Airway stents: Current practice and future directions

摘要

Historical evolution of airway stents began with the adaptation of endoprosthesis used in vascular and gastrointestinal procedures. In 1990, Jean-Francois Dumon published the first report of a dedicated silicone airway stent with a unique delivery system that continues to be used nowadays. Since then, additional developments in airway stenting have occurred such as the development of new alloys for self exapandable metallic stents with and without coverings. Stents are currently used for a wide variety of indications such as treatment of benign or malignant tracheobronchial stenosis with good symptom relief, quality of life and performance status scores in patients undergoing treatment for malignant airway involvement. Airway stents are also indicated in selected cases of benign airway obstruction and closure of trachea-esophageal or other types of fistulous tracts involving the central airways. Self-expandable metallic stents offer distinct advantages such as ease of placement, avoidance of use of general anesthetics and specific disadvantages such as granulation tissue formation and difficulty in manipulation and removal after placement. Current challenges in airway stenting include short and long term complications such as migration, granulation tissue, airway secretion management and stent infections. New technology is currently under development including drug-eluting airway stents, biodegradable stents and three-dimensional printing to achieve better conformation to the size and anatomy of the airway.