Ann Thorac Surg 2002;73:944
© 2002 The Society of Thoracic Surgeons
Invited commentary
Keith S. Naunheim, MDa
a Department of Surgery, Saint Louis University Health Sciences Center, 3635 Vista Ave, PO Box 15250, St. Louis, MO 63110-0250, USA
e-mail: naunheim{at}slu.edu
The article by Madden and colleagues describes a small but clinically varied series of patients treated with expandable metallic stents for endobronchial pathology. The results obtained were generally very good with a very high incidence of dyspnea relief and a low incidence of serious complications. This favorable outcome suggests that endobronchial stenting should be in the armamentarium of any thoracic surgeon who deals with serious airway compromise secondary to benign or malignant disease.
However, this article also raises questions. The open mesh portion of the stent becomes incorporated into the respiratory epithelium thus making them difficult, if not impossible, to remove. Is it a good idea to use it, as the authors did, at sites of benign stenosis? Could a silicone stent that could be subsequently removed be utilized instead of a non-removable stent that will persist as a foreign body? Should tracheal tears be treated with covered stents as occurred in two patients in this series (both of whom subsequently died) or is this contraindicated?
There is no question that expandable metallic stents will be of significant benefit in the treatment of endobronchial pathology. However, many questions will only be answered with their continuing use. Will one of the expandable stents (UltraFlex, Gianturco, WallStent) prove to be optimal or will different situations be better handled with different stents? Will there be a continuing role for the use of silicon stents that are potentially removable? When will utilization of covered stents be preferable to uncovered stents? What is certain is that cardiothoracic surgeons should continue to be involved in this form of airway management. Our familiarity with rigid bronchoscopy and critical airway compromise suggests that we are the appropriate physicians to deal with these difficult clinical problems.
Related Article
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Experience with ultraflex expandable metallic stents in the management of endobronchial pathology
- Brendan P. Madden, Subir Datta, and Nick Charokopos
Ann. Thorac. Surg. 2002 73: 938-944.
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