Cryoablation for the Treatment of Post-Tracheostomy Tracheal Stenosis in Neurological Patients.

Abstract

Introduction: Post-tracheostomy tracheal stenosis is a clinically relevant late complication of tracheostomy. To date, there is no standardized treatment strategy for post-tracheostomy tracheal stenosis. Contact cryoablation is one of the applicable methods. The aim of the present study was to explore the efficacy and safety of contact cryoablation for the treatment of post-tracheostomy tracheal stenosis.

Methods: A total of 63 consecutive patients were included in this unicentre, combined retrospective and prospective observational study in an intensive care unit of a German neurological specialist hospital from 30 April 2020 to 21 March 2024. Post-tracheostomy tracheal stenoses were confirmed by tracheoscopy. All eligible patients were primarily treated with contact cryoablation. Primary endpoint was the rate of successful removal of the tracheostomy tube (decannulation) until hospital discharge. Technical success was defined as the absence of an endoscopically relevant residual post-tracheostomy tracheal stenosis, and clinical success was defined as the absence of symptoms, e.g., dyspnoea and stridor, both at discretion of the endoscopist and treating physician.

Results: A total of 78 interventions were performed (median: 1 per patient). Cryoablation was applied in 67% of patients at least once. A total of 70% of patients could be decannulated after treatment. Technical success and clinical success were achieved in 88% and 70% of patients, and in only 5% of patients surgical treatment was performed. No complications were observed.

Conclusion: Contact cryoablation appears to be an effective, complication-free, simple, and non-surgical treatment option for patients with post-tracheostomy tracheal stenosis. It could be an excellent option for every patient with suitable stenosis morphology. However, other endoscopic modalities must be available or complementarily used for non-suitable stenosis morphologies.