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F20. Patency of Airway Bypass Stents is Prolonged With Use of Drug Eluting Stents
Cliff K. Choong, Loc Phan, Patrick Massetti, Fabio J. Haddad, Edmund J. Roschak, Joel D. Cooper; St Louis, MO; Mountain View, CA; , MO; , CA; , MO
Objective: Airway bypass via transbronchial fenestration has been shown to improve forced expiratory volume and flow in explanted human emphysematous lungs. We have previously demonstrated the feasibility and safety of airway bypass stent placement in a canine model but found that the majority of stents occluded within 2 weeks. The aim of this study was to evaluate the influence of controlled release paclitaxel stents on prolongation of patency.
Methods: Under general anesthesia, suitable segmental and subsegmental bronchial wall sites were selected by direct visualization using a flexible bronchoscope. A doppler probe was used to detect and avoid sites with adjacent blood vessels. Transbronchial passages were formed using a 25 gauge transbronchial needle tipped catheter and dilated with a 2.5 mm balloon integrated into the needle-catheter. A specifically designed expandable stainless steel stent (3 mm long x 3 mm wide), coated with silicone rubber impregnated with paclitaxel, was placed within the passage and expanded until secured about the bronchial wall. Fifty control stents (no paclitaxel impregnation) and 107 paclitaxel eluting stents were placed in 25 dogs. Animals were bronchoscoped at intervals to assess stent patency.
Results: Eight instances of minor and brief bleeding occurred during stent placement and resolved without incident. There was no pneumothorax or mortality associated with stent placement. No delayed hemorrhage or pneumothorax occurred. Patency results of control and paclitaxel stents are shown in the table below.
Conclusions: In an animal model, the use of specifically designed paclitaxel eluting airway bypass stents was feasible and safe, and resulted in a significant prolongation of patency.
Patency Results of Stents
| Duration of Follow Up |
1 week |
2 weeks |
4 weeks |
8 weeks |
12 weeks |
| Patency of Control stents (n=50) |
10% |
5% |
0% |
|
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| Patency of Paclitaxel stents (n=107) |
100% |
99% |
96% |
76% |
65% |
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