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

Abstract

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.