The MicroFlow Spacer: A drug-eluting stent for the ethmoid sinus

Current standard surgical treatment for chronic inflammatory disease of the ethmoid sinus is endoscopic ethmoidectomy. Unfortunately, the use of traditional rigid instrumentation, with or without a micro-debrider, has been associated with middle meatal trauma and postoperative scarring, as well as breach of protective bony barriers like lamina papyracea and fovea ethmoidalis. Persistent mucosal edema of the ethmoid cavity after surgery is also a difficult problem to manage.A new surgical tool, the Relieva Stratus (Acclarent, Inc.), is a drug-eluting sinus stent that was recently introduced into clinical practice as an option for minimally invasive treatment of chronic ethmoid mucosal disease. This device is easily and temporarily implanted into the ethmoid complex during routine endoscopic sinus surgery. It is infused with 0.3 mL of triamcinolone that slowly leeches out of the device to bathe the adjacent ethmoid sinus mucosa, thereby providing local and targeted delivery of this anti-inflammatory agent. The Stratus is typically retained for 14 to 28 days, thus providing a sustained release of medication while in place. The device is subsequently easily removed in the office setting. This article describes this new technology, its indications for use, and the proper technique of deployment.