Endobronchial stents

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Endobronchial stents
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Extra? Intraluminal? Both?
Curative potential!
Beware imminent respiratory failure
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Caution!

• Patients at risk smoking ? COPD, poor
  cardiovascular status, end stage recurrences post
  chemo/RT
• Significant obstruction with imminent resp.
  failure
• ? anatomical/structural changes due extensive
  peribronchial tumor and previous treatment(s)
• ? fatal hemorrhage, perforation ? suffocation

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Central airways obstruction ? Action!
ERS/ATS statement on interventional pulmonology
Eur Respir J. 200219356 JF Dumon et al. Chest
198486163
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Imminent suffocation ? immediate action
Emergency intubation
Stent gives immediate sustained effect
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Pushing a vue technique
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Modificated Tygon stent 12 cm 80
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Y stent for the main carina region
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Inoperable severe tracheobronchomalacia
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Dont go too far!
Operable Benign stenosis, double stented with
Ultraflex. Embedded in the wall close to the
esophagus and large vessels
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Stents Dumons work! Rev Mal Respir 1999 16641

• Excellent expertise team, daily practice
• 1,574 prosthesis (1,058 patients)
• Tracheal 54 LMB 21 and RMB 18
• Avg. time in place benign 1.2 yrs (max 6.2)
  malignant 4 months (max 4.7 yrs)
• Migration 9.5
• Granuloma 7.9
• Obstruction 3.6

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Postintubation tracheal stenoses (Brichet A et
al. Eur Respir J 1999 13888)
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Airways physiology for better stent
Lutz Freitag et al. Hemer - Germany
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Silicon, Nitinol expandable, hybrids
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Central airways obstruction ? Acute!
ERS/ATS statement on interventional pulmonology
Eur Respir J. 200219356
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Chest 20011201811-1814
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Imminent death! Euthanasia
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Mini stents (Emphasys)
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Extra? Intraluminal? Both?
Stent
Debulking coagulation
Beware imminent respiratory failure
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Bronchoscopic stenting
After emergency has been dealt with
? Multidisciplinary approach surgery oncology