Expandable metal stents for non-malignant bronchial obstruction

Multidisciplinary airway stent team: a comprehensive approach and protocol for tracheobronchial stent treatment

Tracheobronchial stents are being used with increasing frequency to treat major airway obstruction from both malignant and benign processes. Traditionally, stents have been placed via rigid bronchoscopy, flexible bronchoscopy, or fluoroscopy by members of various individual disciplines. We describe a novel multidisciplinary airway stent team (MAST) protocol for tracheobronchial stent placement and endoscopic management of major airway obstruction. A patient with symptoms of airway obstruction is generally first evaluated with a computed tomography scan and a videotaped flexible bronchoscopy. These studies are reviewed by the team otolaryngologist, pulmonologist, and interventional radiologist. A treatment plan, including the type and location of stents and the need for adjuvant therapies, is formulated. Stent placement is performed in the operating room under general anesthesia. Rigid bronchoscopy, with flexible bronchoscopy and fluoroscopy as needed, allows precise stent placement and the best use of various therapeutic methods. The MAST protocol combines the skills, knowledge, and unique therapeutic options of specialists from otolaryngology, pulmonology, and interventional radiology. This approach allows optimal stent placement and the use of other endobronchial therapies, including laser ablation, balloon dilation, photodynamic therapy, cryotherapy, and brachytherapy. A protocol with representative case reports is presented, along with a review and comparison of several of our most commonly used stents. Otolaryngologists who practice bronchoesophagoscopy, by virtue of their operative skill and knowledge of airway management, are well equipped to become leaders of MASTs and are encouraged to initiate MASTs at their institutions.

Bronchial obstruction after upper lobectomy: kinked bronchus relieved by stenting

Post resectional kinking of the lower lobe bronchus caused obstructive symptoms in 2 patients following upper lobectomy. Exaggerated upward displacement of the remaining lower lobe seemed to be causative. Intrabronchial stenting relieved the obstruction in each case with satisfactory intermediate term results.

Open surgery for removal of a failing Gianturco stent with reversed sleeve resection of the right middle and lower lobes

Although the use of a metallic stent in the treatment of benign tracheobronchial stenosis has been reported as a useful and safe technique, the incorporation of wire stents into the airway may be irreversible and is associated with problems. The authors' experience in a patient with incorrectly positioned metallic stent in the right main bronchus, which was successfully treated with bronchial sleeve resection, is presented.

An unusual cause of recurrent pneumonia

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