STENT FLEXIBILITY - AN ESSENTIAL FEATURE IN THE TREATMENT OF DYNAMIC AIRWAY COLLAPSE

Implantation of endobronchial stents for treatment of dynamic airway c ollapse represents a suitable therapeutic option to alleviate distress ing symptoms. We report the case of a 43 year old patient suffering fr om progressive respiratory distress 2 weeks after insertion of a ballo on-expandable radial noncompliant Palmaz stent in an unstable segment of the left main bronchus, with the aim of preventing symptomatic airw ay collapse. Bronchial instability had developed following sleeve rese ction of the right lung due to adenoid cystic carcinoma. Explantation revealed compression and deformation of the stent, Peak expiratory flo w (PEF) had declined to a low of 138 L . s(-1) (forced expiratory volu me in one second (FEV(1)) 1.02 L), With placement of a Strecker stent, having the ability to re-expand within certain limits, bronchial coll apse could be avoided and marked clinical improvement as well as expir atory flow increase was noted (PEF 7.10 L . s(-1); FEV(1) = 2.03 L), A t 13 months follow-up, clinical status was unchanged. A decline in for ced expiratory flow (PEF 5.96 L . s(-1); FEV(1) 1.69 L), however, indi cated a possible change in the structural integrity of the Strecker st ent. We conclude that physical properties of endobronchial stents may be crucial for good functional results in major airway collapse. Stiff prostheses, when compressed, can induce severe airway obstruction.