Paclitaxel-Coated Balloons in Refractory Nonanastomostic Airway Stenosis Following Lung Transplantation

Greer, Mark; Fuehner, Thomas; Warnecke, G.; Noack, Heiko; Heilmann, Thomas; Haverich, Axel; Welte, Tobias; Gottlieb, Jens

doi:10.1111/ajt.12845

Cited by 5 publications

(7 citation statements)

References 24 publications

(33 reference statements)

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“…While the short term follow up showed stability of the airway stenosis, 3 patients showed no demonstrable effect of PCB when comparing their pre-PCB dilation luminal diameter to their last reported luminal diameter at follow up. These findings are similar to what was reported by Greer et al [ 5 ], who were the first to describe the use of PCB dilations in treatment refractory non-anastomotic airway stenosis post lung transplantation. They found that following a single application, luminal patency was maintained in 6 of 12 patients at 270 days.…”

Section: Discussionsupporting

confidence: 91%

“…Currently, there are various treatment modalities that demonstrate efficacy, yet offer a time limited effect, and have inherent limitations. Non-drug coated balloon dilations represent the mainstay of treatment with silicone or self-expanding metal stents used as a last resort [ 5 ]. A well-documented drawback of placing a silicone stent in the airway is the development of excessive granulation tissue [ 12 ] which can occur in up to 50% of patients who have an airway stent [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…To minimize damage to the paclitaxel coating, Greer and colleagues [ 5 ] advanced and positioned the PCB in the airway over a guidewire. The flexible bronchoscope was inserted simultaneously and adjacent to the guidewire to directly visualize the PCB dilation.…”

Section: Discussionmentioning

confidence: 99%

“…Paclitaxel-coated balloons (PCB) (IN.PACT Admiral, Medtronic, Santa Rosa, CA, USA) have been shown effective in preventing restenosis in the vascular setting [ 4 ]. PCBs have shown some efficacy in airway stenosis for lung transplant recipients [ 5 ], though there is still very limited data regarding PCBs for airway stenoses.…”

Section: Introductionmentioning

confidence: 99%

“…PCBs have been described for the treatment of coronary and peripheral artery disease [ 6 ], dysfunctional dialysis access [ 9 ], in-stent restenosis in TIPS [ 10 ], and biliary anastomotic stricture after liver transplantation [ 11 ]. One study reported encouraging results describing the use of PCBs in 12 lung transplant recipients who developed treatment refractory non-anastomotic airway stenosis [ 5 ]. The aim of this study is to describe our experience with PCB airway dilation for CAO.…”

Section: Introductionmentioning

confidence: 99%

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Paclitaxel-coated balloon dilation for central airway obstruction

Sakata

Nelson

Mullon

et al. 2018

Respiratory Medicine Case Reports

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IntroductionCentral airway obstruction (CAO) often requires repeated interventional procedures which offer variable efficacy, a time-limited effect, and have inherent limitations. Paclitaxel has been used to prevent restenosis in blood vessels. The literature describing the use of paclitaxel to prevent recurrent airway stenosis is limited. We sought to describe our experience using a paclitaxel-coated balloon (PCB) for CAO.Material and methodsWe performed a retrospective review of all patients who underwent PCB airway dilation. We collected: basic demographics, details of the CAO, details of the bronchoscopes used, PCB size, PCB dilation pressure, duration of PCB inflation, concurrent non-PCB interventions, estimated pre- and post-PCB CAO luminal diameter, follow up bronchoscopy date and luminal diameter, and spirometry results.ResultsPCB dilation was performed in 10 cases on 5 patients. Eight PCB dilations were performed for CAO related to distal airway stent stenosis. Concurrent non-PCB interventions were performed with 6 PCB dilations. Nine cases documented improvements and 1 was unchanged immediately post-PCB dilation. Median luminal diameter pre-PCB dilation was 2 mm. Immediately post-PCB dilation, the median change in luminal diameter was 2 mm. Follow up bronchoscopy information was available for 9 cases. For these 9 cases, luminal diameter was unchanged in 5 and worse in 4 when compared to immediate post-PCB dilation.ConclusionPCB dilation in benign CAO produced a modest effect in this cohort of challenging airways. Larger prospective studies are needed to assess how a PCB would perform when compared to a non-drug coated balloon.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paclitaxel-coated balloon dilation for central airway obstruction

Sakata

Nelson

Mullon

et al. 2018

Respiratory Medicine Case Reports

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Airway Complications After Lung Transplantation

Santacruz¹,

Kalanjeri²,

Machuzak³

2016

Diseases of the Central Airways

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Application of paclitaxel as adjuvant treatment for benign cicatricial airway stenosis

Qiu

Zhang

Wang

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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Benign cicatricial airway stenosis (BCAS) is a potentially life-threatening disease. Recurrence occurs frequently after endoscopic treatment. Paclitaxel is known to prevent restenosis, but its clinical efficacy and safety is undetermined. Therefore, in this study, we investigated the efficacy and associated complications of paclitaxel as adjuvant treatment for BCAS of different etiologies. The study cohort included 28 patients with BCAS resulting from tuberculosis, intubation, tracheotomy, and other etiologies. All patients were treated at the Department of Respiratory Diseases, Beijing Tian Tan Hospital, Capital Medical University, China, between January 2010 and August 2014. After primary treatment by balloon dilation, cryotherapy, and/or high-frequency needle-knife treatment, paclitaxel was applied to the airway mucosa at the site of stenosis using a newly developed local instillation catheter. The primary outcome measures were the therapeutic efficacy of paclitaxel as adjuvant treatment, and the incidence of complications was observed as well. According to our criteria for evaluating the clinical effects on BCAS, 24 of the 28 cases achieved durable remission, three cases had remission, and one case showed no remission. Thus, the durable remission rate was 85.7%, and the combined effective rate was 96.4%. No differences in outcomes were observed among the different BCAS etiologies (P=0.144), and few complications were observed. Our results indicated that paclitaxel as an adjuvant treatment has greater efficacy than previously reported BCAS treatment methods.

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Paclitaxel-Coated Balloons in Refractory Nonanastomostic Airway Stenosis Following Lung Transplantation

Cited by 5 publications

References 24 publications

Paclitaxel-coated balloon dilation for central airway obstruction

Paclitaxel-coated balloon dilation for central airway obstruction

Airway Complications After Lung Transplantation

Application of paclitaxel as adjuvant treatment for benign cicatricial airway stenosis

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