Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

Abstract

Purpose: To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. Materials and Methods: We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. Results: We achieved technical success in all the three patients with immediate relief of dyspnea. Conclusion: Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.

Keywords

Fluoroscopy - local anesthesia - malignant tracheal stricture - self-expandable nitinol stent - transnasal bronchoscopy

Publication History

Article published online:
30 July 2021

• References

• 1 Breitenbücher A, Chhajed PN, Brutsche MH, Mordasini C, Schilter D, Tamm M. Long-term follow-up and survival after ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration 2008;75:443-9.
• 2 Profili S, Manca A, Feo CF, Padua G, Ortu R, Canalis GC, et al. Palliative airway stenting performed under radiological guidance and local anesthesia. Cardiovasc Intervent Radiol 2007;30:74-8.
• 3 Shin JH, Kim SW, Shim TS, Jung GS, Kim TH, Ko GY, et al. Malignant tracheobronchial strictures: Palliation with covered retrievable expandable nitinol stent. J Vasc Interv Radiol 2003;14:1525-34.
• 4 Shin JH, Song HY, Shim TS. Management of tracheobronchial strictures. Cardiovasc Intervent Radiol 2004;27:314-24.
• 5 Conacher ID. Anaesthesia and tracheobronchial stenting for central airway obstruction in adults. Br J Anaesth 2003;90:367-74.
• 6 Finlayson GN, Brodsky JB. Anesthetic considerations for airway stenting in adult patients. Anesthesiol Clin 2008;26:281-91, vi.
• 7 Tanigawa N, Sawada S, Okuda Y, Sougawa M, Komemushi A, Kojima M, et al. Expandable metallic stent placement in upper tracheal stenosis: Value of laryngeal masks. AJR Am J Roentgenol 2001;177:1423-6.
• 8 Rees CJ. In-office unsedated transnasal balloon dilation of the esophagus and trachea. Curr Opin Otolaryngol Head Neck Surg 2007;15:401-4.
• 9 Verma SP, Smith ME, Dailey SH. Transnasal tracheoscopy. Laryngoscope 2012;122:1326-30.
• 10 ASGE Technology Committee, Rodriguez SA, Banerjee S, Desilets D, Diehl DL, Farraye FA, et al. Ultrathin endoscopes. Gastrointest Endosc 2010;71:893-8.
• 11 Juvekar NM, Neema PK, Manikandan S, Rathod RC. Anesthetic management for tracheal dilatation and stenting. Indian J Anaesth 2003;47:307-10.
• 12 Puma F, Ragusa M, Avenia N, Urbani M, Droghetti A, Daddi N, et al. The role of silicone stents in the treatment of cicatricial tracheal stenoses. J Thorac Cardiovasc Surg 2000;120:1064-9.
• 13 Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: Long-term outcomes analysis. Chest 2003;124:1993-9.
• 14 Schmidt B, Olze H, Borges AC, John M, Liebers U, Kaschke O, et al. Endotracheal balloon dilatation and stent implantation in benign stenoses. Ann Thorac Surg 2001;71:1630-4.
• 15 Hong SH, Moon YE, Lee SR, Cho SJ, Kwon OK. Anesthetic management for the insertion of a self-expandable metallic tracheal stent under venovenous extracorporeal membrane oxygenation. Korean J Anesthesiol 2012;63:569-70.
• 16 Herth F, Becker HD, LoCicero J 3 rd , Thurer R, Ernst A. Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy. Chest 2001;119:1910-2.