Factors predicting outcome following airway stenting for post-tuberculosis tracheobronchial stenosis

Background and objective: Silicone airway stents are used to widen narrowed airways in patients with post-tuberculosis tracheobronchial stenosis (PTTS). After mechanical stabilization, stents can be removed from the majority of patients leaving restored airway patency. However, in a significant minority re-stenosis develops post-sten removal thus necessitating surgical intervention or long-term stenting. In this study, we sought to establish prognostic factors for successful airway intervention in PTTS. Methods: We retrospectively investigated 71 patients who underwent silicone stenting due to PTTS. After stenting, bronchoscopic toileting and/or repositioning was performed during follow up. At 6-12 months after clinical stabilization, stents were planned to be removed. Patients with patent airways were followed if no further intervention was required. If restenosis developed, patients underwent re-stenting or operation. Clinical parameters were analysed to determine favourable prognostic factors. Results: Stents were successfully removed in 40 patients at a median 12.5 months after insertion. In 27 patients, stent re-insertion was carried out and four patients underwent surgical management. Multivariate logistic regression analysis revealed that successful stent removal was independently associated with atelectasis <1 month before bronchoscopic intervention, and absence of complete lobar atelectasis. Conclusions: Airway intervention, including silicone stenting, can be successful in patients with PTTS, when the intervention is performed within 1 month of atelectasis and before complete lobar atelectasis.