Granulomatous Tracheal Stenosis after Sleeve Resection Successfully Treated by a Stent-in-stent Procedure Using Z-stent Partially Covered with Polyurethane

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  • ポリウレタン外張り両端フレアー型金属ステントを用いた Stent-in-stent により治療し得た気管形成術後肉芽腫性高度気管狭窄の 1 例

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A 47-year-old man suffering from anastomotic stenosis after sleeve resection of the carina due to tracheal adenoid cystic carcinoma presented with imminent asphyxia. An uncovered z-stent successfully dilated the stenosis, however, restenosis of the lumen caused by granuloma formation reacting to the presence of the stent occured 18 months later. Because Nd-YAG laser irradiation with limited success resulted in mucosal edema at the site of the stenosis causing imminent asphyxia, emergency placement of a stent-in-stent was performed. The stent constructed by the author was by joining 4 z-stents constructed of 0.016 inch stainless-steel guidewire, and the central portion was wrapped with 0.035 mm thick polyurethane membrane. The size of this partially covered stent was 18 mm in proximal and distal diameter, 10 mm in central diameter, 55 mm long, and both ends flared outwards. It was positioned accurately dilating the stenosis under fluoroscopic guidance via a 18 Fr. teflon sheath. The covered portion compressed the granuloma, and there was no migration of the stent or occlusion of the orifice of right main bronchus. The symptoms disappeared immediately after stenting and the patient has been alive for 8 months. It is considered that a z-stent partially covered with a polyurethane membrane is suitable for the management of severe tracheal stenosis and long-term observation is expected in the present case.

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