Tracheal Wire Stent Complications in Malacia: Implications of Position and Design

Background. Although expandable endoluminal wire stents that can be incorporated into body tissues are very attractive for use in the airway, disease-related factors that can lead to stent failure have received little attention in the literature. Methods. The cases of all 4 patients who underwent insertion of one or more Gianturco stents into the trachea, main bronchi, or both for tracheobronchial malacia in our institution were reviewed. Results. All three tracheal stents required removal for stent-related complications within the first 6 months. Complications included metallic strut fracture and unraveling or breakage of the encircling nylon suture leading to progressively bizarre and widening radiographic configurations suggesting imminent airway perforation. One of the six bronchial stents disrupted 10 months after insertion. Conclusions. Our findings suggest relatively less dynamic, repetitive bending wire stress in the bronchus (and likewise strictured trachea) compared with the malacic trachea. Although Gianturco stents are easily placed and give excellent functional results, we recommend against their use in the trachea for tracheal malacia. The bronchial position may be reasonably safe. (Ann Thorac Surg 1997;63:209–13)