The use of centrifugated autologous lipoaspirate in the endoscopic management of idiopathic subglottic stenosis: results from a retrospective non-randomized study

PURPOSE: Idiopathic subglottic stenosis (iSGS) is a rare, progressive fibroinflammatory disease that predominantly affects middle-aged women. Although endoscopic treatments have improved, recurrence rates remain high and no standardized therapeutic approach has been defined. This exploratory retrospective pilot study aimed to assess feasibility, safety and explore the preliminary signal of benefit of intralesional injection of centrifuged autologous lipoaspirate as an adjunct to endoscopic balloon dilation in patients with iSGS. METHODS: A retrospective pilot observational study was conducted at the Tracheal Team of the University Hospital of M. and the Otorhinolaryngology Unit of S.O. Hospital, B., I., from 2015 to 2024. Twenty-six adult women with histologically confirmed iSGS and at least 12 months of follow-up were included. Patients received either standard endoscopic balloon dilation with intralesional corticosteroid injection (n=19) or balloon dilation followed by injection of centrifuged autologous lipoaspirate (n=7). The primary outcome was recurrence within 24 months, defined as the need for reintervention due to symptomatic restenosis. Secondary outcomes included time-to-recurrence, Subglottic Stenosis-6 (SGS-6) scores, and perioperative complications. RESULTS: Overall, recurrence occurred in 16 of 26 patients (61.6%). Recurrence was lower in the lipoaspirate group (2/7, 28.6%) compared with the standard group (14/19, 73.7%), with Pearson's χ² of 4.4 (P = 0.036; Fisher's exact P=0.06). Median time-to-recurrence was longer in the lipoaspirate group (482 days) than in the standard group (240 days) (Long-rank test p=0.047). CONCLUSIONS: In this retrospective pilot study, patients with idiopathic subglottic stenosis treated with intralesional injection of centrifuged autologous lipoaspirate following endoscopic balloon dilation showed a preliminary signal of lower recurrence rate and longer recurrence-free survival.