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J Thorac Cardiovasc Surg 2008;136:1328-1335
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Factors leading to tracheobronchial self-expandable metallic stent fracture

Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan

Received for publication July 14, 2007; revisions received March 10, 2008; accepted for publication May 4, 2008.

^_* Address for reprints: Han-Pin Kuo, MD, PhD, Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun Hwa N Rd, Taipei, Taiwan. (Email: q8828{at}ms11.hinet.net).

Objective: This retrospective study was to determine factors that contribute to self-expandable metallic stent fracture in patients with tracheobronchial disease.

Methods: From 2001 to 2006, 139 patients (age, 62.1 ± 15.4 years; range, 23–87 years) with benign (n = 62) and malignant (n = 77) tracheobronchial disease received 192 Ultraflex (Boston Scientific, Natick, Mass) self-expandable metallic stents (98 in patients with benign disease and 94 in patients with malignant disease).

Results: Seventeen fractured self-expandable metallic stents were found; the incidence was 12.2% (17/139 patients) among patients with tracheobronchial disease. Tortuous airway (odds ratio, 4.06; 95% confidence interval, 1.04–18.34; P = .04) independently predicted self-expandable metallic stent fracture. Most self-expandable metallic stent fractures (64.7%, 11/17) were detected 500 to 1000 days after self-expandable metallic stent implantation. Clinical presentations for patients with fractured self-expandable metallic stents included dyspnea exacerbation (70.6%, 12/17) and cough (23.5%, 4/17).

Conclusions: Self-expandable metallic stent fracture is not uncommon in patients with tracheobronchial disease. Tortuous airway is an independent predictor for it. Although management of the fractured self-expandable metallic stent in our study was feasible and safe, self-expandable metallic stents should be restricted to a more select population.

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