The evolution of airway stenting research: a bibliometric analysis of the 100 most influential articles

Introduction

Airway stenting has remained a cornerstone of interventional pulmonology for decades (1). Since the introduction of silicone stents, clinicians have widely used them to palliate, bridge, or manage post-operative complications in both benign and malignant central airway obstruction (2). Over the past three decades, advances in rigid and flexible bronchoscopy (3,4), image-guided navigation and peri-procedural management (5,6), and—most notably—materials science have greatly expanded the field. Current innovations span self-expandable metallic stents (7,8), fully biodegradable alloys and polymers (9-11), drug-eluting or bioactive coatings (12,13), iodine-125-loaded radioactive stents (14), and patient-specific devices fabricated by three-/four-dimensional (3D/4D) printing (13,15,16). These developments have broadened indications, reshaped long-term follow-up strategies, and fostered multidisciplinary collaboration among interventional pulmonology, thoracic surgery, biomaterials science, and engineering.

Despite these advances, major challenges remain: optimal use of metal stents in benign disease (17); stent migration and exuberant granulation (18,19); infection and mucus impaction (20); stent fracture and retrieval (21,22); optimization of ventilation dynamics (23); and real-world long-term outcomes (24). Emerging approaches—computational fluid dynamics and finite-element modelling (16,23), drug-eluting design (12,25), and fully degradable airway stents (10,26,27)—are shifting the focus from simple lumen relief to precise structural reconstruction and functional restoration. A comprehensive mapping of the field’s knowledge landscape and research frontiers is therefore warranted.

Bibliometrics provides a quantitative means to examine a field’s intellectual structure and evolutionary trajectory (28,29). To achieve a comprehensive mapping, we employed a multi-level analytical strategy. First, we identified the 100 most-cited articles from the Web of Science Core Collection (WoSCC) to map the field’s foundational literature and key contributors. Second, to enhance the robustness of our thematic analysis and mitigate single-database bias, we created an extended dataset (n=175) by merging high-cited literature from both WoSCC and Scopus. Finally, to overcome citation-lag bias and capture the current research frontier, we conducted a targeted analysis of recent clinical trials retrieved from PubMed. This study used Bibliometrix (R) (30), CiteSpace (31), and VOSviewer (32). Our analysis delineates the field’s collaborative networks and thematic evolution. The resulting multi-faceted evidence map aims to validate historical trends with current clinical evidence, guide future technological advances, and support data-driven decisions for clinical practice. We present this article in accordance with the BIBLIO reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1579/rc).

Methods

All bibliographic data were retrieved from the Science Citation Index Expanded (SCI-EXPANDED) within Clarivate’s WoSCC.

We conducted a search using the topic query TS = (“airway stent” OR “tracheal stent” OR “bronchial stent” OR “endotracheal stent”), which retrieved 1,677 records. We then applied automatic filters for the period 2009–2025 and for English-language publications, which reduced the dataset to 1,626 items. To maintain a homogeneous corpus, we excluded conference papers, early-access articles, and book chapters, resulting in 1,150 peer-reviewed research articles.

The remaining records were sorted in descending order of total citations. Two independent reviewers then screened titles and abstracts and, when necessary, full texts. Articles unrelated to airway stents, incomplete, or duplicated were excluded, and disagreements were resolved through discussion. The final dataset comprised the 100 most-cited articles that form the basis of this bibliometric analysis (Figure 1). The full list of these 100 articles is provided in the online table (available at https://cdn.amegroups.cn/static/public/jtd-2025-1579-1.xls).

Figure 1 Flow diagram of the literature search and screening process. WoSCC, Web of Science Core Collection.

After the final screening, we exported the dataset, including the full records and cited references, as a plain-text file named “download_1_100”. We then imported this file into three bibliometric platforms—Bibliometrix (R package), CiteSpace (v 6.3 R3), and VOSviewer (v 1.6.20). Our analyses examined countries/regions, institutions, authors, journals, co-cited references, and keywords, providing a comprehensive overview of the knowledge structure and evolution of airway-stent research.

To further enhance the breadth and robustness of our keyword analysis, we performed a supplementary search in the Scopus database. After merging and deduplicating these results with the WoS data, an extended corpus of 175 unique articles was established specifically for a more comprehensive keyword clustering analysis. Furthermore, to overcome citation-lag bias and capture the current research frontier, we conducted a targeted search in PubMed for clinical trials published in recent years, which were qualitatively analyzed to provide a snapshot of emerging clinical trends.

Results

Output of publications

As shown in Figure 2, publication output for the 100 most-cited airway-stenting articles [2009–2025] followed a three-phase trajectory: rapid growth, relative stability, and temporary decline. During 2009–2011, the field experienced an initial surge: influential publications rose from 10 in 2009 to 13 in 2010, then fell slightly to 9 in 2011. This early burst coincided with the publication of large single- or multicentre clinical reports and key innovations in self-expandable metallic stents. From 2012 to 2019, output stabilized at 6–9 articles per year, with secondary peaks in 2013, 2016, and 2019. These peaks likely reflect continued advances, such as drug-eluting and biodegradable stents, supported by the accumulation of animal and clinical evidence. Publication output fell sharply in 2020 (one article), rebounded in 2021 (seven articles), and dropped again in 2022 (three articles), mirroring coronavirus disease 2019 (COVID-19)-related research disruptions. The apparent drop after 2023 probably stems from citation lag, because recent articles have not yet accrued enough citations to enter the top-100 list. Overall, papers published during the 2010–2019 period account for 78% of the most-cited set, underscoring that decade’s pivotal impact on current airway-stenting research.

Figure 2 Annual output and citations of the 100 most influential airway stenting articles [2009–2025].

Countries/regions

During 2009–2025, researchers from 41 countries contributed to the 100 most-cited airway-stenting papers. The United States led with 28 publications, followed by China with 19. A tightly clustered trio—France, Germany, and England—each produced 11 influential articles, whereas Spain (n=7), Japan (n=6), South Korea (n=6), Switzerland (n=5), and Italy (n=5) rounded out the top ten (Table 1).

Figure 3 mirrors these patterns, where node size scales is proportional to output, and a blue-to-red gradient indicates the temporal distribution of each country’s publications. The collaboration network shows that influence depends on more than publication count. The United States holds the most central position (betweenness centrality =0.35), serving as the primary bridge between otherwise disconnected clusters. Despite publishing only one or two papers, Belgium, Austria, and Bulgaria exhibit similarly high centrality (~0.33), demonstrating that well-targeted collaborations can confer disproportionate structural impact. Among larger contributors, England (0.28) and Spain (0.26) maintain strong intermediary roles, whereas Germany (0.16) and Switzerland (0.12) add further connectivity. In contrast, China’s rapidly growing corpus shows low centrality (0.01), which implies that most work arises from domestic or region-focused partnerships rather than globally integrated teams.

Figure 3 International collaboration network of countries/regions contributing to the 100 most influential airway stenting articles. Node size represents the number of publications; the thickness and depth of the purple rim indicate betweenness centrality (bridge role in the network); concentric color rings (from blue to red) reflect the time period of participation [2009–2022]. Countries with deeper purple rims have higher centrality, suggesting stronger bridging capabilities within the global collaboration structure. CST, China standard time; LBY, look back years; L/N, links per node; LRF, link retaining factor.

Institutions

Between 2009 and 2025, 269 institutions appeared as author affiliations among the 100 most-cited airway-stenting papers. Harvard University, Harvard Medical School, and Harvard University Medical Affiliates each produced nine papers, forming a tight Boston-based cluster that collectively accounts for more than one-quarter of all high-impact publications (Table 2).

Outside the United States, Aix-Marseille Université (9 papers) and its clinical partner Assistance Publique-Hôpitaux de Marseille (8 papers) led continental output, whereas Ruprecht-Karls-Universität Heidelberg topped the German list with seven.

Figure 4 reveals three dense collaboration hubs. The crimson French cluster is centred on Aix-Marseille and Paris’s Assistance Publique-Hôpitaux de Paris (APHP). An orange-green German-UK cluster is anchored by Heidelberg and Imperial College London. A blue-green constellation surrounds the Harvard institutions. The colour gradient traces a steady expansion of institutional participation from deep blue in 2009 to scarlet in 2025. Despite their large node sizes, the Harvard institutions lie at the network periphery (betweenness centrality ~0.01), which indicates that most of their collaborations are confined to the Boston cluster.

Figure 4 Institutional collaboration network in airway stenting research. Node size represents the number of highly cited articles; the thickness and depth of the purple rim indicate betweenness centrality; concentric color rings denote the year of participation [2009–2022]. Institutions with deeper purple rims are structurally more influential in the global collaboration network. CCs, connected components; CST, China standard time; LBY, look back years; L/N, links per node; LRF, link retaining factor.

Structural influence, measured by betweenness centrality, is dominated by APHP (0.36), which serves as the principal bridge between the European and North-American subnetworks. Heidelberg (0.22) and Imperial College London (0.19) likewise function as key intermediaries, even though they contribute fewer high-impact papers than the Harvard or Marseille groups. Mid-sized U.S. centres—Johns Hopkins University and the Ohio University System—show moderate centrality (0.08–0.09) and help knit together otherwise fragmented American teams.

These results echo the country-level analysis: influence in the global network depends less on publication volume than on the diversity and reach of collaborative ties.

Authors and cited authors

Over the study period, 636 researchers co-authored the 100 most-cited papers. The field’s output is largely driven by a core group of prolific authors. Prominent among them are Hervé Dutau and Armin Ernst, who have sustained a steady output since the early 2010s (Figure 5A). Collaboration analysis reveals that these authors anchor two dominant, tightly knit clusters: a European group led by Dutau and a North-American group centered on Ernst (Figure 5B).

Figure 5 Analysis of author productivity, collaboration, and co-citation in airway stenting research. (A) Top authors’ production over time. Node size is proportional to the number of articles (N.Articles), and color intensity represents the total citations per year (TC per Year). (B) Author collaboration network. Nodes represent authors, and node size indicates the number of publications. Lines connecting nodes represent collaborative relationships. (C) Author co-citation network. Nodes represent co-cited authors. Node size denotes the co-citation frequency, and the thickness and depth of the purple rim indicate betweenness centrality. CCs, connected components; CST, China standard time; LBY, look back years; L/N, links per node; LRF, link retaining factor.

A complementary co-citation analysis highlights the field’s intellectual pillars (Figure 5C). Lutz Freitag, Christoph T. Bolliger, and Hervé Dutau are the most frequently co-cited authors, forming the conceptual backbone of modern airway stenting research. Notably, Freitag also demonstrates the highest structural importance, acting as a pivotal conceptual bridge that links otherwise disparate studies. Detailed author productivity rankings are provided in Table S1.

Journals

Among the 100 most-cited airway-stenting papers, 55 journals were represented, yet most articles appeared in only a few respiratory and cardiothoracic journals. Chest published 13 benchmark papers, followed by Respiration with 11. Annals of Thoracic Surgery, European Journal of Cardio-Thoracic Surgery, and Journal of Thoracic and Cardiovascular Surgery each contributed three to four high-impact studies (Figure 6A). Other outlets—such as Respirology, Acta Biomaterialia, and the American Journal of Roentgenology—broadened disciplinary coverage, although none published more than two papers.

Figure 6 Journal analysis in airway-stenting research. (A) Most relevant sources (ranked by number of documents); (B) most locally cited sources; (C) journal dual-map overlay, with a single green citation path indicating a primary citation flow from journals in the Medicine/Medical/Clinical domain to those in the Molecular/Biology/Genetics domain.

Local citation patterns reinforced these distributions. Chest received 373 intra-set citations, far exceeding Annals of Thoracic Surgery (n=242) and Journal of Thoracic and Cardiovascular Surgery (n=176). In contrast, European Respiratory Journal and Laryngoscope, despite modest output, still ranked in the top ten for local citations, underscoring their conceptual influence (Figure 6B).

The dual-map overlay (Figure 6C) reveals one dominant citation path (green): articles in Medicine/Medical/Clinical journals primarily cite work in the Molecular/Biology/Genetics domain. This pattern underscores the translational nature of airway-stent research, where clinical studies routinely build on basic biomedical discoveries.

Cited references

Co-citation analysis of the 100 most-cited articles identified 2,160 core references. In the visualised network (Figure 7A), Saad CP 2003 (33) and Dumon JF 1990 (34) sit at the centre; their thick, dark-purple rims denote dominance in both co-citation frequency and betweenness centrality. These pioneering reports on silicone and metallic airway stents laid the field’s methodological foundation and now act as pivotal hubs guiding subsequent research.

Figure 7 Reference analysis in airway-stenting research. (A) Reference co-citation network; node size denotes co-citation frequency, purple rim thickness and depth encode betweenness centrality, and concentric colors indicate citation year. (B) Top 20 references exhibiting the strongest citation bursts from 2009 to 2022; red bars mark burst periods. CCs, connected components; CST, China standard time; LBY, look back years; L/N, links per node; LRF, link retaining factor.

Table 3 confirms the pattern: Saad 2003 (17 co-citations), Dumon 1990 (13 co-citations), and Agrafiotis M 2009 (11 co-citations) are the most frequently co-cited, and Dumon 1990 shows the highest betweenness centrality (0.29).

Citation-burst analysis (Figure 7B) shows a clear shift in research priorities. The first peak [2009–2010] centres on early stent-placement techniques, exemplified by Miyazawa T [2000] (43) and Martínez-Ballarín JI [1996] (44) (burst strength ~3.1). The second wave [2012–2017], driven by Ernst A [2004] (38) and Chung FT [2011] (39), reflects the focus on tumour-specific stent strategies and the inclusion of patient-outcome metrics. The most recent burst [2018–2022] centres on engineering-oriented work led by Freitag L [2017] (45), which indicates that individualized, image-guided stent design is now the leading research frontier.

Collectively, the network topology, burst dynamics, and top-ranked references show that the field has evolved from technique-driven case series into an interdisciplinary domain that merges materials science, oncology, and outcomes research, yet remains anchored to a few landmark clinical trials and procedural guidelines.

Keywords

The co-occurrence map (Figure 8A) reveals three thematic clusters. A red cluster centres on “management”, linking clinical terms such as interventional bronchoscopy, rigid bronchoscopy, and obstruction. The blue cluster revolves around tracheal stenosis and connects paediatric topics—bronchomalacia and children—to reconstructive surgery. A green cluster, dominated by metallic stents and lung transplantation, bridges device engineering with transplantation-related airway complications.

Figure 8 Keyword analysis in airway-stenting research. (A) Keyword co-occurrence network; node size indicates frequency, and colours denote clusters. (B) Overlay visualisation showing temporal evolution of terms. (C) Top 25 keywords with the strongest citation bursts [2009–2022]; red bars mark burst periods. CCs, connected components; CST, China standard time; LBY, look back years; L/N, links per node; LRF, link retaining factor.

Keyword metrics (Table 4) corroborate these structural roles. “Management” is the most frequent term (42 occurrences), whereas the highest betweenness centrality belongs to “complications” (0.30) and “airway stenting” (0.28), underscoring their role as bridges between otherwise separate topics. Notably, “benign tracheobronchial stenosis” and “rigid bronchoscopy” also exhibit high centrality despite modest frequency, emphasising their strategic importance in linking technology-oriented and disease-specific strands of the field.

The temporal overlay (Figure 8B) traces concept evolution. Early work [2009–2012] focused on procedural safety; keywords such as “complications”, “obstruction”, and “silicone stents” dominated. Between 2013 and 2016, interest shifted toward metallic stents, tracheal stenosis, and outcome-oriented concepts (e.g., outcome analysis). From 2017 onward, the map extends into engineering and biologics, introducing keywords such as “biocompatibility”, “cartilaginous matrix”, and “3D printing”.

Citation-burst analysis (Figure 8C) sharpens this trajectory. The first bursts [2009–2012] centre on “silicone stents” and “airway stenting” (burst strength 1.9–1.8), reflecting renewed interest in foundational techniques. The second wave [2014–2016] features “metallic stents” and “tracheal stenosis”, paralleling device optimisation and expanding indications. The most recent bursts [2019–2022] target “3D printing”, “behaviour”, and “fabrication”, signalling a pivot toward personalised, image-guided, bio-inspired stent design.

Specifically, this analysis highlights 3D-printed, biodegradable, and drug-eluting stents as emerging research hotspots. The keyword “3D printing” exhibited a strong citation burst (strength 1.31) from 2016 to 2022 (Figure 8C), underscoring a surge in research on personalized stents for improved anatomical fit. This trend is supported by the related keyword “fabrication”, which showed a citation burst from 2019 to 2022. Similarly, interest in biodegradable stents is reflected by terms like “biodegradable metals” appearing in the mid-2010s timeline and a burst for “biocompatibility” from 2017 to 2019. Finally, early work on drug-eluting variants is evident from terms like “paclitaxel drug-eluting tracheal stent” showing activity around 2012–2014, aimed at addressing complications such as granulation tissue formation. As shown in the co-occurrence network (Figure 8A), these innovations all connect to central clinical themes like “management” and “complications”, underscoring their role in solving long-standing challenges in the field.

To enhance the breadth and robustness of the keyword analysis, we created an extended dataset of 175 articles by merging and deduplicating high-cited literature from the Scopus database with our WoS data. The keyword clustering timeline view generated from this extended dataset (Figure 9) not only validates the findings of the main analysis but also clearly reveals three evolutionary stages. First, the research origin focused on foundational surgical concepts such as #0 “trachea” and #4 “tracheotomy”. Next, the core phase shifted to modern interventional therapies, represented by #2 “metallic stent” and #3 “interventional pulmonology”. Finally, the current research frontier is defined by emerging clusters such as #6 “biodegradable airway stent”, #9 “biomaterials”, and #12 “translational research”. This extended analysis confirms the field’s clear trajectory from basic surgical procedures to advanced bioengineering solutions and enhances the reliability of our conclusions.

Figure 9 Clustering timeline view showing the temporal evolution of research themes, based on the extended dataset (n=175). CCs, connected components; CST, China standard time; LBY, look back years; L/N, links per node; LRF, link retaining factor.

Clinical trials

An analysis of clinical trials from the past 5 years [2021–2025] reveals a clear research focus on three key areas: advanced procedural planning, next-generation device evaluation, and the management of complications to improve patient-centered outcomes.

The trend toward personalization is exemplified by a 2025 study from Leonardi et al. (46), which demonstrated that using 3D airway reconstruction for pre-procedural planning significantly reduced operative time and stent migration rates. Efforts to refine existing technology are also prominent. A multicenter study by Madisi et al. [2024] (8) established a favorable safety profile for the third-generation Bonastent, while a preclinical trial by Cho et al. [2024] (47) showed that a novel hydrophilic polymer coating could reduce airway injury associated with silicone stents. Furthermore, recent research has concentrated on improving quality of life by managing common complications. Salguero et al. [2024] (48) found that nebulized hypertonic saline may be more effective in preventing mucus plugging. Similarly, a randomized trial by Pu et al. [2024] (49) provided prospective evidence that stenting for excessive central airway collapse significantly improves respiratory symptoms, quality of life, and exercise capacity. Recent clinical studies on airway stenting are summarized in Table 5.

Collectively, these recent trials indicate a clear trajectory towards creating safer, more effective, and personalized airway stenting solutions.

Discussion

This bibliometric study examines airway-stent articles indexed in Web of Science [2009–2025] and maps their research landscape and evolution. The United States leads with 28 highly cited papers, confirming its dominant role in airway-stent research. France, Germany, and the United Kingdom each contribute 11 key papers, remaining critical drivers of progress. China ranks second with 19 papers, reflecting rapid growth; however, most studies are domestic, and its international bridging role remains limited. The Boston cluster—centred on Harvard University and Harvard Medical School—produces the most highly cited papers, whereas Aix-Marseille Université and Heidelberg University lead in Europe. High-impact studies cluster in a few authoritative journals; Chest stands out, publishing 13 top-cited papers and accruing the most citations, underscoring its position as the field’s core outlet. Annual output peaked in 2010, stabilised with secondary peaks in 2013, 2016, and 2019, dropped sharply after 2020 due to COVID-19, and has stayed low since 2023, likely attributable to citation lag. These findings indicate that the 2010s were a “golden decade” laying the foundation for modern airway-stent research. Overall, North-American and Western-European scholars still dominate knowledge production, whereas China’s contributions could be further amplified through deeper integration into global collaborations.

Authorship and network analyses highlight the disproportionate contributions of a small core of researchers. Hervé Dutau tops the list with nine highly cited papers, followed by Armin Ernst (eight) and George A. Eapen (four). These prolific authors form tight networks: Dutau leads a Europe-centred cluster, whereas Ernst and Eapen anchor the North-American core, with frequent cross-border cooperation linking the two. A Franco-German network led by Felix J. F. Herth also serves as a bridge, underscoring the value of interregional and interinstitutional cooperation for high-impact research. Co-citation analysis identifies Saad 2003 and Dumon 1990 as leading hubs with 17 and 13 co-citations, respectively; Dumon 1990 also holds the highest betweenness centrality (0.29), making it a pivotal bridge between thematic clusters. Other keystone papers, such as Agrafiotis 2009 and Ernst 2004, link subfields of disease management, complication prevention, and technical optimisation through high co-citation and intermediate centrality. Collectively, these studies form the conceptual pillars of airway-stent research, integrating material advances with clinical application and providing a solid base for future work. Collaboration and co-citation patterns show that airway-stent research relies on teamwork and knowledge sharing; interdisciplinary, cross-border innovation boosts impact, and classic studies bridge clinical practice with basic science. A dual-map overlay confirms a strong translational profile: highly cited clinical papers appear in medical journals but cite heavily from molecular biology, materials science, and other basic fields, demonstrating that engineering and biomaterials advances drive clinical innovation.

Keyword evolution and burst analyses trace the technological evolution of airway stenting. In 2009–2012, keywords focused on implantation safety, complication control, and silicone stents, reflecting a focus on safe placement and the management of stenoses. From 2013 to 2016, hotspots shifted to self-expandable metallic stents, tracheal stenosis, and outcome evaluation, signaling a shift toward performance optimization and mid-term follow-up. After 2017, terms like 3D printing, biodegradable materials, and drug-eluting stents surged, defining the current research frontier. Customized printed stents are designed to match patient anatomy; biodegradable devices aim to avoid long-term complications; and bioactive coatings are developed to target granulation, infection, and tumour recurrence. Burst analysis corroborates this path: 2009–2012 bursts centred on “silicone stent”, 2014–2016 on “metal stent” and “tracheal stenosis”, and after 2019 on “3D printing” and “stent fabrication”. Over the past 15 years, the focus has shifted from maintaining simple lumen patency to achieving precise anatomical reconstruction and functional restoration. Researchers continue to explore new materials and processes to overcome limitations and improve long-term efficacy and safety, illustrating the field’s dynamism and ongoing innovation.

3D printing offers distinct advantages for patient-specific airway-stent design (53). Transforming patient computed tomography (CT) data into precise airway models enables production of bespoke stents that closely match the anatomy, thereby improving positional stability and reducing migration (14,54). For example, digital-light-processing printing has produced elastic, biodegradable stents whose mechanical properties rivaling those of conventional silicone devices and the ability to degrade over 6–7 weeks in vivo, eliminating the need for removal surgery (10). Other investigators have embedded chemotherapeutics in 3D-printed, drug-eluting stents that maintain patency while continuously releasing agents to suppress granulation and local tumour recurrence (13). Nevertheless, key challenges persist: some degradable resins lack adequate strength or are brittle (55); long-term behaviour in the humid airway environment—including effects on mucociliary clearance and blockage risk—remains uncertain (56); and large-scale clinical trials are still required to verify durability and safety (57). Promising strategies include pairing 3D-printing with bio-inspired degradable materials (58) and applying artificial intelligence (AI)-driven, data-centric design to create stent architectures tailored to patient-specific anatomy and airflow dynamics (59). Rigorous multicentre prospective trials are essential to establish long-term efficacy and facilitate widespread adoption.

Biodegradable airway stents have recently become a major research focus for interventional management of airway stenosis (60). Since these stents dissolve after providing support, they eliminate explantation and reduce chronic complications—benefits that are particularly valuable in benign and paediatric cases (61-63). Notable advances include polydioxanone (PDS) stents, now under clinical evaluation for post-transplant bronchial anastomotic stenosis, which fully degrade and show favourable biocompatibility within 90 days in preclinical models (27,64). Ultra-high-ductility Mg-Li-Zn alloy stents have been validated in vitro and in rabbit airways, demonstrating gradual resorption over several months without adverse reactions, suggesting their potential for pediatric applications (55). Challenges remain: heterogeneous degradation can cause inadequate support or restenosis if resorption is too rapid (65), and robust long-term safety and efficacy data are still lacking (14). Future research should focus on refining materials and structures to align degradation with mechanical demands and, where appropriate, add drug coatings for local anti-tumour or anti-scarring therapy. If these challenges are resolved, biodegradable stents could markedly improve airway-stenosis management by reducing complications, eliminating secondary procedures, and enhancing long-term outcomes.

Although this study outlines the field’s landscape and main trends, several limitations warrant acknowledgement. First, our core analysis relies on the WoS Core Collection, and our extended analysis includes Scopus, both of which predominantly index English-language articles. While this approach ensures data quality and consistency for network analysis, studies in other languages or indexed in different databases may have been missed. This approach may introduce a geographic and linguistic bias. Second, our primary method of ranking by total citations inherently favors older papers, a phenomenon known as citation-lag bias. To address this, we supplemented our main analysis with a targeted review of the most recent clinical trials from PubMed. This forward-looking analysis provides a snapshot of the current research frontier that citation counts alone cannot capture. Third, we recognize that bibliometric metrics like citation counts do not directly measure clinical merit or true innovative quality. By analyzing the objectives and outcomes of recent clinical trials, we have attempted to bridge this gap, connecting quantitative trends with their practical clinical implications. Finally, while our main analysis focuses on the 100 most-cited papers to identify the field’s foundational works, we broadened our scope with an extended thematic analysis of 175 articles from both WoS and Scopus. This approach enhances the robustness of our trend analysis and adds to the diversity of the included literature, although many mid-impact studies are still excluded. While these limitations warrant caution, we believe our multi-level analytical strategy provides a comprehensive and balanced overview of the field.

Looking ahead, our findings highlight several priorities for future research. First, long-term clinical outcomes require greater emphasis; large, extended-follow-up studies should compare the efficacy and safety of different stent types in benign and malignant conditions to guide practice. Second, continuous optimization of biofunctionality and biocompatibility is essential, including controllable degradation kinetics, anti-scarring and anti-infective coatings, and biomimetic structures that preserve mucociliary clearance. Third, strengthening international, multidisciplinary collaboration is pivotal; high-impact advances often arise from cross-border teams that integrate clinical and engineering expertise. Expanding global networks, promoting multicentre trials and data sharing, and uniting clinicians with materials scientists and bioengineers will accelerate breakthroughs in materials, technologies, and clinical applications, ultimately improving patient outcomes and quality of life.

Conclusions

In conclusion, this bibliometric analysis provides a comprehensive map of the global airway stent research landscape, revealing a clear and dynamic evolution from foundational techniques toward sophisticated, patient-specific technologies. Our findings offer a robust, evidence-based framework that not only validates past progress but also illuminates the path forward. Future breakthroughs will undoubtedly emerge from the convergence of three critical areas: rigorous long-term clinical trials, pioneering advances in biomaterials and stent design, and synergistic international collaboration. By strategically uniting engineering innovation with clinical expertise, the research community can accelerate the translation of next-generation devices from concept to clinic, ultimately establishing a new standard of care and improving patient outcomes worldwide.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the BIBLIO reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1579/rc

Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1579/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1579/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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