1 "The role of tracheal stenting in the alternative treatment of tracheal stenosis" Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital, Mashad, IRAN Bannazadeh M. MD Assistant professor of thoracic surgery, Valiasr Hospital, Tehran, IRAN Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital, Mashad, IRAN Bannazadeh M. MD Assistant professor of thoracic surgery, Valiasr Hospital, Tehran, IRAN

2 Etiology of tracheal stenosis Common cause:Common cause: (a)Prolonged intubation (b)Tracheal tumor (benign or malignant) Uncommon cause:Uncommon cause: (a)Trauma (b)Infection (c)Postaspiration Common cause:Common cause: (a)Prolonged intubation (b)Tracheal tumor (benign or malignant) Uncommon cause:Uncommon cause: (a)Trauma (b)Infection (c)Postaspiration

3 Treatment of tracheal stenosis The best method of treatment is tracheal resection.The best method of treatment is tracheal resection. Tracheal surgery demands very skilled surgeons.Tracheal surgery demands very skilled surgeons. The most important complication of tracheal resection is tracheal stenosis.The most important complication of tracheal resection is tracheal stenosis. The best method of treatment in posttracheal resection stenosis is repeated tracheal resection.The best method of treatment in posttracheal resection stenosis is repeated tracheal resection. The best method of treatment is tracheal resection.The best method of treatment is tracheal resection. Tracheal surgery demands very skilled surgeons.Tracheal surgery demands very skilled surgeons. The most important complication of tracheal resection is tracheal stenosis.The most important complication of tracheal resection is tracheal stenosis. The best method of treatment in posttracheal resection stenosis is repeated tracheal resection.The best method of treatment in posttracheal resection stenosis is repeated tracheal resection.

4 Material & method This is a prospective study (case series) in patients with tracheal stenosis who weren’t candidate for tracheal surgery in Tehran Vali Asr hospital from 2001 to 2003.This is a prospective study (case series) in patients with tracheal stenosis who weren’t candidate for tracheal surgery in Tehran Vali Asr hospital from 2001 to Patient selection :Patient selection : (1)Inoperable tracheal malignancy (2) Non tumoral stenosis which is complicated with previous surgery (3)Inability to stand a major operation (poor general condition or CNS problem)

5 Method of study Patient’s that Exclude from study:Patient’s that Exclude from study: (1)Inability to perform rigid bronchoscopy (vocal cod paralysis) (2)Patient’s disagreement (3)Follow up less than 6 month

6 Stent properties Polyflex stent with introducer systemPolyflex stent with introducer system Silicon stent with polyester mesh for maintaining airway patencySilicon stent with polyester mesh for maintaining airway patency Size : inner diameter : 6-22 mm in 2 mm stepsSize : inner diameter : 6-22 mm in 2 mm steps length : mm in 10 mm steps length : mm in 10 mm steps

7 Appropriate stent size Stent internal diameter: Maximum size of tracheal dilation with rigid bronchoscope +3mm +4mm Stent length: length of stenosis +2cm

8 Technique of stent insertion

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10 Technique of stent insertion

11 Technique of stent insertion

12 Technique of stent insertion

13 Technique of stent insertion

14 Technique of stent insertion

15 Technique of stent insertion

16 Technique of stent insertion

17 Technique of stent insertion

18 Technique of stent insertion

19 Technique of stent insertion

20 Internal view of trachea after stent insertion

21 Radiography of patient after stent insertion

22 Radiography of patient after stent insertion

23 Result of study

24 Age frequency 50 to 59 y 16.67% 10 to 19 y 8.33% 20 to 29 y 41.67% 40 to 49 y 8.33% 30 to 39 y 25%

25 Sex frequency Female33.33% Male66.67%

26 The cause of tracheal stenosis Tracheal malignancy 16.67% Chemical gas inhalation 8.33% Post intubation 75%

27 Time between extubation and beginning of symptom’s of stenosis 31 to 45 days 22.22% 0 to 15 days 22.22% 16 to 30 days 55.66%

28 Internal diameter of stenosis Frequencypercent 0 to 0.5 cm650.00% 0.51 to 0.6 cm325.00% 0.61 to 0.7 cm325.00% Total %

29 Evaluation of stent efficacy (A)Clinical symptoms: 1.Improvement of stridor 2.Activity of patient Activity of patientFrequencyPercent Excellent % Good % Intermediate % Fair 00.00% Total %

30 Evaluation of stent efficacy One month after stent insertion Frequency Percent Excellent216.67% Good650.00% Intermediate % Fair00.00% Total %

31 Evaluation of stent efficacy Two weeks after stent removedFrequencyPercent Excellent00.00% Good218.18% Intermediate 19.09% Fair872.73% Total %

32 Evaluation of stent efficacy  (B) Paraclinic study : 1.P.F.T (before and after stental inserties) 2.Peakflowmetry (before and after stental inserties) Displacement of 3 columned 8.33% Displacement of 1 columned 33.33% Displacement of2 columned 58.33%

33 Stenting complications Without complication 25% With complication 75%

34 Stenting complication Late77.78% Intera operative 11.11% Immediately11.11%

35 Late complication 77.78% Granulation tissue Retention of secretion Automatic stental extrusion Mouth bad smell Tumoral growth 44.44% 11.11% 0 10% 20% 30% 40% 50% 60% 70% 80%

36 Duration of stenting 0 to 30 days 20% 31 to 60 days 20% 61 to 90 days 30% 91 to 120 days 30%

37 Cause of stent removal (A)In benign disease : The stent was removed in 30% of patients in ideal time (3 to 4 month) without complication but in 70% of patients because of some complications we removed had to stent obligatory in less than 3 month.

38 Cause of early stent removal Mouth bad smell 14.29% granulation85.71%

39 Cause of stent removal (B) In malignancy : In one patient stent was kept in place until death time but in one patient because of tumoral ingrowth at first the stent was removed and after rigid bronchoscopy, tumor removed and the stent replaced again and patient was reffered to radiotherapy.

40 conclusion Stent removal in benign conditions showed signs of recurrence which needed another alternative treatment. This problem makes the role of stent insertion questionable. But the use of stent in malignant conditions is indicated where it is the only alternative, and its role is approved.Stent removal in benign conditions showed signs of recurrence which needed another alternative treatment. This problem makes the role of stent insertion questionable. But the use of stent in malignant conditions is indicated where it is the only alternative, and its role is approved.

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