Review of Advanced Airway Cryosurgical Techniques

Ratwani, Ankush; Fernando, Hiran C.; Khandhar, Sandeep J.; Mahajan, Amit

doi:10.2174/1573398x13666170828111043

Cited by 4 publications

(5 citation statements)

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“…Other centers have reported success with treating tracheal stenosis with cryotherapy by either cryotherapy probe and/or cryospray. 26 These interventional methods have yielded excellent results and better outcomes for our patients.…”

Section: Discussionmentioning

confidence: 95%

Management and Discussion of COVID-19 Related Tracheal Stenosis: A Single Center Retrospective Review

Sweidan,

Anaim,

Patel

et al. 2024

IMCRJ

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SARS-CoV-2 virus has led to an unprecedented amount of tracheal stenosis. Rigid bronchoscopy can serve as a curative measure or bridge therapy to tracheal resection. We also briefly discuss the pathophysiology of tracheal stenosis from prolonged intubation and SARS-CoV-2 virus. This should be differentiated from other forms of airway obstruction such as tracheobronchomalacia which would be considered a pseudo-tracheal stenotic disease. The aim of this study is to evaluate stenosis that is unable to be improved with positive airway pressure or “PAP” therapies and required stenting and/or subsequent tracheal resection. By performing Rigid Bronchoscopy and subsequent stenting of airways, we demonstrated outcomes for long term airway patency regarding patients who were intubated secondary to the SARS-CoV-2 virus. We demonstrate superb outcomes in a consecutive case series of 6 patients managed with rigid bronchoscopy, airway stent and tracheal resection. The patients were all managed from a pulmonary perspective by the physicians mentioned in this study.

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Section: Discussionmentioning

confidence: 95%

Management and Discussion of COVID-19 Related Tracheal Stenosis: A Single Center Retrospective Review

Sweidan,

Anaim,

Patel

et al. 2024

IMCRJ

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“…Cryosurgical techniques, or cold thermal ablation procedures, which include the use of cryoprobe (CP) and spray cryotherapy (SCT), avoid this risk of airway combustion [10]. Both techniques utilize extreme cold produced via the Joules-Thompson effect, whereby rapid expansion of a released high-pressure gas (liquid nitrogen or CO2) results in very low temperatures [1,10,11]. Initially used as a sequential treatment to promote tumor destruction using iterative freeze-thaw cycles, CP has been used recently as a contact treatment method to debulk central airway tumors for immediate relief (cryoextraction) [12].…”

Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Current practices in the management of central airway obstruction

Ratwani

Davis

Maldonado

2021

Current Opinion in Pulmonary Medicine

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Purpose of reviewAirway obstruction continues to cause substantial pulmonary morbidity and mortality. We present a review of classic, current, and evolving management techniques, highlighting recently published studies on the topic. Recommendations have historically been primarily based on anecdotal experience, case reports, and retrospective studies, but more solid evidence has emerged in the last decade. Recent findingsNovel endobronchial stents are being developed to mitigate the issues of stent migration, mucus plugging, fracture, and granulation tissue formation. Endobronchial drug delivery has become an active area of translational and clinical research, especially with regards to antineoplastic agents used for malignant airway stenosis. Even classic or updated techniques such as spray cryotherapy, injections of mitomycin-c, and balloon dilation have recently been examined in methodologically sound studies. Finally, recently published data have confirmed that patient breathlessness and quality of life improve significantly with therapeutic airway interventions. A multimodal and multidisciplinary approach to patient care is key to achieving the best outcomes.

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“…SCT utilizes a low boiling point cryogen (most often liquid nitrogen) stored at high pressures to produce a rapid flash-freezing of tissue upon exiting the catheter at normal body temperatures. 13,14 It is postulated that SCT may lead to a more extended treatment response by only damaging intracellular organelles, thus potentially preserving the extracellular matrix to aid in improved tissue repair. 15 At this time, the truFreeze system (STERIS, Mentor, OH) is the only Federal Drug Association (FDA) 510(k)-cleared SCT delivery system approved for airway and esophageal use in the United States (US).…”

mentioning

confidence: 99%

“…Spray cryotherapy (SCT) has recently been proposed as an adjunct therapy to prevent stenosis recurrence. SCT utilizes a low boiling point cryogen (most often liquid nitrogen) stored at high pressures to produce a rapid flash-freezing of tissue upon exiting the catheter at normal body temperatures 13,14 . It is postulated that SCT may lead to a more extended treatment response by only damaging intracellular organelles, thus potentially preserving the extracellular matrix to aid in improved tissue repair 15 .…”

mentioning

confidence: 99%

Spray Cryotherapy for Benign Large Airway Stenosis

Ratwani

Lentz

Chen

et al. 2023

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Benign airway stenosis (BAS) represents a significant burden on patients, providers, and healthcare systems. Spray cryotherapy (SCT) has been proposed as an adjunctive treatment to reduce BAS recurrence. We sought to examine safety and practice variations of the latest SCT system when used for BAS.Methods: We conducted a retrospective multicenter cohort study in seven academic institutions within the Interventional Pulmonary Outcomes Group. All patients who underwent at least one SCT session with a diagnosis of BAS at the time of procedure at these institutions were included. Demographics, procedure characteristics, and adverse events were captured through each center's procedural database and electronic health record.Results: A total of 102 patients underwent 165 procedures involving SCT from 2013 to 2022. The most frequent etiology of BAS was iatrogenic (n = 36, 35%). In most cases, SCT was used prior to other standard BAS interventions (n = 125; 75%). The most frequent SCT actuation time per cycle was five seconds. Pneumothorax complicated four procedures, requiring tube thoracostomy in two. Significant post-SCT hypoxemia was noted in one case, with recovery by case conclusion and no long-term effects. There were no instances of air embolism, hemodynamic compromise, or procedural or in-hospital mortality.Conclusion: SCT as an adjunctive treatment for BAS was associated with a low rate of complications in this retrospective multicenter cohort study. SCT-related procedural aspects varied widely in examined cases, including actuation duration, number of actuations, and timing of actuations relative to other interventions.

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Review of Advanced Airway Cryosurgical Techniques

Cited by 4 publications

References 0 publications

Management and Discussion of COVID-19 Related Tracheal Stenosis: A Single Center Retrospective Review

Management and Discussion of COVID-19 Related Tracheal Stenosis: A Single Center Retrospective Review

Current practices in the management of central airway obstruction

Spray Cryotherapy for Benign Large Airway Stenosis

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