Airway stenting for central airway obstruction: a review

Abstract

Central airway obstruction is a serious complication of various diseases, most often malignancy. Malignant etiologies include primary lung cancer as most common though metastases from various other cancers can obstruct the airways as well. Benign etiologies include inflammatory or fibrotic changes due to prior airway interventions (e.g., endotracheal intubation or tracheostomy) or specific autoimmune conditions. Different interventional modalities exist including various electrosurgical or mechanical debulking tools, though these are sometimes insufficient or contraindicated for the purpose of restoration of airway patency. The placement of stents is thus needed in certain particularly complex or refractory cases. Airway stenting requires careful patient selection and stent selection along with a thorough knowledge of relevant anatomy and procedural technique. Indeed, certain clinical presentations are better suited for stent placement and more likely to achieve a symptomatic benefit. Moreover, a variety of stents exist with each having different attributes that may better fit specific conditions. Complications must be managed properly as well. These include stent migration, granulation tissue formation, and stent-related infection which can have clinically significant consequences. In this review, we will discuss airway stenting for central airway obstruction with regard to these various subject areas as well as conclude with discussion of future research directions.

Keywords: Airway obstruction; bronchoscopy; interventional pulmonology; stenosis; stent.

Figure 1

Some of the various manifestations of central airway obstruction. In this depiction, this is due to mass effect by tumor.

Figure 2

Example of airway stents produced using 3DP technology. A patient’s CT scan was imported into 3DP software which was then used to produce a negative mold on a 3D printer (A). Silicone was injected into this mold to produce the final stent product (B). 3DP, three-dimensional printing; CT, computed tomography.