Tracheal torsion assessed by a computer-generated 3-dimensional image analysis predicts tracheal self-expandable metallic stent fracture

Chih Teng Yu, Chun Liang Chou, Fu Tsai Chung, Jei Tsai Wu, Yuan Chang Liu, Yun Hen Liu, Ting Yu Lin, Shu Min Lin, Horng Chuang Lin, Chun Hua Wang, Han Pin Kuo, Hao Cheng Chen, Chien Ying Liu

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Objective: Self-expandable metallic stents are used to relieve airway stenosis in selected patients; however, fracture of these stents may occur. This analysis aims to investigate the extent of tracheal torsion, assessed by a computed-generated reformatted 3-dimensional tracheal reconstruction from 2-dimensional computed tomographic images in predicting fracture of tracheal self-expandable metallic stents. Methods: From 2001 to 2007, 32 patients (aged 62.8 ± 14.1 years) with benign tracheal diseases received chest computed tomographic evaluation and Ultraflex (Boston Scientific, Natick, Mass) self-expandable metallic stents. The bending angles of the central axis and peripheral wall of the trachea at choke point were measured from the computed-generated 3-dimensional tracheal images. Results: Seventeen fractured stents were found among the patients. The median time for stent fracture was 865 days after implantation. Receiver operating characteristic curve analysis revealed that a 19° bending angle of the tracheal central axis (area under the curve, 0.929; 95% confidence interval, 0.847-1.012; P < .001) and a 44° maximal bending angle of the peripheral tracheal wall (area under the curve, 0.918; 95% confidence interval, 0.821-1.012; P < .001) had maximal power in predicting tracheal fracture of self-expandable metallic stents. Conclusions: Three-dimensional tracheal reconstructions from 2-dimensional chest computed tomographic data are useful in assessing the severity of tracheal torsion. Tortuous trachea with a central axis bending angle of 19° or more and peripheral tracheal wall maximal bending angle of 44° or more were associated with a high probability of fracture of the self-expandable metallic stent.

Original languageEnglish
Pages (from-to)769-776
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number4
Publication statusPublished - Oct 1 2010
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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