Tracheal stents are man-made tubes designed to keep the trachea from collapsing or narrowing.  The latest generation are made of nitinol and placed inside the trachea using flouroscopy, radiography and/or bronchoscopy while the patient is under anesthesia.  Sizing of the stent is very important.  When measurements are obtained under anesthesia, the patient sometimes has to be recovered without a stent while a stent specific to their measurements is ordered. When it arrives, the patient is re-anesthetized and the stent is placed.

Tracheal stenting is consider a salvage or “last resort” measurement in the treatment of collapsing trachea.  All medical management must be exhausted first.  This can include proper weight management (keep them lean), cough suppressives, anti-inflammatories, bronchodilators, etc.  An overweight patient suffers much more from this condition than they would if they had a lean body. Weight management can make a huge difference in the comfort level of these patients. If the pet is in a smoking environment, this must be eradicated.  If all these means are exhausted and quality of life is still poor due to respiratory distress or excessive cough, tracheal stenting can be considered.  Stenting is not a cure. Tracheal collapse is progressive and stenting should be considered a palliative measure.

Complications of stenting are many and varied.  Death from anesthesia, respiratory distress syndrome, occlusion of the trachea or severe swelling can occur.  Stents can fracture, shorten, migrate or collapse. Removal of stents is often difficult if not impossible. Segmental collapse can occur.  Excess granulation tissue can develop in the lumen of the trachea causing further airway occlusion. Dead space (lateral gaps) between the tracheal walls and the stent can permit accumulation of mucus and/or infectious agents.  Tearing of the trachea can result in subcutaneous emphysema and/or pneumomediastinum. Larygngospasm, secondary inflammation and/or infection or pneumonias can occur.  Repeat bronchoscopy is sometimes necessary to evaluate worsening conditions.  Cough is not usually eliminated and must be aggressively minimized with cough suppressants to reduce the incidence of stent fracture or excess granulation tissue formation.  The vast majority of stented patients require long term medication.

Stenting addresses only the tracheal collapse.  It does nothing for smaller airway (such as bronchi, bronchiolar) collapse.