Palliative treatment for tracheal stenoses using carbon dioxide laser and the Gianturco stent - Long-term results

Between September 1992 and March 1998, the self-expandable Gianturco prosth esis was inserted in 23 patients suffering from tracheal stenosis. After ra dial incision and dilation of the stenosis as described by Shapshay, the po sitioning of the stent was performed during an endoscopic procedure under o ptical control. The prosthesis used was a double-ring stent 50 mm long and 20 mm in diameter, The follow-up period ranged between 0.5 and 67 months wi th an average of 31 +/- 18 months. Pulmonary function tests showed an avera ge improvement of the peak expiratory flow (50%) from preoperative results of 1.06 +/- 0.60 L/s to short-term postoperative results of 2.08 +/- 0.78 L /s and long-term postoperative results of 2.11 +/- 0.78 L/s. The mean peak inspiratory flow (50%) improved from 1.43 +/- 0.85 L/s to 2.40 +/- 1.29 L/s at short term and to 2.56 +/- 1.70 L/s at long term. Eight patients out of the 23 had to undergo a second endoscopic procedure: 3 patients for granul oma vaporization; 1 patient to change a malpositioned stent; 2 patients to add a second stent because of insufficient tracheal enlargement; and 2 pati ents to resect mucosal membranes between the 2 stent rings and to place a s econd stent. Optical control of the accurate positioning and use of this mo del of Gianturco prosthesis helped to avoid the severe complications descri bed in the literature (migration, extrusion, fracture, wall erosion, and he morrhage). The followup must particularly target the prevention of granulom as. The self-expandable Gianturco prosthesis can be advocated for long-term palliative treatment of tracheal stenoses that are inoperable by an extern al surgical approach.