Stenting at the Flow-limiting Segment in Tracheobronchial Stenosis due to Lung Cancer

• Published in: American journal of respiratory and critical care medicine Vol. 169; no. 10; pp. 1096 - 1102
• Main Authors: Miyazawa, Teruomi, Miyazu, Yuka, Iwamoto, Yasuo, Ishida, Atsuko, Kanoh, Koji, Sumiyoshi, Hidetaka, Doi, Masao, Kurimoto, Noriaki
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 15.05.2004; American Lung Association; American Thoracic Society
• Subjects: Adult; Aged; Aged, 80 and over; Airway Obstruction - diagnosis; Airway Obstruction - mortality; Airway Obstruction - therapy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bronchial Diseases - diagnosis; Bronchial Diseases - mortality; Bronchial Diseases - therapy; Bronchoscopy - methods; Cause of Death; Cohort Studies; Constriction, Pathologic; Endosonography - methods; Female; Humans; Intensive care medicine; Lung Neoplasms - diagnosis; Male; Medical sciences; Middle Aged; Prognosis; Prospective Studies; Risk Assessment; Severity of Illness Index; Spirometry; Stents; Survival Rate; Tomography, X-Ray Computed; Tracheal Stenosis - diagnosis; Tracheal Stenosis - mortality; Tracheal Stenosis - therapy; Treatment Outcome; Lung disease; Intensive care; Respiratory disease; Lung cancer; Tracheobronchial; expiratory flow limitation; Stenosis; choke point; flow-volume curve; Bronchopulmonary malignant tumor; dynamic airway collapse; Bronchus disease; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200312-1784OC

Airway stenting at the wave-speed flow-limiting segment (the choke point) is assessed. We determined prospectively the precise location of the choke point using the flow-volume curve, endobronchial ultrasonography, ultrathin bronchoscopy, and three-dimensional computed tomography scan before and after stenting in 64 patients with extrincic compression due to lung cancer. We noted distinct flow-volume curve patterns specific to the type of stenosis. The tracheal stenosis group indicated fixed narrowing patterns with an expiratory plateau, bronchial stenosis group dynamic collapse patterns with an expiratory flow deterioration (choking), carinal stenosis group combined fixed and dynamic patterns, and extensive stenosis group complex patterns containing elements of all the former. After stenting, almost full-function patterns with significant improvement in PEF were observed in all groups (p < 0.01, p < 0.05, p < 0.001, p < 0.01, respectively). In patients with extensive stenosis, implantation of additional stents was required when the choke points were observed to have migrated to the areas of malacia with cartilage destruction by the tumor. Secondary stenting at migrated choke points resulted in a significant improvement in PEF over the initial stenting (p < 0.01). Stenting at the choke point improved expiratory flow limitation by increasing the cross-sectional area, supporting the weakened airway wall and relieving dyspnea.