The Benefit and Effectiveness of Biodegradable Drug-Coated Stents in Refractory Pediatric Laryngotracheal Stenosis

Introduction: Laryngotracheal stenosis (LTS) is one of the most common causes of pediatric airway obstruction. Patients with LTS who receive multiple treatments and fail to decannulate are defined as having refractory LTS. For these patients, the treatments are especially complicated and unsatisfied. Biodegradable drug coated stents (BDCS) offer the advantage of providing stable airway support, avoiding a secondary operation for removal and the coated slow-release drug can also prevent the process of restenosis. We aim to explore the role of BDCS in treating refractory LTS.

Methods: This study enrolled patients with refractory LTS (enrolled patients all received previous treatments in other medical centers and failed to decannulate) who had undergone previous unsuccessful treatments between 2017 and 2023. Patients were categorized into two groups based on the utilization of BDCS. The primary outcome measure was the achievement of decannulation in patients who initially had a tracheotomy tube in place. Secondary outcome measures included the total duration of the treatment process and the extent of stenosis improvement.

Results: Of the 89 patients with refractory LTS, 66 patients (74.1%) eventually achieved decannulation. The decannulation rate was significantly higher in the BDCS group (P=0.020). In patients who achieved decannulation, BDCS significantly reduced overall duration time (P=0.044) and total interventions (P=0.029). Additionally, BDCS was a significant risk factor associated with final decannulation (P=0.025). We observed that 12 patients showed improvement in stenosis within one month after the postoperative follow-up, and those with BDCS had a higher improvement rate (P=0.047).

Conclusions: BDCS would be a promising choice in patients with serve refractory LTS.