Endobronchial Stents: Past, Present, and Future

Tracheobronchial prostheses, known as airway stents, are used to palliate the effects of large airway obstruction. The most common types of stents in current clinical use are made of silicone or metallic wire. An ideal stent should possess several characteristics: (1) it should be easy to insert and remove, if necessary; (2) it should be available in different sizes to match the obstruction; (3) once placed, it should maintain its position without migration; (4) it should be firm enough to resist compressive forces, yet have sufficient elasticity to conform to the airway contours; (5) it should be made of inert material, so as not to irritate the airway, precipitate infection, or promote granulation tissue; (6) it should exhibit the same characteristics of the normal airway so that mobilization of secretions is not impaired. We do not yet have an ideal airway stent that combines the advantages of silicone and metal stents. In this article, the advantages and disadvantages of currently available stents are reviewed, and some thoughts on the future development of airway stenting will be mentioned.

Airway stent - silicone - metal

REFERENCES

• 1 Graziano J L, Spinazzola A, Neville W E. Prosthetic replacement of the tracheal carina.  Ann Thorac Surg. 1967;  4 1-11
• 2 Montgomery W W. T-tube tracheal stent.  Arch Otolaryngol. 1965;  82 320-321
• 3 Duvall A J, Bauer W. An endoscopically introducable T-tube for tracheal stenosis.  Laryngoscope. 1977;  87 2031-2037
• 4 Cooper J D, Todd T RJ, 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
• 5 Cooper J D, Pearson F G, Patterson G A et al.. Use of silicone stents in the management of airway problems.  Ann Thorac Surg. 1989;  47 371-378
• 6 Dumon J F. A dedicated tracheobronchial stent.  Chest. 1990;  97 328-332
• 7 Wallace M J, Charnsagavej C, Ogawa K et al.. Tracheobronchial tree: expandable metallic stents used in experimental and clinical applications.  Radiology. 1986;  158 309-312
• 8 Uchida B T, Putnam J S, Rosch J. Modifications of Gianturco expandable wire stents.  AJR Am J Roentgenol. 1988;  150 1185-1187
• 9 Colt H G, Dumon J F. Airway stents: present and future.  Clin Chest Med. 1995;  16 465-478
• 10 Wood D E. Airway stenting.  Chest Surg Clin N Am. 2001;  11 841-860
• 11 Westaby S, Jackson J W, Pearson F G. A bifurcated silicone rubber stent for relief of traceobronchial obstruction.  J Thorac Cardiovasc Surg. 1982;  83 414-417
• 12 Dumon J F, Cavaliere S, Diaz-Jimenez J P et al.. Seven-year experience with the Dumon prosthesis.  J Bronchol. 1996;  3 6-10
• 13 Freitag L, Eicker R, Linz B, Greschuchna D. Theoretical and experimental basis for the development of dynamic airway stent.  Eur Respir J. 1994;  7 2038-2045
• 14 Zannini P, Melloni G, Chiesa G, Carretta A. Self-expanding stents in the treatment of tracheobronchial obstruction.  Chest. 1994;  106 86-90
• 15 Coons H G. Self-expanding stainless steel biliary stents.  Radiology. 1989;  170 979-985
• 16 Domscke W, Foerster E CH, Matek W et al.. Self-expanding mesh stent for esophageal cancer stenosis.  Endoscopy. 1990;  22 134-136
• 17 Dunne J A, Sabanathan S. Use of metallic stent in relapsing polychondritis.  Chest. 1994;  105 864-867
• 18 Gillams A, Dick R, Doolex J S et al.. Self-expandable stainless steel endoprosthesis for biliary strictures.  Radiology. 1990;  174 137-140
• 19 Simonds A K, Dirving J D, Clark S W et al.. Use of expandable metal stents in the treatment of bronchial obstruction.  Thorax. 1989;  44 680-681
• 20 Strecker F P, Liermann D, Barth K H et al.. Expandable tubular stents for treatment of arterial occlusive disease: experimental and clinical results.  Radiology. 1990;  175 87-102
• 21 Varela A, Maynar M, Irving D et al.. Use of Gianturco self-expandable stents in the tracheobronchial tree.  Ann Thorac Surg. 1990;  49 806-809
• 22 Wright K C, Wallace S, Charnsangavej C et al.. Percutaneous endovascular stents: an experimental evaluation.  Radiology. 1985;  156 69-72
• 23 Filler R M, Forte V, Fraga J C, Matute J. The use of expandable metallic airway stents for tracheobronchial obstruction in children.  J Pediatr Surg. 1995;  30 1050-1055
• 24 Shaffer J P, Allen J N. The use of expandable metal styents to facilitate extubation in patients with large airway obstruction.  Chest. 1998;  114 1378-1382
• 25 Susanto I, Peters J I, Levine S M, Sako E Y, Anzueto A, Bryan C L. Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation.  Chest. 1998;  114 1330-1335
• 26 Carre P, Rousseau H, Lombart L et al.. Balloon dilatation and self-expanding metal Wallstent insertion.  Chest. 1994;  105 343-348
• 27 Rousseau H, Dahan M, Lauque D et al.. Self-expandable prosthesis in the tracheobronchial tree.  Radiology. 1993;  188 199-203
• 28 Vinnograd I, Klin B, Brosh T et al.. A new intratracheal stent made from nitinol, an alloy with “shape memory effect”.  J Thorac Cardiovasc Surg. 1994;  107 1255-1266
• 29 Madden B P, Datta S, Charokopos N. Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology.  Ann Thorac Surg. 2002;  73 938-944
• 30 Bollinger C T. Airway stent.  Semin Respir Crit Care Med. 1997;  18 563-570
• 31 Monnier P, Mudry A, Stanzel F et al.. The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers.  Chest. 1996;  110 1161-1168
• 32 Sawada S, Tanigawa N, Kobayashi M et al.. Treatment with Gianturco expandable metallic stents.  Radiology. 1993;  188 205-208
• 33 Rodriguez A N, Diaz-Jimenez J P, Edell E S. Silicone stents versus metal stents for management of benign tracheobronchial disease. Con: metal stents.  J Bronchol. 2000;  7 184-187
• 34 Hind C RK, Donnelly R J. Expandable metal stents for tracheal obstruction: permanent or temporary? A cautionary tale.  Thorax. 1992;  47 757-758
• 35 Nashef S A, Dromer C, Velly J F, Labrousse L, Couraud L. Expanding wire stents in benign tracheobronchial disease: indications and complications.  Ann Thorac Surg. 1992;  54 937-940
• 36 Lehman J D, Gordon R L, Kerlan Jr R K et al.. Expandable metallic stents in benign tracheobronchial obstruction.  J Thorac Imaging. 1998;  13 105-115
• 37 Hramiec J E, Haasler G B. Tracheal wire stent complications in malacia: implications of position and design.  Ann Thorac Surg. 1997;  63 209-212
• 38 Varela A, Maynar M, Irving D et al.. Use of Gianturco self-expandable stents in the tracheobronchial tree.  Ann Thorac Surg. 1990;  49 806-809
• 39 Lee K W, Im J G, Han J K, Kim T K, Park J H, Yeon K M. Tuberculous stenosis of the left main bronchus: results of treatment with balloons and metallic stents.  J Vasc Interv Radiol. 1999;  10 352-358
• 40 Jantz M A, Silvestri G A. Silicone stents versus metal stents for management of benign tracheobronchial disease. Pro: metal stents.  J Bronchol. 2000;  7 177-183
• 41 Rauber K, Franke C, Rau W S. Self-expanding stainless steel endotracheal stenta: an animal study.  Cardiovasc Intervent Radiol. 1989;  12 274-276
• 42 Spatenka J, Khagani A, Irving J D. Gianturco self-expanding metallic stents in treatment of tracheobronchial stenosis after single lung and heart-lung transplantation.  Eur J Cardiothorac Surg. 1991;  5 648-652
• 43 Tsang V, Williams A M, Goldstraw P. Sequential Silastic and expandable metal stent for tracheobronchial strictures.  Ann Thorac Surg. 1992;  53 856-860
• 44 Furman R H, Backer C L, Dunham M E, Donaldson J, Mavroudis C, Holinger L D. The use of balloon-expandable metallic stents in the treatment of pediatric tracheomalacia and bronchomalacia.  Arch Otolaryngol Head Neck Surg. 1999;  125 203-207
• 45 Filler R M, Forte V, Chait P. Tracheobronchial stenting for the treatment of airway obstruction.  J Pediatr Surg. 1998;  33 304-311
• 46 Hautmann H, Huber R M. Stent flexibility: an essential feature in the treatment of dynamic airway collapse.  Eur Respir J. 1996;  9 609-611
• 47 Bolliger C T, Heitz M, Hauser R, Probst R, Perruchoud A P. An airway Wallstent for the treatment of tracheobronchial malignancies.  Thorax. 1996;  51 1127-1129
• 48 Ladas G, Goldstraw P. Airway Wallstent.  Thorax. 1997;  52 664-665
• 49 Dasgupta A, Dolmatch B L, Abi-Saleh W J, Mathur P N, Mehta A C. Self-expandable metallic airway stent insertion employing flexible bronchoscopy: preliminary results.  Chest. 1998;  114 106-109
• 50 Martinez-Ballarin J I, Diaz-Jimenez J P, Castro M J, Moya J A. Silicone stents in the management of benign tracheobronchial stenoses: tolerance and early results in 63 patients.  Chest. 1996;  109 626-629
• 51 Diaz-Jimenez J P, Munoz E, Ballarin J, Kovitz K, Pressas F. Silicone stents in the manegement of obstructive tracheobronchial lesions: 2 year experience.  J Bronchol. 1994;  1 15-18
• 52 Shapshay S M, Beamis Jr J F, Dumon J F. Total cervical tracheal sttenosis: treatment by laser, dilation, and stenting.  Ann Otol Rhinol Laryngol. 1989;  98 890-895
• 53 Simpson G T, Strong M S, Healy G B, Shapshay S M, Vaughan C W. Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis.  Ann Otol Rhinol Laryngol. 1982;  91 384-388
• 54 Strausz J. Management of postintubation tracheal stenosis with stent implantation.  J Bronchol. 1997;  4 294-296
• 55 Sarodia B D, Dasgupta A, Mehta A C. Management of airway manifestations of relapsing polychondritis: case reports and review of literature.  Chest. 1999;  116 1669-1675
• 56 Korpela A, Aarnio P, Sariola H, Tormala P, Harjula A. Comparison of tissue reaction in the tracheal mucosa surrounding a bioabsorbable and silicone airway stents.  Ann Thorac Surg. 1998;  66 1772-1776
• 57 Saito Y, Minami K, Kobayashi M et al.. New tubular bioabsorbable knitted airway stent: biocompatibility and mechanical strength.  J Thorac Cardiovasc Surg. 2002;  123 161-167
• 58 Saito Y, Minami K, Kaneda H et al.. New tubular bioabsorbable knitted airway stent: feasibility assessment for delivery and deployment in a dog model.  Ann Thorac Surg. 2004;  , in press