Placement of self-expanding metallic tracheobronchial Y stent with laryngeal mask airway using conscious sedation under fluoroscopic guidance

Background: Central airway obstruction and fistula are treated with a tracheobronchial Y stent. In the currently used self-expandable metal Y stents, the delivery system is 8 mm in diameter and requires either a 9 mm tracheal tube or rigid bronchoscope to enable airway control during insertion. In this study we present a novel technique of laryngeal mask airway (LMA) assisted Y stent insertion, enabling airway control during deployment of the Y stent.

Methods: All procedures using LMA in assisting Y stent insertions between 2014-2020 were reviewed. Data collected included demographics, clinical diagnosis and disease characteristics, indication, procedural success rates, clinical outcome and survival.

Results: A total of 10 patients with a median age of 61.5 years (range 37-73) underwent LMA assisted Y stent insertion. Indications for stent insertion were malignant disease with central airway obstruction or fistula. In all cases airway patency was achieved leading to improvement of symptoms and performance status. No procedural complications were reported. The median survival was 4.5 weeks (range: 2-26).

Conclusions: LMA assisted Y stent insertion enables airway control during the procedure. In comparison to silicone Y stent insertion, the procedure is less cumbersome, shorter in duration and does not require the use of general anesthesia or rigid bronchoscopy.

Key points: SIGNIFICANT FINDINGS OF THE STUDY: LMA assisted Y stent insertion enables airway control during the implantation of metallic self-expanding Y stent. The procedure does not require the use of general anesthesia or rigid bronchoscopy.

What this study adds: In this study we present the technique and outcomes of LMA assisted Y stent insertion. This method of Y stent insertion provides an additional treatment option for patients with central airway obstruction and fistula.