Multidisciplinary airway stent team: A comprehensive approach and protocolfor tracheobronchial stent treatment

Tracheobronchial stents are being used with increasing frequency to treat m ajor airway obstruction from both malignant and benign processes. Tradition ally, stents have been placed via rigid bronchoscopy, flexible bronchoscopy , or fluoroscopy by members of various individual disciplines. We describe a novel multidisciplinary airway stent team (MAST) protocol for tracheobron chial stent placement and endoscopic management of major airway obstruction . A patient with symptoms of airway obstruction is generally first evaluate d with a computed tomography scan and a videotaped flexible bronchoscopy. T hese studies are reviewed by the team otolaryngologist, pulmonologist, and interventional radiologist. A treatment plan, including the type and locati on of stents and the need for adjuvant therapies, is formulated. Stent plac ement is performed in the operating room under general anesthesia. Rigid br onchoscopy, with flexible bronchoscopy and fluoroscopy as needed, allows pr ecise stent placement and the best use of various therapeutic methods. The MAST protocol combines the skills, knowledge, and unique therapeutic option s of specialists from otolaryngology, pulmonology, and interventional radio logy. This approach allows optimal stent placement and the use of other end obronchial therapies, including laser ablation, balloon dilation, photodyna mic therapy, cryotherapy, and brachytherapy. A protocol with representative case reports is presented, along with a review and comparison of several o f our most commonly used stents. Otolaryngologists who practice bronchoesop hagoscopy, by virtue of their operative skill and knowledge of airway manag ement, are well equipped to become leaders of MASTs and are encouraged to i nitiate MASTs at their institutions.