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Since that time, an array of airway stents have developed to treat complex airway disease in children. Pediatric-specific applications of airway stents include use after tracheal reconstruction for congenital tracheal stenosis
not responsive to medical therapy. However, the ideal pediatric airway stent has yet to be developed. The ideal airway stent for pediatric patients should be easy to place, should support the airway without the development of significant complications, and should be easy to remove to allow maximal growth of the airway.
Furthermore, the radial force used to keep certain kinds of stents in place has been shown to damage the microcirculation and serves as the nidus for mucosal injury and subsequent granulation tissue formation.
used to treat canine tracheal collapse. The 2 types of helical stents share certain advantages. These include ease of deployment, limited mucus production, and focal mucosal changes limited to the areas of stent contact. The helical design provides radial support with substantially less mucosal contact and at a lower pressure. The results of the study by Mondal colleagues provide further evidence that the stent design provides less of a nidus for granulation tissue formation. This was also shown with the CasMin-Twine helical stent animal study. Where the 2 stents diverge is the novel removal tool associated with the helical Niti-S stent. Removal of the stent should allow optimal growth of the airway. A primary limitation of the study by Mondal colleagues is the short duration of therapy. After tracheal reconstruction for example, it can take 2 to 6 months for the airway to endothelialize.
It remains to be seen whether the helical Niti-S stent will be as amenable to removal with longer durations of therapy. However, the early advantages of the helical Niti-S certainly seem to be taking us toward a more ideal pediatric airway stent.
New tracheal stainless steel pilot study: twelve month follow-up in a rabbit model.
Disclosures: The author reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
We sought to demonstrate in an animal model that helical stents made from a nickel titanium alloy called nitinol (NiTi) and designed for malacic airways could be delivered and removed without significant trauma while minimally impeding mucus clearance during the period of implantation.
We were pleased to read the commentaries by Bryant1 and Overbey and colleagues2 on our published preclinical evaluation of a pediatric airway stent.3 We are encouraged by their opinions and concur with their comments toward translating our technology for the treatment of malacic airways in pediatric patients.