Linear Endobronchial Ultrasound-Guided Microwave Ablation for Malignant Central Airway Obstruction: A World-First Case.

We report the world's first case of malignant central airway obstruction (MCAO) successfully treated with microwave ablation (MWA) under real-time linear endobronchial ultrasound (EBUS) guidance. A 72-year-old male with stage IVB lung adenocarcinoma presented with severe dyspnea from a tumour causing 90% obstruction of the right main bronchus. Using a linear EBUS scope, we performed precise tumour mapping and positioned a MWA antenna with a 0.7 cm safety margin. Controlled energy was delivered until an intratumoral temperature of 80°C was reached, achieving immediate cytoreduction. The procedure resulted in 100% luminal recanalization without requiring a stent. EBUS-guided MWA is a feasible, safe, and highly effective technique for MCAO, offering unparalleled precision and thermal control. This novel approach represents a significant advancement in interventional pulmonology, enabling effective treatment of complex airway tumours while enhancing patient safety.