The use of self-expandable metallic stents in the airways in the adult population

Abstract

The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the “gold standard” for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.

Keywords::

• airway stenting
• benign airway stenosis
• bronchoscopy
• central airway obstruction
• self-expandable metallic stent

Acknowledgements

The authors would like to thank L Freitag (Essen, Germany) for sharing his huge knowledge and experience in airway stenting.

Financial & competing interests disclosure

H Dutau is a consultant for Novatech SA. AI Musani is a consultant for Boston Scientific, USA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The use of self-expanding metallic stents (SEMS) may be considered for the treatment of malignant central airway obstruction due to extrinsic disease.

• SEMS may be used to maintain airway patency following endobronchial debulking techniques.

• SEMS can be used to restore or maintain airway patency in conjunction with other treatments such as external beam radiotherapy.

• Patients require careful specialist follow-up after stent insertion.

• Stents should be used with caution in non-malignant disease, considering their long-term complications. SEMS may be difficult to remove following long-term placement.

• SEMS should only be used in benign disease after all other therapeutic options have been exhausted.

• A risk–benefit assessment should be performed, incorporating immediate and long-term implications, prior to selecting any particular type of stent.