C78-29 Contralateral Migration of a Left Main Bronchial Silicone Stent: A Case Report

Abstract Introduction Stent migration is a known complication of endobronchial stent procedures, particularly with silicone stents, yet the risk factors and prevention strategies remain incompletely understood. We present a case of a woman who underwent endobronchial stent placement for left mainstem bronchus (LMB) obstruction secondary to non-small cell lung cancer (NSCLC), later complicated by contralateral stent migration. This case highlights the importance of enhanced patient identification, standardized surveillance protocols, and device design modifications to minimize stent-related complications. Case Presentation A 70-year-old female with Moderate COPD on 3 L home oxygen and NSCLC on chemoradiation presented to the ED hypoxemic with dyspnea and cough. Imaging revealed moderate left pleural effusion and a large left hilar mass causing extrinsic compression of the LMB with collapse of the left lung. Thoracentesis was attempted; however, it was complicated by a small pneumothorax (2 cm). Although initially managed conservatively, a pleural pigtail catheter was placed as the pneumothorax continued to enlarge. With catheter placement, 1 L of cytology-negative exudative pleural fluid was drained. The pneumothorax resolved, and the chest tube was removed per protocol. Repeat imaging was suggestive of hydropneumothorax, believed to represent an ex-vacuo phenomenon secondary to persistent bronchial obstruction. A repeat pigtail catheter was placed, and rigid bronchoscopy was performed with balloon dilation of the LMB. As the patient had a nickel allergy, a silicon-based stent was placed without any immediate complication. A five-day follow-up CT thorax revealed stent migration across the carina into the right main bronchus without evidence of obstruction. The stent was later removed bronchoscopically, along with the previously placed pigtail, resulting in resolution of the air leak and effusion. Eventually, her symptoms improved, and she was discharged with home oxygen, with a plan for chemoradiation. Discussion Endobronchial stent complications include migration, infection, granulation tissue formation, fracture, and restenosis. Silicone stents, while flexible and removable, have a greater tendency to migrate compared to metallic stents. In this case, silicone stent was utilized due to the patient’s documented nickel allergy. Although some studies advocate for surveillance bronchoscopy within 4-6 weeks of stent placement, the optimal interval and its impact on patient morbidity, mortality, and healthcare costs remain unclear. Prospective studies are needed to identify patients at higher risk, such as those with dynamic airway collapse or recent pleural interventions, and to validate device design modifications that minimize stent migration and improve patient outcomes. This abstract is funded by: None