Insertion of Central Airway Stents – Endoscopic Vs Fluoroscopic Guided Techniques

Introduction: Tracheal stents are deployed to attenuate intrinsic or extrinsic airway compression. They remain the gold standard for management of airway stenosis, especially when surgical resection is contraindicated. This study aimed to determine whether stent placement, by either fluoroscopic guidance or rigid bronchoscopy, resulted in improved procedural outcomes. Methods: We compared two techniques of tracheal stent insertion and their associated complications. Method one involved insertion of stent under fluoroscopic guidance, while Method two involved placement with rigid bronchoscopy under direct vision. Both techniques require pre-operative airway assessment with Computed Tomography imaging, but require different anesthetic intervention. Data from patients receiving stent insertion over a period of 4 years, at either Nepean Hospital or Beaumont Hospital, was assessed. Results: Both techniques enabled appropriate stent placement, resulting in patent airways and attenuation of dyspnea. Rigid bronchoscopy is advantageous in a setting lacking intraoperative image intensifier or flexible bronchoscopy; however insertion of stents under fluoroscopic guidance enables management of more distal stenosis, an area of challenge for rigid bronchoscopy. Conclusion: Tracheal stenting can be performed via different techniques with similar results in patient outcomes. We demonstrate that tracheal stenting via rigid bronchoscopy can be successfully performed to provide patients with patent airways in the emergency setting and may represent a more viable option in facilities lacking intraoperative image intensifier or flexible bronchoscopy.