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A6470 - The Case of the Slippery Stent: A Case Report Describing Multiple Stent Migrations
Author Block: P. Sankhyan1, A. Mahajan1, T. Bhandari2, K. L. Nguyen2, C. T. Cook2; 1Internal Medicine, East Tennessee State University, Johnson City, TN, United States, 2Internal Medicine, East Tennessee State University, Johnson city, TN, United States.
INTRODUCTION : Bronchial stenting is commonly used to relieve bronchial stenosis secondary to both malignant and benign conditions leading to bronchial obstructions. Our case represents an interesting course of stent migration and bronchial restenosis multiple times requiring repeat bronchoscopies and stent repositioning, despite use of studded stents.
CASE DESCRIPTION : We present the case of a 61 year old lady with the past medical history of Non Small Cell Lung Carcinoma diagnosed 1 year prior to this admission, status post radiation therapy and chemotherapy. Her follow up Computed Tomography (CT) scan showed extrinsic compression of malignant tumor with airway narrowing leading to severe tracheobronchial stenosis. She had 70% and 90% extrinsic compression of the right and left mainstem bronchi respectively, with severe extrinsic compression of the carina as well. A covered Self-Expandable Metallic Stent (SEMS) was placed in the left mainstem bronchus to ensure airway patency and hence to relieve her dyspnea. Over the course of the next year she underwent several CT scans that showed stent migration and left main stem restenosis and had to undergo revision interventional bronchoscopy with stent repositioning and balloon dilation multiple times . This was despite the fact that she had studded stents placed in order to minimize dislodgement. The patient had relief in symptoms after the procedures.
DISCUSSION/CONCLUSION: Bronchial stent placement is a safe and effective procedure that is used to relieve respiratory symptoms like cough, dyspnea due to tracheobronchial stenosis occurring due to malignant or benign conditions leading to bronchial obstructions. Even though routine follow up bronchoscopies are not recommended, patients who experience continued dyspnea should undergo repeat bronchoscopy to determine that the stents are patent and in the correct position. Most common complications after stent insertions are hemoptysis and stent migration or dislodgment. Other complications include respiratory wall inflammation or erosion, infection, mucus plugging, granulation tissue formation, respiratory wall thinning and rarely rupture. Stent migration has a reported incidence ranging between 5-10%, as described in different studies and most commonly occurs due to tumor overgrowth or relief of extrinsic compression, hence leading to change in the position of the stent. It is important to rule out stent migration in patients like ours who have continued or worsening respiratory symptoms.