Treatment of airway obstruction by metallic stents in infants and children.

OBJECTIVE

The internal metallic stent is a relatively new and controversial method for the treatment of airway collapse in infants and children. The study examined the outcomes of this treatment in a large group of patients and defined clear indications for airway stenting.

METHODS

A retrospective review was conducted of 32 patients in whom 42 stents were inserted. The patients were divided into three groups with respect to the stented segment: group A, trachea (n = 14); group B, bronchi (n = 16); and group C, trachea and bronchi (n = 2).

RESULTS

In 30 cases, there was immediate improvement of respiratory obstruction, and 23 patients could be weaned, at least temporarily, from ventilation. Excessive granulation developed after the stenting in 26 patients. In 6 patients, all in group A, the granulation and inflammatory reaction generated severe airway obstruction, necessitating thoracotomy in 2 cases. One patient died of airway obstruction, and another died during the attempt to remove the stent; both were in group A. Stents placed for 2 to 72 months (mean 8.7 months) have now been removed in 11 patients. Six children are alive and well with stents in place, 2 from group A and 4 from group B. Fifteen patients died during the follow-up period; in 13 cases, death was related to the associated disease.

CONCLUSION

The use of metallic stents, especially in the trachea, is associated with a high rate of complications. Granulation tissue, which often develops after stenting, is a major concern. Removal of the stents is arduous and carries a high risk of complications. The use of stents should be restricted to the limited situations in which conventional initial therapy has failed.