Implantation of Accuflex and Strecker Stents in Malignant Bronchial Stenoses by Flexible Bronchoscopy

• Published in: Chest Vol. 112; no. 1; pp. 134 - 144
• Main Authors: Hauck, Rainer W., Lembeck, Rolf M., Emslander, Hans P., Schömig, Albert
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.07.1997; American College of Chest Physicians
• Subjects: Accuflex stent; Alloys; Anesthesia, Local; Biological and medical sciences; bronchial carcinoma; Bronchial Diseases - etiology; Bronchial Diseases - physiopathology; Bronchial Diseases - therapy; bronchial occlusion; bronchial stenosis; Bronchoscopes; Bronchoscopy - methods; Constriction, Pathologic - etiology; Constriction, Pathologic - physiopathology; Constriction, Pathologic - therapy; Equipment Design; Esophageal Neoplasms - complications; Esophageal Neoplasms - mortality; Female; flexible bronchoscopy; Follow-Up Studies; Humans; Lung Neoplasms - complications; Lung Neoplasms - mortality; Male; Medical sciences; Middle Aged; nitinol stent; Pneumology; Respiratory Function Tests; Stents; Strecker stent; Survival Rate; Tantalum; tantalum stent; Time Factors; Tumors of the respiratory system and mediastinum; Strecker stent; tantalum stent; bronchial carcinoma; bronchial occlusion; flexible bronchoscopy; Accuflex stent; nitinol stent; bronchial stenosis; Bronchoscopy; Human; Lung disease; Respiratory disease; Prosthesis; Instrumentation therapy; Bronchus; Stenosis; Implantation; Palliative treatment; Malignant tumor; Stent; Bronchopulmonary; Flexible; Equipment; Bronchus disease; Complication; Endoscopy; Technique; Comparative study
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.112.1.134

Silicone and metal stents are available for the treatment of malignant bronchial stenoses. This project sought to compare the self-expanding nitinol Accuflex stent (Boston Scientific Corp; Watertown, Mass) with the passively expandable tantalum Strecker stent (Boston Scientific Corp; Watertown, Mass), both implanted by flexible bronchoscopy under local anesthesia and sedation. In 51 patients with malignant bronchial stenosis, 14 nitinol and 51 tantalum stents were used and stenoses of 75 to 100% were treated. The intervention was successful in all but one patient; a mean patency of 93% was achieved. In the follow-up period, the probability of survival was significantly lower in patients with total bronchus occlusion than in patients with stenotic alterations (44 vs 109 days; p<0.05). In 10 patients, lung function analysis after stent implantation revealed a significant increase in PaO2 (65 vs 71 mm Hg; p<0.01), inspiratory vital capacity (2.5 vs 2.7 L; p<0.05), and FEV1 (1.8 vs 2.0 L; p<0.05). Mucus retention was the main (39%) adverse factor in the early phase after stent implantation, whereas tumor penetration became the most frequent problem (67%) in the later phase. Recanalizing interventions were necessary in 18% of the cases in which tumor penetration occurred. Stent distortion occurred in 12 patients with Strecker and in none with Accuflex stents. In comparison to the Strecker stent, the self-expanding Accuflex stent is preferable owing to its excellent flexibility and faster delivery system. Both types of stents could be sufficiently deployed within the lesion and allowed for highly precise positioning. Furthermore, no general anesthesia was required. The fiberbronchoscopic mode of implantation under sedation is very efficient even for tumor patients with severe impairment of their physical and respiratory condition.