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Images in Thorax
‘Double-bifurcated’ stent: when 3D is not an option
  1. Nicolas Guibert1,
  2. Julien Mazières2,
  3. Benjamin Moreno3,
  4. Hervé Dutau4,
  5. Gavin Plat5,
  6. Valentin Héluain5,
  7. Romain Kessler6,
  8. Michele Porzio6
  1. 1 Pulmonology, University Hospital Centre Toulouse, Toulouse, France
  2. 2 Thoracic Oncology, CHU Toulouse, Hôpital Larrey, Toulouse, France
  3. 3 AnatomikModeling, Toulouse, France
  4. 4 Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hopital Nord, Marseille, France
  5. 5 Pulmonology, CHU Toulouse, hopital Larrey, Toulouse, France
  6. 6 Pneumology, CHU de Strasbourg, Strasbourg, France
  1. Correspondence to Dr Nicolas Guibert, Pulmonology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France; guibert.n{at}chu-toulouse.fr

https://doi.org/10.1136/thorax-2022-219954

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    Limited but encouraging outcomes have been reported with patient-specific stents, designed and manufactured based on the patient’s corrected anatomy.1–4 These personalised stents will probably benefit most if bifurcated and/or of complex shape with multiple angles, diameters and lengths to consider. From our (still limited) experience, anastomotic strictures following airway surgeries may represent a particularly appealing application (lung transplantation, sleeve lobectomy, tracheal and carinal resections with airway reimplantation).

    Here, we report the first use of a customised ‘double-bifurcated’ stent to treat multifocal airway stenoses after a complex airway surgery. This 56-year-old patient underwent in 2016 a tracheal and carinal resection for an adenoid cystic carcinoma, with implantation of the bronchus intermedius (BI) to a neocarina and of the right upper lobe (RUL) in the trachea. Unfortunately, there was subsequent development of highly symptomatic (dyspnoea, retention pneumoniae) stenoses of the trachea and BI. Since August 2019, most commercially available stents (15 in the past 27 months; 9 Bonastent, 8 Aerstent straight, 1 Aerstent bifurcated, 1 Novatech silicone stent) had to be removed for severe adverse events: (1) bifurcated stents were not suited (the right branch was too …

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    Footnotes

    • Contributors NG: principal iInvestigator of the trial. Conception and design of the work. Computer aided design of the stent. Stents implantation. Acquisition and interpretation of data. Drafting manuscript. JM: Interpretation of data. Revising manuscript. Approved the final version of the manuscript. BM: Computer aided design of the stents. Approved the final version of the manuscript. HD: Coinvestigator in the trial. Revised manuscript. Approved the final version of the manuscript. GP: Coinvestigator in the trial. Revised manuscript. Approved the final version of the manuscript. VH: Coinvestigator in the trial. Revised manuscript. Approved the final version of the manuscript. RK: Treating pulmonologist of the patient. Previous stents implantation. Revised manuscript. Approved the final version of the manuscript. MP: Treating pulmonologist of the patient. Previous stents implantation. Revised manuscript. Approved the final version of the manuscript.

    • Funding This work was supported by Toulouse University Hospital and ADERSPOT (Association pour le Développement de l'Enseignement, de la Recherche et des Soins en Pneumo-Oncologie de Toulouse).

    • Competing interests HD is consultant for NovatechTM. BM is the CEO of AnatomoikModeling.

    • Provenance and peer review Not commissioned; externally peer reviewed.