Airway stents are tubular endoluminal devices used to maintain patency of the central airways (trachea and main bronchi) compromised by intrinsic obstruction (tumor, granulation tissue, post-intubation stenosis) or extrinsic compression (mediastinal mass, lymphadenopathy, vascular ring). Available stent types include silicone (Dumon, Polyflex) requiring rigid bronchoscopy for placement and easy repositioning, self-expanding metallic stents (covered or uncovered nitinol, stainless steel) deployed through flexible bronchoscopy for distal lesions, and hybrid stents combining metal scaffolding with silicone covering for tumor in-growth resistance.
Indications include malignant airway obstruction with imminent or established respiratory compromise (advanced lung cancer, esophageal cancer with airway invasion, mediastinal lymphoma, metastatic disease), benign tracheal stenosis from prolonged intubation, post-tracheostomy stenosis, anastomotic complications after lung transplant or sleeve resection, tracheomalacia, and tracheoesophageal fistula. Pre-procedure imaging with CT and bronchoscopic mapping defines lesion length, location, and degree of stenosis, guiding stent selection. Procedures are performed under general anesthesia, often combined with debulking via mechanical removal, electrocautery, argon plasma coagulation, laser, cryotherapy, or photodynamic therapy.
Outcomes depend on indication: malignant obstruction shows immediate symptom relief in 85-95%, with median patency 3-6 months matching survival; benign stenosis has more variable durability with risk of granulation tissue formation requiring repeat interventions. Complications include migration (5-15%), mucus plugging, granulation overgrowth at stent margins, stent fracture, and rare perforation. Routine surveillance bronchoscopy every 3-6 months allows early intervention for these complications. Adjunctive therapies include nebulized saline, mucolytics, and treatment of underlying disease. Patient selection by a multidisciplinary team including interventional pulmonology, thoracic surgery, oncology, and anesthesiology optimizes outcomes.