Stent flexibility: an essential feature in the treatment of dynamic airway collapse

Implantation of endobronchial stents for treatment of dynamic airway collapse represents a suitable therapeutic option to alleviate distressing symptoms. We report the case of a 43 year old patient suffering from progressive respiratory distress 2 weeks after insertion of a balloon-expandable radial noncompliant Palmaz stent in an unstable segment of the left main bronchus, with the aim of preventing symptomatic airway collapse. Bronchial instability had developed following sleeve resection of the right lung due to adenoid cystic carcinoma. Explanation revealed compression and deformation of the stent. Peak expiratory flow (PEF) had declined a low of 1.38 L.s-1 (forced expiratory volume in one second (FEV1) 1.02 L). With placement of a Strecker stent, having the ability to re-expand within certain limits, bronchial collapse could be avoided and marked clinical improvement as well as expiratory flow increase was noted (PEF 7.10 L.s-1; FEV1 = 2.03 L). At 13 months follow-up, clinical status was unchanged. A decline in forced expiratory flow (PEF 5.96 L.s-1; FEV1 1.69 L), however, indicated a possible change in the structural integrity of the Strecker stent. We conclude that physical properties of endobronchial stents may be crucial for good functional results in major airway collapse. Stiff prostheses, when compressed, can induce severe airway obstruction.