Endoscopic management of subglottic stenosis with innovative transcordal stent

Single-stage tracheal resection and anastomosis represents the gold standard for benign subglottic stenosis' management. Nevertheless, also considering the complexity of the surgical procedure, some patients are considered unfit for tracheal surgery (stenosis involving vocal cords, comorbidities, and relapse after surgery). Until now, the only alternative was tracheostomy which represents the only real alternative to secure the patency of the airway. Thanks to the creation of "transcordal stents", patients considered unfit for surgery have a valid alternative to tracheostomy and the conformation of the stent reduces the risk of stent migration, preserving airway patency, swallowing, and phonation. This study aims to evaluate the use of a new custom-made transcordal stent, comparing its safeness with traditional transcordal stent. Between 2017 and 2021, 28 consecutive patients underwent transcordal stenting for benign tracheal stenosis in 3 centers. Patients were divided into 2 groups: 16 treated with the new custom-made stent (Group 1) and 12 treated with conventional stents (Group 2). Intra-, post-operative complications, swallowing capacity, quality of voice, granulation tissue, stent migration, and quality of life (QoL) were compared between the two groups. Group 2 showed reduced swallowing capacity (p = 0.0001), higher rate of stent migration (p = 0.0003), higher rate of granulation tissue (p = 0.0044), and higher rate of stent replacement (p = 0.0001). Voice reduction was not significantly different between the two groups. QoL was better in Group 1. Despite this represent the largest study analyzing transcordal stenting as definitive treatment of subglottic stenosis in patients unfit for surgery, results could not draw definitive conclusions because of the small number of patients, the lack of randomization, and the small follow-up. Nevertheless, the use of the new custom-made transcordal stent could be considered safe and effective, guaranteeing stable results with low rate of long-term complications and better QoL compared to the traditional stents.