When one-size-doesn't-fit-all: The emerging role of customized 3D stents

Non-malignant airway stenoses remain major challenges in interventional pulmonology, particularly when long-term stenting is required. Although conventional silicone airway stents effectively restore patency, their standardized geometry often fails to accommodate patient-specific airway anatomy, leading to migration, granulation tissue formation, mucus plugging, and repeated bronchoscopic interventions that limit long-term tolerance and efficacy. Advances in high-resolution imaging and modeling, and additive manufacturing have enabled the emergence of patient-specific, 3D-engineered silicone airway stents, predominantly produced using mold-based approaches. Early clinical experience suggests that personalization improves anatomical congruence and mechanical stability, particularly in anatomically complex non-malignant disease. The strongest evidence supports their use in post-surgical and post-lung transplant anastomotic complications, where distorted anatomy and prolonged stenting magnify the limitations of conventional devices. Additional emerging indications include complex inflammatory or post-infectious bronchial stenoses, selected benign tracheal stenoses with anatomical distortion, and refractory airway fistulas requiring customized occlusion. This narrative review summarizes current design principles, workflow, and patient selection for patient-specific airway stents. While evidence remains limited, ongoing trials and technological advances may broaden clinical indications, contingent on standardized reporting, biomechanical validation, regulatory clarity, and comparative studies establishing long-term clinical and economic value.