P. Monnier et al., THE USE OF THE COVERED WALLSTENT FOR THE PALLIATIVE TREATMENT OF INOPERABLE TRACHEOBRONCHIAL CANCERS - A PROSPECTIVE, MULTICENTER STUDY, Chest, 110(5), 1996, pp. 1161-1168
Study objective: To investigate the safety, efficacy, and tolerance of
the covered Wallstent for the palliative treatment of inoperable trac
heobronchial cancer. Design: An 8-month prospective study employing ei
ther a rigid bronschoscope or a flexible delivery system for prosthesi
s insertion. Setting: Multicentric setting involving four teaching hos
pitals in Switzerland and Germany. Patients: Forty patients (29 men, 1
1 women), average age of 62 years, presenting with an inoperable trach
eobronchial cancer. Interventions: After partial airway recanalization
with an Nd-YAG laser, the covered Wallstent was inserted 23 times usi
ng a rigid bronchoscope (Rigidstep device), and 27 times using a flexi
ble delivery system (Telestep device) under fluoroscopic and endoscopi
c visualization. Results: Clinical and endoscopic examination at 1, 30
, and 90 days showed improvement in the bronchial lumen and in the dys
pnea index. No serious complication (death, perforation, hemorrhage, i
nability to remove an improperly placed prosthesis) was observed durin
g surgery. Late complications included migration (12%), inflammatory g
ranulations or tumor regrowth at the tip of the prosthesis (36%), and
symptomatic retention of secretion (38%). Conclusions: Compared with o
ther tracheobronchial prostheses, notably the Dumon stent, the covered
Wallstent presents the following advantages: insertion with visual gu
idance, treatment of extrinsic compressions and esophagobronchial fist
ulas, and little chance of migration when the prosthesis diameter is c
hosen correctly. The following disadvantages can be noted: high price;
both repositioning and extraction of the released stent are more diff
icult, though certainly possible; and risk of granulations at the tips
of the prosthesis and retention of secretions. Suggestions are made f
or potential improvements to the stent and insertion system that may r
esult in a significant decrease in early and late complications.