Airway Stenting for Patients With Benign Airway Disease and the Food and Drug Administration Advisory: A Call for Restraint

摘要

Airway stenting has become a common techniquenfor treating central airway obstruction (CAO)ncaused by a variety of malignant and benign diseases.nThe original stents used by Duvall and Bauer,n1nCooper et al,n2 and Dumon3 were silastic and re-nquired general anesthesia and rigid bronchoscopy fornplacement. The advent of the Wallstent (BostonnScientific Corporation; Natick, MA) introduced annew generation of stents that were metallic, self-nexpanding, and easily deployable, the so-called self-nexpanding metal stent (SEMS). However, the ease ofndeployment came with a cost. Over time, the metal-nlic stents integrate into the airway, leading to com-nplications such as stent fracture, erosion into adja-ncent structures, mucous retention, and granulationntissue formation. This is especially true in patientsnwith benign airway disease, whose life expectancy isnnot inherently limited by their primary disease and innwhom the stents can exist for years. This point wasnhighlighted by Stephens and Wood,n4 who found thatnthe vast majority of all early and late deaths followingnairway procedures for patients with benign andnmalignant CAO occurred in the malignant group.