Stening® Y

Stent Traqueocarinobrónquico

Código SY

Descripción:

Prótesis flexible traqueocarinobrónquica para el soporte de la bifurcación traqueal y del ángulo carinal.

Este stent puede tener ramas bronquiales rectas o en bisel para evitar la oclusión del lobular superior derecho.

Extensión traqueal de longitud variable, en diámetros 13, 15 ó 16 milímetros.

esquema stent en Y

Dimensiones (mm)

Código  Diámetro A B C D  E
SY13-11-11 13 90 35 40 13 11
SY15-12-12 15 70 30 30 15 12
SY15-12-12L 15 110 30 30 15 12
SY16-13-13 16 70 30 35 16 13
SY16-13-13L 16 110 30 35 16 13
Stents en Y - Traqueocarinobronquicos
Stent en Y - Traqueocarinobrónquico con pinza cocodrilo para implante

Adenocarcinoma

adenocarcinoma - stent en Y

Consultas o comentarios sobre este dispositivo:


8/3/2012 - Luis Sergio

Estimados doctores y/o consultores técnicos: en 2009 sufrí una intoxicación por monóxido de carbono, generando como consecuencia necesaria una intubación por un período superior a 20 días, resultando en una estenosis traqueal.
Actualmente utilizo una prótesis que tengo que cambiar cada 2 años.
Me gustaría saber cual es el plazo de validez de las protesis stening por favor
att. Luís Sergio.


8/3/2012 - Dr. Ricardo Isidoro

El tiempo de esterilización y almacenaje (4 años), indicado en el envase, no se relacionan con el tiempo de "permanencia" de un stent.

Este último, depende de la interrelación entre los muchos y distintos tipos de dispositivos protésicos, con el paciente, y las
circunstancias particulares en que se encuentra. Este tiempo de reemplazo es entonces muy variable, desde unas pocas semanas hasta años, y siempre es determinado por el médico tratante.

Cordialmente
Stening SRL

7/6/2012 - josr luis sanchez

Buenas tardes, soy un paciente de la ciudad de Mexico. Mi hospital no cuenta con canulas aun y yo uso actualmente una canula de mongomery del numero 13 estandar en forma T. Quisiera saber si ustedes me la pueden proveer y emviar y que debo hacer ya que me urge cambiarmela por que la que tengo actualmente ya esta muy colonizada y muy infectada. Ruego su pronta respuesta

21/6/2012 - angel alberto lucio cisneros

buenos dias soy paciente que necesita la canula montgomery numero 13 standard me podrian decir donde la consigo o un lugar o telefono donde la encuentre garcias por su atencion de la manera mas atenta me urge gracias buen dia

11/3/2013 - eduardo romero

buenos dias dr. ricardo isidoro

me podria usted informar si manejan tambien los anillos traqueales superiores e inferiores, su costo y el envio a la ciudad de guadalajara,jalisco, mexico, y si tambien me puede decir los calibres de los tubos en t y en base a que se pide en medida, mis numeros donde puede localizarme

013336153412

7/3/2015 - Erica Everitt

We are trying to find a suitable product for a patient who has tracheal obstruction with relapsing polychondritis (just below subglottic space) We have tried a montgomery t tube but this isn't long enough as the stenosis is causing partial bronchial collapse we also think that the silicone material isn't rigid enough to stop the collapse. We are looking to try and use a Y connector to stop this occurring but need the trachea stenting as well. Would you be able to advise or meet with our team to see what we can do to resolve these problems. Many Thanks Erica

7/3/2015 - Stening SRL

Dear Erica, thank you for your contact.

Please, we would like you to confirm us if we didn't misunderstand you:
the patient has a high tracheal stenosis, just below subglottis
he also has dynamic bronchial collapse

Beyond this confirmations, we also need to know which is the external diameter of the Montgomery tube you have used with the patient?
the bronchial collapse occurs in both bronchia, or only in one of them? (if just one, please specify left or right)
Best regards,
Ricardo Isidoro, M.D.

7/3/2015 - Erica Everitt

Hi Ricardo,

Thanks for getting back to me. Your summary is correct.
The partial bronchial collapse is left and right. We haven't used a Y connector before so not sure how these work with a tracheal stent. Is it possible to combine the two?
I will have to double check the t tube sizes.
Any ideas on what could solve this chaps issues will be gratefully received. He currently has a moores tube size 8 in-situ hence our urgency to find a solution.

Regards
Erica

7/3/2015 - Stening SRL

Dear Dr. Erica, I would like to mention:

1) Is it possible to combine two devices? For example a Y stent with a straight one? or a Y stent with a Montgomery T-tube?
Yes, it is. But it is not recommended. We have to be economical and always try using the smallest and suitable devices. We must remember that the device itself is also a foreign object for the airway.

2) Can a stent support the bronchial collapse?
Yes, it can. A stent of Stening brand supports a load of 800 grams of pressure by square centimeter. European and American stents support similar loads (stress/strain) with an error of 10%.

But this test were done with straight stents. The walls of the bronchial branches in Y stents are thinner than a classic one, and it tolerance to compression is lower.

Even so, it is quite possible that a Y stent can support and solve this collapse.

7/3/2015 - Stening SRL

3) If the patient is breathing through a Moore tube, the tracheal stenosis will evolve faster until complete tracheal closure. It is a more complex situation and hard to solve.

Therefore, the case will require two treatments:
The tracheal stenosis treatment
The main bronchia dinamic collapse treatment.

So, you will need to:
- Submit the patient to a general anesthesia procedure, with muscle relaxation.
- The anesthesiologist must ventilate the patient through the Moore tube
- An experienced bronchoscopist will proceed to tracheal intubation with rigid bronchoscope, cautiously approaching to the area of stenosis.
- You will use an orthodox method for the recovery of the tracheal lumen (progressive dilatation, followed radial cuts, etc).
- Then, you will enter with the bronchoscope through the stenosis, stopping at the entrance of the Moore tube
- Now remove the cannula and begin to ventilate the patient through the rigid bronchoscope
- Proceed with the bronchoscope and explore the carinal area and bronchial division.
- Then, proceed to implant a Y stent with a short tracheal branch (as short as possible). To prevent obstruction of the right upper lobe bronchus, the stent in "Y" can has the end of his right branch at an angle of 45 degrees.
This termination at an angle of 45 favors the ventilation of the right upper lobe, but is less efficient to solve the bronchial collapse than a classical termination of the right branch of the stent.

7/3/2015 - Stening SRL

You can solved this dilemma by choosing between one or other termination of the right branch of Y stent, if available. One with bronchial classic branches, but with a neat hole in the right branch, so that the lobar bronchus ipsilateral will not be occluded by the stent.

So, you will proceed to implant the Y steng in the tracheal bifurcation with the help of an introductory clip Freitag, such as a Stortz or anyone of the operator's preference.

This will treat the bronchial affection. Now, we turn to superior tracheal stenosis. As you know, it has a very difficult solution. It will require a lot of sessions of dilatation, time and patience.

The stenosis was already dilated to introduce the bronchoscope. Now you can reinsert a Mongomery T-tube number 13 or 14 (external diameter in millimeters).

A classic model is used. But it has to be implanted inverted, so the shorter tracheal end is toward the main carina, and the longest end towards the larynx, ACROSS the vocal cords.

This transcordal disposition of the t-tube is safe. The swallowing reeducation of the patient will avoid future aspirations into the airway.

The t-tube must remain ALWAYS closed. It must be remembered that an open trachea leads to the failure of any bronchial stent.

In the attached PDF file, in pages 41-43, you will find the technical description for the insertion of a t-tube. We highly recommend the "band method" for its precision and safety.

In Argentina we have a model of a straight subglottic stent, than can be useful in high stenosis cases.

This subglottic stent prevents the use of t-tube, shortening treatment and allowing the immediate close of tracheostomy.

7/3/2015 - Erica Everitt

Dear Ricardo,
That's great, we use montgomery t tubes regularly but have never needed to use a Y stent before so your advice is appreciated. I will discuss this further with my colleagues.
Regards
Erica

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