Late Breaking Abstract: EXHALE airway stents for emphysema (EASE) trial: CT analysis shows stent-based regional changes mediate early benefit & later loss
P. Shah, D. J. Slebos, P. F. G. Cardoso, B. Levine, K. Voelker, J. Goldin, F. Abtin, M. E. Russell, J. D. Cooper, G. W. Sybrecht (London, United Kingdom; Groningen, Netherlands; Porto Alegre, Brazil; Phoenix, Sarasota, Los Angeles, Mountain View, Philadelphia, United States Of America; Homburg, Germany)
Source: Annual Congress 2010 - State of the art imaging
Session: State of the art imaging
Session type: E-Communication Session
Number: 5274
Disease area: Airway diseases
Abstract Purpose : The use of CT imaging to evaluate regional and stent changes over 6 months following Airway Bypass (AB) treatment.Methods: EASE is a prospective, 2:1 randomized trial comparing AB with sham control (SC) in severe homogenous emphysema (RV/TLC≥0.65). Passages were created under doppler guidance, and stents were placed if technically possible. 1d and 6mo CT scans were performed at TLC and RV. Independent core lab analysis (MedQIA) measures were used to calculate %RV per lobe. Two reviewers graded 415 stents from 100 subjects for stent patency in multiple views per pre-specified criteria.Results: Mean 5.8±1.6 passages (range 2-14) were created per subject, with mean 4.7±1.4 stents placed. Stent distribution was similar across lobes. At 1d, Δ%RV varied across lobes (-27% to +2%) with 89% lobes with reductions of >5% and 11% with reductions >15%. By 6 mo, 4±1.6 stents per subject were in place, with 1 subject having 0 stents, 5, 11, 14, 28, 24, & 27 subjects had 1, 2, 3, 4, 5, and 6 stents, respectively in place. At 6 mo, RV benefit was not preserved in 56% of lobes with 33% lobes maintaining reductions >5%. Of 415 stents graded, 46% were occluded, 10% probably occluded, 20% probably patent, 24% patent. Incidental post-procedure bronchoscopy suggests varying types of occlusion like fibrosis, mucous and lung parenchyma.Conclusions: CT analysis permits objective assessment of regional effects and patency over time. Analysis showed initial reduction in the majority of the lobes and later decline of lung volume benefit associated with loss of stent patency. Improving stent patency by better placement and reducing occlusion may extend durability.
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P. Shah, D. J. Slebos, P. F. G. Cardoso, B. Levine, K. Voelker, J. Goldin, F. Abtin, M. E. Russell, J. D. Cooper, G. W. Sybrecht (London, United Kingdom; Groningen, Netherlands; Porto Alegre, Brazil; Phoenix, Sarasota, Los Angeles, Mountain View, Philadelphia, United States Of America; Homburg, Germany). Late Breaking Abstract: EXHALE airway stents for emphysema (EASE) trial: CT analysis shows stent-based regional changes mediate early benefit & later loss. Eur Respir J 2010; 36: Suppl. 54, 5274
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