The self-expanding metallic stent(SEMS) is an acceptable palliative therapy for advanced tracheobronchial disease in the absence of surgical alternatives. Immediate relief of symptoms and ease of administration makes stenting an attractive option for complicated tracheobronchial pathology. However, late complications related to granulation tissue, infection, and primary stent failure has been described. This study tracks our local experience over a four-year period for delayed stent complications requiring intervention or hospitalization.
Retrospective Study; single center; longitudinal tracking using the VAMC computerized patient record system/remote access system.
618 bronchoscopy procedures were performed by the Pulmonary Service at the Richmond VA Medical Center (1999-2003). 62 interventional procedures were performed, including 15 SEMS procedures in 12 patients for a total of 22 stents (Wallstent, Ultraflex; Boston Scientific Corporation). Primary diagnosis includes malignancy(4), transplant-related bronchial stenosis(3)or dehiscence(1), and benign tracheobronchial disorders with severe respiratory compromise(4). Immediate improvement was noted in 10/12 pts; survival beyond 30d was noted in 9/12. Patients still alive 5/9 (range 2mo-48mo post-SEMS). Late complications (beyond 30d) were seen in 7/9 pts. Patients with malignancy(4): no SEMS complications reported; deaths were related to pneumonia(1/4), underlying malignancy (2/4) or myocardial infarct (1/4). Transplant-related disorders(4): one early death related to sepsis, one late death related to aspergillus. SEMS complications included recurrent infection with mucous plugging (3/4). Non-malignant tracheobronchial disease(4): no early deaths; one late death (11 months) due to COPD/hypercapneic respiratory failure. Late complications included recurrent infections (4/4), significant granulation tissue (3/4) and primary stent failure (2/4) requiring replacement SEMS. Multiple bronchoscopies were required in most patients, with >5 procedures in 3/9; >10 in 1/9; stent-related hospitalizations were common, including >3 admissions in 5/9 pts.
SEMS is a reasonable therapy, offering immediate palliation of symptoms if surgical treatment is not available. However, potential late complications may require multiple bronchoscopic interventions or hospitalizations.
Further studies are recommended to determine the long-term benefits of tracheobronchial stenting. Newer stent designs and better patient selection may offer improved results with fewer late complications.
L.C. Moses, Boston