The Westaby T-Y tracheobronchial stent in otolaryngology

Placement of tracheobronchial silicone Y-stents: Multicenter experience and systematic review of the literature

Background:

Airway obstruction or tracheoesophageal fistula (TEF) near the tracheal carina requires placement of Y-shaped stents. Herein, we describe our multicenter experience with the placement of Dumon silicone Y-stents. We also conduct a systematic review for studies describing the deployment of airway silicone Y-stents.

Methods:

This was a retrospective analysis of consecutive subjects who underwent placement of silicone Y-stents. The clinical details including the underlying diagnosis, indication for the placement of silicone Y-stents, success of stent placement, and follow-up are presented. The PubMed and EMBASE databases were also reviewed for studies describing the placement of silicone Y-stents.

Results:

During the study, 27 silicone Y-stents were placed. The mean (standard deviation) age of the study population (85.2% males) was 57.7 (13.5) years. The stents were placed for airway obstruction in 77.8% and TEF in 29.6% of the patients. The most common underlying disease was carcinoma of the esophagus. The degree of airway obstruction was grade 3–4 in 18 subjects, and respiratory failure was encountered in 18 subjects. The stent was deployed successfully in all the subjects. No deaths were encountered during stent placement. Most subjects had rapid relief of symptoms following the procedure. Excessive secretions and mucostasis were the most common stent-related complications followed by the development of granulation tissue. The systematic review yielded nine studies (338 subjects with airway obstruction and/or TEF). The most common indication for silicone Y-stent placement was tracheobronchial obstruction and TEF due to malignancy. Benign disorders that necessitated stent placement included postintubation tracheal stenosis, airway malacia, and others. The stent was successfully placed in 98% with only one periprocedural death. Granulation tissue formation and mucostasis were the most common stent-related complications.

Conclusion:

Placement of silicone Y-stent is a safe and effective procedure that provides quick relief of symptoms in subjects presenting with airway obstruction and TEF at or near the tracheal carina.

Nitinol stents: their value in tracheobronchial obstruction

Recurrent tracheobronchial obstruction whether due to a benign or malignant cause is not always amenable to surgery and one is left with the dilemma of what to do for a patient who is slowly asphyxiating. Various modalities have been employed in the past with varying degrees of success. However due to the recent innovations in 'superelastic' biocompatible alloys we present our clinical experience with a new generation of metallic stents made from Nitinol. Over a 12-month period we inserted eight stents in six patients with malignant and benign tracheobronchial obstruction. Almost all patients had dramatic improvement in their symptoms and there was little airway reaction observed up to 18 months after insertion. However, one should exercise caution in inserting them for benign conditions as we regard them as permanent implants. Also evident is the inherent morbidity in this group of patients and this needs to be carefully considered prior to treatment.