Progressive experience in tracheal stenting with self-expandable stents

We experienced an unacceptably high 21% complication rate with the stainless steel Gianturco stent: a 68-month mean follow-up (range: 37–96 months) of 23 patients revealed three stent fractures and two migrations. Consequently, we began using nitinol mesh stents (Ultraflex) for fibrous stenoses and silicone-covered prostheses (Rush) for proliferative tracheal tumors. The extractable nitinol stent, made from alloy with thermal memory, was palliatively used in 15 patients with fibrous tracheal stenosis; the mean follow-up currently covers 21 months (range: 1–60 months). The silicone-covered prosthesis was used for two patients with inoperable tracheal tumor; follow-up covers 4 months and 2 months, respectively. The prostheses were positioned under visual guidance via the endoscopic approach. The median forced inspiratory volume in 1 s (FIV₁) improved from 2.1 l/s (IQR: 0.7–2.4) to 3.2 l/s (IQR: 0.9–3.4) ( P =0.018, Wilcoxon signed rank test). The median ratio of peak inspiratory flow (PIF 50%) to peak expiratory flow (PEF 50%) was 1.0 preoperatively (IQR: 0.8–1.5) and 1.8 postoperatively (IQR: 0.6–6.3). Between months 1 and 12, six granulomas developed. Five were treated with antibiotics and steroid aerosol inhalation therapy and one required CO₂ laser vaporization. On day 10, one stent migration was observed. The migrated stent was substituted. To date, no stent fracture has been observed. Nitinol and silicone-covered prostheses can be proposed for the palliative treatment of fibrous tracheal stenoses and tracheal tumors, respectively.