Tracheal Stent Placement

Tracheal collapse is a disease common in many small breed dogs where the cartilages of the trachea weaken over time. As they weaken, the negative pressure created when the pet inhales is too much for the trachea to maintain its shape so it collapses. This narrows the pet's airway and makes it difficult to bring air in. The decreased airflow causes hypoxia and leads to dyspnea and coughing. This is a chronic progressive disease that is manageable, but not curable

Once medical therapy fails, surgical therapy is recommended. The two main forms of treating tracheal collapse include placement of tracheal rings (in case of cervical tracheal collapse) and tracheal stenting. Since this disease is progressive, dogs with cervical tracheal collapse will eventually develop intrathoracic tracheal collapse.

We feel that it is important to inspect the trachea with a scope prior to stent placement as well as post-stent placement. Post-stent placement evaluation is key to make sure that there are no spaces between the stent and the trachea (make sure there is good apposition). Some clinicians also advocate doing a bronchoalveolar wash in these patients, since most of them will have a secondary bacterial infection.

The tracheal stent is placed within the lumen (opening of the trachea) and it forces it to remain open. For this procedure, we anesthetize a patient and guide a nitinol (nickel-titanium alloy) stent into the trachea. Since tracheal collapse may begin in some areas and eventually spread to affect the entire trachea, our goal is to stent as much of the trachea as possible. The stents expand once released into the trachea and provide additional support to prevent collapse.

The stent should be placed under fluoroscopic guidance to best evaluate where to start deployment. The stent is placed through the endotracheal tube, which is pulled as the stent is placed. We recommend using a Y-piece to allow oxygen delivery at the time of stent placement. Slight forward force is made during deployment to help the stent open to its maximal capacity.

It is important to take chest radiographs post-stent placement to document placement. Additionally, it is important to retake chest radiographs routinely to make sure the stent is intact.

Controlling coughing is key post-stent placement because coughing can also put pressure on the stent and it may contribute to stent fracture.

Possible complications of this procedure include fracture of the stent, excessive formation of granulation tissue around the stent, and stent migration (very rare). With the recent advances in stent technology and an increased knowledge of proper stent size and placement, these complications are significantly less common than they previously were, but they can still potentially occur. Unfortunately stent placement will not "cure" the disease. The majority of patients who receive a stent will have reduced severity of clinical signs, but they will not go away completely. The stent itself can cause some degree of irritation within the trachea, so we expect that some coughing will continue. Less commonly, the coughing may get worse (if it were present); however, the stent will help prevent any acute life threatening crises from the trachea collapsing. Following placement the pet may still need to be on medication for the rest of their life depending on how they do. The stent will also not address a main stem bronchi collapse.