Silicone Stents in the Management of Inoperable Tracheobronchial Stenoses – Discussion (2)

A correctly positioned stent represents much less of an irritation than the obstruction it relieved and improves the expectoration of mucus dramatically, although the stented area is devoid of the normal mucociliary clearance mechanism. However, in contrast to the report of Dumon, migration remains a problem in certain types of stenoses. Our five migrations all occurred in short (<2.5 cm axial length) and conical stenoses with mostly intact mucosa, although adequate-size stents had been chosen. This is not surprising as the cylindrical Dumon stent does not fit a conical airway, and short stents have very few studs on the outside. This becomes especially important when the stenotic airway is lined with smooth mucosa and there is no intraluminal tumor growth permitting firm anchorage of the studs. We therefore think that this type of stenosis presents a clear limitation for an otherwise excellent stent. In this situation, we prefer to insert Gianturco stents for vital indications although we have observed tumor growth through the wire mesh.
Complications were rare and mostly reversible (mucus obstruction, migration). The endobronchial fire taught us to temporarily remove an indwelling stent before a subsequent laser session. Mucus obstructions were easily relieved by fiberoptic bronchoscopy and further impactions were prevented by regular inhalation of saline solution. Migrations resulted in serious coughing and increased dyspnea but the clinical picture was not life-threatening.