STENT-IN-STENT TECHNIQUE FOR MANAGEMENT OF PERIPHERAL MALIGNANT ENDOBRONCHIAL OBSTRUCTION

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Airway stenting is used to restore patency of airways with malignant obstruction. Stent-in-stent (SIS) technique has been in central airway We describe a case endobronchial obstruction the right upper lobe (RUL) managed SIS technique. CASE PRESENTATION: 56-year-old male history Laryngeal Carcinoma surgical resection and chemo-radiation was transferred for management recurrent hemoptysis lung atelectasis. He tachypneic hypoxic requiring 2L oxygen. Labs revealed leukocytosis, hemoglobin 9.6gm/dl no coagulopathy. CT Chest showed atelectasis due mainstem mass. Rigid bronchoscopy (RB) demonstrated friable mass main stem frank blood airway. Initially Diode laser employed removal pedunculated tumor originating RUL, followed by debulking RB cryoprobe from bronchus intermedius (BI). tamponade argon plasma coagulation were hemostasis. BF-P190 Olympus scope identify distal RUL posterior segment 7x22 mm iCAST stent placed patency. Right middle (RML) lower (RLL) not localized at time. A staged performed few days later. inspection which occlusion end tumor, advancement mild pressure through sub segmental airways, under fluoroscopy guidance second 7x22mm overlapping first stent. Additional BI RLL branches. Under direct visualization 10x38 RLL. remained stable off oxygen post procedure, reinflation lung. discharged bronchodilators hypertonic saline significant improvement his quality life. DISCUSSION: commonly complex balloon expandable stainless steel that fully encapsulated two layers polytetrafluoroethylene. The deployment smallest size 5x16mm largest 10x38mm. smaller can be upsized larger sized shortening length. present placement stents likely traversing hilar establish patency, resulting complete reexpansion CONCLUSIONS: Peripheral occluded malignancy result reinflation, increased pulmonary reserves patient tolerate chemotherapy radiation. customization appropriate REFERENCE #1: Sethi, Sonali, et al. "Clinical Success Stenting Distal Bronchi 'Lobar Salvage’ Bronchial Stenosis:” Journal Bronchology & Interventional Pulmonology, vol. 25, no. 1, 2018, pp. 9–16, doi:10.1097/LBR.0000000000000422. #2: Majid A, Kheir F, Chung J, Alape D, Husta B, Oh S, Folch E.. Covered Balloon-Expanding Stents Stenosis. J Interv Pulmonol. 2017 Apr;24(2):174-177. doi: 10.1097/LBR.0000000000000364.J 2017. PMID: 28323735 DISCLOSURES: No relevant relationships Muhammad Arif, source=Web Response disclosure submitted Ali Saeed; Hursh Sarma, Andrew Talon, Cindrel Tharumia Jagadeesan,