"The role of tracheal stenting in the alternative treatment of tracheal stenosis"

1. "The role of tracheal stenting in the alternative treatment of tracheal stenosis" Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital, Mashad, IRAN Bannazadeh M. MD Assistant professor of thoracic surgery, Valiasr Hospital, Tehran, IRAN

2. Etiology of tracheal stenosis • Common cause: • Prolonged intubation • Tracheal tumor (benign or malignant) • Uncommon cause: • Trauma • Infection • Postaspiration

3. Treatment of tracheal stenosis • The best method of treatment is tracheal resection. • Tracheal surgery demands very skilled surgeons. • The most important complication of tracheal resection is tracheal stenosis. • The best method of treatment in posttracheal resection stenosis is repeated tracheal resection.

4. Material & method • This is a prospective study (case series) in patients with tracheal stenosis who weren’t candidate for tracheal surgery in Tehran Vali Asr hospital from 2001 to 2003. • Patient selection : • Inoperable tracheal malignancy • Non tumoral stenosis which is complicated with previous surgery • Inability to stand a major operation (poor general condition or CNS problem)

5. Method of study • Patient’s that Exclude from study: • Inability to perform rigid bronchoscopy (vocal cod paralysis) • Patient’s disagreement • Follow up less than 6 month

6. Stent properties • Polyflex stent with introducer system • Silicon stent with polyester mesh for maintaining airway patency • Size : inner diameter : 6-22 mm in 2 mm steps length : 20-80 mm in 10 mm steps

7. Appropriate stent size • Stent internal diameter: Maximum size of tracheal dilation with rigid bronchoscope +3mm +4mm • Stent length: length of stenosis +2cm

8. Technique of stent insertion

9. Technique of stent insertion

10. Technique of stent insertion

11. Technique of stent insertion

12. Technique of stent insertion

13. Technique of stent insertion

14. Technique of stent insertion

15. Technique of stent insertion

16. Technique of stent insertion

17. Technique of stent insertion

18. Technique of stent insertion

19. Technique of stent insertion

20. Internal view of trachea after stent insertion

21. Radiography of patient after stent insertion

22. Radiography of patient after stent insertion

23. Result of study

24. Age frequency 10 to 19 y 8.33% 50 to 59 y 16.67% 40 to 49 y 8.33% 20 to 29 y 41.67% 30 to 39 y 25%

25. Sex frequency Female 33.33% Male 66.67%

26. The cause of tracheal stenosis Chemical gas inhalation 8.33% Tracheal malignancy 16.67% Post intubation 75%

27. Time between extubation and beginning of symptom’s of stenosis 31 to 45 days 22.22% 0 to 15 days 22.22% 16 to 30 days 55.66%

28. Internal diameter of stenosis

29. Evaluation of stent efficacy • Clinical symptoms: • Improvement of stridor • Activity of patient

30. Evaluation of stent efficacy

31. Evaluation of stent efficacy

32. Evaluation of stent efficacy • (B) Paraclinic study : • P.F.T (before and after stental inserties) • Peakflowmetry (before and after stental inserties) Displacement of 3 columned 8.33% Displacement of 1 columned 33.33% Displacement of2 columned 58.33%

33. Stenting complications Without complication 25% With complication 75%

34. Stenting complication Intera operative 11.11% Immediately 11.11% Late 77.78%

35. Late complication 80% 77.78% 70% 60% 44.44% 50% 40% 30% 20% 11.11% 11.11% 11.11% 10% 0 Tumoral growth Granulation tissue Retention of secretion Automatic stental extrusion Mouth bad smell

36. Duration of stenting 0 to 30 days 20% 91 to 120 days 30% 61 to 90 days 30% 31 to 60 days 20%

37. Cause of stent removal • In benign disease : The stent was removed in 30% of patients in ideal time (3 to 4 month) without complication but in 70% of patients because of some complications we removed had to stent obligatory in less than 3 month.

38. Cause of early stent removal Mouth bad smell 14.29% granulation 85.71%

39. Cause of stent removal (B) In malignancy : In one patient stent was kept in place until death time but in one patient because of tumoral ingrowth at first the stent was removed and after rigid bronchoscopy, tumor removed and the stent replaced again and patient was reffered to radiotherapy.

40. conclusion • Stent removal in benign conditions showed signs of recurrence which needed another alternative treatment. This problem makes the role of stent insertion questionable. But the use of stent in malignant conditions is indicated where it is the only alternative, and its role is approved.