What is the key question?

• What is the current experience with balloon expandable, covered, stainless steel stents (iCast) in the management of inoperable lobar airway stenosis?

What is the bottom line?

• Historically, lobar and segmental bronchi have not been amenable to stenting and the clinical benefits of lobar stenting remain questionable.
• This retrospective study assessed the feasibility, complications, and long-term impact of using the Atrium iCast stent (a covered stainless steel balloon deployed stent) for management of lobar airway stenosis.
• A total of 122 iCast stents were deployed in 3.5 years in 38 patients with lobar bronchial stenosis of mixed etiology (45% malignant and 55% benign). All stents were placed under general anesthesia using either a supraglottic airway, an endotracheal tube of >8.5mm diameter, or through rigid bronchoscopy. All patients had symptomatic or radiographic improvement. In total, 93% (15/16) showed improvements in their pulmonary function tests, with an average improvement in forced expiratory volume (FEV1) of 12.3% (range, 4%-23%). The mean time to stent revision or removal was 85 days.
• Common complications included migration (10%), granulation tissue formation (5%), deployment malfunction (2%), stent dislodgement immediately after deployment (2%), mucous plugging (1%), and tumor occlusion (1%).
• Overall, the authors denote that stenting small airways for lobar salvage is safe and effective in improving outcomes with regard to symptoms, radiographic improvement, and pulmonary function tests.
• Prospective randomized controlled studies are necessary to further validate the above findings.

Why read on?

• The authors share their extensive experience with the use of iCast stents for lobar bronchial stenting in both malignant and benign airway diseases, a tool that can be potentially incorporated in the armamentarium of every interventional pulmonologist.