Successful Treatment of Recurrent Airway Stenosis With Paclitaxel‐Coated Balloons: A Case Report

ABSTRACT

Although current treatment strategies for nonmalignant airway stenosis may offer short‐term relief, their effectiveness is limited by high recurrence rates, often requiring additional procedures. While paclitaxel‐coated balloons (PCB) have demonstrated effectiveness in treating stenosis across various vascular and nonvascular conditions, their evidence in recurrent airway stenosis remains limited. Here, we present the case of a 35‐year‐old female with bronchial stenosis who underwent multiple bronchoscopic interventions, all of which were complicated by restenosis. Following the addition of a PCB to the therapeutic regimen, the patient achieved sustained airway patency.

Here, we present a patient with recurrent bronchial stenosis who, despite undergoing multiple bronchoscopic dilation procedures, achieved sustained airway patency only after the addition of a paclitaxel‐coated balloon to the therapeutic regimen.

1. Introduction

The treatment of nonmalignant airway stenosis remains a significant challenge, as existing strategies, such as mechanical debulking, rigid bronchoscopic dilation and balloon dilation are limited by high recurrence rates, often requiring repeated interventions [1, 2]. In cases of recurrent disease, stent placement is the treatment of choice; however, their use is frequently associated with numerous complications, including restenosis, granulation tissue formation, stent migration and infection [1, 3]. As a result, there is still no clear consensus on the optimal management of recurrent airway stenosis [1].

Recently, paclitaxel‐coated balloons (PCB) have emerged as a promising treatment option for a wide range of vascular and nonvascular stenotic conditions [2, 4]. Due to its anti‐proliferative properties, paclitaxel may prove especially beneficial in the setting of frequent restenosis. However, despite these encouraging results, the use of PCB in recurrent airway stenosis has minimal evidence [2].

Here, we present a patient with recurrent bronchial stenosis who, despite undergoing multiple bronchoscopic dilation procedures, achieved sustained airway patency only after the addition of a PCB to the therapeutic regimen.

2. Case Report

A 35‐year‐old female with a history of premature birth at 21 weeks, bronchopulmonary dysplasia, multiple pneumothoraxes and gastroesophageal reflux disease s/p Nissen fundoplication presented with shortness of breath, cough and stridor. On chest computed tomography, significant air trapping and proximal mainstem bronchi stenosis were noted. Bronchoscopy revealed a fibrotic bridge connecting the lateral walls of the distal trachea [5], complete occlusion of the right mainstem bronchus (RMB) and partial occlusion of the left mainstem bronchus (LMB) and bronchus intermedius (BI). The airway diameters are detailed in Figure 1. Serial balloon dilation and hybrid knife electrosurgery were performed, with a repeat procedure after 1 month.

FIGURE 1.

Longitudinal assessment of airway diameter. Changes in airway diameter pre‐ and post‐paclitaxel‐coated balloon dilation.

Six months later, the patient presented with worsening respiratory symptoms. Bronchoscopy was performed, revealing severe restenosis of the LMB and moderate restenosis of the RMB and BI. Hybrid knife electrosurgery and serial balloon dilation were repeated.

One month later, restenosis was noted on the follow‐up bronchoscopy (Figure 2A). Hybrid knife electrosurgery and serial balloon dilation were again performed, along with the application of paclitaxel via a 12 × 40 mm balloon at 3 atm for 2 min (Figure 2B,C). No immediate complications were noted. At the 1‐month follow‐up, the patient reported substantial symptomatic improvement. Bronchoscopic examination revealed a normal‐sized LMB with only mild residual stenosis of the RMB and BI, which were treated with additional PCB dilation for 2 min. Four months later, the patient showed sustained airway patency with no evidence of restenosis on follow‐up bronchoscopy (Figure 3). At the 6‐month follow‐up, the patient remained asymptomatic with continued improvement in respiratory status.

FIGURE 2.

Paclitaxel‐coated balloon dilation. (A) Pre‐PCB dilation bronchoscopy showing moderate stenosis of the LMB and RMB. (B) PCB application at 3 atm for 2 min. (C) Post‐PCB dilation bronchoscopy. LMB, left mainstem bronchus; PCB, paclitaxel‐coated balloon; RMB, right mainstem bronchus.

FIGURE 3.

Improvement in airway diameter over time. (A, B) Most recent bronchoscopy showing sustained airway patency: (A) Right and left mainstem bronchi and (B) bronchus intermedius.

3. Discussion

The management of nonmalignant airway stenosis is guided by several factors, including the severity of symptoms, the degree of stenosis and the presence of comorbidities. For mild, asymptomatic stenoses, conservative management is recommended, while more severe cases often require bronchoscopic intervention. Although current treatment strategies can provide short‐term relief, their long‐term effectiveness remains limited [1, 6]. Furthermore, in cases of recurrent airway stenosis, alternative therapeutic strategies like stent placement, are associated with a high risk of complications [1, 3]. For instance, a retrospective study reported a decline in primary patency rates from 92% at 3 months to 20% at 12 months in 59 patients with tracheobronchial stenosis who underwent balloon dilation [6]. Similarly, Jeong et al. [7] reported that among 19 patients with postoperative tracheobronchial stenosis who received stents, 70% experienced complications, including restenosis (43%), granulation tissue overgrowth (33%), stent migration (32%) and mucostasis (30%). In light of these challenges, exploring alternative treatment options for recurrent airway stenosis is crucial to improving long‐term patient outcomes.

PCB have demonstrated to be a safe and effective option for the treatment of stenosis in various clinical settings, including coronary and peripheral artery disease, dialysis access sites and post‐transplant biliary anastomotic strictures [2, 4]. Although the use of paclitaxel for recurrent or refractory airway stenosis has shown encouraging results, studies are scarce. Notably, a preclinical study by Wang et al. [8] showed that paclitaxel significantly reduced stenosis by inhibiting fibroblast proliferation following airway injury in a rabbit model. Compared to the control group (59% ± 13%), stenosis was reduced to 22% ± 7% in the treatment group. These findings were later confirmed by Chen et al. [9], who further highlighted the antiproliferative effects of paclitaxel on human pulmonary fibroblasts, underscoring its potential application in drug‐eluting airway stents.

Later on, Greer et al. [1] evaluated the use of PCB dilation in a clinical study in 12 patients with refractory nonanastomotic airway stenosis post‐lung transplantation. Their findings showed that a single application maintained luminal patency in 50% of patients at 270 days, with no significant peri‐interventional or early post‐interventional complications reported. Similarly, a study by Qiu et al. [3] showed that adjuvant treatment with paclitaxel resulted in sustained airway patency (> 6 months) without further intervention in 24 of 28 patients with benign cicatricial airway stenosis. However, limited short‐term benefits of PCB dilation have also been reported, with authors recommending its use only after prior therapies have failed [2]. While our patient's findings show an encouraging trend toward airway patency (Figure 1), larger multicentre studies are warranted to further assess the safety, efficacy and durability of this approach.

Our case highlights the complexities involved in the management of nonmalignant airway stenosis, particularly in cases of recurrent disease. While current strategies may offer short‐term relief, their long‐term effectiveness is limited. In our case, PCB successfully achieved sustained airway patency after multiple failed attempts with conventional methods, highlighting its potential as a therapeutic option for recurrent airway stenosis.

Author Contributions

Concept and design: All authors. Acquisition, analysis or interpretation of data: All authors. Drafting of the manuscript: Paola Gutierrez‐Gallegos. Critical review of the manuscript for important intellectual content: All authors. Administrative, technical or material support: David Abia‐Trujillo. Supervision: Sebastian Fernandez‐Bussy.

Ethics Statement

The authors declare that written informed consent was obtained for the publication of this manuscript and accompanying images using the consent form provided by the Journal.

Conflicts of Interest

The authors declare no conflicts of interest.

Gutierrez‐Gallegos P., Vu L. H., Yu Lee‐Mateus A., et al., “Successful Treatment of Recurrent Airway Stenosis With Paclitaxel‐Coated Balloons: A Case Report,” Respirology Case Reports 13, no. 6 (2025): e70261, 10.1002/rcr2.70261.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.