The role of airway stents in the management of pediatric tracheal, carinal, and bronchial disease

Objective: A variety of stents are available to aid in the management of co mplex tracheal, carinal and bronchial stenoses. We reviewed our multi-insti tutional experience with airway stents in children. Methods: Thirty-three c hildren (age, 13 days-18 years) from four institutions have had a total of 40 stents placed to aid in the management of complex airway stenoses. Three stent types were utilized: 29 silastic stents, five expandable metal stent s and six customized carinal stents (four patients had two stents and one p atient had four stents). Thirty children had tracheal stents, six children had bronchial stents, and two infants had carinal stents (three children ha d stenting of more than one area and two had stenting of all three location s). Twenty-eight patients (age, 5 months- 18 years; mean, 8.06 years; SEM, 1.13 years) had stents placed after a variety of airway reconstructive proc edures. Four underwent stenting in a non-operative setting and one as preop erative stabilization. Results: Twenty-seven patients survived. One patient died early due to bleeding. Five patients died late: two due to bleeding, one from mediastinitis, and two patients with functional airways died late from unrelated problems. Complications are related to stent type and locati on. Carinal stents can migrate; several techniques are available to help ma nage this problem. Wire stents are essentially non-removable requiring peri odic dilation. Silastic stents stimulate granulation tissue formation requi ring periodic bronchoscopic removal. Conclusion: Tracheal stenting can aid in the management of pediatric airway problems. Complications are common, b ut can be managed with appropriate intervention (C) 2000 Elsevier Science B .V. All rights reserved.