Complications of metal stent therapy in benign airway obstruction

BACKGROUND: To describe Mayo Clinic's experience with metal stent complications in benign tracheobronchial obstruction. METHODS: Retrospective review of metal stents in benign airway conditions evaluated at Mayo Clinic Rochester, Minnesota. RESULTS: Twenty-eight patients were identified from 1994 to 2006; 16 males and 12 females (mean age 56 y). Mean stent duration was 22 months. Symptoms included cough, dyspnea, and hemoptysis. A metal stent was in the trachea in 8, mainstem bronchus in 12, whereas 8 patients had more than 1 stent. Tracheal stent indications included tracheomalacia, posttracheostomy stricture, idiopathic, and radiation-induced stenosis. Bronchial stent indications included bronchomalacia, postoperative bronchial torsion, Wegener granulomatosis, fibrosing mediastinitis, tracheobronchial papillomatosis, tracheoesophageal fistula, and tuberculosis. All metal stents but two were removed with rigid bronchoscopy. Indications for removal included obstructing granulation tissue, stent migration, wire fracture with granulation, inadequate stent size, and dynamic obstruction. Complications of removal included hemorrhage (>100 mL) in 2 patients. Mean operating time was 127.9 minutes. After stent removal, 10 patients required no further therapy. Silicone stents were inserted in 9, Montgomery T-tube in 4, right pneumonectomy in 2, left pneumonectomy in 1, and tracheal resection with reconstruction in 1 patient. Follow-up revealed 6 patients have died and 4 continue to receive periodic revision of silicone stents. CONCLUSIONS: Metal stent complications in benign tracheobronchial obstruction include obstructing granulation tissue and stent migration. Metal stents may be difficult and time-consuming to remove and, may cause significant hemorrhage during removal. Our experience suggests these devices are not appropriate for long-term management of benign airway lesions.