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Stenting at the Flow-limiting Segment in Tracheobronchial Stenosis due to Lung Cancer

Department of Pulmonary Medicine, Hiroshima City Hospital; Department of Internal Medicine, Fukushima Co-op Hospital; Department of Pulmonary Medicine, Hiroshima Prefectural Hospital; and Department of Surgery, Hiroshima National Hospital, Hiroshima City, Hiroshima, Japan

Correspondence and requests for reprints should be addressed to Teruomi Miyazawa, M.D., Ph.D., Department of Pulmonary Medicine, Hiroshima City Hospital, 7-33 Naka-Ku, Moto-machi, Hiroshima, Japan 730-8518. E-mail: miyazawt{at}carrot.ocn.ne.jp

Airway stenting at the wave-speed flow-limiting segment (the choke point) is assessed. We determined prospectively the precise location of the choke point using the flow–volume curve, endobronchial ultrasonography, ultrathin bronchoscopy, and three-dimensional computed tomography scan before and after stenting in 64 patients with extrincic compression due to lung cancer. We noted distinct flow–volume curve patterns specific to the type of stenosis. The tracheal stenosis group indicated fixed narrowing patterns with an expiratory plateau, bronchial stenosis group dynamic collapse patterns with an expiratory flow deterioration (choking), carinal stenosis group combined fixed and dynamic patterns, and extensive stenosis group complex patterns containing elements of all the former. After stenting, almost full-function patterns with significant improvement in PEF were observed in all groups (p < 0.01, p < 0.05, p < 0.001, p < 0.01, respectively). In patients with extensive stenosis, implantation of additional stents was required when the choke points were observed to have migrated to the areas of malacia with cartilage destruction by the tumor. Secondary stenting at migrated choke points resulted in a significant improvement in PEF over the initial stenting (p < 0.01). Stenting at the choke point improved expiratory flow limitation by increasing the cross-sectional area, supporting the weakened airway wall and relieving dyspnea.

Key Words: choke point • expiratory flow limitation • dynamic airway collapse • flow–volume curve

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