Tracheal Stent Placement In Dog With Tracheal Collapse: Woh Woh The Pomeranian

Tracheal collapse syndrome is a debilitating condition common in small breed dogs. 13-year-old Woh Woh had a 6-year history of chronic coughing. The cough worsened with episodes of syncope (fainting) despite medical management and exercise restriction. Intraluminal tracheal stenting is a minimally invasive procedure that can improve the quality of life for dogs with severe TCS.

“Woh Woh came into our lives in December 2003 – just 3 months young & slightly larger than the ball he was playing with. When my sister carried him & asked if he wanted to be our Woh Woh, he licked her nose. There was no turning back!” ~ Angeline Poh

“Inspector Woh keeps us in his radar everywhere we go. He is very smart, knows our daily activities and where the coolest spot in the house is. He always tugged at his leash and it took a toil on his breathing. When I learnt about tracheal stenting, it was a great chance to improve his quality of life.”

JANUARY 2017: WOH WOH WAS REFERRED TO vet specialist dr patrick maguire at mount pleasant vet centre (gelenggang)

During physical examination, Woh Woh was cyanotic* and observed to have the classical ‘honking’ cough. On thoracic auscultation, a left-sided heart murmur was detected.

* When there is not enough oxygen being carried to the body by red blood cells, the skin and mucous membranes can turn a bluish or purplish colour. This condition is known as cyanosis. 

Chest radiographs revealed marked tracheal narrowing with concurrent cardiac enlargement.

what is tracheal collapse?

The trachea, or windpipe, is a tube that delivers air to and from the lungs during respiration. There are small rings of cartilage along the tracheal wall to maintain the tube shape and keep the airway open. If the cartilage becomes weak, the tracheal rings flatten, making it difficult for air to get to the lungs. Signs of tracheal collapse include coughing, noisy breathing, exercise intolerance. Some dogs like Woh Woh can turn cyanotic when stressed or excited.

FEBRUARY 2017: further diagnostic evaluation and tracheal stent placement BY vet specialist DR NATHALEE PRAKASH AND DR ANTHONY GOH

Tracheoscopy revealed a grade III tracheal collapse and concurrent bronchial collapse. Stent sizing was performed radiographically using an oesophageal marker catheter.

A self-expanding nitinol tracheal stent was deployed under fluoroscopic guidance to hold Woh Woh’s trachea open and help him breathe again.

Due to Woh Woh’s compromised condition, concurrent conditions that exacerbate coughing were investigated during stent placement. Echocardiography performed revealed mitral valve disease. There was no indication of pulmonary hypertension that could have contributed to the fainting episodes on the echocardiography. Other concurrent findings include elevation of liver enzymes and hypothyroidism. These conditions had been managed by the referring vet with medications and a hepatic diet.

Bronchoscopic examination was performed to ensure that the stent was not impinging on the carina or larynx.

Post-procedural radiographs were performed to check stent placement

Post-procedural radiographs were performed to check stent placement

In addition to his on-going medication, post-procedural medication included a broad-spectrum antibiotic, corticosteroid, anti-tussive and bronchodilator therapy. The bronchoalveolar lavage results showed a very low grade, mixed inflammation and bacterial culture was negative. Antibiotics were subsequently discontinued and Woh Woh was discharged two days after stent placement.

“Woh Woh is so intelligent, hiding medicine in his food makes us very creative. He has tried all sorts of food – kaya, chicken breast, bread, chestnuts.”

During his review 2 weeks after discharge, Woh Woh was less cyanotic and honking less. There was a 50% reduction in coughing frequency and no fainting episodes.

6 months post-stenting, Woh Woh was doing well and coughing only when excited. Here he is with BFF Mochi.

Inspector Woh is a pest buster at night! Catching lizards and creepy crawly bugs that fly in after the rain.

“When Woh Woh was younger, he demanded his daily walks, rain or shine. Everybody knew him in the park. He had several girlfriends and nemesis – one moment, he would be Romeo at a girlfriend’s door and the next, pompously walking past his nemesis as if daring him to come out and fight!”

“Senior dogs require a lot of patience and care, extra attention and a healthier diet, I’m lucky Woh Woh is bolster-size. Nowadays I carry Woh Woh to ‘inspect’ the neighbourhood. He may be old but in our hearts, he is forever our little boy.” ~ Angeline

Intraluminal tracheal stent placement is a palliative, minimally invasive procedure to restore an obstructed or narrowed tracheal lumen.
  • TCS is common in small breed dogs. These patients usually present with a distinctive honking cough and may show signs of breathing difficulty, cyanosis and fainting episodes during stress.
  • Diagnosis of TCS can be made by chest radiographs but as the collapse is dynamic, fluoroscopy and endoscopic examination may be required in some cases.
  • Management of TCS consists of weight loss, use of harnesses instead of collars to reduce tracheal pressure, limiting exposure to respiratory irritants (e.g. smoke, dust).
  • The stent reduces but does not resolve coughing completely. Concurrent conditions such as bronchial collapse, chronic bronchitis and congestive heart failure should be evaluated and managed to optimise success post-stenting.
  • Intraluminal tracheal stenting can result in rapid and significant improvement of clinical signs in patients with severe TCS. However, it should be considered as a palliative procedure and reserved for dogs who do not respond to medical management.

Medical write-up by Dr Jeenise Ng and Dr Anthony Goh, Mount Pleasant Vet Centre (Gelenggang) with contributions from Angeline Poh.