A retrospective comparison of silicone and hybrid metal tracheobronchial Y stents

Abstract

Background: Malignant central airway obstruction (MCAO) is a common and deadly complication of both lung cancer and non-lung cancers that have metastasized to the lungs. Tumors affecting the main carina offer a particular challenge and often require a specialized tracheobronchial Y stent placement. Historically, silicone Y stents have been the only Y stents available, however, newer hybrid metal Y stents have emerged as potential treatment options. We sought to compare various technical factors of silicone and hybrid Y stent placement.

Methods: Patients diagnosed with primary or secondary lung cancer who underwent bronchoscopic stenting for MCAO at Roswell Park Comprehensive Cancer Center between 2014 and 2024 were included in this study. Data were collected on demographics, disease characteristics, bronchoscopy procedures, associated complications, and subsequent interventions. Procedure duration, complication rates, and the need for future interventions were compared between silicone and hybrid Y stents using the Mann-Whitney U test, Fisher's exact test, and the Chi-squared test.

Results: After a thorough review, 34 patients were included in the study, with 14 receiving hybrid metal stents and 20 receiving silicone stents. The procedure time for hybrid stents was significantly shorter than that for silicone stents (56 vs. 91 minutes, P=0.001). Additionally, patients with hybrid metal stents required fewer repeat bronchoscopies (mean: 0.21 vs. 1.15, P=0.03). There were no significant differences between the two groups in terms of early or late complications, 30-day mortality rates, or the degree of obstruction improvement.

Conclusions: Hybrid metal Y stents may have an advantage in speed of placement and the need for repeat bronchoscopies while having a similar degree of improvement in obstruction and complication rates.

Keywords: Malignant central airway obstruction (MCAO); hybrid metal Y stent; procedure time; silicone Y stent.

Figure 1

Bronchoscopic image with MCAO visualized from trachea into main stem bronchi (on the left), after hybrid metal stent placement (top right), after silicone stent placement (bottom right). MCAO, malignant central airway obstruction.