Majid Adnan, Kheir Fayez, Chung Jey, Alape Daniel, Husta Bryan, Oh Scott, Folch Erik
*Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center ¶Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA ‡Interventional Pulmonology, California Pacific Medical Center, San Francisco ∥Interventional Pulmonology, University of California, Los Angeles, CA §Interventional Pulmonology, Lenox Hill Hospital, New York, NY.
J Bronchology Interv Pulmonol. 2017 Apr;24(2):174-177. doi: 10.1097/LBR.0000000000000364.
The balloon-expanding stents are widely available but rarely described for use within the tracheobronchial tree. This report describes our experience with these stents in airway stenosis particularly as a lobar salvage therapy.
This was a retrospective review of all records in which the balloon-expanding stents were used at a tertiary medical center. Ages, sex, location of stenosis, etiology of stenosis, stent size, duration of stent placement and associated interventions for airway stenosis were recorded. Patient's self-reported respiratory symptoms, dyspnea scale, and radiographic imaging at baseline and after stent placement were also reported.
Twenty-one Atrium iCAST stents were inserted in 18 patients with malignant and benign airway disease. The median age was 69.5 years (interquartile range, 53.5 to 74). Most stents (n=20, 95%) were deployed in the lobar airways. There was a significant improvement in the modified Medical Research Council dyspnea scale from median of 3 to 2 (P<0.05). Self-reported respiratory symptoms improved in 14 patients (78%, P<0.05). Radiographic improvement post Atrium iCAST stent placement was achieved in 15 patients (83%). No deaths were related to airway stenting complications. Adverse events related to stents included migration (n=2, 9.5%), granulation tissue formation (n=2, 9.5%) and mucus plugging (n=1, 4.8%).
Lobar stenting with balloon-expanding metallic stents appears feasible, safe and improves symptoms as well as radiographic atelectasis in patients with lobar airway stenosis in this small case series. Larger studies are needed to confirm this observation and to address long-term safety.
球囊扩张支架已广泛应用，但在气管支气管树中的应用却鲜有报道。本报告描述了我们在气道狭窄中使用这些支架的经验，特别是作为一种肺叶挽救治疗方法。
这是一项对三级医疗中心所有使用球囊扩张支架记录的回顾性研究。记录患者的年龄、性别、狭窄部位、狭窄病因、支架尺寸、支架置入持续时间以及气道狭窄的相关干预措施。还报告了患者自我报告的呼吸症状、呼吸困难量表以及支架置入前后的影像学检查结果。
18例患有恶性和良性气道疾病的患者共置入了21枚Atrium iCAST支架。中位年龄为69.5岁（四分位间距为53.5至74岁）。大多数支架（n = 20，95%）置入了肺叶气道。改良医学研究理事会呼吸困难量表从中位数3显著改善至2（P < 0.05）。14例患者（78%，P < 0.05）自我报告的呼吸症状有所改善。15例患者（83%）在置入Atrium iCAST支架后影像学表现有所改善。无死亡与气道支架置入并发症相关。与支架相关的不良事件包括移位（n = 2，9.5%）、肉芽组织形成（n = 2，9.5%）和黏液堵塞（n = 1，4.8%）。
在这个小病例系列中，对于肺叶气道狭窄患者，使用球囊扩张金属支架进行肺叶支架置入似乎可行、安全，且能改善症状以及影像学上的肺不张。需要更大规模的研究来证实这一观察结果并探讨长期安全性。
