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Airway Stenting for Patients With Benign Airway Disease and the Food and Drug Administration Advisory*: A Call for Restraint

Mark E. Lund, MD, FCCP; Seth Force, MD, FCCP
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Affiliations: Philadelphia, PA ,  Atlanta, GA ,  Dr. Lund is Assistant Professor of Medicine, Interventional Chest and Diagnostic Procedures Network Steering Committee, Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine. Dr. Force is Assistant Professor of Surgery, Section of Thoracic Surgery, The Emory Clinic.

Correspondence to: Seth D. Force, MD, FCCP, Section of Thoracic Surgery, The Emory Clinic, Bldg A, Rm 2213, Atlanta, GA 30324; e-mail: Seth_force@emoryhealthcare.org



Chest. 2007;132(4):1107-1108. doi:10.1378/chest.07-0242
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Airway stenting has become a common technique for treating central airway obstruction (CAO) caused by a variety of malignant and benign diseases. The original stents used by Duvall and Bauer,1 Cooper et al,2 and Dumon3 were silastic and required general anesthesia and rigid bronchoscopy for placement. The advent of the Wallstent (Boston Scientific Corporation; Natick, MA) introduced a new generation of stents that were metallic, self-expanding, and easily deployable, the so-called self-expanding metal stent (SEMS). However, the ease of deployment came with a cost. Over time, the metallic stents integrate into the airway, leading to complications such as stent fracture, erosion into adjacent structures, mucous retention, and granulation tissue formation. This is especially true in patients with benign airway disease, whose life expectancy is not inherently limited by their primary disease and in whom the stents can exist for years. This point was highlighted by Stephens and Wood,4 who found that the vast majority of all early and late deaths following airway procedures for patients with benign and malignant CAO occurred in the malignant group.

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