Endotracheal nitinol stents

Lessons from the learning curve

Bianca Siegel, John P. Bent, Robert F. Ward

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective. To reflect on lessons learned placing endotracheal nitinol stents in children. Study Design. Case series with chart review. Setting. Tertiary care children's hospital. Subjects and Methods. All children who underwent nitinol cervical tracheal stenting were included. Records were carefully reviewed for intraoperative and postoperative complications, management choices, outcomes, and factors that influenced results. Results. Between 1999 and 2011, 7 children underwent 13 stent placements. Median follow-up was 5 years (range, 1-12 years). Six patients underwent stenting as a salvage procedure following open attempts at airway reconstruction. Four patients remain decannulated with their stent in place (median follow-up 7 years). The fifth patient had his stent removed endoscopically after 50 days because it became apparent that his obstruction was primarily laryngeal. The sixth child had his stent removed via a tracheal fissure after 14 months because of recalcitrant subglottic inflammation at the superior stent border. The seventh patient was decannulated for over 2 years but ultimately required tracheotomy replacement because of stenosis with the stent lumen. Complications included stent migration (23%), restenosis (29%), edema (29%), and granulation (57%). Conclusion. Endotracheal nitinol stents provide a realistic opportunity for decannulation in children for whom other options have failed but should be reserved only as a salvage procedure in severely complicated airways. Our experience has taught valuable lessons about stent indications, sizing, characteristics, and deployment, as well as means to avoid and manage their complications.

Original languageEnglish (US)
Pages (from-to)671-677
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume148
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

Fingerprint

Learning Curve
Stents
nitinol
Tracheotomy
Intraoperative Complications
Tertiary Healthcare
Edema
Pathologic Constriction
Inflammation

Keywords

  • Decannulation
  • Nitinol stent
  • Pediatric airway
  • Pediatric tracheal obstruction
  • Subglottic stenosis
  • Tracheomalacia

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

Cite this

Endotracheal nitinol stents : Lessons from the learning curve. / Siegel, Bianca; Bent, John P.; Ward, Robert F.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 148, No. 4, 04.2013, p. 671-677.

Research output: Contribution to journalArticle

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abstract = "Objective. To reflect on lessons learned placing endotracheal nitinol stents in children. Study Design. Case series with chart review. Setting. Tertiary care children's hospital. Subjects and Methods. All children who underwent nitinol cervical tracheal stenting were included. Records were carefully reviewed for intraoperative and postoperative complications, management choices, outcomes, and factors that influenced results. Results. Between 1999 and 2011, 7 children underwent 13 stent placements. Median follow-up was 5 years (range, 1-12 years). Six patients underwent stenting as a salvage procedure following open attempts at airway reconstruction. Four patients remain decannulated with their stent in place (median follow-up 7 years). The fifth patient had his stent removed endoscopically after 50 days because it became apparent that his obstruction was primarily laryngeal. The sixth child had his stent removed via a tracheal fissure after 14 months because of recalcitrant subglottic inflammation at the superior stent border. The seventh patient was decannulated for over 2 years but ultimately required tracheotomy replacement because of stenosis with the stent lumen. Complications included stent migration (23{\%}), restenosis (29{\%}), edema (29{\%}), and granulation (57{\%}). Conclusion. Endotracheal nitinol stents provide a realistic opportunity for decannulation in children for whom other options have failed but should be reserved only as a salvage procedure in severely complicated airways. Our experience has taught valuable lessons about stent indications, sizing, characteristics, and deployment, as well as means to avoid and manage their complications.",
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