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J Thorac Cardiovasc Surg 2005;130:146-150
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Treatment of airway obstruction by metallic stents in infants and children

^a Department of Pediatric Surgery, Dana Children’s Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
^b Department of Anesthesiology, Dana Children’s Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Received for publication December 8, 2003; revisions received August 25, 2004; accepted for publication October 12, 2004.

^_* Address for reprints: Itzhak Vinograd, MD, Department of Pediatric Surgery, Dana Children’s Hospital Sourasky Medical Center, Tel-Aviv, Israel (Email: vinopesu{at}tasmc.health.gov.il).

OBJECTIVE: The internal metallic stent is a relatively new and controversial method for the treatment of airway collapse in infants and children. The study examined the outcomes of this treatment in a large group of patients and defined clear indications for airway stenting.

METHODS: A retrospective review was conducted of 32 patients in whom 42 stents were inserted. The patients were divided into three groups with respect to the stented segment: group A, trachea (n = 14); group B, bronchi (n = 16); and group C, trachea and bronchi (n = 2).

RESULTS: In 30 cases, there was immediate improvement of respiratory obstruction, and 23 patients could be weaned, at least temporarily, from ventilation. Excessive granulation developed after the stenting in 26 patients. In 6 patients, all in group A, the granulation and inflammatory reaction generated severe airway obstruction, necessitating thoracotomy in 2 cases. One patient died of airway obstruction, and another died during the attempt to remove the stent; both were in group A. Stents placed for 2 to 72 months (mean 8.7 months) have now been removed in 11 patients. Six children are alive and well with stents in place, 2 from group A and 4 from group B. Fifteen patients died during the follow-up period; in 13 cases, death was related to the associated disease.

CONCLUSION: The use of metallic stents, especially in the trachea, is associated with a high rate of complications. Granulation tissue, which often develops after stenting, is a major concern. Removal of the stents is arduous and carries a high risk of complications. The use of stents should be restricted to the limited situations in which conventional initial therapy has failed.

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