title: Treatment of Benign Tracheal Stenosis Using Endoluminal Spray Cryotherapy.
abstract: Tracheal stenosis is a debilitating disorder with heterogeneity in terms of disease characteristics and management. Repeated recurrences substantially alter patients' quality of life. There is limited evidence for the use of spray cryotherapy (SCT) in the management of benign airway disease.
  
  
  
  To report our early results for the use of SCT in patients with benign tracheal stenosis.
  
  
  
  Data were extracted from the medical records of a consecutive series of patients with benign airway stenosis secondary to granulomatosis with polyangiitis (GPA) (n = 13), prior tracheotomy or tracheal intubation (n = 8), and idiopathic strictures (n = 5) treated from September 1, 2013, to September 30, 2015, at a tertiary care hospital.
  
  
  
  Airway narrowing was quantified on a standard quartile grading scale. Response to treatment was assessed by improvement in airway caliber and the time interval for reintervention.
  
  
  
  Delivery of 4 5-second SCT cycles and 2 balloon dilatations.
  
  
  
  Twenty-six patients (median [range] age, 53 [16-83] years; 20 [77%] female) underwent 48 SCT sessions. Spray cryotherapy was successfully used without any substantial intraoperative or postoperative complications in all patients. In a median (range) follow-up of 11 (1-26) months, all patients had improvement in symptoms. Before the institution of SCT, 23 patients (88%) had grade III or IV stenosis. At the last evaluation after induction of SCT, 4 (15%) had grade III or IV stenosis, with a mean (SD) change of 1.39 (0.51) (P < .001). Patients with GPA required significantly fewer SCT procedures (mean [SD], 1.38 [0.96] vs 2.31 [1.18]; P = .03) during the study period.
  
  
  
  Spray cryotherapy was a safe adjunct modality to accomplish airway patency in patients with benign tracheal stenosis. Although efficacy evidence is limited for SCT, it may be useful for patients who have experienced treatment failure with conventional modalities. Further analysis of this cohort will determine the physiologic durability of the reported short-term changes. Additional trials are warranted for further evaluation of this modality.
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Faiz Y
authors.initials: FY
authors.lastname: Bhora
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Adil
authors.initials: A
authors.lastname: Ayub
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Forleiter
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Chyun-Yin
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Khalid
authors.initials: K
authors.lastname: Alshehri
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Sadiq
authors.initials: S
authors.lastname: Rehmani
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Adnan M
authors.initials: AM
authors.lastname: Al-Ayoubi
authors.affiliation: Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Wissam
authors.initials: W
authors.lastname: Raad
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai West, Mount Sinai Health System, New York, New York.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lebovics
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000150:complications; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D014135:Tracheal Stenosis / Q000628:therapy*; D014140:Tracheotomy / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult