Double tracheal stents reduce side effects of progression of malignant tracheoesophageal fistula treated with immunotherapy: A case report

BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case with 10 mo follow-up.CASE SUMMARY Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma.The patient then received four doses of toripalimab.Subsequently,rapid,progressive deterioration of the original fistula was found.Although the fistula enlarged rapidly after immunotherapy,it remained covered completely,and likely because of this,his condition remained stable.Therefore,immunotherapy could be continued to treat the primary tumor.Despite these efforts,the patient died of the advancement of his esophageal cancer.CONCLUSION Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.

Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective:To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula.Methods:Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected,and all patients underwent tracheal silicone stenting,comparing dyspnea classification and Karnofsky score before and after stenting,and conducting post-treatment follow-up.Results:In 32 patients with tracheoesophageal fistula,dyspnea grading improved from grades III and IV to grades 0 to II.Before treatment,10 patients(31.06%)were in grade IV,17 patients(53.12%)were in grade III,and five patients(15.62)were in grade II;after treatment,13 patients(40.63%)were in grade I,12 patients(37.50%)were in grade I,and seven patients(21.87%)were in grade 0(P<0.05);Karnofsky score(37.52±4.86 before treatment)improved significantly to 71.39±8.24 one week after treatment(P<0.05).Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent,11 with silicone 18-14-14 stent,three with silicone Y15-12-12,and seven with silicone stent 16-13-13.Conclusion:Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible,simple,and safe,with reliable near-term efficacy,and is worthy of popularization and application.

Preparation and Research of a Bionic Woven Tracheal Stent with Horizontal Pipeline

The paper designed a bionic woven tracheal stent and the stent was a multi-layer tubular structure with a transverse pipeline.Polydioxanone( PDO) monofilament and β-hydroxybutyrate and β-hydroxyvalerate copolymers/polylactic( PHBV/PLA) multifilament were chosen as the tissue engineering tracheal stent materials,and chitosan was chosen as the coating material. This study selected appropriate basic fabric structures and prepared the tracheal stent by setting reasonable weaving parameters,then treated the sample with coating and heat setting. Radical compression performances of the horizontal pipeline and longitudinal pipeline of this tracheal stent were investigated,and the experimental results showed that the stent had good performance on radial supporting force and elastic recovery,which meant it could supply adequate supports for cell growth and tissue regeneration of tracheal lesions; the horizontal pipeline could provide a good experimental foundation for reconstruction of the cartilage ring.

Self-Expanding Nitinol Stent for Treatment of Tracheal Stenosis Caused by Pulmonary Hypertension:1 case report

A 38 year-old man was admitted because of half a year of recurrent bouts of eough and shortness of breath and 20 days of hemoptysis. He had been apparently healthy until the illness. In the recent 6 months, the dyspnea and fatigue gradually onset and became more severe, the hemoptysis being 100-200 mL per day. Spells of chest pain are associated with coughing. Despite accepting antibiotic and antispasmodic therapy in a hospital, there was no obvious improvement and he was transferred to our hospital. Physical examination on admission: He was in acute distress and anemic face With P 110/min., R 30/min., T36. 8oC and Bp 100/60 mmHg. There were Wheezes, medium and fine

A novel wavy non-uniform ligament chiral stent with J-shaped stress-strain behavior to mimic the native trachea

Tracheal stents are an important form of treatment for benign or malignant central airway obstruction.However,the mechanical behavior of current tracheal stents is significantly different from that of the native trachea,which leads to a variety of serious complications.In this study,inspired by the structure of the native trachea,a wavy non-uniform ligament chiral tracheal stent is proposed,in which J-shaped stress-strain behavior and negative Poisson's ratio response are achieved by replacing the tangential ligament of tetrachiral and anti-tetrachiral hybrid structure with a wavy non-uniform ligament.Through the combination of theoretical analysis,finite element analysis and experimental tests,a wide range of desired J-shaped stress-strain curves are explored to mimic the native porcine trachea by tailoring the stent geometry.Besides,the negative Poisson’s ratio and auxetic diameter curves versus axial strain of the stent are also studied in detail,thus contributing to the enhancement of cross-section ventilation and reducing the migration of the stent.This novel tracheal stent with a unique microstructure shows a potential to perfectly match the physiological activities of the native trachea and thereby reduce potential complications.

Preparation and characterization of paclitaxel-loaded poly lactic acid-co-glycolic acid coating tracheal stent

Background In-stent restenosis caused by airway granulation poses a challenge due to the high incidence of recurrence after treatment.Weekly applications of anti-proliferative drugs have potential value in delaying the recurrence of airway obstruction.However,it is not practical to subject patients to repeated bronchoscopy and topical drug applications.We fabricated novel pacilitaxel-eluting tracheal stents with sustained and slow pacilitaxel release,which could inhibit the formation of granulation tissue.And we assessed the quality and drug release behaviors of drug-eluting stents （DESs） in vitro.Methods Stents were dipped vertically into a coating solution prepared by dissolving 0.5 g （2％ w/v） of poly lactic acid-coglycolic acid （PLGA） and 0.025 g （0.1％ w/v） of pacilitaxel in 25 ml of dichloromethane.DES morphology was examined by scanning electron microscopy （SEM）.Pacilitaxel release kinetics from these DESs was investigated in vitro by shaking in PBS buffer followed by high performance liquid chromatography （HPLC）.Results Using an orthogonal experimental design,we fabricated numerous pacilitaxel/PLGA eluting tracheal stents to assess optimum coating proportions.The optimum coating proportion was 0.1％ （w/v） pacilitaxel and 2％ （w/v） PLGA,which resulted in total pacilitaxel loading of （16.380 6±0.002 1） mg/stent.By SEM the coating was very smooth and uniform.Pacilitaxel released from DES was at （0.376 3±0.003 8） mg/d,which is a therapeutic level.There was a prolonged,sustained release of pacilitaxel of ＞40 days.Conclusions Paclitaxel-loaded PLGA coating tracheal stents were successfully developed and evaluated.Quality assessments demonstrated favorable surface morphology as well as sustained and effective drug release behavior,which provides an experimental reference for clinical practitioners.

Design of 4D printed shape-changing tracheal stent and remote controlling actuation

has a good application prospect.The biodegradable stent can effectively reduce the damage to patients and improve the therapeutic performance of stents.In this work,a series of shape memory polylactic acid(Fe_(3)O_(4))composite tracheal stents were manufactured by 4D printing.The composite tracheal stents with different structures were designed.Moreover,with the addition of magnetic particles Fe3 O4,the shape memory PLA/Fe_(3)O_(4)composite tracheal stent has a magnetic driving effect.Under the magnetic field,the shape recovery process is completed within 40 s,and the shape recovery rate is more than 99%.Moreover,the 4D printed tracheal stent was also triggered by the irradiation of infrared lamp to realize the remote controlling recovery.The research on the structure design and driving method of 4D printing tracheal stent expands the application scope of shape memory polymer composites in biomedical field,provides a new way for personalized implantable medical devices and minimally invasive surgery.It is of great significance for better precision medical treatment.

A comprehensive review on metallic biomaterials for airway stenosis repair

In recent years,the incidence of airway stenosis in respiratory diseases increases year by year.Among many treatment methods,tracheal stent implantation is a very effective way.Metallic stents have been the first choice for tracheal stent implantation due to their excellent mechanical properties,low rate of migration,and minimal effect on the ciliary movement of the trachea.In this paper,the research progress of metal tracheal stents is introduced in detail from three aspects of mechanical properties,degradation properties,and biocompatibility,including traditional inert metallic tracheal stents and new degradable metallic tracheal stents,and its future research and development are prospected:although the current research on biodegradable metal tracheal stents is still in its infancy,with only some studies of magnesium-based,iron-based,and zinc-based tracheal stents,they are considered as the best material for preparing future metal tracheal scaffolds considering their biodegradability and biocompatibility.