AIRWAY WELDING: LASER MODIFICATION OF AN AIRWAY STENT AFTER DEPLOYMENT FOR MANAGEMENT OF POST LUNG TRANSPLANT BRONCHIAL STENOSIS

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchial stenosis is the most common airway complication post-lung transplant. We describe a novel technique of stent modification in lung transplant patient with critical bronchial RUL and bronchus intermedius (BI). A bare metal (BMS) iCAST were modified using laser after deployment without any complications. CASE PRESENTATION: 74-year-old man underwent bilateral for IPF. Post course was complicated by recurrent RUL/BI requiring multiple balloon dilations. He presented to our hospital 12 months post severe respiratory distress hypoxic. Despite being placed on HFNC, his oxygenation continued deteriorate. Chest CT showed obstructive atelectasis RLL. Flexible bronchoscopy revealed 1-2 mm BI. After measurements, 6x16 covered deployed The proximal end about 80% airway. Radial cuts made electrocautery knife followed dilation minimal improvement patency. T-1470 LiteTouch used cutting polytetrafluoroethylene (PTFE) covering expose its skeleton. closed forcep bend exposed pillar towards RC1 anchor from moving distally RML, also improving To fully salvage airway, Boston Scientific ExpressTM BMS deployed. Due short segment, jailed mitigate this, breaking three links bending pillars forceps. Balloon welded segment allowed 6 opening mid-section stent, releasing BI stent. Distal segments RML/RLL appeared patent. Succeeding procedure, extubated. Repeat at 4 weeks appropriate position. DISCUSSION: Airway size matching one main variables reducing stent-related Ill-fitting stents shorten life Owing variations anatomy between donors recipients, an ideal does not exist. Our had already tried dilations no avail, so we opted use maintain time seconds W melt cross-links has open-cell design, will deployment. This feature shortening minimizes oversizing jailing. did hold architecture welding. CONCLUSIONS: expect that on-site metallic can be therapy stenosis. REFERENCE #1: Santacruz JF, Mehta AC. complications management transplantation: ischemia, dehiscence, Proc Am Thorac Soc. 2009 Jan 15;6(1):79-93. doi: 10.1513/pats.200808-094GO. PMID: 19131533. #2: Majid A, Kheir F, Chung J, Alape D, Husta B, Oh S, Folch E. Covered Balloon-Expanding Stents Stenosis. J Bronchology Interv Pulmonol. 2017 Apr;24(2):174-177. 10.1097/LBR.0000000000000364. 28323735. DISCLOSURES: No relevant relationships Muhammad Arif, source=Web Response Ilya Berim, Abid Khokar, disclosure submitted Ali Saeed; Andrew Talon, Melinda Wang,