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• W4387247943 abstract "SESSION TITLE: Stent It Up! SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Tracheal stents have high likelihood of migration which can lead to airway compromise and glottic injury (1). External fixation of tracheal silicone stents for benign diseases has previously been described to anchor these stents to the anterior tracheal wall to prevent migration (2). We now present two cases in which external fixation of tracheobronchial stents was used to treat patients with tracheal obstruction due to malignant airway disease. CASE PRESENTATION: The indication for both cases was tracheal narrowing from thyroid cancer. One case was anaplastic thyroid cancer with extrinsic compression of the upper trachea. The other case was angioinvasive oncocytic follicular carcinoma of the thyroid with invasion to the trachea which required debulking procedure of tracheal mass prior to stent placement. Both patients underwent rigid bronchoscopy under general anesthesia with balloon dilatation prior to placement of Ultraflex tracheobronchial covered metallic stents (Boston Scientific, MA). Once stent position was satisfactory, a 22 gauge lumbar puncture needle was introduced in to the trachea through the stent under direct visualization and a 2-0 prolene suture was inserted through the needle. The needle was then removed and re-inserted under direct visualization in close proximity to the first point of entry. A Core Dx mini-forceps (Boston Scientific, MA) was then introduced through the needle to grasp the prolene suture and bring it out to the skin. A silicon button was then used to anchor the suture and the stent to the skin. Post intervention, both patients received treatment with inhaled bronchodilators, mucolytics as well as total of 7 days antibiotics. Both patients noted significant improvement in symptoms post-intervention and continued treatment with chemoradiation. One patient did go on to develop a neck/chest wound that required longer course of antibiotics. The other patient was eventually transitioned to comfort care 8 weeks after stent placement due to progressive cancer. Repeat bronchoscopic evaluation for both patients was consistent with intact positioning of stent. DISCUSSION: External fixation of tracheal stents can provide significant improvement in quality of life for patients with malignant airway disease. Given minimally invasive, it can lead to quicker recovery time when compared to traditional surgical options and it can expand treatment options for those patients who are not considered ideal surgical candidates. Care should be taken to identify deviated tracheal anatomy and a low threshold to administer antibiotics due to higher risk of skin breakdown and infections thereof. CONCLUSIONS: External fixation of covered metallic tracheobronchial stents is a helpful technique that can be used in symptom palliation for malignant compression of the trachea and minimize risk of stent migration. REFERENCE #1: Lee HJ, Labaki W, Yu DH, Salwen B, Gilbert C, Schneider ALC, Ortiz R, Feller-Kopman D, Arias S, Yarmus L. Airway stent complications: the role of follow-up bronchoscopy as a surveillance method. J Thorac Dis. 2017 Nov;9(11):4651-4659. doi: 10.21037/jtd.2017.09.139. PMID: 29268534; PMCID: PMC5721036. REFERENCE #2: Niwa H, Oki M, Saka H, Torii A, Yamada A, Shigematsu F, Ishida A, Kogure Y. External fixation of airway stents for upper tracheal stenosis and tracheoesophageal fistula. Interact Cardiovasc Thorac Surg. 2021 Aug 18;33(3):442-447. doi: 10.1093/icvts/ivab098. PMID: 33880543; PMCID: PMC8923419. DISCLOSURES: Consultant relationship with VisionAir Solutions Please note: 02/2022 - 03/2022 Added 12/01/2022 by Sameer Avasarala, source=Web Response, value=Consulting fee No relevant relationships by Nicole Fowler No relevant relationships by Damarys Hernandez No relevant relationships by Shawn Li No relevant relationships by Tanmay Panchabhai No relevant relationships by Benjamin Young" @default.
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• W4387247943 date "2023-10-01" @default.
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• W4387247943 title "ROLE OF EXTERNAL FIXATION OF COVERED METALLIC STENTS IN SYMPTOM PALLIATION IN MALIGNANT COMPRESSION OF THE TRACHEA" @default.
• W4387247943 doi "https://doi.org/10.1016/j.chest.2023.07.3486" @default.
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