Self-expandable metallic stents (SEMS) have transformed the management of central airway obstructions, offering a minimally invasive solution for patients with malignant airway conditions. These stents provide immediate symptom relief, restore airway patency, and adapt to complex airway anatomies, making them indispensable in interventional pulmonology. This article explores the historical evolution, design innovations, indications, deployment techniques, and management of complications associated with SEMS. It emphasizes patient selection, preparation, and step-by-step deployment protocols using both flexible and rigid bronchoscopies. This chapter also addresses post-procedure care, follow-up strategies, and the nuanced management of complications, including stent migration, granulation tissue formation, and airway infections. Emerging trends such as advanced imaging techniques, hybrid stents, and artificial intelligence (AI) integration are also discussed, highlighting their potential to enhance procedural accuracy and patient outcomes. The use of hybrid stents and biodegradable materials, combined with AI-driven procedural planning and surveillance, underscores the ongoing advancements in airway stenting technology. By synthesizing recent literature and incorporating clinical insights, this comprehensive review aims to serve as a valuable resource for interventional pulmonologists, guiding optimal SEMS placement and management to improve patient care in airway obstruction cases.