0
Correspondence |

ResponseResponse FREE TO VIEW

Masahide Oki, MD, FCCP; Hideo Saka, MD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine, Nagoya Medical Center.

Correspondence to: Masahide Oki, MD, FCCP, Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan; e-mail: masahideo@aol.com


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):429-430. doi:10.1378/chest.13-2473
Text Size: A A A
Published online
To the Editor:

We thank Dr Dahlqvist and colleagues for the report on their initial experience with the use of a new dedicated bifurcated silicone stent, “Oki stent,” for two posttransplant patients with bronchus intermedius stenosis. In our original study,1 all enrolled patients had a malignant disease. Their report suggested the usefulness of the Oki stent for the benign as well as malignant airway stenosis.

Airway stenosis is the most frequent airway complication in lung transplant recipients, and stent placement is the most frequently described treatment.2 Thus, posttransplant airway stenosis is one of the major indications for stent placement in benign diseases. Despite the benign nature of airway stenosis, metallic stents rather than silicone stents have been used more frequently3,4 because of the ease of stent placement.4 The significant limitation of metallic stents is the difficulty of removal, especially for stents left in place for a long time.3 Late complications associated with metallic stent implantation, including restenosis, frequently occur and often require stent removal. In a large retrospective study of 65 recipients with metallic stent implantation, the frequency of restenosis was reported to be 52%.3 Furthermore, the need for the stent is often temporary rather than permanent. In the studies on silicone stent placement for posttransplant airway stenosis, the reported success rate of stent removal without recurrence of airway stenosis ranged from 70% to 80%.4,5 Thus, silicone stents, which can be removed easily, are preferred for the management of posttransplant airway stenosis. In lung transplant recipients, the bronchus intermedius often is involved3,4 because an anastomotic stenosis extends or a nonanastomotic distal bronchial stenosis occurs. For treatment using a silicone stent in such cases, a window method traditionally has been used in which an opening is punched out in the silicone straight stent wall so that ventilation is not prevented in the upper lobe.4 However, the window method has some drawbacks. There is a discrepancy in size between the right main stem bronchus and the bronchus intermedius, so the silicone straight stent may not fit well. This may lead to migration or excessive granulation tissue formation. Furthermore, the window method is useless for right upper lobe stenosis, which occasionally occurs in lung transplant recipients.2,4 The Oki stent was designed to adapt to the anatomic structure of right bronchi and, thus, seems especially suitable.

The letter by Dr Dahlqvist and colleagues is the first report, to our knowledge, to suggest the usefulness of the Oki stent for the treatment of airway stenosis after lung transplantation in clinical practice. We hope that further studies or reports will reinforce their findings.

Acknowledgments

Other contributions: The prototype bifurcated silicone stents (total of 10 stents) were provided to the authors by Novatech SA, La Ciotat, France.

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]
 
Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009;6(1):79-93. [CrossRef] [PubMed]
 
Gottlieb J, Fuehner T, Dierich M, Wiesner O, Simon AR, Welte T. Are metallic stents really safe? A long-term analysis in lung transplant recipients. Eur Respir J. 2009;34(6):1417-1422. [CrossRef] [PubMed]
 
Thistlethwaite PA, Yung G, Kemp A, et al. Airway stenoses after lung transplantation: incidence, management, and outcome. J Thorac Cardiovasc Surg. 2008;136(6):1569-1575. [CrossRef] [PubMed]
 
Dutau H, Cavailles A, Sakr L, et al. A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: short- and long-term outcomes. J Heart Lung Transplant. 2010;29(6):658-664. [CrossRef] [PubMed]
 

Figures

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]
 
Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009;6(1):79-93. [CrossRef] [PubMed]
 
Gottlieb J, Fuehner T, Dierich M, Wiesner O, Simon AR, Welte T. Are metallic stents really safe? A long-term analysis in lung transplant recipients. Eur Respir J. 2009;34(6):1417-1422. [CrossRef] [PubMed]
 
Thistlethwaite PA, Yung G, Kemp A, et al. Airway stenoses after lung transplantation: incidence, management, and outcome. J Thorac Cardiovasc Surg. 2008;136(6):1569-1575. [CrossRef] [PubMed]
 
Dutau H, Cavailles A, Sakr L, et al. A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: short- and long-term outcomes. J Heart Lung Transplant. 2010;29(6):658-664. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543