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| |  New Airway Stent Improves Quality of Life in Cancer Patients: Presented at CHEST By John Gever CHICAGO, IL -- October 24, 2007 -- A new self-expanding hybrid airway stent improved breathing ability and quality of life in patients with malignant airway obstructions, according to research presented here at CHEST 2007, the annual meeting of the American College of Chest Physicians. Two types of airway stents have been used in recent years to prevent growths in and around bronchial tubes from reducing airway patency. These are self-expanding metal stents (SEMS) and silicone stents. SEMSs are simpler to insert but cannot easily be removed later. Silicone stents can be removed easily, but the initial placement requires rigid bronchoscopy and general anaesthesia. Michael A. Jantz, MD, Associate Professor of Medicine and Director of Interventional Pulmonology, University of Florida College of Medicine, Gainesville, Florida, United States, presented results on a new type of stent that incorporates features of both types of stents. This hybrid stent, which was introduced commercially in the United States in February 2007, is made of an expandable nickel-titanium alloy mesh that is completely coated with a polyurethane membrane. Like SEMS, it can be placed with a flexible bronchoscope under local anaesthesia, but it is designed not to lodge permanently in the airway. In their study, Dr. Jantz and colleagues enrolled 56 patients with cancerous airway obstructions, median age 65.7 years, who were treated at 11 centres in the United States and Europe. Physicians rated ease of placement, and patients were evaluated for dyspnoea and lumenal patency at 1 week and 30 and 90 days after the stent was placed. Patients regularly used nebulised albuterol to reduce mucus accumulation. Dr. Jantz said 88% of patients showed increases of greater than 50% in lumenal patency, and stenosis was decreased by a mean of 65% among all patients. With 45 patients evaluable 1 week after stent placement, 37 showed improved dyspnoea scores, significantly more than would be expected from random chance (P <.05), Dr. Jantz said. Improved dyspnea was considered to equate with better quality of life. The significant improvement was maintained at 30 days (P <.05). In addition, 22 of 31 evaluable patients continued to show improvement in dyspnoea relative to baseline. At the 90-day evaluation, 16 patients had survived, too few to permit a statistically significant improvement, Dr. Jantz said. Mean survival among patients in the trial was 45 days. Physicians rated the hybrid stent as simple to place, with a mean score of 3.6 on a scale of 1 to 4. The stent designers met their goal of making it easy to remove perhaps too well, Dr. Jantz said. Migration of the stent from its original location was found in seven patients, including two who coughed out the device. However, he said, the manufacturer has now modified the stent design to include struts that are intended to better hold the stent in place. Dr. Jantz said, stent removal in the patients with migration problems was accomplished without complications. Other potential adverse effects, such as mucus accumulation, in-folding or fractures did not occur in the trial. The nebulised albuterol treatment was key to preventing mucus buildup, he said. Funding for this study was provided by Alveolus Inc., manufacturer of the hybrid stent.
[Presentation title: A Prospective Multicenter Trial of a Self-expanding Hybrid Stent in Malignant Airway Obstruction. Abstract 883]
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