Pulmonary Procedures |

Clinical Success Stenting Lobar and Segmental Bronchi for "Lobar Salvage" in Bronchial Stenosis FREE TO VIEW

Sonali Sethi; Juan Wang; Michael Machuzak; Francisco Almeida; Joseph Cicenia; Atul Mehta; Thomas Gildea
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Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):732A. doi:10.1378/chest.1992298
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SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Airway stents are commonly deployed in central airways to reestablish luminal patency. Historically, when bronchial stenosis involves 3rd-4th generation bronchi, stenting is not a suitable option. The Atrium Icast stent, most commonly used in vascular procedures, is a film-cast encapsulated metallic stent that can easily be placed and removed from lobar and segmental airways. It ranges 5-10mmx16-59mm and involves one-step deployment under direct visualization using a flexible bronchoscope. We report our experience at the Cleveland Clinic in deploying this stent for lobar salvage.

METHODS: Bronchoscopy records of patients who had placement of an Icast stent were retrospectively reviewed between 1/2012-3/2014. For each patient, the age, gender, location and histology of malignant or benign disease, stent size, duration of stent placement, outcome, and complications were recorded.

RESULTS: Over 2 years, a total of 69 ICast stents were deployed in 25 patients with subsegmental bronchial stenosis(SBS). Ten patients had SBS after lung transplantation, 10 patients with malignant disease had SBS secondary to XRT(70%) or external compression(30%), and 5 patients had SBS secondary to non-malignant diseases. The avg age was 60yrs. Majority of stents were placed in the RML(38%), followed by RLL(19%), LLL(19%), LUL(14%), and RUL(10%). Most common stent size deployed was 7x16mm(50%), followed by 7x22mm(29%), 6x16mm(17%), 6x22mm(2%), and 5x16mm(2%). Mean time to stent revison or removal was 71d. All patients had follow-up and clinical improvement. No death was related to airway stenting complications. Common complications included migration, granulation tissue formation, and mucous occlusion. Three patients had stents removed for migration; 1 patient for granulation tissue formation; 1 transplant recipient completely stenosed the RML after stent removal at 3 mos which could not be recaptured; and 4 transplant recipients had removal of stents with permanent airway patency achieved over an avg of 10 mos.

CONCLUSIONS: Deploying an Icast stent is safe and effective in palliating lobar and subsegmental airway obstruction resulting in lobar salvage. Complication rates are comparable with other airway stents. In addition, this stent has the advantage of easy placement and removability during flexible bronchoscopy.

CLINICAL IMPLICATIONS: Subsegmental bronchial stenting helps to improve quality of life among patients with airway complications after lung transplantation and SBS secondary to malignant and benign diseases.

DISCLOSURE: The following authors have nothing to disclose: Sonali Sethi, Juan Wang, Michael Machuzak, Francisco Almeida, Joseph Cicenia, Atul Mehta, Thomas Gildea

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