Custom 3-D Airway Stent Restores Patient’s Quality of Life

June 05, 2024

Sam Elkurd of Avon Lake, Ohio, loves being outside, gardening and caring for plants and trees around his home. But in 2014, he began coughing and experiencing shortness of breath. He was ultimately diagnosed with idiopathic pulmonary fibrosis, a disease that causes scarring and stiffness of the lungs and makes it difficult to breathe. The disease is irreversible and gets worse over time.

“It was a miserable life,” he said. “I couldn’t sleep without an oxygenator attached to my nose. I couldn’t shower or do stairs without oxygen. I had to take oxygen everywhere and I couldn’t garden because it was too difficult to drag my oxygen tank outside.”

In late 2016, Sam underwent a left lung transplant. It was successful, but he experienced some complications that led to narrowing of the airway passage to his new lung, and resulting in him needing an airway stent to ensure that air could reach the transplanted lung. While immediate results are generally positive after stent placement, over time, patients sometimes develop complications that can diminish efficacy, including inflammation, mucus formation and mechanical rubbing. These issues can cause tissue formation and may block the opening of the stent. Sam found himself in and out of the hospital for procedures related to his stent.

Commercial Stents Aren’t Always Effective

“The biggest contributor to the development of these complications is that traditional stents don’t fit all that well,” said Benjamin Young, MD, medical director of bronchoscopy at University Hospitals Cleveland Medical Center. “Commercially available stents are either straight cylinders or in the shape of a Y, with straight limbs. There is no accounting for the airway curvature, branching or changing diameter as the airway extends deeper into the lung. Poor fit leads to an exacerbation of these problems.”

In late 2019, the U.S. Food and Drug Administration approved custom 3-D patient-specific airway stents. The team at UH Cleveland Medical Center placed the first of these in November 2020 and has since utilized this technology for many other patients with notable outcomes.

Dr. Young recommended a custom airway stent Sam for in late 2020.

Creating a Custom Stent for Sam

The process of creating a custom stent begins with a high-resolution CT scan. The image is uploaded, and a computer software program creates a 3-D reconstruction of the airway. Using the software, the physician then designs a stent that matches the specific unique parameters of the patient’s airway, accounting for airway diameter and length, branching, wall thickness and angulation.

From this virtual prescription, a custom mold is 3-D printed and medical-grade silicone is injected to create a stent that exactly fits the patient’s airway. The stent is implanted under sedation in an outpatient setting by a thoracic surgeon or interventional pulmonologist, and patients generally go home the same day.

“The 3-D printed stent is a much better match to a person’s anatomy,” said Dr. Young. “It works better and lasts longer, with fewer complications. Providing this for our patients who need it, like Sam, helps them live more comfortably and get back to their normal lives.”

Back to the Life He Loves

“It’s like day and night,” Sam said. “I can breathe now and I don’t have complications. I only go to the hospital for routine visits. I can help my wife around the house, run errands and play with my grandchild.”

Best of all, Sam is back outside, busy in the garden.

“3-D stents are really a game changer in airway stenting and offer clinicians more opportunities to treat patients who don’t respond to standard therapy or who experience complications with traditional commercial airway stents,” said Dr. Young. “We’re so glad Sam has had a positive outcome and we’re working to make sure more patients have access to this technology.”