Wabip 2016.optima airway stent silione-hybrid, metalic

Name Surname

Title

Conflict of interest disclosure

XI have the following, real or perceived direct or indirect conflicts of interest that relate to this presentation:

Affiliation / financial interest Nature of conflict / commercial company name

Tobacco-industry and tobacco corporate affiliate related conflict of interest

Grants/research support (to myself, my institution or department):

Honoraria or consultation fees:

Participation in a company sponsored bureau:

Stock shareholder:

Spouse/partner:

Other support or other potential conflict of interest:

2013

STENTS used:

Ultraflex (Boston Sc.)

AERO (Merit)

Dumon (Novatech)/Hood (E.Benson Hood)

SOBQ:Short of Breath Questionarie

SF-36 Short Form Health Survey questionnaire

(6-8 weeks)

…..No comments on clinical efficacy

Benefits of airway stenting for CAO.

Timing of airway stenting ?

SPOC = Role of a Silicone Prosthesis to Prevent Airway Obstruction Recurrence in Lung Cancers

75 patients randomized (39 stent ; 36 no stent) primary endpoint : 1 year survival without recurrence >50% Recurrence rate local obstruction strongly decreased in stent arm Survical at 1 year : no difference.

Vergnon et al. ERS Congress 2013 Oral presentation.

Silicone SEMS partially covered

SEMS totally covered

Silicone SEMS partially covered

SEMS fully covered

SETTING AND EQUIPMENTMECHANICAL PROPERTIESMANIPULATION

SPECIAL SITUATIONSCOMPLICATIONS

When no high quality RCT are available extrapolated evidence to “analytic” opinion (Grade D)

?NiceCould be better Yin and Yang

SETTING & EQUIPMENTSilicone SEMS partially

coveredSEMS fully

coveredGeneral anaesthesia

Y Convenient Convenient

C-arm fluoroscopy

N Convenient Convenient

Special equipment (rigid scopes)

Y N N

Sterilazation process (instruments)

Y N N

CLASSIFICATION

1

MECHANICAL PROPERTIESSilicone SEMS partially

coveredSEMS fully

coveredWall thickness 1.5 0.25 0.25Flexibility Low Acceptable Acceptable

Radial compression

Acceptable Low Acceptable

Sealing (fistula) Acceptable High High

Extensibility No Depends manufacturer

Depends manufacturer

CLASSIFICATION

2

Different wall thickness

0.25 mm 1.5 mm

Ext Diam Int Diam r Area

SILICONE SEMS 14 11 5.5 95.03

SEMS 14 13.5 6.75 143.13

48.105 mm2


coveredSEMS fully


Radial compression





CLASSIFICATION

2

CompressionNoppen

Polyflex

Dumon

Microtech

AlveolusUltraflex


coveredSEMS fully


Radial compression





CLASSIFICATION

2

LENGTH

DIAMETER

Fully deployed16 mm

50 mm


coveredSEMS fully


Radial compression





CLASSIFICATION

2

MANIPULATION OF THE STENTSilicone SEMS partially

coveredSEMS fully

coveredSizing Support of rigid

scopesStandard difficulty

Standard difficulty

Loading Can be difficultReloading possible

--Reloading not

possible

--Reloading not

possibleDeployment Blindly Endoscopically

or fluoroEndoscopically

or fluoro

Resposition Easy Can be difficult Can be difficult

Retrival Easy Can be difficult Can be difficult

Customization on site

Easy (length and orifice)

Not possible Not possible

CLASSIFICATION

3

Pushing and pulling back a long Y silicone stent


coveredSEMS fully



Standard difficulty


--Reloading not

possible

--Reloading not



or fluoro






CLASSIFICATION

3


coveredSEMS fully



Standard difficulty


--Reloading not

possible

--Reloading not



or fluoro






CLASSIFICATION

3


coveredSEMS fully



Standard difficulty


--Reloading not

possible

--Reloading not



or fluoro






CLASSIFICATION

3


coveredSEMS fully



Standard difficulty


--Reloading not

possible

--Reloading not



or fluoro






CLASSIFICATION

3

On situ customization of a silicone stent


coveredSEMS fully



Standard difficulty


--Reloading not

possible

--Reloading not



or fluoro






CLASSIFICATION

3

SPECIAL SITUATIONSSilicone SEMS partially

coveredSEMS fully

coveredY stenting Y (better if

simetrical stenosis)

N Y (can adapt to diferent angles and diameters)

Conical shape N Depends manufacturer


Telescoped stent Y, but reducing lumen

Possible, but concerns on non

covered part

Y

Tracheostomy cannula + stent

Y, but reducing lumen

N Y

CLASSIFICATION

4

Full visual control under fluoroscopy

Guide-wire very useful

Can exchange branches

(extending to intermedious

bonchus


coveredSEMS fully








covered part

Y



N Y

CLASSIFICATION

4


coveredSEMS fully








covered part

Y



N Y

CLASSIFICATION

4


coveredSEMS fully








covered part

Y



Y Y

CLASSIFICATION

4

COMPLICATIONSSilicone SEMS partially

coveredSEMS fully covered

Mucostasis Moderate Moderate High

Granuloma Low Moderate Moderate

Fracture/Detachment

N Y Y

Migration Very low Low Low

Tumor ingrowty N Y Y

Pseudomembrane Y N N

CLASSIFICATION

5

Mucosatasis Coat detachment

COMPLICATIONSSilicone SEMS partially


Mucostasis Moderate Moderate High

Granuloma Low Moderate Moderate

Fracture/Detachment

N Y Y

Migration Very low Low Low

Tumor ingrowth N Y Y

Pseudomembrane Y N N

CLASSIFICATION

5

CONCLUSIONSilicone SEMS partially


SETTING AND EQUIPMENTMECHANICAL PROPERTIESMANIPULATION

SPECIAL SITUATIONSCOMPLICATIONS

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Wabip 2016.optima airway stent silione-hybrid, metalic