Efficacy and Safety of a Retrieval Hook for Removal of Retrievable Expandable Tracheobronchial Stents
Section snippets
Patients
Between December 1997 and October 2003, 91 covered retrievable nitinol stents were placed in 72 patients with benign and malignant tracheobronchial strictures. Patients included were from the authors' previous reports (11, 12). In this study, 31 patients underwent stent removal. Forty-five tracheobronchial stents were removed from 31 patients: 37 of 45 tracheobronchial stents were removed from 23 patients with benign tracheobronchial strictures; eight tracheobronchial stents were removed from
RESULTS
Forty-one of 45 tracheal or bronchial stents (91.1%) were successfully removed with a retrieval hook by the standard (n = 37), proximal mesh (n = 1), or eversion (n = 3) techniques. Four stents that could not be removed with a retrieval hook were removed by rigid bronchoscopy with use of general anesthesia. After stent removal, all patients showed improvement of symptoms such as dyspnea and pain.
Twenty-nine of 45 stents (all 10 migrated stents, two stents with tumor overgrowth, two misplaced
DISCUSSION
Although expandable metallic stent placement for benign and malignant tracheobronchial strictures has been introduced as an easy, effective, and safe therapeutic option, the greatest hurdle is stent removal when complications occur or when the stent is no longer needed. A major indication of difficulty in stent removal is excessive tissue hyperplasia through the mesh of the stent, especially in uncovered metallic stents. Some authors reported the use of general anesthesia and forceps/rotation
Acknowledgments
The authors thank Bonnie Hami, MA, Department of Radiology, University Hospitals Health System, Cleveland, OH, for her editorial assistance in the preparation of this manuscript.
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Removal of covered metallic stents with a bullet head for bronchopleural fistula using a fluoroscopy-assisted interventional technique
2020, Clinical RadiologyCitation Excerpt :When severe granulation tissue proliferation, restenosis, stent migration, stent fracture, sputum expectoration difficulty, or fistula healing occurs after stent implantation, stents need to be removed or replaced.5–7 Most airway stents are removed under surgical, rigid or flexible bronchoscopy, and occasionally under fluoroscopy.8,9 The present authors have successfully designed and applied a Y-shaped self-expandable covered metallic stent with a bullet head and a hinged self-expandable covered metallic stent with a bullet head to treat BPFs of corresponding types, which not only improves the quality of life of patients but also prolongs survival.
Tracheobronchial Interventions
2020, Image-Guided Interventions: Expert Radiology Series, Third EditionRecurrent Benign Urethral Strictures Treated with Covered Retrievable Self-Expandable Metallic Stents: Long-Term Outcomes over an 18-Year Period
2017, Journal of Vascular and Interventional RadiologyCitation Excerpt :Tissue ingrowth through the interstices between the nitinol wires has been found to result in stent occlusion or luminal narrowing (4,16,17,21,23,25). The use of a covered stent was supposed to avoid tissue ingrowth, but it was observed even when using PU-covered REMSs as a result of PU degradation or separation (23,26–31). To overcome this problem, REMS that were covered with PTFE membrane were developed.
Removal of metallic stents using flexible bronchoscope: Report of 29 cases
2010, Journal of Medical Colleges of PLAManagement of airway involvement of oesophageal cancer using covered retrievable nitinol stents
2009, Clinical RadiologyCitation Excerpt :In patients with complications such as stent migration, the stents were removed using a retrieval set consisting of a sheath, a dilator, and a hook wire. Detailed techniques for airway stent placement and removal were as described previously.25,26 Stent expansion and position were evaluated after airway stent placement by conventional radiography and bronchoscopy.
Use of a Retrievable Metallic Stent Internally Coated with Silicone to Treat Airway Obstruction
2008, Journal of Vascular and Interventional RadiologyCitation Excerpt :The indications for stent removal included stent-related complications (eg, stent migration) or marked granulation tissue formation or tumor growth above or below the stent. The stents were removed under fluoroscopic guidance by using a retrieval hook (9). When the hook grasped and pulled the drawstring of the proximal end of the stent into a sheath, the proximal end collapsed and the stent could be removed (Fig 2).
Supported in part by a grant (#HMP-98-G2–043) for a Highly Advanced National Project, Ministry of Health and Welfare, Republic of Korea.
None of the authors has identified a potential conflict of interest.