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 journalArticle

5 Citations (Scopus)

Abstract

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
Volume140
Issue number4
DOIs
Publication statusPublished - Oct 1 2010
Externally publishedYes

Fingerprint

Stents
Trachea
Area Under Curve
Tracheal Diseases
Thorax
Confidence Intervals
ROC Curve
Pathologic Constriction
Self Expandable Metallic Stents

ASJC Scopus subject areas

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

Cite this

Tracheal torsion assessed by a computer-generated 3-dimensional image analysis predicts tracheal self-expandable metallic stent fracture. / Yu, Chih Teng; Chou, Chun Liang; Chung, Fu Tsai; Wu, Jei Tsai; Liu, Yuan Chang; Liu, Yun Hen; Lin, Ting Yu; Lin, Shu Min; Lin, Horng Chuang; Wang, Chun Hua; Kuo, Han Pin; Chen, Hao Cheng; Liu, Chien Ying.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No. 4, 01.10.2010, p. 769-776.

Research output: Contribution to journalArticle

Yu, Chih Teng ; Chou, Chun Liang ; Chung, Fu Tsai ; Wu, Jei Tsai ; Liu, Yuan Chang ; Liu, Yun Hen ; Lin, Ting Yu ; Lin, Shu Min ; Lin, Horng Chuang ; Wang, Chun Hua ; Kuo, Han Pin ; Chen, Hao Cheng ; Liu, Chien Ying. / Tracheal torsion assessed by a computer-generated 3-dimensional image analysis predicts tracheal self-expandable metallic stent fracture. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 140, No. 4. pp. 769-776.
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abstract = "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.",
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T1 - Tracheal torsion assessed by a computer-generated 3-dimensional image analysis predicts tracheal self-expandable metallic stent fracture

AU - Yu, Chih Teng

AU - Chou, Chun Liang

AU - Chung, Fu Tsai

AU - Wu, Jei Tsai

AU - Liu, Yuan Chang

AU - Liu, Yun Hen

AU - Lin, Ting Yu

AU - Lin, Shu Min

AU - Lin, Horng Chuang

AU - Wang, Chun Hua

AU - Kuo, Han Pin

AU - Chen, Hao Cheng

AU - Liu, Chien Ying

PY - 2010/10/1

Y1 - 2010/10/1

N2 - 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.

AB - 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.

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