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Benign Tracheobronchial Strictures: Long-Term Results and Factors Affecting Airway Patency After Temporary Stent Placement

¹ Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea.
² Department of Radiology, Seoul National University Bundang Hospital, Seoul, South Korea.

OBJECTIVE. The purpose of our study was to evaluate long-term results and identify factors affecting airway patency after temporary placement of a covered, retrievable nitinol stent for benign tracheobronchial strictures.

MATERIALS AND METHODS. Polyurethaneor polytetrafluoroethylene (PTFE)-covered retrievable expandable nitinol stents were placed fluoroscopically in 24 patients with benign tracheobronchial strictures. Improvement in respiratory status and complications were evaluated. Maintained patency of airway after temporary stenting was calculated and compared between the 2- and 6-month stenting groups. Factors for maintained patency after temporary stenting were evaluated.

RESULTS. A total of 30 stents were successfully placed and well tolerated in 24 patients. Tissue hyperplasia, stent migration, and bronchial obstruction of the left upper lobe occurred in 36.7%, 13.3%, and 3.3% of patients, respectively. All stents were successfully removed electively either 2 (n = 12) or 6 (n = 12) months after placement or when complications occurred (n = 6). During the follow-up period (mean, 24 months), dyspnea recurred in 15 of the 24 patients. The 6-month stenting group showed a lower recurrence rate (41.7% vs 83.3%, p = 0.045) and a better mean maintained patency (39.7 ± 7.8 vs 9.4 ± 5.4 months, p = 0.001) than the 2-month stenting group. Multivariate analysis showed that duration of stent placement (p = 0.002) and the occurrence of tissue hyperplasia (p = 0.026) were associated with maintained patency after temporary stenting.

CONCLUSION. Temporary placement of a covered, retrievable, expandible nitinol stent may be a safe and effective treatment for benign tracheobronchial strictures during the period the stent is in place. A high symptomatic recurrence rate of 62.5% was found after stent removal. Shortterm placement of the stent and tissue hyperplasia were associated with decreased airway patency.

Keywords: airway • fluoroscopy • interventional radiology • stents • tracheobronchial strictures

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