- Henri G Colt, MD
Henri G Colt, MD
- Professor of Medicine
- University of California Irvine
Airway stents, also known as tracheobronchial prostheses, are tube-shaped devices that are inserted into an airway. They are usually placed bronchoscopically and can be used to treat a variety of large airway diseases. The indications for airway stenting, types of stents, insertion technique, and potential complications are reviewed here. Other strategies for managing central airway obstruction are discussed separately. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults".)
Indications — There are many indications for airway stenting [1-13], including the following:
●Malignant tracheobronchial obstruction in a patient who is undergoing external beam radiation and/or chemotherapy, or who has exhausted his or her curative therapeutic options.
●Malignant tracheobronchial obstruction that persists despite endobronchial resection and dilation.
●Postintubation subglottic stenosis that fails endobronchial resection and dilation.
- Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002; 19:356.
- Ernst A, Silvestri GA, Johnstone D, American College of Chest Physicians. Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. Chest 2003; 123:1693.
- Puma F, Ragusa M, Avenia N, et al. The role of silicone stents in the treatment of cicatricial tracheal stenoses. J Thorac Cardiovasc Surg 2000; 120:1064.
- Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest 2003; 124:1993.
- Colt HG, Dumon JF. Airway stents. Present and future. Clin Chest Med 1995; 16:465.
- Chhajed PN, Malouf MA, Tamm M, Glanville AR. Ultraflex stents for the management of airway complications in lung transplant recipients. Respirology 2003; 8:59.
- Saad CP, Ghamande SA, Minai OA, et al. The role of self-expandable metallic stents for the treatment of airway complications after lung transplantation. Transplantation 2003; 75:1532.
- Noppen M, Poppe K, D'Haese J, et al. Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease. Chest 2004; 125:723.
- Chan KP, Eng P, Hsu AA, et al. Rigid bronchoscopy and stenting for esophageal cancer causing airway obstruction. Chest 2002; 122:1069.
- Wan IY, Lee TW, Lam HC, et al. Tracheobronchial stenting for tuberculous airway stenosis. Chest 2002; 122:370.
- Low SY, Hsu A, Eng P. Interventional bronchoscopy for tuberculous tracheobronchial stenosis. Eur Respir J 2004; 24:345.
- Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest 2005; 127:984.
- Mughal MM, Gildea TR, Murthy S, et al. Short-term deployment of self-expanding metallic stents facilitates healing of bronchial dehiscence. Am J Respir Crit Care Med 2005; 172:768.
- Murgu SD, Colt HG. Tracheobronchomalacia and excessive dynamic airway collapse. Respirology 2006; 11:388.
- Colt HG, Crawford SW. In vitro study of the safety limits of bronchoscopic argon plasma coagulation in the presence of airway stents. Respirology 2006; 11:643.
- Strausz, J, Kis, S, Papai, Z, et al. Tracheobronchial silicone stent implantation with the flexible bronchoscope. J Bronchol 1994; 1:123.
- Nomori H, Horio H, Suemasu K. Dumon stent placement via endotracheal tube. Chest 1999; 115:582.
- Cooper JD, Pearson FG, Patterson GA, et al. Use of silicone stents in the management of airway problems. Ann Thorac Surg 1989; 47:371.
- Dumon JF. A dedicated tracheobronchial stent. Chest 1990; 97:328.
- Dutau H, Toutblanc B, Lamb C, Seijo L. Use of the Dumon Y-stent in the management of malignant disease involving the carina: a retrospective review of 86 patients. Chest 2004; 126:951.
- Oki M, Saka H. Double Y-stenting for tracheobronchial stenosis. Eur Respir J 2012; 40:1483.
- Noppen, M, Dhaese, J, Meysman, M, et al. A new screw thread tracheal endoprosthesis. J Bronchol 1996; 3:22.
- Noppen M, Meysman M, Claes I, et al. Screw-thread vs Dumon endoprosthesis in the management of tracheal stenosis. Chest 1999; 115:532.
- Coolen D, Slabbynck H, Galdermans D, et al. Insertion of a self-expandable endotracheal metal stent using topical anaesthesia and a fibreoptic bronchoscope: a comfortable way to offer palliation. Thorax 1994; 49:87.
- de Mello-Filho FV, Antonio SM, Carrau RL. Endoscopically placed expandable metal tracheal stents for the management of complicated tracheal stenosis. Am J Otolaryngol 2003; 24:34.
- Lunn W, Feller-Kopman D, Wahidi M, et al. Endoscopic removal of metallic airway stents. Chest 2005; 127:2106.
- Rousseau H, Dahan M, Lauque D, et al. Self-expandable prostheses in the tracheobronchial tree. Radiology 1993; 188:199.
- Miyazawa T, Yamakido M, Ikeda S, et al. Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 2000; 118:959.
- Madden BP, Park JE, Sheth A. Medium-term follow-up after deployment of ultraflex expandable metallic stents to manage endobronchial pathology. Ann Thorac Surg 2004; 78:1898.
- Varela A, Maynar M, Irving D, et al. Use of Gianturco self-expandable stents in the tracheobronchial tree. Ann Thorac Surg 1990; 49:806.
- Stockton PA, Ledson MJ, Hind CR, Walshaw MJ. Bronchoscopic insertion of Gianturco stents for the palliation of malignant lung disease: 10 year experience. Lung Cancer 2003; 42:113.
- Puma F, Farabi R, Urbani M, et al. Long-term safety and tolerance of silicone and self-expandable airway stents: an experimental study. Ann Thorac Surg 2000; 69:1030.
- Gaissert HA, Grillo HC, Wright CD, et al. Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 2003; 126:744.
- Bolliger CT, Breitenbuecher A, Brutsche M, et al. Use of studded Polyflex stents in patients with neoplastic obstructions of the central airways. Respiration 2004; 71:83.
- Bolliger, CT, Arnoux, A, Oeggerli, MV, et al. Covered Wallstent insertion in a patient with conical tracheobronchial stenosis. J Bronchol 1995; 2:215.
- Freitag L, Eicker R, Linz B, Greschuchna D. Theoretical and experimental basis for the development of a dynamic airway stent. Eur Respir J 1994; 7:2038.
- Dooms C, De Keukeleire T, Janssens A, Carron K. Performance of fully covered self-expanding metallic stents in benign airway strictures. Respiration 2009; 77:420.
- Dumon, JF, Cavaliere, S, Diaz-Jimenez, JP, et al. Seven year experience with the Dumon prosthesis. J Bronchol 1996; 3:6.
- Food and Drug Administration. FDA public health notification: complications from metallic tracheal stents in patients with benign airway disorders, 2005 www.fda.gov/cdrh/safety/072905-tracheal.html (Accessed on January 15, 2007).
- Madden BP, Loke TK, Sheth AC. Do expandable metallic airway stents have a role in the management of patients with benign tracheobronchial disease? Ann Thorac Surg 2006; 82:274.
- Miyazawa T, Miyazu Y, Iwamoto Y, et al. Stenting at the flow-limiting segment in tracheobronchial stenosis due to lung cancer. Am J Respir Crit Care Med 2004; 169:1096.
- Kim J, Shin JH, Kim JH, et al. Metallic stent placement for the management of tracheal carina strictures and fistulas: technical and clinical outcomes. AJR Am J Roentgenol 2014; 202:880.
- Matsuo T, Colt HG. Evidence against routine scheduling of surveillance bronchoscopy after stent insertion. Chest 2000; 118:1455.
- Zakaluzny SA, Lane JD, Mair EA. Complications of tracheobronchial airway stents. Otolaryngol Head Neck Surg 2003; 128:478.
- Burningham AR, Wax MK, Andersen PE, et al. Metallic tracheal stents: complications associated with long-term use in the upper airway. Ann Otol Rhinol Laryngol 2002; 111:285.
- Lemaire A, Burfeind WR, Toloza E, et al. Outcomes of tracheobronchial stents in patients with malignant airway disease. Ann Thorac Surg 2005; 80:434.
- Ranu H, Madden BP. Endobronchial stenting in the management of large airway pathology. Postgrad Med J 2009; 85:682.
- Grosu HB, Eapen GA, Morice RC, et al. Stents are associated with increased risk of respiratory infections in patients undergoing airway interventions for malignant airways disease. Chest 2013; 144:441.
- Alazemi S, Lunn W, Majid A, et al. Outcomes, health-care resources use, and costs of endoscopic removal of metallic airway stents. Chest 2010; 138:350.
- Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169:1278.
- Wood DE, Liu YH, Vallières E, et al. Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 2003; 76:167.
- Rafanan AL, Mehta AC. Stenting of the tracheobronchial tree. Radiol Clin North Am 2000; 38:395.
- Profili S, Manca A, Feo CF, et al. Palliative airway stenting performed under radiological guidance and local anesthesia. Cardiovasc Intervent Radiol 2007; 30:74.
- Cosano Povedano A, Muñoz Cabrera L, Cosano Povedano FJ, et al. [Endoscopic treatment of central airway stenosis: five years' experience]. Arch Bronconeumol 2005; 41:322.
- Thornton RH, Gordon RL, Kerlan RK, et al. Outcomes of tracheobronchial stent placement for benign disease. Radiology 2006; 240:273.
- Eisner MD, Gordon RL, Webb WR, et al. Pulmonary function improves after expandable metal stent placement for benign airway obstruction. Chest 1999; 115:1006.
- Gelb AF, Zamel N, Colchen A, et al. Physiologic studies of tracheobronchial stents in airway obstruction. Am Rev Respir Dis 1992; 146:1088.
- Hauck RW, Römer W, Schulz C, et al. Ventilation perfusion scintigraphy and lung function testing to assess metal stent efficacy. J Nucl Med 1997; 38:1584.
- Vergnon JM, Costes F, Bayon MC, Emonot A. Efficacy of tracheal and bronchial stent placement on respiratory functional tests. Chest 1995; 107:741.
- Breitenbücher A, Chhajed PN, Brutsche MH, et al. Long-term follow-up and survival after Ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration 2008; 75:443.
- Madden, BP, Sheth, A, Walters, N. Does large airway intervention for patients with malignant disease result in early clinical benefit? Am J Respir Crit Care Med 2007; 175:A622.