TRACHEOBRONCHIAL STENTING FOR THE TREATMENT OF AIRWAY-OBSTRUCTION

Purpose: The authors report a 5-year experience of inserting the Palma z stent into infants and children who had a variety of major airway ob structions. Methods: From 1992 to 1997, 30 balloon expandable stents ( Palmaz) were inserted in the trachea (n = 18) and bronchi (n = 12) of 16 infants, ages 1 week to 26 months (median, 9 months), suffering fro m th ree types of serious airway obstruction. In group 1, 10 stents we re placed in eight children for tracheal or bronchomalacia. In group I I, 11 stents were inserted in four infants for stricture at the site o f surgical repair of stenosis. In group III, nine stents were placed t o relieve airway compression from enlarged pulmonary arteries associat ed with severe congenital heart disease in three children and mediasti nal lymphangioma in one. Tracheal stents were 30 mm long and were expa nded to 8 to 10 mm at placement. Bronchial stents were 12 to 15 mm lon g and were expanded to 7 to 9 mm. The nonexpanded stents were placed o n an inflatable balloon catheter and were inserted into the desired po sition in the airway through a bronchoscope or endotracheal tube using x-ray control. They were expanded and fixed in place by inflating the balloon to its rated diameter. Results: In group I, granulation tissu e developed over the stents in five of eight cases. Obstructing granul ations were removed by scraping or balloon compression in three and re sulted in earlier than the planned removal in two. Stents have now bee n removed in six of eight cases. Major airway obstruction has not recu rred. In group II, stents have been in place in all cases for 13 to 56 months after insertion, but in one child with three stents, two were removed for obstructive granulations 44 months after insertion. All ar e well. All group III patients could be extubated after stenting, but two with heart disease died after 3 and 12 months of palliation. Durin g the course of follow-up, stents in the bronchi of two had migrated, and an additional stent was required. Autopsy in one showed full-thick ness bronchial erosion but no perforation by the stent, A total 11 of 30 stents have been removed bronchoscopically in seven children withou t complications. Another child referred here for tracheal stent remova l after laser resection of granulations died at attempted removal beca use the stent was ''welded'' into the tracheal wall by the inflammator y reaction. Manipulation of the stent completely occluded the airway. Conclusions: Airway stents can be inserted easily and safely and left in-situ for prolonged periods to relieve major airway obstruction from a variety of causes. Tissue reaction may necessitate bronchoscopic ma nipulation and early stent removal, and adds to the difficulty of remo val. Copyright a 1998 by W.B. Saunders Company.