Relapsing Polychondritis (RP) is characterized by the inflammation and destruction of the cartilaginous structure of many organs, including the respiratory tract. For patients with RP, stenting at the choke point (CP) relates to an increase in airway stiffness in the affected airway. Vulnerability of stenting at the CP is that migration of the CP can occur after the initial stenting is performed.
We implanted ultraflex stents in 7 of 13 RP cases with malacia. To assess the location of the CP, we measured intra-airway pressure and cross-sectional areas of the airway from bronchi to trachea using bronchoscopic imaging technology. We also evaluated variable intra-thoracic stenosis using pulmonary function tests, airway measurements with 3D-CT and EBUS.
For all 7 patients stented, choke points were detected in the trachea, mainstem bronchus or bronchi. After initial implantation of stents at the CP, the CP migrated to the bronchi. Additional stents were required. After implantation, flow-volume curves displayed significant improvements to flow limitation and pressure differences decreased significantly. CT on expiration revealed mosaic patterns indicating air trapping due to migration of the CP to small bronchi. Bi-level positive airway pressure (BiPAP) was required for all cases.
Investigation into the migration of the CP during stenting is imperative for the detection of migration as additional stents and BiPAP may be needed.
This study explores the phenomena and pitfalls of CP migration in RP.
Teruomi Miyazawa, No Financial Disclosure Information; No Product/Research Disclosure Information