Medical Management Versus Stent Placement in Dogs with Tracheal Collapse

In the literature

Congiusta M, Weisse C, Berent AC, Tozier E. Comparison of short-, intermediate-, and long-term results between dogs with tracheal collapse that underwent multimodal medical management alone and those that underwent tracheal endoluminal stent placement. J Am Vet Med Assoc. 2021;258(3):279-289.

The Research …

Distinguishing the 2 main types of tracheal collapse can help with treatment approaches and response to therapy. Traditional-type tracheal collapse presents as dynamic respiratory dysfunction that worsens due to progressive weakening of the tracheal cartilage and the trachealis dorsalis muscle. Malformation-type tracheal collapse is caused by dorsal deviation of the ventral tracheal ring borders at the level of the thoracic inlet, causing respiratory signs to be more static. Both types should be initially treated typically with a combination of antitussives, anxiolytics/sedatives, anti-inflammatory drugs, and antimicrobials that can be adjusted based on clinical signs and response to therapy. Endoluminal tracheal stenting or tracheal ring prosthetic placement can physically open the collapsing airway when signs are severe or medical management does not provide acceptable improvement of signs and quality of life.

In this study, short- (45 days postdiagnosis), intermediate- (46-180 days postdiagnosis), and long-term (>180 days postdiagnosis) outcomes were compared in dogs with tracheal collapse that underwent medical management alone (n = 84) and dogs with subsequent tracheal endoluminal stent placement after failed medical management (n = 75). 

Traditional-type tracheal collapse was diagnosed via radiography in 107 dogs; malformation-type tracheal collapse was diagnosed in 43 dogs; and type of tracheal collapse was undetermined in 9 dogs. The proportion of dogs with malformation-type tracheal collapse that underwent stent placement (38 of 43 [88%]) was significantly greater than the proportion of dogs with traditional-type tracheal collapse that underwent stent placement (37 of 107 [35%]). 

Medical management resulted in short-term improvement, but clinical scores worsened for nearly half of this group by the long-term follow-up. Dogs with mild to moderate disease responded for months to years, but dogs with more severe clinical signs deteriorated more rapidly with medical management alone. Mean survival time (MST) was only 12 days in dogs with the most severe clinical scores treated with medical management alone, whereas MST was 1,338 days in dogs with severe disease treated with tracheal stenting. 

The authors recommended earlier intervention with stent placement in dogs presented with severe, refractory clinical signs. 

Overall, MST from the time of diagnosis by the referring clinician was longer in dogs treated with tracheal stenting (5.2 years) compared with dogs receiving medical management alone (3.7 years); however, this difference is not statistically significant. It is important to consider that all dogs managed with tracheal stenting had failed medical management. Significantly shorter MST was associated with age (>8.8 years), presence of concurrent cardiac disease, need for emergency examination during intermediate-term follow-up, and diagnosis of pneumonia during intermediate-term follow-up.

...TO YOUR PATIENTS

Key pearls to put into practice:

• Multimodal medical management can alleviate clinical signs in dogs with mild to moderate tracheal collapse for months to years, after which tracheal stenting can extend survival.

• Dogs presented with severe, refractory tracheal collapse typically benefit from earlier tracheal stenting.

• Dogs with malformation-type tracheal collapse are more likely to require tracheal stenting than dogs with traditional-type tracheal collapse.