C78-08 Cleaning the Pipes With a Self Expanding Metallic Y Stent in a Carinal Obstruction - A Life Saving Bridge to Chemotherapy in Advanced Disease

Introduction The Central Valley remains a healthcare desert with limited access to subspecialists, resulting in delayed diagnosis & management of complex diseases. Large-cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive lung cancer, accounting for only 0.3-3% of lung malignancies. Its overlapping histopathologic features with small-cell & non-small-cell carcinoma make the diagnosis challenging. Central airway obstruction due to LCNEC can be rapidly fatal, necessitating urgent interventional management. Case Presentation A 63-year-old female chronic smoker presented with progressive dyspnea & hemoptysis. A prior CT revealed 8.8 × 7.7cm right upper & middle lobe mass encasing the trachea causing lobar collapse & contralateral bronchus compression at carina. She required escalation to high-flow oxygen therapy.On day 2, bronchoscopy with endobronchial ultrasound revealed a large fungating mass at the posterior tracheal wall, narrowing > 80% of the tracheal lumen & occluding the right main bronchus & contralateral bronchus compression at carinal level. Post procedure, she became hypoxemic & admitted to ICU. Given the degree of airway compromise, she was transferred to a tertiary facility locally with interventional pulmonology (IP).Patient underwent urgent rigid bronchoscopy with mechanical coring & airway recanalization with improved saturation post-recanalization.Further excision of the tracheal & right mainstream bronchus tumor was done with combination cryotherapy (2.4 mm probe), mechanical debulking (rigid forceps) & an APC laser for coagulation. Upper & middle bronchi were completely obstructed by extrinsic compression & tumor invasion, unsalvageable at the secondary carina. The lower lobe bronchus was stented with a 20x50 MM (L1 30 MM L2 15 MM) Microtech self-expanding metallic Y Stent. The limbs of the Y stent were flipped to cover the right main stem with the longer limb till the secondary carina. Patient was extubated immediately following the procedure with symptomatic improvement. Pathology demonstrated LCNEC metastatic to mediastinal lymph nodes. After stabilization, she was initiated on chemotherapy with carboplatin & etoposide. Discussion LCNEC frequently presents at an advanced stage & carries a poor prognosis. Airway obstruction is a major cause of mortality in these patients. Intervention with stent placement provides immediate relief of obstruction, improves oxygenation, & serves as a bridge to definitive systemic therapy. In an underserved region, timely access to interventional pulmonology is critical to prevent deterioration & facilitate optimal care. This case highlights the lifesaving role of IP in managing malignant central airway obstruction. Placement of a self-expanding metallic Y-stent enabled airway stabilization and initiation of chemotherapy, emphasizing the importance of improving subspeciality access in resource-limited settings.