Department of Internal Medicine
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
To the Editor:
We would like to report an incidence of breakage and expulsion
of a wire mesh stent (Wallstent; Schneider; Minneapolis, MN) in
a patient who required multiple stents for idiopathic
A 69-year-old man with tracheobronchomalacia had two Wallstents
inserted in the trachea and left main bronchus (LMB) in February 1996.
He did well for approximately 11/2 years and returned with
increasing shortness of breath. Flexible bronchoscopy in October 1997
revealed granulomas involving the stents, and the lower end of the
tracheal stent was overhanging the LMB. Both of the granulomas and the
lower portion of the tracheal stent were ablated with Nd-YAG laser
photoresection. A Rusch Y stent was inserted in the trachea
after balloon dilation of the existing tracheal stent. The Rusch Y
stent had to be subsequently removed in December 1997 because of
frequent mucous plugging.
The patient returned 3 months later with an “exacerbation of
asthma,” of 1 week’s duration and had coughed up two wire stent
fragments (Fig 1).
Bronchoscopy at the time revealed wires protruding from an intact
tracheal stent (Fig 2)
and dynamic collapse of the posterior wall of the trachea. No
intervention was done at that time. The patient returned again in June
1998 after having coughed up two more pieces of wire stent fragments
while having swallowed the third one.
During both of these episodes, the patient experienced hemoptysis and
was fearful of losing the stent and recurrence of his symptoms.
Flexible bronchoscopy is being increasingly used to insert
self-expandable metallic stents for management of large airway
obstruction.1–3 Though complications of Wallstents like
stent migration, granuloma formation, infection, and stent expulsion
have been reported, to our knowledge, this is the first incident of
spontaneous breakage and expulsion of wire stent fragments. We
speculate that damage to the stent occurred during subsequent
manipulation through the stent, and spontaneous breakage occurred by
the dynamic maneuvers, like coughing.
We highlight this occurrence as a reminder that Wallstents are
delicate, and one needs to be careful about forcible manipulation
through the stent. It also raises concern about structural manipulation
of the Wallstent, for example, by laser ablation. If such manipulations
are mandatory, then patients should be warned of later expulsion of
wires to decrease their anxiety. This is also likely to lead to loss of
stent function, which may require insertion of a second stent through
the first stent.
Correspondence to: Atul C. Mehta, MBBS, FCCP, Department
of Pulmonary/Critical Care Medicine, A-90, Cleveland Clinic Foundation,
9500 Euclid Avenue, Cleveland, OH 44195
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