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Correspondence |

New Bifurcated Silicone Stent for the Treatment of Posttransplant Bronchus Intermedius StenosisNew Silicone Stent in Posttransplant Stenosis: New Silicone Stent in Posttransplant Stenosis FREE TO VIEW

Caroline Dahlqvist, MD; Sebahat Ocak, MD, PhD; Jean Paul d’Odémont, MD
Author and Funding Information

From the Division of Pulmonology, CHU Mont-Godinne.

Correspondence to: Caroline Dahlqvist, MD, Division of Pulmonology, CHU Mont-Godinne, Ave G. Thérasse, 1, 5530 Yvoir, Belgium; e-mail: caroline.dahlqvist@uclouvain.be


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):429. doi:10.1378/chest.13-2167
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Published online
To the Editor:

In a recent issue of CHEST (August 2013), Oki and Saka1 published their preliminary results with a new dedicated bifurcated silicone stent (Novatech SA) in the management of malignant stenoses around the primary right carina. We report here our initial experience with this “Oki stent” for the treatment of posttransplant bronchus intermedius stenosis.

Given their particular conformation, posttransplant bronchus intermedius stenoses often are difficult to treat effectively. In particular, choosing the right stent to prevent restenosis is an important issue. Silicone Y-stents and Montgomery T-tubes have been used previously with promising results.2,3 In both cases, the stents were positioned on the primary right carina, with the upper arm allowing ventilation and drainage of the upper lobe and simultaneously preventing migration. However, the dimensions and angulation of the upper lobe arm do not always fit into the right bronchial tree. According to good preliminary results in patients with cancer,1,4 we chose to use the new Oki stent in two patients after lung transplantation.

Grade 45 bronchus intermedius stenoses developed in a 62-year-old woman and a 55-year-old woman 3 and 2 months, respectively, after bilateral lung transplantation for COPD. Before the Oki stent placement, the first patient underwent five rigid bronchoscopy procedures for dilatation, and the second underwent one procedure. Stenting was performed according to the pulling method,1,4 allowing correct positioning in both cases. Unfortunately, the stent in the second patient was removed accidentally during a flexible bronchoscopy procedure 1 month later. Given the reoccurrence of the stenosis, a second Oki stent with a longer upper lobe arm was placed to decrease the risk of migration. Both patients experienced immediate symptom relief after stent positioning. Preoperative FEV1 was 550 mL (33% predicted) for the first patient and 740 mL (33% predicted) for the second, and it increased to 1,050 mL (48% predicted) and 1,500 mL (67% predicted), respectively, 1 week after the intervention. Five months after the procedure, no complications were observed for the first patient. Eight weeks after the second Oki stent placement, the second patient presented with sputum retention and a minimal granulomatous reaction at the distal extremity of the stent. On the basis of this preliminary experience, the new bifurcated silicone stent seems to be a promising and well-tolerated alternative for the treatment of posttransplant bronchus intermedius stenosis.

References

Oki M, Saka H. New dedicated bifurcated silicone stent placement for stenosis around the primary right carina. Chest. 2013;144(2):450-455. [CrossRef] [PubMed]
 
Lee HJ, Puchalski J, Sterman DH, et al. Secondary carina Y-stent placement for post-lung-transplant bronchial stenosis. J Bronchology Interv Pulmonol. 2012;19(2):109-114. [CrossRef] [PubMed]
 
Lari SM, Gonin F, Colchen A. The management of bronchus intermedius complications after lung transplantation: a retrospective study. J Cardiothorac Surg. 2012;7:8. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, Kogure Y. Silicone y-stent placement on the carina between bronchus to the right upper lobe and bronchus intermedius. Ann Thorac Surg. 2009;87(3):971-974. [CrossRef] [PubMed]
 
Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH. A proposed classification system of central airway stenosis. Eur Respir J. 2007;30(1):7-12. [CrossRef] [PubMed]
 

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Tables

References

Oki M, Saka H. New dedicated bifurcated silicone stent placement for stenosis around the primary right carina. Chest. 2013;144(2):450-455. [CrossRef] [PubMed]
 
Lee HJ, Puchalski J, Sterman DH, et al. Secondary carina Y-stent placement for post-lung-transplant bronchial stenosis. J Bronchology Interv Pulmonol. 2012;19(2):109-114. [CrossRef] [PubMed]
 
Lari SM, Gonin F, Colchen A. The management of bronchus intermedius complications after lung transplantation: a retrospective study. J Cardiothorac Surg. 2012;7:8. [CrossRef] [PubMed]
 
Oki M, Saka H, Kitagawa C, Kogure Y. Silicone y-stent placement on the carina between bronchus to the right upper lobe and bronchus intermedius. Ann Thorac Surg. 2009;87(3):971-974. [CrossRef] [PubMed]
 
Freitag L, Ernst A, Unger M, Kovitz K, Marquette CH. A proposed classification system of central airway stenosis. Eur Respir J. 2007;30(1):7-12. [CrossRef] [PubMed]
 
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