PURPOSE: Airway complications after lung tranplantation range from 7 to 14% and include bronchial stenosis and bronchomalacia. Treatment of these complications include thermal ablation, balloon dilatation, and stent placement. The purpose of this study is to describe our experience with the Alveolus tracheobronchial stent in the management of these complications.
METHODS: The Alveolus tracheobronchial stent (Alveolus, Inc.) is a new, completely covered, self-expanding nitinol metallic stent. The stents were inserted via flexible bronchoscopy with conscious sedation. Stent deployment was performed under direct bronchoscopic visualization. The degree of stenosis pre and post-stent placement were estimated by bronchoscopic visualization using the proximal airway size as a reference.
RESULTS: Seven patients underwent stent implantation. Indications were stenosis (N=4), bronchomalacia (N=2), and stenosis plus bronchomalacia (N=1)along the anastomosis. The timing of intervention ranged from 3 to 19 months after transplantation. Adjunctive electrocautery was performed in 2 patients and balloon dilatation in 1 patient. The left mainstem bronchial anastomosis was stented in 4 patients and the right mainstem bronchial anastomosis in 3 patients. The average degree of stenosis decreased from 80% to 20%. Pulmonary function tests improved in all patients. Stent migration occurred in 1 patient with bronchomalacia. Other complications have not yet been observed.
CONCLUSION: Our initial experience with the Alveolus tracheobronchial stent as part of management of lung transplant anastomosis-related complications has been favorable. The stent is fully covered which may allow for stent removal at a later time once the stenosis has been maximally dilated and is stable. The potential for removability offers an advantage over current metal stents. Longer clinical follow-up will be required to compare the Alveolus stent to other metal and silicone stents in terms of migration, mucus retention, granulation tissue formation, and ease of removability.
CLINICAL IMPLICATIONS: The Alveolus tracheobronchial stent appears efficacious in the management of lung transplant anastomotic complications. Long term follow-up will be necessary to define the efficacy and complication profile of the Alveolus tracheobronchial stent in comparison to other metal stents and silicone stents.
DISCLOSURE: Sebastian Fernandez-Bussy, Consultant fee, speaker bureau, advisory committee, etc. Scientific advisory board for Alveolus, Inc.; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. The Alveolus tracheobronchial stent is not approved for use in benign airway disease.