Management of malignant carinal involvement using ‘side‐by‐side’ method of bilateral self‐expandable metallic stents

• Published in: Respirology case reports Vol. 7; no. 2; pp. e00396 - n/a
• Main Authors: Takeda, Takayuki, Itano, Hideki, Wakasa, Ryo, Saitoh, Masahiko, Takeda, Sorou
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.02.2019; John Wiley & Sons, Inc
• Subjects: Airway management; Bilateral self‐expandable metallic stents; Case reports; Case Series; central airway obstruction; interventional pulmonology; Lung cancer; malignant main carinal involvement; side‐by‐side method; central airway obstruction; Bilateral self‐expandable metallic stents; side‐by‐side method; interventional pulmonology; malignant main carinal involvement
• ISSN: 2051-3380; 2051-3380
• DOI: 10.1002/rcr2.396

Central airway obstruction caused by cancer requires urgent interventional pulmonology. Malignant main carinal involvement is one of the most challenging situations, usually treated by rigid bronchoscopic intervention under general anaesthesia. However, these patients tend to be in poor condition due to underlying malignancy. Therefore, less‐invasive strategies are needed. Six patients with lung cancer exhibiting malignant carinal involvement treated using the ‘side‐by‐side’ method of bilateral self‐expandable metallic stents using fibre‐optic bronchoscopy under topical anaesthesia were retrospectively investigated. The median procedure time was 29.5 min (range: 23–38), and the palliation of dyspnoea was achieved in all cases. The median survival time after intervention was 58.5 days (range: 23–172). The cause of death was acute coronary syndrome in two patients, aspiration pneumonia in two, upper gastrointestinal perforation in one, and catheter‐related blood stream infection in one. This strategy was less invasive and suitable for patients with poor performance status. Central airway obstruction (CAO) is critical and life‐threatening for cancer patients and is categorized as an oncological emergency that requires urgent intervention. Malignant carinal involvement is considered one of the most difficult situations among CAO, which is usually treated by rigid bronchoscopic intervention under general anaesthesia. The application of ‘side‐by‐side’ method of bilateral self‐expandable metallic stents has been reported in the management of malignant carinal involvement. This technique is useful in the treatment of patients of poor performance status who would not tolerate general anaesthesia. We retrospectively analysed six patients who were treated by this method in terms of effectiveness, tolerance, and safety of the procedure.