PURPOSE: Central airway obstruction and its management has been an area of in-depth discussion amongst Interventional pulmonologists and cardiothoracic surgeons. Significant controversy regarding management of extrinsic compression from a benign causes remains. The most efficient method to manage these situations has not been defined in the literature. Current management techniques all require the use of the rigid bronchoscope or surgery. The limitations of rigid bronchoscopy are well known. We report the ability to place polymer based stents via flexible bronchoscopy in a procedure room under moderate sedation.
METHODS: 7 patients at the Paris Interventional Pulmonology Clinic in Paris, Texas and Brody School of Medicine with benign airway obstructions were evaluated for stent placement. Our patients had functional impairment secondary to tracheomalacia and stenosis secondary to substernal goiters or fibrosis. Polyflexr® stents ranging from 18mm to 20 mm in diameter and 4 - 6 cm in length were placed in the bronchoscopic suite under moderate sedation. The length of obstruction was assessed by dynamic CT scans and bronchoscopy. External radio-opaque markers defined the obstruction and a super-stiff Jag Wire® was placed bronchoscopically to guide the loading unit. The loading device with the distal end occupied by an inflated endobronchial balloon was advanced into place along the guide wire. Once positioning was confirmed by fluoroscopic visualization, stents were deployment by standard methodology.
RESULTS: 6 stents were deployed without complication or discomfort, in 1 case mechanical limitations of the procedure prevented successful deployment. Post-procedure location was confirmed by fluoroscopy and CXR. All deployed stents remained in position until removal prior to definitive surgery; one case had significant granulation response.
CONCLUSION: This case series demonstrates a delivery system for polymer-based stents with a flexible bronchoscope that can be done in a bronchoscopy suite with minimal sedation. It appears that flexible bronchoscopic deployment is a low risk procedure.
CLINICAL IMPLICATIONS: The next step is to create evidence based literature that documents the safety and efficacy of stent deployment by a flexible bronchoscope.
DISCLOSURE: Chirag Patel, No Financial Disclosure Information; No Product/Research Disclosure Information