Background:

Central airway obstruction (CAO) is a life-threatening condition that causes significant morbidity due to airflow limitation, hypoxemia, and impaired quality of life. Spray Cryotherapy (SCT) induces controlled tissue necrosis at approximately -196 °C while preserving extracellular matrix collagen, potentially reducing restenosis risk. This study aims to evaluate the safety and clinical efficacy of nitrogen-based SCT compared to mechanical dilation-based modalities in the management of CAO.

Methods:

This single-center retrospective study reviewed 56 patients who underwent liquid nitrogen-based SCT between July 2023 and November 2025. The cohort included data extracted from EPIC EMR, constituting a diverse range of indications, specifically inflammatory, autoimmune, and idiopathic diseases. Following the SCT application, mechanical balloon dilation or radial incision was performed to achieve maximum luminal patency.  

Results:

Primary etiologies included idiopathic stenosis (45%), granulomatosis with polyangiitis (GPA; 29%), and post-traumatic/post-intubation (PT/PI; 18%). At presentation, 68% of patients had 51-75% stenosis, and 27% had 76-100% stenosis.

1-year restenosis rate following SCT was 55%, notably lower than the 75-85% for other dilation-based modalities. A higher number of sprays correlated with fewer restenoses but didn’t reach statistical significance (p = 0.35). Patients with PT/PI stenosis experienced significantly earlier restenosis (median 2.5 months) compared with idiopathic (4.0 months) and GPA-related disease (5.5 months) (p < 0.05).

Conclusion:

Nitrogen-based SCT is a safe and effective intervention for CAO, demonstrating lower recurrence rates compared with traditional dilation strategies. These findings support SCT as a promising alternative to other modalities.