Sharma Deepankar, Kang Le, Shepherd Ray W
Department of Pulmonary and Critical Care Medicine, Columbus Regional Health, Columbus, IN.
Division of Pulmonary and Critical Care.
J Bronchology Interv Pulmonol. 2023 Jan 1;30(1):24-31. doi: 10.1097/LBR.0000000000000840.
Bronchoscopic spray cryotherapy (SCT) is utilized in the field of interventional pulmonology for treating benign and malignant airway stenosis as a standard tool to maintain airway patency. Stent-related complications include tumor overgrowth, granulation tissue, and epithelialization. Thermal ablation can have a limited role in such scenarios due to the risk of airway fire and damage to the existing stent. SCT is a potential therapy using ultra-low temperatures that can allow stents to remain in place during treatment. However, there has been no study demonstrating the safety of SCT on the integrity and physical properties of tracheobronchial stents. We report the results of the first study demonstrating the safety of SCT utilized to treat stent-associated granulation or malignant airway disease. The aim of this study was to demonstrate the effects of SCT on the physical properties of airway stents in an ex vivo environment.
Various types of airway stents were subjected to multiple intervals of SCT for up to 30 seconds, and then the cycle was repeated 3 times. After every cycle, we compressed the stents to 60% of their original size, and compression and expansion force data was collected immediately after, at 3-minute and 5-minute intervals, and compared with the baseline readings.
There was no significant change in the association between diameter and compression/expansion force, including any derangement in returning to the original diameter or any physical damage to any of the stents even after 3 prolonged SCT sessions of 30 seconds.
Our study provides the first evidence that the use of SCT in conjunction with existing silicone/metal stents is feasible and does not cause any physical damage to the stents or alters their ability to maintain the original diameter.
支气管镜下喷雾冷冻治疗（SCT）在介入肺病学领域用于治疗良性和恶性气道狭窄，是维持气道通畅的标准工具。支架相关并发症包括肿瘤过度生长、肉芽组织和上皮化生。由于存在气道着火和损伤现有支架的风险，热消融在这种情况下的作用可能有限。SCT是一种使用超低温的潜在治疗方法，可使支架在治疗期间保持原位。然而，尚无研究证明SCT对气管支气管支架完整性和物理性能的安全性。我们报告了第一项证明SCT用于治疗支架相关肉芽组织或恶性气道疾病安全性的研究结果。本研究的目的是在体外环境中证明SCT对气道支架物理性能的影响。
对各种类型的气道支架进行多次SCT，每次持续30秒，然后重复该循环3次。每个循环后，我们将支架压缩至其原始尺寸的60%，并在压缩后立即、3分钟和5分钟间隔收集压缩和扩张力数据，并与基线读数进行比较。
直径与压缩/扩张力之间的关系没有显著变化，即使在进行3次持续30秒的长时间SCT后，任何支架也没有出现恢复到原始直径的紊乱或任何物理损伤。
我们的研究提供了首个证据，即SCT与现有的硅酮/金属支架联合使用是可行的，不会对支架造成任何物理损伤，也不会改变其维持原始直径的能力。
