Removal of Metal Tracheal Stent: A Difficult Foreign Body

With its introduction in 1986, the use of metal tracheal stents gained favor due to relative ease of deployment and reduced risk of stent migration and mucus plugging. However, adverse events associated with metal stenting led the FDA to publish a recommendation against its use for benign airway stenosis in 2005. We present a case which illustrates the difficulty in removal of a metal stent from the airway.

Our patient is a 47-year-old woman with a history of postintubation tracheal stenosis. She underwent multiple interventions with Thoracic Surgery at an outside facility, including stenting with an Ultraflex expandable metal stent. Her course was complicated by recurrent intraluminal granulation tissue, which led to placement of additional metal stents, as well as a tracheostomy due to obstructive proximal granulation tissue. On presentation at our institution, removal of the stents was recommended due to recurrent tracheitis and proximity of stent fragments to the innominate artery on CT imaging. She underwent direct microlaryngoscopy and bronchoscopy, and stent fragments were removed using a hemostat through the trach stoma. Postoperative imaging has confirmed retained stent fragments, and additional procedures have been required for further removal.

Removal of metal stents from the trachea is challenging for several reasons. Neoepithelization of respiratory mucosa makes identification of fragments difficult. Furthermore, growth of granulation tissue through the metal lattice framework, as well as the stents' tendency to fracture, complicates extraction. This case illustrates the dangers of metal stenting for benign airway stenosis. Laryngoscope, 134:3977-3980, 2024.