Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for patients with complex tracheobronchial stenosis: initial clinical experience

PURPOSE

We aimed to report our preliminary results of subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for patients with complex lower tracheal-carinal-main bronchial complex stenosis.

MATERIALS AND METHODS

Seven consecutive patients with lower tracheal-carinal-main bronchial complex stenosis underwent Y-shaped stent insertion under local anesthesia. During the procedure, subcarinal ventilation was performed using a 4 F angiographic catheter, and stent insertion was performed under the protection of ventilation. Data on technical success, clinical outcome, and follow-up were collected and analyzed.

RESULTS

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia was technically successful in all patients without any major procedure-related complications. Seven stents were inserted in seven patients. Respiratory function improved in all patients, with the Hugh-Jones classification of respiratory status improving from grade IV–V before stenting to grade I–II after stenting. During the follow-up, one patient experienced re-stenosis of the stent. Average survival time was 185.7 days (range, 96–285 days) after the stenting procedure.

CONCLUSION

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia can be an effective, simple, and safe method for lower tracheal-carinal-main bronchial complex stenosis.Airway stenosis is usually caused by local primary lung cancer, esophageal cancer, or some other mediastinal tumors. Airway stent insertion is an effective and widely used method to manage this condition (1, 2). However, as the stent introducer sheath or bronchoscopy can aggravate hypoxia, asphyxia is the most serious procedure-related complication during airway stenting or interventional bronchoscopy. The incidence of asphyxia was reported in 1.5%–14.3% of cases undergoing airway stent insertion (2–4).To overcome this complication, Dolan et al. (5) used a thin ventilation catheter to support tracheobronchial stent insertion for three patients with tracheobronchial stenosis. Before stent insertion, the distal tip of the ventilation catheter was placed across the stenosis for ventilation, and then the stent insertion was performed under the protection of ventilation. However, there is no similar technique used for placement of Y-shaped airway stent. In this study, we reported our initial clinical experience of subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for seven patients with lower tracheal-carinal-main bronchial complex stenosis.