A New Approach to the Treatment of Congenital Tracheal Stenosis: Balloon Tracheoplasty and Expandable Metallic Stenting

Background/purpose: Many surgical procedures have been unsatisfactory for the treatment of congenital tracheal stenosis. The authors used intraluminal balloon dilatation and expandable metallic airway stent for this condition.

Methods: From 1997 to 2000, balloon expandable stents (Palmaz) were inserted into the trachea in 5 infants, aged 7 days to 12 months who had severe airway obstruction caused by tracheal stenosis. Tracheal stents were placed after intraluminal balloon dilatation of complete tracheal rings. The stents were placed on balloon catheters and were inserted into the desired position bronchoscopically using x-ray control. They were expanded and fixed in place by inflating the balloon to appropriate diameter. The stents were 10 to 40 mm long and 6 to 8 mm in diameter.

Results: Four patients have been relieved of airway obstruction after this procedure. One patient died after 9 months of palliation. In all patients, granulation tissue developed over the stents and could be managed by scraping or balloon compression. Stents have been in place for 9 to 36 months after insertion without any other complication.

Conclusions: Airway stents after balloon tracheoplasty can be left for prolonged periods to relieve tracheal obstruction. This technique may provide an important remedy in infants and children with congenital tracheal stenosis.