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Published ahead of print on February 12, 2004, doi:10.1164/rccm.200312-1784OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 10, May 2004, 1096-1102

A more recent version of this article appeared on May 15, 2004
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Submitted on December 31, 2003
Accepted on February 9, 2004

Stenting at the Flow-Limiting Segment in Tracheobronchial Stenosis Due to Lung Cancer

Teruomi Miyazawa1*, Yuka Miyazu1, Yasuo Iwamoto1, Astuko Ishida1, Koji Kanoh2, Hidetaka Sumiyoshi3, Masao Doi3, and Noriaki Kurimoto4

1 Department of Pulmonary Medicine, Hiroshima City Hospital, Hiroshima, Japan, 2 Department of Internal Medicine, Fukushima Co-op Hospital, Hiroshima, Japan, 3 Department of Pulmonary Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan, 4 Department of Surgery, Hiroshima National Hospital, Higashi Hiroshima, Japan

* To whom correspondence should be addressed. 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 CT 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 peak expiratory flow were observed in all groups (p<0.01, p<0.05, p<0.001, p<0.01, respectively). In cases of 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 peak expiratory flow over the initial stenting (p<0.01). Stenting at the choke point improved expiratory flow limitation by increasing the cross-sectional area, supporting weakened airway wall and relieved dyspnea.
Key words: Choke point, Expiratory flow limitation, Dynamic airway collapse, Flow-volume curve




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