Expanding applications of 3D-Printed stents to non-stenotic airways

Abstract

Tracheobronchial stents have advanced significantly since their introduction in the 1980s, with virtual airway modeling and three-dimensional (3D) printing enabling the production of patient-specific custom airway stents. Since their FDA approval in 2019, 3D-printed custom stents have offered a promising solution for complex airway conditions. However, their use has primarily focused on tracheal stenosis and tracheobronchomalacia. The two cases presented here demonstrate novel applications of 3D printed stents in non-malignant airway diseases, specifically extrinsic vascular compression and bronchopleural fistula (BPF) from airway dehiscence.

The first case describes a 27-year-old male with tetralogy of Fallot complicated by extrinsic vascular compression of the bilateral mainstem bronchi, leading to recurrent mucus plugging, lung collapse, and respiratory failure. We designed a custom undersized Y stent to maintain airway patency while minimizing risks of vascular erosion. The second case details a 38-year-old post-lung transplant patient with a non-healing BPF with airway dehiscence and resultant respiratory failure. A bifurcated 3D-printed stent was successfully deployed to bypass the large fistula, resolving a chronic air leak.

These cases illustrate the versatility and potential of 3D-printed stents in addressing complex airway pathologies beyond tracheal stenosis or malacia and highlight critical considerations in stent design and deployment.