PURPOSE:Lung cancer is associated with high morbidity and mortality. Morbidity in patients with lung cancer is often due to central airway obstruction leading to dyspnea and post obstructive pneumonias. Palliation of airway obstruction is an important aspect in the care of these patients.
METHODS:The Alveolus tracheobronchial stent is a completely covered self expanding nitinol metallic stent. The stents were deployed using fiberoptic bronchoscopy under direct visualization and with conscious sedation. All patients receiving Alveolus stents for malignant airway issues at the University of Florida between February 2007 and April 2008 were included in this study. The pre and post stent airway lumen was estimated by visualization during bronchoscopy.
RESULTS:A total of 54 stents were placed in 30 patients. Of these, 23 patients had a diagnosis of NSCLC, 3 had small cell lung cancer, and 4 had esophageal cancer. Indications for stent placement included endoluminal mass (n =10), submucosal tumor infiltration (n= 19), extrinsic compression (n = 2), and fistula (n =4). Location of stent placement included the trachea (n =14), right mainstem bronchus (n= 11), left mainstem bronchus (n =14), BI (n =8), RLL (n = 4), LLL (n= 2), and RUL (n =1). Some stents were removed due to migration (n =2), malpositioning (n =5), infolding (n = 2), occlusion due to granulation tissue (n = 2), and incorrect sizing (n =2). One stent was coughed out. Average pre stent stenosis was 70 %. There was at least a 50 % improvement in lumen diameter post stent placement in all patients. Adjunctive treatments included electrocautery snare resection (n = 4), electrocautery or APC ablation (n= 8), placement of an Atrium iCAST or Boston Scientific Ultraflex stent (n = 7), and balloon dilatation (n=1).
CONCLUSION:The Alveolus stent produced at least a 50% increase in luminal size in all patients. The migration rate in our experience was low.
CLINICAL IMPLICATIONS:The Alveolus tracheobronchial stent is effective in the palliation of malignant airway obstructions and has an acceptable complication rate.
DISCLOSURE:Varsha Kulkarni, Consultant fee, speaker bureau, advisory committee, etc. Dr Michael Jantz is on the Medical Advisory Board of Alveolus Inc.; No Product/Research Disclosure Information