Thorac Cardiovasc Surg 2011; 59(3): 163-168
DOI: 10.1055/s-0030-1250667
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Granulation Tissue Formation following Dumon Airway Stenting: The Influence of Stent Diameter

H.-C. Hu1 , Y.-H. Liu2 , Y.-C. Wu2 , M.-J. Hsieh2 , Y.-K. Chao2 , C.-Y. Wu2 , P.-J. Ko2 , C.-Y. Liu1
  • 1Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, Province of China
  • 2Department of Thoracic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Province of China
Further Information

Publication History

received Sept. 11, 2010

Publication Date:
08 April 2011 (online)

Abstract

Objectives: The present study aimed to determine whether stent diameter influences granulation tissue formation following stent placement for major airway stenosis. Patients and Methods: Forty-two stent procedures (32 tracheal stents, 3 carinal stents, and 7 bronchial stents) were performed in 40 patients. Seventy-nine stent edge regions (62 tracheal, 17 bronchial stents) were evaluated in this study. Results: Granulation tissue formation was encountered in 11 patients (28.21 %). Of the 34 upper ends of evaluated tracheal stents, granulation tissue formation was observed in 6 (17.65 %), whereas granulation tissue formation was observed in 2 (7.14 %) of the 28 lower ends of tracheal stents evaluated. Of the 17 bronchial stent edge regions, granulation tissue formation occurred in 3 (17.65 %) (p = 0.4352). The rate of granulation tissue formation was higher in those patients with a stent-to-airway diameter ratio of > 90 % (p < 0.0001). Receiver operating characteristic curve analysis further demonstrated that a cut-off stent-to-airway diameter ratio of 90 % was effective in predicting granulation tissue formation (AUC: 0.897, Std. error = 0.036, p < 0.0001, 95 % CI = 0827–0.968, n = 79). Conclusions: A stent-to-airway diameter ratio of 90 % was found to be the critical cut-off point for predicting granulation tissue formation. Therefore, the optimal stent-to-airway diameter ratio should be ascertained before stent placement.

References

  • 1 Fang T J, Lee L I, Li H Y. Powered instrumentation in the treatment of tracheal granulation tissue for decannulation.  Otolaryngol Head Neck Surg. 2005;  133 520-524
  • 2 Lu M S, Liu Y H, Ko P J et al. Preliminary experience with bronchotherapeutic procedures in central airway obstruction.  Chang Gung Med J. 2003;  26 240-249
  • 3 Gaissert H A, Grillo H C, Wright C D, Donahue D M, Wain J C, Mathisen D J. Complication of benign tracheobronchial strictures by self-expanding metal stents.  J Thorac Cardiovasc Surg. 2003;  126 744-747
  • 4 Dialani V, Ernst A, Sun M et al. MDCT detection of airway stent complications: comparison with bronchoscopy.  AJR Am J Roentgenol. 2008;  191 1576-1580
  • 5 Montgomery W W. The surgical management of supraglottic and subglottic stenosis.  Ann Otol Rhinol Laryngol. 1968;  77 534-546
  • 6 Cooper J D, Todd T R, Ilves R, Pearson F G. Use of the silicone tracheal T-tube for the management of complex tracheal injuries.  J Thorac Cardiovasc Surg. 1981;  82 559-568
  • 7 Burningham A R, Wax M K, Andersen P E, Everts E C, Cohen J I. Metallic tracheal stents: complications associated with long-term use in the upper airway.  Ann Otol Rhinol Laryngol. 2002;  111 285-290
  • 8 de Mello-Filho F V, Antonio S M, Carrau R L. Endoscopically placed expandable metal tracheal stents for the management of complicated tracheal stenosis.  Am J Otolaryngol. 2003;  24 34-40
  • 9 Chhajed P N, Tamm M, Glanville A R. Role of flexible bronchoscopy in lung transplantation.  Semin Respir Crit Care Med. 2004;  25 413-423
  • 10 Fraga J C, Filler R M, Forte V, Bahoric A, Smith C. Experimental trial of balloon-expandable, metallic Palmaz stent in the trachea.  Arch Otolaryngol Head Neck Surg. 1997;  123 522-528
  • 11 Saad C P, Murthy S, Krizmanich G, Mehta A C. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis.  Chest. 2003;  124 1993-1999
  • 12 Dumon J F. A dedicated tracheobronchial stent.  Chest. 1990;  97 328-332
  • 13 Wood D E, Liu Y H, Vallieres E, Karmy-Jones R, Mulligan M S. Airway stenting for malignant and benign tracheobronchial stenosis.  Ann Thorac Surg. 2003;  76 (1) 167-172 discussion 173-174

Dr. Chien-Ying Liu, MD

Department of Thoracic Medicine
Chang Gung Memorial Hospital

199 Tun-Hwa N. Road

105 Taipei

Taiwan, Province of China

Phone: +88 6 33 28 12 00 ext 51 08

Fax: +88 6 33 27 24 74

Email: cyliu01@adm.cgmh.org.tw

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