Self-expanding metal stents are used to palliate benign strictures.
We examined the complications of this approach.
Methods
Between 1997 and 2002, we observed recurrent airway obstruction and
extension of benign inflammatory strictures after the placement of
tracheobronchial Microvasive Ultraflex stents and Wallstents (Boston Scientific
Corp, Natick, Mass), in 10 patients with postintubation strictures and 5 with
other indications; all but 1 patient were referred to us. Patients with tracheal
(9), subglottic (1), combined tracheal and subglottic (3), and bronchial (2)
strictures had been treated with covered and uncovered Wallstents (6) and
Microvasive Ultraflex stents (9).
Results
After stent insertion, stricture and granulations within previously
normal airway were seen in all patients. New subglottic strictures resulting
from the stent caused hoarseness in 4 patients. A bronchoesophageal fistula was
found in 1 patient at presentation and a tracheoesophageal fistula in another
during extraction of a Wallstent. Primary surgical reconstruction, judged to
have been feasible before wire stent insertion in 10 patients, was possible
after stenting in only 7 and failed in 2. Palliative tubes were placed in 60%
(9/15). Self-expanding metal stents may lengthen luminal damage, incite
subglottic strictures, and cause esophagorespiratory fistula in inflammatory
airway strictures. The injury is severe, occurs after a short duration of
stenting, and precludes definitive surgical treatment or requires more extensive
tracheal resection.
Conclusion
The current generation of self-expanding metal stents should be
avoided in benign strictures of trachea and bronchi.
