Customized self-expanding bare metal Y stents in the treatment of malignant carinal stenosis: a retrospective analysis

Abstract

BACKGROUND: Self-expanding Y metal stent insertion is a safe and effective palliative method for malignant lesions involving the lower trachea, tracheal carina, and the main-stem bronchi. However, the length and degree of airway stenosis in different patients tend to vary, which leads to a call for a customized Y stent that could achieve a better treatment effect. METHODS: This retrospective analysis included patients who received customized self-expanding bare metallic Y stents for malignant carinal stenosis at Beijing Tiantan Hospital, Capital Medical University between January 2007 and June 2020. CT scans and initial bronchoscopy were performed to provide reliable data for stent selection and size customization. Data on technical success, clinical success, and follow-up were analyzed. RESULTS: A total of 36 patients (26 males and 10 females; median age, 61 years; age range, 30-83 years) were enrolled. Technical success was 97.2% (35/36), while clinical success was 97.2% (35/36). There was no procedure-related mortality. Out of 35 patients, 4 (11.4%) had stent-associated complications that did not affect the procedure of stent insertion. Re-stenosis of the stent due to tumor progression was the main mid- and long-term stent-related complication (65% and 57.1%, respectively), followed by stent fractures (5% and 14.3%, respectively). CONCLUSIONS: The current study described the design and insertion of customized self-expanding bare metal Y-stents and demonstrated the feasibility of their use for maintaining tracheal and main-stem bronchus patency in malignant carinal stenosis. This approach could be used as a bridging method before commencing adjuvant therapy and final palliative therapy for the relief of symptoms.