Airway obstruction caused by functional failure of a tracheal stent

Central airway obstruction can be treated with stenting of the airway. A 30-year-old man with known metastatic myxoid liposarcoma presented with central airway obstruction due to tracheal compression from mediastinal metastases. A self-expanding metallic stent was placed under general anaesthesia. During emergence, he developed complete airway obstruction with ensuing hypoxaemia. Emergency intubation was performed and the patient was manually ventilated with high airway pressures to maintain oxygenation. The rigid bronchoscope was reintroduced, which revealed complete collapse of the stent and worsened compression of the upper trachea. The collapsed stent was removed and a silicon stent was deployed, but the compression remained uncorrected. A second partially covered metallic stent was inserted within the silicon stent, overlapping in length. This restored airway patency with an uneventful emergence from anaesthesia.