Figure 1
A covered retrievable expandable stent
A covered retrievable expandable stent.
Clinical History
A 61-year-old woman presented with dyspnea and was referred to our department after a few days of tracheal intubation.
Imaging Findings
A 61-year-old woman presented with dyspnea, which developed one month ago, and was referred to our department. Two months ago, she underwent tracheal intubation for 5 days. A plain radiograph and 3D
CT showed concentric narrowing at the middle portion of the trachea. A retrieval expandable stent was placed at the stenotic segment and 6 months after it was removed.
Discussion
In the recent past, different kinds of covered and uncovered expandable metallic stents have been used successfully in patients with tracheobronchial stenosis (1–5). However, the use of
uncovered expandable metallic stents has some limitations, not only because the uncovered stents are not suitable for the treatment of esophagorespiratory fistula, but also because mucosal
hyperplasia or progressive tumor ingrowth through the openings between the stent struts of the uncovered stents tends to cause progressive dyspnea. It is also interesting to note that the longer a
follow-up period, the higher the recurrence rate and fracture and/or migration rate of the stent (4,5). Thus, treatment with uncovered expandable metallic stent is effective in patients with dyspnea
due to malignant tracheobronchial stenosis and is less effective in patients with benign stenosis because of delayed complications. To overcome the limitations of uncovered expandable metallic
stents, we used a polyurethane-covered retrievable expandable stent and a device to remove that stent. The covered retrievalable expandable metallic stent has several advantages over the conventional
uncovered expandable metallic stent such as a little chance of tumor ingrowth, little chance of stent struts fracture, can be easily relocatable or removable if placed incorrectly, and can be easily
removable if it causes complications. The covered stent, however, has important limitations. The insertion of a covered stent within the distal bronchial tree may occlude an orifice to an upper lobe,
whereas placement at the level of the main carina may lead to obstruction of the main bronchus. In addition, the covered stent may hinder the mucociliary movements of the normal tracheobronchial
tree.
Differential Diagnosis List
Stenosis due to endotracheal tuberculosis.
Final Diagnosis
Stenosis due to endotracheal tuberculosis.
References
[1] Song HY, Shim TS, Kang SG, et al. Tracheobronchial strictures: Treatment with a polyurethane-covered retrievable expandable nitinol stentInitial experience. Radiology 1999; 213:905-912. (PMID: 11058659)
[2] Miyayama S, Matsui O, Kamimura R, Kakuta K, Takashima T. Partially covered Gianturco stent for tracheobronchial stricture caused by intraluminal tumor. Cardiovasc Intervent Radiol 1997; 20:60-62. (PMID: 8994727)
[3] Schmidt B, Massenkeil G, John M, Arnold R, Witt C. Temporary tracheobronchial stenting in malignant lymphoma. Ann Thorac Surg 1999; 67:1448-1450. (PMID: 10355429)
[4] Perini S, Gordon RL, Golden JA, LaBerge JM, Wilson MW, Kerlan RK. Deformation and migration of Palmaz stents after placement in the tracheobronchial tree. J Vasc Interv Radiol 1999; 10:209-215. (PMID: 10082110)
Case information
| URL: | https://eurorad.org/case/815 |
| DOI: | 10.1594/EURORAD/CASE.815 |
| ISSN: | 1563-4086 |
Figure 2
The steps involved in the placement of a stent
A plain radiograph showing a focal stenosis at the trachea.
The stenotic segment being dilated with a balloon catheter.
The stent being placed at the stenotic trachea. Note an hourglass deformity of the stent from the stenosis.
The stent being fully expanded without migration, one week after the placement.
The stent being retrieved with a hook wire 6 months after the placement. Note a collapsed proximal segment of the tracheal stent during removal of the stent.
A plain radiogram obtained 4 months after the stent removal showing the well-expanded previous tracheal stenosis.
A covered retrievable expandable stent
A covered retrievable expandable stent.
The steps involved in the placement of a stent
A plain radiograph showing a focal stenosis at the trachea.
The stenotic segment being dilated with a balloon catheter.
The stent being placed at the stenotic trachea. Note an hourglass deformity of the stent from the stenosis.
The stent being fully expanded without migration, one week after the placement.
The stent being retrieved with a hook wire 6 months after the placement. Note a collapsed proximal segment of the tracheal stent during removal of the stent.
A plain radiogram obtained 4 months after the stent removal showing the well-expanded previous tracheal stenosis.
