Airway & Bronchoscopy

Airway Stent Selection & Troubleshooting

Covers sizing strategies, deployment workflows, complication prevention, emergent rescue tactics, and post-placement surveillance algorithms for airway stents.

Stent selection • Deployment technique • Complication managementReading time · 30mWord count · 3,754

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Exam mapping & scope

This chapter covers device selection, indications/contraindications, sizing and deployment, complication prevention/management, and special scenarios (post-transplant anastomotic disease, tracheobronchomalacia, and aerodigestive fistulas). The emphasis is on practical, exam-relevant decisions for malignant and non-malignant central airway obstruction (CAO), including contemporary options (customized/3D-printed and bioabsorbable stents).

Focus this round

Sizing pearls
Deployment pitfalls
Rescue algorithms

High-yield pearls

Classify the obstruction: Intrinsic (endoluminal), extrinsic (compression), or mixed. Debulk intrinsic, stent extrinsic/mixed; reassess need after oncologic therapy.
Silicone is king in benign disease: Removable, customizable, safer long-term profile; avoid uncovered or partially covered metallic stents in benign disease.
Sizing rules that show up on exams: Extend ~5 mm beyond both ends of the lesion. Typical diameters: trachea 14–16 mm; mainstem 12–13 mm; bronchus intermedius 10–11 mm. Slightly oversize when no rigid anchor is present (e.g., malacia, fistula).
Deployment: Rigid bronchoscopy under general anesthesia is standard for silicone; measure length endoscopically; dilate before deployment; complete expansion with balloon or rigid instruments if needed.
Migration risk: Rises with under-sizing or post-therapy tumor involution; consider hourglass stents or external fixation when necessary; Y or Oki stents reduce migration at the carina/primary right carina.
Mucus impaction kills: Prevent with humidification and saline nebulization; ensure airway toilet plans post-op; early bronchoscopic follow-up.
Granulation at edges: Minimize shear (good fit, gentle landing zones), treat with mechanical/thermal tools; exchange stent if recurrent.
TEF or BEF: Airway stent first when double stenting is needed; beware pressure necrosis when both airway and esophageal stents are present.

Related chapters

Study notes

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