Self-expandable stents for tracheal stenosis: experience in two patients

Birth and Growth of Neuroimaging and Vascular Intervention at Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram—Part I

This article is a historical narrative that traces the growth of neuroradiology and interventional radiology at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram. From its humble origins in the pre-CT scan era of the mid and late 1970s, when invasive diagnostic procedures such as percutaneous carotid angiography, myelography, pneumoencephalography (PEG) and ventriculography were the mainstay of neuroimaging, the authors take the reader through their gradual foray into catheter four-vessel angiography and later free-flow embolization of arteriovenous malformations (AVMs), and finally to the use of microcatheters for selective embolization procedures. The equipment used in those early years—fluoroscopic tilting table, roll-film cameras, serial changers, PEG tables—provide an insight to an era with all its challenges before the advent of digital imaging. The authors’ efforts to indigenize some of the hardware such as metallic stents and embolization material such as hydrogel spheres and lyophilized dura are also highlighted. The development of peripheral vascular intervention alongside neuroradiology is also highlighted. The authors pay tribute to an early pioneer of neuroradiology in India, Prof. Mahadevan Pillai, who was a guiding light to them during those nascent years.

Bronchoscopic balloon dilatation in the combined management of postintubation stenosis of the trachea in adults

Bronchoscopic balloon dilatation (BBD) using angioplasty balloon catheters has been employed successfully in the treatment of tracheobronchial stenoses in children and has worked with variable success in adults with bronchial stenosis. In adults with tracheal stenosis, BBD only has been reported anecdotally. In this study, experience with BBD using a valvuloplasty balloon catheter in the combined treatment (with Nd-YAG laser photoresection and stenting) of severe benign postintubation tracheal stenoses in three adults is delineated. BBD was particularly successful in establishing tracheal patency when laser photoresection was contraindicated or was too dangerous; BBD allowed easy insertion of tracheal stents and the "opening" of folded silicone stents. BBD is a simple, inexpensive, safe, and efficient adjunct in the combined treatment of severe postintubation rigid tracheal stenosis in selected adults.