Efficacy and Safety of a Retrieval Hook for Removal of Retrievable Expandable Tracheobronchial Stents

https://doi.org/10.1097/01.RVI.0000133506.09685.A3Get rights and content

PURPOSE

To evaluate the efficacy and safety of use of a retrieval hook for removal of retrievable expandable tracheobronchial stents.

MATERIALS AND METHODS

With fluoroscopic guidance, a retrieval hook was used to remove 45 retrievable expandable tracheobronchial stents in 31 patients. Indications for stent removal included tissue hyperplasia (n = 16), stent migration (n = 10), stent misplacement (n = 2), tumor overgrowth (n = 2), persistent gastrobronchial fistula (n = 1), and incompletely expanded stent (n = 1). Thirteen stents were electively removed after temporary use. The success rate, causes of failure, and complications related to stent removal with a retrieval hook were analyzed.

RESULTS

Forty-one of 45 stents (91.1%) were successfully removed with a retrieval hook. The following difficulties were encountered: disruption of the polyurethane membrane (n = 3) and an untied drawstring (n = 1). The removal procedure failed in four cases (8.9%) because of excessive tissue hyperplasia (n = 4) in the proximal portion of the stent. The hook wire fractured in two of the four failed cases. The overall complication rate was 4.4% (minor bleeding, n = 2).

CONCLUSION

For complications with or temporary use of retrievable expandable tracheobronchial stents, removal with a retrievable hook shows promising initial results.

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.

Cited by (32)

  • Removal of covered metallic stents with a bullet head for bronchopleural fistula using a fluoroscopy-assisted interventional technique

    2020, Clinical Radiology
    Citation 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 Edition
  • Recurrent 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 Radiology
    Citation 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.

  • Management of airway involvement of oesophageal cancer using covered retrievable nitinol stents

    2009, Clinical Radiology
    Citation 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 Radiology
    Citation 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).

View all citing articles on Scopus

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.

View full text