Management of malignant central airway stenosis with X-ray-guided Y-shaped covered self-expanding metallic stents: evaluating efficacy and safety.

[BACKGROUND] Malignant central airway stenosis (MCAS), a severe complication in advanced thoracic oncology, frequently causes debilitating dyspnea, necessitating stent placement for rapid alleviation. The management of carinal lesions, in particular, demands the deployment of an integrated Y-shaped stent to address the concomitant complex airway obstruction. X-ray guidance is a standard ancillary method employed in this technically challenging procedure. This study aimed to evaluate the efficacy and safety of X-ray-guided placement of Y-shaped covered self-expanding metallic stents (SEMS) in patients with MCAS.

[METHODS] In this single-center retrospective study, 22 patients with MCAS involving the carina were enrolled and underwent X-ray-guided placement of Y-shaped covered SEMS. Outcomes assessed included technical and clinical success rates, comparisons of pre- and post-procedural physiological and quality-of-life metrics [airway stenosis grade, oxygen saturation on room air, modified British Medical Research Council (mMRC) dyspnea scores, and Karnofsky Performance Scores (KPS)], and complications.

[RESULTS] The technical success rate of stent placement was 100%, and clinical success was achieved in 86.4% (19/22) of patients. The procedure resulted in significant symptomatic improvements: the airway stenosis grade decreased from 4.09±0.61 to 1.14±0.35, room-air oxygen saturation (in 19 evaluable patients) increased from (81.79±2.90)% to (94.00±3.21)%, mMRC dyspnea scores decreased from 3.95±0.21 to 2.73±0.70, and the KPS improved from 26.36±9.02 to 62.73±15.18 (all P<0.05). Complications requiring specific intervention occurred in 27.3% of patients, including secretion retention (18.2%) and restenosis due to granulation tissue hyperplasia (13.6%), with one patient experiencing both. No instances of stent migration or pneumothorax were recorded. The survival rates at 1, 3, and 6 months were 81.6%, 29.3%, and 11.7%, respectively, with a mean survival of 2.9 months.

[CONCLUSIONS] X-ray-guided implantation of the Y-shaped covered SEMS represents an effective and safe palliative strategy for MCAS. It reliably alleviates dyspnea, improves functional status, and creates a critical therapeutic window for definitive oncology care, all while maintaining an acceptable safety profile.