Metallic stent insertion and removal for post-tracheotomy and post-intubation tracheal stenosis

To study the safety and effectiveness of fluoroscopic insertion and removal of self-expandable metallic airway stent for post-tracheotomy tracheal stenosis (PTTS) and post-intubation tracheal stenosis (PITS).

We conducted a retrospective analysis of 32 patients who underwent fluoroscopic stenting from September 2011 to March 2017. The patients ranged in age from 12 to 69 years. Thirty-eight airway stents were implanted, 35 covered stents and three bare stents. Nineteen airway stents were used for 16 cases of PITS or PTTS. All patients underwent chest CT scans with/without bronchoscopy prior to stent removal. The indication of stent removal and post-interventional complications were analyzed.

All 38 airway stents were successfully inserted. Insufficient expansion and tissue hyperplasia were most common complications after stenting. Thirty five of 38 airway stents were successfully removed fluoroscopically, with a technical success rate of 92.1%. Routine removal was performed after 2.9 ± 0.3 months, and stent restenosis was found after a mean duration of 2.7 ± 0.3 months. There were six complications of stent removal with no death. Four stents showed strut fracture after removal, of which three stent pieces retained. Two patients showed dyspnea immediately after removal and required mechanical ventilation in PTTS. One patient with PTTS lost of follow-up during a mean period of 33.7 ± 3.9 months. The one-, three- and five-year patency rates were 87.1%, 76.2% and 70.8%, respectively. There was no significant difference between PITS and PTTS.

Fluoroscopic insertion and removal of airway stent is safe and effective for PITS and PTTS. A three-month retention time is reasonable for airway stents.