Bronchopleural Fistula Cured by Customized Airway Metallic Stent

We read with great interest the important article by Avasarala et al.1Avasarala S.K. Freitag L. Mehta A.C. Metallic endobronchial stents: a contemporary resurrection.Chest. 2019; 155: 1246-1259Abstract Full Text Full Text PDF Scopus (21) Google Scholar They have done a great job to review the application of metallic endobronchial stents in airway disease. They addressed the contemporary indications including tracheoesophageal fistula, tracheomediastinal fistula, relapsing polychondritis, excessive dynamic airway collapse, lung transplantation (airway dehiscence and lobar stenting), benign airway stenosis, and tracheobronchial injury. However, a challenge disease, bronchopleural fistula (BPF) or bronchial stump fistula (BSF), has been neglected. BPF or BSF is a severe and life-threatening complication after pneumonectomy or lobectomy. In 2006, we first report the application of a bullet-shaped, angled stent (Han’s stent) for BSF, and 83.33% patients get permanent closure.2Han X. Wu G. Li Y. et al.A novel approach: treatment of bronchial stump fistula with a plugged, bullet-shaped, angled stent.Ann Thorac Surg. 2006; 81: 1867-1871Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Subsequently, we successfully placement customized airway metallic stent in 148 patients with BPF or BSF.3Han X. Yin M. Li L. et al.Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single-center study of 148 consecutive patients.Surg Endosc. 2018; 32: 4116-4124Crossref PubMed Scopus (26) Google Scholar Symptom relief was achieved in 141 patients at 30 days’ follow-up after stenting. The stent we used included a Y-shaped self-expandable covered metallic stent with a bullet head, hinged self-expandable covered metallic stent with a bullet head, L-shaped self-expandable covered metallic stent, Y-shaped self-expandable covered metallic stent, and a hinged self-expandable covered metallic stent. As we illustrated, metallic stent placement plays an important role in BPF or BSF, as does a customized airway metallic stent. Metallic Endobronchial Stents: A Contemporary ResurrectionCHESTVol. 155Issue 6PreviewAirway stenting has been practiced for several decades. It is one of the most common procedures performed by interventional pulmonologists. Typically, these stents are implanted to maintain the tubular patency of the tracheobronchial tree. They are only considered as a temporizing measure, or when a surgical option cannot be pursued. Through the past few decades, a number of metallic airway stents have been introduced into the market. First generation stents were comparatively simplistic and crafted from stainless steel. Full-Text PDF ResponseCHESTVol. 156Issue 5PreviewWe are appreciative of the feedback and response from Li et al regarding our manuscript. Bronchopleural fistulas are an important entity, with significant clinical implications, including a high mortality rate.1 Full-Text PDF