THE ROLE OF THE DYNAMIC STENT IN THE PALLIATION OF CARINAL AND DISTAL TRACHEAL STENOSES

Abstract

Satisfactory palliation of the lesions involving the carinal region is difficult to achieve because the stenting is conducted in an unsuitable anatomy, in highly symptomatic patients.

During the period 1987-2000 we performed 785 operative rigid bronchoscopies in 524 patients, 184 of whom received a respiratory stent. The stenting of the carinal region was carried out in 27 patients with the use of the Frietag Dynamic stent. In this group of patients indication for stenting was as follows: - advanced lung cancer (22); - esophageal cancer invading the lower trachea (1); - severe tracheobronchomalacia (2); - postintubation stenosis of the lower trachea (2). No perioperative mortality was observed.

All patients experienced symptomatic improvement. Followup ranged from 1 to 60 months: all neoplastic patients died for advanced disease without significant respiratory problems with a median survival of 5.6 months; three patients treated for benign diseases are still alive at 2, 31 and 65 months from stent deployment.

No major complications were observed: in two patients the stent was removed after few days due to mucous retention; furthermore we observed symptomatic respiratory infections caused by a residual space between the tracheal wall and the prosthesis in other two patients with severe COPD.

Dynamic stent is to be considered the stent of choice for palliation of the carinal region because it is effective and well tolerated with a low complications rate. The main limitations of such prosthesis are the shortness of the right bronchial branch and the size, sometimes inadequate.