SEMS Implantation Therapy

The patients were administered intramuscular diazepam (10 mg) and anisodamine (10 mg) and intravenous dexamethasone (10 mg), 30 min before the procedure. The procedures were performed under fluoroscopic guidance, without the use of bronchoscopy. Interventional radiologists placed the stent under local anesthesia. Patients lay on the examination bed, with ECG monitoring. A gag was used to open the mouth. Oxygen was administered via a nasal catheter, and a sputum aspirator was prepared. Under fluoroscopy, a 0.035-inch hydrophilic guide wire (Cook Corporation, Bloomington, IN, USA) and a 5 F vertebral artery catheter (Cordis Company, New Jersey, USA) were introduced transorally into the trachea or bronchus. Then, 5 mL of 2% lidocaine and 5 mL of 0.01% epinephrine were quickly sprayed via the catheter. Tracheography was performed to determine the location of airway stenosis. After the guide wire and catheter pass through the stenosis, the guide wire was withdrawn. Retract the catheter while injecting contrast agent for airway imaging. We could use this technique to define the distal end of the stenotic component of the main bronchus. Exchange with stiff guide wire into one side bronchus, 9 F sheath tubes was placed along guide wire. Another 0.035-inch hydrophilic hard wire was introduced for Y-shaped or small Y-shaped stenting. In general, the bronchial component of the stent was slowly released 0.5 to 1 cm beyond the distal end of the stenotic component of the main bronchus. After the stent was successfully inserted, the sputum aspiration tube was introduced for sputum drainage to avoid suffocation (5, 14).

The patients were given aerosol inhalation and anti-inflammatory treatment after SEMS implantation, and their vital signs were closely monitored. A repeat CT was performed 5–7 days after the implantation to observe the position of the stent, degree of expansion, and lung recruitment.