Fenestrated outdoes conventional silicone stents in benign central airway stenosis

The use of fenestrated stents results in longer patency, fewer complications, and improved biomechanical performance than conventional silicone stents, without compromising the structural integrity of the stent, according to a study.

A total of 118 patients with benign central airway stenosis participated in this retrospective study and received either fenestrated (n=53) or conventional (n=65) silicone stents between 2019 and 2023. Propensity score matching was used to compare technical success, complication rate, patency time, and removal rate between the two cohorts.

The researchers also evaluated the equivalent stress, total deformation, static pressure, and turbulent intensity of fenestrated and conventional stents via finite element analysis and computational fluid dynamics simulations.

PSM analysis involved 35 patients with fenestrated stents and 35 with conventional stents. All patients achieved a successful stent insertion.

Compared with the conventional stents, the fenestrated stents demonstrated a significantly lower cumulative incidence of overall complications (log-rank test p<0.001), migration (log-rank test p=0.006), granulation (log-rank test p=0.006), and mucus retention (log-rank test p=0.007).

Notably, fenestrated silicone stent independently correlated with a lower incidence of overall complications (adjusted hazard ratio [aHR], 0.23, 95 percent confidence interval [CI], 0.11‒0.48; p<0.001), migration (aHR, 0.15, 95 percent CI, 0.03‒0.68; p=0.013), granulation (aHR, 0.29, 95 percent CI, 0.13‒0.63; p=0.002), and mucus retention (aHR, 0.44, 95 percent CI, 0.20‒0.94; p=0.034).

In biomechanical analysis, fenestrated and conventional stents showed similar equivalent stress and static pressure. However, fenestrated stents demonstrated increased localized flexibility and slightly higher turbulent intensity.

“Silicone stents are the gold standard for inoperable benign central airway stenosis but are often limited by complications,” the researchers said.