removal of intact stents, whereas 92.3% of patients with UCMS were removed damaged or piecemeal. In CMS or UCMS, major complications of stent removal included mucosal tear with bleeding and unveiling of significant granulation tissue from behind the stent. No deaths occurred during the procedure.

CMSs can be effectively and safely removed by a flexible bronchoscope with a retrieval hook without major sequelae, whereas UCMSs are very difficult to remove, and complications are very common. Metallic stents should be used only as a last resort in patients with airway disorders.