wabip 2016.optima airway stent silione-hybrid, metalic
TRANSCRIPT
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Name Surname
Title
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Conflict of interest disclosure
XI have the following, real or perceived direct or indirect conflicts of interest that relate to this presentation:
Affiliation / financial interest Nature of conflict / commercial company name
Tobacco-industry and tobacco corporate affiliate related conflict of interest
Grants/research support (to myself, my institution or department):
Honoraria or consultation fees:
Participation in a company sponsored bureau:
Stock shareholder:
Spouse/partner:
Other support or other potential conflict of interest:
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2013
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STENTS used:
Ultraflex (Boston Sc.)
AERO (Merit)
Dumon (Novatech)/Hood (E.Benson Hood)
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SOBQ:Short of Breath Questionarie
SF-36 Short Form Health Survey questionnaire
(6-8 weeks)
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…..No comments on clinical efficacy
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Benefits of airway stenting for CAO.
Timing of airway stenting ?
SPOC = Role of a Silicone Prosthesis to Prevent Airway Obstruction Recurrence in Lung Cancers
75 patients randomized (39 stent ; 36 no stent) primary endpoint : 1 year survival without recurrence >50% Recurrence rate local obstruction strongly decreased in stent arm Survical at 1 year : no difference.
Vergnon et al. ERS Congress 2013 Oral presentation.
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Silicone SEMS partially covered
SEMS totally covered
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Silicone SEMS partially covered
SEMS fully covered
SETTING AND EQUIPMENTMECHANICAL PROPERTIESMANIPULATION
SPECIAL SITUATIONSCOMPLICATIONS
When no high quality RCT are available extrapolated evidence to “analytic” opinion (Grade D)
?NiceCould be better Yin and Yang
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SETTING & EQUIPMENTSilicone SEMS partially
coveredSEMS fully
coveredGeneral anaesthesia
Y Convenient Convenient
C-arm fluoroscopy
N Convenient Convenient
Special equipment (rigid scopes)
Y N N
Sterilazation process (instruments)
Y N N
CLASSIFICATION
1
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MECHANICAL PROPERTIESSilicone SEMS partially
coveredSEMS fully
coveredWall thickness 1.5 0.25 0.25Flexibility Low Acceptable Acceptable
Radial compression
Acceptable Low Acceptable
Sealing (fistula) Acceptable High High
Extensibility No Depends manufacturer
Depends manufacturer
CLASSIFICATION
2
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Different wall thickness
0.25 mm 1.5 mm
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Ext Diam Int Diam r Area
SILICONE SEMS 14 11 5.5 95.03
SEMS 14 13.5 6.75 143.13
48.105 mm2
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MECHANICAL PROPERTIESSilicone SEMS partially
coveredSEMS fully
coveredWall thickness 1.5 0.25 0.25Flexibility Low Acceptable Acceptable
Radial compression
Acceptable Low Acceptable
Sealing (fistula) Acceptable High High
Extensibility No Depends manufacturer
Depends manufacturer
CLASSIFICATION
2
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CompressionNoppen
Polyflex
Dumon
Microtech
AlveolusUltraflex
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MECHANICAL PROPERTIESSilicone SEMS partially
coveredSEMS fully
coveredWall thickness 1.5 0.25 0.25Flexibility Low Acceptable Acceptable
Radial compression
Acceptable Low Acceptable
Sealing (fistula) Acceptable High High
Extensibility No Depends manufacturer
Depends manufacturer
CLASSIFICATION
2
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LENGTH
DIAMETER
Fully deployed16 mm
50 mm
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MECHANICAL PROPERTIESSilicone SEMS partially
coveredSEMS fully
coveredWall thickness 1.5 0.25 0.25Flexibility Low Acceptable Acceptable
Radial compression
Acceptable Low Acceptable
Sealing (fistula) Acceptable High High
Extensibility No Depends manufacturer
Depends manufacturer
CLASSIFICATION
2
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MANIPULATION OF THE STENTSilicone SEMS partially
coveredSEMS fully
coveredSizing Support of rigid
scopesStandard difficulty
Standard difficulty
Loading Can be difficultReloading possible
--Reloading not
possible
--Reloading not
possibleDeployment Blindly Endoscopically
or fluoroEndoscopically
or fluoro
Resposition Easy Can be difficult Can be difficult
Retrival Easy Can be difficult Can be difficult
Customization on site
Easy (length and orifice)
Not possible Not possible
CLASSIFICATION
3
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Pushing and pulling back a long Y silicone stent
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MANIPULATION OF THE STENTSilicone SEMS partially
coveredSEMS fully
coveredSizing Support of rigid
scopesStandard difficulty
Standard difficulty
Loading Can be difficultReloading possible
--Reloading not
possible
--Reloading not
possibleDeployment Blindly Endoscopically
or fluoroEndoscopically
or fluoro
Resposition Easy Can be difficult Can be difficult
Retrival Easy Can be difficult Can be difficult
Customization on site
Easy (length and orifice)
Not possible Not possible
CLASSIFICATION
3
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MANIPULATION OF THE STENTSilicone SEMS partially
coveredSEMS fully
coveredSizing Support of rigid
scopesStandard difficulty
Standard difficulty
Loading Can be difficultReloading possible
--Reloading not
possible
--Reloading not
possibleDeployment Blindly Endoscopically
or fluoroEndoscopically
or fluoro
Resposition Easy Can be difficult Can be difficult
Retrival Easy Can be difficult Can be difficult
Customization on site
Easy (length and orifice)
Not possible Not possible
CLASSIFICATION
3
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MANIPULATION OF THE STENTSilicone SEMS partially
coveredSEMS fully
coveredSizing Support of rigid
scopesStandard difficulty
Standard difficulty
Loading Can be difficultReloading possible
--Reloading not
possible
--Reloading not
possibleDeployment Blindly Endoscopically
or fluoroEndoscopically
or fluoro
Resposition Easy Can be difficult Can be difficult
Retrival Easy Can be difficult Can be difficult
Customization on site
Easy (length and orifice)
Not possible Not possible
CLASSIFICATION
3
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MANIPULATION OF THE STENTSilicone SEMS partially
coveredSEMS fully
coveredSizing Support of rigid
scopesStandard difficulty
Standard difficulty
Loading Can be difficultReloading possible
--Reloading not
possible
--Reloading not
possibleDeployment Blindly Endoscopically
or fluoroEndoscopically
or fluoro
Resposition Easy Can be difficult Can be difficult
Retrival Easy Can be difficult Can be difficult
Customization on site
Easy (length and orifice)
Not possible Not possible
CLASSIFICATION
3
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On situ customization of a silicone stent
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MANIPULATION OF THE STENTSilicone SEMS partially
coveredSEMS fully
coveredSizing Support of rigid
scopesStandard difficulty
Standard difficulty
Loading Can be difficultReloading possible
--Reloading not
possible
--Reloading not
possibleDeployment Blindly Endoscopically
or fluoroEndoscopically
or fluoro
Resposition Easy Can be difficult Can be difficult
Retrival Easy Can be difficult Can be difficult
Customization on site
Easy (length and orifice)
Not possible Not possible
CLASSIFICATION
3
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SPECIAL SITUATIONSSilicone SEMS partially
coveredSEMS fully
coveredY stenting Y (better if
simetrical stenosis)
N Y (can adapt to diferent angles and diameters)
Conical shape N Depends manufacturer
Depends manufacturer
Telescoped stent Y, but reducing lumen
Possible, but concerns on non
covered part
Y
Tracheostomy cannula + stent
Y, but reducing lumen
N Y
CLASSIFICATION
4
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Full visual control under fluoroscopy
Guide-wire very useful
Can exchange branches
(extending to intermedious
bonchus
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SPECIAL SITUATIONSSilicone SEMS partially
coveredSEMS fully
coveredY stenting Y (better if
simetrical stenosis)
N Y (can adapt to diferent angles and diameters)
Conical shape N Depends manufacturer
Depends manufacturer
Telescoped stent Y, but reducing lumen
Possible, but concerns on non
covered part
Y
Tracheostomy cannula + stent
Y, but reducing lumen
N Y
CLASSIFICATION
4
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SPECIAL SITUATIONSSilicone SEMS partially
coveredSEMS fully
coveredY stenting Y (better if
simetrical stenosis)
N Y (can adapt to diferent angles and diameters)
Conical shape N Depends manufacturer
Depends manufacturer
Telescoped stent Y, but reducing lumen
Possible, but concerns on non
covered part
Y
Tracheostomy cannula + stent
Y, but reducing lumen
N Y
CLASSIFICATION
4
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SPECIAL SITUATIONSSilicone SEMS partially
coveredSEMS fully
coveredY stenting Y (better if
simetrical stenosis)
N Y (can adapt to diferent angles and diameters)
Conical shape N Depends manufacturer
Depends manufacturer
Telescoped stent Y, but reducing lumen
Possible, but concerns on non
covered part
Y
Tracheostomy cannula + stent
Y, but reducing lumen
Y Y
CLASSIFICATION
4
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COMPLICATIONSSilicone SEMS partially
coveredSEMS fully covered
Mucostasis Moderate Moderate High
Granuloma Low Moderate Moderate
Fracture/Detachment
N Y Y
Migration Very low Low Low
Tumor ingrowty N Y Y
Pseudomembrane Y N N
CLASSIFICATION
5
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Mucosatasis Coat detachment
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COMPLICATIONSSilicone SEMS partially
coveredSEMS fully covered
Mucostasis Moderate Moderate High
Granuloma Low Moderate Moderate
Fracture/Detachment
N Y Y
Migration Very low Low Low
Tumor ingrowth N Y Y
Pseudomembrane Y N N
CLASSIFICATION
5
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CONCLUSIONSilicone SEMS partially
coveredSEMS fully covered
SETTING AND EQUIPMENTMECHANICAL PROPERTIESMANIPULATION
SPECIAL SITUATIONSCOMPLICATIONS
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