Double stent insertion for combined malignant airway and superior vena cava obstruction

The present study sought to assess the feasibility and effectiveness of double stent insertion as a means of managing combined malignant airway and superior vena cava (SVC) obstruction (CMASO). From July 2010 to January 2018, twelve consecutive patients with CMASO were treated by double stent insertion (airway and SVC stents) in our centers. We assessed data pertaining to both technical and clinical success rates, as well as to long-term patient outcomes. The use of double stents (12 airway stents and 19 SVC stents) was technically successful in all study subjects, with a 0 to 92 days period between the 2 stent insertions (mean 27.8 days). Patients did not show evidence of any procedure-related complications. Mean patient Hugh-Jones grades improved from 4.4 +/- 0.5 before inserting the airway stent down to 1.2 +/- 0.4 following this insertion (P<.001). Mean SVC pressure was reduced from 17.5 +/- 2.8 mm Hg before the stent insertion down to 6.7 +/- 1.4 mm Hg following this insertion (P<.001). Fifty-six days after insertion, a single patient experienced re-obstruction of their SVC stent. All patients died within the follow-up period, with a median survival time of 113 days for these 12 patients. This double stent insertion protocol is both effective and safe as a means of offering palliative care to those with CMASO.