Endotracheal Nitinol Stents: Lessons from the Learning Curve. Issue 4 (15th January 2013)

• Record Type: Journal Article
• Authors: Siegel, Bianca; Bent, John P.; Ward, Robert F.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 148:Issue 4(2013)
• Page Start: 671
• Page End: 677
• Publication Date: 2013-01-15
• Subjects: pediatric airway -- nitinol stent -- subglottic stenosis -- tracheomalacia -- decannulation -- pediatric tracheal obstruction; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599812474235
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: To reflect on lessons learned placing endotracheal nitinol stents in children. Study Design: Case series with chart review. Setting: Tertiary care children's hospital. Subjects and Methods: All children who underwent nitinol cervical tracheal stenting were included. Records were carefully reviewed for intraoperative and postoperative complications, management choices, outcomes, and factors that influenced results. Results: Between 1999 and 2011, 7 children underwent 13 stent placements. Median follow‐up was 5 years (range, 1‐12 years). Six patients underwent stenting as a salvage procedure following open attempts at airway reconstruction. Four patients remain decannulated with their stent in place (median follow‐up 7 years). The fifth patient had his stent removed endoscopically after 50 days because it became apparent that his obstruction was primarily laryngeal. The sixth child had his stent removed via a tracheal fissure after 14 months because of recalcitrant subglottic inflammation at the superior stent border. The seventh patient was decannulated for over 2 years but ultimately required tracheotomy replacement because of stenosis with the stent lumen. Complications included stent migration (23%), restenosis (29%), edema (29%), and granulation (57%). Conclusion: Endotracheal nitinol stents provide a realistic opportunity for decannulation in children for whom other options have failed but should be reserved only as a salvage procedure in severely complicated airways. Our experience has taught valuable lessons about stent indications, sizing, characteristics, and deployment, as well as means to avoid and manage their complications.