Airway stenting for malignant and benign tracheobronchial stenosis

Background. Patients with benign and malignant central airway obstruction suffer from disabling dyspnea, obstructive pneumonia, and impending suffocation. Therapeutic bronchoscopy provides immediate and gratifying palliation. Airway stenting is the principal modality used to manage intrinsic tracheobronchial pathology and extrinsic airway compression. This report provides the details of the indications, techniques, and results of airway stenting in our practice. Methods. University of Washington patients undergoing bronchoscopy with stent placement or revision from May 1992 through December 2001 were extracted from a prospective patient database. Details of the stent procedure were obtained from the medical records and office charts. Early outcomes were assessed by patient symptoms and signs, and late outcomes were assessed by patient follow-up visits, follow-up bronchoscopy, or discussions, or a combination of these with the patient, patient's family, or referring physician. Results. One hundred forty-three patients underwent 309 stent procedures of which 67% were for malignant disease. Eighty-two percent required urgent or emergent intervention, and 77% had compromise of more than three fourths of the airway lumen. Eighty-seven percent of stents placed were silicone rubber and 15% of patients required multiple stents to achieve airway palliation. Significant improvement was achieved in 94% of patients but required multiple endoscopies to maintain improvement in 41%. There was no stent-related mortality and only one major complication required surgery. Conclusions. Airway stenting provides prompt and durable palliation in unresectable patients with central airway obstruction. Frequently multiple stents and multiple procedures will be necessary to maintain a satisfactory airway.