Journal of Vascular and Interventional Radiology
Volume 20, Issue 7 , Pages 912-920, July 2009

Endobronchial Dilation for the Management of Bronchial Stenosis in Patients after Lung Transplantation: Effect of Stent Placement on Survival

  • Nadine Abi-Jaoudeh, MD

      Affiliations

    • Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Rita Jean Francois, MD

      Affiliations

    • Department of Pneumology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Vincent L. Oliva, MD

      Affiliations

    • Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Marie France Giroux, MD

      Affiliations

    • Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Eric Therasse, MD

      Affiliations

    • Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Andrée Cliche, MSc

      Affiliations

    • Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Miguel Chaput, MD, MSc

      Affiliations

    • Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Pasquale Ferraro, MD

      Affiliations

    • Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Charles Poirier, MD

      Affiliations

    • Department of Pneumology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • ,
  • Gilles Soulez, MD, MSc

      Affiliations

    • Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
    • Corresponding Author InformationAddress correspondence to G.S.

Received 14 October 2008; received in revised form 5 April 2009; accepted 7 April 2009.

Purpose

To compare the outcome of patients treated with balloon dilation and stent placement in the management of bronchial strictures after lung transplantation.

Materials and Methods

Forty-one lung recipients were treated with balloon dilation or stent placement between January 1997 and July 2005. Stent placement was reserved for cases of bronchoplasty technical failure or restenosis. Clinical files and results of pulmonary function tests and bronchoscopic evaluation were reviewed. Dyspnea and cough were defined according to the Breathlessness, Cough, and Sputum Scale. Patient survival and bronchial patency after bronchial intervention were estimated with the Kaplan-Meier method and Cox proportional hazards regression with analysis of stent implantation as a cofactor.

Results

Twenty-three of the 41 patients (56%) received a stent because of balloon dilation failure or stenosis recurrence. A total of 243 procedures were performed in 106 strictures (205 bronchoplasties and 38 stent insertions). At the first session, primary patency was higher in patients treated with stents (71%) than in those who underwent bronchoplasty (19%) (P = .037). Mean survival in patients with stents was longer than that in those who underwent bronchoplasty (82 vs 22 months, respectively), and stent insertion was associated with a 66% reduction in the risk of death (P < .02). Primary patency was 40 months for stented strictures versus 10 months for strictures treated with bronchoplasty (P < .02). Dyspnea and cough were improved after intervention (P < .001), and the forced expiratory volume in 1 second (FEV1) was ameliorated by 17% (P < .00003) at last follow-up.

Conclusions

Clinical outcome and FEV1 were improved after bronchoplasty and stent placement. Longer patient survival and bronchial patency were observed after stent insertion.

Abbreviations: CI, confidence interval, FEV1, forced expiratory volume in 1 second

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 This work was supported by a clinical research scholarship (to G.S.) from Fonds de la recherche en santé du Québec (FRSQ).

 None of the authors have identified a conflict of interest.

PII: S1051-0443(09)00359-5

doi:10.1016/j.jvir.2009.04.045

Journal of Vascular and Interventional Radiology
Volume 20, Issue 7 , Pages 912-920, July 2009

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