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Tracheobronchial stenting for the treatment of airway obstruction
1Department of Surgery, University of Toronto, and The Hospital for Sick Children, Ontario, Canada.
Insights
Palmaz stent insertion in pediatric airway obstruction offers a safe and effective solution for prolonged relief. While tissue reactions may require intervention, stenting successfully manages major airway issues in infants and children.
Area of Science:
- Pediatric Pulmonology
- Interventional Pulmonology
- Biomedical Engineering
Background:
- Major airway obstructions in infants and children pose significant management challenges.
- The Palmaz stent is a balloon-expandable stent used for airway support.
Purpose of the Study:
- To evaluate the 5-year experience of using Palmaz stents in pediatric patients with major airway obstructions.
- To assess the safety and efficacy of airway stenting in a pediatric population.
Main Methods:
- 30 Palmaz stents were inserted in the trachea (n=18) and bronchi (n=12) of 16 infants and children (age 1 week to 26 months).
- Stents were used for tracheal/bronchomalacia, post-surgical strictures, and airway compression.
- Stent placement was performed via bronchoscopy or endotracheal tube under X-ray guidance.
Main Results:
- In tracheal/bronchomalacia cases, 6/8 stents were removed successfully; no recurrence of obstruction.
- In post-surgical stricture cases, stents remained in place for 13-56 months, with one removal due to granulation tissue.
- Airway compression cases showed initial success, but two patients with congenital heart disease died within 12 months; stent migration and bronchial erosion were observed.
Conclusions:
- Airway stenting with Palmaz stents is an easily and safely performed procedure for prolonged relief of major airway obstructions.
- Tissue reactions can necessitate bronchoscopic intervention and may complicate stent removal.
Purpose:
The authors report a 5-year experience of inserting the Palmaz stent into infants and children who had a variety of major airway obstructions.
Methods:
From 1992 to 1997, 30 balloon expandable stents (Palmaz) were inserted in the trachea (n = 18) and bronchi (n = 12) of 16 infants, ages 1 week to 26 months (median, 9 months), suffering from three types of serious airway obstruction. In group 1, 10 stents were placed in eight children for tracheal or bronchomalacia. In group II, 11 stents were inserted in four infants for stricture at the site of surgical repair of stenosis. In group III, nine stents were placed to relieve airway compression from enlarged pulmonary arteries associated with severe congenital heart disease in three children and mediastinal lymphangioma in one. Tracheal stents were 30 mm long and were expanded to 8 to 10 mm at placement. Bronchial stents were 12 to 15 mm long and were expanded to 7 to 9 mm. The nonexpanded stents were placed on an inflatable balloon catheter and were inserted into the desired position in the airway through a bronchoscope or endotracheal tube using x-ray control. They were expanded and fixed in place by inflating the balloon to its rated diameter.
Results:
In group I, granulation tissue developed over the stents in five of eight cases. Obstructing granulations were removed by scraping or balloon compression in three and resulted in earlier than the planned removal in two. Stents have now been removed in six of eight cases. Major airway obstruction has not recurred. In group II, stents have been in place in all cases for 13 to 56 months after insertion, but in one child with three stents, two were removed for obstructive granulations 44 months after insertion. All are well. All group III patients could be extubated after stenting, but two with heart disease died after 3 and 12 months of palliation. During the course of follow-up, stents in the bronchi of two had migrated, and an additional stent was required. Autopsy in one showed full-thickness bronchial erosion but no perforation by the stent. A total 11 of 30 stents have been removed bronchoscopically in seven children without complications. Another child referred here for tracheal stent removal after laser resection of granulations died at attempted removal because the stent was "welded" into the tracheal wall by the inflammatory reaction. Manipulation of the stent completely occluded the airway.
Conclusions:
Airway stents can be inserted easily and safely and left in-situ for prolonged periods to relieve major airway obstruction from a variety of causes. Tissue reaction may necessitate bronchoscopic manipulation and early stent removal, and adds to the difficulty of removal.