IMPLANTATION OF ACCUFLEX AND STRECKER STENTS IN MALIGNANT BRONCHIAL STENOSES BY FLEXIBLE BRONCHOSCOPY

Silicone and metal stents are available for the treatment of malignant bronchial stenoses. This project sought to compare the self-expanding nitinol Accuflex stent (Boston Scientific Corp; Watertown, Mass) with the passively expandable tantalum Strecker stent (Boston Scientific C orp; Watertown, Mass), both implanted by flexible bronchoscopy under l ocal anesthesia and sedation. In 51 patients with malignant bronchial stenosis, 14 nitinol and 51 tantalum stents were used and stenoses of 75 to 100% were treated. The intervention was successful in all but on e patient; a mean patency of 93% was achieved. In the follow-up period , the probability of survival was significantly lower in patients with total bronchus occlusion than in patients with stenotic alterations ( 44 vs 109 days; p<0.05). In 10 patients, lung function analysis after stent implantation revealed a significant increase in PaO2 (65 vs 71 m m Hg; p<0.01), inspiratory vital capacity (2.5 vs 2.7 L; p<0.05), and FEV1 (1.8 vs 2.0 L; p<0.05). Mucus retention was the main (39%) advers e factor in the early phase after stent implantation, whereas tumor pe netration became the most frequent problem (67%) in the later phase. R ecanalizing interventions were necessary in 18% of the cases in which tumor penetration occurred. Stent distortion occurred in 12 patients w ith Strecker and in none with Accuflex stents. In comparison to the St recker stent, the self-expanding Accuflex stent is preferable owing to its excellent flexibility and faster delivery system. Both types of s tents could be sufficiently deployed within the lesion and allowed for highly precise positioning. Furthermore, no general anesthesia was re quired. The fiberbronchoscopic mode of implantation under sedation is very efficient even for tumor patients with severe impairment of their physical and respiratory condition.