Endoscopically placed nitinol stents for pediatric tracheal obstruction

Mukesh Prasad, John P. Bent, Robert F. Ward, Max M. April

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: To provide preliminary clinical data regarding endoscopically placed nitinol stents for children with tracheal obstruction as a temporizing measure to allow for trach tube decannulation while awaiting growth to allow for tracheal resection. Methods: This case series describes the experiences of two children (ages 5 and 15) who were dependent upon tracheotomy because of acquired tracheal obstruction. Both patients had combined tracheomalacia and tracheal stenosis. After failing tracheoplasty with rib graft augmentation both patients suffered from extensive tracheal disease, which was too long to allow for immediate tracheal resection. Intervention: Endoscopic placement of nitinol stents in the obstructed tracheal segment using fluoroscopic guidance. All tracheotomy tubes were removed immediately after successful stent deployment with the patient still under general anesthesia. Results: Four stents were placed in total. The first patient's initial stent was too narrow and was, therefore, removed and replaced at a later date with a larger diameter stent. The second patient experienced distal migration of his initial stent requiring stent removal and replacement at a later date. Both patients remain successfully decannulated (follow-up, 25 and 26 months) and are currently living more normal lives as they grow and await tracheal resection. Conclusion: Preliminary use of nitinol stents for pediatric tracheal obstruction has enabled successful decannulation in two children with complicated airways. Our results with this series of patients suggest that nitinol stents can be safely used in children as a temporizing measure until tracheal resection can be safely performed. With this approach children can live free from the hassles of trach care, social isolation and peer ridicule. Limited pediatric experience exists in the literature about nitinol stents. Thus, our experience with stent selection and placement will help others avoid problems encountered in this initial series.

Original languageEnglish (US)
Pages (from-to)155-160
Number of pages6
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume66
Issue number2
DOIs
StatePublished - Nov 11 2002

Fingerprint

Stents
Pediatrics
Tracheotomy
Tracheal Diseases
nitinol
Tracheomalacia
Tracheal Stenosis
Social Isolation
Ribs
General Anesthesia
Transplants

Keywords

  • Nitinol stent
  • Stent
  • Tracheal obstruction
  • Tracheomalacia

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Endoscopically placed nitinol stents for pediatric tracheal obstruction. / Prasad, Mukesh; Bent, John P.; Ward, Robert F.; April, Max M.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 66, No. 2, 11.11.2002, p. 155-160.

Research output: Contribution to journalArticle

Prasad, Mukesh ; Bent, John P. ; Ward, Robert F. ; April, Max M. / Endoscopically placed nitinol stents for pediatric tracheal obstruction. In: International Journal of Pediatric Otorhinolaryngology. 2002 ; Vol. 66, No. 2. pp. 155-160.
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abstract = "Objective: To provide preliminary clinical data regarding endoscopically placed nitinol stents for children with tracheal obstruction as a temporizing measure to allow for trach tube decannulation while awaiting growth to allow for tracheal resection. Methods: This case series describes the experiences of two children (ages 5 and 15) who were dependent upon tracheotomy because of acquired tracheal obstruction. Both patients had combined tracheomalacia and tracheal stenosis. After failing tracheoplasty with rib graft augmentation both patients suffered from extensive tracheal disease, which was too long to allow for immediate tracheal resection. Intervention: Endoscopic placement of nitinol stents in the obstructed tracheal segment using fluoroscopic guidance. All tracheotomy tubes were removed immediately after successful stent deployment with the patient still under general anesthesia. Results: Four stents were placed in total. The first patient's initial stent was too narrow and was, therefore, removed and replaced at a later date with a larger diameter stent. The second patient experienced distal migration of his initial stent requiring stent removal and replacement at a later date. Both patients remain successfully decannulated (follow-up, 25 and 26 months) and are currently living more normal lives as they grow and await tracheal resection. Conclusion: Preliminary use of nitinol stents for pediatric tracheal obstruction has enabled successful decannulation in two children with complicated airways. Our results with this series of patients suggest that nitinol stents can be safely used in children as a temporizing measure until tracheal resection can be safely performed. With this approach children can live free from the hassles of trach care, social isolation and peer ridicule. Limited pediatric experience exists in the literature about nitinol stents. Thus, our experience with stent selection and placement will help others avoid problems encountered in this initial series.",
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