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Sample records for culotte stenting procedure

  1. A Pilot Study on Culottes versus Crossover Single Stenting for True Coronary Bifurcation Lesions

    PubMed Central

    Zhang, Linlin; Zhong, Wenliang; Luo, Yukun; Chen, Lianglong

    2016-01-01

    Background The purpose of our study was to compare clinical and angiographic outcomes of planned culottes technique with that of provisional crossover single stenting in the treatment of true coronary bifurcation lesions (CBL) with drug-eluting stent (DES). Methods True CBL patients (n = 104) were randomly assigned to either the provisional stenting of the side branch (crossover group) or the culottes group. Additional side branch (SB) stenting in the crossover group was required if there was thrombolysis in myocardial infarction flow ≤ 1 flow). The primary end point was the occurrence of major adverse cardiac events (MACE) at nine months, including cardiac death, myocardial infarction, target lesion/vessel revascularization and in-stent thrombosis. The secondary end point was angiographic in-segment restenosis at nine months. Results The rate of MACE at nine months was similar between the crossover and culottes groups (7.7% vs. 7.7%, p = 1.000). Additional SB stenting in the crossover group was required in 3.8% of patients. There was one procedural occlusion of SB in the crossover group. At nine months, the rate of in-segment restenosis was similar in the parent main vessel (0% vs. 1.9%, p = 1.000), main branch (1.9% vs. 7.7%, p = 0.363) and SB (17.3% vs. 9.6%, p = 0.250) between the crossover and culottes groups, respectively. Conclusions This study demonstrated that there is no significant difference in cumulative MACE or in-segment restenosis between crossover and culottes groups. Larger randomized clinical trials are warranted to re-evaluate the outcomes of the provisional crossover stenting versus the culottes stenting techniques utilizing DES for true CBL. PMID:27471358

  2. Technical aspects of the culotte technique.

    PubMed

    Erglis, Andrejs; Lassen, Jens Flensted; Di Mario, Carlo

    2015-01-01

    The culotte technique provides near perfect coverage of the carina and side branch ostium at the expense of an excess of metal covering the proximal end. It can be used in almost all true bifurcation lesions, but should be avoided in bifurcations when there is a large mismatch between the proximal main branch and the side branch diameters. The main disadvantage of this technique is that rewiring of both branches through the stent struts is required, which can be difficult, technically demanding, and time-consuming.

  3. What to Expect After a Stent Procedure

    MedlinePlus

    ... time after the stent procedure. Your doctor will let you know when you can go back to your normal activities. Metal detectors used in airports and other screening areas don't affect stents. Your stent shouldn't cause metal ...

  4. Fenestration of a Papyrus PK covered stent to recover the occluded left main bifurcation after sealing a left main perforation during a CTO procedure.

    PubMed

    Werner, Gerald S; Ahmed, Waqar H

    2017-09-01

    Covered stents are indicated for coronary perforations, but they may seal off major side branches in that process. We report the successful sealing of an ostial left main perforation, induced by a guide catheter in the course of a retrograde approach to treat a chronic total occlusion (CTO) of the right coronary artery (RCA) in a 76year old woman with prior CABG. The implanted Papyrus covered stent, however, overlapped the left main bifurcation and occluded the non-grafted circumflex artery (CX) resulting in acute ischemia. Through a double lumen catheter advanced over the wire located in the left anterior descending coronary artery (LAD) territory, a stiff recanalization wire could be advanced from the side-port to penetrate the stent membrane towards the CX. This was successfully achieved, and after subsequent dilatation, a drug-eluting stent was implanted in Culotte-fashion from the CX to the left main with subsequent kissing-balloon dilatation. The clinical symptoms subsided immediately, and the RCA was finally recanalized in antegrade parallel wire technique. No periprocedural infarct was observed during 48h of follow-up before discharge. At clinical follow-up of 6months the patient is symptom-free. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Micro-invasive glaucoma surgery (MIGS): a review of surgical procedures using stents

    PubMed Central

    Pillunat, Lutz E; Erb, Carl; Jünemann, Anselm GM; Kimmich, Friedemann

    2017-01-01

    Over the last decade several novel surgical treatment options and devices for glaucoma have been developed. All these developments aim to cause as little trauma as possible to the eye, to safely, effectively, and sustainably reduce intraocular pressure (IOP), to produce reproducible results, and to be easy to adopt. The term “micro-invasive glaucoma surgery (MIGS)” was used for summarizing all these procedures. Currently MIGS is gaining more and more interest and popularity. The possible reduction of the number of glaucoma medications, the ab interno approach without damaging the conjunctival tissue, and the probably safer procedures compared to incisional surgical methods may explain the increased interest in MIGS. The use of glaucoma drainage implants for lowering IOP in difficult-to-treat patients has been established for a long time, however, a variety of new glaucoma micro-stents are being manufactured by using various materials and are available to increase aqueous outflow via different pathways. This review summarizes published results of randomized clinical studies and extensive case report series on these devices, including Schlemm’s canal stents (iStent®, iStent® inject, Hydrus), suprachoroidal stents (CyPass®, iStent® Supra), and subconjunctival stents (XEN). The article summarizes the findings of published material on efficacy and safety for each of these approaches. PMID:28919702

  6. Stenting Procedure for Sinus Stenosis with Transverse-Sigmoid Dural Arteriovenous Fistulas

    PubMed Central

    Fukumoto, S.; Ueda, T.; Igase, K.; Ohue, S.; Kumon, Y.; Ohnishi, T.

    2006-01-01

    Summary We reported the dural AVF case with sinus stenosis, that was entirely treated through the stenting procedure. 61-year-old male had been realizing the attack which causes bilateral visual problem. He would have suffered from the intracranial hypertension caused by dural AVF in the right transverse sinus and left transverse sinus stenosis. We performed TVE and sinus stenting, then used the antiplatelet and the anticoagulant. However, six months later, he suffered from SAH due to recurrence of dural AVF. We performed TVE again, denser packing than usual. Two years later, he have no symptom, angiographically, there was no recurrence of dural AVF and patency of stented sinus. We think denser embolizations should have performed in case of dural AVF with sinus stenting. PMID:20569627

  7. J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.

    PubMed

    Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

    2014-11-01

    Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures.

  8. Covered Stents in the Treatment of Peripheral Arterial Aneurysms: Procedural Results and Midterm Follow-Up

    SciTech Connect

    Beregi, Jean-Paul; Prat, Alain; Willoteaux, Serge; Vasseur, Marc-Antoine; Boularand, Valerie; Desmoucelle, Frederic

    1999-01-15

    Purpose: To evaluate initial and midterm results of percutaneous treatment of peripheral aneurysms using covered stents. Methods: Between June 1994 and December 1997 we used covered stents (EndoPro System or Passager) on 19 patients with peripheral aneurysms (7 iliac, 5 subclavian, 3 femoral, 3 popliteal, 1 carotid). Results: Successful aneurysm exclusion was achieved in 18 of 19 patients (95%). In the short term (<30 days), one patient died of puncture site hemorrhage complicated by myocardial infarction; two femoral stents were surgically removed because of leakage. At subsequent follow-up (mean 20 months) two further unrelated deaths occurred. At 1 year (intention-to-treat) the stent was patent in 13 of 19 patients (68%) and the aneurysm was excluded in 17 of 19 (89%). Conclusion: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural success. Continued exclusion of the aneurysms is achieved in a large proportion of patients but there is a relatively high rate of stent thrombosis.

  9. Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis.

    PubMed

    Ruiz-Salmerón, R J; Gamero, M A; Carrascosa, C; Pérez, S; de Araujo, D; Marcos, F; Rodríguez de Leiras, S; Vizcaíno, M; Caparrós, C; Izquierdo, G

    2013-01-01

    The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151). No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08). Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  10. Endovascular Stent-Graft Repair as a Late Secondary Procedure After Previous Aortic Grafts

    SciTech Connect

    Matsagas, Miltiadis I. Anagnostopoulos, Constantine E.; Papakostas, John C.; DeRose, Joseph J.; Siminelakis, Stavros; Katsouras, Christos S.; Toumpoulis, Ioannis K.; Drossos, George E.; Michalis, Lampros K.

    2006-08-15

    Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were studied in three different cases. An anastomotic aneurysm after previous thoracic aortic graft for coarctation, a second-stage elephant trunk repair (descending thoracic aortic aneurysm), and a secondary aneurysm proximal to a previous abdominal aortic graft were successfully treated with endovascular stent-grafts. During the follow-up period no lethal events or major aortic or graft-related complications were observed, except a type II endoleak in the anastomotic aortic aneurysm case. An endovascular stent-graft can be safely deployed into a previously implanted vascular graft, avoiding repeat surgery.

  11. Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: A novel effective rescue procedure

    PubMed Central

    Mutignani, Massimiliano; Dioscoridi, Lorenzo; Dokas, Stefanos; Aseni, Paolo; Carnevali, Pietro; Forti, Edoardo; Manta, Raffaele; Sica, Mariano; Tringali, Alberto; Pugliese, Francesco

    2016-01-01

    Between April 2013 and October 2015, 6 patients developed periampullary duodenal or jejunal/biliary leaks after major abdominal surgery. In all patients, percutaneous drainage of the collection or re-operation with primary surgical repair was attempted at first but failed. A fully covered enteral metal stent was placed in all patients to seal the leak. Subsequently, we cannulated the common bile duct and, in some cases, and the main pancreatic duct inserting hydrophilic guidewires through the stent after dilating the stent mesh with a dilatation balloon or breaking the meshes with Argon Plasma Beam. Finally, we inserted a fully covered biliary metal stent to drain the bile into the lumen of the enteral stent. In cases of normal proximal upper gastrointestinal anatomy, a pancreatic plastic stent was also inserted. Oral food intake was initiated when the abdominal drain outflow stopped completely. Stent removal was scheduled four to eight weeks later after a CT scan to confirm the complete healing of the fistula and the absence of any perilesional residual fluid collection. The leak resolved in five patients. One patient died two days after the procedure due to severe, pre-existing, sepsis. The stents were removed endoscopically in four weeks in four patients. In one patient we experienced stent migration causing small bowel obstruction. In this case, the stents were removed surgically. Four patients are still alive today. They are still under follow-up and doing well. Bilio-enteral fully covered metal stenting with or without pancreatic stenting was feasible, safe and effective in treating postoperative enteral leaks near the biliopancreatic orifice in our small series. This minimally invasive procedure can be implemented in selected patients as a rescue procedure to repair these challenging leaks. PMID:27606045

  12. iStent as a Solo Procedure for Glaucoma Patients: A Systematic Review and Meta-Analysis.

    PubMed

    Malvankar-Mehta, Monali S; Chen, Yufeng Nancy; Iordanous, Yiannis; Wang, Wan Wendy; Costella, John; Hutnik, Cindy M L

    2015-01-01

    Glaucoma is a leading cause of irreversible blindness. It is firmly entrenched in the traditional treatment paradigm to start with pharmacotherapy. However, pharmacotherapy is not benign and has been well documented to have a number of significant challenges. Minimally invasive glaucoma surgery (MIGS) that targets the outflow pathway with minimal to no scleral dissection has resulted in the need to reconsider the glaucoma treatment paradigm. To perform a systematic review and meta-analysis to evaluate and quantify the effect on post-operative intraocular pressure (IOP) and number of topical glaucoma medications, in patients receiving the iStent MIGS device as the solo procedure without concurrent cataract surgery. A systematic review was conducted by searching various databases between January 1, 2000, and June 30, 2014. Studies reporting up to a maximum follow-up period of 24 months were retrieved and screened using the EPPI-Reviewer 4 gateway. Percentage reduction in IOP (IOPR%), and mean reduction in topical glaucoma medications after surgery were computed. Meta-analysis was performed using STATA v. 13.0. The standardized mean difference (SMD) was calculated as the effect size for continuous scale outcomes. Heterogeneity was determined using the I2 statistics, Z-value, and χ2 statistics. Fixed-effect and random-effect models were developed based on heterogeneity. Sub-group analysis was performed based on the number of iStents implanted and the follow-up period. The outcome measures were changes in the IOP and number of glaucoma medications. The search strategy identified 105 records from published literature and 9 records from the grey literature. Five studies with 248 subjects were included for quantitative synthesis. A 22% IOP reduction (IOPR%) from baseline occurred at 18-months after one iStent implant, 30% at 6-months after two iStents implantations, and 40% at 6-months after implantation of three iStents. A mean reduction of 1.2 bottles per patient of

  13. iStent as a Solo Procedure for Glaucoma Patients: A Systematic Review and Meta-Analysis

    PubMed Central

    Malvankar-Mehta, Monali S.; Chen, Yufeng Nancy; Iordanous, Yiannis; Wang, Wan Wendy; Costella, John; Hutnik, Cindy M. L.

    2015-01-01

    Background Glaucoma is a leading cause of irreversible blindness. It is firmly entrenched in the traditional treatment paradigm to start with pharmacotherapy. However, pharmacotherapy is not benign and has been well documented to have a number of significant challenges. Minimally invasive glaucoma surgery (MIGS) that targets the outflow pathway with minimal to no scleral dissection has resulted in the need to reconsider the glaucoma treatment paradigm. Purpose To perform a systematic review and meta-analysis to evaluate and quantify the effect on post-operative intraocular pressure (IOP) and number of topical glaucoma medications, in patients receiving the iStent MIGS device as the solo procedure without concurrent cataract surgery. Methods A systematic review was conducted by searching various databases between January 1, 2000, and June 30, 2014. Studies reporting up to a maximum follow-up period of 24 months were retrieved and screened using the EPPI-Reviewer 4 gateway. Percentage reduction in IOP (IOPR%), and mean reduction in topical glaucoma medications after surgery were computed. Meta-analysis was performed using STATA v. 13.0. The standardized mean difference (SMD) was calculated as the effect size for continuous scale outcomes. Heterogeneity was determined using the I2 statistics, Z-value, and χ2 statistics. Fixed-effect and random-effect models were developed based on heterogeneity. Sub-group analysis was performed based on the number of iStents implanted and the follow-up period. The outcome measures were changes in the IOP and number of glaucoma medications. Results The search strategy identified 105 records from published literature and 9 records from the grey literature. Five studies with 248 subjects were included for quantitative synthesis. A 22% IOP reduction (IOPR%) from baseline occurred at 18-months after one iStent implant, 30% at 6-months after two iStents implantations, and 40% at 6-months after implantation of three iStents. A mean

  14. Symptomatic stent cast.

    PubMed

    Keohane, John; Moore, Michael; O'Mahony, Seamus; Crosbie, Orla

    2008-02-01

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  15. Design of the exhale airway stents for emphysema (EASE) trial: an endoscopic procedure for reducing hyperinflation.

    PubMed

    Shah, Pallav L; Slebos, Dirk-Jan; Cardoso, Paulo F G; Cetti, Edward J; Sybrecht, Gerhard W; Cooper, Joel D

    2011-01-07

    Airway Bypass is a catheter-based, bronchoscopic procedure in which new passageways are created that bypass the collapsed airways, enabling trapped air to exit the lungs. The Exhale Airway Stents for Emphysema (EASE) Trial was designed to investigate whether Exhale® Drug-Eluting Stents, placed in new passageways in the lungs, can improve pulmonary function and reduce breathlessness in severely hyperinflated, homogeneous emphysema patients (NCT00391612). The multi-center, randomized, double-blind, sham-controlled trial design was posted on http://www.clinicaltrials.gov in October 2006. Because Bayesian statistics are used for the analysis, the proposed enrollment ranged from 225 up to 450 subjects at up to 45 institutions. Inclusion criteria are: high resolution CT scan with evidence of homogeneous emphysema, post-bronchodilator pulmonary function tests showing: a ratio of FEV1/FVC < 70%, FEV1 ≤ 50% of predicted or FEV1 < 1 liter, RV/TLC ≥ 0.65 at screening, marked dyspnea score ≥ 2 on the modified Medical Research Council scale of 0-4, a smoking history of at least 20 pack years and stopped smoking for at least 8 weeks prior to enrollment. Following 16 to 20 supervised pulmonary rehabilitation sessions, subjects were randomized 2:1 to receive either a treatment (Exhale® Drug-Eluting Stent) or a sham bronchoscopy. A responder analysis will evaluate the co-primary endpoints of an FVC improvement ≥ 12% of the patient baseline value and modified Medical Research Council dyspnea scale improvement (reduction) ≥ 1 point at the 6-month follow-up visit. If through the EASE Trial, Airway Bypass is shown to improve pulmonary function and reduce dyspnea while demonstrating an acceptable safety profile, then homogeneous patients will have a minimally invasive treatment option with meaningful clinical benefit. ClinicalTrials.gov: NCT00391612.

  16. Design of the exhale airway stents for emphysema (EASE) trial: an endoscopic procedure for reducing hyperinflation

    PubMed Central

    2011-01-01

    Background Airway Bypass is a catheter-based, bronchoscopic procedure in which new passageways are created that bypass the collapsed airways, enabling trapped air to exit the lungs. The Exhale Airway Stents for Emphysema (EASE) Trial was designed to investigate whether Exhale® Drug-Eluting Stents, placed in new passageways in the lungs, can improve pulmonary function and reduce breathlessness in severely hyperinflated, homogeneous emphysema patients (NCT00391612). Methods/Design The multi-center, randomized, double-blind, sham-controlled trial design was posted on http://www.clinicaltrials.gov in October 2006. Because Bayesian statistics are used for the analysis, the proposed enrollment ranged from 225 up to 450 subjects at up to 45 institutions. Inclusion criteria are: high resolution CT scan with evidence of homogeneous emphysema, post-bronchodilator pulmonary function tests showing: a ratio of FEV1/FVC < 70%, FEV1≤50% of predicted or FEV1 < 1 liter, RV/TLC≥0.65 at screening, marked dyspnea score ≥2 on the modified Medical Research Council scale of 0-4, a smoking history of at least 20 pack years and stopped smoking for at least 8 weeks prior to enrollment. Following 16 to 20 supervised pulmonary rehabilitation sessions, subjects were randomized 2:1 to receive either a treatment (Exhale® Drug-Eluting Stent) or a sham bronchoscopy. A responder analysis will evaluate the co-primary endpoints of an FVC improvement ≥12% of the patient baseline value and modified Medical Research Council dyspnea scale improvement (reduction) ≥1 point at the 6-month follow-up visit. Discussion If through the EASE Trial, Airway Bypass is shown to improve pulmonary function and reduce dyspnea while demonstrating an acceptable safety profile, then homogeneous patients will have a minimally invasive treatment option with meaningful clinical benefit. Trial Registration ClinicalTrials.gov: NCT00391612 PMID:21214899

  17. High coronary calcium score and post-procedural CK-MB are noninvasive predictors of coronary stent restenosis

    PubMed Central

    Lee, Jae-Beom; Choi, Yun-Seok; Chung, Woo-Baek; Kwon, Ami; Park, Chul-Soo; Lee, Man-Young

    2017-01-01

    Purpose High coronary calcium score (CCS) and post-procedural cardiac enzyme may be related with poor outcomes in patients with coronary stent implantation. Methods A total of 1,072 patients (63.2% male, mean age: 61.7±10.3 years) who underwent coronary multi-detect computed tomography at index procedure and follow-up coronary angiography (CAG) after drug-eluting stent (DES) were divided into two groups: those with and without target lesion revascularization (TLR; >50% reduction in luminal stent diameter or angina symptoms on follow-up CAG). The CCSs for predicting stent revascularization were elucidated. Results There were no significant differences between the two groups with regard to risk factors. The initial CCS was significantly higher in the TLR group (1,102.4±743.7 vs 345.8±51.05, P=0.04). After adjustment of significant factors for TLR, only CCS and post-procedural creatine kinase MB form (CK-MB) elevation were significant predictors of coronary artery TLR. Receiver operation curve revealed that >800 in CCS had 69% in sensitivity and 88% in specificity about predicting the TLR. Conclusion High CCS with post-procedural CK-MB might be the useful predictors for TLR after DES implantation. PMID:28255235

  18. Patient-specific endovascular simulation influences interventionalists performing carotid artery stenting procedures.

    PubMed

    Willaert, W I M; Aggarwal, R; Van Herzeele, I; O'Donoghue, K; Gaines, P A; Darzi, A W; Vermassen, F E; Cheshire, N J

    2011-04-01

    The ability to perform patient-specific simulated rehearsal of complex endovascular interventions is a technological advance with potential benefits to patient outcomes. This study aimed to evaluate whether patient-specific rehearsal of a carotid artery stenting (CAS) procedure has an influence on tool selection and the use of fluoroscopy. Following case note and computed tomography (CT) angiographic review of a real patient case, subjects performed the CAS procedure on a virtual reality simulator. Endovascular tool requirements and fluoroscopic angles were evaluated with a pre- and post-case questionnaire. Participants also rated the simulation from 1 (poor) to 5 (excellent). Thirty-three endovascular physicians with varying degrees of CAS experience were recruited: inexperienced (5-20 CAS procedures) n = 11, moderately (21-50 CAS procedures) n = 7 or highly experienced (>50 CAS procedures) n = 15. For all participants, 96 of a possible 363 changes (26%) were observed from pre- to post-case questionnaires. This was most notable for optimal fluoroscopy C-arm position 15/33 (46%), choice of selective catheter 13/33 (39%), choice of sheath or guiding catheter 11/33 (33%) and balloon dilatation strategy 10/33 (30%). Experience with the CAS procedure did not influence the degree of change significantly (p > 0.05), and all groups exhibited a considerable modification in tool and fluoroscopy preference. The model was considered realistic and useful as a tool to practice a real case (median score 4/5). Patient-specific simulated rehearsal of a complex endovascular procedure strongly influences tool selection and fluoroscopy preferences for the real case. Further research has to evaluate how this technology may transfer from in vitro to in vivo and if it can reduce the radiation dose and the number of endovascular tools used and improve outcomes for patients in the clinical setting. Copyright © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All

  19. Effects of eicosapentaenoic acid on peri-procedural (type IVa) myocardial infarction following elective coronary stenting.

    PubMed

    Kurita, Akiyoshi; Takashima, Hiroaki; Ando, Hirohiko; Kumagai, Soichiro; Waseda, Katsuhisa; Gosho, Masahiko; Amano, Tetsuya

    2015-08-01

    The aim of this study was to assess the effect of eicosapentaenoic acid (EPA) on peri-procedural (type IVa) myocardial infarction (MI) following elective percutaneous coronary intervention (PCI). We analyzed data from 165 of 178 consecutive patients with stable angina pectoris who underwent de novo successful stent implantation in the native coronary artery. Patients were assigned to receive statin therapy in combination with 1800mg/day of EPA or statin alone. Post-procedural index of microcirculatory resistance (IMR) values were calculated for 30 patients in the EPA group and 32 controls. In the multivariate logistic model, EPA administration, low kidney function, and the presence of slow flow/no reflow were significantly and independently associated with type IVa MI. Post-procedural IMR values were significantly lower in the EPA group [19.8 (6.4, 51.1) vs. 27.8 (8.2, 89.3), p=0.003] compared to the control group. Pre-treatment with EPA in addition to statins significantly reduced the incidence of type IVa MI compared to statin therapy only, which may be attributed to the ability of EPA to reduce microvascular dysfunction induced by PCI. Copyright © 2014. Published by Elsevier Ltd.

  20. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not?

    SciTech Connect

    Inal, Mehmet; Aksungur, Erol; Akguel, Erol; Oguz, Mahmut; Seydaoglu, Guelsah

    2003-02-15

    The aim of this paper was to evaluate the necessity of percutaneous transhepatic catheter drainage and balloon dilation procedures performed before stent insertion. One hundred and twenty-six patients with unresectable malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 183 metallic biliary endoprotheses. Forty-four (35%) patients underwent metallic stent insertion in a one-stage procedure and 82(65%) had undergone percutaneous transhepatic catheter drainage before stent insertion. Balloon dilation of the stenosis before stent placement (pre-dilation) was performed in 53 (42%) of 126 patients. The rate of the 30-day mortality was 11%, with no procedure-related deaths. The total rate of early complications was 29%, and 84% of these complications were due to percutaneous transhepatic catheter drainage and pre-dilation procedures. Percutaneous transhepatic catheter drainage and pre-dilation had no clinical or statistically significant effect on the patients' survival and stent patency rate. Percutaneous transhepatic catheter drainage and balloon dilation increased the cost of stent placement 18% and 19%, respectively. Palliation of malignant biliary obstruction with percutaneous transhepatic stent insertion should be done directly, in the simplest way, without performing percutaneous transhepatic catheter drainage and balloon dilation before stent placement. It is more useful, safe, and cost-effective.

  1. Simulation of carotid artery stenting reduces training procedure and fluoroscopy times.

    PubMed

    Gosling, Andre F; Kendrick, Daniel E; Kim, Ann H; Nagavalli, Anil; Kimball, Ethan S; Liu, Nathaniel T; Kashyap, Vikram S; Wang, John C

    2017-07-01

    Outcomes from carotid artery stenting (CAS) are related to experience and technical expertise of the operator. Simulation of CAS may enhance clinical proficiency. We interrogated the impact of endovascular simulation of CAS procedures in operators who are at various stages of training. Twelve trainees (students [n = 4]; junior surgery residents, postgraduate year [PGY] 1-3 [n = 4]; and senior surgery residents or fellows, PGY 4-7 [n = 4]) were apprised of characteristics of an endovascular simulator and CAS procedures. This was followed by four independent sessions that were assessed for objective measures including procedure and fluoroscopy times and contrast agent use. A qualitative analysis grading steps of CAS by two observers using a Likert scale was performed. One-way analysis of variance and paired t-tests were employed for data analysis. For all participants (n = 12), procedure times (mean, 920 ± 279 seconds for the first session vs 454 ± 156 seconds for the fourth session; P < .01; confidence interval [CI], 315-621) and fluoroscopy cumulative times (mean, 421 ± 230 seconds for the first session vs 222 ± 102 seconds for the fourth session; P < .01; CI, 78-285) decreased with progression of cases. Students and PGY 1-3 residents decreased their procedure times significantly in comparison of initial and final sessions (P < .05 and P < .01, respectively). For all groups, fluoroscopy cumulative times were reduced, and this decrement was significant in the PGY 1-3 cohort (mean, 444 ± 8 seconds for the first session vs 265 ± 51 seconds for the fourth session; P < .01; CI, 81-276). Initial CAS procedure times were significantly different between groups (P < .05), but this was observed to resolve by the final case at study completion. Qualitatively, the Likert scores of students and PGY 1-3 residents significantly improved with case repetition, specifically in the following steps: (1) cannulation of common carotid artery and (2) sizing

  2. Dr. Sun's Procedure for Type A Aortic Dissection: Total Arch Replacement Using Tetrafurcate Graft With Stented Elephant Trunk Implantation

    PubMed Central

    Ma, Wei-Guo; Zheng, Jun; Liu, Yong-Min; Zhu, Jun-Ming; Sun, Li-Zhong

    2013-01-01

    Sun's procedure is a modified elephant trunk technique that integrates the advantages of open surgical and endovascular repairs as a treatment of type A aortic dissection. It is named after Dr. Li-Zhong Sun and refers to total arch replacement using a four-branched graft with implantation of a special stented endovascular graft. Since its introduction, it has produced excellent early and late clinical outcomes. We present a video of this procedure and make an overview regarding the technical aspects, surgical indications, and clinical outcomes of Sun's procedure. PMID:26798674

  3. Open stent-grafting: aborted procedure in a patient with mega aorta syndrome.

    PubMed

    Bashar, Abul Hasan Muhammad; Kazui, Teruhisa; Suzuki, Kazuchika; Terada, Hitoshi; Yamashita, Katsushi; Washiyama, Naoki

    2006-08-01

    Open stent-grafting is a recent technical modification of endoluminal stent-grafting, in which a stent-graft is inserted into the descending thoracic aorta through an opening in the aortic arch, to treat distal arch aneurysms or aortic dissection. Controversy remains as to whether patients with mega aorta syndrome, or those with very wide aneurysm necks, could be candidates for stent-graft treatment--open or endoluminal. We recently attempted open stent-grafting in a patient with mega aorta syndrome who had a distal aortic arch aneurysm. A previous attempt at surgical resection of the aneurysm through left thoracotomy ended in failure because of severe adhesion in the left lung. This time, we planned total arch replacement with open stent-graft exclusion of the aneurysm. However, open stent-grafting had to be abandoned intraoperatively due to technical difficulties as well as our lack of experience with such difficult cases. Conventional total arch replacement with elephant trunk was performed instead. Due to its deep location, the distal neck of the aneurysm could not be reached through median sternotomy and, therefore, the distal aortic anastomosis was performed within the aneurysm cavity. Thus, the distal portion of the aneurysm was not excluded from circulation. The future treatment plan in the present case is further complicated by the fact that a second-stage surgery through left thoracotomy will not be possible. Conventional total arch replacement proved rather inappropriate as a treatment strategy in the present case. Open stent-grafting might have been a more useful approach is spite of the challenges posed by the aneurysm. There needs to be a consensus as to whether patients with mega aorta syndrome or those with very wide aneurysm necks could be candidates for stent-graft treatment--open or endoluminal in difficult circumstances.

  4. The treatment of carotid artery bifurcation stenoses with systematic stenting: experience of first 100 consecutive cardiological procedures.

    PubMed

    Sganzerla, Paolo; Bocciarelli, Monica; Savasta, Carlo; Bonin, Monica; Tavasci, Emanuela; Fini, Matteo; Perlasca, Elena; Alioto, Giusy; Colombo, Francesca; Passaretti, Bruno

    2004-10-01

    Carotid endarterectomy still represents the gold standard treatment of carotid artery bifurcation stenosis but percutaneous angioplasty with stenting is rapidly growing as a non-invasive alternative. In this paper we report the results of systematic application of carotid stenting performed in a cardiological setting, particularly as regards clinical management of patients and technical approach. One-hundred (100) procedures of carotid artery stenting (CAS) on 94 consecutive patients, both symptomatic and asymptomatic, with a carotid stenosis > 70%, were performed over a period of 30 months. The technical approach was directly derived from coronary angioplasty with use of large lumen guiding catheters, 0.014 in. intravascular guidewires and distal protection devices usually employed in coronary interventions. In 3 cases, a post-carotid endarterectomy restenosis and in 97 cases, a de-novo lesion, were treated respectively; in 71 cases, the degree of stenosis was 71-89% and in 29 cases, 90-99%. Cerebral protection was obtained with a distal to the lesion endovascular filter in 63 cases. Immediate technical success, i.e. residual stenosis of the treated vessel < 30% and no significant pathologic acceleration of blood flow (< 1.5 m/sec) at the Doppler ultrasound evaluation, was achieved in all procedures (100%). Ninety-six (96) procedures were totally uncomplicated; in-hospital cerebral complications were 1 TIA, 2 minor and 1 major strokes; at 30-day follow-up one additional major stroke occurred. Despite a particularly high incidence of comorbidities, neither unfavorable cardiological complications nor neurologic deaths were reported. Systematic CAS is a feasible treatment of the carotid artery bifurcation stenosis with high procedural success and low perioperative and short term complications. Its performance in a cardiological setting can combine satisfying procedural results and potentially successful handling of cardiovascular complications.

  5. Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures.

    PubMed

    Little, M W; Oakley, T; Briggs, J H; Sutcliffe, J A; Allouni, A K; Makris, G; Bratby, M J; Tapping, C R; Patel, R; Wigham, A; Anthony, S; Phillips-Hughes, J; Uberoi, R

    2016-10-01

    To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %). Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %. Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

  6. Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses.

    PubMed

    Chiastra, Claudio; Wu, Wei; Dickerhoff, Benjamin; Aleiou, Ali; Dubini, Gabriele; Otake, Hiromasa; Migliavacca, Francesco; LaDisa, John F

    2016-07-26

    The optimal stenting technique for coronary artery bifurcations is still debated. With additional advances computational simulations can soon be used to compare stent designs or strategies based on verified structural and hemodynamics results in order to identify the optimal solution for each individual's anatomy. In this study, patient-specific simulations of stent deployment were performed for 2 cases to replicate the complete procedure conducted by interventional cardiologists. Subsequent computational fluid dynamics (CFD) analyses were conducted to quantify hemodynamic quantities linked to restenosis. Patient-specific pre-operative models of coronary bifurcations were reconstructed from CT angiography and optical coherence tomography (OCT). Plaque location and composition were estimated from OCT and assigned to models, and structural simulations were performed in Abaqus. Artery geometries after virtual stent expansion of Xience Prime or Nobori stents created in SolidWorks were compared to post-operative geometry from OCT and CT before being extracted and used for CFD simulations in SimVascular. Inflow boundary conditions based on body surface area, and downstream vascular resistances and capacitances were applied at branches to mimic physiology. Artery geometries obtained after virtual expansion were in good agreement with those reconstructed from patient images. Quantitative comparison of the distance between reconstructed and post-stent geometries revealed a maximum difference in area of 20.4%. Adverse indices of wall shear stress were more pronounced for thicker Nobori stents in both patients. These findings verify structural analyses of stent expansion, introduce a workflow to combine software packages for solid and fluid mechanics analysis, and underscore important stent design features from prior idealized studies. The proposed approach may ultimately be useful in determining an optimal choice of stent and position for each patient.

  7. Wingspan experience at Beijing Tiantan Hospital: new insights into the mechanisms of procedural complication from viewing intraoperative transient ischemic attacks during awake stenting for vertebrobasilar stenosis.

    PubMed

    Jiang, W-J; Yu, W; Du, B; Wong, E H C; Gao, F

    2010-06-01

    Intracranial vertebrobasilar artery (VBA) stenosis portends a stroke and death rate of 8.5-22.8% annually despite medical therapy. Stenting has emerged as a treatment option but also carries substantial risk. Awake stenting under local anesthesia to minimize major procedural complication was investigated. Between January 2007 and December 2008, 43 of 46 consecutive patients with severe symptomatic intracranial VBA stenosis underwent elective angioplasty assisted with self-expanding Wingspan stent under local anesthesia at our institute. All data were collected prospectively. All 43 patients tolerated the stenting procedure under local anesthesia well. Forty-two patients (97.7%) were stented successfully. Within 30 days, there were three periprocedural strokes, including thromboembolic infarct, pontine perforator infarct and intracranial hemorrhage, without fatality. In addition, five patients had intraoperative brainstem transient ischemic attacks (TIAs) seconds after the deployment of the stent delivery system across the tortuous VBA. The symptoms and signs included impaired consciousness (n=5), dysarthria (n=3), convulsion (n=2), conjugate horizontal gaze palsy (n=2), nystagmus (n=2) and pinpoint pupils (n=1). There was angiographic evidence of VBA straightening without thromboembolism. The TIAs resolved within minutes of prompt removal of the delivery catheter. VBA stenting under local anesthesia is feasible with a 7% periprocedural stroke risk. Awake stenting allows timely detection of intraoperative TIAs. The mechanism of intraoperative TIA appears to be stent delivery system induced VBA straightening and distortion of its vascular tree. A devastating stroke may ensue if the TIA is not detected and distortion of VBA perforators is not reversed promptly.

  8. "Procedural trauma risks longitudinal shortening of the Promus Element™ stent platform".

    PubMed

    Shannon, Joanne; Latib, Azeem; Takagi, Kensuke; Chieffo, Alaide; Figini, Filippo; Sacco, Francesco; Ferrarello, Santo; Montorfano, Matteo; Colombo, Antonio

    2013-04-01

    This case series raises further awareness of the potential for longitudinal shortening with the Promus Element™ (Boston Scientific, MN) drug-eluting stent (DES) platform. With safety at the forefront of DES development, newer generation systems are utilizing thinner platforms with little or no polymer. Although these contemporary, ultrathin platforms also improve conformability and deliverability, specific design characteristics might inadvertently reduce longitudinal strength. To date, there are no randomized data addressing this issue in vivo for any stent platform, with opinion based on individual experience and bench testing. We report five cases of longitudinal shortening with the Promus Element stent occurring in our institution over a 15-month period. During the same period, we experienced only isolated cases with other second generation DES platforms. Our experience supports recently published bench-top data correlating the two-link design of this platform with the risk of compression. Copyright © 2012 Wiley Periodicals, Inc.

  9. New stents for SFA.

    PubMed

    MINAR, E; SCHILLINGER, M

    2009-10-01

    Endovascular stent implantation was introduced to femoropopliteal procedures almost two decades ago. Initial results with balloon-expandable stainless steel stents and self expanding Elgiloy stents, however, were disappointing. In particular, recurrence rates after long-segment femoropopliteal stenting were rather high, in the range of 60% to 80% at 1 year. After years of stagnation, recent developments in femoropopliteal stent technology have been promising. Self-expanding nitinol stents have been evaluated in several prospective studies. Initial problems with stent fractures seem to be resolved using second-generation devices. The second generation of Nitinol stents have an enhanced flexibility particularly also in axial direction due to a reduction of cell interconnections and a more spiral orientation of the interconnections. However, until now there is no proof of any impact of the stent design on restenosis rate. Otherwise, stenting has been shown to be beneficial compared to balloon angioplasty especially in longer femoropopliteal lesions. The superior fracture resistance of the latest stent generation in combination with the production of long nitinol stents of up to 20 cm in length allow that more difficult and complex lesions can be treated endovascularly. The main unresolved problem with femoropopliteal stenting is the treatment of instent restenosis. Future concepts to further improve long-term patency after femoropopliteal stenting are therefore under investigation, including drug-eluting stents (DES), biodegradable stents, and coated stent-grafts. Stent grafts appear to be a viable option for the treatment of complex superficial femoral artery lesions, with comparable outcomes to prosthetic above-knee femoropopliteal bypass surgery. Concerning DES, we have to wait for the results of the ongoing studies.

  10. Experimental Comparison of the Hemodynamic Effects of Bifurcating Coronary Stent Implantation Techniques

    NASA Astrophysics Data System (ADS)

    Brindise, Melissa; Vlachos, Pavlos; AETheR Lab Team

    2015-11-01

    Stent implantation in coronary bifurcations imposes unique effects to the blood flow patterns and currently there is no universally accepted stent deployment approach. Despite the fact that stent-induced changes can greatly alter clinical outcomes, no concrete understanding exists regarding the hemodynamic effects of each implantation method. This work presents an experimental evaluation of the hemodynamic differences between implantation techniques. We used four common stent implantation methods including the currently preferred one-stent provisional side branch (PSB) technique and the crush (CRU), Culotte (CUL), and T-stenting (T-PR) two-stent techniques, all deployed by a cardiologist in coronary models. Particle image velocimetry was used to obtain velocity and pressure fields. Wall shear stress (WSS), oscillatory shear index, residence times, and drag and compliance metrics were evaluated and compared against an un-stented case. The results of this study demonstrate that while PSB is preferred, both it and T-PR yielded detrimental hemodynamic effects such as low WSS values. CRU provided polarizing and unbalanced results. CUL demonstrated a symmetric flow field, balanced WSS distribution, and ultimately the most favorable hemodynamic environment.

  11. Effect of Optimal Medical Therapy Before Procedures on Outcomes in Coronary Patients Treated With Drug-Eluting Stents.

    PubMed

    Iijima, Raisuke; Nakamura, Masato; Matsuyama, Yutaka; Muramatsu, Toshiya; Yokoi, Hiroyoshi; Hara, Hidehiko; Okada, Hisayuki; Ochiai, Masahiko; Suwa, Satoru; Hozawa, Hidenari; Kawai, Kazuya; Awata, Masaki; Mukawa, Hiroaki; Fujita, Hiroshi; Nanto, Shinsuke

    2016-09-15

    It has not been established whether the achievement of optimal medical therapy (OMT) before implantation of a drug-eluting stent has a clinical benefit for patients with stable coronary artery disease (CAD). This study included 3,004 patients with CAD treated with drug-eluting stent from 123 Japanese participating centers. The achievement of OMT was defined as control of blood pressure <130/80 mm Hg, hemoglobin A1c <7.0%, and low-density lipoprotein cholesterol <100 mg/dl. The primary end point was target vessel failure, a composite of death related to the target vessel, myocardial infarction, or clinically driven revascularization at 24 months after stent implantation. Immediately before the procedure, only 548 patients (18.2%) had achieved all 3 target criteria (the achieved OMT group), whereas the remaining 2,456 patients failed to achieve one or more criteria (the non-OMT group). At 24 months, the incidence of target vessel failure was 7.0% in the achieved OMT group versus 10.0% in the non-OMT group (hazard ratio 0.68, 95% CI 0.48 to 0.96, p = 0.03). The incidence of non-Q-wave myocardial infarction was also lower in the achieved OMT group than in the non-OMT group (0.5% vs 1.5%, p = 0.08). Multivariate logistic regression analysis identified that hemoglobin A1c <7.0% was the only protective predictor of 24-month target vessel failure (odds ratio 0.56, 95% CI 0.43 to 0.73, p <0.01). In conclusion, this study demonstrated that in patients with stable CAD scheduled for stent implantation, achievement of OMT before percutaneous coronary intervention significantly reduced subsequent cardiac events. Achievement of OMT is still insufficient in modern clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Hybrid procedure for celiac trunk aneurysm repair via left reno-splenic bypass and stent-graft deployment.

    PubMed

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Chiappa, Roberto; Caselli, Giovanni

    2012-01-01

    Celiac trunk aneurysm is one of the rarest forms of splanchnic artery aneurysm. Conventional open vascular surgery is associated with increased rates of morbidity and mortality and can require complex vascular reconstruction.We describe the case of a 42-year-old patient with celiac trunk aneurysm whom we treated by means of a hybrid surgical-endovascular procedure. We performed a left reno-splenic bypass, after which we used a direct splenic artery approach to deploy a self-expandable 6 × 50-mm stent-graft across the splenic and hepatic arteries. One year later, the stability of the repair was confirmed.

  13. Hybrid Procedure for Celiac Trunk Aneurysm Repair via Left Reno-Splenic Bypass and Stent-Graft Deployment

    PubMed Central

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Chiappa, Roberto; Caselli, Giovanni

    2012-01-01

    Celiac trunk aneurysm is one of the rarest forms of splanchnic artery aneurysm. Conventional open vascular surgery is associated with increased rates of morbidity and mortality and can require complex vascular reconstruction. We describe the case of a 42-year-old patient with celiac trunk aneurysm whom we treated by means of a hybrid surgical-endovascular procedure. We performed a left reno-splenic bypass, after which we used a direct splenic artery approach to deploy a self-expandable 6 × 50-mm stent-graft across the splenic and hepatic arteries. One year later, the stability of the repair was confirmed. PMID:22719156

  14. Predictors of early stent occlusion among plastic biliary stents.

    PubMed

    Khashab, Mouen A; Kim, Katherine; Hutfless, Susan; Lennon, Anne Marie; Kalloo, Anthony N; Singh, Vikesh K

    2012-09-01

    A major disadvantage of plastic biliary stents is their short patency rates. The aim of this study was to identify predictors of early stent occlusion among patients receiving conventional plastic biliary stents. Early stent occlusion was defined as worsening cholestatic liver test results of a severity sufficiently significant to warrant ERCP with stent exchange prior to the planned stent exchange, or as symptoms of cholangitis. The association of cumulative stent diameter, demographics, stricture location, procedure indication, Charlson comorbidity index, history of prior early stent occlusion, presence of gallbladder, and performance of sphincteromy with the occurrence of early stent occlusion was studied using logistic regression and multivariate analysis. Our patient cohort comprised 343 patients (mean age 59.3 years) who underwent 561 ERCP procedures with the placement of one or more plastic biliary stents (mean number of stents per procedure 1.2, mean total diameter of stents per procedure 12 Fr). Early stent occlusion occurred in 73 (13 %) procedures. Female gender was protective against early stent occlusion (adjusted OR 0.54, 95 % CI 0.32-0.90, p = 0.02), while hilar stricture location was independently associated with a significantly increased risk of early stent occlusion (adjusted OR 3.41, 95 % CI 1.68-6.90, p = 0.0007). Early occlusion of conventional biliary stents occurred in 13 % of cases. While female gender decreased the risk of early stent occlusion, hilar stricture location was a significant predictor of early stent occlusion. Our results suggest that physicians should consider early elective stent exchange in patients with hilar strictures.

  15. Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation.

    PubMed

    Ma, Wei-Guo; Zhu, Jun-Ming; Zheng, Jun; Liu, Yong-Min; Ziganshin, Bulat A; Elefteriades, John A; Sun, Li-Zhong

    2013-09-01

    The Sun's procedure is a surgical technique proposed by Dr. Li-Zhong Sun in 2002 that integrates total aortic arch replacement using a tetrafurcated graft with implantation of a specially designed frozen elephant trunk (Cronus(®)) in the descending aorta. It is used as a treatment option for extensive aortic dissections or aneurysms involving the ascending aorta, aortic arch and the descending aorta. The technical essentials of Sun's procedure include implantation of the special open stented graft into the descending aorta, total arch replacement with a 4-branched vascular graft, right axillary artery cannulation, selective antegrade cerebral perfusion for brain protection, moderate hypothermic circulatory arrest at 25 °C, a special anastomotic sequence for aortic reconstruction (i.e., proximal descending aorta → left carotid artery → ascending aorta → left subclavian artery → innominate artery), and early rewarming and reperfusion after distal anastomosis to minimize cerebral and cardiac ischemia. The core advantage of Sun's procedure lies in the use of a unique stented graft, which has superior technical simplicity, flexibility, inherent mechanical durability and an extra centimeter of attached regular vascular graft at both ends. Since its introduction in 2003, the Sun's procedure has produced satisfactory early and long-term results in over 8,000 patients in China and more than 200 patients in South American countries. In a series of 1,092 patients, the authors have achieved an in-hospital mortality rate of 6.27% (7.98% in emergent or urgent vs. 3.98% in elective cases). Given the accumulating clinical experience and the consequent, continual evolution of surgical indications, the Sun's procedure is becoming increasingly applied/used worldwide as an innovative and imaginative enhancement of surgical options for the dissected (or aneurysmal) ascending aorta, aortic arch and proximal descending aorta, and may become the next standard treatment for type

  16. Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

    PubMed Central

    Grundmann, Reinhart T

    2013-01-01

    There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann’s procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial. PMID:23515179

  17. Trans aqueductal, third ventricle - Cervical subarachnoid stenting: An adjuvant cerebro spinal fluid diversion procedure in midline posterior fossa tumors with hydrocephalus: The technical note and case series.

    PubMed

    Teegala, Ramesh

    2016-01-01

    Persistent or progressive hydrocephalus is one of the complex problems of posterior fossa tumors associated with hydrocephalus. The author evaluated the effectiveness of single-stage tumor decompression associated with a stent technique (trans aqueductal third ventricle - Cervical subarachnoid stenting) as an adjuvant cerebro spinal fluid (CSF) diversion procedure in controlling the midline posterior fossa tumors with hydrocephalus. Prospective clinical case series of 15 patients was evaluated from July 2006 to April 2012. Fifteen clinicoradiological diagnosed cases of midline posterior fossa tumors with hydrocephalus were included in this study. All the tumors were approached through the cerebello medullary (telo velo tonsilar) fissure technique. Following the excision of the posterior fossa tumor, a sizable stent was placed across the aqueduct from the third ventricle to the cervical subarachnoid space. There were nine male and six female patients with an average age of 23 years. Complete tumor excision could be achieved in 12 patients and subtotal excision with clearance of aqueduct in remaining three patients. Hydrocephalus was controlled effectively in all the patients. There were no stent-related complications. This study showed the reliability of single-stage tumor excision followed by placement of aqueductal stent. The success rate of this technique is comparable to those of conventional CSF diversion procedures. This is a simple, safe, and effective procedure for the management of persistent and or progressive hydrocephalus. This technique may be very useful in situations where the patient's follow-up is compromised and the patients who are from a poor economic background. Long-term results need further evaluation to assess the overall functioning of this stent technique.

  18. Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis

    PubMed Central

    Morofuji, Toru; Inaba, Shinji; Aisu, Hiroe; Takahashi, Kayo; Saito, Makoto; Higashi, Haruhiko; Yoshii, Toyofumi; Sumimoto, Takumi

    2017-01-01

    Objective The underlying mechanisms of stent thrombosis are not completely understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS). Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases. Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis. PMID:28154268

  19. Biodegradable Ureteral Stents

    NASA Astrophysics Data System (ADS)

    Chew, Ben H.; Hadaschik, Boris A.; Paterson, Ryan F.; Lange, Dirk

    2008-09-01

    Ureteral stents have been associated with painful symptoms and require a secondary procedure for removal if the suture tether is removed. Biodegradable stents have been attempted in the past, but are no longer used since they resulted in histological inflammation or unpredictable variability in degradation time. This article reviews past degradable materials used in both the prostatic urethra and ureter as well as identifies a new degradable ureteral stent that lasts between 2 to 4 weeks in a porcine model.

  20. A Report of Successful Procedural, Clinical, and Angiographic Outcomes with a Tapered Stent of a Patient in Naturally Tapered Coronary Vessel

    PubMed Central

    Kumar, Yerra Shiv

    2017-01-01

    In cases involving stenosis or occlusions in major parts of a long vessel, natural tapering of coronary vessels may create dilemma in deciding the optimal stent size during percutaneous coronary intervention. In this regard, tapered stents have been developed recently. Herein, we present a case of 67-year-old male patient with triple vessel disease including two tandem lesions in naturally tapered Left Anterior Descending (LAD) artery. The patient received a 3.0–2.5x60 mm Sirolimus-eluting BioMime Morph stent (Meril life Sciences, Gujarat, India) in the mid-distal LAD lesion along with conventional stent implantations in other two lesions. The procedure was successful and good coronary flow was obtained after revascularization. The patient remained asymptomatic thereafter. At one year, angiographic follow-up revealed good flow and no restenosis in the LAD vessel. We are of opinion that using tapered stents with decremented diameter may offer the advantages of excellent adaptation to vessel size, vessel tapering, and good apposition in patients with long coronary lesions in tapered vessels. PMID:28273994

  1. Update in urethral stents.

    PubMed

    Bahouth, Z; Meyer, G; Yildiz, G; Nativ, O; Moskovitz, B

    2016-10-01

    Urethral stents were first introduced in 1988, and since then, they have undergone significant improvements. However, they did not gain a wide popularity and their use is limited to a small number of centers around the world. Urethral stents can be used in the entire urethra and for various and diverse indications. In the anterior urethra, it can be used to treat urethral strictures. In the prostatic urethra, they can be used for the treatment of prostatic obstruction, including benign, malignant and iatrogenic prostatic obstruction. Moreover, although not widely used, it can be also applied for the treatment of posterior urethral stricture and bladder neck contracture, usually resulting in urinary incontinence and the need for subsequent procedures. Our main experience are with Allium urethral stents, and as such, we provide the latest updates in urethral stents with special emphasis on the various types of Allium urethral stents: bulbar, prostatic and bladder neck stents.

  2. Gastrointestinal Stent Update

    PubMed Central

    2010-01-01

    The use of self-expanding metallic stents in the upper gastrointestinal tract, placed under radiologic imaging or endoscopic guidance, is the current treatment of choice for the palliation of malignant gastrointestinal outlet obstructions. Advances in metallic stent design and delivery systems have progressed to the stage where this treatment is now considered a minimally invasive therapy. Metallic stent placement will broaden further into the field of nonsurgical therapy for the gastrointestinal tract. To date, metallic stents placed in the esophagus, gastric outlet, colorectum, and bile ducts are not intended to be curative, but rather to provide a palliative treatment for obstructions. The evolution of metallic stent technology will render such procedures not only palliative but also therapeutic, by enabling local drug delivery, and the use of biodegradable materials will reduce procedure-related complications. PMID:21103290

  3. Future developments in biliary stenting

    PubMed Central

    Hair, Clark D; Sejpal, Divyesh V

    2013-01-01

    Biliary stenting has evolved dramatically over the past 30 years. Advancements in stent design have led to prolonged patency and improved efficacy. However, biliary stenting is still affected by occlusion, migration, anatomical difficulties, and the need for repeat procedures. Multiple novel plastic biliary stent designs have recently been introduced with the primary goals of reduced migration and improved ease of placement. Self-expandable bioabsorbable stents are currently being investigated in animal models. Although not US Food and Drug Administration approved for benign disease, fully covered self-expandable metal stents are increasingly being used in a variety of benign biliary conditions. In malignant disease, developments are being made to improve ease of placement and stent patency for both hilar and distal biliary strictures. The purpose of this review is to describe recent developments and future directions of biliary stenting. PMID:23837001

  4. The "Lantern" Procedure to Simplify Treatment of Retrograde Type A Dissection After Thoracic Endograft Stenting.

    PubMed

    Tsai, Chung-Lin

    2016-04-01

    The emergency repair of retrograde type A aortic dissection after thoracic endovascular aortic repair is a complex and challenging surgical procedure and carries a surgical challenge. Previous studies have reported a significant mortality in the complex repair of retrograde type A aortic dissection after thoracic endovascular aortic repair. We devised a simplified hybrid method-the "Lantern" procedure-to solve this retrograde type A aortic dissection complication.

  5. Percutaneous valved stent repair of a failed homograft: implications for the Ross procedure.

    PubMed

    Pretorius, Victor; Jones, Alan; Taylor, Dylan; Coe, Yashu; Ross, David B

    2008-08-01

    A case of percutaneous pulmonary valve implantation following a failed homograft in the pulmonary position is reported. A 16-year-old boy developed infective endocarditis of his pulmonary homograft, which was implanted four years earlier during a Ross procedure for congenital aortic stenosis. Following successful medical therapy, the boy was symptomatic due to pulmonary stenosis and regurgitation. A 22 mm Melody valve (Medtronic, USA) was successfully implanted percutaneously. His symptoms resolved and he was discharged home one day after the procedure. Echocardiography at the six-month follow-up demonstrated a normally functioning pulmonary valve. Percutaneous pulmonary valve replacement may make the Ross procedure a more attractive option for patients with aortic stenosis, particularly in the pediatric population.

  6. Overlap stenting for in-stent restenosis after carotid artery stenting

    PubMed Central

    Nishihori, Masahiro; Ohshima, Tomotaka; Yamamoto, Taiki; Goto, Shunsaku; Nishizawa, Toshihisa; Shimato, Shinji; Izumi, Takashi; Kato, Kyozo

    2016-01-01

    ABSTRACT Our aim was to assess the clinical safety and efficacy of overlap stenting for in-stent restenosis after carotid artery stenting. The study was conducted between July 2008 and February 2015. A database of consecutive carotid artery stenting procedures was retrospectively assessed to identify the cases of in-stent restenosis that were treated with overlap stenting under proximal or distal protection. The clinical and radiological records of the patients were then reviewed. Of the 155 CAS procedures in 149 patients from the database, 6 patients met the inclusion criteria. All the 6 patients were initially treated with moderate dilatation because of the presence of an unstable plaque. The technical success rate of the overlap stenting was 100%, with no 30-day mortality or morbidity. In addition, there was no further in-stent restenosis during a follow-up period of over 12 months. These results indicated that overlap stenting for in-stent restenosis after carotid artery stenting was both safe and effective in our cohort. PMID:27303101

  7. Stent Graft in Managing Juxta-Renal Aortoiliac Occlusion

    SciTech Connect

    Prabhudesai, V. Mitra, K.; West, D. J.; Dean, M. R. E.

    2003-09-15

    Endovascular procedures are frequently used as an alternative to surgical bypass in aortic and iliac occlusion. Stents have revolutionized the scope of such endovascular procedures, but there are few reports of stents or stent grafts in occlusive juxta-renal aortic occlusion. We present a case where such occlusion was managed by use of a stent graft with successful outcome.

  8. Intra-procedural stent thrombosis: a new risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention for acute coronary syndromes.

    PubMed

    Brener, Sorin J; Cristea, Ecaterina; Kirtane, Ajay J; McEntegart, Margaret B; Xu, Ke; Mehran, Roxana; Stone, Gregg W

    2013-01-01

    The aim of this study was to examine the incidence, correlates, and consequences of intra-procedural stent thrombosis (IPST) in patients with acute coronary syndromes (ACS). Stent thrombosis (ST) is a rare but serious complication of percutaneous coronary intervention (PCI). The Academic Research Consortium definition of ST excludes events occurring during PCI. Angiograms from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) and HORIZONS-AMI (Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction) trials were reviewed frame-by-frame at an independent core laboratory for the occurrence of IPST. Patients with versus without IPST were compared to identify baseline characteristics associated with IPST and demonstrate the independent association between IPST and adjudicated events at 30 days and 1 year. Intra-procedural ST occurred in 47 (0.7%) of 6,591 patients. The occurrence of IPST was associated with ST-segment elevation myocardial infarction presentation, high white blood cell count, treatment of thrombotic and bifurcation lesions, bivalirudin monotherapy, bail-out IIb/IIIa inhibitor use, and implantation of bare-metal (rather than drug-eluting) stents. Major adverse ischemic events were markedly higher in patients with versus without IPST, including mortality at 30 days (12.9% vs. 1.4%, p < 0.0001) and 1 year (12.9% vs. 3.1%, p < 0.0001). Out-of-lab Academic Research Consortium definite or probable ST also occurred significantly more often among IPST patients at 30 days (17.4% vs. 1.8%, p < 0.0001) and 1 year (19.9% vs. 2.7%, p < 0.0001). Intra-procedural ST was a significant independent predictor of 1-year mortality (hazard ratio: 3.86, 95% confidence interval: 1.66 to 9.00, p = 0.002). Intra-procedural ST is a relatively rare complication of PCI in ACS but is strongly associated with subsequent out-of-lab ST and mortality. Intra-procedural ST should be considered as a distinct category of ST and routinely

  9. Fluoroscopy Guided Transurethral Placement of Ureteral Metallic Stents

    PubMed Central

    Myung Gyu, Song; Seo, Tae Seok; Park, Cheol Min; Choi, Jae Woong; Lee, Jong Mee; Park, Yang Shin

    2015-01-01

    Ureteral stent exchange is usually performed under both fluoroscopic and cystoscopic guidance. We experienced two cases with retrograde placement of metallic ureteral stent via urethra under fluoroscopic guidance. When patients with double-J ureteral stent (DJUS)have symptom and want to change DJUS to metallic stent, fluoroscopic guided transurethral placement of ureteral metallic stent is a good option as alternative of cystoscopic procedure or percutaneous procedure through percutaneous nephrostomy tract. PMID:26557281

  10. The Impact of Post-Procedural Asymmetry, Expansion, and Eccentricity of Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting Stent on Clinical Outcomes in the ABSORB II Trial.

    PubMed

    Suwannasom, Pannipa; Sotomi, Yohei; Ishibashi, Yuki; Cavalcante, Rafael; Albuquerque, Felipe N; Macaya, Carlos; Ormiston, John A; Hill, Jonathan; Lang, Irene M; Egred, Mohaned; Fajadet, Jean; Lesiak, Maciej; Tijssen, Jan G; Wykrzykowska, Joanna J; de Winter, Robbert J; Chevalier, Bernard; Serruys, Patrick W; Onuma, Yoshinobu

    2016-06-27

    The study sought to investigate the relationship between post-procedural asymmetry, expansion, and eccentricity indices of metallic everolimus-eluting stent (EES) and bioresorbable vascular scaffold (BVS) and their respective impact on clinical events at 1-year follow-up. Mechanical properties of a fully BVS are inherently different from those of permanent metallic stent. The ABSORB II (A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions) trial compared the BVS and metallic EES in the treatment of a de novo coronary artery stenosis. Protocol-mandated intravascular ultrasound imaging was performed pre- and post-procedure in 470 patients (162 metallic EES and 308 BVS). Asymmetry index (AI) was calculated per lesion as: (1 - minimum scaffold/stent diameter/maximum scaffold/stent diameter). Expansion index and optimal scaffold/stent expansion followed the definition of the MUSIC (Multicenter Ultrasound Stenting in Coronaries) study. Eccentricity index (EI) was calculated as the ratio of minimum and maximum scaffold/stent diameter per cross section. The incidence of device-oriented composite endpoint (DoCE) was collected. Post-procedure, the metallic EES group was more symmetric and concentric than the BVS group. Only 8.0% of the BVS arm and 20.0% of the metallic EES arm achieved optimal scaffold/stent expansion (p < 0.001). At 1 year, there was no difference in the DoCE between both devices (BVS 5.2% vs. EES 3.1%; p = 0.29). Post-procedural devices asymmetry and eccentricity were related to higher event rates while there was no relevance to the expansion status. Subsequent multivariate analysis identified that post-procedural AI >0.30 is an independent predictor of DoCE (hazard ratio: 3.43; 95% confidence interval: 1.08 to 10.92; p = 0.037). BVS implantation is more frequently associated with post-procedural asymmetric and eccentric morphology compared

  11. What Are the Risks of Having a Stent?

    MedlinePlus

    ... Having a Stent? Risks Related to Percutaneous Coronary Intervention Percutaneous coronary intervention (PCI), the procedure used to place stents, is ... as part of a procedure called percutaneous coronary intervention or PCI, sometimes called angioplasty. Shows how a ...

  12. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection.

  13. Sun’s procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation

    PubMed Central

    Ma, Wei-Guo; Zhu, Jun-Ming; Zheng, Jun; Liu, Yong-Min; Ziganshin, Bulat A.; Elefteriades, John A.

    2013-01-01

    The Sun’s procedure is a surgical technique proposed by Dr. Li-Zhong Sun in 2002 that integrates total aortic arch replacement using a tetrafurcated graft with implantation of a specially designed frozen elephant trunk (Cronus®) in the descending aorta. It is used as a treatment option for extensive aortic dissections or aneurysms involving the ascending aorta, aortic arch and the descending aorta. The technical essentials of Sun’s procedure include implantation of the special open stented graft into the descending aorta, total arch replacement with a 4-branched vascular graft, right axillary artery cannulation, selective antegrade cerebral perfusion for brain protection, moderate hypothermic circulatory arrest at 25 °C, a special anastomotic sequence for aortic reconstruction (i.e., proximal descending aorta → left carotid artery → ascending aorta → left subclavian artery → innominate artery), and early rewarming and reperfusion after distal anastomosis to minimize cerebral and cardiac ischemia. The core advantage of Sun’s procedure lies in the use of a unique stented graft, which has superior technical simplicity, flexibility, inherent mechanical durability and an extra centimeter of attached regular vascular graft at both ends. Since its introduction in 2003, the Sun’s procedure has produced satisfactory early and long-term results in over 8,000 patients in China and more than 200 patients in South American countries. In a series of 1,092 patients, the authors have achieved an in-hospital mortality rate of 6.27% (7.98% in emergent or urgent vs. 3.98% in elective cases). Given the accumulating clinical experience and the consequent, continual evolution of surgical indications, the Sun’s procedure is becoming increasingly applied/used worldwide as an innovative and imaginative enhancement of surgical options for the dissected (or aneurysmal) ascending aorta, aortic arch and proximal descending aorta, and may become the next standard treatment

  14. iStent® Trabecular Microbypass Stent: An Update

    PubMed Central

    Resende, Arthur Fernandes; Patel, Neal Sanjay; Waisbourd, Michael; Katz, L. Jay

    2016-01-01

    Due to the high rates of complications and failure experienced with current glaucoma procedures, there is a continuous search for a safer and more effective glaucoma surgery. A new class of procedures termed minimally invasive glaucoma surgeries (MIGS) aim to fill this void by offering an alternative method of IOP reduction associated with markedly reduced complication rates and shorter recovery times. The iStent, a trabecular microbypass stent, is a MIGS device that has quickly gained popularity. The device allows aqueous humor to directly drain from the anterior chamber into Schlemm's canal by bypassing an obstructed trabecular meshwork. This review examines publications about the iStent, focusing on the device's efficacy, safety, and cost when a single iStent or multiple iStents are implanted in combination with cataract surgery or as a solo procedure. Current data suggest that the iStent is a safe and effective tool in the management of mild-to-moderate glaucoma, notable for its limited complications and absence of serious adverse events following implantation. As valuable experience is gained performing ab interno MIGS, increasing familiarity with angle anatomy and iStent placement, and as newer stent designs are developed, there is promise of continual improvement in the surgical management of glaucoma. PMID:27413541

  15. Successful use of covered stent to treat superior systemic baffle obstruction and leak after atrial switch procedure.

    PubMed

    Dragulescu, Andreea; Sidibe, Noumou; Aubert, Francoise; Fraisse, Alain

    2008-09-01

    Progressive dyspnea and cyanosis occurred in a 41-year-old patient status after Mustard atrial switch repair for transposition of great arteries. Cardiac catheterization and magnetic resonance imaging revealed the association of superior limb systemic venous baffle obstruction and leaks with right-to-left shunting. He underwent successful dilation of the venous channel and obstruction of baffle leaks by using a covered stent.

  16. The need for stent-lesion matching to optimize outcomes of intracoronary stent implantation.

    PubMed

    Lanzer, Peter; Strupp, Gerhard; Schmidt, Wolfram; Topoleski, L D Timmie

    2013-11-01

    Intracoronary stents have markedly improved the outcomes of catheter-based coronary interventions. Intracoronary stent implantation rates of over 90% during coronary angioplasty are common. Stent implantations are associated with a small but statistically significant number of adverse outcomes including restenosis, thrombosis, strut malapposition, incomplete strut endothelialization, and various types of stenting failure. Better matching of biomechanical properties of stents and lesions could further improve the clinical outcome of intracoronary stenting. Thus, in this article, we assess the need for advanced intracoronary stent-lesion matching. We reviewed the data on biomechanics of coronary stents and lesions to develop knowledge-based rationale for optimum intracoronary stent selection. The available technical information on marketed intracoronary stents and the current understanding of the biomechanical properties of coronary lesions at rest and under stress are limited, preventing the development of knowledge-based rationale for optimum intracoronary stent selection at present. Development of knowledge-based selection of intracoronary stents requires standardization of mechanical stent testing, communication of the nonproprietary technical data on stents by the industry and dedicated research into procedural stent-lesion interactions.

  17. Tracheobronchial stents in children.

    PubMed

    Antón-Pacheco, Juan L

    2016-06-01

    Tracheobronchial obstruction is infrequent in children and still remains a challenging matter of concern. Management alternatives vary from conservative treatment to complex surgical techniques or endoscopic interventional procedures. Airway stenting in children is relatively recent and follows the trail of the experience in adult patients. Nevertheless, there are basic differences between both age groups like the benign nature of most obstructions and the small size of the pediatric airway. These specific features raise the issues of the precise role of tracheobronchial stenting in children and the selection of the most adequate device. Stents fall into four main categories according to the material they are made of: metallic, plastic, hybrid, and biodegradable. Each type has its own advantages and drawbacks so the ideal stent is not yet available. Despite increasing experience with stenting, definite clinical criteria for their use in children are yet to be established. Even so, there seems to be a basic general agreement that stents may play a role in particular clinical settings in which there are no other therapeutic options. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Renal Artery Stent Outcomes

    PubMed Central

    Murphy, Timothy P.; Cooper, Christopher J.; Matsumoto, Alan H.; Cutlip, Donald E.; Pencina, Karol M.; Jamerson, Kenneth; Tuttle, Katherine R.; Shapiro, Joseph I.; D’Agostino, Ralph; Massaro, Joseph; Henrich, William; Dworkin, Lance D.

    2016-01-01

    BACKGROUND Multiple randomized clinical trials comparing renal artery stent placement plus medical therapy with medical therapy alone have not shown any benefit of stent placement. However, debate continues whether patients with extreme pressure gradients, stenosis severity, or baseline blood pressure benefit from stent revascularization. OBJECTIVES The study sought to test the hypothesis that pressure gradients, stenosis severity, and/or baseline blood pressure affects outcomes after renal artery stent placement. METHODS Using data from 947 patients with a history of hypertension or chronic kidney disease from the largest randomized trial of renal artery stent placement, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, we performed exploratory analyses to determine if subsets of patients experienced better outcomes after stent placement than the overall cohort. We examined baseline stenosis severity, systolic blood pressure, and translesion pressure gradient (peak systolic and mean) and performed interaction tests and Cox proportional hazards analyses for the occurrence of the primary endpoint through all follow-up, to examine the effect of these variables on outcomes by treatment group. RESULTS There were no statistically significant differences in outcomes based on the examined variables nor were there any consistent nonsignificant trends. CONCLUSIONS Based on data from the CORAL randomized trial, there is no evidence of a significant treatment effect of the renal artery stent procedure compared with medical therapy alone based on stenosis severity, level of systolic blood pressure elevation, or according to the magnitude of the transstenotic pressure gradient. (Benefits of Medical Therapy Plus Stenting for Renal Atherosclerotic Lesions [CORAL]; NCT00081731) PMID:26653621

  19. Ureteral Stents. New Materials and Designs

    NASA Astrophysics Data System (ADS)

    Monga, Manoj

    2008-09-01

    Issues of stent migration and challenges of stent placement can be addressed adequately with current stent designs and materials, and an emphasis on precision in technique. Future changes in ureteral stents will need to maintain the current standard that has been set with existing devices in these regards. In contrast, new advances are sorely needed in encrustation and infection associated with ureteral stents. The main target for future development in ureteral stent materials lies in a biodegradable stent that degrades either on demand or degrades reliably within one-month with predictable degradation patterns that do not predispose to urinary obstruction, discomfort or need for secondary procedures. The main target for future development in ureteral stent design is improved patient comfort.

  20. Safety and Efficacy of Two Trabecular Micro-Bypass Stents as the Sole Procedure in Japanese Patients with Medically Uncontrolled Primary Open-Angle Glaucoma: A Pilot Case Series

    PubMed Central

    Hosoda, Shingo; Yaguchi, Saori

    2017-01-01

    Purpose. To evaluate efficacy and safety of a trabecular micro-bypass stent system when used as the sole procedure in Japanese patients with medically uncontrolled primary open-angle glaucoma (POAG). Design. Prospective nonrandomized interventional pilot study. Methods. Ten eyes of 10 Japanese patients with medically uncontrolled POAG taking three ocular hypotensive medications were treated using only the implantation of two iStent trabecular micro-bypass stents. Each patient continued to take the same ocular hypotensive medications used preoperatively throughout the study. Intraocular pressure (IOP) and endothelial cell density (ECD) were determined at baseline and at 1, 3, and 6 months postoperatively. Best-corrected visual acuity (BCVA) was measured at baseline and 6 months after surgery. Results. Mean IOP was 22.0 ± 3.0 mmHg at baseline and 16.9 ± 3.6 mmHg at 6 months, which represented a mean reduction of 5.1 mmHg or 23.2%. No significant changes were observed in the ECD and BCVA. Complications that occurred during the early postoperative period included hyphema, peripheral anterior synechiae, and occlusion of the stent by the iris. Conclusion. Implantation of two trabecular micro-bypass stents as the sole procedure in Japanese POAG patients effectively reduced IOP and exhibited a favorable safety profile. Clinical Trials Registration number is UMIN000004002. PMID:28265466

  1. Next generation biodegradable ureteral stent in a yucatan pig model.

    PubMed

    Chew, Ben H; Lange, Dirk; Paterson, Ryan F; Hendlin, Kari; Monga, Manoj; Clinkscales, Kenneth W; Shalaby, Shalaby W; Hadaschik, Boris A

    2010-02-01

    Ureteral stents are commonly used to facilitate kidney drainage but they may produce significant stent symptoms and morbidity, and require a secondary procedure for removal. Previous biodegradable stents showed bio-incompatibility or inconsistent degradation, requiring extra procedures to remove undegraded stent fragments. We previously reported a first generation biodegradable stent composed of suture-like material that required placement through the lumen of a sheath and degraded by 10 weeks. We now report second and third generation biodegradable stents that degrade more rapidly and can be placed directly over a polytetrafluoroethylene guidewire. Two groups of 16 Yucatan pigs each were unilaterally stented endoscopically with a control nondegradable (biostable) stent or a second generation degradable Uriprene stent. Blood studies, renal ultrasound and excretory urography were done throughout the study to determine renal function, hydronephrosis and stent degradation. Genitourinary organs were harvested at necropsy for pathological analysis. A third generation stent designed to improve degradation time was bilaterally implanted endoscopically into 4 Yorkshire Farm pigs (total of 8 stents), followed by excretory urography weekly to assess degradation and kidney function. Biomaterial parameters were tested. Second generation stents began degrading at 2 weeks and were completely degraded by 10 weeks. All third generation stents were degraded by 4 weeks. Hydronephrosis was considerably less in the Uriprene group than in control biostable stented kidneys. Biostable stented ureters showed an average higher degree of inflammation, uropathy and nephropathy. Physical characteristics indicate that Uriprene stents are significantly more resistant to stent compression and have markedly higher tensile strength and coil strength comparable to that of other commercially available plastic stents. Our study confirms that Uriprene stents are biocompatible and provide good renal

  2. Safety, efficacy and costs associated with direct coronary stenting compared with stenting after predilatation

    PubMed Central

    IJsselmuiden, A.; Serruys, P.W.; Tangelder, G.J.; Slagboom, T.; van der Wieken, R.; Kiemeneij, F.; Laarman, G.J.

    2004-01-01

    Objectives Comparison of the in-hospital success rates, procedural costs and short-term clinical outcomes of direct stenting versus stenting after balloon predilatation. Methods Altogether, 400 patients with angina pectoris and/or myocardial ischaemia due to coronary stenoses in a single native vessel were randomised to either direct stenting or stenting after predilatation. Baseline characteristics were evenly distributed between the two groups. Results Procedural success rates were similar (96.0% direct stenting group vs. 94.5% predilatation) as well as final successful stent implantation (98.3 vs. 97.8%), while the primary success rate of direct stenting alone was 88.3%, p=0.01. In multivariate analysis, angiographic lesion calcification was an independent predictor of unsuccessful direct stenting (odds ratio 7.1, 95% confidence interval 2.8-18.2, p<0.0001). Rates of troponin I rises >0.15 μg/l, used as a measure of distal embolisation, were similar in both groups (17.8 vs. 17.1%). Rates of major adverse cardiac events at 30 days were 4.5% in the direct stenting group versus 5.5% in the predilated group (ns). Direct stenting was associated with savings in fluoroscopy time, and angiographic contrast agent use, and a reduction in utilisation of angioplasty balloons (0.4 vs. 1.17 balloons per patient, p<0.001). Mean per patient procedural costs associated with direct stenting versus predilatation were €2545±914 versus €2763±842 (p=0.01), despite the implantation of more stents in the directly stented group. Conclusion Compared with a strategy of stenting preceded by balloon predilatation, direct stenting was equally safe and effective, with similar in-hospital and 30-day clinical outcomes, and modest procedural cost-savings. A calcified lesion predicted unsuccessful direct stenting. PMID:25696356

  3. Stent graft implantation in an aortic pseudoaneurysm associated with a fractured Cheatham-Platinum stent in aortic coarctation.

    PubMed

    Kuhelj, Dimitrij; Berden, Pavel; Podnar, Tomaž

    2016-03-01

    We report a case of aortic pseudoaneurysm associated with a fractured bare Cheatham-Platinum stent following stenting for aortic coarctation. These complications were recognised 6 years after the implantation procedure and were successfully managed by percutaneous stent graft implantation. Staged approach for stent dilatation might prevent development of aortic pseudoaneurysms. In addition, careful follow-up is warranted after stenting for aortic coarctation, particularly in patients with recognised aortic wall injury.

  4. One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field

    PubMed Central

    Hopkins, L. Nelson; Siddiqui, Adnan H.

    2017-01-01

    Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay – but it does not abolish – CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint. Nevertheless CAS – using a widely open-cell, first-generation stent and first-generation (distal/filter) neuroprotection – has been criticised for its relative excess of (mostly minor) strokes by 30 days, a significant proportion of which were post-procedural. Atherosclerotic plaque protrusion through conventional carotid stent struts, confirmed on intravascular imaging, has been implicated as a leading mechanism of the relative excess of strokes with CAS vs. CEA, including delayed strokes with CAS. Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several multi-centre/multi-specialty clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (EPS) and RoadSaver/Casper were recently published and included routine DW-MRI cerebral imaging peri-procedurally and at 30 days (CGuard EPS). Data from more than 550 patients in mesh-covered carotid stent clinical studies to-date show an overall 30-day complication rate of ~1% with near-elimination of post-procedural events. While more (and long-term) evidence is still anticipated, these results – taken together with optimised intra-procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) and the positive 12-month mesh-covered stent data reports in 2017 – are transforming the carotid

  5. Treatment of central venous in-stent restenosis with repeat stent deployment in hemodialysis patients.

    PubMed

    Ronald, James; Davis, Bradley; Guevara, Carlos J; Pabon-Ramos, Waleska M; Smith, Tony P; Kim, Charles Y

    2017-05-15

    To report patency rates for stent deployment for treatment of in-stent stenosis of the central veins of the chest in hemodialysis patients. A retrospective analysis was performed on 29 patients who underwent 35 secondary percutaneous transluminal stent (PTS) deployments for in-stent stenosis within the central veins that were refractory to angioplasty and ipsilateral to a functioning hemodialysis access (in-stent PTS group). For comparison, patency data were acquired for 47 patients who underwent 78 successful percutaneous transluminal angioplasty (PTA) procedures for in-stent stenosis (in-stent PTA group) and 55 patients who underwent 55 stent deployments within native central vein stenosis refractory to angioplasty (native vein PTS group). The 3-, 6-, and 12-month primary lesion patency for the in-stent PTS group was 73%, 57%, and 32%, respectively. The 3-, 6-, and 12-month primary patency for the in-stent PTA group was 70%, 38%, and 17% and for the native vein PTS group was 78%, 57%, and 26%, which were similar to the in-stent PTS group (p = 0.20 and 0.41, respectively). The 3-, 6-, and 12-month secondary access patency was 91%, 73%, and 65% for the in-stent PTS group. Sub-analysis of the in-stent PTS group revealed no difference in primary (p = 0.93) or secondary patency rates (p = 0.27) of bare metal stents (n = 23) compared with stent grafts (n = 12). Stent deployment for central vein in-stent stenosis refractory to angioplasty was associated with reasonable patency rates, which were similar to in-stent PTA and native vein PTS.

  6. A comparative evaluation of early stent occlusion among biliary conventional versus wing stents.

    PubMed

    Khashab, Mouen A; Hutfless, Susan; Kim, Katherine; Lennon, Anne Marie; Canto, Marcia I; Jagannath, Sanjay B; Okolo, Patrick I; Shin, Eun Ji; Singh, Vikesh K

    2012-06-01

    Conventional plastic stents with a lumen typically have limited patency. The lumenless wing stent was engineered to overcome this problem. The objective of this study was to compare the incidence of early stent occlusion (symptomatic occlusion/cholangitis necessitating re-insertion within 90 days) for wing stents and conventional plastic stents. Patients with biliary pathology treated with plastic biliary stenting during the period 2003-2009 comprised the study cohort. Patients who had at least one biliary wing stent placed comprised the wing stent group, whereas patients who underwent only conventional stent plastic placement comprised the conventional stent group. Patients were stratified by indication: benign biliary strictures (group 1), malignant biliary strictures (group 2), or benign biliary non-stricture pathology (group 3). The association of stent type with the occurrence of primary outcome by indication was analyzed by use of multivariable logistic regression. Three-hundred and forty-six patients underwent 612 ERCP procedures with placement of plastic biliary stent(s). On multivariate analysis, early stent occlusion did not differ between the wing and conventional groups in groups 1, 2, and 3. Among patients who achieved primary outcome in group 2, significantly fewer patients in the wing group had cholangitis (6.7% vs. 39.1%, P = 0.03). Among patients who achieved primary outcome in group 3, significantly fewer patients in the wing group had cholangitis (10% vs. 50%, P = 0.03). Early stent occlusion was similar for wing stents and conventional plastic stents. Wing stents, however, were associated with a lower incidence of cholangitis in patients with malignant biliary obstruction and benign non-stricturing biliary pathology.

  7. Carotid artery stenting: which stent for which lesion?

    PubMed

    Bosiers, Marc; Deloose, Koen; Verbist, Jürgen; Peeters, Patrick

    2005-01-01

    The different geometries and working principles of carotid stents (nitinol or cobalt chromium, open- or closed-cell configuration) provide each product with unique functional properties. The individual characteristics of each device may make it an attractive choice in one circumstance but render it less desirable in other situations. In approximately 75% of all procedures, all types of stents will achieve similar outcomes, making adequate device selection unnecessary. For the remaining quarter, careful preoperative screening is mandatory. In addition to eventual access issues, the choice of the optimal carotid stent depends mainly on arterial anatomy and lesion morphology. When treating a tortuous anatomy, stents with a flexible and comformable open-cell configuration are preferred. In arteries with a significant mismatch between common carotid artery and internal carotid artery diameter, cobalt chromium (Elgiloy) or tapered nitinol stents are selected. Lesions with suspected high emboligenicity are best covered with stents with a closed-cell configuration, whereas highly calcified lesions need treatment with nitinol stents. Thorough knowledge of the characteristics, advantages and disadvantages, and working principles of the different available stents is mandatory to optimally select the materials to be used for patients eligible for carotid revascularization.

  8. [Pyeloureteral stenting using nitinol stents].

    PubMed

    Guliev, B G; Zagazezhev, A M

    2016-11-01

    To test the effectiveness of nitinol stents in restoring patency of pyeloureteral segment (PUS). Endoureteral nitinol stents were used in 54 patients. The indications for stenting were recurrent strictures of upper urinary tract and ureteral tumor obstruction in 34 and 20 patients, respectively. In 9 (16.6%) of them, including 4 women and 5 men aged 28-65 years, stenting was performed for extensive recurrent PUS strictures. In 8 patients extensive strictures resulted from various surgical interventions on the PUS. In 2 patients, PUS narrowing was caused by open pyelolithotomy, in 6 patients by pyeloplasty, both open (4) and laparoscopic (2). A female patient with solitary right kidney and Bourneville - Pringle disease of the PUS received two metal prostheses. In all cases, nitinol stents were adequately installed in PUS. Hematuria was observed in 1 patient. During the follow-up period of 8 to 60 months, the results of stenting were considered good in 6 (66.7%) and satisfactory in 2 (22.2%) patients. At month 10, 1 (11.1%) patient developed the stent obstruction by proliferative tissue and underwent ureteroscopy with recanalization of the nitinol stent. The patient with Bourneville - Pringle disease was found to have a stone formed in the renal pelvic end of the endoprosthesis; she underwent percutaneous nephrolithotripsy. In another patient a lower calyceal stone migrated and wedged into the proximal end of the stent. The stone was extracted using percutaneous nephroscopy. Pyeloureteral stenting is an effective method to restore patency of the PUS in patients with extensive recurrent strictures. For adequate functioning of the stents, they need to be of optimal length and correctly installed.

  9. A new removable airway stent

    PubMed Central

    Amundsen, Tore; Sørhaug, Sveinung; Leira, Håkon Olav; Tyvold, Stig Sverre; Langø, Thomas; Hammer, Tommy; Manstad-Hulaas, Frode; Mattsson, Erney

    2016-01-01

    Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use. PMID:27608269

  10. Self-expanding metal stents in malignant esophageal obstruction: a comparison between two stent types.

    PubMed

    Schmassmann, A; Meyenberger, C; Knuchel, J; Binek, J; Lammer, F; Kleiner, B; Hürlimann, S; Inauen, W; Hammer, B; Scheurer, U; Halter, F

    1997-03-01

    Self-expanding metal stents are a promising alternative in the palliation of malignant esophageal obstruction, but the relative value of different stent types is not well established. During a 3-year enrollment period in four different centers, 82 consecutive patients with malignant dysphagia without tumor recurrence after surgery or esophagorespiratory fistulas received either an uncovered Wallstent (44 patients) or a knitted nitinol stent (38 patients). Age (median: 79 yr), sex (F:M = 33:67), dysphagia score (median: 3), Karnofsky score (median: 53), body mass index (median: 19), type of pretreatment, tumor stage, stricture length (median: 5.4 cm), and stricture location were comparable in both stent groups. After stent placement, median dysphagia score improved markedly in both groups by two points. Procedure-related mortality (16 vs 0%; p < 0.01), early complication rate (32 vs 8%; p < 0.01), and severe persistent pain after stent placement (23 vs 0%; p < 0.002) were higher in the Wallstent compared with the knitted nitinol stent group. In contrast, stent dysfunction (7 vs 32%; p < 0.005), reintervention rate (9 vs 34%; p < 0.005), and costs were lower in the Wallstent compared with the nitinol stent group. In malignant esophageal obstruction, both stents markedly improved dysphagia. Uncovered Wallstents seem to cause more early severe complications than knitted nitinol stents. In contrast, stent dysfunction, reintervention rate, and costs appear to be higher in the nitinol stent group.

  11. Degradation behavior of biodegradable Fe35Mn alloy stents.

    PubMed

    Sing, N B; Mostavan, A; Hamzah, E; Mantovani, D; Hermawan, H

    2015-04-01

    This article reports a degradation study that was done on stent prototypes made of biodegradable Fe35Mn alloy in a simulated human coronary arterial condition. The stent degradation was observed for a short-term period from 0.5 to 168 h, which simulates the early period of stenting procedure. Potentiodynamic polarization and electrochemical impedance spectroscopy were used to quantify degradation rate and surface property of the stents. Results showed that signs of degradation were visible on both crimped and expanded stents after 1 h of test, mostly located on the stent's curvatures. The degradation rate of stent was higher compared to that of the original alloy, indicating the surface altering effect of stent fabrication processing to degradation. A single oxide layer was formed and detected as a porous structure with capacitive behavior. Expanded stents exhibited lower polarization resistance compared to the nonexpanded ones, indicating the cold work effect of expansion procedure to degradation. © 2014 Wiley Periodicals, Inc.

  12. [Absorbable coronary stents. New promising technology].

    PubMed

    Erbel, Raimund; Böse, Dirk; Haude, Michael; Kordish, Igor; Churzidze, Sofia; Malyar, Nasser; Konorza, Thomas; Sack, Stefan

    2007-06-01

    Coronary stent implantation started in Germany 20 years ago. In the beginning, the progress was very slow and accelerated 10 years later. Meanwhile, coronary stent implantation is a standard procedure in interventional cardiology. From the beginning of permanent stent implantation, research started to provide temporary stenting of coronary arteries, first with catheter-based systems, later with stent-alone technology. Stents were produced from polymers or metal. The first polymer stent implantation failed except the Igaki-Tamai stent in Japan. Newly developed absorbable polymer stents seem to be very promising, as intravascular ultrasound (IVUS) and optical coherence tomography have demonstrated. Temporary metal stents were developed based on iron and magnesium. Currently, the iron stent is tested in peripheral arteries. The absorbable magnesium stent (Biotronik, Berlin, Germany) was tested in peripheral arteries below the knee and meanwhile in the multicenter international PROGRESS-AMS (Clinical Performance and Angiographic Results of Coronary Stenting with Absorbable Metal Stents) study. The first magnesium stent implantation was performed on July 30, 2004 after extended experimental testing in Essen. The magnesium stent behaved like a bare-metal stent with low recoil of 5-7%. The stent struts were absorbed when tested with IVUS. Stent struts were not visible by fluoroscopy or computed tomography (CT) as well as magnetic resonance imaging (MRI). That means, that the magnesium stent is invisible and therefore CT and MRI can be used for imaging of interventions. Only using micro-CT the stent struts were visible. The absorption process could be demonstrated in a patient 18 days after implantation due to suspected acute coronary syndrome, which was excluded. IVUS showed a nice open lumen. Stent struts were no longer visible, but replaced by tissue indicating the previous stent location. Coronary angiography after 4 months showed an ischemia-driven target lesion

  13. Post-sialendoscopy ductoplasty by salivary duct stent placements.

    PubMed

    Su, Chin-Hui; Lee, Kuo-Sheng; Tseng, Te-Ming; Hung, Shih-Han

    2016-01-01

    With damage to a duct or papilla after sialendoscopy, a stent may be necessary to prevent re-stenosis and for maintaining the salivary duct open after complete sialendoscopy. However factors affecting outcomes and complications after stent placement remain unclear. This study aimed to report preliminary experiences in salivary duct stent placement after sialendoscopy. Data from 35 procedures in 33 patients who received sialendoscopy with salivary duct stent placements at Mackay Memorial Hospital between October 2013 and June 2014 were recorded and compared for clinical data, as well as procedural techniques, findings, and outcomes. In the 35 stent placement procedures, the hypospadias silastic stent tubes were used in 27 and the Fr. 5 pediatric feeding tubes were used in the remaining eight. When the hypospadias silastic stent tubes were used for stenting, the stent obstruction and irritation rates were higher compared to those who used the Fr. 5 pediatric feeding tube (100 vs. 0 % and 67 vs. 33 %, respectively). None of the stents secured by a 5-0 nylon suture were complicated by dislocation but when the stents were secured by 6-0 nylon sutures, the dislocation rate went as high as 47.4 %. The duration needed for salivary duct stent placement might be potentially shortened to only 2 weeks. If a salivary duct stent is intended to be placed for a certain period before its scheduled removal, a suture strength equivalent or stronger than the 5-0 nylon suture should be considered for stent fixation.

  14. Therapeutic efficacy and stent patency of transhepatic portal vein stenting after surgery

    PubMed Central

    Jeon, Ung Bae; Kim, Chang Won; Kim, Tae Un; Choo, Ki Seok; Jang, Joo Yeon; Nam, Kyung Jin; Chu, Chong Woo; Ryu, Je Ho

    2016-01-01

    AIM To evaluate portal vein (PV) stenosis and stent patency after hepatobiliary and pancreatic surgery, using abdominal computed tomography (CT). METHODS Percutaneous portal venous stenting was attempted in 22 patients with significant PV stenosis (> 50%) - after hepatobiliary or pancreatic surgery - diagnosed by abdominal CT. Stents were placed in various stenotic lesions after percutaneous transhepatic portography. Pressure gradient across the stenotic segment was measured in 14 patients. Stents were placed when the pressure gradient across the stenotic segment was > 5 mmHg or PV stenosis was > 50%, as observed on transhepatic portography. Patients underwent follow-up abdominal CT and technical and clinical success, complications, and stent patency were evaluated. RESULTS Stent placement was successful in 21 patients (technical success rate: 95.5%). Stents were positioned through the main PV and superior mesenteric vein (n = 13), main PV (n = 2), right and main PV (n = 1), left and main PV (n = 4), or main PV and splenic vein (n = 1). Patients showed no complications after stent placement. The time between procedure and final follow-up CT was 41-761 d (mean: 374.5 d). Twenty stents remained patent during the entire follow-up. Stent obstruction - caused by invasion of the PV stent by a recurrent tumor - was observed in 1 patient in a follow-up CT performed after 155 d after the procedure. The cumulative stent patency rate was 95.7%. Small in-stent low-density areas were found in 11 (55%) patients; however, during successive follow-up CT, the extent of these areas had decreased. CONCLUSION Percutaneous transhepatic stent placement can be safe and effective in cases of PV stenosis after hepatobiliary and pancreatic surgery. Stents show excellent patency in follow-up abdominal CT, despite development of small in-stent low-density areas. PMID:27956806

  15. Novel side branch ostial stent.

    PubMed

    Chen, Shao-Liang; Lv, Shu-Zheng; Kwan, Tak W

    2009-04-01

    Bifurcation lesions are technically challenging and plagued by a high incidence of restenosis, especially at the side branch orifice, which results in a more frequent need for revascularization during the follow-up period. This report discusses two clinical experiences with a novel side branch ostial stent, the BIGUARD stent, designed for the treatment of bifurcation lesions; procedural success with no in-hospital complications was observed in types IVb and Ia lesions.

  16. Expandable stents: unique devices and clinical uses.

    PubMed

    Ross, Andrew S; Kozarek, Richard A

    2011-07-01

    The use of stents throughout the gastrointestinal tract has evolved over the past century. The evolution of endoscopic ultrasound and significant improvements in stent design are key factors that have allowed endoscopists to drive the use of stents in gastroenterology into new directions. Endoscopic creativity remains crucial in the evolution of any new endoscopic technology. Finally, the use of multidisciplinary teams, including endoscopists, radiologists, and surgeons, allows for the exchange of ideas and procedural planning necessary for successful innovation.

  17. Predictive Factors of In-Stent Restenosis in Renal Artery Stenting: A Retrospective Analysis

    SciTech Connect

    Vignali, Claudio Bargellini, Irene; Lazzereschi, Michele; Cioni, Roberto; Petruzzi, Pasquale; Caramella, Davide; Pinto, Stefania; Napoli, Vinicio; Zampa, Virna; Bartolozzi, Carlo

    2005-04-15

    Purpose. To retrospectively evaluate the role of clinical and procedural factors in predicting in-stent restenosis in patients with renovascular disease treated by renal artery stenting. Methods. From 1995 to 2002, 147 patients underwent renal artery stenting for the treatment of significant ostial atherosclerotic stenosis. Patients underwent strict clinical and color-coded duplex ultrasound follow-up. Ninety-nine patients (111 stents), with over 6 months of continuous follow-up (mean 22{+-}12 months, range 6-60 months), were selected and classified according to the presence (group A, 30 patients, 32 lesions) or absence (group B, 69 patients, 79 lesions) of significant in-stent restenosis. A statistical analysis was performed to identify possible preprocedural and procedural predictors of restenosis considering the following data: sex, age, smoking habit, diabetes mellitus, hypertension, serum creatinine, cholesterol and triglyceride levels, renal artery stenosis grade, and stent type, length and diameter. Results. Comparing group A and B patients ({chi}{sup 2} test), a statistically significant relation was demonstrated between stent diameter and length and restenosis: the risk of in-stent restenosis decreased when the stent was {>=}6 mm in diameter and between 15 and 20 mm in length. This finding was confirmed by multiple logistic regression analysis. Stent diameter and length were proved to be significantly related to in-stent restenosis also when evaluating only patients treated by Palmaz stent (71 stents). Conclusion. Although it is based on a retrospective analysis, the present study confirms the importance of correct stent selection in increasing long-term patency, using stents of at least 6 mm in diameter and with a length of approximately 15-20 mm.

  18. Emerging Stent and Balloon Technologies in the Femoropopliteal Arteries

    PubMed Central

    Pastromas, Georgios; Katsanos, Konstantinos; Krokidis, Miltiadis; Karnabatidis, Dimitrios

    2014-01-01

    Endovascular procedures for the management of the superficial femoral (SFA) and popliteal artery disease are increasingly common. Over the past decade, several stent technologies have been established which may offer new options for improved clinical outcomes. This paper reviews the current evidence for SFA and popliteal artery angioplasty and stenting, with a focus on randomized trials and registries of nitinol self-expanding stents, drug-eluting stents, dug-coated balloons, and covered stent-grafts. We also highlight the limitations of the currently available data and the future routes in peripheral arterial disease (PAD) stent and balloon technology. PMID:24672355

  19. Subintimal Double-Barrel Restenting of an Occluded Primary Stented Superficial Femoral Artery

    SciTech Connect

    Duterloo, Dirk Lohle, Paul N.M.; Lampmann, Leo E.H.

    2007-06-15

    In-stent re-stenosis is a frequent complication of endovascular stents, especially in the superficial femoral artery (SFA). Endovascular re-intervention of in- or peri-stent occlusive disease consists of recanilization through the occluded stent. In our case report, we describe the endovascular treatment of a previously placed stent in the SFA. We unintentionally passed the affected stent subintimally, in a double barrel fashion next to the first stent. The procedure was without any complications and with a successful angiographic result. At one year follow-up the patient still has no complaints and the stent is still patent.

  20. Subintimal Double-Barrel Restenting of an Occluded Primary Stented Superficial Femoral Artery

    PubMed Central

    Lohle, Paul N.M.; Lampmann, Leo E.H.

    2007-01-01

    In-stent re-stenosis is a frequent complication of endovascular stents, especially in the superficial femoral artery (SFA). Endovascular re-intervention of in- or peri-stent occlusive disease consists of recanilization through the occluded stent. In our case report, we describe the endovascular treatment of a previously placed stent in the SFA. We unintentionally passed the affected stent subintimally, in a double barrel fashion next to the first stent. The procedure was without any complications and with a successfull angiographic result. At one year follow-up the patient still has no complaints and the stent is still patent. PMID:17410397

  1. Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

    SciTech Connect

    D'Ercole, Loredana; Quaretti, Pietro; Cionfoli, Nicola; Klersy, Catherine; Bocchiola, Milena; Rodolico, Giuseppe; Azzaretti, Andrea; Lisciandro, Francesco; Cascella, Tommaso; Zappoli Thyrion, Federico

    2013-04-15

    To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity. MESD were evaluated with radiochromic films in 31 patients (mean age 72 {+-} 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 {+-} 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included. MESD values (mean 0.96 {+-} 0.42 Gy) were <2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (N{sub FR}) were 269 Gy cm{sup 2}, 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1-102.7, p < 0.05) and N{sub FR} overexposures (OR 10.8, 95 % CI 1.1-109.5, p < 0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1-0.9, p = 0.042), and stenosis {>=} 90 % increased the risk of N{sub FR} overexposure (OR 2.8, 95 % CI 1.1-7.4, p = 0.040). At multivariable analysis, stenosis {>=} 90 % (OR 2.8, 95 % CI 1.1-7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1-109.5, p = 0.027) were associated with overexposure for two or more parameters. Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

  2. Economic evaluation of sirolimus-eluting stents

    PubMed Central

    Shrive, Fiona M.; Manns, Braden J.; Galbraith, P. Diane; Knudtson, Merril L.; Ghali, William A.

    2005-01-01

    Background Sirolimus-eluting stents have recently been shown to reduce the risk of restenosis among patients who undergo percutaneous coronary intervention (PCI). Given that sirolimus-eluting stents cost about 4 times as much as conventional stents, and considering the volume of PCI procedures, the decision to use sirolimus-eluting stents has large economic implications. Methods We performed an economic evaluation comparing treatment with sirolimus-eluting and conventional stents in patients undergoing PCI and in subgroups based on age and diabetes mellitus status. The probabilities of transition between clinical states and estimates of resource use and health-related quality of life were derived from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Information on effectiveness was based on a meta-analysis of randomized controlled clinical trials (RCTs) comparing sirolimus-eluting and conventional stents. Results Cost per quality-adjusted life year (QALY) gained in the baseline analysis was Can$58 721. Sirolimus-eluting stents were more cost-effective in patients with diabetes and in those over 75 years of age, the costs per QALY gained being $44 135 and $40 129, respectively. The results were sensitive to plausible variations in the cost of stents, the estimate of the effectiveness of sirolimus-eluting stents and the assumption that sirolimus-eluting stents would prevent the need for cardiac catheterizations in the subsequent year when no revascularization procedure was performed to treat restenosis. Interpretation The use of sirolimus-eluting stents is associated with a cost per QALY that is similar to or higher than that of other accepted medical forms of therapy and is associated with a significant incremental cost. Sirolimus-eluting stents are more economically attractive for patients who are at higher risk of restenosis or at a high risk of death if a second revascularization procedure were to be required

  3. Preprocedural planning for endovascular stent-graft placement.

    PubMed

    Kicska, Gregory; Litt, Harold

    2009-03-01

    Endovascular stent grafts have become a viable treatment for aortic thoracic and abdominal aneurysms in both elective and emergent situations. Computed tomographic (CT) angiography is the primary tool for determining eligibility for this procedure. This article discuses the preprocedural evaluation of an endovascular stent candidate. Evaluation begins with identification of the aneurysm pathology and its relationship to treatment efficacy. The radiologist must evaluate the aneurysm geometry for compatibility with stent hardware. Aneurysm features that suggest a contraindication must be recognized. Procedures that involve a combination of endovascular stenting and surgical revascularization are discussed so that the reader understands the limits of stent eligibility. Vascular access for stent placement must also be evaluated for the ability to accommodate stent delivery. The radiologist also must be familiar with CT imaging protocols and alternative methods of imaging that can evaluate stent feasibility. The utility of three-dimensional processing is discussed.

  4. Spontaneous Subcapsular Renal Hematoma: Strange Case in an Anticoagulated Patient with HWMH after Aortic and Iliac Endovascular Stenting Procedure

    PubMed Central

    Greco, Michele; Benedetto, Filippo; Spinelli, Francesco; Traxer, Olivier; Tefik, Tzevat; Pappalardo, Rosa

    2016-01-01

    Spontaneous subcapsular renal hematoma is a rare condition in clinical practice. It is caused by renal cysts, benign and malignant renal tumors, vascular lesions, and antiplatelet or anticoagulant therapy. In this paper we report an unusual case of rupture of a renal cyst of a 66-year-old male patient during an aortic and iliac endovascular procedure for a massive calcified atheroma above the iliac bifurcation. We suspected that the bolus of high weight molecular heparin given during the procedure caused the rupture of the cyst. According to the literature, this is the first case of renal cyst rupture during an endovascular aortic procedure after administering a high weight molecular heparin bolus. PMID:27579210

  5. Treatment of Vertebro-Basilar Dissecting Aneurysms Using Intravascular Stents

    PubMed Central

    Yamasaki, S.; Hashimoto, K.; Kawano, Y.; Yoshimura, M.; Yamamoto, T.; Hara, M.

    2006-01-01

    Summary Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections. In this report, three patterns of stent application are described and their method of selection is discussed. PMID:20569619

  6. Review of stents for the carotid artery.

    PubMed

    Bosiers, M; Deloose, K; Verbist, J; Peeters, P

    2006-04-01

    The individual characteristics of a stent may make it an attractive choice in some circumstances, but render it a less desirable option in others. The applicability depends primarily on the arterial anatomy and the specific details of the lesion being treated. A careful assessment by the interventionalist is required to select the proper type of stent that is of appropriate size. Certainly, personal preferences and familiarity with a specific device may legitimately influence the decision to choose one stent over another. Finally, stent design can play a role in the selection procedure. Although carotid stents are often functionally equivalent in the clinical setting and have been used successfully to treat a wide variety of lesions, a basic knowledge of stent geometry can contribute to make up your mind in certain carotid cases.

  7. Stenting of the Upper Gastrointestinal Tract: Current Status

    SciTech Connect

    Katsanos, Konstantinos; Sabharwal, Tarun Adam, Andreas

    2010-08-15

    Minimally invasive image-guided insertion of self-expanding metal stents in the upper gastrointestinal tract is the current treatment of choice for palliation of malignant esophageal or gastroduodenal outlet obstructions. A concise review is presented of contemporary stenting practice of the upper gastrointestinal tract, and the procedures in terms of appropriate patient evaluation, indications, and contraindications for treatment are analyzed, along with available stent designs, procedural steps, clinical outcomes, inadvertent complications, and future technology. Latest developments include biodegradable polymeric stents for benign disease and radioactive or drug-eluting stents for malignant obstructions.

  8. Clinical outcomes of compromised side branch (stent jail) after coronary stenting with the NIR stent.

    PubMed

    Bhargava, B; Waksman, R; Lansky, A J; Kornowski, R; Mehran, R; Leon, M B

    2001-11-01

    Acute side-branch (SB) compromise or occlusion stent jail after native coronary stenting is a matter of concern. Attempts at maintaining SB patency can be a technical challenge. The purpose of this study was to determine the clinical impact of SB compromise or occlusion in patients undergoing stenting of parent vessel lesions. We evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction, and repeat revascularization rates at 6 months) in 318 consecutive patients undergoing NIR stent implantation across an SB. Based on independent angiographic analysis, 218 (68.6%) patients had no poststent SB compromise, 85 (26.7%) patients had narrowed SB (> 70% narrowing, without total occlusion), and 15 (4.7%) patients had an occluded SB after stent implantation. The baseline patient and lesion characteristics were similar between the groups. Procedural success was 100%. Patients with SB occlusion had a higher stents/lesion ratio (P < 0.006). Side-branch occlusion was associated with higher in-hospital ischemic complications (Q-wave myocardial infarction, 7%; non-Q-wave myocardial infarction, 20%; P < 0.05) compared to patients with SB compromise or normal SB. At 6-month follow-up, there was a trend for more myocardial infarctions in the group with SB occlusion during the index procedure (Q-wave myocardial infarction, 7% vs. 1% in the narrowed and 0% in normal SB; P = 0.09). However, late target lesion revascularization and mortality were similar in the three groups (P = 0.91). SB occlusion after parent vessel stenting is associated with more frequent in-hospital Q-wave and non-Q-wave myocardial infarctions. However, with the NIR stent, side-branch compromise or occlusion does not influence late (6 month) major adverse events, including death, myocardial infarction, or need for repeat revascularization.

  9. Percutaneous Stent-Graft Repair of Anastomotic Pseudoaneurysms following Vascular Bypass Procedures: A Report of Two Cases

    PubMed Central

    Rundback, John; Haug, James; Herman, Kevin; Manno, Joseph; Cerda, Martin

    2013-01-01

    Anastomotic pseudoaneurysms are common entities following vascular bypass procedures and, if left untreated, serious complications such as thromboses, infection, and rupture can frequently occur. Therefore, attempts to employ various methods of repair have been utilized in treating anastomotic pseudoaneurysms to maximize operational success and future risk reduction. Herein, the authors report two cases of anastomotic pseudoaneurysms which were repaired percutaneously utilizing a combination of strategies such as careful preoperational image planning, multiple commercially available devices, and secondary embolization techniques. PMID:23365781

  10. Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes.

    PubMed

    Parthipun, Aneeta; Diamantopoulos, Athanasios; Kitrou, Panagiotis; Padayachee, Soundrie; Karunanithy, Narayan; Ahmed, Irfan; Zayed, Hany; Katsanos, Konstantinos

    2015-08-01

    To report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery. This was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford-Becker stage 3-6; P1-P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan-Meier (K-M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes. From August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford-Becker stage was five at baseline and 37/50 (74.0%) were chronic total occlusions. Technical success was achieved in all cases (100%). Stented lesion length was 114.2 ± 36.9 mm (range 6-20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2% with an 86.1 ± 5.9% freedom from TLR and 87 ± 5.0% AFS (K-M estimates). The TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery.

  11. In Stent Restenosis Predictors after Carotid Artery Stenting

    PubMed Central

    Cosottini, Mirco; Michelassi, Maria Chiara; Bencivelli, Walter; Lazzarotti, Guido; Picchietti, Silvia; Orlandi, Giovanni; Parenti, Giuliano; Puglioli, Michele

    2010-01-01

    Purpose. The long-term efficacy of carotid artery stenting is debated. Predictors of stent restenosis are not fully investigated. Our aim was to assess the incidence of long term restenosis after CAS and to identify some predictors of restenosis. Methods. We retrospectively selected 189 treated patients and we obtained the survival Kaplan-Meier curves for overall survival, for freedom from stroke or death and from restenosis. To correlate clinical, radiological, and procedural variables to stent restenosis, an univariate analysis was performed while to determine independent predictors of restenosis, a multivariate analysis was applied. Results. At 1, 3, and 5 years, the cumulative overall survival rate was 98%, 94%, and 92% with a cumulative primary patency rate of 87%, 82.5%, and 82.5%. The percentage residual stenosis after CAS and multiple stents deployment were independent predictors of restenosis, while diabetes and tumors are suggestive but not significant predictors of restenosis. Conclusions. In our CAS experience, encouraging long-term results seem to derive from both neurological event free rate and restenosis incidence. Adequate recanalization of the treated vessel is important to limit the development of stent restenosis. Multiple stents deployment, and with less evidence, diabetes, or neoplasms has to be considered to facilitate restenosis. PMID:20798894

  12. A review of the iStent® trabecular micro-bypass stent: safety and efficacy

    PubMed Central

    Wellik, Sarah R; Dale, Elizabeth A

    2015-01-01

    There is a significant demand for procedures that can effectively treat glaucoma with low risk and good visual outcomes. To fill this void, procedures termed “minimally invasive glaucoma surgery”, are gaining in popularity. This review will focus on the safety and efficacy of one such minimally invasive glaucoma surgery procedure, the trabecular micro-bypass stent. This stent is intended to lower intraocular pressure by directly cannulating Schlemm’s canal and thereby enhancing aqueous outflow. Recent randomized controlled trials and case series have demonstrated the micro-bypass stent to be a relatively safe procedure, with limited complications and no serious adverse sequelae. The most common complication across all studies was stent obstruction or malposition, which generally did not result in any adverse outcome in vision or pressure control. In addition, increased rates of hypotony, choroidal hemorrhage, or infection were not seen with the micro-bypass stent in comparison to cataract surgery alone. PMID:25931808

  13. Drug-eluting versus bare-metal coronary stents: where are we now?

    PubMed

    Amoroso, Nicholas S; Bangalore, Sripal

    2012-11-01

    Drug-eluting stents have dramatically reduced the risk of restenosis, but concerns of an increased risk of stent thrombosis have provided uncertainty about their use. Recent studies have continued to show improved procedural and clinical outcomes with drug-eluting stents both in the setting of acute coronary syndromes and stable coronary artery disease. Newer generation drug-eluting stents (especially everolimus-eluting stents) have been shown to be not only efficacious but also safe with reduced risk of stent thrombosis when compared with bare-metal stents, potentially changing the benchmark for stent safety from bare-metal stents to everolimus-eluting stents. While much progress is being made in the development of bioabsorbable polymer stents, nonpolymer stents and bioabsorbable stent technology, it remains to be seen whether these stents will have superior safety and efficacy outcomes compared with the already much improved rates of revascularization and stent thrombosis seen with newer generation stents (everolimus-eluting stents and resolute zotarolimus-eluting stents).

  14. Stent edge dissection: depth of injury and adverse outcome.

    PubMed

    Goldstein, James A

    2015-08-01

    Deep stent edge dissection by OCT predicts adverse outcome. STEMI culprit lesions are most susceptible to edge dissection. Procedural performance influences edge dissection. © 2015 Wiley Periodicals, Inc.

  15. Angioplasty and Vascular Stenting

    MedlinePlus

    ... Drug-coated (also called drug-eluting) stents have recently been approved for clinical use by the U.S. ... you notify the MRI department that you have recently had a stent. Although stents used today may ...

  16. Trimming a Metallic Biliary Stent Using an Argon Plasma Coagulator

    SciTech Connect

    Rerknimitr, Rungsun Naprasert, Pisit; Kongkam, Pradermchai; Kullavanijaya, Pinit

    2007-06-15

    Background. Distal migration is one of the common complications after insertion of a covered metallic stent. Stent repositioning or removal is not always possible in every patient. Therefore, trimming using an argon plasma coagulator (APC) may be a good alternative method to solve this problem. Methods. Metallic stent trimming by APC was performed in 2 patients with biliary Wallstent migration and in another patient with esophageal Ultraflex stent migration. The power setting was 60-100 watts with an argon flow of 0.8 l/min. Observations. The procedure was successfully performed and all distal parts of the stents were removed. No significant collateral damage to the nearby mucosa was observed. Conclusions. In a patient with a distally migrated metallic stent, trimming of the stent is possible by means of an APC. This new method may be applicable to other sites of metallic stent migration.

  17. A Comparison of Peri-Procedural Myocardial Infarction between Paclitaxel-Coated Balloon and Drug-Eluting Stent on De Novo Coronary Lesions

    PubMed Central

    Her, Ae-Young; Cho, Kyoung-Im; Singh, Gillian Balbir; Garg, Scot; Kim, Yong Hoon; Koo, Bon-Kwon

    2017-01-01

    Purpose This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients. Materials and Methods In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours after percutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT). Results One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidence interval: 3.44–533.87, p=0.004). Conclusion Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES. PMID:27873501

  18. Nitinol Esophageal Stents: New Designs and Clinical Indications

    SciTech Connect

    Strecker, Ernst-Peter; Boos, Irene; Vetter, Sylvia; Strohm, Michael; Domschke, Sigurd

    1996-11-15

    Purpose: To evaluate the clinical use of covered and noncovered, knitted nitinol stents in patients presenting new stent indications. Methods: Self-expandable, knitted nitinol stents were implanted in four patients for treatment of dysphagia. In two patients who had malignant strictures and had esophago-respiratory fistulae and in one patient with an esophagocutaneous fistula, polytetrafluoroethylene (PTFE)-covered stents were implanted. One patient received a noncovered stent, but a retrograde approach through a percutaneous endoscopic gastrostomy (PEG) fistula had to be chosen for recanalization of an esophageal occlusion. Two patients received stents for treatment of benign strictures. Results: Recanalization of the stricture and stent implantation were performed under fluoroscopic control without any procedure-related morbidity or mortality. Dysphagia improved in all patients and the esophageal fistulae could be sealed off by covered stents. During a maximum follow-up of 18 months, there was no stent migration or esophageal perforation. Complications observed were stent stenosis due to food impaction (1/4) and benign stent stenosis (2/2). Most complications could be treated by the interventional radiologist. Conclusion: Self-expandable, covered Nitinol stents provide an option for the treatment of dysphagia combined with esophageal fistulae. In combination with interventional radiology techniques, even complex strictures are accessible. For benign strictures, the value of stent treatment has not yet been proven.

  19. Novel biodegradable polydioxanone stents in a rabbit airway model.

    PubMed

    Novotny, Ladislav; Crha, Michal; Rauser, Petr; Hep, Ales; Misik, Jan; Necas, Alois; Vondrys, David

    2012-02-01

    This study was undertaken to evaluate safety and biocompatibility of a novel biodegradable polydioxanone stent in a rabbit tracheal model. Metallic and silicone stents represent standard therapeutic approaches for hollow organ stenosis, although complications have been reported repeatedly. Biodegradable stents could reduce the risks associated with this procedure while still achieving the purpose of maintaining lumen patency. A commercially available polydioxanone suture strand with a long safety record was used to manufacture the self-expanding stents. The polydioxanone stents were then implanted bronchoscopically and under fluoroscopic guidance into the tracheas of white rabbits (N = 25). Periodic clinical examination was performed. Histopathologic examination concluded the study for the 5 experimental groups at 3, 4, 5, 10, and 15 weeks after implantation. There were no unexpected deaths and no stent displacements during the study. The animals remained in good condition, without stent debris expectoration. Macroscopic examination revealed that the tracheal lumen stayed open. Histologic examination showed that tracheal damage score was highest 5 weeks after stenting, including in-stent necrosis of the epithelium. Stent degradation was complete with no remnants after 10 weeks, leaving the trachea completely healed at 15 weeks after implantation. This animal airway model has demonstrated acceptable safety and biocompatibility of this novel biodegradable polydioxanone stent. We suggest that polydioxanone stenting be used for further clinical studies for cases in which complete stent degradation after temporary airway treatment is desirable. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  20. Endotracheal nitinol stents: lessons from the learning curve.

    PubMed

    Siegel, Bianca; Bent, John P; Ward, Robert F

    2013-04-01

    To reflect on lessons learned placing endotracheal nitinol stents in children. Case series with chart review. Tertiary care children's hospital. All children who underwent nitinol cervical tracheal stenting were included. Records were carefully reviewed for intraoperative and postoperative complications, management choices, outcomes, and factors that influenced results. Between 1999 and 2011, 7 children underwent 13 stent placements. Median follow-up was 5 years (range, 1-12 years). Six patients underwent stenting as a salvage procedure following open attempts at airway reconstruction. Four patients remain decannulated with their stent in place (median follow-up 7 years). The fifth patient had his stent removed endoscopically after 50 days because it became apparent that his obstruction was primarily laryngeal. The sixth child had his stent removed via a tracheal fissure after 14 months because of recalcitrant subglottic inflammation at the superior stent border. The seventh patient was decannulated for over 2 years but ultimately required tracheotomy replacement because of stenosis with the stent lumen. Complications included stent migration (23%), restenosis (29%), edema (29%), and granulation (57%). Endotracheal nitinol stents provide a realistic opportunity for decannulation in children for whom other options have failed but should be reserved only as a salvage procedure in severely complicated airways. Our experience has taught valuable lessons about stent indications, sizing, characteristics, and deployment, as well as means to avoid and manage their complications.

  1. Long-term follow-up of stent implantation versus stent-like angioplasty in unstable angina.

    PubMed

    Marzocchi, A; Ortolani, P; Piovaccari, G; Marrozzini, C; Palmerini, T; Marinucci, L; Saia, F; Bacchi-Reggiani, M L; Branzi, A; Magnani, B

    1999-03-01

    Stent-like plain old balloon angioplasty (POBA, < or = 30% residual diameter stenosis) in patients with stable angina resulted in a clinical and angiographic long-term outcome equivalent to stenting. In unstable angina POBA showed lower acute and long-term efficacy than in the stable setting. Data comparing stent-like POBA and coronary stenting in unstable angina are lacking in the literature. The aim of this retrospective single-center study was to compare the long-term effectiveness of stent-like POBA and coronary stenting in unstable angina. From January 1996 to December 1996 we retrospectively examined 187 consecutive patients with unstable angina who underwent coronary angioplasty on a native vessel: 135 had coronary stenting in addition to POBA and 50 achieved a stent-like result with POBA. Two patients, with major contraindication to coronary stenting, who did not reach a stent-like angiographic result, were also treated with only POBA but were excluded from the study. Stent implantation indications were: elective (54 stents, 30%), suboptimal angiographic result (104 stents, 58%), and bail-out situation (21 stents, 12%). Stent implantation showed high angiographic (98.5%) and clinical (95.5%) success. Stent thrombosis occurred only in 2 patients (1.5%). At quantitative coronary angiography the stent group showed a higher post-procedure minimal lumen diameter (2.74 +/- 1.25 vs 2.27 +/- 0.58 mm, p = 0.025), acute gain (1.95 +/- 1.28 vs 1.43 +/- 0.57 mm, p = 0.007) and lower residual stenosis diameter (13.89 +/- 7.43 vs 20.4 +/- 7.28%, p = 0.001) than the stent-like POBA group. At 1-year follow-up the stent group showed a higher event-free survival rate (77.9 vs 64.6%, p = 0.009) mainly due to lower recurrence of angina and repetition of percutaneous procedures. Stent-like POBA procedure and baseline lesion length > or = 10 mm proved to be the only independent predictors of long-term ischemic event occurrence. In conclusion, in unstable angina, stent

  2. Gastroesophageal stenting for the management of post sleeve gastrectomy leak

    PubMed Central

    Guzaiz, Noha; Arabi, Mohammad; Khankan, Azzam; Salman, Refaat; Al-Toki, Mohammed; Qazi, Shahbaz; Alzakari, Abdulmohsin; Al-Moaiqel, Mohammad

    2016-01-01

    Objectives To retrospectively evaluate the effectiveness of gastroesophageal stenting for post sleeve gastrectomy staple line leaks using removable self-expandable stents. Methods Between April 2012 and June 2015, 12 consecutive patients (6 males) with mean age of 34 years: (21-38 years) presented with staple line leak 1-8 weeks after the operation (mean 2.8 weeks). Patients underwent gastroesophageal stenting by interventional radiology. A total of 23 stents were deployed with mean length of 17.8 cm (7-24 cm) and mean diameter 25.6 mm (18-36 mm). Stent re-insertion was needed in 7 patients (9 procedure), while 6 patients required percutaneous collection drainage and 3 patients required endoscopic glue injection with clipping. Two stent removal procedures were carried out under endoscopic visualization after failed stent capture under fluoroscopy, while the remaining stents were successfully removed by interventional radiology. Results Stent placement was technically successful in all patients. Stent migration occurred in 6 patients (50%). There is a tendency for stent migration with shorter stent length (R= -0.557, p=0.008). The mean duration of stenting was 60.5 days (14-137 days). All patients underwent stent removal and resumed oral intake with no recurrence of leak at a mean follow up time of 190 days (14-410 days). Complications included gastrointestinal bleeding (n=1), proximal esophageal stricture (n=1) and stent occlusion (n=1). Conclusion Gastroesophageal stenting as a primary measure after diagnosis of early post sleeve gastrectomy leak appears to offer a safe and effective alternative option in obviating repeat surgical interventions. Minimally invasive interventions may still be required for the management of persistent leak. PMID:27874149

  3. Stenting precision: "Image small, miss small".

    PubMed

    Goldstein, James A

    2016-09-01

    Stenting by angiography alone predisposes to geographic miss STEMI culprit lesions are most susceptible to Geographic Miss Direct coronary imaging assures procedural precision and perfection. © 2016 Wiley Periodicals, Inc.

  4. Evaluation of Polyurethane Nasolacrimal Duct Stents: In Vivo Studies in New Zealand Rabbits

    SciTech Connect

    Wilhelm, K.E. Grabolle, B.; Urbach, H.; Tolba, R.; Schild, H.; Paulsen, F.

    2006-10-15

    The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.

  5. Acute appendicitis due to appendiceal obstruction from a migrated biliary stent.

    PubMed

    Tzovaras, George; Liakou, Paraskevi; Makryiannis, Evaghelos; Paroutoglou, George

    2007-01-01

    Endoscopic plastic biliary stenting is a common procedure in the management of benign biliary pathology. Complications from biliary stenting are rare, with stent occlusion being the most common. Another late complication of long-term biliary stenting is stent migration, which occasionally can result in bowel perforation and obstruction. We report an extremely unusual complication of acute appendicitis due to appendiceal orifice obstruction from a migrated biliary stent. The condition was suspected from the history in association with the radiological findings and was successfully treated nonoperatively with endoscopic stent removal.

  6. Braided thin-walled biodegradable ureteral stent: preliminary evaluation in a canine model.

    PubMed

    Zhang, Ming Qing; Zou, Ting; Huang, Yi Chen; Shang, Ya Feng; Yang, Gang Gang; Wang, Wen Zu; Zhou, Jun Mei; Wang, Lu; Chen, Fang; Xie, Hua

    2014-04-01

    To evaluate a novel designed degradable ureteral stent. A total of 24 male Beagles, each with bilateral stents implanted (a biodegradable ureteral 4.5-Fr stent and a standard 4-Fr biostable stent) were divided into four groups. Intravenous pyelography, B-mode ultrasonography, and blood and urine tests were carried out before the procedure (0 weeks), and at 1-, 2-, 3- and 4-week intervals. Meanwhile, the mechanical characteristics of stents were tested, and scanning electron microscopy images of the biodegradable braided stents were obtained at different time-points postoperatively. In addition, histopathological changes were compared between the two different stents. All biodegradable braided stents began degrading at 1 week, and had completely degraded by 4 weeks. Hydronephrosis was equivalent during the first 2 weeks, but less with the biodegradable stents than with the control biostable stents at 3 and 4 weeks. Preoperative and postoperative blood and urine results were similar. The mechanical properties of the biodegradable stents were better than conventional biostable stents. Scanning electron microscopy images obtained at different weekly intervals showed that stents degraded in a predictable fashion. Histological testing of the urinary tract showed that the stent-related tissue reactivity of the two different stents were similar. Our novel braided thin-walled biodegradable stents provide temporary renal drainage as good as commercially available biostable stents. They also have good biocompatibility and physical characteristics. Therefore, they might have clinical application. © 2013 The Japanese Urological Association.

  7. Transcatheter treatment of IVC channel obstruction and baffle leak after Mustard procedure for d-transposition of the great arteries using Amplatzer ASD device and multiple stents.

    PubMed

    Schneider, D J; Moore, J W

    2001-04-01

    A patient with d-transposition of the great arteries who underwent the Mustard operation at one year of age developed intermittent symptomatic cyanosis as a young adult. Evaluation demonstrated a large baffle leak with bidirectional flow and stenosis of the intra-atrial IVC baffle channel. Initially, a single stent was placed to relieve the obstruction, followed by placement of an Amplatzer septal occluder device which assumed suboptimal position after release. Placement of additional stents securely repositioned the ASD device into excellent position, resulting in complete occlusion of the baffle leak and no residual obstruction in the IVC channel.

  8. Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes

    SciTech Connect

    Parthipun, Aneeta; Diamantopoulos, Athanasios; Kitrou, Panagiotis; Padayachee, Soundrie; Karunanithy, Narayan; Ahmed, Irfan; Zayed, Hany; Katsanos, Konstantinos E-mail: katsanos@med.upatras.gr

    2015-08-15

    PurposeTo report the immediate and mid-term clinical and anatomical outcomes of a novel, hybrid, heparin-bonded, nitinol ring stent (TIGRIS; Gore Medical) when used for the treatment of lesions located in the popliteal artery.Materials and MethodsThis was a prospective single-centre registry. Patients eligible for inclusion were individuals suffering from symptomatic popliteal arterial occlusive disease (Rutherford–Becker stage 3–6; P1–P3 segments) and treated with placement of the TIGRIS stent(s). Patients were prospectively scheduled for clinical review and duplex ultrasound follow-up after 6 and 12 months. Outcome measures included immediate technical success, primary vessel patency, in-stent binary restenosis (evaluable by Duplex at 50 % threshold; PSVR > 2.0), freedom from target lesion revascularization (TLR) and amputation-free survival (AFS) estimated by Kaplan–Meier (K–M) survival analysis. Cox proportional-hazards regression analysis was also performed to adjust for confounders and search for independent predictors of outcomes.ResultsFrom August 2012 to March 2014, a total of 54 popliteal TIGRIS stents were implanted in 50 limbs of 48 patients (27 men and 21 women; mean age 76.0 ± 1.7 years). Median Rutherford–Becker stage was five at baseline and 37/50 (74.0 %) were chronic total occlusions. Technical success was achieved in all cases (100 %). Stented lesion length was 114.2 ± 36.9 mm (range 6–20 cm). Median follow-up was 11.8 ± 0.8 months. After 12 months, primary patency of the TIGRIS stent was 69.5 ± 10.2 % with an 86.1 ± 5.9 % freedom from TLR and 87 ± 5.0 % AFS (K–M estimates).ConclusionThe TIGRIS hybrid heparin-bonded nitinol ring stent is a safe and effective endovascular option for complex occlusive disease of the popliteal artery.

  9. The burden of chronic ureteral stenting in cervical cancer survivors

    PubMed Central

    Fan, Yunhua; Jarosek, Stephanie; Elliott, Sean P.

    2017-01-01

    ABSTRACT Purpose Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). Materials and Methods From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The “no cancer” group was drawn from the 5% Medicare sample. Results 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. Conclusions The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate. PMID:27649113

  10. Carotid Artery Stenting versus Endarterectomy

    PubMed Central

    Gahremanpour, Amir; Perin, Emerson C.; Silva, Guilherme

    2012-01-01

    For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies. The results of clinical trials and, consequently, the meta-analyses of those trials produced conflicting results regarding the comparative effectiveness and safety of carotid endarterectomy and carotid stenting. These conflicting results arose because of differences in patient population, trial design, outcome measures, and variability among centers in the endovascular devices used and in operator skills. Careful appraisal of the trials and meta-analyses, particularly the most recent and largest National Institutes of Healthsponsored trial (the Carotid Revascularization Endarterectomy vs Stenting Trial [CREST]), showed that carotid stenting and endarterectomy were associated with similar rates of death and disabling stroke. Within the 30-day periprocedural period, carotid stenting was associated with higher risks of stroke, especially for patients aged >70 years, whereas carotid endarterectomy was associated with a higher risk of myocardial infarction. The slightly higher cost of stenting compared with endarterectomy was within an acceptable range by cost-effectiveness standards. We conclude that carotid artery stenting is an equivalent alternative to carotid endarterectomy when patient age and anatomy, surgical risk, and operator experience are considered in the choice of treatment approach. PMID:22949763

  11. Towards Individualized Tracheobronchial Stents: Technical, Practical and Legal Considerations.

    PubMed

    Freitag, Lutz; Gördes, Martin; Zarogoulidis, Paul; Darwiche, Kaid; Franzen, Daniel; Funke, Faustina; Hohenforst-Schmidt, Wolfgang; Dutau, Hervé

    2017-01-01

    Stent placement has been established as a standard procedure for treating airway obstructions. Other indications are localized malacias and fistulas. Though many different stents with various diameters and lengths are available, the shapes are hardly ever ideal because of the distorted anatomy in patients with diseased airways. There are technical and legal limitations for customizing purchased airway stents. Individually tailored stents would be preferable. New techniques of additive manufacturing such as 3D printing make it possible to produce optimized stents for a particular patient. Using CT data and bronchoscopic images, stents can be constructed that match a particular anatomical situation and apply the optimized expansion force. We give an overview of the currently available manufacturing techniques for polymeric stents and report about our own experience. Direct on-site printing of polyurethane stents in a hospital and printing individual extrusion molds for silicone stents in a certified cleanroom are both feasible. Furthermore, there are promising attempts of combining mechanically customized stents with surface modifications, drug-eluting features, biodegradability, and time-dependent adaptation (4D printing). Truly optimized airway stents with the potential of solving the well-known stent problems such as granulation tissue formation, remodeling, mucostasis, and infections are in reach. The technical hurdles are probably easier to overcome than the legal constraints. The legal situations are discussed from a physician's and a manufacturer's perspective. © 2017 S. Karger AG, Basel.

  12. Iliocaval Confluence Stenting for Chronic Venous Obstructions

    SciTech Connect

    Graaf, Rick de; Wolf, Mark de; Sailer, Anna M.; Laanen, Jorinde van Wittens, Cees; Jalaie, Houman

    2015-10-15

    PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.

  13. Forgotten biliary stents: ignorance is not bliss.

    PubMed

    Kumar, Saket; Chandra, Abhijit; Kulkarni, Rugved; Maurya, Ajeet Pratap; Gupta, Vishal

    2017-06-22

    Endoscopic biliary stenting is a common procedure in routine gastroenterology practice. Plastic stents are the most common type of stents used and are indicated mainly for short-term biliary drainage. Prolonged indwelling plastic stents can result in disastrous complications. We conducted a retrospective analysis of patients who presented with complications of forgotten biliary stents in a tertiary care hospital during January 2010 to October 2016. All patients were managed either by endoscopic or surgical means. Details of these patients were obtained from departmental patient database, endoscopy records, and surgical register. A total of 21 cases of retained biliary stents were managed in the study period and their outcome was analyzed. The median age was 47 years (range 17-70 years) and 17 (80.9%) patients were female. Primary indication of biliary stenting was stone disease in 76.2% (n = 16), while benign biliary stricture accounted for 19% of cases (n = 4). Mean duration at presentation to hospital after ERCP stenting was 3.53 years (range 1-14 years), with cholangitis being the most common presentation (66.67%). Definitive endoscopic treatment for forgotten stent and its associated complication was possible only in five patients (23.8%); in remaining 16 (76.2%) cases, surgical exploration was required. Despite life-threatening complications and major surgical interventions, no mortality was recorded. Instances of forgotten biliary stents presenting with serious complications are not uncommon in Indian setup. Patients either ignore advice for timely stent removal or are unaware of the presence of endoprosthesis or need for removal. Adequate patient counseling, information, and proper documentation are essential to avoid this condition.

  14. In vivo evaluation of the third generation biodegradable stent: a novel approach to avoiding the forgotten stent syndrome.

    PubMed

    Chew, Ben H; Paterson, Ryan F; Clinkscales, Kenneth W; Levine, Barry S; Shalaby, Shalaby W; Lange, Dirk

    2013-02-01

    Ureteral stents are prone to irritation, encrustation and infection, and they require additional procedures for removal. Furthermore, indwelling polymer stents are often forgotten with devastating consequences to the patient. We describe the degradation time, and physiological and histological responses elicited by a novel biodegradable ureteral stent in a porcine model. A total of 16 female Yorkshire pigs were used in the study. Ten biodegradable Uriprene™ stents and 6 biostable Polaris™ stents were cystoscopically inserted unilaterally in 2 groups of animals. Excretory urogram, and blood and urine tests were performed on different days until day 28. Biostable stents were removed on day 21. On day 28 all pigs underwent necropsy for microscopic and histological evaluation. Nine of the 10 biodegradable stents (90%) degraded completely by 4 weeks, while 1 pig had 3 fragments smaller than 1.5 cm in the bladder. Excretory urogram showed equivalent drainage and significantly less hydronephrosis in biodegradable stented kidneys. Blood and urine parameters were similar in the 2 groups. A transient increase in serum creatinine on day 7 in 40% of the pigs with a degradable stent resolved by day 10. There were significantly fewer abnormal histological findings in the degradable stent group. We evaluated drainage characteristics in an unobstructed ureter and results may not be representative of what develops in obstructed ureters. The third generation biodegradable stent is a safe, effective alternative to conventional polymer stents, resulting in equivalent drainage and less hydronephrosis. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. Influence of initial acute myocardial infarction presentation on the outcome of surgical procedures after coronary stent implantation: a report from the CREDO-Kyoto PCI/CABG Registry Cohort-2.

    PubMed

    Tokushige, Akihiro; Shiomi, Hiroki; Morimoto, Takeshi; Ono, Koh; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Iwabuchi, Masashi; Shizuta, Satoshi; Tada, Tomohisa; Tazaki, Junichi; Kato, Yoshihiro; Hayano, Mamoru; Abe, Mitsuru; Hamasaki, Shuichi; Tei, Chuwa; Nakashima, Hitoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Kimura, Takeshi

    2013-01-01

    Several previous publications have consistently reported that surgical procedures performed early after coronary stenting were associated with significantly higher risk for ischemic events than those performed late. In the current post hoc analysis of the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting Registry Cohort-2, we compared the outcomes of early (within 42 days) versus late surgery (beyond 42 days) after coronary stenting stratified by the initial clinical presentations [acute myocardial infarction (AMI) [early N = 153, and late N = 586] and non-AMI (early N = 202, and late N = 1457)]. Cumulative incidence of death/myocardial infarction/stent thrombosis at 30 days after surgery was significantly higher in the early group than in the late group in the AMI stratum [18.4 vs. 2.6 %, P < 0.0001, and adjusted HR 5.65 (95 % CI 2.42-13.5), P < 0.0001], but not in the non-AMI stratum [3.0 vs. 1.8 %, P = 0.3, and adjusted HR 1.52 (95 % CI 0.47-4.17), P = 0.5]. There was a significant interaction for the risk of ischemic events between the clinical presentation and the timing of surgery (P interaction = 0.03). Deaths in patients with early surgery in the AMI stratum were mostly related to preoperative complications of AMI (76 %), but not related to perioperative stent-related complications (4.0 %). In conclusion, significantly higher risk of early versus late surgery for perioperative ischemic events was seen only in patients with initial AMI presentation, but not in patients with non-AMI presentation. Previous observations suggesting higher risk in early surgery might not be related to the timing after stent implantation per se, but related to more morbid preoperative conditions in patients who underwent early surgery.

  16. A Case of Late Femoral Pseudoaneurysm Caused by Stent Disconnection

    SciTech Connect

    Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele Tozzi, Matteo; Carrafiello, Gianpaolo

    2010-10-15

    We present the case of a late superficial femoral artery stent disconnection causing an asymptomatic pseudoaneurysm successfully treated with a stent-graft. A 67-year-old female was referred to our department for evaluation of claudication of the left lower limb and was diagnosed to have a total occlusion of the superficial femoral artery. Three nitinol stents were used to revascularize this artery. At 48 months, duplex-ultrasonography control revealed the presence of a 45-mm saccular femoral dilatation; X-rays and CT angiography showed fractures of the proximal stents and the presence of a pseudoaneurysm at the site of the distal stents disconnection. The pseudoaneurysm was excluded using two stent-grafts. We conclude that patients and surgeons should be aware of structural complications with all stents. Rigorous follow-up controls should be mandatory. Endovascular repair proved to be feasible and durable to manage a previous endovascular procedure.

  17. Treatment of bifurcation in-stent restenotic lesions with beta radiation using strontium 90 and sequential positioning pullback technique: procedural details and clinical outcomes.

    PubMed

    Costa, Ricardo; Joyal, Michel; Harel, Francois; Fox, Tim; Crocker, Ian; Arsenault, Andre; Gregoire, Jean; Bonan, Raoul

    2003-08-01

    In-stent restenotic lesions have been problematic for many patients with the need for multiple repeat percutaneous coronary interventions (PCI). The need for repeat PCI has been significantly reduced in patients since the advent of vascular brachytherapy. In-stent restenosis resulting in bifurcation presents even more of a challenge. The use of radiation therapy for the treatment of this kind of lesion has not yet been reported. The purpose of this paper is to present five cases of radiation therapy in bifurcation in-stent restenotic lesions using the intraluminal beta radiation catheter delivery system (Beta-Cath System, Novoste Corporation, Norcross, Georgia). We reviewed the database of patients enrolled in our Compassionate Use Registry between August 1999 and April 2002. The data is reported for 5 patients who received radiation in both branches of bifurcation lesions with the Beta-Cath catheter system. The mean diameter of the vessels was 3.1 mm 0.5 mm. The dose administered was from 18.3 to 23 Gy, with an overlap of 3.3 to 10.3 mm; the hinge angle between the branches went from 43.3 to 65.4 . Angiographic follow-up was obtained at 6 months in 4 patients, with a single patient showing a focal (< 5 mm) edge lesion treated by balloon angioplasty (TVR no TLR). No aneurysms or zones of ectasia were noted. Beta radiation with the Beta-Cath catheter system appears to be safe, secure and clinically useful in in-stent restenotic bifurcation lesions.

  18. Carotid Artery Stenting Using a Novel Self-Expanding Braided Nickel-Titanium Stent: Feasibility and Safety Porcine Trial

    SciTech Connect

    Ahlhelm, Frank Kaufmann, Ralf; Ahlhelm, Dirk Ong, Mai Fang; Roth, Christian Reith, Wolfgang

    2009-09-15

    We studied the deliverability and safety of a braided, self-expanding, closed-cell nickel-titanium (NiTi) stent (E-volution, Jotec GmbH, Hechingen, Germany) especially designed for the endovascular treatment of carotid artery bifurcation stenosis with special regard to in-stent stenosis and thrombosis compared with a laser-cut reference nitinol stent in a porcine model of percutaneous vascular interventions. We aimed to assess histopathologic response in minipig carotid and subclavian arteries. Eight minipigs received a total of 42 stents: 14 reference stents and 28 E-volution stents. Eleven of the E-volution stents were additionally coated with heparin. Control angiography was obtained immediately before and after vascular intervention as well as 4 weeks after the procedure. Primary endpoints were 28 days of angiographic analyses as well as histomorphometric analysis, including injury score, inflammation score, luminal diameter, vessel diameter, maximal neointimal thickness, and area of in-stent stenosis. Secondary end points were procedural success, 28-day mortality, and stent thrombosis. All stents could be delivered successfully without procedural complications, morbidity, or mortality during our observation time. As confirmed by histology, no in-stent thrombosis was observed. Compared with common carotid arteries, subclavian arteries are significantly more vulnerable to developing in-stent stenosis caused by neointima proliferation (p < 0.05). Compared with the use of 1 single stent/artery, serial application of two stents leads to a more excessive but not significantly different neointimal proliferation (p > 0.05). The E-volution stent, especially when heparin coated, is in line with the comparison to the laser-cut reference stent displaying similar results of angiographic, histologic, and histomorphometric analyses (p > 0.05). Compared with the reference laser-cut stent, the self-expanding nitinol stent (E-volution) with its advanced braiding technology is

  19. Procedural and follow-up outcomes among patients undergoing successful recanalisation of coronary chronic total occlusions using biolimus drug-eluting stents.

    PubMed

    Saraf, S; Cockburn, J; Ferreira, I; Hopkins, S; Hildick-Smith, D

    2014-07-01

    This study aimed at evaluating the outcome of Biolimus eluting stent (BES) implantation in the treatment of chronic total coronary occlusions (CTO). We identified patients who underwent successful angioplasty for a CTO lesion with ≥1 BES between June 2008 and March 2012. All patients were followed up for major adverse cardiac events (MACE), which comprised death, non-fatal myocardial infarction (MI), cerebrovascular accident, target vessel revascularization (TVR), target lesion revascularization (TLR) and stent thrombosis. 125 patients underwent successful CTO angioplasty with ≥1 Biolimus-eluting stents. Mean age was 63.8 ± 12.0 years, and 82.4 % were males. Lesion location was right coronary artery (n = 80, 64 %), left anterior descending artery (n = 35, 28 %) and left circumflex artery (n = 10, 8 %). During follow-up of 579 ± 293 days, all cause mortality was n = 8 (6.4 %) patients, non-fatal MI was n = 3 (2.4 %), TVR was n = 3 (2.4 %) and TLR was n = 1 (0.8 %). Overall MACE was, therefore, n = 15 (12 %). BES is safe and effective in treatment of CTO lesions, with a low rate of major adverse cardiovascular events during follow-up.

  20. Everolimus-eluting bioresorbable vascular scaffolds versus second generation drug-eluting stents for percutaneous treatment of chronic total coronary occlusions: Technical and procedural outcomes from the GHOST-CTO registry.

    PubMed

    La Manna, Alessio; Chisari, Alberto; Giacchi, Giuseppe; Capodanno, Davide; Longo, Giovanni; Di Silvestro, Michele; Capranzano, Piera; Tamburino, Corrado

    2016-11-15

    We aimed at comparing the acute performance of bioresorbable scaffolds (BRS) and second-generation drug-eluting stents (DES) for the treatment of chronic total occlusions (CTO). There is a lack of knowledge regarding the use of BRS in CTO. Key outcomes of interest were technical and procedural success. Technical success was defined as successful stent delivery and implantation, postprocedural residual diameter stenosis <30% within the treated segment, and restoration of thrombolysis in myocardial infarction (TIMI) grade 3 flow. Procedural success was defined as technical success with no in-hospital major adverse cardiac events (MACE). Between May 2013 and May 2014, 32 patients underwent CTO percutaneous coronary intervention (PCI) with the Absorb BRS (Abbott Vascular, Santa Clara, CA) and were compared with a historical control group of 54 patients who had undergone CTO PCI with second-generation DES. Baseline characteristics were similar between the BRS and DES groups, with the exception of a larger mean reference vessel diameter in the BRS group (2.92 ± 0.34 vs 2.50 ± 0.68; P < 0.001). Technical success was less likely to be achieved in the BRS group compared with the DES group (78.1% vs 96.3%, P = 0.012). Procedural success rates were 78.1% and 94.4% in the BRS and DES group, respectively (P = 0.035). Compared with second-generation DES for PCI of CTO lesions, BRS were associated with lower rates of technical and procedural success. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. Direct coronary stenting by transradial approach: rationale and technical issues.

    PubMed

    Burzotta, Francesco; Hamon, Martial; Trani, Carlo; Kiemeneij, Ferdinand

    2004-10-01

    Direct stent implantation using radial approach represents to date the less invasive, less traumatic strategy to perform a percutaneous coronary intervention, rendering its adoption an attraction for many interventional cardiologists. A growing series of reports suggests the feasibility of transradial direct stenting in a variety of clinical situations. Here we discuss the main advantages of the adoption of this technique. Moreover, a detailed analysis of the technical issues specifically related with each phase of transradial direct stenting procedures is reported.

  2. Subacute Drug-Eluting Stent Thrombosis Caused by Stent Underexpansion: Evaluation by Optical Coherence Tomography

    PubMed Central

    Martín-Reyes, Roberto; Jiménez-Valero, Santiago; Navarro, Felipe; Moreno, Raúl

    2011-01-01

    We present the case report of a patient presenting with ST segment elevation myocardial infarction due to a subacute drug-eluting stent trombosis within the proximal segment of the left circumflex artery (LCX). Six days before a total chronic occlusion was treated at the mid segment of the LCX by overlapping two drug-eluting stents. Optical coherence tomography (OCT) was helpful to demonstrate stent underexpansion of the overlaping segment as the main mechanism of early stent thrombosis. This case is illustrative about the potential role of OCT to identify the mechanisms of ST and thus guiding the PCI procedure. Moreover, our case shows the capability of the Imagewire to cross a severe stenosis due to stent underexpansion that could not be crossed by the IVUS catheter. PMID:21423540

  3. Palliation of Pyloric Stenosis Caused by Gastric Cancer Using an Endoscopically Placed Covered Ultraflex Stent: Covered Stent Inside an Occluded Uncovered Stent

    SciTech Connect

    Nakamura, Toshifumi; Kitagawa, Mutsuo; Takehira, Yasunori; Yamada, Masami; Nishiwaki, Yoshiro; Nakamura, Hirotoshi

    2000-07-15

    A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation showed a very narrow residual lumen. A covered Ultraflex stent (length 10 cm, inner diameter 18u23 mm) was inserted through the first stent and expanded to its maximum diameter over the next 2 days. The patient's vomiting and nausea improved rapidly. He died 6 months after the second stenting procedure, from metastatic tumor spread, having remained free of nausea and vomiting. In this case, a covered metallic stent prevented tumor ingrowth and maintained gastrointestinal patency.

  4. Flow Characteristics Near to Stent Strut Configurations on Femoropopliteal Artery

    NASA Astrophysics Data System (ADS)

    Paisal, Muhammad Sufyan Amir; Fadhil Syed Adnan, Syed; Taib, Ishkrizat; Ismail, Al Emran; Kamil Abdullah, Mohammad; Nordin, Normayati; Seri, Suzairin Md; Darlis, Nofrizalidris

    2017-08-01

    Femoropopiteal artery stenting is a common procedure suggested by medical expert especially for patient who is diagnosed with severe stenosis. Many researchers reported that the growth of stenosis is significantly related to the geometry of stent strut configuration. The different shapes of stent geometry are presenting the different flow pattern and re-circulation in stented femoropopliteal artery. The blood flow characteristics near to the stent geometry are predicted for the possibility of thrombosis and atherosclerosis to be formed as well as increase the growth of stenosis. Thus, this study aims to determine the flow characteristic near to stent strut configuration based on different hemodynamic parameters. Three dimensional models of stent and simplified femoropopliteal artery are modelled using computer aided design (CAD) software. Three different models of stent shapes; hexagon, circle and rectangle are simulated using computational fluid dynamic (CFD) method. Then, parametric study is implemented to predict the performance of stent due to hemodynamic differences. The hemodynamic parameters considered are pressure, velocity, low wall shear stress (WSSlow) and wall shear stress (WSS). From the observation, flow re-circulation has been formed for all simulated stent models which the proximal region shown the severe vortices. However, rectangular shape of stent strut (Type P3) shows the lowest WSSlow and the highest WSS between the range of 4 dyne/cm2 and 70 dyne/cm2. Stent Type P3 also shows the best hemodynamic stent performance as compare to others. In conclusion, Type P3 has a favourable result in hemodynamic stent performance that predicted less probability of thrombosis and atherosclerosis to be formed as well as reduces the growth of restenosis.

  5. Simultaneous Thrombosis of Two Drug-Eluting Stents After Discontinuation of Dual Antiplatelet Therapy for a Day

    PubMed Central

    Chen, Hung Yi

    2012-01-01

    Stent thrombosis is rare but can lead to potential severe consequence. The incidence is relative higher in drug-eluting sent than bare-metal stent implantation. Dual antiplatelet therapy is the major treatment to avoid early and late stent thrombosis. Simultaneous two stents thrombosis is rare. Although mechanical or/and procedure factors may predispose to stent thrombosis occurred, simultaneous two stents thrombosis implies possibly ineffective antiplatelet therapy. We report a case with simultaneous two stent thrombosis and complicated with cardiogenic shock after lost antiplatelet therapy for one day. We try to emphasize to properly educate patients about the importance of continuous drug use to avoid catastrophic tragedy.

  6. Stenting for restenotic lesions with the BARD XT stent.

    PubMed

    Rahel, Braim M; Suttorp, Maarten J; Te Riele, Hans A; Bal, Egbert T; Ernst, Sjef M; Mast, E Gijs; Ten Berg, Jurriën M; Kelder, Johannes C; Plokker, H W Thijs

    2003-06-01

    Conventional PTCA for the treatment of restenotic lesions is associated with a high rate of recurrence (30-50%). Primary stenting decreases the restenosis rate at long-term follow-up. One-hundred consecutive patients with restenosis received a Bard XT stent. Follow-up angiography was performed after 6 months. Angiograms were compared by means of computed quantitative analysis. The mean pretreatment reference diameter was 2.88 +/- 0.51 mm. The mean minimal luminal diameter (MLD) increased from 1.09 +/- 0.57 mm to 2.70 +/- 0.44 mm. The percent diameter stenosis decreased from 66 +/- 13% to 15 +/- 10%. The procedural success rate was 99%. At 6 month follow-up repeat angiography was performed in 86 patients. The mean MLD was 1.74 +/- 0.67 mm with a mean diameter stenosis of 41 +/- 20%. Residual anginal complaints were reported in 29% of patients. In-stent restenosis (defined as diameter stenosis of more than 50%) occurred in 18% of the patients. Placement of the Bard XT stent in restenotic lesions is feasible, has an excellent short term outcome and yields a favorable result at 6 month follow-up angiography.

  7. Complications during renal artery stent placement for atherosclerotic ostial stenosis

    SciTech Connect

    Beek, Frederik J. A.; Kaatee, Robert; Beutler, Jaap J.; Ven, Peter J. van der; Mali, Willem P. T. M.

    1997-05-15

    Purpose. To describe short-term complications during stent placement for atherosclerotic renal artery ostial stenosis. Methods. Sixty-one arteries in 50 patients were treated with Palmaz stents. Nineteen patients had a single functioning kidney, 23 had a bilateral stenosis, which was stented bilaterally in 11, and 8 had a unilateral stenosis. The complications were grouped as those related to the catheterization procedure, those related to stent placement, and those possibly related to either category. The complications were divided into those with severe clinical significance (SCS), those with minor clinical significance (MCS), and radiological-technical complications (RTC). The stent placement procedures were ordered chronologically according to examination date and the complications were tabulated per group of 10 patients. Results. Five (10%) SCS, 5 (10%) MCS, and 8 (16%) RTC occurred in 50 patients. The catheterization procedure led to 2 SCS, 3 MCS, and 1 RTC. Stent placement gave rise to 7 RTC. Three SCS and 2 MCS could have been related to either catheterization or stent placement. More SCS occurred in the first group of 10 patients than in the following groups. Conclusion. Renal artery stent placement for atherosclerotic ostial stenosis has a considerable complication rate and a learning curve is present. The complications related to the actual stent placement were without clinical consequences.

  8. Stenting as a palliative method in the management of advanced squamous cell carcinoma of the oesophagus and gastro-oesophageal junction

    PubMed Central

    Kużdżał, Jarosław

    2016-01-01

    Advanced squamous cell carcinoma of the oesophagus and gastroesophageal junction usually requires palliative treatment, and the method of choice is stenting. There are several types of stents currently available, including: self-expandable metallic stents (fully or partially covered); self-expandable plastic stents; biodegradable stents. Each of the mentioned stents has its advantages and limitations, and requires a proper, patient-tailored selection. Due to the close anatomical relationship between the oesophagus and bronchial tree, some patients may require bilateral stenting. Oesophageal stenting may not only be considered as a palliative procedure, but can also be implemented to alleviate dysphagia during preoperative chemotherapy and/or radiotherapy. PMID:28133493

  9. Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management.

    PubMed

    Sen, Volkan; Bozkurt, Halil Ibrahim; Yonguc, Tarık; Aydogdu, Ozgu; Yarimoglu, Serkan; Degirmenci, Tansu; Minareci, Suleyman

    2015-01-01

    Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.

  10. The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release.

    PubMed

    Diaz, Orlando; Lopez, Gloria; Roehm, John O F; De la Rosa, Ginna; Orozco, Fernando; Almeida, Rafael

    2017-04-24

    Stroke due to the release of embolic debris during the placement of a stent to correct carotid artery stenosis is a constant procedural and peri-procedural threat. The new all metal Casper stent has been created with two layers of nitinol, the inner layer of which has pores diminutive enough to prevent embolic release. To evaluate the safety, effectiveness, and utility of the double layer nitinol Casper carotid artery stent in the treatment of patients with severe carotid artery stenosis. 19 patients with severe internal carotid artery stenosis, 14 symptomatic and 5 asymptomatic, were treated with the Casper stent. After stent placement, angiographic and cone beam CT images were recorded in all patients. The unique low profile delivery system allowed for easy stent placement, re-sheathing, and repositioning of the stent. The large cell external layer produced excellent apposition to the artery wall. The inner layer prevented prolapse of atherosclerotic debris through the device. Plaque coverage was achieved; residual stenosis ranged from 0% to 20%. Long term angiographic follow-up in 5 patients showed wall apposition of the device covering the lesion and no restenosis. There were no procedure related complications. Two patients experienced a delayed ischemic stroke, likely related to inconsistent medical management. The Casper has been an excellent stent for the treatment of internal carotid artery stenosis and its internal micromesh layer has been effective in preventing plaque prolapse. It provides the flexibility of large cell stents and the inner layer provides maximum protection against plaque prolapse. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. iStent trabecular micro-bypass stent for open-angle glaucoma

    PubMed Central

    Le, Kim; Saheb, Hady

    2014-01-01

    Trabecular micro-bypass stents, commonly known as iStents, are micro-invasive glaucoma surgery (MIGS) devices used to treat open-angle glaucoma. Like other MIGS procedures that enhance trabecular outflow, the iStent lowers intraocular pressure (IOP) by creating a direct channel between the anterior chamber and Schlemm’s canal. iStents are typically implanted at the time of phacoemulsification for patients with open-angle glaucoma and visually significant cataracts. This review summarizes the published data regarding the efficacy, safety, and cost considerations of trabecular micro-bypass stents. Most studies found statistically significant reductions in mean IOP and ocular medication use after combined phacoemulsification with single or double iStent implantation. The devices were found to be very safe, with a safety profile similar to that of cataract surgery. Complications were infrequent, with the most common complications being temporary stent obstruction or malposition, which resolved with observation or secondary procedures. Future studies are needed to evaluate long-term outcomes, patient satisfaction, cost effectiveness, and expanded indications. PMID:25284980

  12. Biodegradable Airway Stents - Bench to Bedside: A Comprehensive Review.

    PubMed

    Dutau, Hervé; Musani, Ali Imran; Laroumagne, Sophie; Darwiche, Kaid; Freitag, Lutz; Astoul, Philippe

    2015-01-01

    Airway stents are indicated to treat symptomatic narrowing or to close fistulas of the central airways. They are generally divided into two types: the silicone stents and the metallic stents. Unlike in malignancies, removability is a major objective of temporary stenting in benign conditions, which poses the challenge of a new rigid bronchoscopic procedure under general anesthesia and stent removal with all its attendant risks and costs. The concept of a biodegradable (BD) stent that could maintain the patency of an airway for a predetermined duration of time is very appealing. These BD stents would gradually degrade and eventually vanish from the airway once they are no longer needed. Such stents are currently an area of intense research. Another very promising concept of drug delivery with such stents is also a very exciting area of current research. The aim of this comprehensive review is to discuss all pertinent available literature on the use of BD materials in various clinical applications and to extensively review all animal and humans trials involving BD airway stents. © 2015 S. Karger AG, Basel.

  13. Stabilization of Coronary Stents Using the Floating-Wire Technique.

    PubMed

    Li, Yue; Xue, Jingyi; Li, Shuang; Sheng, Li; Sun, Danghui; Li, Weimin; Gong, Yongtai

    2015-11-01

    Excessive movement of coronary stents within the artery can make accurate stent placement difficult. This study assessed the use of the floating-wire technique to reduce stent motion to improve placement accuracy. During percutaneous coronary intervention, if excessive stent movement prevented accurate stent placement, the floating-wire technique was performed to reduce stent motion within the coronary artery during both stent positioning and deployment. Postprocedural angiograms were analyzed by two independent operators to measure the motion length of the stent delivery system relative to the coronary artery before and after using the floating-wire technique. The floating-wire technique was considered necessary in 19 patients. No procedural complications occurred. The extent of motion was markedly reduced by using the floating-wire technique (4.04 ± 1.25 mm to 1.11 ± 0.81 mm; P<.001). The floating-wire technique is an effective and safe method to reduce stent movement and facilitate accurate stent deployment. This simple technique can be easily applied in any interventional cardiac catheterization laboratory without the need for additional training or equipment.

  14. Pulmonary Arterial Stent Implantation in an Adult with Williams Syndrome

    SciTech Connect

    Reesink, Herre J.; Henneman, Onno D. F.; Delden, Otto M. van; Biervliet, Jules D.; Kloek, Jaap J.; Reekers, Jim A.; Bresser, Paul

    2007-07-15

    We report a 38-year-old patient who presented with pulmonary hypertension and right ventricular dysfunction due to pulmonary artery stenoses as a manifestation of Williams syndrome, mimicking chronic thromboembolic pulmonary hypertension. The patient was treated with balloon angioplasty and stent implantation. Short-term follow-up showed a good clinical result with excellent patency of the stents but early restenosis of the segments in which only balloon angioplasty was performed. These stenoses were subsequently also treated successfully by stent implantation. Stent patency was observed 3 years after the first procedure.

  15. Radiological Management of Superior Vena Caval Stent Migration and Infection

    SciTech Connect

    Srinathan, Sadeesh McCafferty, Ian; Wilson, Ian

    2005-01-15

    We report a case of venous obstruction secondary to Hodgkin's lymphoma. Multiple Wallstents were inserted into the superior vena cava to relieve obstructive symptoms secondary to tumor. This procedure was complicated by stent migration into the right ventricle and a presumed stent infection. We describe the percutaneous management of these complications and discuss the issues surrounding the use of stents in this setting. We conclude that these complications can be managed percutaneously. However, the technical details of stent placement are essential in minimizing complications of this type.

  16. Pulmonary arterial stent implantation in an adult with Williams syndrome.

    PubMed

    Reesink, Herre J; Henneman, Onno D F; van Delden, Otto M; Biervliet, Jules D; Kloek, Jaap J; Reekers, Jim A; Bresser, Paul

    2007-01-01

    We report a 38-year-old patient who presented with pulmonary hypertension and right ventricular dysfunction due to pulmonary artery stenoses as a manifestation of Williams syndrome, mimicking chronic thromboembolic pulmonary hypertension. The patient was treated with balloon angioplasty and stent implantation. Short-term follow-up showed a good clinical result with excellent patency of the stents but early restenosis of the segments in which only balloon angioplasty was performed. These stenoses were subsequently also treated successfully by stent implantation. Stent patency was observed 3 years after the first procedure.

  17. Nasolacrimal Polyurethane Stent: Complications with CT Correlation

    SciTech Connect

    Pinto, Isabel T.; Paul, Laura; Grande, Carlos

    1998-11-15

    Purpose: To evaluate initial results in patients with epiphora secondary to obstruction of the nasolacrimal duct treated by placement of a polyurethane stent, and to discuss the technical problems and complications arising during the procedure, with visualization of the anatomy of the drainage apparatus using computed tomography (CT). Methods: We inserted 20 polyurethane Song stents under fluoroscopic guidance after dacryocystography in 19 patients with grade 3-4 epiphora caused by idiopathic obstruction of the nasolacrimal duct. CT scans were obtained following stent placement in all patients. Results: We focus on the technical problems and complications that arose during these procedures. During negotiation of the guidewire past the obstruction at the level of the junction of the duct with the lacrimal sac, the guidewire created a false passage in a posterior suborbital direction in two cases and towards the posterior midline in another. In all cases the guidewire was withdrawn and reinserted through the proper anatomic route without further difficulty or complications. In two cases the stent was improperly positioned wholly or partially outside the nasolacrimal system (one medially, one posteriorly). In one case the stent was removed and reinserted; in the other it remains in place and functional. CT was performed in all these cases to ensure proper anatomic alignment and determine what had gone wrong. The epiphora was completely resolved in 13 cases and partially relieved in four; there were three cases of stent obstruction. Epistaxis of short duration (1 hr) occurred in seven patients and headache in one. Conclusions: Treatment of epiphora with polyurethane stents is a technique that is well tolerated by patients and achieves a high success rate, yet problems in placement may be encountered. Though no major consequences for patients are involved, cognizance of such difficulties is important to avoid incorrect positioning of stents.

  18. Insulin-treated diabetes mellitus: An important, actionable risk marker after coronary stenting.

    PubMed

    Hillegass, William B

    2016-01-01

    Insulin treatment for diabetes is a simple but important risk marker for doubled adjusted death and myocardial infarction rates and tripled stent thrombosis risk after coronary stenting. Insulin treatment does not predict meaningfully increased major bleeding or additional revascularization procedures after drug eluting coronary stent implantation. Third generation P2 Y12 receptor antagonists substantially lower risk of events in diabetics after stenting with insulin treated diabetics having twice the magnitude of benefit of diabetics not needing insulin.

  19. Stent explantation from an arteriovenous fistula for hemodialysis: a case report.

    PubMed

    Nano, Giovanni; Dalainas, Ilias; Casana, Renato; Bianchi, Paolo; Lupattelli, Tommaso; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    Percutaneous transluminal angioplasty is the first treatment of a dysfunctional vascular access for hemodialysis. A case of stenting of a native arteriovenous hemodialysis fistula is reported that was treated with a stent placement at the anastomosis level, with explantation of the stent after complete thrombosis of the fistula 48 hours after the procedure. It is preferable to treat arteriovenous fistulas with simple balloon dilatation, avoiding stenting of the fistula, especially in the anastomosis site.

  20. [Endoscopic trachea stenting for scar strictures as a preparation for the surgical treatment].

    PubMed

    Starkov, Iu G; Solodinina, E N; Slepenkova, K V; Esakov, Iu S

    2013-01-01

    The article analyzes the results of the endoscopic tracheal stenting of 33 patients with cicatrical stenosis. The patients aged 19-72 years. All patients had the acquired stenosis after intubation and tracheostomy. In 12 cases the procedure was successful, no complications were observed. In 3 cases the endoscopic stentin was the final stage of the treatment. The temporary stenting was effective in 8 cases. Stent migration was observed in 2 patients. The stent exposition ranged 8-90 days.

  1. Tricuspid valved stent implantation: novel stent with a self-expandable super-absorbent polymer.

    PubMed

    Iino, Kenji; Lozonschi, Lucian; Metzner, Anja; Marczynski-Bühlow, Martin; Renner, Jochen; Cremer, Jochen; Lutter, Georg

    2011-08-01

    Trans-catheter aortic and pulmonary valve replacement procedures can result in favorable outcomes in selected patients. The aim of this study was to investigate the functioning of a novel self-expanding valved stent with super-absorbent polymer (SAP) for minimally invasive replacement of the tricuspid valve. A newly designed nitinol stent with SAP was specially designed for the tricuspid annulus. This device was composed of right atrial anchoring elements, a left ventricular tubular stent, and a trileaflet bovine pericardial valve. The stent was coated with a waterproof material, and a pouch containing SAP for minimizing paravalvular leakage was placed beneath the atrial element. Seven pigs underwent minimally invasive off-pump tricuspid valved stent implantation. This was performed through a lower ministernotomy using a transventricular approach under transesophageal echocardiographic guidance. After 1 and 6h, a complete echocardiographic evaluation and hemodynamics (Swan-Ganz catheter) were performed. Six of seven pigs exhibited normal hemodynamics immediately after tricuspid valved stent implantation and maintained stability for the entire period of monitoring. In one pig, a part of the atrial stent elements was deployed into the right ventricle, leading to significant paravalvular leakage, and died very soon. All subsequent animals survived with good results in the observation period. Accurate positioning of the valved stent was documented in six of seven pigs. SAP expanded and filled the gap between the stent and the native annulus in all animals. Mild paravalvular leakage was found in two of the six animals. Nevertheless, the observed leakage decreased to trace levels 6h after implantation. In the additional four pigs, only trace tricuspid regurgitation was revealed. No right ventricular outflow tract obstruction was detected. Trans-apical off-pump tricuspid valved stent implantation is feasible in an acute experimental setting, and SAP may help to reduce

  2. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction.

    PubMed

    Stone, Gregg W; Lansky, Alexandra J; Pocock, Stuart J; Gersh, Bernard J; Dangas, George; Wong, S Chiu; Witzenbichler, Bernhard; Guagliumi, Giulio; Peruga, Jan Z; Brodie, Bruce R; Dudek, Dariusz; Möckel, Martin; Ochala, Andrzej; Kellock, Alison; Parise, Helen; Mehran, Roxana

    2009-05-07

    -eluting stents, as compared with bare-metal stents, significantly reduced angiographic evidence of restenosis and recurrent ischemia necessitating repeat revascularization procedures. No safety concerns were apparent at 1 year. (ClinicalTrials.gov number, NCT00433966.) 2009 Massachusetts Medical Society

  3. Nasolacrimal Stenting: Toward Improving Outcomes with a Simple Modification of the Song Stent

    SciTech Connect

    Lanciego, Carlos Miguel, Silvia De; Padilla, Manuel; Perea, Miguel; Rodriguez-Merlo, Rufo; Garcia-Garcia, Lorenzo

    2006-08-15

    The purpose of this study was to evaluate, in a prospective, single-center study, the effectiveness of Song's polyurethane stents, modified 'in-house,' in the percutaneous management of epiphora. Patients (n = 170; age range 18-83, mean = 64; 50 male, 120 female) with severe epiphora had the modified stents inserted (183 eyes/195 stents) to treat unilateral/bilateral and complete/partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 119 cases (61%) and chronic dacryocystitis in 76 (39%). The set designed by Song was used in all patients but modified by us such that the extreme end is cone-shaped. The original technique was slightly modified by us and the procedure was conducted on an outpatient basis. The initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 180 eyes and partial in 3. On follow-up (mean = 18 months; range: 2 days to 24 months), 165 of 195 stents (85%) remained patent. Primary patency rates at follow-up were 86%, 84%, 84%, and 79% in the first 6 months, second and third 6 months, and the present (24 months), respectively. Stents became obstructed in 30 patients, but all but 2 were easily withdrawn and 20 of these patients remained asymptomatic for a mean of 14 months (secondary patency of 67%). Following stent removal, the withdrawn stent was replaced with a new stent in the same intervention on 14 occasions. In another six cases, patency was re-established without the need of a second stent. The procedure is simple and safe, both in stent insertion as well as in mechanical de-blocking and withdrawal when occluded. Success was >80 % in the short term (1-year follow-up). Stenting failure does not preclude other treatment because with the modification that we had introduced, the extreme end of the stent becomes more accessible to mechanical de-blocking, withdrawal, and relocation. The levels of primary and secondary patencies are promising and warrant more

  4. Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis

    PubMed Central

    Zhang, Jiaqiao; Xu, Chuou; He, Deng; Lu, Yuchao; Hu, Henglong; Qin, Baolong; Wang, Yufeng; Wang, Qing; Li, Cong; Liu, Jihong

    2016-01-01

    Purpose To clarify the outcome of flexible ureteroscopy (fURS) for management of renal calculi without preoperative stenting. Methods A total of 171 patients who received 176 fURS procedures for unilateral renal stones were reviewed. All procedures were divided into two groups depending on whether they received ureteral stenting preoperatively. Baseline characteristics of patients, stone burden, operation time, stone-free rates, and complications were compared between both groups. Results Successful primary access to the renal pelvis was achieved in 104 of 114 (91.2%) patients without preoperative stenting, while all procedures with preoperative stenting (n = 62) were successfully performed. A total of 156 procedures were included for further data analysis (56 procedures in stenting group and 100 in non-stenting group). No significant differences was found regardless of a preoperative stent placement in terms of stone-free rate (73.2% with stenting vs. 71.0% without, P = 0.854), operative time (70.4 ± 32.8 with stenting vs. 70.2 ± 32.1 without, P = 0.969). Conclusions fURS for management of renal stone without preoperative ureteral stenting are associated with well outcome in short term follow-up. Our study may help patients and doctors to decide if an optional stent is placed or not. PMID:27917317

  5. Impact of Coronary Plaque Characteristics on Late Stent Malapposition after Drug-Eluting Stent Implantation

    PubMed Central

    Hong, Sung-Jin; Kim, Byeong-Keuk; Shin, Dong-Ho; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo

    2015-01-01

    Purpose To evaluate the impact of pre-procedural coronary plaque composition assessed by virtual histology intravascular ultrasound (VH-IVUS) on late stent malapposition assessed by optical coherence tomography (OCT) following drug-eluting stent (DES) implantation. Materials and Methods The study population consisted of 121 patients (121 lesions) who underwent both pre-procedural VH-IVUS and follow-up OCT after DES implantation. The association between pre-procedural plaque composition [necrotic core (NC), dense calcium (DC), fibrotic (FT), and fibro-fatty (FF) volumes] assessed by VH-IVUS and late stent malapposition (percent malapposed struts) or strut coverage (percent uncovered struts) assessed by follow-up OCT was evaluated. Results Pre-procedural absolute total NC, DC, FT, and FF plaque volumes were 22.9±19.0, 7.9±9.6, 63.8±33.8, and 16.5±12.4 mm3, respectively. At 6.3±3.1 months post-intervention, percent malapposed and uncovered struts were 0.8±2.5% and 15.3±16.7%, respectively. Pre-procedural absolute total NC and DC plaque volumes were positively correlated with percent malapposed struts (r=0.44, p<0.001 and r=0.45, p<0.001, respectively), while pre-procedural absolute total FT plaque volume was weakly associated with percent malapposed struts (r=0.220, p=0.015). Pre-procedural absolute total DC plaque volume was the only independent predictor of late stent malapposition on multivariate analysis (β=1.12, p=0.002). There were no significant correlations between pre-intervention plaque composition and percent uncovered struts. Conclusion Pre-procedural plaque composition was associated with late stent malapposition but not strut coverage after DES implantation. Larger pre-procedural absolute total DC plaque volumes were associated with greater late stent malapposition. PMID:26446634

  6. Airway stents in children.

    PubMed

    Nicolai, T

    2008-04-01

    Airway obstruction in children is a rare, but difficult clinical problem, with no clear agreement on optimal therapeutic approach. Stenting of the airway has been used successfully in adults, and is an attractive alternative in children. Fundamental differences of pediatric compared to adult use include the benign nature of most stenoses, the narrow and soft airways of children, the required long-term tolerance and adaptation to growth. These differences may significantly alter the therapeutic balance, calling into question the precise role stents play in the treatment of airway obstruction in children. Stent placement can be technically demanding but is not exceedingly difficult. Experience is necessary to select the proper size and type of stent. Metal stents usually achieve airway patency and clinical improvement in the majority of cases, while this is less frequently the case with silicone stents. Some complications such as granulation and secretion retention seem to occur in most children after stent implantation. Unfortunately, severe complications including death have been reported in a significant proportion of children. Stent related mortality can be estimated at 12.9% from published data, but these include complication centered reports. The initial euphoria for airway stents in children has largely abated and most authors agree that they should only be employed in circumstances with no good alternatives. It is crucial that all surgical and medical alternatives are considered and the decision to place a stent is not made because other options are overlooked or not available locally. Stent use in a palliative setting has also been reported and is probably reasonable. Stents will only allow limited adaptation for the growth of pediatric airways by balloon dilatation. All metal stents should be considered as potentially permanent, and removal sometimes may only be possible through a surgical and sometimes risky approach.

  7. Stenting of the Lower Gastrointestinal Tract: Current Status

    SciTech Connect

    Katsanos, Konstantinos; Sabharwal, Tarun Adam, Andreas

    2011-06-15

    Colon obstruction due to colorectal cancer is a major surgical emergency. Patients with acute bowel obstruction are usually poor surgical candidates with 10-20% operative mortality and 40-50% operative morbidity rates. Colorectal stenting is an image-guided, minimally invasive procedure, and typical indications include either palliation of inoperable malignant disease or temporary bowel decompression as a bridge to surgery. Colorectal stenting allows the patient to recover before definite elective surgical resection, reducing perioperative morbidity and mortality, overall hospital stay, and associated health care costs. Palliative stenting improves quality of life compared to surgery. A concise review is provided of contemporary stenting practice of the lower gastrointestinal tract, the colon in particular, and both palliative and preoperative adjuvant procedures are evaluated in terms of relevant patient oncology, insertion technique, available stent designs, technical and clinical outcomes, associated complications, and cost-benefit analysis.

  8. Direct coronary stent implantation: safety, feasibility, and predictors of success of the strategy of direct coronary stent implantation.

    PubMed

    Laarman, G; Muthusamy, T S; Swart, H; Westendorp, I; Kiemeneij, F; Slagboom, T; van der Wieken, R

    2001-04-01

    This prospective study was designed to evaluate the feasibility, safety, predictive factors of success, and 6-month follow-up of stent implantation without balloon predilatation (direct stenting) in 250 patients undergoing elective stent implantation. Balloon dilatation prior to stent implantation was a prerequisite to facilitate passage and deployment of the stent. Stent technology has changed tremendously, resulting in stents with improved properties, which may allow stent placement without prior balloon dilatation. Patients with coronary lesions suitable for elective stent implantation were included in this trial. Coronary interventions were undertaken predominantly via the transradial route using 6 Fr guiding catheters. Direct stent implantation was attempted using AVE GFX II coronary stent delivery systems. Upon failure, predilatation was undertaken before reattempting stent implantation. Patient data and ECGs were obtained from case records and from personal or telephone interviews 6 months after the procedure. Values were presented as mean +/- standard deviation. Student's t-test, two-tailed at 5% level of significance, was used to compare the difference of two means. Multivariate logistic regression analysis was performed to establish predictive factors for failure of direct stenting. Two hundred and sixty-six direct stent implantations were attempted in 250 patients. Direct stenting was successful in 226 (85%) cases. Out of 40(15%) cases where direct stenting failed, balloon predilatation facilitated stent implantation in 39. In one lesion, stent implantation was not possible despite adequate predilatation. Predictive factors for failure of direct stenting on multivariate analysis were LCx lesions (P < 0.01), complex lesions (P < 0.01), and longer stents (P < 0.001). Minimal luminal diameter and percentage diameter stenosis of lesions in the successful and the failure group were not significantly different (0.94 +/- 0.39 mm vs. 0.84 +/- 0.41 mm, P = NS

  9. Emergency Coronary Stenting with Wiktor Stent Ñ Immediate and Late Results.

    PubMed

    Bertrand; Legrand; Bilodeau; Martinez; Kulbertus

    1997-01-01

    In case of failed angioplasty, coronary stenting has gradually emerged as a non-surgical method to restore vessel patency and optimize coronary blood flow. There is still little clinical and angiographic information on the use of radiopaque single loose interdigitating wire stents in angioplasty complicated by threatened or acute closure. Seventy-one patients received Wiktor stents after threatened vessel closure in 53 cases and acute closure in 18 cases. Stent delivery was successful in 98%. In-hospital death occurred in 1 case (1.4%). Stents occlusion were faced in 10 cases (14%), of which 6 presented early and 4 late after the procedure. Urgent bypass surgery was needed in 9 cases (12%) and 7 patients (10%) developed acute myocardial infarction. Serious bleeding complications occurred in 7 cases (10%) and vascular repair was performed in 4 patients (5%). During a follow-up of 20 +/- 10 months, 2 patients died, no myocardial infarction was observed and recurrence of angina was noted in 17 patients (24%). Angiographic analysis showed an acute gain in minimal lumen diameter of 1.71 +/- 0.22 mm and a late loss of 0.63 +/- 0.17 mm. Angiographic restenosis (diameter stenosis > 50%) presented in 20% of patients. Therefore, Wiktor stenting yields similar results than currently used stents in acute closure and strictly defined threatened vessel closure following angioplasty.

  10. Residual stresses in coronary artery stents.

    PubMed

    Möller, D; Reimers, W; Pyzalla, A; Fischer, A

    2001-01-01

    In western industrial countries, coronary heart disease is the most common cause of death. The reason is a coronary sclerosis, which by the generation of plaques narrows the inner lumen of an artery and, thus, deteriorates the blood supply. This leads to symptoms like burning pain or increased pressure in the chest, and finally to an under supply and damage of the heart muscle. In order to keep those portions of arteries that are covered by a plaque open, the stent technique was developed in the 1980s and is increasingly used since about 13 years. These stents are usually made of wires or of a slotted tube and are of two kinds: self-expanding and balloon expanding. Both types are implanted after being mounted on a catheter and expanded in the desired position. Self-expanding stents make use of the elastic deformation, while the other group of stents are expanded by a balloon, which brings about a plastic deformation of certain regions of the stent structure. Thus, after implantation, parts of these stents undergo two steps of distinct plastic deformation. First during compression, which is necessary for the mounting procedure on the catheter (crimping), and second during expansion for implantation. In this article, the residual stresses generated during crimping and expansion are presented and discussed. These stresses are stored in the structure of a portion of a stent after implantation and are superimposed on those stresses generated by the more than 700 million cyclic heart beats during the patient's life. This work is a part of several interdisciplinary research projects by the authors in order to gain reliable fail-safe criteria for the static and cyclic mechanical properties of coronary stents.

  11. Stent graft for nephrologists: concerns and consensus.

    PubMed

    Salman, Loay; Asif, Arif

    2010-07-01

    The role of the stent graft is emerging in the management of arteriovenous dialysis access. Physicians are incorporating this device in the management of three distinct problems--vein-graft anastomotic stenosis, pseudoaneurysm formation, and cephalic arch stenosis--with varying degrees of success. Indeed, a recent randomized, controlled trial to evaluate the role of angioplasty plus stent graft versus angioplasty alone for the management of stenosis at the vein-graft anastomosis led to the approval of the stent graft by the Food and Drug Administration; however, several elements of the management of stenosis at the vein-graft anastomosis/cephalic arch as well as the repair of pseudoaneurysms by stent graft remain controversial. The situation is further complicated and warrants a cost-to-benefit ratio analysis when the added cost of the device is appended to the procedure. In contrast to the controversies, angioplasty-induced complete vascular rupture is one situation in which a stent graft is indicated beyond any doubt. With recent conditional Food and Drug Administration approval, it is anticipated that the use of stent grafts might increase in our patients. In this context, it is critically important that nephrologists be familiar with the current controversies and consensus that surround the use of stent grafts for dialysis access. Just as therapeutic interventions are analyzed in other disciplines within nephrology, these experts must appraise the use of this device for dialysis access. This report presents an up-to-date synopsis on the use of the stent graft that would assist renal physicians in requesting or rejecting the device for the optimal management of their patient's vascular access dysfunction.

  12. Angiographic restenosis in ephesos coronary stents: experience from a large medical center in Ankara, Turkey.

    PubMed

    Altin, Timucin; Berkalp, Berkten; Ozdol, Cagdas; Akyurek, Omer; Sayin, Tamer; Kervancioglu, Celal; Oral, Dervis; Erol, Cetin

    2008-01-01

    Coronary stent restenosis, which emerges in late periods after implantation, has not been completely abolished. Our aim was to investigate the restenosis rates of Ephesos coronary stents. In all, 96 patients (66 men) with 135 Ephesos coronary stents were included. Control angiograms were performed after 160 +/- 60 days. Quantitative coronary analysis was performed during the procedure and control angiogram. The stents were divided into 2 groups according to the presence or absence of restenosis. Groups were compared with clinical and angiographic variables. Restenosis was observed in 31 (23%) of 135 stents. Preprocedure percent diameter stenosis was higher (P = .02), whereas minimum lumen diameter ( P = .02), mean age (P < .001), and hypertension incidence ( P = .043) was less, and there was a trend toward smaller stent size ( P = .054) in the restenosis group. By multivariate analysis, age <50 years (P < .001) and stent size <3.0 mm (P = .016) were independent predictors of restenosis. Ephesos coronary stents seems to have acceptable restenosis rates.

  13. Forgotten/retained double J ureteric stents: A source of severe morbidity in children.

    PubMed

    Nerli, Rajendra B; Magdum, Prasad V; Sharma, Vikas; Guntaka, Ajay Kumar; Hiremath, Murigendra B; Ghagane, Shridhar

    2016-01-01

    The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. Hospital records of all patients' <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain.

  14. Complete resolution of systemic venous baffle obstruction and baffle leak using the Gore Excluder covered stent in two patients with transposition of the great arteries and prior Mustard procedure.

    PubMed

    Hill, Kevin D; Fudge, J Curt; Rhodes, John F

    2010-11-15

    We present two patients with a history of Mustard repair of transposition of the great arteries. Both patients presented with exertional limitation and demonstrated superior systemic venous baffle obstruction as well as multiple baffle leaks. In both patients stent relief of obstruction and baffle leak exclusion was accomplished using a combination of bare metal stents and the aortic extension portion of the Gore Excluder covered stent (W.L. Gore and Associates, Flagstaff, Arizona). Copyright © 2010 Wiley-Liss, Inc.

  15. Portal vein stent placement for the treatment of postoperative portal vein stenosis: long-term success and factor associated with stent failure.

    PubMed

    Kato, Atsushi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshitomi, Hideyuki; Furukawa, Katsunori; Miyazaki, Masaru

    2017-02-01

    Portal vein stenosis develops due to different causes including postoperative inflammation and oncological processes. However, limited effective therapy is available for portal vein stenosis. The objectives of this study were to evaluate the efficacy of a portal vein stent for portal vein stenosis after hepatobiliary pancreatic surgery and to determine the factors associated with stent patency. From December 2003 to December 2015, portal vein stents were implanted in 29 patients who had portal vein stenosis after hepatobiliary pancreatic surgery. We conducted a retrospective analysis to evaluate the efficacy and safety of portal vein stent placement. Twelve clinical variables were analyzed for their role in stent patency. The symptoms before portal vein stent placements included nine patients with hepatic encephalopathy, six patients with gastrointestinal bleeding, four patients with ascites, and four patients with hyperbilirubinemia. Portal vein thrombosis due to postoperative portal stenosis was found in four patients. Portal vein stent were successfully implanted without any major complications. Of the 21 patients with symptoms, 17 showed improvement, and stent patency was maintained in 22 (76%) patients. The presence of a collateral vein is the only variable related to the development of an occlusion after portal stenting. Portal vein stent were implanted safely and had good long-term patency. This procedure is useful to relieve portal hypertension-related symptoms and to improve the quality of life. Our data strongly suggest that embolization to block blood flow in a collateral vein during portal vein stent placement will improve the patency of the stent.

  16. Treatment of Intra- and Extracranial Arterial Dissections Using Stents and Embolization

    SciTech Connect

    Joo, Jin Yang; Ahn, Jung Yong Chung, Young Sun; Han, In Bo; Chung, Sang Sup; Yoon, Pyeong Ho; Kim, Sang Heum; Choi, Eun Wan

    2005-06-15

    Purpose. To evaluate the safety and efficacy of stent placement for extracranial and intracranial arterial dissections. Methods. Eighteen patients underwent endovascular treatment of carotid and vertebral dissections using intraluminal stent placement. Five patients with arterial dissection were treated, 2 using one insertion of a single stent and 3 using placement of two stents. Patients with a dissecting aneurysm were treated as follows: 7 patients with insertion of one stent, 4 with placement of two stents, and 2 by stent-assisted Guglielmi detachable coil embolization. In the 18 patients in whom stenting was attempted, the overall success in reaching the target lesion was 94.4%. Of the 17 patients treated with stents, stent release and positioning were considered optimal in 16 (94%) and suboptimal in one (6%). In patients who underwent a successful procedure, all parent arteries were preserved. There were no instances of postprocedural ischemic attacks, new neurologic deficits, or new minor or major strokes prior to patient discharge. In follow up, all patients were assessed, using the modified Rankin scale, as functionally improved or of stable clinical status. The reduction in dissection-induced stenosis or pseudoaneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischemic or hemorrhagic) suggest that stent placement offers a viable alternative to complex surgical bypass or reconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remain to be determined in a larger series.

  17. Patient-specific modeling of intracranial aneurysmal stenting

    NASA Astrophysics Data System (ADS)

    Appanaboyina, Sunil; Mut, Fernando; Löhner, Rainald; Putman, Christopher M.; Cebral, Juan R.

    2007-03-01

    Simulating blood flow around stents in intracranial aneurysms is important for designing better stents and to personalize and optimize endovascular stenting procedures in the treatment of these aneurysms. However, the main difficulty lies in the generation of acceptable computational grids inside the blood vessels and around the stents. In this paper, a hybrid method that combines body-fitted grid for the vessel walls and adaptive embedded grids for the stent is presented. Also an algorithm to map a particular stent to the parent vessel is described. These approaches tremendously simplify the simulation of blood flow past these devices. The methodology is evaluated with an idealized stented aneurysm under steady flow conditions and demonstrated in various patient-specific cases under physiologic pulsatile flow conditions. These examples show that the methodology can be used with ease in modeling any patient-specific anatomy and using different stent designs. This paves the way for using these techniques during the planning phase of endovascular stenting interventions, particularly for aneurysms that are difficult to treat with coils or by surgical clipping.

  18. Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection

    PubMed Central

    Shi, Ke-Da; Ji, Feng

    2017-01-01

    Endoscopic submucosal dissection (ESD) of superficial esophageal cancer has been increasingly used as an alternative to surgery because it is minimally invasive and has a high rate of en bloc resection. However, a high rate of esophageal stricture is observed after ESD for large lesions, which can dramatically decrease the patient’s quality of life. Stricture prevention is necessary to allow for endoscopic therapy to expand. We, herein, review the most recent evidence and discuss the role of the metallic self-expandable stent and the biodegradable stent in esophageal stricture prevention. Limited studies suggested that prophylactic stenting could reduce the stricture rate without increasing the number of complications. In addition, the number of bougie dilation procedures was significantly lower with stent placement. Esophageal stenting is a promising option for post-ESD stricture prevention. However, current evidence is too preliminary to formulate practice standards. Future studies are needed to further validate the efficacy and safety of prophylactic stenting and determine the best strategy for stricture prevention. Stent migration is the most common complication. A new stent that has advantages of a low migration rate and minimal tissue reaction will need to be developed. Therefore, randomized controlled trials with long-term follow-up periods are required before prophylactic stenting could be considered a valid option to prevent post-ESD stricture. PMID:28246466

  19. An Update to Hepatobiliary Stents

    PubMed Central

    Moy, Brian T.; Birk, John W.

    2015-01-01

    Endoscopic stent placement is a common primary management therapy for benign and malignant biliary strictures. However, continuous use of stents is limited by occlusion and migration. Stent technology has evolved significantly over the past two decades to reduce these problems. The purpose of this article is to review current guidelines in managing malignant and benign biliary obstructions, current endoscopic techniques for stent placement, and emerging stent technology. What began as a simple plastic stent technology has evolved significantly to include uncovered, partially covered, and fully covered self-expanding metal stents (SEMS) as well as magnetic, bioabsorbable, drug-eluting, and antireflux stents.1 PMID:26357636

  20. Metallic Stents for Tracheobronchial Pathology Treatment

    SciTech Connect

    Serrano, Carolina; Laborda, Alicia; Lozano, Juan M.; Caballero, Hugo; Sebastian, Antonio; Lopera, Jorge; Gregorio, Miguel Angel de

    2013-12-15

    Purpose: To present the 7-year experience of the treatment of benign and malignant tracheobronchial stenoses using metallic stents. Patients and Methods: One hundred twenty-three stents were inserted in 86 patients (74 benign and 12 malignant stenoses). Ninety-seven stents were placed in the trachea and 26 in the bronchi. The procedures were performed under fluoroscopic and flexible bronchoscopic guidance with the patient under light sedation. In cases of severe stenotic lesions or obstructions, laser resection was performed before stent placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. Results: The technical success was 100 %. Dyspnea disappearance, forced expiratory volume in the first second, and pulmonary functional data improvement was observed in all patients (p < 0.001). Complications were detected in 23 patients (26.7 %). Mean follow-up time was 6.3 {+-} 1.2 months in patients with malignant lesions and 76.2 {+-} 2.3 months patients with in benign lesions. By the end of the study, 100 % of patients with malignant pathology and 6.7 % of patients with benign lesions had died. Conclusion: Endoluminal treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients who are poor candidates for surgery. In unresectable malignant lesions, the benefit of metallic stenting is unquestionable. In benign lesions, the results are satisfactory, but sometimes other interventions are required to treat complications. New stent technology may improve these results.

  1. Double-Layered PTFE-Covered Nitinol Stents: Experience in 32 Patients with Malignant Esophageal Strictures

    SciTech Connect

    Park, Jung Gu; Jung, Gyoo-Sik Oh, Kyung Seung; Park, Seon-Ja

    2010-08-15

    We evaluated the effectiveness of a double-layered polytetrafluoroethylene (PTFE)-covered nitinol stent in the palliative treatment of malignant esophageal strictures. A double-layered PTFE-covered nitinol stent was designed to reduce the propensity to migration of conventional covered stent. The stent consists of an inner PTFE-covered stent and an outer uncovered nitinol stent tube. With fluoroscopic guidance, the stent was placed in 32 consecutive patients with malignant esophageal strictures. During the follow-up period, the technical and clinical success rates, complications, and cumulative patient survival and stent patency were evaluated. Stent placement was technically successful in all patients, and no procedural complications occurred. After stent placement, the symptoms of 30 patients (94%) showed improvement. During the mean follow-up of 103 days (range, 9-348 days), 11 (34%) of 32 patients developed recurrent symptoms due to tumor overgrowth in five patients (16%), tumor ingrowth owing to detachment of the covering material (PTFE) apart from the stent wire in 3 (9%), mucosal hyperplasia in 2 (6%), and stent migration in 1 (3%). Ten of these 11 patients were treated by means of placing a second covered stent. Thirty patients died, 29 as a result of disease progression and 1 from aspiration pneumonia. The median survival period was 92 days. The median period of primary stent patency was 190 days. The double-layered PTFE-covered nitinol stent seems to be effective for the palliative treatment of malignant esophageal strictures. We believe that the double-layer configuration of this stent can contribute to decreasing the stent's migration rate.

  2. Palliative stent implantation for coarctation in neonates and young infants

    PubMed Central

    Sreeram, Isabel; Sreeram, Narayanswami; Bennink, Gerardus

    2012-01-01

    Background: In selected neonates and infants, primary palliative stent implantation may be indicated for coarctation of the aorta. We describe our experience with this approach in five consecutive patients. Methods: Five neonates and infants (age range 6 to 68 days, gestation 33 to 38 weeks, weight range at procedure of between 1650 to 4000 g) underwent palliative stent implantation as primary therapy for coarctation of the aorta. Indications for primary stent implantation were varied. All procedures were performed by elective surgical cut down of the axillary artery. Standard coronary stents (diameter 4.5 to 5 mm, length 12 to 16 mm) were delivered via a 4F sheath. The axillary artery was repaired after removal of the sheath. Results: All procedures were acutely successful, and without procedural complications. All patients survived to hospital discharge. Four patients have subsequently undergone elective stent removal and surgical repair of the arch, at between 38 and 83 days following stent implantation. Complete stent removal was achieved in three patients. Over a follow-up ranging between 8 weeks and 36 months, none of the patients has had any further complications. Conclusions: This palliative approach is warranted in carefully selected patients. Long-term follow-up is required. PMID:23129903

  3. Exclusion of Atherosclerotic Plaque from the Circulation Using Stent-Grafts: Alternative to Carotid Stenting with a Protection Device?

    SciTech Connect

    Peynircioglu, Bora Geyik, Serdar; Yavuz, Kivilcim; Cil, Barbaros E.; Saatci, Isil; Cekirge, Saruhan

    2007-09-15

    Purpose. To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts. Methods. Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47-83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1-42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination .Results. The technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts. Conclusions. Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs.

  4. Esophagojejunal Anastomosis Fistula, Distal Esophageal Stenosis, and Metalic Stent Migration after Total Gastrectomy

    PubMed Central

    Al Hajjar, Nadim; Popa, Calin; Al-Momani, Tareg; Margarit, Simona; Graur, Florin; Tantau, Marcel

    2015-01-01

    Esophagojejunal anastomosis fistula is the main complication after a total gastrectomy. To avoid a complex procedure on friable inflamed perianastomotic tissues, a coated self-expandable stent is mounted at the site of the anastomotic leak. A complication of stenting procedure is that it might lead to distal esophageal stenosis. However, another frequently encountered complication of stenting is stent migration, which is treated nonsurgically. When the migrated stent creates life threatening complications, surgical removal is indicated. We present a case of a 67-year-old male patient who was treated at our facility for a gastric adenocarcinoma which developed, postoperatively, an esophagojejunostomy fistula, a distal esophageal stenosis, and a metallic coated self-expandable stent migration. To our knowledge, this is the first reported case of an esophagojejunostomy fistula combined with a distal esophageal stenosis as well as with a metallic coated self-expandable stent migration. PMID:25945277

  5. Esophagojejunal anastomosis fistula, distal esophageal stenosis, and metalic stent migration after total gastrectomy.

    PubMed

    Al Hajjar, Nadim; Popa, Calin; Al-Momani, Tareg; Margarit, Simona; Graur, Florin; Tantau, Marcel

    2015-01-01

    Esophagojejunal anastomosis fistula is the main complication after a total gastrectomy. To avoid a complex procedure on friable inflamed perianastomotic tissues, a coated self-expandable stent is mounted at the site of the anastomotic leak. A complication of stenting procedure is that it might lead to distal esophageal stenosis. However, another frequently encountered complication of stenting is stent migration, which is treated nonsurgically. When the migrated stent creates life threatening complications, surgical removal is indicated. We present a case of a 67-year-old male patient who was treated at our facility for a gastric adenocarcinoma which developed, postoperatively, an esophagojejunostomy fistula, a distal esophageal stenosis, and a metallic coated self-expandable stent migration. To our knowledge, this is the first reported case of an esophagojejunostomy fistula combined with a distal esophageal stenosis as well as with a metallic coated self-expandable stent migration.

  6. Status and Literature Review of Self-Expandable Metallic Stents for Malignant Colorectal Obstruction

    PubMed Central

    Cheung, Dae Young; Lee, Yong Kook

    2014-01-01

    Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review. PMID:24570885

  7. High-Resolution CT and Angiographic Evaluation of NexStent Wall Adaptation

    SciTech Connect

    Nemes, Balazs Lukacs, Levente; Balazs, Gyoergy; Dosa, Edit; Berczi, Viktor; Huettl, Kalman

    2009-05-15

    Carotid stenting is a minimally invasive treatment for extracranial carotid artery stenosis. Stent design may affect technical success and complications in a certain subgroup of patients. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which has a unique rolled sheet design. Forty-one patients had 42 carotid arteries treated with angioplasty and stenting for internal carotid artery stenosis. The mean patient age was 65 {+-} 10 years. All patients underwent high-resolution computed tomographic angiography after the stent implantation. Data analysis included pre- and postprocedural stenosis, procedure complications, plaque calcification, and stent apposition. We reviewed the angiographic and computed tomographic images for plaque coverage and stent expansion. All procedures were technically successful. Mean stenosis was reduced from 84 {+-} 8% before the procedure to 15.7 {+-} 7% after stenting. Two patients experienced transient ischemic attack; one patient had bradycardia and hypotension. Stent induced kinking was observed in one case. Good plaque coverage and proper overlapping of the rolled sheet was achieved in all cases. There was weak correlation between the residual stenosis and the amount of calcification. The stent provides adequate expansion and adaptation to the tapering anatomy of the bifurcation.

  8. A direct nitinol stent delivery technique for endovascular treatment: a sheath-less stenting technique.

    PubMed

    Shintani, Yoshiaki; Kawasaki, Tomohiro; Fujimura, Takashi; Ishida, Kouichirou; Higuchi, Takanori; Kajiwara, Masataka; Fukuoka, Ryota; Orita, Yoshiya; Umeji, Kyoko; Koga, Hisashi; Koga, Nobuhiko

    2015-04-01

    Access site problems often cause serious complications in endovascular treatment. The aim of this study is to investigate whether a sheath-less nitinol stenting technique leads to reduce access site complications. This study was a single-center retrospective analysis of a prospectively maintained database. The study enrolled consecutive 98 patients with 111 lesions undergoing provisional stenting for de novo iliac artery or femoro-popliteal artery stenosis between August 2010 and November 2011. The patients were divided into two groups, a conventional procedure group and a sheath-less procedure group. The outcomes of this study were peri-procedural access site complications, initial success rate, procedure time, hemostatic time and bed-rest time. Forty-four lesions in 39 patients that treated using the sheath-less nitinol stent delivery technique were compared with 67 lesions in 59 patients treated using the conventional procedure. All procedures were successful. The incidence of pseudoaneurysm was significantly lower in the sheath-less procedure group than in the conventional procedure group (p = 0.043). However, there were no significant differences in any other complications. No significant difference was observed in the procedural time (p = 0.309). However, hemostatic time and bed-rest time were significantly shorter in the sheath-less procedure than in the conventional procedure (p < 0.0001). A sheath-less stenting technique reduced the access site incidence of pseudoaneurysm and did not increase other access site complications. Besides, this technique shortened hemostatic time and bed-rest time. The sheath-less stenting technique is considered to be a useful method for endovascular treatment.

  9. Headache after carotid artery stenting.

    PubMed

    Suller Marti, A; Bellosta Diago, E; Velázquez Benito, A; Tejero Juste, C; Santos Lasaosa, S

    2017-04-18

    Headache after carotid artery stenting is a headache with onset during the procedure or in the first few hours after it, and where there is no evidence to suggest a complication of that procedure. The purpose of this study is to describe the main features of these headaches based on our clinical experience. Observational prospective study of a sample of patients undergoing carotid artery stenting at Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain. We recorded sociodemographic characteristics, cardiovascular risk factors, carotid artery disease, and history of primary headache; data were gathered using structured interviews completed before and 24hours after the procedure. We included 56 patients (mean age 67±9.52 years); 84% were men. Twelve patients (21.4%) experienced headache, 83.3% of whom were men; mean age was 60.58±9.31 years. Headache appeared within the first 6hours in 7 patients (58.4%) and during the procedure in 4 (33.3%). Pain lasted less than 10minutes in 4 patients (33.3%) and between 10 and 120minutes in 5 (41.7%). Headache affected the frontotemporal area in 7 patients (58.3%); 7 patients (58.3%) described pain as unilateral. It was oppressive in 8 patients (66.7%) and of moderate intensity in 6 (50%). Nine patients (75%) required no analgesics. We found no statistically significant associations with any of the variables except for age (P=.007; t test). In our sample, headache after carotid artery stenting was mild to moderate in intensity, unilateral, oppressive, and short-lasting. Further studies are necessary to gain a deeper knowledge of its characteristics and associated risk factors. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction.

    PubMed

    Cho, Jae Hee; Jeon, Tae Joo; Park, Jeong Youp; Kim, Hee Man; Kim, Yoon Jae; Park, Seung Woo; Chung, Jae Bock; Song, Si Young; Bang, Seungmin

    2011-02-01

    /or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.

  11. Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones

    PubMed Central

    Wang, Hai; Man, Libo; Li, Guizhong; Huang, Guanglin; Liu, Ning; Wang, Jianwei

    2017-01-01

    Background and aim Ureteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones. Methods Databases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. Results We identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group. Conclusions Our analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings. PMID:28068364

  12. Cost comparison between two modes of Palmaz Schatz coronary stent implantation: transradial bare stent technique vs. transfemoral sheath-protected stent technique.

    PubMed

    Kiemeneij, F; Hofland, J; Laarman, G J; van der Elst, D H; van der Lubbe, H

    1995-08-01

    Coronary Palmaz Schatz stent implantation is usually performed by using the sheath protected stent delivery system (SDS) via the percutaneous transfemoral route. However, downsizing of PTCA equipment made transradial coronary stenting feasible. Bare stent implantation, 6F technique, increased patient mobility, reduced vascular complications and reduced hospital stay may increase cost effectiveness of this novel technique. Two well-documented patient groups selected for elective single vessel and single lesion Palmaz Schatz stent implantation were retrospectively compared. Group A (transradial stenting; n = 35) was compared to Group B (transfemoral stenting; n = 25) derived from the Benestent population, included in our hospital. A comparison was made for three areas of interest: (1) procedural consumption of material (the number of guiding catheters, guidewires, balloon catheters and stents), (2) postprocedural need for diagnostic and therapeutic procedures for stent-related complications, and (3) duration of hospital stay. Differences between these subjects in Group A and B were translated to hospital costs. Although more guiding catheters were used in group A (1.69 +/- 0.87 vs. 1.08 +/- 0.28; P = 0.001), the use of the SDS contributed importantly to higher material costs in group B (cost reduction in group A; 13%). Less patients in group A required diagnostic (2 vs. 7; P = 0.027) and therapeutic (0 vs. 5; P = 0.01) procedures for bleeding complications (cost reduction; 93%). Hospitalization in Group A was shorter (6.4 +/- 4.7 vs. 11.6 +/- 9.9 days; P = 0.005), caused by early and safe mobilization, less vascular complications, and preprocedural adjustment on coumadin (cost reduction; 45%).(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Outcomes of Prosthetic Hemodialysis Grafts after Deployment of Bare Metal versus Covered Stents at the Venous Anastomosis

    SciTech Connect

    Kim, Charles Y. Tandberg, Daniel J.; Rosenberg, Michael D.; Miller, Michael J.; Suhocki, Paul V.; Smith, Tony P.

    2012-08-15

    Purpose: To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts. Methods: Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group. Results: Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01). Conclusion: The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

  14. Coronary artery stent (image)

    MedlinePlus

    ... with a balloon catheter and expands when the balloon is inflated. The stent is then left there to help keep the artery open. ... with a balloon catheter and expands when the balloon is inflated. The stent is then left there to help keep the artery open.

  15. Palliative Airway Stenting Performed Under Radiological Guidance and Local Anesthesia

    SciTech Connect

    Profili, Stefano; Manca, Antonio; Feo, Claudio F. Padua, Guglielmo; Ortu, Riccardo; Canalis, Giulio C.; Meloni, Giovanni B.

    2007-02-15

    Purpose. To assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures. Methods. We report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec. Results. We obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration. Conclusions. Tracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated.

  16. Controlled Atrial Fibrillation after Pulmonary Vein Stenting

    PubMed Central

    Park, Young-Ah; Seo, Jiwon

    2017-01-01

    When there is no pulmonary vein reconnection after catheter ablation for atrial fibrillation, patients can experience recurrence of atrial fibrillation without clear evidence of non-pulmonary vein foci. We describe a patient with significant pulmonary vein stenosis and recurrent atrial fibrillation after four ablation procedures. After successful pulmonary vein stenting, the symptoms were resolved, and sinus rhythm was maintained for 2 years without treatment with antiarrhythmic medication. We believe pulmonary vein stenting potentially controlled atrial fibrillation by providing pulmonary vein pressure relief or by compressing the epicardial triggers occurring at the pulmonary vein ostium. PMID:28765746

  17. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy.

    PubMed

    Slim, Rita; Smayra, Tarek; Chakhtoura, Ghassan; Noun, Roger

    2013-11-01

    Laparoscopic sleeve gastrectomy is known to be associated with a risk of gastric staple line leak. We report on our experience with endoscopic stenting of the anomalous leaking tract. Three cases of post sleeve gastric leak confirmed by computed tomography scan were treated by endoscopic stenting of their leak with a plastic endoprosthesis under fluoroscopic and endoscopic guidance. Endoscopic stenting by means of biliary or pancreatic endoprosthesis was successful in the three patients. The median number of endoscopy procedures per patient was 1.3. Stents were extracted 6 to 10 weeks after their placement. Neither morbidity nor recurrence was noticed on follow-up. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy proved to be an efficacious technique for leak healing.

  18. Treatment of Carotid Siphon Aneurysms with a Microcell Stent

    PubMed Central

    Leonardi, M.; Dall’Olio, M.; Princiotta, C.; Simonetti, L.

    2008-01-01

    Summary The treatment of giant, large, multiple or wide-necked carotid siphon aneurysms has always represented a challenge for neurosurgeons and neuroradiologists. Very recently the use of stents with tiny holes has been proposed by two companies: Balt Silk Stent in Europe and Pi-peline in America. We have used the Silk stent on a few patients and describe our first case who now has an eleven month follow-up. The carotid siphon presented three converging aneurysms sharing a very large common neck. The Silk stent (Balt Extrusion, Montmorency, France) was deployed through a 4F Balt introducer. The procedure was uneventful and very quick. As soon as the stent was positioned contrast medium stagnation was displayed within the aneur-ysm. The patient’s post-operative course was normal and she was discharged three days later in good health. PMID:20557742

  19. [Problems with Ureteral Stents – a Never-Ending Story].

    PubMed

    Betschart, Patrick; Schmid, Hans-Peter; Abt, Dominik

    2016-03-16

    Temporary drainage of the upper urinary tract by internal ureteral stents is a common procedure to assure renal function and to treat pain caused by ureteral obstruction. Ureteral stents are frequently associated with side effects like urinary symptoms, pain or hematuria resulting in frequent medical consultations. In addition to good patient education, symptomatic drug therapy of stent-associated symptoms is often indicated and sufficient. However, complications like stent dysfunction or significant urinary tract infections have to be kept in mind, as they require further diagnostics and treatment. Therefore, especially general practitioners as a primary point of contact for the patients should be familiar with common ureteral stent-associated problems, their treatment and indications for patient referrals.

  20. Open stent grafting for complex diseases of the thoracic aorta: clinical utility.

    PubMed

    Uchida, Naomichi

    2013-03-01

    Open stent grafting is an alternative treatment for extensive thoracic aortic replacement. However, this procedure is associated with a high incidence of spinal cord injury, which has limited its application. Multiple factors have been suggested to explain the risk of spinal cord injury, including deep delivery of the stent graft, history of operation of the downstream aorta, and postoperative low blood pressure. Cerebrospinal fluid drainage or a hybrid operation in combination with trans-femoral thoracic stent grafting is useful for preventing spinal cord injury. Open stent grafting remains an alternative treatment for atherosclerotic aneurysms with dilatation of the ascending aorta. Open stent grafting for acute aortic dissection is effective for remodeling of the false lumen. The graft diameter for aortic dissection should be 90 % of the total diameter of the aorta, and the distal landing zone should be limited to the T7 vertebral level to prevent new intimal tears or spinal cord injury. Open stent grafting seems a feasible bailout strategy for the treatment of retrograde aortic dissection after TEVAR for type B aortic dissection. Newly designed devices for open stent grafts include the Matsui-Kitamura stent graft or branched open stent graft, which is produced in Japan. The effectiveness of open stent grafting in the treatment of Marfan syndrome remains unclear. A commercially available device for open stent grafting would be desired in Japan. In conclusion, an open stent graft remains an alternative treatment for complex thoracic aortic pathologies.

  1. Extracorporeal shock wave lithotripsy in the primary treatment of encrusted ureteral stents.

    PubMed

    Irkilata, Lokman; Ozgur, Berat Cem; Sancaktutar, Ahmet Ali; Akdeniz, Ekrem; Aydin, Mustafa; Demirel, Huseyin Cihan; Aydin, Hasan Riza; Doluoglu, Omer Gokhan; Resorlu, Berkan; Atilla, Mustafa Kemal

    2015-08-01

    Double pigtail (JJ) ureteral stents, are the most commonly used method of urinary diversion in the ureteral obstructions. Encrustations may occur as a result of prolonged exposure due to forgetting these stents in the body. Removing these materials might be an annoyance. Forty-four patients from three tertiary referral centres with forgotten JJ stents left in them between the years 2007 and 2014 were included in the study. Stents could not be removed by attempted cystoscopy. As an alternative approach, extracorporeal shock wave lithotripsy (ESWL) was the first choice since it is minimally invasive. The results of that treatment are presented along with the relevant demographic data. JJ stenting for urolithiasis was performed in 36 patients, after open surgery in five patients, and for oncological reasons in three patients. ESWL was applied to stents or to any suspicious region adjacent to the stent. In 29 of 44 patients, the stents were easily removed under cystoscopic procedures while in one patient the fragmented residual stent was spontaneously excreted. In eight patients, ureteroscopy was required; in five patients, percutaneous nephrolithotripsy was required; and in one patient, open surgery was required in order to remove stents. ESWL can be considered as a first-line treatment when a forgotten JJ stent is detected despite all precautions after any kind of urological intervention involving insertion of ureteral stents.

  2. Management of Forgotten Ureteral Stents: Relationship Between Indwelling Time and Required Treatment Approaches.

    PubMed

    Polat, Hacı; Yücel, Mehmet Özgür; Utangaç, Mehmet M; Benlioğlu, Can; Gök, Alper; Çift, Ali; Kalyenci, Bedreddin; Lök, Uğur; Gülaçtı, Umut

    2017-08-04

    Double-J stents are widely used in urology practice, and removal of these stents can sometimes be forgotten. To investigate whether indwelling time of double-J stent can predict which treatment modality is required for removal of the stent from the body. A multicentre, retrospective observational study. The data of 57 patients who were treated for forgotten ureteral stents between January 2007 and December 2014 were evaluated retrospectively. Patients were classified into four groups according to indwelling time of the stents: 6-12 months, 13-24 months, 25-36 months, and <36 months. Encrustation and associated stone burden of the stents were evaluated with non-contrast stone protocol computerised tomography. Patients were classified according to their duration of the stent indwelling time. Simple cystoscopic stent retrieval was performed in 71.4% of patients in the 6-12 months group, 44% of patients in the 13-24 months group, 6.2% of patients in the 25-36 months group, and 11.1% of patients in the <36 months group. A percutaneous or open surgery was required in no patients with an indwelling time of double-J stent shorter than 30 months. Transurethral and/or percutaneous combined endo-urological approaches are usually sufficient for the removal of forgotten double-J stents. Transurethral procedures are sufficient for the treatment of patients with double-J stent indwelling times less than 30 months.

  3. Forgotten urological stent.

    PubMed

    Bhuiyan, Z H; Bhuiyan, N I; Khan, S A; Tawhid, M H; Islam, M F

    2011-10-01

    "Forgotten" Ureteral stent DJ stent related complication is not uncommon even in the era of modern urology in the developed world. In this context we have undertaken a retro-prospective study in relation to its various causes, complications, management and prevention of forgotten stents in a single teaching institute. The study period was from January'04 to December'09. The sample size was 60. The effect of "forgotten stent" in our study reflects mild UTI to various complications including severe renal failure. We had approached all of our cases judiciously using various modalities of minimal access endourological techniques either alone or in combinations with successful outcome. The study concluded that it is vary easy to prevent "forgotten stent" and so its complications. However if we confront such unwanted complications that could be managed successfully with the use of endourological techniques. We did not use other techniques like laparoscopy and open surgery in this study.

  4. Peri-stent aneurysm formation following a stent implant for stenotic intracranial vertebral artery dissection: a technical report of two cases successfully treated with coil embolization.

    PubMed

    Ishimaru, Hideki; Nakashima, Kazuaki; Takahata, Hideaki; Matsuoka, Yohjiro

    2013-02-01

    Although stenting for stenotic vertebral artery dissection (VAD) improves compromised blood flow, subsequent peri-stent aneurysm (PSA) formation is not well-known. We report two cases with PSA successfully treated with coil embolization. Three patients with stenotic intracranial VAD underwent endovascular angioplasty at our institution because they had acute infarction in posterior circulation territory and clinical evidence of hemodynamic insufficiency. In two of three patients balloon angioplasty at first session failed to relieve the stenosis, and a coronary stent was implanted. Angiography immediately after stenting showed no abnormality in case 1 and minimal slit-like projection at proximal portion of the stent in case 2. Angiography obtained 16 months after the stenting revealed PSA in case 1. In case 2, angiography performed 3 months later showed that the projection at proximal portion enlarged and formed an aneurysm outside the stent. Because follow-up angiographies showed growth of the aneurysm in both cases, endovascular aneurysmal embolization was performed. We advanced a microcatheter into the aneurysm through the strut of existing stent and delivered detachable coils into the aneurysm lumen successfully in both cases. The post-procedural course was uneventful, and complete obliteration of aneurysm was confirmed on angiography in both cases. Stenting for stenotic intracranial VAD may result in delayed PSA; therefore, follow-up angiographies would be necessary after stenting for stenotic intracranial arterial dissection. Coil embolization through the stent strut would be a solution for enlarging PSA.

  5. Role of metallic stents in benign esophageal stricture

    NASA Astrophysics Data System (ADS)

    Shim, Chan Sup

    2012-10-01

    Simple esophageal strictures, which are focal, straight, and large in diameter, usually require 1 - 3 dilation sessions to relieve symptoms. However, complex strictures, which are long, tortuous, or associated with a severely compromised luminal diameter, are usually more difficult to treat with conventional bougie or balloon dilation techniques, and often have high recurrence rates. Although the permanent placement of self-expandable metal stents (SEMS) has been used to manage refractory benign esophageal strictures, this procedure is associated with additional problems, such as stricture from tissue hyperplasia, stent migration, and fistula formation. Thus, several new types of stents have been developed, including temporary SEMS, self-expandable plastic stents (SEPS), and biodegradable stents. The use of these new products has produced varied results. Temporary SEMS that have been used to relieve benign esophageal conditions have caused granulation tissue at both ends of the stent because of contact between the mucosa and the exposed metal components of the stent, thus hindering stent removal. We examined the tissue response to two new types of SEMS, a flange-type and a straighttype, each coated with a silicone membrane on the outside of the metal mesh. These two SEMS were evaluated individually and compared with a conventional control stent in animal experiments. Although the newly designed stents resulted in reduced tissue hyperplasia, and were thus more easily separated from the esophageal tissue, some degree of tissue hyperplasia did occur. We suggest that newly designed DES (drug-eluting stents) may provide an alternative tool to manage refractory benign esophageal stricture.

  6. Hybrid procedure combining clip on wrapping and stent placement for ruptured supraclinoid blood blister-like aneurysm of the internal carotid artery.

    PubMed

    Nagasaki, Hirokazu; Narikiyo, Michihisa; Nagayama, Gota; Nagao, Seiya; Tsuboi, Yoshifumi; Kambayashi, Chisaku

    2017-03-01

    Blood blister-like aneurysms of the supraclinoid portion of the internal carotid artery are rare, fragile, and thin-walled lesions with a higher rate of rebleeding. Our case underwent a hybrid procedure combining direct surgical and endovascular approach.

  7. Intraarterial Pressure Gradients After Randomized Angioplasty or Stenting of Iliac Artery Lesions

    SciTech Connect

    Tetteroo, Eric; Haaring, Cees; Graaf, Yolanda van der; Schaik, Jan P.J. van; Engelen, A.D. van; Mali, Willem P.T.M.

    1996-11-15

    Purpose: To determine initial technical results of percutaneous transluminal angioplasty (PTA) and stent procedures in the iliac artery, mean intraarterial pressure gradients were recorded before and after each procedure. Methods: We randomly assigned 213 patients with typical intermittent claudication to primary stent placement (n= 107) or primary PTA (n= 106), with subsequent stenting in the case of a residual mean pressure gradient of > 10 mmHg (n= 45). Eligibility criteria included angiographic iliac artery stenosis (> 50% diameter reduction) and/or a peak systolic velocity ratio > 2.5 on duplex examination. Mean intraarterial pressures were simultaneously recorded above and below the lesion, at rest and also during vasodilatation in the case of a resting gradient {<=} 10 mmHg. Results: Pressure gradients in the primary stent group were 14.9 {+-} 10.4 mmHg before and 2.9 {+-} 3.5 mmHg after stenting. Pressure gradients in the primary PTA group were 17.3 {+-} 11.3 mmHg pre-PTA, 4.2 {+-} 5.4 mmHg post-PTA, and 2.5 {+-} 2.8 mmHg after selective stenting. Compared with primary stent placement, PTA plus selective stent placement avoided application of a stent in 63% (86/137) of cases, resulting in a considerable cost saving. Conclusion: Technical results of primary stenting and PTA plus selective stenting are similar in terms of residual pressure gradients.

  8. [Stent for neurovascular diseases].

    PubMed

    Sakai, Nobuyuki; Sakai, Chiaki

    2009-09-01

    A stent is a medical device that can provide scaffolding to vessels and organ walls to keep the arteries open. Different types of stents have been used in the filed of neurovascular diseases, such as atherosclerosis and aneurysms. Carotid artery stenting (CAS) was approved in 2007 in Japan, and it has been widely used as an alternative to carotid endarterectomy (CEA) for treating severe carotid artery stenosis. According to current approval, the indications of carotid artery stenting are observed in high-surgical-risk patients, patients with more than 50% symptomatic stenosis, and those with more than 80% asymptomatic stenosis. The use of nickel-titanium (nitinol) crush-resistant self-expanding stents (Precise) and emblic-protection devices (Angioguard XP) has been approved. Intracranial atherosclerotic disease have frequently posed a risk for recurrent stroke despite the intensive medical treatment. The design of the Wingspan stent system is different from that of balloon-expandable stents. Target lesions are predilated with an undersized angioplasty balloon, followed by stent deployment. Another important indication is for intracranial aneurysms. Since the discovery Guglielmi dechatable coils (GDC) in the early 1990s, endovascular treatment has been drastically improved all over the world. However, a high recurrence rate is observed when large and wide-necked aneurysms are treated with detachble coils. The application of self-expanding stents such as Neuroform, Enterprize, or LEO, is effective for packing coils into the aneurysm, and flow modification effect can be achieved for the curative reconstruction of the parent arteries. Further reserch will confirm the application of stents for the treatment of cerebrovascular disease.

  9. Differences in Endothelial Injury After Balloon Angioplasty, Insertion of Balloon-Expanded Stents or Release of Self-Expanding Stents: An Electron Microscopic Experimental Study

    SciTech Connect

    Harnek, Jan; Zoucas, Evita; Carlemalm, Erik; Cwikiel, Wojciech

    1999-01-15

    Purpose: To evaluate which of six different commonly available stents inserted into an artery without percutaneous transluminal angioplasty (PTA) causes the least endothelial damage. To compare the degree of endothelial injury after insertion of such a stent with injury caused by PTA. Methods: Twelve healthy pigs were used in the experiments. In the first part of the study six different types of stents were inserted into the common iliac arteries. In the second part of the study self-expanding stents with large spaces between the wires were used. PTA was performed in the contralateral iliac artery. The pigs were killed immediately after the procedure and resected specimens examined after fixation, using scanning electron microscopy. Results: All procedures but two were accomplished successfully. More endothelium was preserved after insertion of self-expanding stents with large spaces between the wires, compared with stents with small spaces and balloon-expanded stents. After insertion of self-expanding stents with large spaces, 50.1% {+-} 16.4% of the endothelium remained intact, compared with only 5.6% {+-} 7.7% after PTA. The difference was statistically significant (p < 0.001). Conclusion: Self-expanding stents with large spaces between the wires, inserted without PTA, cause less damage to the endothelium than other stents and significantly less damage than PTA.

  10. Primary Stenting in Infrarenal Aortic Occlusive Disease

    SciTech Connect

    Nyman, Ulf; Uher, Petr; Lindh, Mats; Lindblad, Bengt; Ivancev, Krasnodar

    2000-03-15

    Purpose: To evaluate the results of primary stenting in aortic occlusive disease.Methods: Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months).Results: Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented.Conclusions: Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.

  11. Stent intussusception after thromboaspiration through a platinum chrome stent: a particular case of longitudinal stent deformation.

    PubMed

    Mila, Rafael; Vignolo, Gustavo; Trujillo, Pedro

    2015-04-01

    The need to improve stent deliverability has led to the development of thinner and more flexible stents. However, there is concern about decreased longitudinal strength. The number of longitudinal stent deformation reports has dramatically increased. We report a case of stent longitudinal deformation after thromboaspiration through a new generation platinum chrome bare metal stent. Images show an "intussusception effect," an extreme form of the previously described "concertina deformation," as the mechanism of shortening. Since stent technology is constantly evolving, newer devices will probably be designed to have less susceptibility to longitudinal stent deformation.

  12. Reverse waffle cone technique in management of stent dislodgement into intracranial aneurysms.

    PubMed

    Luo, Chao-Bao; Lai, Yen-Jun; Teng, Michael Mu-Huo; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

    2013-09-01

    Stent-assisted coil embolization (SACE) is a common method to manage intracranial wide-neck aneurysm. Using this technique, a stent must be successfully deployed into the parent artery to cross the aneurysm neck. We describe the reverse waffle cone technique in management of intra-procedural stent dislodgement during SACE of internal carotid artery (ICA) wide-neck aneurysms. Two patients with unruptured wide-neck ICA aneurysms underwent SACE. Intra-procedural forward stent migration occurred during catheterization with proximal stent dislodgement and migration into the aneurysm sac. Navigation of a second stent to bridge the aneurysm neck failed in one patient because the second stent was impeded by the dislodged stent. Using the reverse waffle cone technique, a microcatheter was navigated into the aneurysm sacs. Coils were safely detached into each aneurysm sac without any device assistance. The two wide-neck aneurysms were successfully treated with preservation of flow to the internal carotid arteries. The complication of intra-procedural distal stent migration and dislodgement, with proximal stent prolapse into an aneurysm sac, may not result in a failure to coil the aneurysm. The reverse waffle cone technique provides an effective treatment in the management of this complication. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Inadvertent intracoronary stent extraction 10 months after implantation complicating cutting balloon angioplasty for in-stent restenosis

    SciTech Connect

    Almeda, Francis Q.; Billhardt, Roger A

    2003-09-01

    We report the case of an unusual complication for Cutting Balloon Angioplasty (CBA) during treatment for instent restenosis (ISR), which resulted in inadvertent intracoronary stent extraction 10 months after implantation. In this case report, CBA was utilized to treat an ISR lesion in the distal right coronary artery (RCA). Due to difficulty in withdrawing the cutting balloon into the guide after treatment of the lesion, the entire system (guide, cutting balloon, and guidewire) was removed as a unit from the body. Upon examination of the system, the previously placed stent in the distal RCA was attached to the microtomes of the cutting balloon. Although the precise mechanisms for stent extraction in this case remain speculative, the initial stent used in the distal RCA may have been undersized, and this may have played a major role in this complication. Although there is limited data regarding the optimal strategy to treat the site of the inadvertent stent extraction, we opted to re-stent the area with a properly-sized coronary stent. Following the intervention, there was no residual stenosis with TIMI 3 flow through the vessel. The patient remained asymptomatic and a serum troponin drawn 18 hours after the procedure was normal, and he was discharged the next day. The interventionist must be vigilant about this rare but serious complication when applying CBA in the treatment of ISR, particularly when an undersized or underdeployed stent is suspected.

  14. A Fatal Complication: Intestinal Perforation Secondary to Migration of a Biliary Stent

    PubMed Central

    Güngör, Gülay; Okur, Nazan

    2016-01-01

    Summary Background Stent insertion is widely performed to restore biliary drainage in hepatic, biliary, and pancreatic obstructive conditions. Intestinal perforation due to the migration of these stents is an extremely rare late-term complication that is associated with a high rate of mortality. The current report aimed at presenting the radiological findings of a case of extraluminal biliary stent migration into the pelvic region that caused intestinal perforation. Case Report We report a case of an 85-year-old male with a history of previous stent insertion who presented with a sudden – onset severe abdominal pain. An abdominal multidetector computed tomography (MDCT) revealed a tubular foreign body density, compatible with intestinal perforation due to migration of the biliary stent. Conclusions Biliary stent insertion becomes a more common procedure. This serious complication must always be remembered in patients presenting with abdominal pain after stent insertion. PMID:27141238

  15. Endovascular Gene Delivery from a Stent Platform: Gene- Eluting Stents

    PubMed Central

    Fishbein, Ilia; Chorny, Michael; Adamo, Richard F; Forbes, Scott P; Corrales, Ricardo A; Alferiev, Ivan S; Levy, Robert J

    2015-01-01

    A synergistic impact of research in the fields of post-angioplasty restenosis, drug-eluting stents and vascular gene therapy over the past 15 years has shaped the concept of gene-eluting stents. Gene-eluting stents hold promise of overcoming some biological and technical problems inherent to drug-eluting stent technology. As the field of gene-eluting stents matures it becomes evident that all three main design modules of a gene-eluting stent: a therapeutic transgene, a vector and a delivery system are equally important for accomplishing sustained inhibition of neointimal formation in arteries treated with gene delivery stents. This review summarizes prior work on stent-based gene delivery and discusses the main optimization strategies required to move the field of gene-eluting stents to clinical translation. PMID:26225356

  16. Endovascular Gene Delivery from a Stent Platform: Gene- Eluting Stents.

    PubMed

    Fishbein, Ilia; Chorny, Michael; Adamo, Richard F; Forbes, Scott P; Corrales, Ricardo A; Alferiev, Ivan S; Levy, Robert J

    A synergistic impact of research in the fields of post-angioplasty restenosis, drug-eluting stents and vascular gene therapy over the past 15 years has shaped the concept of gene-eluting stents. Gene-eluting stents hold promise of overcoming some biological and technical problems inherent to drug-eluting stent technology. As the field of gene-eluting stents matures it becomes evident that all three main design modules of a gene-eluting stent: a therapeutic transgene, a vector and a delivery system are equally important for accomplishing sustained inhibition of neointimal formation in arteries treated with gene delivery stents. This review summarizes prior work on stent-based gene delivery and discusses the main optimization strategies required to move the field of gene-eluting stents to clinical translation.

  17. Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients

    PubMed Central

    Kang, Chae Hoon; Yang, Seung Boo; Lee, Woong Hee; Ahn, Jae Hong; Goo, Dong Erk; Han, Nae Jin; Ohm, Joon Young

    2016-01-01

    Background Central vein stenosis or occlusion is a common complication that can lead to significant morbidity and dysfunction of access in the hemodialysis patient. More lesions can develop over time, and preserving access becomes a challenge as life expectancy of the hemodialysis patient increases. Objectives The goal was to compare long-term results and determine the outcomes of open-cell stent versus closed-cell stent for central vein stenosis or occlusion in hemodialysis patients. Patients and Methods From 1997 to 2015, in 401 hemodialysis patients, stent placement for central vein stenosis or occlusion was performed if balloon angioplasty was unsatisfactory, due to elastic recoil or occurrence of restenosis within 3 months. When thrombus was present, primary stenting was performed. A total of 257 open-cell stents and 144 closed-cell stents were used. Angiographic findings including lesion site, central vein stenosis or occlusion, and presence of thrombosis and complication were evaluated. Primary patency rate and mean patency rate of the stent were compared between two stent groups by Kaplan-Meier survival analysis. Results For the open-cell stent group, 159 patients were diagnosed as central vein stenosis and 98 were occlusion. For the closed-cell stent group, 78 were stenosis and 66 were occlusion. There were two complications for central migration and two for procedure-related vein rupture. Open-cell stents and closed-cell stents had mean patency rates of 10.9 ± 0.80 months and 8.5 ± 10.87 months, respectively (P = 0.002). Conclusion The open-cell stent is effective and its performance is higher than that obtained with the closed-cell stent for treating central vein stenosis or occlusion in hemodialysis patients. PMID:27895880

  18. Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients.

    PubMed

    Kang, Chae Hoon; Yang, Seung Boo; Lee, Woong Hee; Ahn, Jae Hong; Goo, Dong Erk; Han, Nae Jin; Ohm, Joon Young

    2016-10-01

    Central vein stenosis or occlusion is a common complication that can lead to significant morbidity and dysfunction of access in the hemodialysis patient. More lesions can develop over time, and preserving access becomes a challenge as life expectancy of the hemodialysis patient increases. The goal was to compare long-term results and determine the outcomes of open-cell stent versus closed-cell stent for central vein stenosis or occlusion in hemodialysis patients. From 1997 to 2015, in 401 hemodialysis patients, stent placement for central vein stenosis or occlusion was performed if balloon angioplasty was unsatisfactory, due to elastic recoil or occurrence of restenosis within 3 months. When thrombus was present, primary stenting was performed. A total of 257 open-cell stents and 144 closed-cell stents were used. Angiographic findings including lesion site, central vein stenosis or occlusion, and presence of thrombosis and complication were evaluated. Primary patency rate and mean patency rate of the stent were compared between two stent groups by Kaplan-Meier survival analysis. For the open-cell stent group, 159 patients were diagnosed as central vein stenosis and 98 were occlusion. For the closed-cell stent group, 78 were stenosis and 66 were occlusion. There were two complications for central migration and two for procedure-related vein rupture. Open-cell stents and closed-cell stents had mean patency rates of 10.9 ± 0.80 months and 8.5 ± 10.87 months, respectively (P = 0.002). The open-cell stent is effective and its performance is higher than that obtained with the closed-cell stent for treating central vein stenosis or occlusion in hemodialysis patients.

  19. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

    SciTech Connect

    Mahnken, Andreas H.; Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M.

    2013-08-01

    BackgroundAortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.MethodsWe report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.ResultsBoth procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.ConclusionTreating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.

  20. [Advantages of endoscopic stenting for malignant gastrointestinal obstructions].

    PubMed

    Meier, P N; Manns, M P

    2006-03-01

    Self-expanding stents play a major role in the interdisciplinary treatment of gastrointestinal obstructions in patients with local nonresectable tumors, advanced metastasis, and pronounced comorbidity. Reinstenting the passage and sealing esophagotracheal fistulae is very effective as palliative treatment for esophageal tumor complications. In hepatobiliary occlusions, the success rate against cholestasis is also high. Enteral and colorectal stents are gaining favor. Required are an experienced endoscopy team and adequate equipment. The rate of procedural complications is generally low, but rare and severe complications such as perforation must be considered. Further improvements in the materials and construction of stents can be expected.

  1. Evaluation of urethral stent placement for benign urethral obstructions in dogs.

    PubMed

    Hill, T L; Berent, A C; Weisse, C W

    2014-01-01

    Benign urethral obstructions (BUO) in dogs result in substantial morbidity because of challenges with conventional therapies. Treatment of malignant urethral obstructions with intraluminal urethral stents is reported to successfully relieve obstructions. To evaluate the efficacy and outcome of urethral stent placement for treatment of BUO in dogs. Eleven client-owned animals with urethral stents placed for treatment of BUO. Retrospective study in which medical records were reviewed in dogs diagnosed with BUO and treated with a metallic urethral stent. Data collected included signalment, cause of benign obstruction, procedure time, size and type of stent, complications, and short- and long-term outcome. Eleven dogs with 15 urethral stents were included. Intraluminal urethral stent(s) relieved the obstructions in all dogs. Four dogs had 2 stents placed in separate procedures because of incomplete patency after treatment (n = 1), inadvertent compression of the stent (n = 1), or tissue ingrowth through the stent (n = 2). The median continence score after stent placement was 10 of 10 (range 3-10) with 6 dogs being continent, 3 mildly incontinent, and 1 each moderately and severely incontinent. All owners considered their dog to have an excellent long-term clinical outcome with long-term urethral patency. The median follow-up time was 24 months (range 4-48). Urethral stents appear to be an effective treatment for benign urinary obstructions. Moderate to severe incontinence developed in a minority (12.5%) of dogs. Stents relieved obstructions in all dogs with an excellent long-term outcome. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  2. Computed tomography measurements for airway stent insertion in malignant airway obstruction.

    PubMed

    Righini, Christian; Aniwidyaningsih, Wahju; Ferretti, Gilbert; Pra, Yves; Raymond, Christel Saint; Ferretti, Katharina; Hustache, Claire; Diab, Samia; Reyt, Emile; Pison, Christophe M

    2010-01-01

    Metallic airway stents for malignant airway obstruction are considered safe, yet are not without complications. This study reviews the role of computed tomography (CT) airway measurements for planning stent placement in malignant airway obstruction before the actual therapeutic procedure to avoid invasive diagnostic evaluation before the stent placement and to reduce complications. This study is a retrospective review of information from a stent order database and medical records of patients receiving stents for malignant airway obstruction at a university hospital over a 12-year period. CT scans were used to determine stent diameter by calculating mean diameters of healthy adjacent zones (proximal and distal), stent length (length of diseased airway), and location and number of potential stents. Results of CT planning before bronchoscopy were judged by complication rates. Patient population consisted of 69 patients, 61.7±14.0 years old, 40 males, in whom 92 stents were inserted. The most frequent cause of airway obstructions was tracheobronchial cancer (32). All patients had nitinol stent placement; 66 stents were covered and 26 were uncovered. Follow-up time was 1 to 1067 days (median: 35 days). Complication rate was 10.1% and mainly involved the patients with tracheal obstruction (6). Complications included stent fractures (2), migration (2), granuloma (1), and infectious tracheitis (2). One early death within 24 hours after the procedure was not related to stent placement. Five patients required follow-up therapeutic bronchoscopy to treat the complications. These results suggest that prestent planning by noninvasive method of obtaining CT scan provides optimal stent size and position, possibly avoiding a diagnostic bronchoscopy and reducing complications. Further prospective study is needed to confirm these results because of limitation of this study's design.

  3. Dedicated bifurcation stents - Mechanistic, hardware, and technical aspects.

    PubMed

    Mishra, Sundeep

    Percutaneous coronary intervention (PCI) in bifurcation lesions is associated with lower success rate, higher acute complication rates and higher event rates in follow-up. The reason for this higher than usual complication rate relates to the relationship between anatomy, flow, and atheroma distribution in bifurcation lesions. Further, stenting these lesions can be a prolonged procedure and can be technically more demanding. The most common complication is the loss of significant side branch (SB). Main vessel (MV) stenting may enhance the carina displacement and atheroma shift across the SB ostium leading to SB ostium narrowing. Finally, complications, if they occur, are more difficult to manage. Dedicated bifurcation stent has been developed to overcome the number of limitations associated with conventional bifurcation PCI. The main advantage of most dedicated bifurcation stents is to allow the operator to perform the procedure on a bifurcation lesion without the need to rewire the SB.

  4. Air cholangiography in endoscopic bilateral stent-in-stent placement of metallic stents for malignant hilar biliary obstruction.

    PubMed

    Lee, Jae Min; Lee, Sang Hyub; Jang, Dong Kee; Chung, Kwang Hyun; Park, Jin Myung; Paik, Woo Hyun; Lee, Jun Kyu; Ryu, Ji Kon; Kim, Yong-Tae

    2016-03-01

    Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction.

  5. Influence of stent configuration on cerebral aneurysm fluid dynamics.

    PubMed

    Babiker, M Haithem; Gonzalez, L Fernando; Ryan, Justin; Albuquerque, Felipe; Collins, Daniel; Elvikis, Arius; Frakes, David H

    2012-02-02

    Embolic coiling is the most popular endovascular treatment available for cerebral aneurysms. Nevertheless, the embolic coiling of wide-neck aneurysms is challenging and, in many cases, ineffective. Use of highly porous stents to support coiling of wide-neck aneurysms has become a common procedure in recent years. Several studies have also demonstrated that high porosity stents alone can significantly alter aneurysmal hemodynamics, but differences among different stent configurations have not been fully characterized. As a result, it is usually unclear which stent configuration is optimal for treatment. In this paper, we present a flow study that elucidates the influence of stent configuration on cerebral aneurysm fluid dynamics in an idealized wide-neck basilar tip aneurysm model. Aneurysmal fluid dynamics for three different stent configurations (half-Y, Y and, cross-bar) were first quantified using particle image velocimetry and then compared. Computational fluid dynamics (CFD) simulations were also conducted for selected stent configurations to facilitate validation and provide more detailed characterizations of the fluid dynamics promoted by different stent configurations. In vitro results showed that the Y stent configuration reduced cross-neck flow most significantly, while the cross-bar configuration reduced velocity magnitudes within the aneurysmal sac most significantly. The half-Y configuration led to increased velocity magnitudes within the aneurysmal sac at high parent-vessel flow rates. Experimental results were in strong agreement with CFD simulations. Simulated results indicated that differences in fluid dynamic performance among the different stent configurations can be attributed primarily to protruding struts within the bifurcation region.

  6. Bioabsorbable Stent Quo Vadis: A Case for Nano-Theranostics

    PubMed Central

    Gundogan, Buket; Tan, Aaron; Farhatnia, Yasmin; Alavijeh, Mohammad S.; Cui, Zhanfeng; Seifalian, Alexander M.

    2014-01-01

    Percutaneous coronary intervention (PCI) is one of the most commonly performed invasive medical procedures in medicine today. Since the first coronary balloon angioplasty in 1977, interventional cardiology has seen a wide array of developments in PCI. Bare metal stents (BMS) were soon superseded by the revolutionary drug-eluting stents (DES), which aimed to address the issue of restenosis found with BMS. However, evidence began to mount against DES, with late-stent thrombosis (ST) rates being higher than that of BMS. The bioabsorbable stent may be a promising alternative, providing vessel patency and support for the necessary time required and thereafter degrade into safe non-toxic compounds which are reabsorbed by the body. This temporary presence provides no triggers for ST, which is brought about by non-endothelialized stent struts and drug polymers remaining in vivo for extended periods of time. Likewise, nano-theranostics incorporated into a bioabsorbable stent of the future may provide an incredibly valuable single platform offering both therapeutic and diagnostic capabilities. Such a stent may allow delivery of therapeutic particles to specific sites thus keeping potential toxicity to a minimum, improved ease of tracking delivery in vivo by embedding imaging agents, controlled rate of therapy release and protection of the implanted therapy. Indeed, nanocarriers may allow an increased therapeutic index as well as offer novel post-stent implantation imaging and diagnostic methods for atherosclerosis, restenosis and thrombosis. It is envisioned that a nano-theranostic stent may well form the cornerstone of future stent designs in clinical practice. PMID:24672583

  7. State of the Art: Which Stent for Which Lesion in Peripheral Interventions?

    PubMed Central

    Henry, Michel; Klonaris, Christos; Amor, Max; Henry, Isabelle; Tzvetanov, Kiril

    2000-01-01

    Applications of endovascular procedures have been expanded dramatically throughout the human body for both occlusive and aneurysmal disease; arteries at the aortoiliac and femoropopliteal levels are no exception. Currently, interventional procedures are the 1st treatment option for most patients who have peripheral artery disease. Although balloon angioplasty alone offers good immediate and long-term results, the addition of stents has been proposed to improve the procedural success of angioplasty and extend its application to more patients with vascular disease. Stenting, however, is controversial. Its use is considered acceptable in the aortoiliac vessels but is more in dispute for the femoro-popliteal vessels. Moreover, the rapid development of endovascular stents for peripheral applications has made stent selection a complicated task for clinical practitioners. Many factors influence the type of stent selected; therefore, knowledge of the stents available—including various designs and individual properties—is mandatory. Appropriate selection depends on adequate preprocedural evaluation of the lesion; the choice of approach; the choice of primary versus selective stent placement; the location and characteristics of the lesion; the availability of stents in the intervention suite; and the experience of the operator. Several stents are now available, but they are not equivalent; it is important to select the stent that is best suited to the lesion. On the basis of our experience using different types of stents, as well as our review of the world medical literature, we summarize the properties of various stents and specific indications for their application. This report is intended for use as a practical guide to stent selection. PMID:10928499

  8. In situ cooling with ice water for the easier removal of self-expanding nitinol stents

    PubMed Central

    Merkel, Daniel; Brinkmann, Eckhard; Wiens, Daniel; Derwahl, Karl-Michael

    2015-01-01

    Background: It is yet to be determined what effects temperature has on the properties of nitinol in order to simplify the process of removing nitinol self-expanding metal stents (SEMS). Materials and methods: We describe the procedure for removal of SEMS in a total of 11 cases with 9 patients. A study involving cooling of nitinol stents in situ with ice water just before their removal was attempted. Results: All stents were removed successfully. In partially covered and in fully covered stents, the stent rigidity was noticeably reduced following cooling. Stent removal was performed by inversion, which was achieved by pulling on the stent from its distal end. No adverse events were observed during this trial. Conclusion: The higher pliability of the stents after ice-water cooling facilitates stent removal. With this method, a mobilization of all stents by the invagination technique was achieved. The separation of the uncoated stent ends from the intestinal wall by the invagination technique, as well as the mucosal vasoconstriction resulting from the cooling, lead to an easier SEMS removal and may serve to prevent severe bleeding of the mucosal wall during this process. PMID:26134772

  9. Ductal recanalization and stenting for late presenters with TGA intact ventricular septum.

    PubMed

    Kothari, Shyam S; Ramakrishnan, Sivasubramanian; Senguttuvan, Nagendra Boopathy; Gupta, Saurabh Kumar; Bisoi, Akshay K

    2011-07-01

    The ideal management strategy for patients presenting late with transposition of great arteries (TGA), intact ventricular septum (IVS), and regressed left ventricle (LV) is not clear. Primary switch, two-stage switch, and Senning operation are the options. Left ventricular retraining prior to arterial switch by ductal stenting may be effective, but the experience is very limited. Five of six children aged 3-6 months with TGA-IVS and regressed LV underwent recanalization and transcatheter stenting of ductus arteriosus. The ductal stent was removed during arterial switch surgery. The procedure was successful in 5/6 patients. All the patients had totally occluded ductus and needed recanalization with coronary total occlusion hardware. The ductus was dilated and stented with coronary stents. In all the patients, there was significant luminal narrowing despite adequate stent placement and deployment. Two patients needed reintervention for abrupt closure of the stent. Ductal stenting resulted in left ventricular preparedness within 7-14 days. One patient died of progressive sepsis after 14 days of stenting, even though the LV was prepared. Four patients underwent successful uneventful arterial switch surgery. During surgery, it was observed that the mucosal folds of duct were protruding through the struts of the stent in one patient. Ductal stenting is a good alternative strategy for left ventricular retraining in TGA with regressed LV even in patients with occluded ducts.

  10. Diamond stents for palliation of malignant bile duct obstruction: a prospective multicenter evaluation.

    PubMed

    Ferlitsch, A; Oesterreicher, C; Dumonceau, J M; Deviere, J; Leban, T; Born, P; Rösch, T; Suter, W; Binek, J; Meyenberger, C; Müllner, M; Schneider, B; Schöfl, R

    2001-08-01

    Various types of self-expandable metal stents have been introduced for biliary drainage in patients with malignant jaundice, showing prolonged patency compared with plastic endoprostheses. However, there has only been prolonged experience with a meaningful number of patients using the Wallstent. We evaluated the Diamond stent, a self-expanding uncoated biliary metal stent, in a prospective uncontrolled multicenter setting. The eligibility criterion was obstructive jaundice due to inoperable malignant disease. Between August 1995 and January 2000, 126 patients, who received a total of 134 Diamond stents in four European centers, were followed prospectively. Technical and clinical success rates were 96 % and 98 %, respectively. No major procedure-related complications occurred. The 30-day mortality rate was 13 %. Stent occlusion occurred in 28 patients (22 %). Overall median stent patency was 477 days; overall median survival was 173 days. Stent occlusion, confirmed by endoscopic retrograde cholangiopancreatography, was successfully treated with plastic stents in all patients. Cost analysis revealed estimated costs of 3440 euros per patient for palliative treatment with the Diamond stent. The Diamond stent compares favorably with other biliary metal stents for patients requiring biliary drainage of malignant jaundice.

  11. Percutaneous biliary drainage using open cell stents for malignant biliary hilar obstruction.

    PubMed

    Ahn, Sun Jun; Bae, Jae Ik; Han, Tae Sun; Won, Je Hwan; Kim, Ji Dae; Kwack, Kyu-Sung; Lee, Jae Hee; Kim, Young Chul

    2012-01-01

    To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

  12. Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction

    PubMed Central

    Ahn, Sun Jun; Han, Tae Sun; Won, Je Hwan; Kim, Ji Dae; Kwack, Kyu-Sung; Lee, Jae Hee; Kim, Young Chul

    2012-01-01

    Objective To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. Materials and Methods During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Results Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Conclusion Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum. PMID:23118579

  13. A New Stent Graft

    PubMed Central

    Nishi, S.; Nakayama, Y.; Ueda, H.; Ishikawa, M.; Matsuda, T.

    2000-01-01

    Summary The use of stents improves the result after balloon coronary angioplasty. Restenosis due to neointimal hyperplasia and proliferation of smooth muscle cells are, however; a concern. In the present report, we studied the prevention of restenosis to allow endothelial cell migration and growth to proceed through micropores using our developed stent graft with micropored segmented polyurethane (SPU) thin film in a normal beagle model. Our developed stent graft was made from Palmaz stent and micropored SPU thin film. The SPU film was arranged into four different micropore densities around the circumference: no micropores, arrangement 4; micropores of 30µm in diameter with an orderly distance of 250µm; (arrangement 1), 500µm; (arrangement 2) and 125µm (arrangement 3) between the neighboring two pores. Micropores were made using the Excimer laser ablation technique. The Palmaz stent was wrapped with micropored film, sutured, and glued with DMF (dimethyl formamide) under aid of a microscope. These stents were placed in the common carotid arteries of beagles (n = 5). They were sacrificed at 1 month, and a histological study and scanning electron microscopy study were performed for evaluation of endoluminal endothelialization. In 10 arteries applied with stent grafts, there was no severe stenosis although it did occur to some extent. All stented arteries were patent. Endothelial cell migration and growth through micropores were observed histologically on micropored SPU thin film in this model, which did not affect the intraluminal diameter. In most non-porous regions, significant thrombi were found between the SPU film and the neointimal layer. On the other hand, in the porous region, little thrombosis was observed except in the lowest density region. In 125µm of distance between two neighboring pores, the neointimal layer was the thinnest, which was suitable for wide intraluminal space after placement of a stent graft. Endothelial cell migration and growth

  14. Elastic Deformation Properties of Implanted Endobronchial Wire Stents in Benign and Malignant Bronchial Disease: A Radiographic In Vivo Evaluation

    SciTech Connect

    Hautmann, Hubert; Rieger, Johannes; Huber, Rudolf M.; Pfeifer, Klaus J.

    1999-03-15

    Purpose: To evaluate the long-term mechanical behavior in vivo of expandable endobronchial wire stents, we imaged three different prostheses in the treatment of tracheobronchial disease. Methods: Six patients with bronchial stenoses (three benign, three malignant) underwent insertion of metallic stents. Two self-expandable Wallstents, two balloon-expandable tantalum Strecker stents and two self-expandable nitinol Accuflex stents were used. Measurements of deformation properties were performed during voluntary cough by means of fluoroscopy, at 1 month and 7-10 months after implantation. The procedures were videotaped, their images digitized and the narrowing of stent diameters calculated at intervals of 20 msec. Results: After stent implantation all patients improved with respect to ventilatory function. Radial stent narrowing during cough reached 53% (Wallstent), 59% (tantalum Strecker stent), and 52% (nitinol Accuflex stent) of the relaxed post-implantation diameter. Stent compression was more marked in benign compared with malignant stenoses. In the long term permanent deformation occurred with the tantalum Strecker stents; the other stents were unchanged. Conclusion: Endobronchial wire stents can be helpful in the treatment of major airway collapse and obstructing bronchial lesions. However, evidence of material fatigue as a possible effect of exposure to recurrent mechanical stress on the flexible mesh tube may limit their long-term use. This seems to be predominantly important in benign bronchial collapse.

  15. Process for making electroformed stents

    DOEpatents

    Hines, Richard A.

    2000-02-01

    This invention is directed to an expandable stent useful for implantation into an artery or the like. The stents are made using electroforming techniques in which an electrically-conductive mandrel is coated with a suitable resist material, after which the resist is exposed to an appropriate light pattern and frequency so as to form a stent pattern in the resist. The mandrel is then electroplated with a suitable stent material. The mandrel is etched away once a sufficient layer of stent material is deposited, leaving a completed stent.

  16. Migrated biliary stent causing perforation of sigmoid colon and pelvic abscess

    PubMed Central

    Mady, Raafat Fadly; Niaz, Osamah Saad; Assal, Mohamed Moustafa

    2015-01-01

    Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice. A plastic stent is usually inserted in patients with obstructive jaundice due to pancreatic cancer as a short-term procedure. Stent migration has been reported as a complication, although in most cases the stent will pass through or remain in the bowel lumen for a period of time. In rare cases, the stent may cause sigmoid perforation and pelvic abscess formation, especially in patients with sigmoid diverticulae or abdominal adhesions due to previous surgery. We present a patient with sigmoid perforation and pelvic abscess due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma. PMID:25870211

  17. Biodegradable airway stents in infants - Potential life-threatening pitfalls.

    PubMed

    Sztanó, B; Kiss, G; Márai, K; Rácz, G; Szegesdi, I; Rácz, K; Katona, G; Rovó, L

    2016-12-01

    The solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. Five SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). The breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing 'foreign body' from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. Polydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4-6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Transradial approach for vertebral artery stenting

    PubMed Central

    Tekieli, Łukasz; Kabłak-Ziembicka, Anna; Paluszek, Piotr; Trystuła, Mariusz; Wójcik-Pędziwiatr, Magdalena; Machnik, Roman; Pieniążek, Piotr

    2015-01-01

    Introductuion Symptomatic severe vertebral artery (VA) stenosis may be treated safely with stent supported angioplasty via femoral access. There is limited clinical data on transradial approach for VA angioplasty in case of peripheral artery disease. Aim To evaluate the safety and efficacy of transradial angioplasty of symptomatic VA stenosis. Material and methods Fifteen patients (age 66 ±7.4 years, 73% men, with VA > 80% stenosis, 11 right-side, all symptomatic from posterior circulation (history of stroke, TIA, or chronic ischaemia symptoms)) with peripheral artery disease (PAD) or unsuccessful attempt via femoral approach were scheduled for VA angioplasty by radial access. Clinical and duplex ultrasound (DUS) follow-up were performed before discharge and 1, 12, and 24 months after VA angioplasty. Results The technical success rate was 100%. In all cases VA angioplasty was performed with the use of single balloon-mounted stent (9 bare metal stents, 6 drug-eluting stents). The mean NASCET VA stenosis was reduced from 85.3% to 5.3% (p < 0.001). No periprocedural death, stroke, myocardial infarction, or transient ischaemic attack occurred. During 24-months follow-up, in 12 of 15 patients chronic ischaemia symptoms release was observed, and no new acute ischaemic neurological symptoms were diagnosed in all patients. One patient died 20 months after intervention from unknown causes. There was one symptomatic borderline VA in-stent stenosis 12 months after angioplasty. Conclusions Transradial VA stenting may be a very effective and safe procedure, and it may constitute an alternative to the femoral approach in patients with symptomatic VA stenosis. PMID:25848368

  19. Stent-Protected Carotid Angioplasty Using a Membrane Stent: A Comparative Cadaver Study

    SciTech Connect

    Mueller-Huelsbeck, Stefan Guehne, Albrecht; Tsokos, Michael; Huesler, Erhard J.; Schaffner, Silvio R.; Paulsen, Friedrich; Hedderich, Juergen; Heller, Martin; Jahnke, Thomas

    2006-08-15

    Purpose. To evaluate the performance of a prototype membrane stent, MembraX, in the prevention of acute and late embolization and to quantify particle embolization during carotid stent placement in human carotid explants in a proof of concept study. Methods. Thirty human carotid cadaveric explants (mild stenoses 0-29%, n = 23; moderate stenoses 30-69%, n = 3; severe stenoses 70-99%, n = 2) that included the common, internal and external carotid arteries were integrated into a pulsatile-flow model. Three groups were formed according to the age of the donors (mean 58.8 years; sample SD 15.99 years) and randomized to three test groups: (I) MembraX, n 9; (II) Xpert bare stent, n = 10; (III) Xpert bare stent with Emboshield protection device, n = 9. Emboli liberated during stent deployment (step A), post-dilatation (step B), and late embolization (step C) were measured in 100 {mu}m effluent filters. When the Emboshield was used, embolus penetration was measured during placement (step D) and retrieval (step E). Late embolization was simulated by compressing the area of the stented vessel five times. Results. Absolute numbers of particles (median; >100 {mu}m) caught in the effluent filter were: (I) MembraX: A = 7, B = 9, C = 3; (II) bare stent: A 6.5, B = 6, C = 4.5; (III) bare stent and Emboshield: A = 7, B = 7, C.=.5, D = 8, E = 10. The data showed no statistical differences according to whether embolic load was analyzed by weight or mean particle size. When summing all procedural steps, the Emboshield caused the greatest load by weight (p 0.011) and the largest number (p = 0.054) of particles. Conclusions. On the basis of these limited data neither a membrane stent nor a protection device showed significant advantages during ex vivo carotid angioplasty. However, the membrane stent seems to have the potential for reducing the emboli responsible for supposed late embolization, whereas more emboli were observed when using a protection device. Further studies are necessary

  20. Migrating biliary stent with final destination at the ileocecal junction causing intestinal obstruction and obstructive biliopathy

    PubMed Central

    Rasalkar, Darshana D; Paunipagar, Bhawan K; Sonavane, Bhawna

    2010-01-01

    Endoscopic plastic biliary stent insertion is a minimally invasive, well-established procedure for the management of benign biliary pathology. We report a case of a migrating stent for over two days, which finally got impacted at the ileocecal junction, leading to intestinal obstruction and obstructive biliopathy. Radiological findings depicted the exact site of the dislodged biliary stent and its related complications, both of which were successfully treated in a nonoperative stepwise manner. PMID:21423909

  1. Influence of Vessel Size and Tortuosity on In-stent Restenosis After Stent Implantation in the Vertebral Artery Ostium

    SciTech Connect

    Zhou Zhiming; Yin Qin; Xu Gelin; Yue Xuanye; Zhang Renliang; Zhu Wusheng; Fan Xiaobing; Ma Minmin; Liu Xinfeng

    2011-06-15

    Purpose: Percutaneous transluminal angioplasty and stenting is emerging as an alternative for treating atherosclerotic stenosis in the vertebral artery ostium. However, in-stent restenosis (ISR) still remains a critical issue to be addressed. Little is known about the relationship between anatomic characteristics of the artery and ISR after stent implantation. In this study, we have evaluated influential factors for ISR in a cohort of the patients with stenting in the vertebral artery ostium. Methods: Sixty-one patients with 63 symptomatic lesions in vertebral artery ostium treated with stenting were enrolled onto this study. An average of 12.5 months' clinical and angiographic follow-up results were analyzed retrospectively. The possible influential factors for ISR, including conventional risk factors of cerebrovascular diseases and morphological characteristics of target lesions, were evaluated by univariate and multivariate regression analysis. Results: Technical success was achieved in all 63 interventional procedures. Stenosis was reduced from (mean {+-} standard deviation) 75.5 {+-} 12% before to 1 {+-} 3.6% after the procedure. During the mean 12.5-month angiographic follow-up, ISR was detected in 17 treated vessels (27.0%), with 2 treated arteries (3.2%) resulting in occlusion, and a stent fracture in 1 case (1.6%). Multivariate Cox regression analysis showed that the tortuosity of V1 (hazard ratio 3.54, P = 0.01) and smaller diameter of the stent (hazard ratio 3.8, P = 0.04) were independent predictors of ISR. Conclusions: Angioplasty and stenting for symptomatic stenosis in the vertebral artery ostium stenosis seem to be feasible and effective. Tortuosity and smaller diameter may affect ISR after stent implantation.

  2. Provisional stenting of coronary bifurcations: insights into final kissing balloon post-dilation and stent design by computational modeling.

    PubMed

    Mortier, Peter; Hikichi, Yutaka; Foin, Nicolas; De Santis, Gianluca; Segers, Patrick; Verhegghe, Benedict; De Beule, Matthieu

    2014-03-01

    This study sought to better understand and optimize provisional main vessel stenting with final kissing balloon dilation (FKBD). Main vessel stenting with FKBD is widely used, but many technical variations are possible that may affect the final result. Furthermore, most contemporary stent designs have a large cell size, making the impact of stent platform selection for this procedure unclear. Finite element simulations were used to virtually deploy and post-dilate 3 stent platforms in 3 bifurcation models. Two FKBD strategies were evaluated: simultaneous FKBD (n = 27) and modified FKBD (n = 27). In the simultaneous FKDB technique, both balloons were simultaneously inflated and deflated. In the modified FKBD technique, the side branch balloon was inflated first, then partially deflated, followed by main branch balloon inflation. Modified FKBD results in less ostial stenosis compared with simultaneous FKBD (15 ± 9% vs. 20 ± 11%; p < 0.001) and also reduces elliptical stent deformation (ellipticity index, 1.17 ± 0.05 vs. 1.36 ± 0.06; p < 0.001). The number of malapposed stent struts was not influenced by the FKBD technique (modified FKBD, 6.3 ± 3.6%; simultaneous FKBD, 6.4 ± 3.4%; p = 0.212). Stent design had no significant impact on the remaining ostial stenosis (Integrity [Medtronic, Inc., Minneapolis, Minnesota], 16 ± 11%; Omega [Boston Scientific, Natick, Massachusetts], 17 ± 11%; Multi-Link 8 [Abbott Vascular, Santa Clara, California], 19 ± 8%). The modified FKBD procedure reduces elliptical stent deformation and optimizes side branch access. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Coronary Stent Infection Presented as Recurrent Stent Thrombosis

    PubMed Central

    Lai, Chih-Hung; Lin, Yung-Kai; Lee, Wen-Lieng

    2017-01-01

    Percutaneous transluminal coronary angioplasty with metal stent placement has become a well-developed treatment modality for coronary stenotic lesions. Although infection involving implanted stents is rare, it can, however, occur with high morbidity and mortality. We describe herein a case of an inserted coronary stent that was infected and complicated with recurrent stent thrombosis, pseudoaneurysm formation and severe sepsis. Despite repeated intervention and bypass surgery, the patient died from severe sepsis. PMID:28120580

  4. Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations.

    PubMed

    Canena, Jorge; Liberato, Manuel; Horta, David; Romão, Carlos; Coutinho, António

    2013-01-01

    Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations. This was a retrospective case series with long-term follow-up of 25 patients who underwent FCSEMS placement for BBCs. This study included 17 patients with postcholecystectomy refractory biliary leaks who had previously undergone unsuccessful sphincterotomy and plastic stent placement, 4 patients with difficult-to-control postsphincterotomy bleeding, and 4 patients with a perforation following endoscopic sphincterotomy. Stents were removed according to clinical evidence of problem resolution. The review included stenting duration, safe FCSEMS removal, clinical efficacy, complications, and long-term outcomes. During the follow-up period, ERCP and cholangioscopy procedures were performed to exclude the possibility of bile duct lesion development. Complete resolution of the initial condition was achieved in all patients. Patients with biliary leaks had a median stent duration time of 16 days (range 7-28 days). Patients with bleeding had stents removed after a median time of 6 days (range 3-15 days). Patients with perforations had their stents removed after a median time of 29.5 days (range 21-30 days). There were no complications related to stenting. Temporary placement of a FCSEMS for 30 days or less is an effective rescue therapy for refractory biliary leaks, difficult-to-control post-endoscopic sphincterotomy bleeding, and perforations. Duration of stenting should be different for each type of condition. Stents can be safely removed, and short-term stenting is associated with the absence of early and late

  5. Comparison of through-the-scope stent insertion with standard stent insertion for the management of malignant colorectal obstruction: a prospective study.

    PubMed

    Wan, Y; Zhu, Y-Q; Chen, N-W; Wang, Z-G; Cheng, Y-S; Shi, J

    2016-10-01

    The aim of the present study was to compare the feasibility, safety and efficacy of the through-the-scope (TTS) stent technique to that of the standard metallic stent technique for the management of malignant colorectal obstruction. Fifty-two patients scheduled to receive stent insertion for the management of acute obstructive colorectal cancer were enrolled in our study and divided into a TTS stent group (n = 24) and a standard stent group (n = 28). The stent insertion procedure was performed under endoscopic and fluoroscopic guidance in all patients. The success rate, complications, fluoroscopic time, and clinical remission rate were recorded and compared. The technique success rate was 100 % (24/24) in the TTS stent group and 78.6 % (22/28) in the standard stent group (p = 0.03). In five patients in the standard stent group, the stent failed to pass through occlusive lesions because of the stiffness of the stent system. Serious bleeding occurred in one patient in the standard stent group. The fluoroscopy time in the TTS stent group was significantly reduced (12.9 ± 6.6 min) compared with that of the standard stent group (24.8 ± 9.8 min; p < 0.01). Silent perforation occurred in 17.9 % (5/28) of the cases in the standard stent group compared with none in the TTS (p = 0.03). Clinical remission was achieved in 97.1 % (23/24) and 78.6 % (22/28) of patients in the TTS and standard stent groups, respectively (p = 0.11). The TTS stent is safer and more feasible for the management of malignant colorectal obstructions than the standard stent, and the TTS technique provides a higher success rate, a similar clinical remission rate, and a markedly reduced fluoroscopic time.

  6. Cerebral Nitinol Stenting in Progressive Stroke and in Crescendo TIAs.

    PubMed

    Cohen-Inbar, Or; Amsalem, Yaaqov

    2015-11-01

    Acute ischemic stroke (AIS) is the third leading cause of death. Arterial stenosis is a common cause of stroke, with a high risk of recurrent stroke. Treatment guidelines for AIS and transient ischemic attack (TIA) are still under debate. Treatment guidelines for progressive stroke or crescendo TIAs do not exist. Percutaneous transluminal angioplasty and stenting (PTAS) is an increasingly attractive treatment option, whose efficacy is yet to be proven. However, stent placement poses both short- and long-term risks such as immediate ischemic events, in-stent stenosis, and stent breakage. Thus the choice of stent type is critical. We report our experience with the LEO + (Balt Extrusion, Montmorency, France) nitinol flexible self-expanding stent for the treatment of progressive cerebrovascular accident or crescendo TIAs. Twelve patients, presenting with a clinical picture of a crescendo TIA or progressive stroke in evolution not halted by optimal medical care, were treated. Patients had a corresponding major cerebral arterial narrowing and evidence of cerebral infarction on imaging. Patients were followed clinically and radiographically. Twelve patients 17 to 80 years of age were treated during the study period (20 months). Sixteen nitinol flexible self-expandable stents (LEO +) were placed. All patients showed moderate to substantial improvement in neurologic functions after the procedure. PTAS should be considered a treatment option in case of progressive stroke or crescendo TIAs coupled with appropriate anatomical findings. This may allow for a substantial improvement in functional and neurologic status. Georg Thieme Verlag KG Stuttgart · New York.

  7. Renal Artery Stenting in Patients with a Solitary Functioning Kidney

    SciTech Connect

    Cioni, Roberto; Vignali, Claudio; Petruzzi, Pasquale; Neri, Emanuele; Caramella, Davide; Vagli, Paola; Bargellini, Irene; Napoli, Vinicio; Pinto, Stefania; Bartolozzi, Carlo

    2001-12-15

    Purpose: To retrospectively evaluate the results of renal artery stenting in patients with renovascular disease and a solitary functioning kidney.Methods: Palmazstents were placed in 16 patients with a solitary functioning kidney,renal artery stenosis, hypertension and renal failure. Stenoses were evaluated with color Doppler ultrasound, MR angiography and digital subtraction angiography (DSA). Indications for stenting were: recoil after percutaneous transluminal renal angioplasty (PTRA) (63%),arterial dissection after PTRA (13%) and primary stenting (25%).Immediate results were evaluated by DSA. On follow-up (6-36 months),patients underwent periodical evaluation of clinical conditions (blood pressure and serum creatinine level) and stent patency, by means of color Doppler ultrasound.Results: Stent placement was successful in all patients (100%). Cumulative primary patency rate was: 100% at 1 day, 93.75% at 6 months, 81.25% at 12 months and 75% at 24 months. A significant reduction in diastolic blood pressure occurred (mean {+-} SD 104 {+-} 6 vs 92 {+-} 3;p < 0.05); renal function improved or stabilized in over 80% of patients. However, there was no significant difference in the creatinine values before and after treatment (mean {+-} SD 200 {+-} 142 mmol/l vs 197 {+-} 182 mmol/l; p> 0.05).Conclusion: Renal artery stenting, both after PTRA and as primary stenting, represents a safe procedure, able to preserve renal function in patients with a solitary functioning kidney.

  8. Advantages and disadvantages of biodegradable platforms in drug eluting stents

    PubMed Central

    Rodriguez-Granillo, Agustina; Rubilar, Bibiana; Rodriguez-Granillo, Gaston; Rodriguez, Alfredo E

    2011-01-01

    Coronary angioplasty with drug-eluting stent (DES) implantation is currently the most common stent procedure worldwide. Since the introduction of DES, coronary restenosis as well as the incidence of target vessel and target lesion revascularization have been significantly reduced. However, the incidence of very late stent thrombosis beyond the first year after stent deployment has more commonly been linked to DES than to bare-metal stent (BMS) implantation. Several factors have been associated with very late stent thrombosis after DES implantation, such as delayed healing, inflammation, stent mal-apposition and endothelial dysfunction. Some of these adverse events were associated with the presence of durable polymers, which were essential to allow the elution of the immunosuppressive drug in the first DES designs. The introduction of erodable polymers in DES technology has provided the potential to complete the degradation of the polymer simultaneously or immediately after the release of the immunosuppressive drug, after which a BMS remains in place. Several DES designs with biodegradable (BIO) polymers have been introduced in preclinical and clinical studies, including randomized trials. In this review, we analyze the clinical results from 6 observational and randomized studies with BIO polymers and discuss advantages and disadvantages of this new technology. PMID:21499496

  9. The Role of Endovascular Stents in Dialysis Access Maintenance.

    PubMed

    El Kassem, Mohamad; Alghamdi, Issam; Vazquez-Padron, Roberto I; Asif, Arif; Lenz, Oliver; Sanjar, Tina; Fayad, Fadi; Salman, Loay

    2015-11-01

    Vascular stenosis is most often the culprit behind hemodialysis vascular access dysfunction, and although percutaneous transluminal angioplasty remains the gold standard treatment for vascular stenosis, over the past decade the use of stents as a treatment option has been on the rise. Aside from the 2 Food and Drug Administration-approved stent grafts for the treatment of venous graft anastomosis stenosis, use of all other stents in vascular access dysfunction is off-label. Kidney Disease Outcomes Quality Initiative recommends limiting stent use to specific conditions, such as elastic lesions and recurrent stenosis; otherwise, additional adapted indications are in procedure-related complications, such as grade 2 and 3 hematomas. Published reports have shown the potential use of stents in a variety of conditions leading to vascular access dysfunction, such as venous graft anastomosis stenosis, cephalic arch stenosis, central venous stenosis, dialysis access aneurysmal elimination, cardiac implantable electronic device-induced stenosis, and thrombosed arteriovenous grafts. Although further research is needed for many of these conditions, evidence for recommendations has been clear in some; for instance, we know now that stents should be avoided along cannulation sites and should not be used in eliminating dialysis access aneurysms. In this review article, we evaluate the available evidence for the use of stents in each of the aforementioned conditions leading to hemodialysis vascular access dysfunctions. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  10. Peri-stent contrast staining and very late stent thrombosis after sirolimus-eluting stent implantation: an observation from the RESTART (REgistry of Stent Thrombosis for review And Re-evaluaTion) angiographic substudy.

    PubMed

    Kozuma, Ken; Kimura, Takeshi; Suzuki, Nobuaki; Miyazawa, Akiyoshi; Waseda, Katsuhisa; Honda, Yasuhiro; Morimoto, Takeshi; Aizawa, Tadanori; Mitsudo, Kazuaki; Miyazaki, Shunichi; Yamaguchi, Tetsu; Isshiki, Takaaki

    2013-11-01

    The aim of the study was to clarify the angiographic characteristics of stent thrombosis (ST) in relation to sirolimus-eluting stents (SES). RESTART is a Japanese registry of SES-associated ST. As an angiographic substudy, coronary angiograms at baseline, at six to 12 months and at the time of ST were analysed. Angiograms of 313 patients (early ST [EST] 169 patients, late ST [LST] 59 patients, and very late ST [VLST] 85 patients) were investigated. Residual dissection post procedure was more frequently seen in the EST group. Stent fracture was more frequently seen in the VLST group than in the EST and LST groups (16.5%, 3.0%, and 3.4%, respectively; p<0.001). Peri-stent contrast staining (PSS), defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter, was remarkably more prevalent in the VLST group than in the EST and LST groups (34.1%, 4.7%, and 6.8%, respectively; p<0.001). Abnormal angiographic findings such as PSS and stent fracture were found significantly more frequently in lesions with VLST than in lesions with EST and LST.

  11. Is direct stent implantation without predilatation safe? Acute and long-term outcome.

    PubMed

    Rahel, Braim M; Suttorp, Maarten Jan; Ten Berg, Jurriën M; Bal, Egbert T; Ernst, Sjef M P G; Mast, E Gijs; Kelder, Johannes C; Plokker, H W Thijs

    2002-08-01

    Direct stenting could potentially lead to a reduction in dissections, time, and restenosis at 6-month follow-up. Using the premounted Palmaz-Schatz Crown stent elective stenting was performed without predilatation in 61 consecutive patients who were compared with a control group of provisional stenting. All patients underwent clinical and angiographic follow-up at 6 months. Direct stenting was successful in 81% of patients. In 16% of the patients predilatation was needed. In 3% the stent could not be implanted despite predilatation. Stent dislodgment occurred in 2% of patients, without embolization. Six-month angiographic follow-up was performed in 51 (84%) of 61 patients. In the direct stenting group the mean preprocedural minimal luminal diameter (MLD) increased from 0.96 +/- 0.47 to 3.09 +/- 0.54 mm directly after the procedure. At 6-month follow-up the MLD measured 2.32 +/- 0.79 mm. In the provisional stenting group the mean MLD increased from 0.92 +/- 0.51 to 2.44 +/- 0.58 mm and was 1.84 +/- 0.70 mm at 6-month follow-up. Restenosis, defined as a diameter stenosis > 50%, occurred in 8% of the direct stenting group compared with 28% in the provisional stenting group (P < 0.001). Direct coronary stent implantation can be attempted safely and efficaciously. The risk of stent loss is low. The initial and long-term angiographic results are significantly better as compared with provisional stenting. The risk of restenosis is significantly lower.

  12. [Treatment of malignant colorectal obstruction by means of endoscopic insertion of self-expandable metallic stents].

    PubMed

    García-Cano, J; González Martín, J A; Redondo-Cerezo, E; Morillas Ariño, J; Pérez García, J I; Pérez Vigara, M G; Gómez Ruiz, C J; Pérez Sola, A

    2003-10-01

    Self-expandable metallic stents are being used increasingly to treat the obstruction of different segments of the digestive tract and biliary tree. We present our centre experience on the initial resolution of malignant colorectal obstruction by means of this type of stents. During a 18-month period, 13 patients patients suffering from malignant obstruction at the level of rectum, sigmoid or descending colon tried to be initially treated by means of endoscopic insertion of stents (non covered enteral Wallstents). Ten procedures were performed with both endoscopy and fluroscopy and three with only endoscopy. In 12 of the 13 patients (92,3%) the obstruction was solved by means of correct stent insertion. All the exclusively endoscopic procedures (without fluoroscopy) were successful. Six (50 %) patients with tumours at the rectosigmoid underwent later scheduled surgery. In the remaining six ones (a patient with an ovarian carcinoma and five with colonic adenocarcinoma) the stents were considered to be a palliative definitive treatment. Stent migration was observed in two of these patients and both were extracted endoscopically. Only one patient needed to have another stent inserted. A tumoural colo-vesical fistula developed in another patient in the palliative group, inside the previous inserted stent, and was treated by coaxial insertion of an esophageal Ultraflex. There were no other complications or mortality related to the endoscopic procedures. Self-expandable metallic stents might be considered, in general, as the initial treatment for the malignant obstruction at the level of rectum, sigmoid and descending colon

  13. [Results of the upper digestive tract stenting with self-expanding stents].

    PubMed

    Fedorov, A G; Davydova, S V; Klimov, A E; Lebedev, N V

    2013-01-01

    The work is based on the analysis of the palliative treatment of 66 patients with malignant upper digestive tract obstruction who underwent implantation of 75 self-expanding metallic stents in the period of 2003-2012 yy. Early postoperative complications developed in 10 (15.2%) cases. Procedure-related complications were observed in 8 (12.1%) patients, non-specific complications occurred in 2 (3.0%) patients. In-hospital lethality was 4.5% (3 patients). 51 patients were followed until death. Symptomatic relapse of obstruction was observed in 4 cases. Median survival was 97 days. Stenting with self-expanding metal stents was concluded to be an effective and safe method of palliation of malignant upper digestive tract stenosis.

  14. Preventing the Forgotten Ureteral Stent by Using a Mobile Point-of-Care Application.

    PubMed

    Ziemba, Justin B; Ludwig, Wesley W; Ruiz, Leticia; Carvalhal, Eduardo; Matlaga, Brian R

    2017-07-01

    The forgotten ureteral stent (FUS) can lead to patient morbidity. To date, tracking ureteral stents is a cumbersome task, given their high frequency of insertion and variable indwelling times. To simplify this process, an application was developed to track patients with indwelling ureteral stents. We report our initial user experience and clinical outcomes with this application. Ureteral Stent Tracker™ (UST) is a secure, Health Insurance Portability and Accountability Act (HIPPA)-compliant, cloud-based point-of-care application. It is designed for logging stent insertion, scheduling the date of anticipated stent extraction, and confirming stent removal. It is accessible via a mobile phone application or web browser interface. We consecutively enrolled all patients who underwent ureteral stent insertion for any indication by two urologists from January 10, 2015, to October 10, 2016. A retrospective chart review was performed of all patients included in the UST database. Data extracted included patient demographics, diagnosis, procedure, and stent characteristics. A total of 115 patients were included with a mean age of 52.4 years; 54% (62/115) were male and 58% (67/115) were Caucasian. This cohort represented 146 ureteral stent care plans with 23 patients (23/115; 20%) having more than one care plan during the study period. The most common procedure performed was ureteroscopy (70/146; 48%) for a diagnosis of nephrolithiasis (108/146; 74%). The median indwelling ureteral stent time was 14 days (interquartile range: 7-45 days). A total of three patients (3/115; 3%) did not return for their scheduled extraction, but were identified only through the application. Each patient was contacted, resulting in effective removal of all three stents in the office. Tracking of ureteral stents is critical to prevent the patient safety issue of the FUS. The UST is a secure, HIPPA-compliant, cloud-based application, which once incorporated into the workflow of a urologic practice

  15. Primary Stent Placement for Recanalization of Iliac Artery Occlusions: Using a Self-Expanding Spiral Stent

    SciTech Connect

    Kim, Jae-Kyu; Kim, Yun-Hyeon; Chung, Sang-Yeung; Kang, Heoung-Keun

    1999-07-15

    Purpose: To report the clinical results for recanalizations of an occluded iliac artery by a self-expanding spiral stent. Methods: We attempted to recanalize 36 iliac artery occlusions in 34 patients [33 men, 1 woman, aged 51-75 years (average 61.6 years)]. The average lesion length was 6.92 cm (range 1-14 cm). The patients' chief complaints were intermittent claudication and resting pain. Fontaine classification was assigned before and after the procedure. Technical and clinical success were also analyzed. Results: Forty-five stents were successfully deployed in 34 patients. All 36 lesions (13 in the external iliac artery, 12 in the common iliac artery, and 11 in both) were patently recanalized on angiography. The follow-up period ranged from 6 months to 36 months (mean 11.9 months). Fourteen stents (39%) with incomplete expansion were dilated with a balloon catheter. Good technical (100%) and clinical (94%) results were obtained. The only complication was one hematoma at the puncture site. Reocclusions were noted in two lesions (5%) at 1 week and 15 months, respectively. Conclusion: A self-expanding spiral stent is a safe and effective device for recanalization of an iliac artery occlusion as the primary stent without any previous intervention.

  16. Partially uncovered Cheatham platinum-covered stent to treat complex aortic coarctation associated with aortic wall aneurysm.

    PubMed

    Butera, Gianfranco; Piazza, Luciane

    2015-04-01

    Percutaneous treatment of aortic coarctation is a widely used option. Covered stents have increased the profile of efficacy and safety of this procedure. Here we report on a 32-year-old woman with significant aortic recoarctation associated with aortic wall aneurysm and close proximity of both lesions to the origin of both the subclavian arteries. It was decided to manually and partially uncover the proximal part of the stent to have a hybrid stent that could act as a bare stent at the level of the origin of the subclavian arteries and as a covered stent at the level of the aneurysm.

  17. Endovascular Stent-Graft Applications in Iatrogenic Vascular Injuries

    SciTech Connect

    Baltacioglu, Feyyaz Cimit, N. Cagatay; Cil, Barbaros; Cekirge, Saruhan; Ispir, Selim

    2003-09-15

    Purpose: To report the results of covered stent applications in iatrogenic vascular injuries. Methods: We report 17 patients (11 men, 6 women; age range 20-59 years, mean age 40 years) who underwent repair of differentiatrogenic vascular lesions by means of endovascular covered stents.The patient population consisted of 8 femoral arteriovenous fistulae, 4 common femoral artery pseudoaneurysms, 1 subclavian artery pseudoaneurysm, 1 abdominal aortic aneurysm, 1 iliac artery perforation, 2 porto-biliary fistulae that developed during TIPS procedure. Balloon-expandable stent-grafts were used in all patients except one. Control studies were performed with angiography. Results: Technical success was achieved in all 17 patients.The mean clinical follow-up period for all 17 patients was 8 months.There were no signs of stent migration or leaks in the control studies.Only one patient developed a hemodynamically insignificant stenosis at the proximal end of the stent. There have been no stent deformations or related complications during the follow-up period. Conclusion: Our short-term results suggest that endovascular treatment is a low-risk procedure and appears less invasive than surgery for the treatment of different types of iatrogenic vascular injuries. Intermediate and long-term results are not available.

  18. Will absorbable metal stent technology change our practice?

    PubMed

    Bosiers, M; Deloose, K; Verbist, J; Peeters, P

    2006-08-01

    Peripheral stents aim to support revascularization procedures of intravascular stenoses by mechanically preventing vessel recoil and counteracting pathophysiologic processes of luminal re-narrowing triggered by procedural injury of the vessel wall. Despite improvements in stenting techniques and concomitant medication, repeated intervention due to target lesion re-stenosis is necessary on a significant percentage of patients. The permanent presence of an artificial implant plays a prominent role in the discussion of mechanisms causing in-stent restenosis. Permanent metallic implants pose the risk of a continuous interaction between non-absorbable stent and surrounding tissue, leading to physical irritation, long-term endothelial dysfunction, or chronic inflammatory reactions. In addition, there is a risk of stent fracture due to external mechanical forces. To overcome these shortcomings, technology of stenting has moved towards the development of temporary implants composed of biocompatible materials which mechanically support the vessel during the period of high risk for recoil and then completely degrade in the long-term perspective. This removes a potential trigger for late restenosis.

  19. Successful removal of an internal pancreatic stent that migrated into the bile duct using double-balloon enteroscopy after pancreaticoduodenectomy.

    PubMed

    Hirono, Seiko; Kawai, Manabu; Yamashita, Yasunobu; Okada, Ken-Ichi; Miyazawa, Motoki; Ueno, Masaki; Maeda, Yoshimasa; Itonaga, Masahiro; Kitano, Masayuki; Yamaue, Hiroki

    2017-07-08

    Internal stents used during pancreaticoduodenectomy (PD) are generally spontaneously passed through the rectum by defecation. However, we encountered six patients with internal stents that migrated into the bile duct after PD. We herein report the outcomes of these six patients and the usefulness of double-balloon enteroscopy (DBE) for removal of such stents from the bile duct. An internal stent was placed across pancreaticojejunostomy in 416 (68.8%) of 605 consecutive patients undergoing PD between 2005 and 2015. This study evaluated the characteristics and outcomes of the six patients whose internal stent migrated into the bile duct. Migration of an internal stent into the bile duct was found during follow-up computed tomography (CT) in 6 (1.4%) of 416 patients who had an internal stent placed during PD. Three patients developed stent-induced cholangitis, and two had bile duct stones. Excluding one patient whose internal stent spontaneously slipped out and disappeared from the bile duct, all patients underwent successful removal of a stent from the bile duct by a single instance of biliary intervention involving DBE. Removal of a stent from the bile duct using DBE is a feasible and useful procedure that should be considered if an internal stent is detected during follow-up CT after PD.

  20. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    NASA Astrophysics Data System (ADS)

    Egger, J.; Großkopf, S.; Freisleben, B.

    2007-03-01

    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, e.g. aortic diameter, right and left common iliac diameter, minimum diameter of distal neck. The selected stent is then simulated to the CT-Data - starting with the initial stent. It hereby becomes apparent if the dimensions of the bifurcated stent graft are exact, i.e. the fitting to the arteries was done properly and no ostium was covered.

  1. Radiopaque biodegradable stent for duct-to-duct biliary reconstruction in pigs.

    PubMed

    Tanimoto, Yoshisato; Tashiro, Hirotaka; Mikuriya, Yoshihiro; Kuroda, Shintaro; Hashimoto, Masakazu; Kobayashi, Tsuyoshi; Taniura, Tokunori; Ohdan, Hideki

    2016-06-01

    Biliary stricture is a common cause of morbidity after liver transplantation. We previously developed a duct-to-duct biliary anastomosis technique using a biodegradable stent tube and confirmed the feasibility and safety of biliary stent use. However, the duration and mechanism of biliary stent absorption in the common bile duct remain unclear. Radiopaque biodegradable biliary stents were created using a copolymer of L-lactide and ε-caprolactone (70: 30) and coated with barium sulfate. Stents were surgically implanted in the common bile duct of 11 pigs. Liver function tests and computed tomography (CT) scans were performed postoperatively, and autopsies were conducted 6 months after biliary stent implantation. After the surgery, all 11 pigs had normal liver function and survived without any significant complications such as biliary leakage. A CT scan at 2 months post-procedure showed that the biliary stents were located in the hilum of the liver. The stents were not visible by CT scan at the 6-month follow-up examination. The surgical implantation of radiopaque biodegradable biliary stents in biliary surgery represents a new option for duct-to-duct biliary reconstruction. This technique appears to be feasible and safe and is not associated with any significant biliary complications. The advantage of coated biliary stent use is that it may be visualized using abdominal radiography such as CT.

  2. Memokath Metallic Stent in the Treatment of Transplant Kidney Ureter Stenosis or Occlusion

    SciTech Connect

    Boyvat, Fatih E-mail: boyvatf@yahoo.com; Aytekin, Cuneyt; Colak, Turan; Firat, Ali; Karakayali, Hamdi; Haberal, Mehmet

    2005-04-15

    Purpose. To determine the efficacy of the Memokath 051 stent (Engineers and Doctors, Hornbaek, Denmark) in the treatment of recurrent ureteral stenosis or occlusion in transplant kidneys. Methods. From October 1985 through January 2004, 1,131 renal transplantations were performed at our center. Four patients who developed recurrent renal transplant ureter obstruction had nephrostomy catheters placed. Antegrade pyelography showed ureteral stenosis in three cases and complete occlusion in one patient. In each case, a Memokath 051 stent was inserted via an antegrade approach. Mean follow-up was 20 months (range 18-21 months). Creatinine levels were measured and ultrasonography was performed during follow-up. Results. All stent procedures were technically successful. During follow-up, one stent migrated within 10 days after stent insertion and was removed cystoscopically. Another stent had to be removed in the 14th month due to resistant infection, and was replaced with a new Memokath 051 stent which remained patent for another 8 months. The other two stents were fully patent at the 18th and 21st month of follow-up, respectively. Conclusion. Placement of a Memokath 051 stent appears to be a promising treatment alternative to balloon dilation, double-J stents and open surgical intervention for ureteral stenosis or occlusion in kidney transplant recipients. Further study of larger series is necessary.

  3. Expandable polyester silicon-covered stent for malignant esophageal strictures before neoadjuvant chemoradiation: a pilot study.

    PubMed

    Siddiqui, Ali A; Loren, David; Dudnick, Robert; Kowalski, Thomas

    2007-03-01

    Patients with resectable esophageal cancer often require placement of a surgical jejunostomy tube prior to receiving chemoradiation so as to maintain adequate nutrition due to their inability to swallow and eat. This study reports a single institutional experience with the Polyflex self-expanding silicone stent (Riisch; Kernen. Germany) in patients with malignant stenosis receiving chemoradiation prior to esophagectomy. This was a retrospective, nonrandomized study of 6 patients who underwent Polyflex esophageal stent placement across a malignant stricture prior to receiving neoadjuvant chemoradiation. The study assessed procedural success, restoration of oral nutrition, migration, and removal of the Polyflex stent. The outcomes measured were the efficacy of treatment, stent-related complications, and changes in the nutritional status of the patient after stent placement. Stent placement was successful in 5 of 6 patients (83%). Restoration of oral nutrition after stent placement occurred in 5 of 5 patients (100%). Migration of the stent into the stomach occurred in 3 patients (60%) without occurrence of gastric outlet obstruction; there was no proximal migration. Stents were successfully removed endoscopically or at the time of esophagectomy. This early experience suggests that the removable silicone Polyflex stent is an effective alternative to a surgical jejunostomy tube for the management of malignant esophageal stenosis in patients for whom neoadjuvant chemoradiation is planned prior to esophagectomy.

  4. Chimney stent technique for treatment of severe abdominal aortic atherosclerotic stenosis.

    PubMed

    Ritter, Jens C; Ghosh, Jonathan; Butterfield, John S; McCollum, Charles N; Ashleigh, Raymond

    2011-03-01

    Application of the "chimney" stent technique is described in a case of complex multilevel atherosclerotic disease involving the juxtarenal aorta. A patient with significant comorbidities was unsuitable for major open reconstructive surgery. He was treated with a combined procedure consisting of chimney stent placement in the juxtarenal aorta, iliac "kissing" stent placement, and right-sided common femoral artery (CFA) replacement. This case shows that the chimney stent technique can be a feasible alternative to leaving a safety wire in the renal arteries and observation during primary angioplasty in complex atherosclerotic lesions of the abdominal aorta.

  5. Outcomes of secondary self-expandable metal stents versus surgery after delayed initial palliative stent failure in malignant colorectal obstruction.

    PubMed

    Yoon, Jin Young; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2013-01-01

    When re-intervention is required due to an occluded first colorectal self-expanding metal stent for malignant colorectal obstruction, serious controversies exist regarding whether to use endoscopic re-stenting or surgery. To compare the clinical outcomes in patients who underwent stent re-insertion versus palliative surgery as a second intervention. A total of 115 patients who received either self-expandable metal stent (SEMS) insertion or palliative surgery for treatment of a second occurrence of malignant colorectal obstruction after the first SEMS placement were retrospectively studied between July 2005 and December 2009. The median overall survival (8.2 vs. 15.5 months) and progression-free survival (4.0 vs. 2.7 months) were not significantly different between the stent and surgery groups (p = 0.895 and 0.650, respectively). The median lumen patency in the stent group was 3.4 months and that in the surgery group was 7.9 months (p = 0.003). The immediate complication rate after second stent insertion was 13.9% and late complication rate was observed in 12 of 79 (15.2%) patients. There was no mortality related to the SEMS procedure. The complication and mortality rates associated with palliative surgery were 3.5% (2/57) and 12.3% (7/57), respectively. Although there is no significant difference in the overall survival between stenting and surgery, a secondary stent insertion had a lower mortality rate despite a shorter duration of temporary colorectal decompression compared to that of palliative surgery.

  6. A double J stent misplaced in the inferior vena cava during Boari flap repair

    PubMed Central

    Maheshwari, Pankaj N.; Oswal, Ajay T.; Wagaskar, Vinayak G.

    2016-01-01

    A 30-year-old lady underwent a Boari flap repair for post-hysterectomy mid-ureteric stricture. The upper end of the double J stent inserted during the procedure was misplaced in the supra-renal inferior venal cava. Cystoscopic stent removal could be performed uneventfully, while the stricture was managed by endoureterotomy. PMID:26941499

  7. [Stents in iliac vascular changes].

    PubMed

    Gross-Fengels, W; Friedmann, G; Fischbach, R; Erasmi, H; Bulling, B

    1991-01-01

    The results of 79 iliac stent placements in 64 patients are reported. The technical success rate was 96%. The systolic pressure gradient dropped from 44 mmHg before to 2.8 mmHg after stent placement. This differed significantly as compared to a group treated by conventional PTA (gradient 5.8 mmHg). The cumulative patency after 18-20 months was 90%. Angiographic controls up to 19 months after "stenting" demonstrated only one secondary stent occlusion. Iliac stents therefore are a very valuable supplement to classic PTA.

  8. Intelligent Optimization of the Film-to-Fiber Ratio of a Degradable Braided Bicomponent Ureteral Stent

    PubMed Central

    Liu, Xiaoyan; Li, Feng; Ding, Yongsheng; Zou, Ting; Wang, Lu; Hao, Kuangrong

    2015-01-01

    A hierarchical support vector regression (SVR) model (HSVRM) was employed to correlate the compositions and mechanical properties of bicomponent stents composed of poly(lactic-co-glycolic acid) (PGLA) film and poly(glycolic acid) (PGA) fibers for urethral repair for the first time. PGLA film and PGA fibers could provide ureteral stents with good compressive and tensile properties, respectively. In bicomponent stents, high film content led to high stiffness, while high fiber content resulted in poor compressional properties. To simplify the procedures to optimize the ratio of PGLA film and PGA fiber in the stents, a hierarchical support vector regression model (HSVRM) and particle swarm optimization (PSO) algorithm were used to construct relationships between the film-to-fiber weight ratio and the measured compressional/tensile properties of the stents. The experimental data and simulated data fit well, proving that the HSVRM could closely reflect the relationship between the component ratio and performance properties of the ureteral stents. PMID:28793658

  9. Multimodal stone therapy for two forgotten and encrusted ureteral stents: a case report

    PubMed Central

    2009-01-01

    Introduction Ureteral stent placement is a common procedure in daily urologic practice. To manage the problems of forgotten stents for many years needs multimodal stone therapy. Case presentation We present a case of a 26-years-old Caucasian, white woman with two forgotten encrusted ureteral stents for 48 months. Multimodal stone therapy including extracorporeal shock wave (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), cystolithotripsy with Lithoclast, and open surgery was necessary to remove all the stones. Using the described combination of techniques, our patient was rendered stone and stent free. Urologists should bear in mind the presence of severe encrustations when they have to deal with a forgotten stent. Conclusion This case shows that combined urologic techniques can achieve successful and safe management of forgotten stents, but treatment should be tailored to the volume of encrustation and associated stone. PMID:19183439

  10. Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study.

    PubMed

    Gökgöl, Can; Diehm, Nicolas; Nezami, Farhad Rikhtegar; Büchler, Philippe

    2015-12-01

    Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of non-calcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stent-specific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.

  11. Antiplatelet therapy in patients undergoing coronary stenting

    PubMed Central

    ten Berg, J.M.; van Werkum, J.W.; Heestermans, A.A.C.M.; Jaarsma, W.; Hautvast, R.M.A.; den Heijer, P.; de Boer, M.J.

    2006-01-01

    Background Anticoagulation after coronary stenting is essential to prevent stent thrombosis. Drug-eluting stents, which are the preferred therapy, may be associated with a higher tendency for stent thrombosis. Methods Patients who underwent coronary stent placement and presented with late stent thrombosis are described. Results Eight patients with stent thrombosis are presented. Early discontinuation of the antithrombotic medication is associated with the occurrence of these complications. Conclusion Long-term antithrombotic therapy seems essential to prevent stent thrombosis, especially for patients treated with drug-eluting stents. PMID:25696663

  12. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures.

    PubMed

    van Boeckel, Petra G A; Vleggaar, Frank P; Siersema, Peter D

    2011-08-01

    It is a challenge to manage refractory benign esophageal strictures (RBES). We compared the efficacy and safety of self-expanding plastic stents (SEPSs) with placement of biodegradable stents for the treatment of RBES. We studied 2 groups of consecutive patients with RBES who received temporary placement (6 weeks) of SEPSs (n = 20) or biodegradable stents (n = 18). Data were collected with respect to clinical outcome, complications, recurrent dysphagia, and reinterventions. SEPSs were removed in 16 (80%) patients. Stent placement was not successful in 1 patient, while stent removal was not performed in another 3 patients. Six (30%) patients with an SEPS were dysphagia-free after a median follow-up of 385 days (range, 77-924 days). Ten (50%) developed recurrent dysphagia. Major complications occurred in 2 patients (10%; 1 with hemorrhage and 1 with perforation). Six patients (33%) with a biodegradable stent were dysphagia-free after a median follow-up of 166 days (range 21-559 days) (P = .83 compared with SEPS). Twelve patients (67%) had recurrent dysphagia. Major complications occurred in 4 patients (22%; 2 with hemorrhage, 2 with severe retrosternal pain) with a biodegradable stent (P = .30 compared with SEPS). Reinterventions were less frequently indicated after biodegradeble stent than after SEPS placement (15 [mean, 0.8 ± 0.6 per stent placed] vs 21 [mean, 1.3 ± 0.4 per stent placed], respectively; P = .03). Placement of SEPSs or biodegradable stents provides long-term relief of dysphagia in 30% and 33%, respectively, of patients with RBES. Biodegradable stents require fewer procedures than SEPSs, offering an advantage. Although stent placement is a viable strategy in patients with RBES, the ideal strategy still needs to be defined. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. Long-term effects of forgotten biliary stents: a case series and literature review.

    PubMed

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documents submitted by the patient did not indicate a replacement of the biliary stent in 3 patients. Two patients knew that they had biliary stents. We also conducted a literature review via the PubMed and Google Scholar databases of English language studies published until March 2014 on forgotten biliary stent. There were 3 men and 2 women ranging in age from 22 to 68 years (mean age 41.6 years). Patients presented with pain in the upper abdomen, jaundice, fever, abnormal liver function tests or dilatation of the biliary tract alone or in combination. Patients' demographic findings are presented in Table 1. A review of three cases reported in the English medical literature also discussed. The mean duration of the patency of the stent is about 12 months. The biliary stenting is performed either with plastic or metal stents, studies recommending their replacement after 3-6 months. Patients with long stayed forgotten biliary stents are inevitably treated with surgical intervention. We recommend for all endoscopic retrograde cholangiopancreatography units provide a stent registry system that the stents placed for various therapeutic procedures are not forgotten both by the patient as well as the physician. There should be a deadline for biliary stents in the registry system for each patient.

  14. Long-term effects of forgotten biliary stents: a case series and literature review

    PubMed Central

    Odabasi, Mehmet; Arslan, Cem; Akbulut, Sami; Abuoglu, Haci Hasan; Ozkan, Erkan; Yildiz, Mehmet Kamil; Eris, Cengiz; Gunay, Emre; Tekesin, Kemal; Muftuoglu, Tolga

    2014-01-01

    There are many studies about the biliary stents, however there is a little information about the long-term stayed forgotten biliary stents except a few case reports. We have reported the results of a number of cases with biliary stents that were forgotten or omitted by the patient and the endoscopist. During February 2010 to May 2013, five patients were referred to the general surgery clinic of Haydarpasa Numune Training and Research Hospital, Istanbul Turkey. Past history and medical documents submitted by the patient did not indicate a replacement of the biliary stent in 3 patients. Two patients knew that they had biliary stents. We also conducted a literature review via the PubMed and Google Scholar databases of English language studies published until March 2014 on forgotten biliary stent. There were 3 men and 2 women ranging in age from 22 to 68 years (mean age 41.6 years). Patients presented with pain in the upper abdomen, jaundice, fever, abnormal liver function tests or dilatation of the biliary tract alone or in combination. Patients’ demographic findings are presented in Table 1. A review of three cases reported in the English medical literature also discussed. The mean duration of the patency of the stent is about 12 months. The biliary stenting is performed either with plastic or metal stents, studies recommending their replacement after 3-6 months. Patients with long stayed forgotten biliary stents are inevitably treated with surgical intervention. We recommend for all endoscopic retrograde cholangiopancreatography units provide a stent registry system that the stents placed for various therapeutic procedures are not forgotten both by the patient as well as the physician. There should be a deadline for biliary stents in the registry system for each patient. PMID:25232385

  15. Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review.

    PubMed

    Betschart, Patrick; Zumstein, Valentin; Piller, Alberto; Schmid, Hans-Peter; Abt, Dominik

    2017-02-25

    Temporary drainage of the upper urinary tract by internal ureteral stents is a routine procedure in endourology. However, it is associated with a clear side-effect profile. Our aim was to evaluate prevention and treatment options of stent-related symptoms. We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using MEDLINE and SCOPUS, and identified 107 appropriate records. A high number of these studies showed clear methodological limitations. Available data clearly support the use of α1 -blockers in patients suffering from stent-related symptoms. It seems that antimuscarinic monotherapy or combination with α1 -blockers might also play an important role, whereas the use of classical analgesics in the treatment of stent-related symptoms has not been assessed systematically within clinical trials so far. Improvements in stent design and material seem to have the potential to reduce stent-related symptoms. However, so far there is no type of stent with outstanding characteristics and clear evidence suggesting fundamental advantages compared with a standard double pigtail stent. Although stent diameter does not seem to influence patients' comfort, it seems to be beneficial to choose a proper stent-length. Coated and drug-eluting stents, as well as intravesical drug application, seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. Furthermore, thorough patient education has the potential to reduce the morbidity associated with ureteral stenting. Further research in the field seems to be mandatory.

  16. Placement of tracheobronchial silicone Y-stents: Multicenter experience and systematic review of the literature.

    PubMed

    Sehgal, Inderpaul Singh; Dhooria, Sahajal; Madan, Karan; Pattabhiraman, Vallandramam; Mehta, Ravindra; Goyal, Rajiv; Akkaraju, Jayachandra; Agarwal, Ritesh

    2017-01-01

    Airway obstruction or tracheoesophageal fistula (TEF) near the tracheal carina requires placement of Y-shaped stents. Herein, we describe our multicenter experience with the placement of Dumon silicone Y-stents. We also conduct a systematic review for studies describing the deployment of airway silicone Y-stents. This was a retrospective analysis of consecutive subjects who underwent placement of silicone Y-stents. The clinical details including the underlying diagnosis, indication for the placement of silicone Y-stents, success of stent placement, and follow-up are presented. The PubMed and EMBASE databases were also reviewed for studies describing the placement of silicone Y-stents. During the study, 27 silicone Y-stents were placed. The mean (standard deviation) age of the study population (85.2% males) was 57.7 (13.5) years. The stents were placed for airway obstruction in 77.8% and TEF in 29.6% of the patients. The most common underlying disease was carcinoma of the esophagus. The degree of airway obstruction was grade 3-4 in 18 subjects, and respiratory failure was encountered in 18 subjects. The stent was deployed successfully in all the subjects. No deaths were encountered during stent placement. Most subjects had rapid relief of symptoms following the procedure. Excessive secretions and mucostasis were the most common stent-related complications followed by the development of granulation tissue. The systematic review yielded nine studies (338 subjects with airway obstruction and/or TEF). The most common indication for silicone Y-stent placement was tracheobronchial obstruction and TEF due to malignancy. Benign disorders that necessitated stent placement included postintubation tracheal stenosis, airway malacia, and others. The stent was successfully placed in 98% with only one periprocedural death. Granulation tissue formation and mucostasis were the most common stent-related complications. Placement of silicone Y-stent is a safe and effective procedure

  17. [Physical properties of Strecker stents].

    PubMed

    Okuda, Y; Sawada, S; Morioka, N; Kodani, K; Ihaya, T; Tanigawa, N; Kobayashi, M; Hashimoto, M; Oouchi, Y; Shimatani, Y

    1995-02-01

    Strecker stent is a balloon-expandable metallic stent that is made of knitted tantalum wire mesh in order to Maintain flexibility. Therefore, the prosthesis is well suited to irregular and tortuous tube organs. We performed several physical experiments using 8 mm and 6 mm diameter stents made of 0.1 mm diameter wire filament. The bearing power of the 8 mm diameter stent against the circumferential compression pressure was divided into two groups, that is, 77-100% and under 66% of expansile rate. The capacity bearing the circumferential compression pressure of the latter group was greater than that of the former. Further, the bearing power of the 6 mm diameter stent was greater than that of the 56% expansile rate of the 8 mm diameter stent. The smaller the expansile rate of the stent, the smaller the minimum radius of curvature within the limits of the stent's plastic. To evaluate the suitability of the stent in clinical use, we made two projections on the inner surface of rubber tubes, and the stents were placed into the rubber tubes at different expansile rates. We evaluated the degree of contact of the stents against the rubber wall by taking soft X-ray photographs. The stents showed good suitability under the condition of incomplete expansion. For the above reasons, we concluded that, from the view-point of bearing power, the stent should be placed in the full expansile state. From the viewpoint of contact against the vessel wall, the stent should be placed in the incomplete expansile state.

  18. Stent selection in patients with myocardial infarction: drug eluting, biodegradable polymers or bare metal stents?

    PubMed

    Mieres, Juan; Rodríguez, Alfredo E

    2012-08-01

    Percutaneous coronary intervention (PCI) has been increasingly used in the last years during interventional procedures in patients with acute coronary syndromes (ACS) including ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In patients with either STEMI, NSTEMI, high risk ACS with EKG changes or cardiac enzymes rises; PCI with bare metal stent (BMS) implantation has been associated with a significant improvement in clinical outcome. Therefore, BMS implantation during primary PCI in STEMI has become a standard of practice. With the introduction of drug eluting stents (DESs) in this decade, the use of these new devices instead of BMSs in patients with STEMI has emerged as a rational PCI alternative in this particular subgroup of patients. In spite of the unquestionable benefits of DESs in terms of reduction of restenosis and TVR, specific concerns have arisen with regard to their long-term safety. High incidence of very late stent thrombosis has been described with these devices, and special attention should be paid in patients with unstable coronary lesions, in which plaque composition and remodeling may play a main role in their safety and long-term outcome. Intraluminal thrombus caused by plaque rupture is the most frequent mechanism of STEMI, in which the necrotic core and thin fibrous cap play a major role. In this context, the use of first DESs designs may be futile or even unsafe because delayed healing may further contribute to plaque instability. Adjunctive invasive imaging tools can improve stent deployment and safety outcome in these lesions with intravascular findings of plaque instability. Recently, other players such as new dedicated antithrombotic BMS designs, including selfexpanding stents or drug-eluting coated balloons, are exploring their potential indications in patients with ACS and myocardial infarction. This paper reports and discusses new stent devices and adjunctive pharmacologic agents. It

  19. Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution: A Randomized Clinical Trial.

    PubMed

    Coté, Gregory A; Slivka, Adam; Tarnasky, Paul; Mullady, Daniel K; Elmunzer, B Joseph; Elta, Grace; Fogel, Evan; Lehman, Glen; McHenry, Lee; Romagnuolo, Joseph; Menon, Shyam; Siddiqui, Uzma D; Watkins, James; Lynch, Sheryl; Denski, Cheryl; Xu, Huiping; Sherman, Stuart

    Endoscopic placement of multiple plastic stents in parallel is the first-line treatment for most benign biliary strictures; it is possible that fully covered, self-expandable metallic stents (cSEMS) may require fewer endoscopic retrograde cholangiopancreatography procedures (ERCPs) to achieve resolution. To assess whether use of cSEMS is noninferior to plastic stents with respect to stricture resolution. Multicenter (8 endoscopic referral centers), open-label, parallel, randomized clinical trial involving patients with treatment-naive, benign biliary strictures (N = 112) due to orthotopic liver transplant (n = 73), chronic pancreatitis (n = 35), or postoperative injury (n = 4), who were enrolled between April 2011 and September 2014 (with follow-up ending October 2015). Patients with a bile duct diameter less than 6 mm and those with an intact gallbladder in whom the cystic duct would be overlapped by a cSEMS were excluded. Patients (N = 112) were randomized to receive multiple plastic stents or a single cSEMS, stratified by stricture etiology and with endoscopic reassessment for resolution every 3 months (plastic stents) or every 6 months (cSEMS). Patients were followed up for 12 months after stricture resolution to assess for recurrence. Primary outcome was stricture resolution after no more than 12 months of endoscopic therapy. The sample size was estimated based on the noninferiority of cSEMS to plastic stents, with a noninferiority margin of -15%. There were 55 patients in the plastic stent group (mean [SD] age, 57 [11] years; 17 women [31%]) and 57 patients in the cSEMS group (mean [SD] age, 55 [10] years; 19 women [33%]). Compared with plastic stents (41/48, 85.4%), the cSEMS resolution rate was 50 of 54 patients (92.6%), with a rate difference of 7.2% (1-sided 95% CI, -3.0% to ∞; P < .001). Given the prespecified noninferiority margin of -15%, the null hypothesis that cSEMS is less effective than plastic stents was rejected. The

  20. Over-the-wire versus through-the-scope stents for the palliation of malignant gastric outlet obstruction: A retrospective comparison study.

    PubMed

    Park, Jung-Hoon; Lee, Jeong Hoon; Song, Ho-Young; Choi, Kee Don; Ryu, Min-Hee; Yun, Sung-Cheol; Kim, Jin Hyoung; Kim, Do Hoon; Yoo, Moon-Won; Hwang, Dae Wook; Tsauo, Jiaywei

    2016-12-01

    To compare the outcomes of over-the-wire (OTW) and through-the-scope (TTS) partially covered stents in patients with malignant gastric outlet obstruction (GOO). A retrospective study was performed in 306 patients who had either OTW (n = 125) or TTS (n = 181) stents placed. Outcomes analysed included technical and clinical success, procedure time, complications, re-intervention, stent patency and survival. One hundred and ninety-three patients met our inclusion criteria, including 125 patients in the OTW group and 68 patients in the TTS group. Technical and clinical outcomes were similar in the two groups. Stent migration rate was higher in the TTS than in the OTW group (P = 0.002) and was associated with straight stent and subsequent chemotherapy in the TTS group. Stent collapse was lower in the TTS than in the OTW group (P = 0.021). Six-month stent patency rate was higher in the OTW than in the TTS group (P = 0.044). TTS and OTW stents for the palliation of malignant GOO resulted in similar technical and clinical outcomes, stent patency and survival. TTS stents were associated with a higher migration rate, especially use of straight stents and subsequent chemotherapy, but a lower stent collapse rate than OTW stents. • OTW and TTS stents are equally effective in palliating GOO symptoms. • Six-month stent patency was higher for OTW than for TTS. • The straight stent and subsequent chemotherapy could increase stent migration. • Complication rates were lower for flared than for straight stents. • It is necessary to develop a multidisciplinary approach to integrate clinical experience.

  1. Coronary covered stents.

    PubMed

    Kilic, Ismail Dogu; Fabris, Enrico; Serdoz, Roberta; Caiazzo, Gianluca; Foin, Nicolas; Abou-Sherif, Sara; Di Mario, Carlo

    2016-11-20

    Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.

  2. Recent developments of imaging modalities of carotid artery stenting.

    PubMed

    Umemoto, Tomoyuki; Pacchioni, Andrea; Nikas, Dimitrios; Reimers, Bernhard

    2017-02-01

    Compared with conventional angiogram-guided procedure, intravascular imaging modalities give us a lot of useful information to make the procedure better. Intravascular imaging modalities give us the information about lesion characters, reference vessel diameter and the interaction between the stent strut and the plaque such as stent strut malapposition or plaque prolapse in real time during the procedure. We can change our strategy according to this information. Intravascular ultrasound (IVUS) is a most common intravascular imaging modality during carotid artery stenting (CAS) in these days. Its advantage is easy to use compared with optical coherence tomograpy (OCT) which has been reported recently in some case reports or case series. However, due to its high resolution, OCT provides more detailed information especially about plaque prolapse and strut malapposition. IVUS and OCT have a potential to improve acute result and reduce the procedural complication by providing the data of lesion character, reference vessel diameter and the interaction of stent strut and vessel wall. Interventionalists who perform CAS procedure should acquire proficiency in imaging modalities during CAS procedure.

  3. Recurrent traumatic urethral strictures near the external sphincter: treatment with a covered, retrievable, expandable nitinol stent--initial results.

    PubMed

    Song, Ho-Young; Park, Hyungkeun; Suh, Tae-Suk; Ko, Gi-Young; Kim, Tae-Hyung; Kim, Eun-Sang; Park, Taehan

    2003-02-01

    To investigate the clinical effectiveness of a covered, retrievable, expandable nitinol stent in treating traumatic urethral strictures near the external sphincter. The stent was 10 mm in diameter when fully expanded and 40-50 mm long. To make it removable, two nylon drawstrings were attached to its lower inner margin. Twelve consecutive men (19-67 years; mean age, 47 years) with traumatic urethral strictures near the external sphincter that were refractory to endoscopic urethrotomy were treated. With fluoroscopic guidance, a stent was placed to completely bridge the external sphincter. The stent was electively removed with a retrieval hook wire 2 months after placement. Stent placement and removal were successful in all patients, with no procedural complications. Mean maximum urine flow rate was 5 mL/sec (range, 3-7 mL/sec) before stent placement and 27 mL/sec (range, 16-40 mL/sec) at 1 week after placement. During the mean follow-up of 20 months (range, 2-37 months) after the first stent removal, strictures recurred in eight of 12 patients. For the eight patients with recurrence, a second stent was placed and 4 months later was removed from seven of the eight patients. During the mean follow-up of 18 months (range, 4-32 months) after the second stent removal, strictures recurred in two patients, in whom a third stent was placed and then removed 4 months later, with good results. Four (33%) of 12 patients, five (62%) of eight patients, and two (100%) of two patients were successfully treated with placement of the first stent, the second stent, and the third stent, respectively. In the remaining patient, the second stent remains in place. Placement of a covered, retrievable, expandable nitinol stent seems to be effective in treating urethral strictures near the external sphincter and warrants further investigation.

  4. Postcatheterization Femoral Arteriovenous Fistulas: Endovascular Treatment with Stent-Grafts

    SciTech Connect

    Onal, Baran Kosar, Sule; Gumus, Terman; Ilgit, Erhan T.; Akpek, Sergin

    2004-09-15

    Purpose: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.Methods: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.Results: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.Conclusion: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

  5. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

    SciTech Connect

    Miyayama, Shiro Yamashiro, Masashi; Takeda, Taro; Aburano, Hiroyuki; Komatsu, Tetsuya; Sanada, Taku; Kosaka, Shotaro; Toya, Daisyu; Matsui, Osamu

    2008-07-15

    We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

  6. Design Optimisation of Coronary Artery Stent Systems.

    PubMed

    Bressloff, Neil W; Ragkousis, Giorgos; Curzen, Nick

    2016-02-01

    In recent years, advances in computing power and computational methods have made it possible to perform detailed simulations of the coronary artery stenting procedure and of related virtual tests of performance (including fatigue resistance, corrosion and haemodynamic disturbance). Simultaneously, there has been a growth in systematic computational optimisation studies, largely exploiting the suitability of surrogate modelling methods to time-consuming simulations. To date, systematic optimisation has focussed on stent shape optimisation and has re-affirmed the complexity of the multi-disciplinary, multi-objective problem at hand. Also, surrogate modelling has predominantly involved the method of Kriging. Interestingly, though, optimisation tools, particularly those associated with Kriging, haven't been used as efficiently as they could have been. This has especially been the case with the way that Kriging predictor functions have been updated during the search for optimal designs. Nonetheless, the potential for future, carefully posed, optimisation strategies has been suitably demonstrated, as described in this review.

  7. Direct Primary or Secondary Percutaneous Ureteral Stenting: What Is the Most Compliant Option in Patients with Malignant Ureteral Obstructions?

    SciTech Connect

    Carrafiello, Gianpaolo Lagana, Domenico; Lumia, Domenico; Giorgianni, Andrea; Mangini, Monica; Santoro, Domenico; Cuffari, Salvatore; Marconi, Alberto; Novario, Raffaele; Fugazzola, Carlo

    2007-09-15

    The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertion of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting ( Euro 637; SD, Euro 115) was significantly higher than that of procedures which involved direct or primary stenting ( Euro 560; SD, Euro 108). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.

  8. Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution

    PubMed Central

    Coté, Gregory A.; Slivka, Adam; Tarnasky, Paul; Mullady, Daniel K.; Elmunzer, B. Joseph; Elta, Grace; Fogel, Evan; Lehman, Glen; McHenry, Lee; Romagnuolo, Joseph; Menon, Shyam; Siddiqui, Uzma D.; Watkins, James; Lynch, Sheryl; Denski, Cheryl; Xu, Huiping; Sherman, Stuart

    2017-01-01

    IMPORTANCE Endoscopic placement of multiple plastic stents in parallel is the first-line treatment for most benign biliary strictures; it is possible that fully covered, self-expandable metallic stents (cSEMS) may require fewer endoscopic retrograde cholangiopancreatography procedures (ERCPs) to achieve resolution. OBJECTIVE To assess whether use of cSEMS is noninferior to plastic stents with respect to stricture resolution. DESIGN, SETTING, AND PARTICIPANTS Multicenter (8 endoscopic referral centers), open-label, parallel, randomized clinical trial involving patients with treatment-naive, benign biliary strictures (N = 112) due to orthotopic liver transplant (n = 73), chronic pancreatitis (n = 35), or postoperative injury (n = 4), who were enrolled between April 2011 and September 2014 (with follow-up ending October 2015). Patients with a bile duct diameter less than 6 mm and those with an intact gallbladder in whom the cystic duct would be overlapped by a cSEMS were excluded. INTERVENTIONS Patients (N = 112) were randomized to receive multiple plastic stents or a single cSEMS, stratified by stricture etiology and with endoscopic reassessment for resolution every 3 months (plastic stents) or every 6 months (cSEMS). Patients were followed up for 12 months after stricture resolution to assess for recurrence. MAIN OUTCOMES AND MEASURES Primary outcome was stricture resolution after no more than 12 months of endoscopic therapy. The sample size was estimated based on the noninferiority of cSEMS to plastic stents, with a noninferiority margin of −15%. RESULTS There were 55 patients in the plastic stent group (mean [SD] age, 57 [11] years; 17 women [31%]) and 57 patients in the cSEMS group (mean [SD] age, 55 [10] years; 19 women [33%]). Compared with plastic stents (41/48, 85.4%), the cSEMS resolution rate was 50 of 54 patients (92.6%), with a rate difference of 7.2% (1-sided 95% CI, −3.0% to ∞; P < .001). Given the prespecified noninferiority margin of −15%, the

  9. Stent-Induced Esophageal Perforation: Treatment by Means of Placing a Second Stent After Removal of the Original Stent

    SciTech Connect

    Jung, Gyoo-Sik Park, Sung-Dal; Cho, Young Duk

    2008-05-15

    A case of esophageal perforation caused by a retrievable covered stent is presented. The distal end of the stent was protruding into the mediastinum, which made it impossible to negotiate a guidewire through the stent into the distal esophagus. The stent was successfully removed with use of a stent retrieval set, and esophageal perforation was treated with a second, covered stent with a good result. Fatality associated with this complication might be prevented by virtue of the retrievability of the stent we used. This result points to the effectiveness of a retrievable stent for the palliative treatment of malignant esophageal stricture.

  10. Mechanical Characteristics of Composite Knitted Stents

    SciTech Connect

    Tokuda, Takanori Shomura, Yuzo; Tanigawa, Noboru; Kariya, Shuji; Komemushi, Atsushi; Kojima, Hiroyuki; Sawada, Satoshi

    2009-09-15

    We used metal wires and fibers to fabricate a composite knitted stent and then compare the mechanical characteristics of this stent with those of a pure metallic stent of the same construction in order to develop a stent that offers a comparable degree of expandability as metallic stents but can be used for highly curved lesions that cannot be treated using metallic stents. We fabricated two types of composite knitted stent (N-Z stents), using nitinol wire with a diameter of 0.12 mm and polypara-phenylene-benzobisoxazole (PBO) multifilament fiber (Zyron AS; Toyobo, Osaka, Japan). Stents were knitted into a cylindrical shape using the same textile pattern as a Strecker stent. Two loop lengths (L) of nitinol wire were used in the N-Z stents: L = 1.84 mm (N-Z stent L = 1.84) and L = 2.08 mm (N-Z stent L = 2.08). For the sake of comparison, we fabricated a metallic stent of nitinol using the same textile pattern (N-N stent L = 1.92). We applied a radial compression force diametrically to each stent and applied a bending force diametrically at the free end of a stent with one end fixed in order to evaluate the relationship between stent elasticity and load values. In addition, we macroscopically evaluated the generation of kinks when the stent was bent 180{sup o}. The radial compressive force when the stent diameter was reduced by 53% was 6.44 N in the case of N-Z stent L = 1.84, 6.14 N in the case of N-Z stent L = 2.08, and 4.96 N in the case of N-N stent L = 1.92 mm. The composite stent had a radial compressive force higher than that of a metallic stent. The restoring force to longitudinal direction at a 90{sup o} bending angle was 0.005 N for N-Z stent L = 1.84, 0.003 N for N-Z stent L = 2.08, and 0.034 N for N-N stent L = 1.92. The restoring force of the composite stent was significantly lower. Finally, the composite stent generated no definitive kinks at a bending angle of 180{sup o}, regardless of loop length. However, the N-N stent clearly produced kinks, causing

  11. Development of gold stents for the treatment of intracranial aneurysms: an experimental study in a canine model.

    PubMed

    Ohyama, Takashiro; Nishide, Takuji; Iwata, Hiroo; Taki, Waro

    2004-01-01

    Gold has often been used in medicine because of its radiopacity and flexibility. To perform stent-supported coil embolization of intracranial aneurysms, we prepared a gold stent and examined its flexibility, radiopacity, and thrombogenic properties in comparison with a stainless steel device implanted in vitro and in vivo. Gold stents were prepared by plating gold on stainless steel stents as a template. Their mechanical properties and trackability in vitro were determined and compared with those of stainless steel stents of the same design. Twenty gold stents and two stainless steel stents were implanted in canine external carotid, vertebral, and renal arteries, as a muscle branch of the maxillary arteries, to examine their performance in vivo. The gold stent exhibited much less radial force and greater flexibility than the stainless steel stent. It also demonstrated superior trackability and radiopacity in the experimental endovascular procedures in canines. Histologic examination showed good patency of the stented artery with slight endothelial hypertrophy. Although there is still room for more radial strength, less influence on intimal hypertrophy, a more suitable flexibility, and a smoother surface, the superior trackability and radiopacity of gold stents seem to support use of this device for the endovascular treatment of intracranial aneurysms.

  12. Simultaneous vertebral and subclavian artery stenting

    PubMed Central

    Tekieli, Łukasz; Machnik, Roman; Kabłak-Ziembicka, Anna; Przewłocki, Tadeusz; Paluszek, Piotr; Trystuła, Mariusz; Musiał, Robert; Dzierwa, Karolina; Pieniążek, Piotr

    2017-01-01

    Introduction Vertebrobasilar territory ischemia leads to disabling neurological symptoms and may be caused both by vertebral artery (VA) and subclavian artery (SA) stenosis. The coexisting symptomatic ipsilateral VA and proximal SA stenosis should be considered as a true bifurcation lesion for percutaneous treatment. Aim To evaluate the safety and efficacy of simultaneous angioplasty of vertebral and subclavian stenosis. Material and methods Fifteen patients (age 69.5 years, 46.7% men, all symptomatic from posterior circulation (history of stroke, transient ischemic attack, chronic ischemia symptoms)) were scheduled for simultaneous SA/VA angioplasty. Clinical and duplex ultrasound follow-up was conducted 1, 6 and 12 months after the procedure. Results The technical success rate was 100%. Single balloon-mounted stent angioplasty was performed for all VAs and for 13 (86.7%) SAs. In 4 cases a simultaneous radial and femoral approach was required. The mean North American Symptomatic Carotid Endarterectomy Trial (NASCET) VA stenosis was reduced from 88.7 ±9.7% to 5.7 ±6.8% and SA stenosis from 80 ±12.2% to 11 ±12.3% (p < 0.01). No periprocedural death, stroke, myocardial infarction or transient ischemic attack occurred. During follow-up (range: 6–107 months) in 10 of 15 (66.7%) patients relief of chronic ischemic symptoms was observed. No stroke/TIA occurred. One cardiovascular and 2 non-cardiovascular deaths were recorded. There was 1 symptomatic vertebral and 1 subclavian in-stent restenosis, and 2 cases of asymptomatic VA in-stent occlusion occurred. Conclusions Simultaneous vertebral and subclavian artery stenting is safe and effective. The restenosis rate remains at an acceptable level and it may be treated successfully with drug-eluting balloon angioplasty. In selected patients a dual radial and femoral approach may facilitate the procedure. PMID:28798785

  13. Ureteroscopic removal of forgotten ureteral stent

    PubMed Central

    Kawahara, Takashi; Ishida, Hiroaki; Kubota, Yoshinobu; Matsuzaki, Junichi

    2012-01-01

    A 69-year-old female had a right ureteral stent placed due to ureteral stricture resulting from cervical cancer in March 2008. The ureteral stent migrated to the ureter and was not exchanged. A new ureteral stent was inserted, and was exchanged every 3 months. The patient was referred to our department to remove the forgotten ureteral stent. In January 2012, her old ureteral stent was removed ureteroscopically, and no ureteral stent encrustation was found. PMID:22707678

  14. Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study

    PubMed Central

    Hamada, Tsuyoshi; Isayama, Hiroyuki; Nakai, Yousuke; Togawa, Osamu; Takahara, Naminatsu; Uchino, Rie; Mizuno, Suguru; Mohri, Dai; Yagioka, Hiroshi; Kogure, Hirofumi; Matsubara, Saburo; Yamamoto, Natsuyo; Ito, Yukiko; Tada, Minoru; Koike, Kazuhiko

    2017-01-01

    Background/Aims In distal malignant biliary obstruction, an antireflux metal stent (ARMS) with a funnel-shaped valve is effective as a reintervention for metal stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line metal stent. Methods Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement. Results In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced non-occlusion cholangitis. Conclusions The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent stent dysfunction due to reflux, further investigation is warranted. PMID:27282268

  15. Endoscopic placement of a new short-term biodegradable pancreatic and biliary stent in an animal model: a preliminary feasibility study (with videos).

    PubMed

    Itoi, Takao; Kasuya, Kazuhiko; Abe, Yuta; Isayama, Hiroyuki

    2011-05-01

    Recently, biodegradable pancreatic stents have been designed and placed in vivo and in vitro. The aim of this study is to investigate the feasibility of endoscopic stenting using the novel, braided, self-expandable, biodegradable, pancreatic and biliary stent in a pig model. A braided, self-expandable, biodegradable stent was endoscopically placed into the pancreatic duct and bile duct in 4 pigs. Eventually, necropsy was performed to evaluate the stent placement after the procedure. Pancreatic and biliary stents were successfully inserted and easily deployed across the papilla into the main pancreatic duct and bile duct, respectively, in all the animals under endoscopic and fluoroscopic guidance. Necropsy performed immediate following stent placement, found that stents had been placed across the papilla and stent expansion had occurred in all cases. Although this stent is not radiopaque and the number of cases was small in this experimental study, endoscopic stenting using this novel, braided, self-expandable, biodegradable, pancreatic and biliary stent was feasible in the pig model. Further animal studies to evaluate the short-term patency, tissue reactivity and degradability of the stents are warranted.

  16. Common femoral endovenectomy in conjunction with iliac vein stenting to improve venous inflow in severe post-thrombotic obstruction.

    PubMed

    Verma, Himanshu; Tripathi, Ramesh K

    2017-01-01

    Post-thrombotic syndrome secondary to iliofemoral deep venous thrombosis is a significant contributor to advanced chronic venous insufficiency. Iliac vein stenting is a standard procedure to treat iliocaval obstruction. In cases with obstruction extending across the groin, venous inflow for an iliac vein stent may be poor and compromise results of iliac vein stenting. Treatment options include extension of stents across the inguinal ligament that may have limitations in improving inflow only from only one vessel. Endovenectomy in this scenario becomes an attractive option with or without iliac vein stenting to provide outflow to the profunda vein, which otherwise is "axially transformed" in chronic iliofemoral deep venous thrombosis. We describe a technique of endovenectomy in combination with iliac vein stenting to establish a patent outflow tract for profunda and femoral veins. Accompanying also is a video demonstration of endovenectomy that will help viewers understand more technical aspects of the procedure.

  17. Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

    PubMed Central

    Xia, Ning; Gong, Ju; Lu, Jian; Chen, Zhi-Jin; Zhang, Li-Yun; Wang, Zhong-Min

    2017-01-01

    AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter. RESULTS Following the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to follow-up. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 ± 65 μmol/L and 63 ± 29 μmol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients’ stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d. CONCLUSION This preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach. PMID:28348491

  18. Could direct stenting reduce no-reflow in acute coronary syndromes? A randomized pilot study.

    PubMed

    Sabatier, Rémi; Hamon, Martial; Zhao, Quan Ming; Burzotta, Francesco; Lecluse, Emmanuel; Valette, Benoit; Grollier, Gilles

    2002-06-01

    Recently, direct stenting has been shown in retrospective and randomized studies to be feasible and safe in highly selected patients, with a potential interest to reduce the cost of the procedure and the rate of no-reflow. This randomized pilot study was designed to compare the incidence of no-reflow after direct stenting or conventional stenting after balloon predilation in acute coronary syndrome-related lesions. Between December 1998 and October 1999, 130 patients in our center with acute coronary syndromes were included in this study and randomized in 2 groups. In group A (n = 65), direct stent implantation was performed without balloon predilation. In group B (n = 65), conventional balloon predilation was carried out before stent implantation. Baseline clinical and angiographic characteristics before the procedure were similar in the 2 groups of patients. No-reflow was observed in 7.7% after direct stenting and in 6.1% after conventional stent implantation (P = not significant). The immediate clinical success rate was similar in the 2 groups. Among the procedural data, only duration of the procedure (shorter in the direct stenting group), the number of balloons used, and the quantity of contrast agent (lower in the direct stenting group) were significantly different between the 2 groups (P <.05). The 6-month clinical outcome was similar in the 2 groups. This randomized study confirms the promising results of previous studies that show the feasibility and the safety of direct coronary stenting in highly selected acute coronary syndrome-related lesions. The major impact of this strategy is the improvement of the cost-benefit ratio, with no major influence on the acute complications and especially on the occurrence of no-reflow in this high-risk population.

  19. [Carotid stenosis: the technic for PTA and stent implantation].

    PubMed

    Thurnher, S

    2000-09-01

    Percutaneous transluminal angioplasty and stenting of carotid artery stenosis represents an innovative experimental modality which has been increasingly employed in high-risk patients. Currently, results from prospective randomized trials are not available; thus, guidelines with regard to indications and technique are preliminary. Numerous technical innovations to avoid associated complications have evolved in neurointerventional procedures. Dedicated guiding catheters and stents using a transfemoral approach have been introduced for treatment of carotid artery disease. Low-profile stent delivery systems may decrease risk of releasing embolic load when crossing high-grade stenosis or kinking of the vessel. The introduction of a cerebral protection with the use of temporary occlusion balloons or filter systems has resulted in a reduction of procedure-related neurological complications, and is strongly recommended by leading experts in the field.

  20. Delayed complications after flow-diverter stenting: reactive in-stent stenosis and creeping stents.

    PubMed

    Cohen, José E; Gomori, John Moshe; Moscovici, Samuel; Leker, Ronen R; Itshayek, Eyal

    2014-07-01

    We assessed the frequency and severity of changes in stent configuration and location after the treatment of intracranial aneurysms, and patterns of in-stent stenosis. We retrospectively reviewed data for consecutive aneurysm patients managed with endovascular implantation of flow-diverter stents (Silk Flow Diverter [Balt Extrusion, Montmorency, France] and Pipeline Embolization Device [ev3/Coviden, Minneapolis, MN, USA]) from October 2011 to July 2012. Routine 2, 6, 9-12, and 16-20 month follow-up angiograms were compared, with a focus on changes in stent configuration and location from immediately after deployment to angiographic follow-up, and the incidence and development of in-stent stenosis. Thirty-four patients with 42 aneurysms met inclusion criteria. The Silk device was implanted in 16 patients (47%, single device in 15), the Pipeline device in 18 (53%, single device in 16). On first follow-up angiography, in-stent stenosis was observed in 38% of Silk devices and 39% of Pipeline devices. In-stent stenosis was asymptomatic in 12 of 13 patients. One woman presented with transient ischemic attacks and required stent angioplasty due to end tapering and mild, diffuse in-stent stenosis. Configuration and location changes, including stent creeping and end tapering were seen in 2/16 patients (13%) with Silk devices, and 0/18 patients with Pipeline devices. We describe stent creeping and end tapering as unusual findings with the potential for delayed clinical complications. In-stent stenosis, with a unique behavior, is a frequent angiographic finding observed after flow-diverter stent implant. The stenosis is usually asymptomatic; however, close clinical and angiographic monitoring is mandatory for individualized management. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Can angiotensin receptor antagonists prevent restenosis after stent placement?

    PubMed

    Peters, Stefan

    2002-01-01

    Restenosis rates after coronary stent implantation in complex lesions are between 30 and 50%. Neointimal hyperplasia promoted by complex interaction between cellular and acellular elements, such as cytokines and growth factors, is thought to be the primary process responsible for restenosis. The risk of in-stent restenosis is increased in patients with a history of restenosis after percutaneous transluminal coronary angioplasty, in long lesions, in total occlusions, in patients with diabetes mellitus, in small vessels, in the proximal parts of the left anterior descending coronary artery and in cases of stent oversizing. In-stent restenosis represents a serious economic burden on society because treatment strategies include expensive approaches such as cutting-balloon angioplasty, rotational atherectomy and brachytherapy. A number of pharmacological agents, including ACE inhibitors, have been unsuccessful in preventing restenosis. Alternative procedures such as brachytherapy, radioactive stents and drug-eluting stents are under evaluation. Although sirolimus- or paclitaxel-eluting stents have been associated with very low restenosis rates over durations of 6 to 12 months, the long-term efficacy and tolerability of this approach is currently being investigated. Although ACE inhibitors have failed in reducing restenosis rates, the selective angiotensin II type 1 (AT(1)) receptor antagonist valsartan has shown encouraging results in the single-center Valsartan for Prevention of Restenosis after Stenting of Type B2/C lesions trial (ValPREST). The ValPREST trial is the first randomized, placebo-controlled study to have evaluated the effect of an angiotensin receptor antagonist on in-stent restenosis in a moderate number of patients. Compared with ACE inhibitors, angiotensin receptor blockers exert additional effects on the pathophysiological processes which lead to restenosis. Angiotensin receptor antagonists may affect several mechanisms involved in neointimal

  2. Computational fluid dynamic simulations of image-based stented coronary bifurcation models

    PubMed Central

    Chiastra, Claudio; Morlacchi, Stefano; Gallo, Diego; Morbiducci, Umberto; Cárdenes, Rubén; Larrabide, Ignacio; Migliavacca, Francesco

    2013-01-01

    One of the relevant phenomenon associated with in-stent restenosis in coronary arteries is an altered haemodynamics in the stented region. Computational fluid dynamics (CFD) offers the possibility to investigate the haemodynamics at a level of detail not always accessible within experimental techniques. CFD can quantify and correlate the local haemodynamics structures which might lead to in-stent restenosis. The aim of this work is to study the fluid dynamics of realistic stented coronary artery models which replicate the complete clinical procedure of stent implantation. Two cases of pathologic left anterior descending coronary arteries with their bifurcations are reconstructed from computed tomography angiography and conventional coronary angiography images. Results of wall shear stress and relative residence time show that the wall regions more prone to the risk of restenosis are located next to stent struts, to the bifurcations and to the stent overlapping zone for both investigated cases. Considering a bulk flow analysis, helical flow structures are generated by the curvature of the zone upstream from the stent and by the bifurcation regions. Helical recirculating microstructures are also visible downstream from the stent struts. This study demonstrates the feasibility to virtually investigate the haemodynamics of patient-specific coronary bifurcation geometries. PMID:23676893

  3. Indications of airway stenting for severe central airway obstruction due to advanced cancer.

    PubMed

    Nagano, Hiroaki; Kishaba, Tomoo; Nei, Yuichirou; Yamashiro, Shin; Takara, Hiroaki

    2017-01-01

    Management of severe central airway obstruction due to advanced cancer is a medical and technical challenge. The impact of airway stenting on the clinical outcome of such patients is unclear. This single-center, retrospective study evaluated 21 patients who underwent airway stenting for advanced cancer. We examined predictors of the post-stenting mortality, including age, serum albumin, tracheal diameter, smoking, opioid use, respiratory failure, and performance status (PS). We also compared survival according to the PS. The mean survival period after stenting was 85.2 days. On univariate analysis, age, albumin, PS before airway stenting, respiratory failure, admission route, and PS grade were the candidates as possible predictors of prognosis after the procedure. On multivariate analysis, PS before airway stenting was identified as possible predictor of prognosis after stenting (HR 1.6180, 95% CI 0.969 to 2.7015, p = 0.066). The mean survival period after stenting was significantly longer in the good PS group, compared to the poor PS group (147.8 days vs. 38.2 days,p = 0.0346). Airway stenting for advanced cancer may be more effective for patients in good general condition than in those with poor performance status.

  4. Endovascular Treatment of Occlusive Lesions in the Aortic Bifurcation with Kissing Polytetrafluoroethylene-Covered Stents.

    PubMed

    Grimme, Frederike A B; Spithoven, J Hans; Zeebregts, Clark J; Scharn, Dirk M; Reijnen, Michel M P J

    2015-09-01

    To determine the clinical outcomes of polytetrafluoroethylene covered balloon expandable stents (CBESs) in occlusive lesions of the aortic bifurcation in a kissing stent configuration. The study included 69 consecutive patients (29 men, 40 women) who underwent kissing stent procedures with CBESs between January 2003 and April 2009 in a single center. Patients who were previously treated with a CBES were excluded. Follow-up consisted of clinical investigation and duplex ultrasound examination. The primary patency was 88.1% at 1 year and 71.5% at 4 years, with secondary patency rates of 88.1% and 75.3%, respectively. For patients receiving a stent for the first time, primary patency was 91.3% at 1 year and 77.1% at 4 years. For patients who had received previous stents, patency was 83.6% at 1 year and 65.2% at 4 years (P = .83). There were no differences in secondary patency and freedom from target lesion reintervention (TLR). Loss of primary patency was mainly caused by stent occlusions (14 cases [78%]). The freedom from TLR at 4 years was 76.8%. Patency rates and freedom from TLR of CBESs in the kissing stent configuration with up to 4 years of follow-up were satisfying and mainly affected by stent occlusions. Studies focusing on optimizing stent configuration and medical care to reduce the incidence of thrombosis are indicated to improve results further. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  5. Image-based dosimetry of an implanted radioactive stent using intravascular ultrasound

    NASA Astrophysics Data System (ADS)

    Peterson, Stephen W.

    Angioplasty has become an increasingly popular and effective treatment for heart disease. Unfortunately, restenosis, a cellular and biological reaction to the procedure, has hindered its effectiveness. Two of the most successful methods of inhibiting restenosis are radiation and stents. The combination of these two components, radioactive stents, is not as common as some of the other methods, yet still has potential of slowing restenosis. Investigation into source characteristics and artery wall radiobiology may illuminate some possible solutions to the problems of restenosis. This work has developed a calculational method to look at in-vivo images of implanted stents and determine the dose to the artery walls in order to test different source characteristics. The images are Intravascular Ultrasound (IVUS) cross-sectional slices of the stent and the artery. From these images, it is possible to determine the implanted stent structure. The pieces of the stent are identified in the images and modeled in a Monte Carlo simulation, using MCNP4c3. The simulation results were combined with the images to give three-dimensional absolute dose contours of the stent. The absolute dose values were verified using radiochromic film and 198Au-plated stents. This work was able to successfully verify the dose results and create a three-dimensional dose map of the implanted stent.

  6. Development of Biliary and Enteral Stents by the Korean Gastrointestinal Endoscopists

    PubMed Central

    Shim, Chan Sup; Kim, Jin Hong; Bok, Gene Hyun

    2016-01-01

    Stenting in the gastrointestinal tract is a common procedure used for palliation of obstruction in the enteral and biliary tract. Today, stenting of malignant and benign strictures is performed at almost every major tertiary hospital in Korea. Moreover, Korea has become a major global supplier of cutting edge technology in the field of self-expanding metal stents. However, the history of stenting in Korea is relatively short and was far behind that of other nations such as Japan and Germany. The authors are humbled and gratified to have been able to observe the development and application of these stents in Korea, first hand. In this article, the authors review the overall history of stenting with a specific focus on the development of stenting in Korea. The development of esophageal, gastroduodenal, biliary, and colonic stents in Korea are reviewed in this article from a chronological and historical point of view, and a personal account of some of the significant moments of stent development in Korea are described. PMID:26956192

  7. Endoscopic management of occluded biliary uncovered metal stents: A multicenter experience

    PubMed Central

    Katsinelos, Panagiotis; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Paikos, Dimitris; Paroutoglou, George; Kapetanos, Dimitris; Terzoudis, Sotiris; Lazaraki, Georgia; Pilpilidis, Ioannis; Fasoulas, Kostas; Atmatzidis, Stefanos; Zavos, Christos; Kountouras, Jannis

    2011-01-01

    AIM: To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents (SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction. METHODS: A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs. The technical success of performed treatment in occluded SEMSs, the patency of the stent, the need for re-intervention and the financial costs of each treatment were analyzed. RESULTS: Fifty four patients were included in the analysis; 21 received Hanaro, 19 Wallstent and 14 Flexus. For the relief of obstruction, a plastic stent was inserted in 24 patients, a second SEMS in 25 and mechanical cleaning was performed in 5 patients. The overall median second patency rates between second SEMSs and plastic stents did not differ (133 d for SEMSs vs 106 d for plastic stents; P = 0.856). Similarly, no difference was found between the overall survival of SEMS and plastic stent groups, and no procedure-related complications occurred. Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece. CONCLUSION: Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs; insertion of plastic stents appears to be the most cost-effective strategy. PMID:21218089

  8. Endoscopic management of occluded biliary uncovered metal stents: a multicenter experience.

    PubMed

    Katsinelos, Panagiotis; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Paikos, Dimitris; Paroutoglou, George; Kapetanos, Dimitris; Terzoudis, Sotiris; Lazaraki, Georgia; Pilpilidis, Ioannis; Fasoulas, Kostas; Atmatzidis, Stefanos; Zavos, Christos; Kountouras, Jannis

    2011-01-07

    To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents (SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction. A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs. The technical success of performed treatment in occluded SEMSs, the patency of the stent, the need for re-intervention and the financial costs of each treatment were analyzed. Fifty four patients were included in the analysis; 21 received Hanaro, 19 Wallstent and 14 Flexus. For the relief of obstruction, a plastic stent was inserted in 24 patients, a second SEMS in 25 and mechanical cleaning was performed in 5 patients. The overall median second patency rates between second SEMSs and plastic stents did not differ (133 d for SEMSs vs 106 d for plastic stents; P=0.856). Similarly, no difference was found between the overall survival of SEMS and plastic stent groups, and no procedure-related complications occurred. Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece. Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs; insertion of plastic stents appears to be the most cost-effective strategy.

  9. Primary Stenting for Complex Atherosclerotic Plaques in Aortic and Iliac Stenoses

    SciTech Connect

    Onal, Baran; Ilgit, Erhan T.; Yuecel, Cem; Ozbek, Erdal; Vural, Murat; Akpek, Sergin

    1998-09-15

    Purpose: To evaluate the efficacy of primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses that are not amenable to balloon angioplasty alone. Methods: Nineteen patients with complex atherosclerotic plaques were treated with a Palmaz stent (n= 19), Wallstent (n= 1), Strecker stent (n= 1), or Memotherm stent (n= 1). A total of 22 stenoses presenting with complex plaque morphology including ulcerated plaques, ulcerated plaques with focal aneurysms, plaques with heavy calcification, severely eccentric plaques, plaques with overhanging edge, and plaques with spontaneous dissection were stented. The lesions were in the aorta (n= 1), common iliac artery (n= 19), or external iliac artery (n= 2). Results: Immediate angiography after stent placement revealed restoration of patency of the stented segment. Focal aneurysms and ulcerated areas were occluded in the follow-up angiographies obtained 4-12 weeks after the procedure. In one case with poor distal runoff and multiple complex lesions of the iliac artery, subacute occlusion occurred. Clinical and angiographic follow-up (3-46 months) revealed patency of all other stented segments. Conclusion: Primary stenting is an effective and reliable approach for complex plaques in stenoses. Patency of the arterial segment with a smooth lumen can be created without the risk of acute complications such as distal embolization, dissection, or occlusion.

  10. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  11. Wave reflection at a stent.

    PubMed

    Crespo, Antonio; García, Javier; Manuel, Fernando

    2013-01-01

    A simple analytical expression has been derived to calculate the characteristics of a wave that reflects at a stent implanted in a uniform vessel. The stent is characterized by its length and the wave velocity in the stented region. The reflected wave is proportional to the time derivative of the incident wave. The reflection coefficient is a small quantity of the order of the length of the stent divided by the wavelength of the unstented vessel. The results obtained coincide with those obtained numerically by Charonko et al. The main simplifications used are small amplitude of the waves so that equations can be linearized and that the length of the stent is small enough so that the values of the wave functions are nearly uniform along the stent. Both assumptions hold in typical situations.

  12. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms.

    PubMed

    Li, Teng-Fei; Shui, Shao-Feng; Han, Xin-Wei; Yan, Lei; Ma, Ji; Guo, Dong; Zhu, Hong-Can; Wang, Shu-Kai; He, Yuan-Hong; Chen, Wen-Wu; Wei, Li-Ping; Wang, Ming-Ke; Song, Tai-Min

    2015-01-01

    The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms. Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA) immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy. The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents) were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence. The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.

  13. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

    SciTech Connect

    Schmelter, Christopher Raab, Udo; Lazarus, Friedrich; Ruppert, Volker; Vorwerk, Dierk

    2015-08-15

    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  14. Excimer Laser LEsion modification to expand non-dilatable stents: the ELLEMENT registry.

    PubMed

    Latib, Azeem; Takagi, Kensuke; Chizzola, Giuliano; Tobis, Jonathan; Ambrosini, Vittorio; Niccoli, Giampaolo; Sardella, Gennaro; DiSalvo, Maria Elena; Armigliato, Pietro; Valgimigli, Marco; Tarsia, Giandomenico; Gabrielli, Gabriele; Lazar, Lawrence; Maffeo, Diego; Colombo, Antonio

    2014-01-01

    Stent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. Existing techniques to optimize stent expansion are sometimes ineffective. The aim of this study was to evaluate the effectiveness and feasibility of Excimer Laser Coronary Angioplasty (ELCA) in improving stent expansion when high-pressure non-compliant balloon inflation was ineffective. ECLA ablation was performed at high energy during contrast injection and only within the underexpanded stent. The primary endpoint of successful laser dilatation was defined as an increase of at least 1mm(2) in minimal stent cross-sectional area (MSA) on IVUS or an increase of at least 20% in minimal stent diameter (MSD) by QCA, following redilatation with the same non-compliant balloon that had been unsuccessful prior to ELCA. Secondary endpoints were cardiac death, myocardial infarction (MI) and target lesion revascularization. Between June 2009 and November 2011, 28 patients with an underexpanded stent despite high-pressure balloon inflation were included. The mean laser catheter size was 1.2±0.4 (range 0.9-2.0mm) and a mean of 62±12mJ/mm(2) at 62±21hertz were required for optimal expansion. Laser-assisted stent dilatation was successful in 27 cases (96.4%), with an improvement in MSD by QCA (1.6±0.6mm at baseline to 2.6±0.6mm post-procedure) and MSA by IVUS (3.5±1.1mm(2) to 7.1±1.9mm(2)). Periprocedural MI occurred in 7.1%, transient slow-flow in 3.6% and ST elevation in 3.6%. During follow-up, there were no MIs, there was 1 cardiac-death, and TLR occurred in 6.7%. The ELLEMENT study confirms the feasibility of ELCA with contrast injection to improve stent underexpansion in undilatable stented lesions. © 2014.

  15. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients.

    PubMed

    Schmelter, Christopher; Raab, Udo; Lazarus, Friedrich; Ruppert, Volker; Vorwerk, Dierk

    2015-08-01

    The study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients. 63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5%), followed by complications of angioplasty with vessel rupture or dissection (31.8%). A high rate of procedural success was achieved (98.5%). The most frequent location of the deployed stent-graft was the draining vein (66.7%). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5% at 6 month, 31.3% at 12 month and 19.2% at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1%), followed by stenosis at the AV access (29.5%) and the deployed stent-graft (23.5%). Re-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  16. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms

    PubMed Central

    Han, Xin-Wei; Yan, Lei; Ma, Ji; Guo, Dong; Zhu, Hong-Can; Wang, Shu-Kai; He, Yuan-Hong; Chen, Wen-Wu; Wei, Li-Ping; Wang, Ming-Ke; Song, Tai-Min

    2015-01-01

    Background The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms. Methods Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA) immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy. Results The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents) were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3–37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence. Conclusions The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms. PMID:26426804

  17. Biliary stents in the millennium.

    PubMed

    Srinivasan, Indu; Kahaleh, Michel

    2011-11-01

    Biliary stents have now been in use for over two decades. Although a plethora of literature has been published on them, this review article is unique in its attempt to summarize important landmark trials and their implications on the management of various pancreatico-biliary disorders. This article will cover the various types of stents currently being used, established and upcoming indications, techniques of placement, and complications associated with stent use.

  18. Stent-assisted coiling strategies for the treatment of wide-necked basilar artery bifurcation aneurysms.

    PubMed

    Zhang, Jian-Zhong; Yang, Peng-Fei; Huang, Qing-Hai; Xu, Yi; Hong, Bo; Zhao, Wen-Yuan; Liu, Jian-Min

    2014-06-01

    Stent-assisted coiling is now the preferred treatment option for wide-necked basilar artery bifurcation aneurysms (BABA). However, the optimal choice of specific treatment strategies is still not well documented. In this paper, based on the "two-neck" theory of BABA, we classified the stent-assisted coiling treatment of BABA into three types: unilateral stent-assisted coiling, unilateral stent plus contralateral microcatheter or microwire-assisted coiling, and bilateral stent-assisted coiling. We assessed the feasibility and effectiveness of different stent-assisted coiling strategies for the treatment of BABA. Twenty-three BABA patients treated with stent-assisted coiling between May 2003 and September 2012 were included. Of the 23 aneurysms, 16 were treated with unilateral stent-assisted coiling, two were treated with unilateral stent and microcatheter or microwire-assisted coiling, and five were treated with bilateral stent-assisted coiling. All 23 BABA were successfully embolized, with a technical success rate of 100%. According to the Raymond classification, the immediate procedural outcome was grade I in nine patients, grade II (neck residue) in four patients and grade III (body filling) in 10 patients. The rate of procedure-related complications was 4.3% (1/23), where intra-operative hemorrhage occurred during coiling due to rupture of the aneurysm. Of the 23 patients, 16 (69.6%) had angiographic follow-up. The mean follow-up duration was 13.5 months (range 1-46 months). Angiographic follow-up showed complete occlusion in 10 patients (62.5%), improvement in two patients (12.5%), stability in three patients (18.7%), and recanalization in one patient (6.25%). The various stent-assisted coiling strategies available at present are feasible and effective for the treatment of wide-necked BABA.

  19. Management of cervical esophageal strictures with self-expanding metalic stents.

    PubMed

    Cindoruk, Mehmet; Karakan, Tarkan

    2006-12-01

    Esophageal strictures due to malignant diseases are treated with self-expanding metalicic stents. However, experience is limited with these metalic stents in the cervical esophagus. Due to technical difficulties and procedure-related complications, the cervical esophagus has been assigned as a risky area for stenting procedures. Another encountered problem is patient discomfort after the procedure. In this case report, we present three patients with cervical esophageal strictures who were successfully treated with self-expandable metalic stents. Two of these patients had inoperable esophageal carcinoma and the third had benign stenosis due to radiotherapy of larynx carcinoma. The two patients with malignant disease survived four and six months, respectively, after the procedure. The last patient with benign disease is still alive and has been without dysphagia symptom for six months.

  20. Carotid stenting using tapered and nontapered stents: associated neurological complications and restenosis rates.

    PubMed

    Brown, Katherine E; Usman, Asad; Kibbe, Melina R; Morasch, Mark D; Matsumura, Jon S; Pearce, William H; Amaranto, Daniel J; Eskandari, Mark K

    2009-01-01

    Self-expanding stent design systems for carotid artery stenting (CAS) have morphed from nontapered (NTS) to tapered (TS); however, the impact of this change is unknown. We reviewed the outcomes of CAS with these two broad categories of stents in a single-center retrospective review of 308 CAS procedures from May 2001 to July 2007. Nitinol self-expanding TS or NTS coupled with cerebral embolic protection devices were used to treat extracranial carotid occlusive disease. Data analysis included demographics, procedural records, duplex exams, and conventional arteriography. Mean follow-up was 18 months (range 1-69). Restenosis was defined as >or=80% in-stent carotid artery stenosis by angiography. The mean age of the entire cohort was 71.3 years (75% men, 25% women). Of the 308 cases, 233 were de novo lesions and 75 had a prior ipsilateral carotid endarterectomy (n = 44) or external beam radiation exposure (n = 31). Preprocedure neurological symptoms were present in 30% of patients. TS were used in 156 procedures and NTS in 152 procedures. The 30-day ipsilateral stroke and death rates were 1.3% and 0.3%, respectively. An additional three (1.0%) posterior circulation strokes occurred. There was no statistically significant difference in the 30-day total stroke rates between TS (3.2%, n = 5) and NTS (1.3%, n = 2) (p = 0.5). At midterm follow-up, restenosis or asymptomatic occlusion was detected in eight cases (2.6%). All occurred in arteries treated with NTS, and this was statistically different when compared to arteries treated with TS (p = 0.03). Furthermore, a post-hoc subgroup analysis revealed significant correlation (chi(2) = 0.02) for restenosis in "hostile necks" when separated by TS vs. NTS. Early CAS outcomes between TS and NTS are comparable. In contrast, self-expanding nitinol TS may have a lower incidence of significant restenosis or asymptomatic occlusion when compared to NTS.

  1. Technical feasibility and revision efficacy of the sequential deployment of endoscopic bilateral side-by-side metal stents for malignant hilar biliary strictures: a multicenter prospective study.

    PubMed

    Lee, Tae Hoon; Park, Do Hyun; Lee, Sang Soo; Choi, Hyun Jong; Lee, Jun Kyu; Kim, Tae Hyeon; Kim, Jong Hyeok; Jeong, Seok; Park, Sang-Heum; Moon, Jong Ho

    2013-02-01

    Theoretically, the side-by-side bilateral placement of metal stents may be technically easier than stent-in-stent bilateral placement in stent revision. However, side-by-side placement can be technically challenging, as the deployment of the first stent can preclude the passage of the second stent. We explored the technical feasibility and revision efficacy of endoscopic bilateral side-by-side stent placement for malignant hilar biliary strictures. Forty-four patients with Bismuth type II or higher malignant hilar biliary strictures were enrolled in seven academic tertiary referral centers. Endoscopic placement of side-by-side bilateral metal stents with 7F thin delivery shaft was performed. The outcome measurements were the technical and functional success, adverse events, endoscopic revision success rate, and stent patency. Overall, the technical and functional success rates were 91 % (40/44), and 98 % (39/40), respectively. Two of the failed patients were converted successfully with subsequent contralateral stent-in-stent placement, and the other patients underwent percutaneous intervention. Early stent-related adverse events occurred in 10 %. The endoscopic revision rate due to stent malfunction during follow-up (median: 180 days) was 45 % (18/40; tumor ingrowth in 4 and in-stent sludge impaction/stone formation in 14 patients). The endoscopic revision success rate was 92 % (12/13). Five patients with comorbidity underwent initial percutaneous intervention. The median survival and stent patency periods were 180 and 157 days, respectively. The sequential placement of a metal stent with a 7F thin delivery shaft in bilateral side-by-side procedures may be feasible and effective for malignant hilar biliary strictures and for endoscopic stent revision.

  2. Angioplasty and stent placement - heart

    MedlinePlus

    PCI; Percutaneous coronary intervention; Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Percutaneous transluminal coronary angioplasty; Heart artery dilatation; Angina - stent placement; ...

  3. Reducing In-Stent Restenosis

    PubMed Central

    McDonald, Robert A.; Halliday, Crawford A.; Miller, Ashley M.; Diver, Louise A.; Dakin, Rachel S.; Montgomery, Jennifer; McBride, Martin W.; Kennedy, Simon; McClure, John D.; Robertson, Keith E.; Douglas, Gillian; Channon, Keith M.; Oldroyd, Keith G.; Baker, Andrew H.

    2015-01-01

    Background Drug-eluting stents reduce the incidence of in-stent restenosis, but they result in delayed arterial healing and are associated with a chronic inflammatory response and hypersensitivity reactions. Identifying novel interventions to enhance wound healing and reduce the inflammatory response may improve long-term clinical outcomes. Micro–ribonucleic acids (miRNAs) are noncoding small ribonucleic acids that play a prominent role in the initiation and resolution of inflammation after vascular injury. Objectives This study sought to identify miRNA regulation and function after implantation of bare-metal and drug-eluting stents. Methods Pig, mouse, and in vitro models were used to investigate the role of miRNA in in-stent restenosis. Results We documented a subset of inflammatory miRNAs activated after stenting in pigs, including the miR-21 stem loop miRNAs. Genetic ablation of the miR-21 stem loop attenuated neointimal formation in mice post-stenting. This occurred via enhanced levels of anti-inflammatory M2 macrophages coupled with an impaired sensitivity of smooth muscle cells to respond to vascular activation. Conclusions MiR-21 plays a prominent role in promoting vascular inflammation and remodeling after stent injury. MiRNA-mediated modulation of the inflammatory response post-stenting may have therapeutic potential to accelerate wound healing and enhance the clinical efficacy of stenting. PMID:26022821

  4. Palliative Treatment of Malignant Colorectal Strictures with Metallic Stents

    SciTech Connect

    Paul Diaz, Laura; Pinto Pabon, Isabel; Fernandez Lobato, Rosa; Montes Lopez, Carmen

    1999-01-15

    Purpose: To assess the effectiveness and safety of self-expanding metallic stents as a primary palliative treatment for inoperable malignant colorectal strictures. Methods: Under radiological guidance 20 self-expanding metallic Wallstents were implanted in 16 consecutive patients with colorectal stenoses caused by malignant neoplasms, when surgical treatment of the condition had been ruled out. The patients were followed up clinically for 1-44 months, until death or termination of this study. Results: The stents were successfully implanted in all cases and resolved the clinical obstruction in all the patients except one, who underwent subsequent colostomy. During follow-up of the remaining 15 patients, clinical complications arising from the procedure were pain (two patients), minor rectal bleeding (one patient), and severe rectal bleeding (one patient) (26%). There were three cases of stent migration and three cases of stent occlusion, and reintervention by us was necessary in 20% of cases (3/15). The mean life span following the procedure was 130 days, and none of the patients exhibited clinical symptoms of obstruction at the time of death (12 patients) or termination of the study (3 patients). Conclusion: Deployment of metallic stents under radiologic guidance is an effective alternative as a primary palliative measure in malignant colorectal obstruction, though the possible clinical complications and need for repeat intervention during follow-up should be taken into account.

  5. Differences in coronary risk factors, procedural characteristics, mortality and stent thrombosis between two all-comers percutaneous coronary intervention registries from Europe and Japan: a patient-level data analysis of the Bern-Rotterdam and j-Cypher registries.

    PubMed

    Onuma, Yoshinobu; Kimura, Takeshi; Räber, Lorenz; Magro, Michael; Girasis, Chrisafios; van Domburg, Ron; Windecker, Stephan; Mitsudo, Kazuaki; Serruys, Patrick W

    2015-09-01

    The reported rate of stent thrombosis (ST) after drug-eluting stent (DES) implantation varies among registries. To investigate differences in baseline characteristics and clinical outcome in European and Japanese all-comers registries, we performed a pooled analysis of patient-level data. The j-Cypher registry (JC) is a multicentre observational study conducted in Japan, including 12,824 patients undergoing SES implantation. From the Bern-Rotterdam registry (BR) enrolled at two academic hospitals in Switzerland and the Netherlands, 3,823 patients with SES were included in the current analysis. Patients in BR were younger, more frequently smokers and presented more frequently with ST-elevation myocardial infarction (MI). Conversely, JC patients more frequently had diabetes and hypertension. At five years, the definite ST rate was significantly lower in JC than BR (JC 1.6% vs. BR 3.3%, p<0.001), while the unadjusted mortality tended to be lower in BR than in JC (BR 13.2% vs. JC 14.4%, log-rank p=0.052). After adjustment, the j-Cypher registry was associated with a significantly lower risk of all-cause mortality (HR 0.56, 95% CI: 0.49-0.64) as well as definite stent thrombosis (HR 0.46, 95% CI: 0.35-0.61). The baseline characteristics of the two large registries were different. After statistical adjustment, JC was associated with lower mortality and ST.

  6. Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE study.

    PubMed

    Prati, Francesco; Stazi, Filippo; Dutary, Jaime; La Manna, Alessio; Di Giorgio, Alessandro; Pawlosky, Tomasz; Gonzalo, Nieves; Di Salvo, Maria Elena; Imola, Fabrizio; Tamburino, Corrado; Albertucci, Mario; Alfonso, Fernando

    2011-11-01

    Lack of stent coverage appears to be associated with stent thrombosis, a problem of particular concern in patients with ST elevation myocardial infarction (STEMI). The DETECTIVE European Multicenter Registry was set up to address the early modality of stent healing in the setting of STEMI. The Registry compared, with an early optical coherence tomography (OCT) evaluation performed at 3-7 days, the patterns of coverage and apposition of the first generation of drug-eluting stents (DESs) and cobalt chromium non-drug-eluting stents (CCSs) that were deployed in culprit lesions and in non-culprit segments. The Registry included only patients with a multi-vessel disease to allow, at 3-7 days from the first angioplasty, a deferred OCT examination and a staged intervention in another vessel. 28 stented lesions (15 patients) eventually entered the final OCT assessment. 13 stents were first-generation DESs, while the remaining 15 were CCSs. 18 stents (64%) were deployed at culprit STEMI lesions, and the remaining 10 (36%) were deployed at non-culprit sites. The distribution of clinical and procedural variables in DES and CCS as well as in culprit and non-culprit sites was not different. In total, 27,019 struts were analysed in 28 stents. The percentage of stent uncoverage in the overall analysis was 11.7%, while the percentage of malapposition and that of struts covered with thrombus were 4.8% and 2.2%, respectively. A low percentage of strut uncoverage was found in all the four studied subgroups: DES 12.8%, CCS 10.9%, stents deployed in culprit lesions 13.2% and stents deployed in non-culprit lesions 8.7%. In conclusion, our data show that in patients with STEMI, a very high percentage of stent struts is covered by an early thin rim of tissue within 7 days after stent positioning. The present data bring new insights in the mechanism and timing of strut coverage.

  7. Nasal packing and stenting

    PubMed Central

    Weber, Rainer K.

    2011-01-01

    Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue. PMID:22073095

  8. Stent evolution for peripheral arterial disease.

    PubMed

    Lejay, A; Thaveau, F; Girsowicz, E; Georg, Y; Heim, F; Durand, B; Chakfé, N

    2012-02-01

    Endovascular treatment and stent implantation for peripheral arterial disease have been proposed for over 20 years. However, the first experiments with stainless stents were relatively disappointing. The first improvement consisted in the introduction of nitinol self-expanding stents. This technology allowed an initial improvement of clinical performances, but the first generation of nitinol stents demonstrated a relatively high rate of fractures. Better knowledge of arterial biomechanics and advances in technology allowed to propose a second generation of nitinol stents with improved flexibility, which decreased the rates of fracture. In-stent restenosis related to neointimal hyperplasia has also led to the development of new concepts to improve patency rates after stenting: drug-eluting stents (coated-stents), biodegradable stents, and covered stents. These technologies will help to treat more complex lesions in the future, but we are still waiting for results of ongoing studies.

  9. Leo Stent for Endovascular Treatment of Broad-Necked and Fusiform Intracranial Aneurysms

    PubMed Central

    Juszkat, R.; Nowak, S.; Smól, S.; Kociemba, W.; Blok, T.; Zarzecka, A.

    2007-01-01

    Summary The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents. Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery15, basilar artery5, basilar tip3, posterior inferior cerebral artery2, M1/M2 segment1, A2 segment1 and vertebral artery1. There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died. Application of Leo stents in cases of broadnecked and fusiform intracranial aneurysms is safe and effective with a low complication rate. PMID:20566117

  10. A rare complication: Undeflatable balloon of the stent

    PubMed Central

    Şatiroğlu, Ömer; Erdoğan, Turan; Durakoğlugil, Murtaza Emre; Uğurlu, Yavuz

    2013-01-01

    Percutaneous coronary intervention is an important modality in the treatment of coronary artery disease. These procedures are usually completed successfully, but occasionally serious complications are encountered. In this paper, we present the case of an undeflatable stent balloon, which is an extremely rare complication that has not been described in the literature. PMID:24265889

  11. In vitro evaluation of stent patency and in-stent stenoses in 10 metallic stents using MR angiography.

    PubMed

    Hamer, O W; Borisch, I; Paetzel, C; Nitz, W R; Seitz, J; Feuerbach, S; Zorger, N

    2006-08-01

    In vitro study to investigate the suitability of contrast enhanced magnetic resonance angiography (CEMRA) for determination of stent patency and grading of in-stent stenoses in 10 metallic stents. The Acculink carotid, DynaLink, Easy Wallstent, JostentSelfX XF, Luminexx, Omnilink, sinus-SuperFlex, SMART, Symphony and ZA stent were separately placed in a vascular phantom. Dedicated stenoses inside the stents generated a concentric lumen narrowing of 50%. CEMRA was performed for each stent. Signal loss inside the stents and artificial lumen narrowing were assessed objectively using the evaluation software of the MR imager. Moreover, three blinded observers determined visibility of stent patency and in-stent stenoses subjectively on a 3-point scale and graded in-stent stenoses. Loss of signal intensity within the stent lumen ranged between 90% (Wallstent) and 5% (ZA), artificial lumen narrowing between 56% (Symphony) and 22% (ZA). For the Symphony and Wallstent, visibility of patency and in-stent stenoses was impaired and the observers' grading exaggerated the degree of stenoses (by 23% and 33%, respectively). For the remainder of stents, patency and stenoses were visible and stenoses were graded accurately (less than 10% discrepancy from reference standard). In this in vitro study, eight of 10 stents presented with MRI characteristics which enabled determination of stent patency and accurate grading of clinically relevant in-stent stenoses.

  12. “Bendy” stents help negotiate hairpin intracardiac curves

    PubMed Central

    Grech, V; DeGiovanni, JV

    2015-01-01

    Simple transposition of the great arteries (TGA) occurs in 0.2 per 1000 live births. The condition is surgically repaired in the neonatal period by the arterial switch procedure (ASO) sometimes preceded by an atrial septostomy. The ASO involves transecting the great arteries and relocating them to the appropriate ventriculo-arterial (VA) connection with attachment of the disconnected coronary arteries to the aorta. In the process, the attachment of the pulmonary artery to the right ventricle involves the Le Compte manoeuvre and to achieve this the pulmonary arteries must be fully mobilised and sometimes the main pulmonary artery may require patch augmentation as well. Nevertheless, pulmonary artery stenosis (PAS) is one of the potential problems with the ASO. However, with improved surgical techniques, this has dropped from around 15% in the 1980s to less than 3%. Apart from surgical revision when PAS occurs, there are interventional options which include angioplasty and/or stent insertion. The latter is preferred in small children and works well in around 60% but may require repeat procedures. In older patients or when angioplasty fails, stent insertion can be considered. These procedures may involve negotiating tight bends in order to reach the site of stenosis. The passage of non-premounted stents may be problematic in such situations, especially with longer stents and tighter bends as they tend to slip off balloon. We describe several techniques that may facilitate such interventions, and these were utilised in an adolescent patient who had had ASO for TGA in the neonatal period. These included manually giving the mounted stent a slight bend in order to help the balloon-stent assembly negotiate hairpin bends. PMID:26865851

  13. Angioplasty and Stenting of the Extracranial Carotid Arteries

    PubMed Central

    Henry, Michel; Amor, Max; Klonaris, Christos; Henry, Isabelle; Masson, Isabelle; Chati, Zukai; Leborgne, Edmond; Hugel, Michèle

    2000-01-01

    We performed percutaneous transluminal angioplasty and stenting in patients with carotid artery stenosis to determine the efficacy of these techniques as an alternative to surgical endarterectomy. From April 1995 through July 1999, 315 carotid angioplasty procedures were performed (right, 151; left, 164) in 290 patients ranging in age from 40 to 93 years. Of these patients, 42% were symptomatic and 58% were asymptomatic. Twenty-five patients underwent bilateral procedures. The mean percentage of stenosis was 82.3% ± 8.7% SD. Angioplasty and stenting were performed without cerebral protection in 165 arteries and with protection in 150. Two methods of protection were used: the Theron technique and the PercuSurge® Guardwire™ temporary occlusion and aspiration system. Balloon dilation and stent placement were successful in 289 patients; in the last patient, severe arterial tortuosity prevented catheterization and stenting. We observed 13 periprocedural neurologic complications due to ischemia (4.2%): 4 transient ischemic attacks (1.3%), 4 minor strokes (1.3%), and 5 major strokes (1.6%), including 1 death. At 6 months, 210 patients had a follow-up angiogram (155) or duplex ultrasound (55). There were 10 restenoses (4.7%), 1 of which was symptomatic and 2 of which showed mild compression of a Palmaz stent without marked stenosis. Primary and secondary 4-year patency rates were 96% and 99%, respectively. These results demonstrate acceptable mortality and morbidity rates related to carotid angioplasty and stenting. However, we found the risk of embolic stroke to be substantial. Cerebral protection may improve the results of carotid angioplasty and expand the indications for this procedure. PMID:10928503

  14. Recanalization of acute carotid stent occlusion using Penumbra 4Max aspiration catheter: technical report and review of rescue strategies for acute carotid stent occlusion.

    PubMed

    Munich, Stephan; Moftakhar, Roham; Lopes, Demetrius

    2013-10-14

    Carotid artery stenting (CAS) has become a widely used treatment for carotid artery stenosis, especially in high-risk patients. Acute in-stent and distal protection device occlusion are potentially catastrophic complications of this procedure. Previously described rescue strategies have included administration of antiplatelet agents (eg, abciximab) with/without thrombolytics and removal of the filter. Here we describe the successful resolution of in-stent occlusion by mechanical thrombolysis using the Penumbra 4Max aspiration catheter. Distal flow was subsequently restored with minimal residual stenosis. The patient did not suffer any consequent neurological deficits. The different strategies that could be used in this critical situation are reviewed.

  15. Combined percutaneous and transurethral lithotripsy for forgotten ureteral stents with giant encrustation.

    PubMed

    Rabani, Seyed Mohammadreza

    2012-01-01

    Ureteral stents are widely used in many urologic practices. However, stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted stent requires combined endourological approaches. To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation. Seventy four patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, a gentle attempt was made to retrieve the stent with the help of an ureteroscopic grasper. In some cases the stent was grasped by a hemostat clamp out of the urethral meatus with a gentle traction to facilitate lithotripsy in the ureter and even in the kidney. Finally, a ureteric catheter was placed adjacent to the stent for injection of radio-contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted stent along with calculus was done and the stent was removed. In 5 out of seven patients, the initial indication for stent placement was for urinary stone disease after open nephrolithotomy and pyeloplasty in other centers and in two patients after TUL. All patients

  16. Combined Percutaneous and Transurethral Lithotripsy for Forgotten Ureteral Stents With Giant Encrustation

    PubMed Central

    Rabani, Seyed Mohammadreza

    2012-01-01

    Background Ureteral stents are widely used in many urologic practices. However, stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted stent requires combined endourological approaches. Objectives To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation. Patients and Methods Seventy four patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, a gentle attempt was made to retrieve the stent with the help of an ureteroscopic grasper. In some cases the stent was grasped by a hemostat clamp out of the urethral meatus with a gentle traction to facilitate lithotripsy in the ureter and even in the kidney. Finally, a ureteric catheter was placed adjacent to the stent for injection of radio-contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted stent along with calculus was done and the stent was removed. Results In 5 out of seven patients, the initial indication for stent placement was for urinary stone disease after open nephrolithotomy and pyeloplasty in other

  17. Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture – a case report and literature review

    PubMed Central

    Dys, Krzysztof; Drelichowska-Durawa, Justyna; Dołega-Kozierowski, Bartosz; Lis, Michał; Sokratous, Kyriakos; Iwanowski, Wojciech; Drelichowski, Stanisław; Witkiewicz, Wojciech

    2013-01-01

    Summary Background: Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. Case Report: A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. Discussion: Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. Conclusions: Frequency of angioplasty and

  18. Stent fabric fatigue of grafts supported by Z-stents versus ringed stents: an in vitro buckling test.

    PubMed

    Lin, Jing; Wang, Lu; Guidoin, Robert; Nutley, Mark; Song, Ge; Zhang, Ze; Du, Jia; Douville, Yvan

    2014-03-01

    Stent-grafts externally fitted with a Z-shaped stents were compared to devices fitted with ringed stents in an in vitro oscillating fatigue machine at 200 cycles per minute and a pressure of 360 mmHg for scheduled durations of up to 1 week. The devices fitted with Z-stents showed a considerably lower endurance limit to buckling compared to the controls. The contact between the apexes of adjacent Z-stents resulted in significant damage to the textile scaffolds and polyester fibers due to the sharp angle of the Z-stents. The ringed stents did not cause any fraying in the textile scaffolds.

  19. Heparin-Coated Coronary Stents.

    PubMed

    van Der Giessen WJ; van Beusekom HM; Larsson; Serruys

    1999-09-01

    The development of the heparin-coated (HC)-stent should be viewed against the backdrop of the early unfavorable results with noncoated stents in the pre-intravascular ultrasound and pre-ticlopidine era. Notwithstanding, results of pilot and randomized trials show a surprisingly low incidence of (sub)acute stent thrombosis under challenging circumstances, such as acute coronary syndromes. Considering the quite low incidence of early complications with noncoated second-generation stents, it may require large trials to prove the clinical efficacy of the heparin- coating against noncoated devices. However, even if the "added value" of the heparin-coating will never be clinically proven, it has helped to enhance the penetration of stent therapy in interventional cardiology. Unlike the situation in 1992, very few cardiologists will now disagree with the statement that stents contribute to the state-of-the-art treatment of patients with angina pectoris or acute myocardial infarction. A preliminary comparison of available trials also suggests that the heparin-coated Palmaz-Schatz stent (Cordis Corp., Waterloo, Belgium) is as effective as the noncoated stent plus abciximab treatment.

  20. A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

    PubMed Central

    Simsekyilmaz, Sakine; Schreiber, Fabian; Weinandy, Stefan; Gremse, Felix; Sönmez, Tolga Taha; Liehn, Elisa A.

    2013-01-01

    Despite the considerable progress made in the stent development in the last decades, cardiovascular diseases remain the main cause of death in western countries. Beside the benefits offered by the development of different drug-eluting stents, the coronary revascularization bears also the life-threatening risks of in-stent thrombosis and restenosis. Research on new therapeutic strategies is impaired by the lack of appropriate methods to study stent implantation and restenosis processes. Here, we describe a rapid and accessible procedure of stent implantation in mouse carotid artery, which offers the possibility to study in a convenient way the molecular mechanisms of vessel remodeling and the effects of different drug coatings. PMID:23711999

  1. Covered metal stents in endoscopic therapy of biliary complications after liver transplantation.

    PubMed

    Cantù, Paolo; Tenca, Andrea; Parzanese, Ilaria; Penagini, Roberto

    2016-08-01

    There is growing interest in using covered self-expandable metal stents for the treatment of benign biliary conditions, and the presence of anastomotic biliary strictures and leaks after liver transplantation provide a valuable opportunity for testing them. The performance of the stents is encouraging, and the technical success rate is high. They provide larger diameter dilation and are easily removed, and can potentially limit costs by reducing the number of procedures needed to treat anastomotic biliary strictures. However, drawbacks such as sub-optimal tolerability and migration may affect both patient management and costs. New stent designs are currently being evaluated. Randomized controlled trials and cost-effectiveness analyses comparing covered metal stents with multiple plastic stent endotherapy are warranted in order to define the role of the former as first-line or rescue treatment. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  2. Are Aortic Stent Grafts Safe in Pregnancy?

    PubMed Central

    Khandanpour, Nader; Mehta, Tapan A.; Adiseshiah, M.; Meyer, Felicity J.

    2015-01-01

    Aortic stent grafts are increasingly used to treat aortic aneurysms and also other aortic pathologies. The safety of aortic stent grafts in pregnancy has never been studied or reported. We report on two cases of aortic stent grafts in pregnant women and discuss the effect of pregnancy on these aortic stent grafts. PMID:26229702

  3. Evolution of patency rates of self-expandable bare metal stents for endovascular treatment of femoro-popliteal arterial occlusive disease: Does stent design matter?

    PubMed

    Treitl, Karla Maria; Woerner, Benedikt; Schinner, Regina; Czihal, Michael; Notohamiprodjo, Susan; Hoffmann, Ulrich; Treitl, Marcus

    2017-09-01

    To analyse the patency rates of femoro-popliteal stenting with different self-expandable Nitinol stent-designs. Two hundred and twenty-two patients (142 (64%) male; age 72.4 ± 11.6 years) with symptomatic femoro-popliteal peripheral arterial occlusive disease (PAOD) underwent percutaneous transluminal angioplasty (PTA) and stenting with three different Nitinol stents (interwoven IW: n = 70; closed-cell CC: n = 85; open-cell OC: n = 67). One-year post-procedural target lesion revascularization (TLR_12M) rates were investigated with regard to co-morbidities: diabetes (DBM), hyperlipidaemia (HLP), hypertension (RR), coronary artery disease (CAD) and degree of calcification. Twelve-month follow-up data were available for 60, 69 and 50 patients in the IW, OC and CC groups (179 patients in total). The cumulative patency (IW: 52 (86.7%); OC: 50 (72.5%); CC: 23 (46.0%); P < 0.001) and the TLR_12M rates (IW: 8 (13.3%); OC: 19 (27.5%); CC: 27 (54.0%); P < 0.001) differed significantly, as did the subgroup analyses (DBM: P = 0.05; RR: P = 0.003; HLP: P = 0.005; CAD: P = 0.02; localization: P < 0.001; calcification: P < 0.001), with the best patency for the IW stent and the highest TLR_12M for the CC stent. The interwoven stent-design was superior to the standard open- and closed-cell stent-designs in endovascular treatment of femoro-popliteal PAOD in a follow-up period of 12 months. • Results of femoro-popliteal stenting are still unsatisfactory. • Comparative studies for currently available different Nitinol stent-designs are lacking. • This is a first comparative study on long-term patency of different Nitinol stent-designs. • Interwoven stent-design leads to improved long-term patency. • Interwoven stent-design leads to lower TLR than other stent-designs.

  4. Carotid Artery Stenting: Single-Center Experience Over 11 Years

    SciTech Connect

    Nolz, Richard Schernthaner, Ruediger Egbert; Cejna, Manfred; Schernthaner, Melanie Lammer, Johannes Schoder, Maria

    2010-04-15

    This article reports the results of carotid artery stenting during an 11-year period. Data from 168 carotid artery stenting procedures (symptomatic, n = 55; asymptomatic, n = 101; symptoms not accessible, n = 12) were retrospectively collected. Primary technical success rate, neurological events in-hospital, access-site complications, and contrast-induced nephropathy (n = 118) were evaluated. To evaluate the influence of experience in carotid artery stenting on intraprocedural neurologic complications, patients were divided into two groups. Group 1 included the first 80 treated patients, and group 2 the remainder of the patients (n = 88). In-stent restenoses at last-follow-up examinations (n = 89) were assessed. The overall primary technical success rate was 95.8%. The in-hospital stroke-death rate was 3.0% (n = 5; symptomatic, 5.4%; asymptomatic, 2.0%; p = 0.346). Neurologic complications were markedly higher in group 1 (4.2%; three major strokes; symptomatic, 2.8%, asymptomatic, 1.4%) compared to group 2 (2.4%; one major and one minor stroke-symptomatic, 1.2%, asymptomatic 1.2%), but this was not statistically significant. Further complications were access-site complications in 12 (7.1%), with surgical revision required in 1 (0.6%) and mild contrast-induced nephropathy in 1 (0.85%). Twenty-one (23.6%) patients had >50% in-stent restenosis during a mean follow-up of 28.2 months. In conclusion, advanced experience in carotid artery stenting leads to an acceptable periprocedural stroke-death rate. In-stent restenosis could be a critical factor during the follow-up course.

  5. Developments in metallic biodegradable stents.

    PubMed

    Hermawan, H; Dubé, D; Mantovani, D

    2010-05-01

    Interest in metallic degradable biomaterials research has been growing in the last decade. Both scientific journals and patent databases record a high increase in publications in this area. Biomedical implants with temporary function, such as coronary stents, are the targeted applications for this novel class of biomaterials. It is expected that stents made of degradable biomaterials, named biodegradable stents, will provide a temporary opening into a narrowed arterial vessel until the vessel remodels and will progressively disappear thereafter. Biodegradable stents made of metal have recently been progressed into preclinical tests in humans after their first introduction in early 2000s. By referring to patents and journal publications, this paper reviews the developments in biodegradable stents, with emphasis on those made of metals, starting from the first design ideas to validation testing.

  6. First clinical experience of "flower petal stenting": a novel technique for the treatment of coronary bifurcation lesions.

    PubMed

    Kinoshita, Yoshihisa; Katoh, Osamu; Matsubara, Tetsuo; Ehara, Mariko; Nasu, Kenya; Habara, Maoto; Suzuki, Takahiko

    2010-01-01

    We sought to report the results of both bench-testing and our first clinical experience with this novel technique. The optimal stenting technique for bifurcation lesions has yet to be defined. This technique works by flaring the proximal side of the stent in side branch out like a flower petal. We tested it in vitro and the resultant stent structure and stent polymer damage was observed in both main branch and side branch with an optical microscopy, multislice computer tomography, intravascular ultrasound, endoscopy, and by electron microscopy. We also applied this technique in 33 patients and assessed patient outcomes up to 9 months prospectively. Drug-eluting stents were used for the bench tests and for all patients. Bench-testing showed complete coverage of the bifurcation with minimal stent-layer overlapping. There was little polymer damage by electron microscopy. Procedural success was achieved in all cases and restenosis occurred in 2 cases. In both restenosis cases, "petal" stenting technique was done reluctantly after another stent had already been deployed in the main branch before any stenting of the side branch. There were no incidences of restenosis when this technique was used electively. In terms of damage to the polymer and ostial strut coverage, this new "flower petal stenting" technique is effective for treatment of bifurcation lesion and it may well be superior to other available techniques. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. BIODEGRADABLE BILIARY STENTS: A NEW APPROACH FOR THE MANAGEMENT OF HEPATICOJEJUNOSTOMY STRICTURES FOLLOWING BILE DUCT INJURY. PROSPECTIVE STUDY

    PubMed Central

    GIMÉNEZ, Mariano E.; PALERMO, Mariano; HOUGHTON, Eduardo; ACQUAFRESCA, Pablo; FINGER, Caetano; VERDE, Juan M.; CÚNEO, Jorge Cardoso

    2016-01-01

    ABSTRACT Background: Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods: In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results: In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion: The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy. PMID:27438039

  8. Mechanisms of Stroke after Intracranial Angioplasty and Stenting in the SAMMPRIS Trial

    PubMed Central

    Derdeyn, Colin P; Fiorella, David; Lynn, Michael J; Rumboldt, Zoran; Cloft, Harry J.; Gibson, Daniel; Turan, Tanya N.; Lane, Bethany F.; Janis, L. Scott; Chimowitz, Marc I.

    2013-01-01

    Background Enrollment in the Stenting and Aggressive Medical Management for the Prevention of stroke in Intracranial Stenosis (SAMMPRIS) trial was halted owing to higher than expected 30-day stroke rates in the stenting arm. Improvement in peri-procedural stroke rates from angioplasty and stenting for intracranial atherosclerotic disease (ICAD) requires an understanding of the mechanisms of these events. Objective To identify the types and mechanisms of peri-procedural stroke after angioplasty and stenting for ICAD. Methods Patients that suffered a hemorrhagic or ischemic stroke or a cerebral infarct with temporary signs (CITS) within 30 days of attempted angioplasty and stenting in SAMMPRIS were identified. Study records, including case report forms, procedure notes, and imaging were reviewed. Strokes were categorized as ischemic or hemorrhagic. Ischemic strokes were categorized as perforator territory, distal embolic, or delayed stent thrombosis. Hemorrhagic strokes were categorized as subarachnoid or intraparenchymal. Causes of hemorrhage (wire perforation, vessel rupture) were recorded. Results Three patients suffered an ischemic stroke after diagnostic angiography. Two were unrelated to the procedure. Twenty-one patients suffered an ischemic stroke (n= 19) or CITS (n=2) within 30 days of angioplasty and stenting. Most (n=15) were perforator territory and many of these occurred after angiographically successful angioplasty and stenting of the basilar artery (n = 8). Six patients suffered subarachnoid hemorrhage (three from wire perforation) and seven a delayed intraparenchymal hemorrhage. Conclusion Efforts at reducing complications from angioplasty and stenting for ICAD must focus on reducing the risks of regional perforator infarction, delayed intraparenchymal hemorrhage, and wire perforation. PMID:23328689

  9. Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms

    PubMed Central

    Akgul, E.; Aksungur, E.; Balli, T.; Onan, B.; Yilmaz, D.M.; Bicakci, S.; Erman, T.

    2011-01-01

    Summary This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results. PMID:21561557

  10. Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection.

    PubMed

    Song, Tae Jun; Lee, Jae Hoon; Lee, Sang Soo; Jang, Ji Woong; Kim, Jung Wook; Ok, Tae Jin; Oh, Dong Wook; Park, Do Hyun; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan; Kim, Song Cheol; Kim, Chul Nam; Yun, Sung Cheol

    2016-11-01

    Preoperative biliary drainage (PBD) with stent placement has been commonly used for patients with malignant biliary obstruction. In PBD, the placement of fully covered self-expandable metal stents (FCSEMSs) may provide better patency duration and a lower incidence of cholangitis compared with plastic stents. We aimed to evaluate which type of stent showed better outcomes in PBD. In this multicenter, prospective randomized trial, we compared PBD with FCSEMSs versus plastic stents in 86 patients with malignant biliary obstruction between January 2012 and December 2014. Patients with obstructive jaundice were randomly assigned to undergo PBD either with plastic stents or FCSEMS placement. Baseline characteristics were not significantly different between the 2 groups. Endoscopic stent placement was technically successful in all patients. Procedure-related adverse events were not significantly different between the 2 groups (plastic vs FCSEMS group; 16.3% vs 16.3%, P = 1.0). Reintervention was required in 16.3% of the plastic stent group and 14.0% of the FCSEMS group (P = .763). The interval to surgery after PBD (plastic vs FCSEMS group; 14.2 ± 8.3 vs 12.3 ± 6.9 days, P = .426) was not significantly different between groups. Surgery-related adverse events occurred in 43.6% of the plastic stent group and 40.0% of the FCSEMS group (P = .755). In patients with resectable malignant biliary obstruction, the outcomes of PBD with plastic stents and FCSEMSs were similar. Considering the cost-effectiveness, PBD with plastic stents may be preferable to FCSEMS placement. (Clinical trial registration number: NCT01789502.). Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  11. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival.

    PubMed

    Carne, Peter W G; Frye, John N R; Robertson, Greg M; Frizelle, Frank A

    2004-09-01

    Expandable, metallic stents provide a new modality of palliation for patients with noncurable metastatic colorectal adenocarcinoma. This study was designed to compare the use of expandable metallic stents as a palliative measure to traditional open surgical management, with particular reference to length of stay, and survival. Patients admitted between 1997 and 2002 with left-sided (splenic flexure and distal), colorectal adenocarcinoma and nonresectable metastatic disease (Stage 4) were treated with expandable metal stents or open surgery (resection, bypass, or stoma). The group of patients having stents inserted were compared with regard to perioperative outcome and survival to those having open surgical procedures. Twenty-two of 25 patients had colonic stents successfully inserted and 19 patients underwent open surgery. The two groups were comparable: stent: median age, 66 (range, 37-88) years; 13 males; and open operation: median age, 68 (range, 51-85) years; 12 males. The tumors were primary in 22 stents procedures and 18 open operations. The site of obstruction was: splenic flexure, 2 stent vs. 0 open operation; descending colon, 2 stent vs. 2 open operation; sigmoid colon, 12 stent vs. 6 open operation; rectum, 9 stent vs. 11 open operation. The American Society of Anesthesiologists (ASA) class was: ASA 1, 0 stent vs. 0 open operation; ASA 2, 6 stent vs. 9 open operation; ASA 3, 15 stent vs. 7 open operation; ASA 4, 4 stent vs. 3 open operation. The open operations were laparotomy only (n = 2), bypass (n = 1), stoma (n = 7), resection with anastomosis (n = 4), resection without anastomosis (n = 5). The complications after open operation were urinary (n = 2), stroke (n = 1), cardiac (n = 2), respiratory (n = 2), deep vein thrombosis (n = 1), anastomotic leak (n = 1). There were no stent-related complications. The mean length of stay was significantly shorter in the stent group (4 vs. 10.4 days; P < 0.0001). There was no difference in survival between the two

  12. Combined Arterial Infusion and Stent Implantation Compared with Metal Stent Alone in Treatment of Malignant Gastroduodenal Obstruction

    SciTech Connect

    Wang Zhongmin; Chen Kemin; Gong Ju; Zheng Yunfeng; Wang Tianxiang

    2009-09-15

    .38 to 1.48 (p < 0.01). There were no short-term complications. Late complications including hematemesis (n = 3), migration (n = 12), and stent occlusion due to tumor overgrowth (n = 5) were evenly distributed between the groups. In the DIT group chemotherapy-induced neutropenia and transient renal dysfunction were detected in six patients, which improved after symptomatic management. Mean survival time after the procedure was 5.9 and 11.1 months for MSI and DIT, respectively (P < 0.001). In conclusion, both MSI and DIT offer effective palliation for malignant gastroduodenal obstruction, but DIT appears to offer superior survival over MSI alone. Ideally, a prospective randomized trial comparing these two techniques should be carried out to validate this result.

  13. Prevalence, factors, and clinical impact of self-expanding stent fractures following iliac artery stenting.

    PubMed

    Higashiura, Wataru; Kubota, Yasushi; Sakaguchi, Shoji; Kurumatani, Norio; Nakamae, Mitsuhiro; Nishimine, Kiyoshi; Kichikawa, Kimihiko

    2009-03-01

    To evaluate the prevalence, factors, and clinical impact of self-expanding stent fracture following iliac artery stenting. A review of the endovascular registry database for our department showed 353 patients with occlusive diseases of the iliac artery who underwent stenting between 1997 and 2007. While clinical data and images were retrospectively reviewed for all patients, 165 patients who underwent self-expanding stenting and plain radiograph with >or=6-months follow-up were analyzed. Mean follow-up was 43 months for 305 stents (elgiloy, n = 83; nitinol, n = 222) implanted in 216 iliac arteries. The mean duration until the last imaging study was 38 months. Items concerning prevalence of stent fracture, factors associated with fracture, and outcomes for patients with stent fracture were analyzed. Stent fracture was detected in 11 of 216 iliac arteries (5.1%). In stent-based analysis, 11 of 305 stents (3.6%) showed stent fracture, classified as type I in 2 stents, type II in 3 stents, type III in 4 stents, type IV in 1 stent, and type V in 1 stent. Stent fracture was detected in 11 of 222 nitinol stents (5.0%), but no Elgiloy stents. Cox proportional hazards regression model indicated stenting for chronic occlusion as a risk factor associated with nitinol stent fracture (hazard ratio [HR] = 6.09, P = 0.008, 95% confidence interval [CI] 1.59-23.3). Cumulative primary patency rates in iliac arteries with and without fractured stents were 90% and 91% at 8 years (P = .80), respectively. Fracture of self-expanding stents is rare in iliac arteries, but stenting for chronic occlusion represents a risk factor for fracture. Fractures of stents placed in iliac arteries rarely affect patency.

  14. Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial

    PubMed Central

    Bressan, Alexsander K; Roberts, Derek J; Edwards, Janet P; Bhatti, Sana U; Dixon, Elijah; Sutherland, Francis R; Bathe, Oliver; Ball, Chad G

    2014-01-01

    Introduction Among surgical oncology patients, incisional surgical site infection is associated with substantially increased morbidity, mortality and healthcare costs. Moreover, while adults undergoing pancreaticoduodenectomy with preoperative placement of an intrabiliary stent have a high risk of this type of infection, and wound protectors may significantly reduce its risk, no relevant studies of wound protectors yet exist involving this patient population. This study will evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among adults undergoing pancreaticoduodenectomy with preoperatively-placed intrabiliary stents. Methods and analysis This study will be a parallel, dual-arm, randomised controlled trial that will utilise a more explanatory than pragmatic attitude. All adults (≥18 years) undergoing a pancreaticoduodenectomy at the Foothills Medical Centre in Calgary, Alberta, Canada with preoperative placement of an intrabiliary stent will be considered eligible. Exclusion criteria will include patient age <18 years and those receiving long-term glucocorticoids. The trial will employ block randomisation to allocate patients to a commercial dual-ring wound protector (the Alexis Wound Protector) or no wound protector and the current standard of care. The main outcome measure will be the rate of surgical site infection as defined by the Centers for Disease Control and Prevention criteria within 30 days of the index operation date as determined by a research assistant blinded to treatment allocation. Outcomes will be analysed by a statistician blinded to allocation status by calculating risk ratios and 95% CIs and compared using Fisher's exact test. Ethics and dissemination This will be the first randomised trial to evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among patients undergoing pancreaticoduodenectomy. Results of this study are expected

  15. Recommendations for Carotid Stenting in Korea

    PubMed Central

    Chang, Hyuk Won; Suh, Sang-il; Jeong, Hae Woong; Suh, Dae Chul

    2015-01-01

    Carotid artery angioplasty with stenting (CAS) is being performed in many hospitals in Korea. Most of the guidelines which are being used are similar, but the practical aspects such as techniques are different between hospitals. For example, usage of various protective devices, the oral antiplatelet regimen prior to procedure and placing of temporary pacemaker to prevent bradycardia are different between hospitals. In this article, we summarize and propose the guidelines for CAS which is currently being accepted in Korea. These guidelines may be helpful in providing protocol to neurointerventionalist who perform CAS and to standardize the process including reporting of CAS in the future comparative trials in Korea. PMID:25763292

  16. Ureteral stents: new ideas, new designs

    PubMed Central

    Al-Aown, Abdulrahman; Kyriazis, Iason; Kallidonis, Panagiotis; Kraniotis, Pantelis; Rigopoulos, Christos; Karnabatidis, Dimitrios; Petsas, Theodore; Liatsikos, Evangelos

    2010-01-01

    Ureteral stents represent a minimally invasive alternative to preserve urinary drainage whenever ureteral patency is deteriorated or is under a significant risk to be occluded due to extrinsic or intrinsic etiologies. The ideal stent that would combine perfect long-term efficacy with no stent-related morbidity is still lacking and stent usage is associated with several adverse effects that limit its value as a tool for long-term urinary drainage. Several new ideas on stent design, composition material and stent coating currently under evaluation, foreseen to eliminate the aforementioned drawbacks of ureteral stent usage. In this article we review the currently applied novel ideas and new designs of ureteral stents. Moreover, we evaluate potential future prospects of ureteral stent development adopted mostly by the pioneering cardiovascular stent industry, focusing, however, on the differences between ureteral and endothelial tissue. PMID:21789086

  17. Cardiac tamponade after malignant superior vena cava stenting: Two case reports and brief review of the literature.

    PubMed

    Da Ines, David; Chabrot, Pascal; Motreff, Pascal; Alfidja, Agaïcha; Cassagnes, Lucie; Filaire, Marc; Garcier, Jean-Marc; Boyer, Louis

    2010-04-01

    Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.

  18. Resolution of inferior venous baffle leak and total venous occlusion using a bare stent and the gore(®) excluder( ®) aortic extension in transposition of the great arteries after mustard procedure.

    PubMed

    Ross, Michael M; Schamberger, Marcus S; Hoyer, Mark H

    2016-01-01

    We present a patient with a history of Mustard repair for transposition of the great arteries. The patient presented with complete inferior venous baffle obstruction and a large baffle leak after several years of cyanosis. Complete relief of the obstruction and exclusion of the baffle leak were accomplished with the use of a combination of bare metal stenting and the Gore(®) Excluder(®) aortic extender. To our knowledge, this represents the first reported use of the Gore(®) Excluder(®) aortic extender in the setting of inferior venous baffle leak and associated total inferior vena cava obstruction. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  19. Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney – a Case Report

    PubMed Central

    Milicevic, Snjezana; Bijelic, Radojka; Jakovljevic, Branislava

    2015-01-01

    Introduction: The efficacy of ureteric stents in the management of various urological conditions causing the upper urinary tract obstruction has been extensively proven, and their contribution to urology remains enormous. The clinical use of ureteric stents is associated with several complications. “Stent syndrome,” encrustation, migration and urothelial hyperplasia are the most common problems related to long-term ureteral stenting. Case report: This work presents an interesting case from our practice: a complete encrustation of a classical polyurethane double J stent two and a half months after its initial instillation, in a 70 year old man, with a solitary functioning kidney, as well as successful removal of it by using a simultaneous treatment of extracorporeal lithotripsy and ureteroscopy with a contact disintegration of encrustations and with percutaneous nephrostomy, as an auxiliary procedure for providing of additional urine derivation. Conclusion: These problems can be overcome by the introduction of new advanced ureteral stent designs and biomaterials. PMID:26543316

  20. Endosonography-guided drainage of malignant fluid collections using lumen-apposing, fully covered self-expanding metal stents.

    PubMed

    Musumba, Crispin; Tutticci, Nicholas; Nanda, Kavinderjit; Kwan, Vu

    2014-08-01

    Endosonography (EUS)-guided drainage of paragastric fluid collections using fully covered self-expanding metal stents (FCSEMS) is now a well-established procedure. Recently, new and specially designed lumen-apposing, fully-covered metal cystgastrostomy stents have been employed for this indication. In this case series, the use of these new stents for the drainage of malignant fluid collections in three symptomatic patients is described. Cases included a large pancreatic pseudocyst, secondary to underlying acute lymphoblastic leukemia, and two large collections of loculated ascites due to metastatic ovarian and cervical cancer, respectively. Technical success in inserting the new stents was achieved in all three patients, and resulted in symptomatic relief. There were no clinically significant complications directly attributed to the stents. These new lumen-apposing cystgastrostomy stents may provide a viable, minimally invasive, and effective alternative for drainage of malignant fluid collections, either for definitive treatment or for palliation of symptoms.

  1. Late presenting, contained rupture of the superficial femoral artery following atherectomy and stenting: case report and literature review.

    PubMed

    Clegg, Stacey; Aghel, Arash; Rogers, R Kevin

    2014-08-01

    Excisional atherectomy alone or followed by stenting is considered an appropriate treatment strategy for patients with lifestyle-limiting claudication due to obstructive infra-inguinal peripheral arterial disease (Ramaiah et al., J Endovasc Ther 2006;13:592-6021). We present a case of a 69-year-old man with eccentric severely calcified disease of the superficial femoral artery (SFA) treated with excisional atherectomy followed by stenting with an interwoven nitinol stent. The procedure was complicated by extravascular stent migration associated with a contained rupture presenting 30 days after the intervention. The complication was successfully treated with a stent graft. Although rare, pseudoaneurysms have been reported at the site of prior atherectomy; however, this case is the first description of a contained rupture post atherectomy associated with erosion of a nitinol stent into an extra-luminal position. The mechanism and management of this complication are discussed. © 2014 Wiley Periodicals, Inc.

  2. Numerical Study of Blood Clots Influence on the Flow Pattern and Platelet Activation on a Stented Bifurcation Model.

    PubMed

    García Carrascal, P; García García, J; Sierra Pallares, J; Castro Ruiz, F; Manuel Martín, F J

    2017-05-01

    Stent implantation is a common procedure followed in arteries affected by atherosclerosis. This procedure can lead to other stenting-related problems. One of these is the deposition and accumulation of blood clots over stent struts. This process can have further consequences, in so far as it can introduce modifications to the flow pattern. This problem is especially critical in stented bifurcations, where resulting stent geometry is more complex. In this regard, a numerical study is presented of the effect on the flow pattern and platelet activation of blood clot depositions on the stent struts of a stented coronary bifurcation. The numerical model is first validated with experimental measurements performed for this purpose. Experiments considered a flow with suspended artificial thrombi, which naturally deposited on stent struts. The location and shape observed were used to create numerical thrombi. Following this, numerical simulations were performed to analyze the influence of the presence of thrombi depositions on parameters such as Time Averaged Wall Shear Stress, Oscillatory Shear Index or Relative Residence Time. Finally, a study was also carried out of the effect of different geometrical configurations, from a straight tube to a stented bifurcation model with thrombus depositions, on platelet activation.

  3. Treatment of acquired nasopharyngeal stenosis using a removable silicone stent.

    PubMed

    De Lorenzi, Davide; Bertoncello, Diana; Comastri, Stefano; Bottero, Enrico

    2015-02-01

    The aim of this prospective study was to characterise patient characteristics and the histories of cats with acquired nasopharyngeal stenosis (ANS), and to describe the use of a removable silicone stent for treatment. ANS was diagnosed in 15 cats with clinical signs present for a median of 4 months. Clinical signs included stertor and inspiratory difficulty, nasal discharge, sneezing, dysphagia, regurgitation, vomiting and anorexia. Radiographs revealed a dorsal deviation or deformation of the caudal part of the soft palate in 10 of the cats, a soft tissue density across the cranial nasopharynx in four and no abnormality in one. The stenosis was initially dilated with a Kelly forceps in 10 of the cats and by balloon dilatation in five. A segment of a 24 Fr silicone thoracic catheter was used for the stent in five cats; in the other 10 cats a segment of a 28 Fr catheter was used. The stent was removed after 3 weeks in 12 cats and after 4 weeks in the other three. Endoscopy revealed an adequate nasopharyngeal diameter in all of the cats. At both 3 and 10 months after surgery the response was considered to be satisfactory, with complete resolution of clinical signs in 14 cats and improvement in the remaining cat. The treatment of ANS by stenosis dilatation followed by temporary stenting with a silicone stent is a rapid, safe, economical and effective procedure.

  4. Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus

    PubMed Central

    Novotný, Róbert; Mitáš, Petr; Hlubocký, Jaroslav; Hrubý, Ján; Slautin, Andrey; Špunda, Rudolf; Lindner, Jaroslav

    2016-01-01

    Introduction. We are presenting a case report of an infected modular abdominal stent graft. Case Presentation. A 67-year-old male patient three years after Cook's modular abdominal aortic aneurysm (AAA) graft implantation for juxtarenal AAA with an implantation of a stent extension into the right common iliac artery for type Ib endoleak. The patient was admitted into our center in severe condition with suspected retroperitoneal bleeding. Computed tomography angiography (CTAG) confirmed retroperitoneal bleeding in the right common iliac artery. An urgent surgical revision was indicated; destructed arterial wall around the stent extension in the right common iliac artery was discovered. Due to the severe state of health of the patient, a resection of the infected stent and affected arterial wall was performed, followed by an iliac-femoral crossover bypass. The patient was transported to the intensive care unit with hepatic and renal failure, with maximal catecholamine support. Combined antibiotic treatment was started. The patient died five hours after the procedure. The cause of death was multiorgan failure caused by sepsis. Hemocultures and perioperative microbiological cultures showed the infection agent to be Staphylococcus aureus methicillin sensitive. Conclusion. Stent graft infection is a rare complication. Treatment is associated with high mortality and morbidity. PMID:26904354

  5. Temporary endoscopic metallic stent for idiopathic esophageal achalasia.

    PubMed

    Coppola, Franco; Gaia, Silvia; Rolle, Emanuela; Recchia, Serafino

    2014-02-01

    Idiopathic achalasia is a motor disorder of the esophagus of unknown etiology caused by loss of motor neurons determining an altered motility. It may determine severe symptoms such as progressive dysphagia, regurgitations, and pulmonary aspirations. Many therapeutic options may be offered to patients with achalasia, from surgery to endoscopic treatments such as pneumatic dilation, botulinum injection, peroral endoscopic myotomy, or endoscopic stenting. Recently, temporary placement of a stent was proposed by Cheng as therapy for achalasia disorders, whereas no Western authors have dealt with it up to date. The present study reports our preliminary experience in 7 patients with achalasia treated with a temporary stent. Partially covered self-expanding metallic stents (Micro-Tech, Nanjin, China) 80 mm long and 30 mm wide were placed under fluoroscopic control and removed after 6 days. Clinical follow-up was scheduled to check endoscopic success, symptoms release, and complications. The placement and the removal of the stents were obtained in all patients without complications. Mean clinical follow-up was 19 months. Five out of 7 patients referred total symptoms release and 2 experienced significant improvement of dysphagia. The procedure was not time consuming and was safe; no mild or severe complications were registered. In conclusion, our results may suggest a possible safe and effective endoscopic alternative treatment in patients with achalasia; however, further larger studies are necessary to confirm these promising, but very preliminary, data.

  6. Plastic biliary stents for malignant biliary diseases.

    PubMed

    Huibregtse, Inge; Fockens, Paul

    2011-07-01

    Plastic biliary endoprostheses have not changed much since their introduction more than 3 decades ago. Although their use has been challenged by the introduction of metal stents, plastic stents still remain commonly used. Much work has been done to improve the problem of stent obstruction but without substantial clinical success. In this review, the authors discuss the history of plastic biliary stent development and the current use of plastic stents for malignant biliary diseases.

  7. Helical CT Angiography of Abdominal Aortic Aneurysms Treated with Suprarenal Stent Grafting: A Pictorial Essay

    SciTech Connect

    Sun Zhonghua

    2003-06-15

    The endovascular repair of abdominal aorticaneurysm (AAA) with stent grafts is rapidly becoming an important alternative to open repair. Suprarenal stent grafting, recently modified from conventional infrarenal stent grafting, is a technique for the purpose of treating patients with inappropriate aneurysm necks.Unlike open repair, the success of endoluminal repair cannot be ascertained by means of direct examination and thus relies on imaging results. The use of conventional angiography for arterial imaging has become less dominant, while helical computed tomography angiography(CTA) has become the imaging modality of choice for both preoperative assessment and postoperative followup after treatment with stent graft implants. There is an increasing likelihood that radiologists will become more and more involved in the procedure of aortic stent grafting and in giving the radiological report on these patients treated with stent grafts. It is necessary for radiologists to be familiar with the imaging findings, including common and uncommon appearances following aortic stent grafting. The purpose of this pictorial essay is to describe and present normal and abnormal imaging appearances following aortic stent grafting based on helical CTA.

  8. Clinical features and patency rates of Remedy® biodegradable peripheral stents

    PubMed Central

    Tiryakioglu, Selma Kenar; Tiryakioglu, Osman; Karahan, Oguz; Demirtas, Sinan; Gokalp, Fatih; Erkoc, Kamuran; Özkan, Hakan; Ozyazicioglu, Ahmet

    2016-01-01

    Summary Objective: The aim of this study was to investigate the mid-term results of Remedy® biodegradable stents, which have recently come into use for lower-extremity arterial occlusive disease. Methods: Sixty-five patients, who underwent surgical intervention in various cardiovascular surgery clinics throughout Turkey, were included in the study. The total number of stents used was 92. The mean age of the patients was 64.11 ± 24.13 years (20–82), and 16 (24.6%) were female. The mean number of stents per patient was 1.42, and 70.7% of the lesions were TASC type A. Patients were followed for a mean of 32 months. Sixty-five patients underwent a control examination using either digital subtraction angiography or colour Doppler ultrasonography. In-stent restenosis was defined as ≥ 50% stenosis in the stent area in asymptomatic patients. The procedure was repeated if the degree of stenosis was ≥ 70%. Results During the follow-up period, restenosis (≥ 50% stenosis) was observed in seven patients (10.7%). The patency rate after secondary intervention was 100%, and there was no loss of limbs in any patient. Restenosis was observed in six patients with superficial femoral artery stents, and in one patient with a popliteal arterial stent. Conclusion Our experience shows that Remedy® biodegradable peripheral stents were safe and effective in our cohort of patients, with acceptable patency rates. PMID:26813981

  9. [Finite Element Analysis of Effect of Key Dimension of Nitinol Stent on Its Fatigue Behaviour].

    PubMed

    Li, Jianjun; Wang, Shengzhang

    2015-04-01

    To evaluate the fatigue behavior of nitinol stents, we used the finite element method to simulate the manufacture processes of nitinol stents, including expanding, annealing, crimping, and releasing procedure in applications of the clinical treatments. Meanwhile, we also studied the effect of the crown area dimension of stent on strain distribution. We then applied a fatigue diagram to investigate the fatigue characteristics of nitinol stents. The results showed that the maximum strain of all three stent structures, which had different crown area dimensions under vessel loads, located at the transition area between the crown and the strut, but comparable deformation appeared at the inner side of the crown area center. The cause, of these results was that the difference of the area moment of inertia determined by the crown dimension induced the difference of strain distribution in stent structure. Moreover, it can be drawn from the fatigue diagrams that the fatigue performance got the best result when the crown area dimension equaled to the intermediate value. The above results proved that the fatigue property of nitinol stent had a close relationship with the dimension of stent crown area, but there was no positive correlation.

  10. Clinical features and patency rates of Remedy(®) biodegradable peripheral stents.

    PubMed

    Tiryakioglu, Selma Kenar; Tiryakioglu, Osman; Karahan, Oguz; Demirtas, Sinan; Gokalp, Fatih; Erkoc, Kamuran; Özkan, Hakan; Ozyazicioglu, Ahmet

    The aim of this study was to investigate the midterm results of Remedy(®) biodegradable stents, which have recently come into use for lower-extremity arterial occlusive disease. Sixty-five patients, who underwent surgical intervention in various cardiovascular surgery clinics throughout Turkey, were included in the study. The total number of stents used was 92. The mean age of the patients was 64.11 ± 24.13 years (20-82), and 16 (24.6%) were female. The mean number of stents per patient was 1.42, and 70.7% of the lesions were TASC type A. Patients were followed for a mean of 32 months. Sixty-five patients underwent a control examination using either digital subtraction angiography or colour Doppler ultrasonography. In-stent restenosis was defined as ≥ 50% stenosis in the stent area in asymptomatic patients. The procedure was repeated if the degree of stenosis was ≥ 70%. During the follow-up period, restenosis (≥50% stenosis) was observed in seven patients (10.7%). The patency rate after secondary intervention was 100%, and there was no loss of limbs in any patient. Restenosis was observed in six patients with superficial femoral artery stents, and in one patient with a popliteal arterial stent. Our experience shows that Remedy(®) biodegradable peripheral stents were safe and effective in our cohort of patients, with acceptable patency rates.

  11. Biodegradable polydioxanone stent as a new treatment strategy for tracheal stenosis in a rabbit model.

    PubMed

    Kawahara, Insu; Ono, Shigeru; Maeda, Kosaku

    2016-12-01

    Congenital tracheal stenosis (CTS) is a rare condition and difficult to treat. Slide tracheoplasty has unsatisfactory outcomes for severe neonatal symptomatic CTS. This study evaluated the use of biodegradable polydioxanone stents (BD stent) in a rabbit model of CTS. Tracheal stenosis was induced in female Japanese white rabbits, 9-10weeks old, by direct scraping of the tracheal mucosa with a nylon brush following transverse incision of the trachea (control group, n=4). Seven days later, we incised the trachea again and inserted a BD stent (15×5mm) into the trachea (stent group, n=4). Arterial blood gas analysis was performed twice weekly for 1month after the procedure. In the control group, respiratory acidosis arising from ventilatory failure was observed on postoperative days 7-10. Rabbits were sacrificed at 11.5days after scraping. Severe tracheal stenosis resulting from inflammatory granulation was detected in the scraped region in all rabbits. In the stent group, arterial blood gas analysis was normal at 28days after stent insertion. The BD stent maintained patency of the tracheal lumen and prolonged survival for 1month. The use of BD stent represents a promising new treatment method for tracheal stenosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Percutaneous transhepatic portal vein stenting for malignant portal vein stenosis secondary to recurrent perihilar biliary cancer.

    PubMed

    Mizuno, Takashi; Ebata, Tomoki; Yokoyama, Yukihiro; Igami, Tsuyoshi; Sugawara, Gen; Mori, Yoshine; Suzuki, Kojiro; Nagino, Masato

    2015-10-01

    Transhepatic portal vein (PV) stenting has been shown to be one of the most important treatments for patients with PV stenosis caused by hepatopancreatobiliary malignancy. Ten consecutive patients with PV stenosis caused by the recurrence of a perihilar biliary malignancy underwent transhepatic PV stenting. A self-expandable metallic stent was deployed at the stenosis site. The patients were retrospectively analyzed with regard to the procedure, complications, and survival after the stent placement. The median interval between the primary resection and the PV stenting was 22 months. The initial hepatic resection was a left trisectionectomy with caudate lobectomy in seven patients, a left hepatectomy with caudate lobectomy in one patient, a right anterior sectionectomy with caudate lobectomy following a left hepatectomy in one patient and a partial liver resection in one patient. The angle of the PV around the stenosis was greater in the patients with PV stenosis located in the right posterior PV. Eight patients with successful PV stent placement were able to receive anticancer treatment, with a median survival of 14 months. The remaining two patients without successful PV stent placement survived less than 6 months. Portal vein stenting might offer relief from the symptoms associated with PV hypertension and the opportunity for sustainable anticancer therapy in patients with recurrent perihilar biliary malignancy. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  13. Angioplasty or Primary Stenting for Infrapopliteal Lesions: Results of a Prospective Randomized Trial

    SciTech Connect

    Randon, C. Jacobs, B.; De Ryck, F.; Vermassen, F.

    2010-04-15

    Excellent results with small stents in coronary arteries have led endovascular therapists to their use in infrapopliteal vessels. However, to date no level I evidence exists to recommend primary stenting over infrapopliteal angioplasty alone. The aim of this randomized single-center trial was to compare their 1-year outcome. A total of 38 limbs in 35 patients with critical limb ischemia were randomized to angioplasty (22 pts) or primary stenting (16 pts). Target lesions were infrapopliteal occluded (36) or stenotic (20) lesions ranging from <2 to >15 cm in length. The mean age was 72 years. At 12 months, there was no statistical difference in survival (angioplasty, 69.3%; primary stenting, 74.7%), in limb salvage (angioplasty, 90%; primary stenting, 91.7%), or in primary and secondary patency (angioplasty, 66 and 79.5%; primary stenting, 56 and 64%) between the groups Renal insufficiency was the only significant negative predicting factor for limb salvage in both groups. In conclusion, the 1-year results for both groups were broadly similar. Stenting has its place in infrapopliteal angioplasty if the procedure is jeopardized by a dissection or recoil, but our results do not support primary stenting in all cases.

  14. [Perioperative management of patients with coronary stents in non-cardiac surgery].

    PubMed

    Jámbor, C; Spannagl, M; Zwissler, B

    2009-10-01

    In patients with coronary stents scheduled for surgery the question arises whether and how antiplatelet therapy should be continued. Risks of perioperative bleeding and of acute stent thrombosis have to be considered simultaneously. The bleeding risk depends primarily on the kind of surgery and on patient comorbidity. The risk of stent thrombosis is increased in these patients due to the thrombogenic surface of the stents. The main determinants are hereby the time duration after stent implantation, the kind of the stent [uncoated (bare-metal stent, BMS) or coated (drug-eluting stent, DES)], as well as angiographic and clinical patient factors. Therefore, perioperative antiplatelet therapy has to be individually adapted for each patient. Bridging with heparin is ineffective. Bridging with intravenous antiplatelet drugs during the perioperative interruption of oral antiplatelet therapy might be a potential procedure in high-risk patients. Whether bedside monitoring of antiplatelet therapy improves the perioperative management of these patients and reduces adverse outcome is object of current studies.

  15. Safety and efficacy of AVE gfx stent implantation via 6 Fr guiding catheters.

    PubMed

    Kiemeneij, F; Laarman, G J; Odekerken, D; Slagboom, T; van der Wieken, R

    1999-08-01

    This prospective study was designed to determine the feasibility of AVE gfx premounted stent systems in combination with 6 Fr guides. Between 1 April and 12 August 1997, 230 patients underwent AVE gfx coronary stent implantation via 6 Fr guides. The radial approach was used in 146 patients (63.5%). In 230 procedures (293 lesions), 237 guiding catheters were used. A total of 331 AVE gfx stents were implanted, 1.4 per patient. Backup, opacification, and friction were considered good in 85.8%, 96.4%, and 76.7%, respectively. Slight and severe friction was felt during combined use of long (> or = 18 mm), large-sized (3.5 mm) stents and small-sized guiding catheters (inner diameter, 0.061-0.062"). The presence of a second protecting guidewire impaired passage of the AVE gfx stent, also in large 6 Fr guides (ID 0.064"). Of 331, 320 (96.7%) stents were successfully deployed at the initial attempt. Ten stents (3%) had to be retrieved. Six of these were successfully placed at a second attempt and three slipped off the balloon, all successfully retrieved from the patient's circulation. At 1 month, 217 patients (94.4%) were free of events. The AVE gfx stent is compatible with 6 Fr guiding catheters. Use of new-generation, large-bore 6 Fr gc (> or = 0.064") is recommended.

  16. Overlapping stents for blood blister-like aneurysms of the internal carotid artery.

    PubMed

    Fang, Yi-Bin; Li, Qiang; Wu, Yi-Na; Zhang, Qi; Yang, Peng-Fei; Zhao, Wen-Yuan; Huang, Qing-Hai; Hong, Bo; Xu, Yi; Liu, Jian-Min

    2014-08-01

    Blood blister-like aneurysms (BBAs) are unique due to their high risk of recurrent bleeding associated with their fragile neck. The best treatment for BBAs is still controversial. This paper sought to evaluate the safety and efficacy of stent-assisted coiling and subsequent overlapping stents (SAC+OS) in the treatment of BBAs. Fifteen consecutive patients with ruptured BBAs managed with SAC+OS were enrolled in this study. The clinical characteristics, procedural data, angiographic outcome, and follow-up results were reviewed. SAC+OS were successfully performed in all 15 cases. The instant angiographic result was total occlusion in 6 cases, residual neck in 7 cases, and residual aneurysm in 2 cases. Angiographic follow-ups revealed total occlusion in all 6 cases treated by triple or quadruple stents, and 6 of 9 cases treated by double stents. Major recanalization was detected in 3 cases treated by double stents. The modified Rankin Scale score at 4-52 months follow-up (23.8 months on average) was 0 in 6 cases, 1 in 8 cases, and 3 in one case. Stent-assisted coiling and subsequent overlapping stents are feasible and safe for BBAs. It can be helpful to further decrease the risk of recanalization with more stents. Early angiographic follow-up within 2 weeks is recommended. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. The role of stents in the treatment of congenital heart disease: Current status and future perspectives

    PubMed Central

    Peters, Bjoern; Ewert, Peter; Berger, Felix

    2009-01-01

    Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of “modern” stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the “ideal stent” has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD. PMID:20300265

  18. Antegrade retrieval of ureteral stents through an 8-French percutaneous nephrostomy route.

    PubMed

    Liang, Huei-Lung; Yang, Tsung-Lung; Huang, Jer-Shyung; Lin, Yih-Huie; Chou, Chen-Pin; Chen, Matt Chiung-Yu; Pan, Huay-Ben

    2008-11-01

    The purpose of this study was to describe the technique of antegrade retrieval of ureteral stents under fluoroscopic guidance through an 8-French nephrostomy. During an 8-year period, we retrieved 26 ureteral stents from 24 patients who were not candidates for retrograde removal or had other conditions precluding use of a retrograde approach. A loop snare or grasping forceps was used to retrieve a ureteral stent in the renal pelvis or calyx or upper ureter through an 8-French vascular sheath with a safety wire in place. A snare catheter advanced into the bladder for retrieval of the bladder end was used in patients in whom retrieval with both a loop snare and a grasping forceps failed. All 26 ureteral stents were successfully retrieved by the antegrade approach. Ten stents were retrieved with a snare alone and nine with a forceps alone. Five stents were retrieved successfully with a forceps after initial failures with snare catheters. Two stents were retrieved with snare catheters advanced into the bladder. The major complication of nephrostomy wound infection occurred in a patient with a urinary tract infection who underwent a one-stage procedure. All minor complications, including pelvic perforation in one patient and blood clot in the renal pelvis in four patients, resolved spontaneously without adverse sequelae. Antegrade percutaneous retrieval of a ureteral stent through an 8-French nephrostomy is safe and effective and has a high degree of technical success. It can be used as a routine interventional practice in radiology.

  19. Forgotten/retained double J ureteric stents: A source of severe morbidity in children

    PubMed Central

    Nerli, Rajendra B.; Magdum, Prasad V.; Sharma, Vikas; Guntaka, Ajay Kumar; Hiremath, Murigendra B.; Ghagane, Shridhar

    2016-01-01

    Background: The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. Materials and Methods: Hospital records of all patients’ <18 years old who underwent removal of forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. Results: During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. Conclusions: Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain. PMID:27251521

  20. Incidence of New Ischaemic Brain Lesions After Carotid Artery Stenting with the Micromesh Roadsaver Carotid Artery Stent: A Prospective Single-Centre Study.

    PubMed

    Ruffino, Maria Antonella; Faletti, Riccardo; Bergamasco, Laura; Fonio, Paolo; Righi, Dorico

    2016-11-01

    Several randomized trials of patients with carotid stenosis show increased adverse neurological events with stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver stent. Between September 2015 and January 2016, 23 consecutive patients (age 74.3 ± 7.3 years, 17.4 % female) underwent carotid artery stenting with the Roadsaver stent, a nitinol double-layer micromesh device. A distal protection device was used in all cases. Diffusion-weighted magnetic resonance imaging was performed 24 h before, and 24 h and 30 days after the procedure. The 24-h post-procedure imaging showed 15 new ipsilateral ischaemic lesions in 7 (30.4 %) patients: median volume 0.076 cm(3) (interquartile range 0.065-0.146 cm(3)). All lesions were asymptomatic. The 30-day imaging showed complete resolution of all lesions and no new ischaemic lesions. Follow-up clinical and ultrasound examinations at 30 days and 6 months recorded no adverse cardiac or cerebrovascular events. Protected stenting with micromesh Roadsaver stent showed good safety and efficacy in the treatment of carotid stenosis, with a low incidence of delayed embolic events and new ipsilateral ischaemic brain lesions. These preliminary results are encouraging, but need to be confirmed with larger populations.

  1. Influence of cardiac motion on stent lumen visualization in third generation dual-source CT employing a pulsatile heart model.

    PubMed

    Petri, Nils; Gassenmaier, Tobias; Allmendinger, Thomas; Flohr, Thomas; Voelker, Wolfram; Bley, Thorsten A

    2017-02-01

    To detect an in-stent restenosis, an invasive coronary angiography is commonly performed. Owing to the risk associated with this procedure, a non-invasive method to detect or exclude an in-stent restenosis is desirable. The purpose of this study was to evaluate the influence of cardiac motion on stent lumen visibility in a third-generation dual-source CT scanner (SOMATOM Force; Siemens Healthcare, Forchheim, Germany), employing a pulsatile heart model (CoroSim(®); Mecora, Aachen, Germany). 13 coronary stents with a diameter of 3.0 mm were implanted in plastic tubes filled with a contrast medium and then fixed onto the pulsatile phantom heart model. The scans were performed while the heart model mimicked the heartbeat. Coronary stents were scanned in an orientation parallel to the scanner z-axis. The evaluation of the stents was performed by employing a medium sharp convolution kernel optimized for vascular imaging. The mean visible stent lumen was reduced from 65.6 ± 5.7% for the stents at rest to 60.8 ± 4.4% for the stents in motion (p-value: <0.001). While the difference in lumen visibility between stents in motion and at rest was significant, the use of this third-generation dual-source CT scanner enabled a high stent lumen visibility under the influence of cardiac motion. Whether this translates into a clinical setting has to be evaluated in further patient studies. Advances in knowledge: The employed modern CT scanner enables a high stent lumen visibility even under the influence of cardiac motion, which is important to detect or exclude an in-stent restenosis.

  2. Human Internal Mammary Artery (IMA) Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis

    PubMed Central

    Hua, Xiaoqin; Deuse, Tobias; Michelakis, Evangelos D.; Haromy, Alois; Tsao, Phil S.; Maegdefessel, Lars; Erben, Reinhold G.; Bergow, Claudia; Behnisch, Boris B.; Reichenspurner, Hermann; Robbins, Robert C.; Schrepfer, Sonja

    2012-01-01

    Preclinical in vivo research models to investigate pathobiological and pathophysiological processes in the development of intimal hyperplasia after vessel stenting are crucial for translational approaches1,2. The commonly used animal models include mice, rats, rabbits, and pigs3-5. However, the translation of these models into clinical settings remains difficult, since those biological processes are already studied in animal vessels but never performed before in human research models6,7. In this video we demonstrate a new humanized model to overcome this translational gap. The shown procedure is reproducible, easy, and fast to perform and is suitable to study the development of intimal hyperplasia and the applicability of diverse stents. This video shows how to perform the stent technique in human vessels followed by transplantation into immunodeficient rats, and identifies the origin of proliferating cells as human. PMID:22617624

  3. Human internal mammary artery (IMA) transplantation and stenting: a human model to study the development of in-stent restenosis.

    PubMed

    Hua, Xiaoqin; Deuse, Tobias; Michelakis, Evangelos D; Haromy, Alois; Tsao, Phil S; Maegdefessel, Lars; Erben, Reinhold G; Bergow, Claudia; Behnisch, Boris B; Reichenspurner, Hermann; Robbins, Robert C; Schrepfer, Sonja

    2012-05-09

    Preclinical in vivo research models to investigate pathobiological and pathophysiological processes in the development of intimal hyperplasia after vessel stenting are crucial for translational approaches (1,2). The commonly used animal models include mice, rats, rabbits, and pigs (3-5). However, the translation of these models into clinical settings remains difficult, since those biological processes are already studied in animal vessels but never performed before in human research models (6,7). In this video we demonstrate a new humanized model to overcome this translational gap. The shown procedure is reproducible, easy, and fast to perform and is suitable to study the development of intimal hyperplasia and the applicability of diverse stents. This video shows how to perform the stent technique in human vessels followed by transplantation into immunodeficient rats, and identifies the origin of proliferating cells as human.

  4. Outcomes of Stent-assisted Coil Embolization of Wide-necked Intracranial Aneurysms Using the Solitaire™ AB Neurovascular Remodeling Device.

    PubMed

    Jeong, Hae Woong; Seung, Won-Bae

    2015-12-01

    This retrospective study presents our experience with respect to the clinical and angiographic outcomes of patients treated with stent-assisted coil embolization using Solitaire™ AB stents. From March 2011 to December 2014, 50 patients with 55 wide-necked and/or complex intracranial aneurysms were evaluated. Four patients presented with an acute subarachnoid hemorrhage. Stent deployment was performed with a standard coiling procedure in 49 aneurysms. Three patients underwent bailout stenting, 2 patients were treated by temporary stenting and one patient was treated only by stenting without coiling for dissecting aneurysm. Successful placement of the Solitaire AB stent was achieved in all the cases. Based on the postprocedural angiographic results, a Raymond 1 was obtained in 32 (59%) of 54 aneurysms, excluded by one case of dissecting aneurysm, and a Raymond 2 in 13 (24%), and a Raymond 3 in 9 (17%). There was one thromboembolic (2%) and three hemorrhagic complications (6%). However, procedure-related morbidity or mortality was not found. Annual follow-up angiographic results from the embolization were obtained in 40 (74.1%) of 54 cases. These results were represented as Raymond 1 in 27 (67.5%), class 2 in 9 (22.5%), and class 3 in 4 (10%) cases. Angiographic improvement associated with progressive thrombosis of the aneurysm was obtained in 10 aneurysms. Four aneurysms were recanalized without requiring additional treatment. In-stent stenosis was found in one aneurysm, but stent migration was not seen on follow-up angiography. Stent-assisted coil embolization using the Solitaire AB stent for treating wide-necked and/or complex intracranial aneurysms was found to be safe and effective immediately post-embolization and after follow-up. Long-term follow-up will be required to identify the effect of the Solitaire AB stent on recanalization rates.

  5. Angioplasty or Stenting of Extra- and Intracranial Vertebral Artery Stenoses

    SciTech Connect

    Hauth, Elke A.M.; Gissler, H. Martin; Drescher, Robert; Jansen, Christian; Jaeger, Horst J.; Mathias, Klaus D.

    2004-01-15

    Purpose: To determine the feasibility and safety of angioplasty or angioplasty and stenting of extra- and intracranial vertebral artery (VA) stenosis. Methods: In 16 consecutive patients (9 men, 7 women; mean age 61 years, range 49-74 years) 16 stenotic VAs were treated with angioplasty orangioplasty and stenting. Eleven stenoses were localized in V1 segment,1 stenosis in V2 segment and 4 stenoses in V4 segment of VA. Fourteen VA stenoses were symptomatic, 2 asymptomatic. The etiology of the stenoses was atherosclerotic in all cases. Results:Angioplasty was performed in 8 of 11 V1 and 2 of 4 V4 segments of the VA. In 3 of 11 V1 segments and 2 of 4 V4 segments of the VA we combined angioplasty with stenting. The procedures were successfully performed in 14 of 16 VAs (87%). Complications were asymptomatic vessel dissection resulting in vessel occlusion in 1 of 11 V1 segments and asymptomatic vessel dissection in 2 of 4 V4 segments of the VA. One patient died in the 24-hr period after the procedure because of subarachnoid hemorrhage as a complication following vessel perforation of the treated V4 segment. Conclusion: Angioplasty orangioplasty and stenting of extracranial VA stenoses can be performed with a high technical success rate and a low complication rate. In intracranial VA stenosis the procedure is technically feasible but complications can be life-threatening. The durability and procedural complication rates of primary stenting without using predilation in extra- and intracranial VA stenosis should be defined in the future.

  6. Evidence-Based Recommendations on Colorectal Stenting: A Report from the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy

    PubMed Central

    Lee, Kwang Jae; Kim, Sang Woo; Kim, Tae Il; Lee, Jong-Hoon; Lee, Bo-In; Keum, Bora; Cheung, Dae Young

    2013-01-01

    Recently, placement of self-expandable metallic stents has been used for the treatment of colorectal obstruction. As domestic awareness of colorectal cancer has increased, the number of colorectal stenting procedures performed has also increased. We aimed to provide evidence-based recommendations for colorectal stenting to aid gastroenterologists in making informed decisions regarding the management of patients who present with colorectal obstruction. The working group consisted of eight gastroenterologists who actively practice and conduct research in the field of colorectal stenting and are the members of the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. A literature search was conducted using the PubMed, Embase, KoreaMed, and the Cochrane Library databases to identify relevant articles published between January 2001 and June 2012. Based on the modified Delphi process, 10 recommendation statements regarding indications, usefulness, methodology and complications of colorectal stenting, and alternative treatments for malignant colorectal obstruction were determined. The contents will be widely distributed, and periodically revised to reflect the latest knowledge. These evidence-based recommendations for colorectal stenting will provide gastroenterologists and patients with appropriate and balanced information, and will improve the quality of care. PMID:23964332

  7. StentBoost Visualization for the Evaluation of Coronary Stent Expansion During Percutaneous Coronary Interventions.

    PubMed

    Cura, Fernando; Albertal, Mariano; Candiello, Alfonsina; Nau, Gerardo; Bonvini, Victor; Tricherri, Hernan; Padilla, Lucio T; Belardi, Jorge A

    2013-12-01

    Inadequate stent implantation is associated with stent thrombosis and restenosis. StentBoost can enhance stent visualization and evaluate stent expansion. Currently, there are limited comparison studies between StentBoost and intravascular ultrasound (IVUS). We aimed to test the correlation and agreement between IVUS and StentBoost measurements. From December 2010 to December 2011, 38 patients (54 stents) were analyzed using IVUS and StentBoost. Minimal stent diameter and proximal and distal edge stent diameter were compared between imaging techniques using Pearson correlation and Bland-Altman scatter plot. There was good correlation between StentBoost and IVUS measurements regarding minimal stent diameter (p < 0.001 in all stent portions) and an optimal agreement between IVUS and StentBoost, while lesser agreement was found between IVUS and quantitative coronary angiography. The assessment of stent implantation using StentBoost showed an adequate correlation and agreement with IVUS. This easily applicable angiographic technique can be used to guide stent implantation.

  8. Clinical results of carotid artery stenting versus carotid endarterectomy

    PubMed Central

    Akinci, Tuba; Derle, Eda; Kibaroğlu, Seda; Harman, Ali; Kural, Feride; Cınar, Pınar; Kilinc, Munire; Akay, Hakki T.; Can, Ufuk; Benli, Ulku S.

    2016-01-01

    Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (≥70%) or symptomatic stenosis (≥50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility. PMID:27744460

  9. Present and future of endovascular SFA treatment: stents, stent-grafts, drug coated balloons and drug coated stents.

    PubMed

    Bosiers, M; Deloose, K; Verbist, J; Peeters, P

    2008-04-01

    The current evolution towards treating more complex femoropopliteal lesions as seen in the renewed TASC II recommendations clearly reflects the continuous evolutions in femoropopliteal stent design. Recent stent design improvements focus on decreasing stent fractures rates which can negatively impact patency rates. By rearranging strut alignment towards helical connecting bridges or full helical stent designs, stent designers have successfully improved the fracture resistance of their stents. The superior fracture resistance of the latest stent generation in combination with the production of long nitinol stents of up to 20 cm in length allow that more difficult and complex lesions can be treated endovascularly. The continuous perfection of nitinol stent platforms followed by the transfer of coronary technologies (e.g. active coatings) towards peripheral devices might broaden the indications for the minimal invasive strategy towards TransAtlantic Inter-Society Consensus (TASC) II C&D lesions.

  10. Incidence and Clinical Impact of Stent Fracture After PROMUS Element Platinum Chromium Everolimus-Eluting Stent Implantation.

    PubMed

    Kuramitsu, Shoichi; Hiromasa, Takashi; Enomoto, Soichiro; Shinozaki, Tomohiro; Iwabuchi, Masashi; Mazaki, Toru; Domei, Takenori; Yamaji, Kyohei; Soga, Yoshimitsu; Hyodo, Makoto; Shirai, Shinichi; Ando, Kenji

    2015-08-17

    This study sought to assess the incidence and clinical impact of stent fracture (SF) after the PROMUS Element platinum-chromium everolimus-eluting stent (PtCr-EES). SF remains an unresolved, clinically relevant issue, even in the newer-generation drug-eluting stent era. From March 2012 to August 2013, 816 patients with 1,094 lesions were treated only with PtCr-EES and 700 patients (85.7%) with 898 lesions undergoing follow-up angiography within 9 months after the index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy, intravascular ultrasound, or optical coherence tomography during the follow-up. We assessed the rate of SF and the cumulative incidence of clinically driven target lesion revascularization and definite stent thrombosis within 9 months after the index procedure. SF was observed in 16 of 898 lesions (1.7%) and 16 of 700 patients (2.2%). Lesions with in-stent restenosis at baseline (odds ratio [OR]: 14.2, 95% confidence intervals [CI]: 5.09 to 39.7; p < 0.001) or hinge motion (OR: 4.31, 95% CI: 1.12 to 16.5; p = 0.03), and total stent length (per 10-mm increase; OR: 1.32, 95% CI: 1.12 to 1.57; p = 0.001) were predictors of SF. Cumulative incidence of clinically driven target lesion revascularization within 9-months was numerically higher in the SF group than that in the non-SF group (18.7% vs. 2.3%). Cumulative incidence of definite stent thrombosis within 9 months after the index procedure was similar between the SF and non-SF groups (0.0% vs. 0.23%). SF after PtCr-EES occurs in 1.7% of lesions and appears to be associated with clinically driven target lesion revascularization. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Drug-Eluting Stents: Do They Increase Heart Attack Risk?

    MedlinePlus

    ... general, drug-eluting stents are preferred over bare-metal stents for most people. Drug-eluting stents are ... keep the blockage from recurring compared to bare metal stents. Plus, studies show the latest drug-eluting ...

  12. Successful percutaneous stent implantation for isolated dismal transverse aortic arch kinking

    PubMed Central

    Zuo, Zhi-Liang; Tsauo, Jia-Yu; Chen, Mao; Feng, Yuan

    2017-01-01

    Abstract Rationale: Isolated dismal transverse aortic arch kinking in adults is rare, and there is no recommended therapy at present. Percutaneous stent implantation may be an effective method to correct it and could be considered. Patient concerns: We report a 46-year-old woman who suffered from recurrent migraine and refractory hypertension with a significant systolic blood pressure difference between upper limbs. Diagnoses: The woman was diagnosed with isolated dismal transverse aortic arch kinking with refractory hypertension. Interventions: Percutaneous stent implantation was performed. Due to the kinking nature of the diseased transverse aortic arch, the first covered stent moved forward to the proximal transverse aortic arch during deploying without the left common carotid artery occlusion. And then, a second stent was placed to cover the residual kinked part of the dismal transverse arch. Outcomes: Angiography and post-procedural computed tomography angiography revealed fully corrected of the diseased segment. At 6-month follow-up after procedure, the patient was free of any symptoms and had a normal blood pressure under antihypertensive treatment. Lessons: This case indicates that transverse aortic arch kinking in isolation can be well treated by percutaneous stent implantation in adult patients. Unlike pure aortic coarctation, elongation and bucking give the rise to the occurrence rate of stent sliding and migration and sometimes a second stent is needed. PMID:28272200

  13. Covered self-expandable metal stents for benign biliary tract diseases.

    PubMed

    Baron, Todd H

    2011-05-01

    Benign biliary diseases are often managed endoscopically using plastic stents. Benign biliary strictures (BBS) respond to placement of multiple large-bore plastic stents, though requiring multiple procedures to place stents, and to exchange stents to prevent and/or treat stent occlusion. Bile leaks close using plastic stents, which divert bile away from the leak into the duodenum. Covered self-expandable metal stents (CSEMS), intended for palliation of malignant biliary obstruction, have been used to treat benign biliary diseases. Advantages include small predeployment and large postexpansion diameters. Lack of imbedding of the metal into the bile duct wall enables removability. For strictures, one CSEMS is inserted without need for dilation and remains in place for up to 6 months. Successful removal has been reported in all cases. Long-term stricture resolution is achieved in up to 92%. Adverse events include migration and new stricture formation. For treatment of complex bile leaks, the covering and large diameter allow successful closure in nearly all cases. Other uses of CSEMS include treatment of postsphincterotomy bleeding and closure of perforations. CSEMS show promise for treatment of BBS and complex biliary leaks. Successful resolution can be achieved in the majority of patients with the advantage of fewer procedures, which offsets their higher cost.

  14. [Larynx: implants and stents].

    PubMed

    Sittel, C

    2009-05-01

    There is a wide variety of devices and materials to be implanted into the human larynx. Some are intended to remain only for a period of time, like laryngeal stents. If removal is not intended the device meets the definition for a medical implant. The majority of implants is used for the treatment of unilateral vocal fold immobility. There a 2 types of implants serving this purpose: Implants in a stricter sense are devices of solid material, which are brought into the paraglottic space through a window in the laryngeal framework (medialization thyroplasty). Several different products are presented in this review. In contrast, there are different substances available for endoscopic injection into the paralyzed vocal fold (injection laryngoplasty). Since some of these substances show a corpuscular consistency and a high viscosity they need to be deposited into the lateral paraglottic space. Therefore, the term "injectable implants" has been coined for these materials. The different substances available are discussed in detail in this review. Laryngeal stents are primarily used in the early postoperative phase after open reconstruction of the larynx. The different devices available on the market are described with their specific characteristics and intended use.

  15. Biodegradable stents in gastrointestinal endoscopy

    PubMed Central

    Lorenzo-Zúñiga, Vicente; Moreno-de-Vega, Vicente; Marín, Ingrid; Boix, Jaume

    2014-01-01

    Biodegradable stents (BDSs) are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines. The experience with the currently the only BDS for endoscopic placement, made of Poly-dioxanone, have shown promising results. However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material, and that can cause stent-induced mucosal or parenchymal injury. This complication rate and modest clinical efficacy has to be carefully considered in individual patients prior to placement of BDSs. Otherwise, the price of these stents therefore it is nowadays an important limitation. PMID:24605020

  16. Limitations of Endovascular Treatment with Stent-Grafts for Active Mycotic Thoracic Aortic Aneurysm

    SciTech Connect

    Ishida, Masaki; Kato, Noriyuki; Hirano, Tadanori; Shimono, Takatsugu; Yasuda, Fuyuhiko; Tanaka, Kuniyoshi; Yada, Isao; Takeda, Kan

    2002-06-15

    An 81-year-old woman with ruptured mycotic thoracic aortic aneurysm was treated with endovascular placement of stent-grafts fabricated from expanded polytetrafluoroethylene and Z-stents. Although exclusion of the aneurysm was achieved at the end of the procedure, a type I endoleak developed on the following day.Despite emergent surgical resection of the aneurysm and extra-anatomical reconstruction, the patient died 2 days later. Stent-graft repair may not be a suitable method for the treatment of ruptured mycotic aneurysm in the presence of active infection.

  17. Percutaneous Placement of Permanent Metallic Stents in the Cystic Duct to Treat Obstructive Cholecystitis.

    PubMed

    Brown, Nicholas I; Jhamb, Ashu; Brooks, Duncan M; Little, Andrew F

    2015-12-01

    This report presents a series of five patients unsuitable for surgery who had nonretrievable self-expanding metallic stents deployed along the cystic duct as treatment for benign and malignant causes of gallbladder obstruction. Techniques are described for draining cholecystitis, removing gallstones, bypassing gallbladder obstructions, and inserting metallic stents across the cystic duct to restore permanent antegrade gallbladder drainage in acute and chronic cholecystitis. Symptoms resolved in all cases, and stents remained patent for as long as 22 months. This procedure may be an effective alternative to cholecystectomy or long-term gallbladder drainage for patients in inoperable condition.

  18. Stent graft exclusion of a pseudoaneurysm in a Blalock-Taussig shunt.

    PubMed

    Sanchez-Recalde, Angel; Garzón, Gonzalo; Oliver, José M

    2010-08-01

    This case is the first report of slow-growing pseudoaneurysm after vessel dissection secondary to two stents implantation into classic Blalock Taussig shunt in a patient with pulmonary atresia and ventricular septal defect. Pseudoaneurysm was successfully excluded by a percutaneous approach with self-expandable stent graft deployment from the aorta to the middle of the Blalock Taussig shunt. Nearly 3 years after the procedure, the classic BT is patent, and there were no restenosis or thrombosis in spite of the very long length of the stented segment.

  19. Pancreatitis-Induced Extrahepatic Portal Vein Stenosis Treated by Percutaneous Transhepatic Stent Placement: a Case Report

    SciTech Connect

    Maleux, G. Vaninbroukx, J.; Verslype, C.; Vanbeckevoort, D.; Hootegem, P. van; Nevens, F.

    2003-08-15

    One month after onset of an acute biliary pancreatitis, a 75-year-old man developed refractory ascites. Duplex ultrasound and CT scan revealed a focal stenosis of the extrahepatic portal vein as confirmed by transhepatic direct portography. In the same session, this stenosis, responsible for symptomatic prehepaticportal hypertension, was successfully dilated and stented and afterwards a residual pressure gradient of 1 mmHg over the stented segment was measured. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination one year later is completely normal.

  20. Endoscopic Removal of a Nitinol Mesh Stent from the Ureteropelvic Junction after 15 Years

    PubMed Central

    Smrkolj, Tomaž; Šalinović, Domagoj

    2015-01-01

    We report a rare case of a patient with a large stone encrusted on a nitinol mesh stent in the ureteropelvic junction. The stent was inserted in the year 2000 after failure of two pyeloplasty procedures performed due to symptomatic ureteropelvic junction stenosis. By combining minimally invasive urinary stone therapies—extracorporeal shock wave lithotripsy, semirigid ureterorenoscopy with laser lithotripsy, and percutaneous nephrolithotomy—it was possible to completely remove the encrusted stone and nitinol mesh stent that was implanted for 15 years, rendering the patient symptom and obstruction free. PMID:26697258

  1. Bare metal or drug-eluting stent implantation in last remaining vessel PCI? A serious dilemma.

    PubMed

    Zhang, Lei; Zhu, Jianhua; Kiemeneij, Ferdinand

    2009-04-01

    This case report describes the treatment of an old male diabetic patient with last remaining vessel coronary artery disease and poor left ventricular function. In presence of an old occlusion of the left main coronary artery, a subtotal stenosis of a dominant right coronary artery required angioplasty. After ample consideration it was decided to implant a bare metal stent (BMS) instead of a drug-eluting stent (DES). The major reason was the fear for early discontinuation of clopidogrel in case a drug-eluting stent was placed. The procedure and follow-up are described followed by an overview of current literature concerning similar pathology.

  2. Retrieval of the Protection Filter with a Soft Coaxial Catheter After Carotid Stenting

    SciTech Connect

    Mayer, Thomas E.; Holtmannspoetter, Markus; Mueller-Schunk, Stefanie

    2009-01-15

    The purpose of this study was to shorten and simplify the procedure of filter retrieval after carotid stenting with cerebral protecting devices. We propose a retrieval method with a soft-tip guiding catheter, which eliminates the step of balloon exchange and introduction of a retriever catheter for the protection filter. The technique was successfully used in our last 60 consecutive patients. One transient deficit occurred. In conclusion, retrieval of the filter with a soft coaxial catheter after carotid stenting is a feasible and safe method and may simplify cerebrovascular protection during stenting.

  3. Optimal stent design for drug delivery.

    PubMed

    Rogers, Campbell D K

    2004-01-01

    The efficacy and safety of drug-eluting coronary stents might differ depending on the pharmacologic agents and stent delivery systems used. Recent research has focused on the various constituents of drug-delivery stents, including the stent backbone, materials used as drug-delivery vehicles, and the physicochemical properties of the pharmacotherapeutic agents themselves. Metal stents coated with an outer layer of polymer (bioabsorbable or non-bioabsorbable) can be drug-loaded, thus providing more controlled and sustained drug delivery and allowing more optimal drug-tissue interactions. Among the next generation of drug-eluting stents will be a stent that uses the non-bioabsorbable polymer phosphorylcholine to release the sirolimus analogue ABT-578; another stent will use a highly deliverable cobalt-chromium metal alloy stent platform and, for the first time, a bioabsorbable polymeric coating (thin-film polylactic acid) for drug encapsulation and release.

  4. Stenting of vertical vein in an infant with obstructed supracardiac total anomalous pulmonary venous drainage

    PubMed Central

    Lim, WK; Leong, MC; Samion, H

    2016-01-01

    A 1.7 kg infant with obstructed supracardiac total anomalous pulmonary venous drainage (TAPVD) presented with severe pulmonary hypertension secondary to vertical vein obstruction. The child, in addition, had a large omphalocele that was being managed conservatively. The combination of low weight, unoperated omphalocele, and severe pulmonary hypertension made corrective cardiac surgery very high-risk. Therefore, transcatheter stenting of the stenotic vertical vein, as a bridge to corrective surgery was carried out. The procedure was carried out through the right internal jugular vein (RIJ). The stenotic segment of the vertical vein was stented using a coronary stent. After procedure, the child was discharged well to the referred hospital for weight gain and spontaneous epithelialization of the omphalocele. Stenting of the vertical vein through the internal jugular vein can be considered in very small neonates as a bridge to repair obstructed supracardiac total anomalous venous drainage. PMID:27212859

  5. Enteral metallic stenting by balloon enteroscopy for obstruction of surgically reconstructed intestine.

    PubMed

    Nakahara, Kazunari; Okuse, Chiaki; Matsumoto, Nobuyuki; Suetani, Keigo; Morita, Ryo; Michikawa, Yosuke; Ozawa, Shun-ichiro; Hosoya, Kosuke; Kobayashi, Shinjiro; Otsubo, Takehito; Itoh, Fumio

    2015-06-28

    We present three cases of self-expandable metallic stent (SEMS) placement using a balloon enteroscope (BE) and its overtube (OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.

  6. Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial.

    PubMed

    Shao, Yi; Zhuo, Jian; Sun, Xiao-Wen; Wen, Wei; Liu, Hai-Tao; Xia, Shu-Jie

    2008-10-01

    We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclusion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.

  7. Magnetic Nanoparticle-Mediated Targeting of Cell Therapy Reduces In-Stent Stenosis in Injured Arteries.

    PubMed

    Polyak, Boris; Medved, Mikhail; Lazareva, Nina; Steele, Lindsay; Patel, Tirth; Rai, Ahmad; Rotenberg, Menahem Y; Wasko, Kimberly; Kohut, Andrew R; Sensenig, Richard; Friedman, Gary

    2016-09-19

    Although drug-eluting stents have dramatically reduced the recurrence of restenosis after vascular interventions, the nonselective antiproliferative drugs released from these devices significantly delay reendothelialization and vascular healing, increasing the risk of short- and long-term stent failure. Efficient repopulation of endothelial cells in the vessel wall following injury may limit complications, such as thrombosis, neoatherosclerosis, and restenosis, through reconstitution of a luminal barrier and cellular secretion of paracrine factors. We assessed the potential of magnetically mediated delivery of endothelial cells (ECs) to inhibit in-stent stenosis induced by mechanical injury in a rat carotid artery stent angioplasty model. ECs loaded with biodegradable superparamagnetic nanoparticles (MNPs) were administered at the distal end of the stented artery and localized to the stent using a brief exposure to a uniform magnetic field. After two months, magnetic localization of ECs demonstrated significant protection from stenosis at the distal part of the stent in the cell therapy group compared to both the proximal part of stent in the cell therapy group and the control (stented, nontreated) group: 1.7-fold (p < 0.001) less reduction in lumen diameter as measured by B-mode and color Doppler ultrasound, 2.3-fold (p < 0.001) less reduction in the ratios of peak systolic velocities as measured by pulsed wave Doppler ultrasound, and 2.1-fold (p < 0.001) attenuation of stenosis as determined through end point morphometric analysis. The study thus demonstrates that magnetically assisted delivery of ECs is a promising strategy for prevention of vessel lumen narrowing after stent angioplasty procedure.

  8. Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

    SciTech Connect

    Akinci, Devrim Akhan, Okan; Ozkan, Fuat; Ciftci, Turkmen; Ozkan, Orhan S.; Karcaaltincaba, Musturay; Ozmen, Mustafa N.

    2007-11-15

    Purpose. The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods. A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results. Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion. Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting.

  9. Long-term tolerance of airway silicone stent in patients with post-tuberculosis tracheobronchial stenosis.

    PubMed

    Verma, Akash; Um, Sang-Won; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung; Kim, Hojoong

    2012-01-01

    Surgery is a well-recognized modality of treatment for benign tracheobronchial stenosis. However, in some benign disease groups, such as tuberculosis, sarcoidosis, war gas exposure, and inhalation burns, multiplicity of involvement or long length of stenosed segment heightens surgical challenge. We investigated the outcomes and long-term tolerability of the Natural stent (N-stent) in such patients with post-tuberculosis tracheobronchial stenosis. A retrospective review was done for 17 patients who underwent silicone stenting (N-stent) for post-tuberculosis tracheobronchial stenosis during January 2000-December 2003 but needed persistent stent placement and still require the stent. Significant increase in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC), expressed as FEV1%, as well as in forced percentual vital capacity (FVC%) (Δ24% and Δ11%, respectively) in the short term and sustained increase in the FEV1% and FVC% (Δ26.5% and Δ16.5%, respectively) in the long term were noted at a median (range) interval of 1 (0.5-72) month and 72 (12-114) months, respectively, along with symptomatic relief. No procedure-related death occurred. Stent-related late complications included granulation tissue formation (76%), migration (70%), and mucostasis (17%). The median duration for which N-stents were tolerated was 7.9 (range, 3-11) years. N-stents are well-tolerated for a prolonged period. Stent-related complications occur, but are easily managed. These results might carry medical implications for those who have airway lesions difficult to correct surgically.

  10. Allium Stents: A Novel Solution for the Management of Upper and Lower Urinary Tract Strictures.

    PubMed

    Bahouth, Zaher; Moskovitz, Boaz; Halachmi, Sarel; Nativ, Ofer

    2017-08-22

    Stents are widely use in endoscopic urological procedures. One of the most important indications is the treatment of urinary tract strictures. Allium(™) Medical has introduced several types of stents for the treatment of different types of urinary tract strictures, based on anatomic location. All the stents are made of nitinol and coated with a co-polymer that reduces encrustations. These stents are self-expandable and have a large caliber and a high radial force. They have different shapes, designed especially for the treatment of each type of stricture. One of the most important features of Allium-manufactured stents is the ease of removal, due to their special unraveling feature. The company has introduced the Bulbar Urethral Stent (BUS) for treatment of bulbar urethral strictures; a rounded stent available in different lengths. Initial data on 64 patients with bulbar urethral stricture treated with the BUS showed a significant improvement in symptoms, with minimal complications and few adverse events. For treatment of prostate obstruction in patients unfit for surgery or unwilling to undergo a classical prostatic surgery, the Triangular Prostatic Stent (TPS) was introduced, which has a triangular shape that fits in the prostatic urethra. Its body has a high radial force attached to an anchor (which prevents migration) through a trans-sphincteric wire (which reduces incontinence rate). Initial data on 51 patients showed significant improvement in symptoms and in urinary peak flow rate, with a relatively small number of complications. The Round Posterior Stent (RPS) was designed for treatment of post radical prostatectomy bladder neck contracture. This short, round stent has an anchor, which is placed in the bladder neck. This stent being relatively new, the clinical data are still limited. Ureteral strictures can be treated with the Ureteral Stent (URS), which is round-shaped, available in different lengths, and has an anchor option (for very distal or very

  11. Emergency cricothyroidotomy following tracheobronchial stenting.

    PubMed

    Cavinato, Simon Robert; Denning, Mike; Madden, Brendan P

    2017-02-24

    A man aged 51 years was referred for tracheobronchial stenting after a poorly differentiated oesophageal carcinoma had progressed to cause stridor. Bronchoscopy revealed a left vocal cord palsy and tumour infiltration into the trachea. A tracheobronchial stent was placed, and after distal migration was endoscopically resited. Returning from theatre, the patient developed severe upper airway obstruction that progressed to cause CO2 narcosis and loss of consciousness. A rapid sequence induction was initiated, and a Glidescope revealed bilateral vocal cord palsy with severe oedema causing an inability to pass a tube or stylet. Tracheostomy was attempted above the suprasternal notch but was obstructed by the stent. Oxygen saturations dropped steadily, reaching as low as 38%. Emergency cricothyroidotomy was performed, compliant with DAS guidelines, that proved successful. The stent was removed, which was blocked with blood and secretions, and tracheostomy was placed 2 days later. The patient made a full neurological recovery.

  12. Advances in Ureteral Stent Design

    NASA Astrophysics Data System (ADS)

    Denstedt, John D.

    2007-04-01

    Ureteral stents are commonly used in urolithiasis patients for relief of obstruction or in association with stone treatments such as ureteroscopy and extracorporeal shock wave lithotripsy. There are currently many different bulk materials and coatings available for the manufacture of ureteral stents, however the ideal material has yet to be discovered. All potential biomaterials must undergo rigorous physical and biocompatibility testing before commercialization and use in humans. Despite significant advances in basic science research involving biocompatibility issues and biofilm formation, infection and encrustation remain associated with the use of biomaterials in the urinary tract. There have been many significant advances in the design of ureteral stents in recent years and these will be highlighted along with a discussion of future aspects of biomaterials and use of stents in association with urolithiasis.

  13. Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study.

    PubMed

    de Waard, D D; Halliday, A; de Borst, G J; Bulbulia, R; Huibers, A; Casana, R; Bonati, L H; Tolva, V

    2017-05-01

    Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly

  14. Posttraumatic infrarenal abdominal aortic pseudoaneurysm treated with bifurcated endovascular graft stent

    PubMed Central

    Erkanli, Korhan; Akturk, Ibrahim Faruk; Aydin, Unal; Akinci, Okan; Yildirim, Aydin

    2015-01-01

    Posttraumatic infrarenal aortic pseudoaneurysms are rare and potentially lethal lesions. We report the case of a 32-year-old man presenting with infrarenal aortic pseudoaneurysm eight months after being stabbed in the back and right flank. His pseudoaneurysm was close to the iliac bifurcation, so we decided to deploy a bifurcated endovascular graft stent, the TriVascular Ovation endovascular stent. Imaging one month after the procedure revealed no endoleak and slight shrinkage of the pseudoaneurysm. PMID:26161108

  15. The role of brachytherapy and Cutting Balloon angioplasty in the current treatment of stent restenosis.

    PubMed

    Bonan, Raoul

    2004-09-01

    The Gamma I, START and INHIBIT trials conclusively demonstrate the feasibility, safety and efficacy of intracoronary radiation as the treatment of choice for stent restenosis. Further reports confirm this finding and extend the indications. Vascular brachytherapy should be made available for all patients with diffuse stent restenosis. Specific devices such as cutting balloons may improve the procedure but does not seem to have an impact alone on the evolution.

  16. Self-expandable metallic stents for palliative treatment of digestive cancer.

    PubMed

    Lopes, César Vivian; Pesenti, Christian; Bories, Erwan; Caillol, Fabrice; Giovannini, Marc

    2008-10-01

    BACKGROUND/GOAL: Self-expandable metallic stents can be used to reestablish luminal continuity in patients with malignancy of the esophagus, gastric outlet, or colon who are at high risk for surgical intervention. Data regarding their complication profiles remain incomplete. Our aim was to evaluate the feasibility and complications of endoscopic stenting in esophageal, gastroduodenal, and colonic malignancies. Between January 2003 and December 2005, 153 patients underwent 182 endoscopic procedures for insertion of 199 metallic stents in a single referral center. Complications were assessed retrospectively. The mean follow-up was 170 days. The mortality was 73.9% (113 patients), 105 cases between 1 and 60 weeks after the procedure (median survival, 17 wk), but none directly related to the stent placement. One single stent was required in 115 (75%) patients, and 37 (24.2%) cases required an overlapping stent. The procedure was unsuccessful in only 1 case of colonic obstruction. Thirty-eight (26.6%) patients developed 52 complications, of which 16 (9.4%) procedure-related complications (perforation, 5; migration, 5; obstruction, 3; misplacement, 2; and hemorrhage, 1) and 36 (21.3%) late complications (obstruction, 20; migration, 9; fistula, 6; and perforation, 1). Eight (5.6%) patients experienced more than 1 complication. Five (3.5%) cases required surgery (colon: 2 perforations, 1 fistula, and 1 obstruction; esophagus: 1 perforation). No significant difference on the complication rates was found for any site in which a metallic stent was inserted. Endoscopic stenting for palliation of digestive cancer, despite a reasonable complication rate, is feasible in most patients. Most dysfunctions are not life-threatening and can be managed endoscopically.

  17. Everolimus-eluting stents in interventional cardiology

    PubMed Central

    Townsend, Jacob C; Rideout, Phillip; Steinberg, Daniel H

    2012-01-01

    Bare metal stents have a proven safety record, but limited long-term efficacy due to in-stent restenosis. First-generation drug-eluting stents successfully countered the restenosis rate, but were hampered by concerns about their long-term safety. Second generation drug-eluting stents have combined the low restenosis rate of the first generation with improved long-term safety. We review the evolution of drug-eluting stents with a focus on the safety, efficacy, and unique characteristics of everolimus-eluting stents. PMID:22910420

  18. Clinical and angiographic results with the NIR stent: First International NIR Endovascular Stent Study (FINESS-II).

    PubMed

    Rutsch, Wolfgang; Kiemeneij, Ferdinand; Colombo, Antonio; Macaya, Carlos; Guermonprez, Jean-Leon; Grip, Lars; Hamburger, Jaap; Umans, Victor; Gotsman, Mervyn; Almagor, Yaron; Morice, Marie-Claude; Garcia, Eulogio; Chevalier, Bernard; Erbel, Raimund; Cobaugh, Michael; Morel, Marie-Angèle; Serruys, Patrick W

    2000-09-01

    BACKGROUND: Although safety and efficacy of the NIR trade mark stent have been reported, the long-term angiographic and clinical outcomes have yet to be investigated. The FINESS-II study (First International NIR Endovascular Stent Study) was designed to assess the procedural safety of single 9 and 16 mm NIR stent implantation, the six-month restenosis rate and finally the six- and 12-month clinical outcome of patients treated with this novel coronary stent. METHODS: Patients with angina and a single de novo lesion in a native coronary artery of >3 and <5 mm diameter were included in this multicentre, prospective, observational trial. Clinical follow-up was obtained at one, six and 12 months. Angiography was performed before and after the stent implantation and at six months. The primary endpoint included major adverse cardiac events (death, myocardial infarction and target lesion revascularization) within 30 days after the procedure. Major bleeding complications and subacute stent thrombosis within the first 30 days were also reported as specific endpoints. Secondary endpoints were major cardiac-event-free survival at six- and 12-month follow-up and angiographic restenosis at six months. RESULTS: A total of 156 patients (81% male, mean age 60 +/- 10 years), with stable (54%), unstable (40%) angina pectoris or silent ischemia (6%) were enrolled. The target vessel diameter was 2.94 +/- 0.54 mm. The minimal lumen diameter pre, post and at follow-up was 1.04 +/- 0.32 mm, 2.64 +/- 0.42 mm and 1.88 +/- 0.63 mm, respectively. Restenosis rate according to the >50% diameter stenosis criterion at six month follow-up was 19% (26/136). At 12 months, the event-free survival rate was 83% (two deaths, one Q-wave and three non-Q-wave myocardial infarctions, four bypass surgery and 17 target lesion revascularizations), while 87% of the patients were free of angina pectoris. CONCLUSION: the outcome of the FINESS-II trial is comparable to those observed in previous stent trials

  19. Selection of a TIPS stent for management of portal hypertension in liver cirrhosis: An evidence-based review

    PubMed Central

    Qi, Xing-Shun; Bai, Ming; Yang, Zhi-Ping; Fan, Dai-Ming

    2014-01-01

    Nowadays, transjugular intrahepatic portosystemic shunt (TIPS) has become a mainstay treatment option for the management of portal hypertension-related complications in liver cirrhosis. Accumulated evidence has shown that its indications are being gradually expanded. Notwithstanding, less attention has been paid for the selection of an appropriate stent during a TIPS procedure. Herein, we attempt to review the current evidence regarding the diameter, type, brand, and position of TIPS stents. Several following recommendations may be considered in the clinical practice: (1) a 10-mm stent may be more effective than an 8-mm stent for the management of portal hypertension, and may be superior to a 12-mm stent for the improvement of survival and shunt patency; (2) covered stents are superior to bare stents for reducing the development of shunt dysfunction; (3) if available, Viatorr stent-grafts may be recommended due to a higher rate of shunt patency; and (4) the placement of a TIPS stent in the left portal vein branch may be more reasonable for decreasing the development of hepatic encephalopathy. However, given relatively low quality of evidence, prospective well-designed studies should be warranted to further confirm these recommendations. PMID:24914368

  20. First-in-man evaluation of the MOMO cobalt-chromium carbon-coated stent.

    PubMed

    Kesavan, Sujatha; Strange, Julian W; Johnson, Thomas W; Flohr-Roese, Silke; Baumbach, Andreas

    2013-01-22

    Bare metal stents continue to be used for the interventional treatment of coronary artery disease. We report the clinical and angiographic results of a multicentre, single-arm evaluation of safety and feasibility of the MOMO stent (Japan Stent Technology Co., Ltd, Okayama Research Park Incubation Centre, Okayama, Japan). The MOMO stent is a novel thin-strut cobalt-chromium carbon-coated stent for the treatment of de novo coronary artery disease (CAD). In this prospective, non-randomised, single-arm study, 40 patients (stable and unstable angina) with single-vessel CAD were recruited into the study from three centres. Patients with lesions ≤15 mm in length and with a target vessel diameter of ≥3 mm were eligible. Angiographic follow-up was performed at six months. Quantitative coronary angiography (QCA) was used to measure acute gain and late luminal loss (LLL). Intravascular ultrasound (IVUS) was performed in 15 consecutive patients from two centres to assess the degree of neointimal proliferation within the stented segment at six-month follow-up. The MOMO stent performed well without any procedural complications with an acute procedure and technical success rate of 100%. Repeat revascularisation was performed in six patients (15%) during the six-month follow-up. Ischaemia-driven revascularisation was documented in three patients (7.5%). No myocardial infarction, stent thrombosis or cardiac death was observed. One non-cardiac death was reported secondary to lung cancer. Binary restenosis was 12.5% (n=5), and the LLL was 0.54±0.3 mm. This first-in-man experience demonstrates proof of concept of the safety and feasibility of the MOMO cobalt-chromium carbon-coated stent for patients with single focal de novo lesions presenting with stable and unstable CAD.

  1. Ketoprofen-eluting biodegradable ureteral stents by CO2 impregnation: In vitro study.

    PubMed

    Barros, Alexandre A; Oliveira, Carlos; Reis, Rui L; Lima, Estevão; Duarte, Ana Rita C

    2015-11-30

    Ureteral stents are indispensable tools in urologic practice. The main complications associated with ureteral stents are dislocation, infection, pain and encrustation. Biodegradable ureteral stents are one of the most attractive designs with the potential to eliminate several complications associated with the stenting procedure. In this work we hypothesize the impregnation of ketoprofen, by CO2-impregnation in a patented biodegradable ureteral stent previously developed in our group. The biodegradable ureteral stents with each formulation: alginate-based, gellan gum-based were impregnated with ketoprofen and the impregnation conditions tested were 100 bar, 2 h and three different temperatures (35 °C, 40 °C and 50 °C). The impregnation was confirmed by FTIR and DSC demonstrated the amorphization of the drug upon impregnation. The in vitro elution profile in artificial urine solution (AUS) during degradation of a biodegradable ureteral stent loaded with ketoprofen was evaluated. According to the kinetics results these systems have shown to be very promising for the release ketoprofen in the first 72 h, which is the necessary time for anti-inflammatory delivery after the surgical procedure. The in vitro release studied revealed an influence of the temperature on the impregnation yield, with a higher impregnation yield at 40 °C. Higher yields were also obtained for gellan gum-based stents. The non-cytotoxicity characteristic of the developed ketoprofen-eluting biodegradable ureteral stents was evaluated in L929 cell line by MTS assay which demonstrated the feasibility of this product as a medical device. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Vascular gene transfer from metallic stent surfaces using adenoviral vectors tethered through hydrolysable cross-linkers.

    PubMed

    Fishbein, Ilia; Forbes, Scott P; Adamo, Richard F; Chorny, Michael; Levy, Robert J; Alferiev, Ivan S

    2014-08-12

    In-stent restenosis presents a major complication of stent-based revascularization procedures widely used to re-establish blood flow through critically narrowed segments of coronary and peripheral arteries. Endovascular stents capable of tunable release of genes with anti-restenotic activity may present an alternative strategy to presently used drug-eluting stents. In order to attain clinical translation, gene-eluting stents must exhibit predictable kinetics of stent-immobilized gene vector release and site-specific transduction of vasculature, while avoiding an excessive inflammatory response typically associated with the polymer coatings used for physical entrapment of the vector. This paper describes a detailed methodology for coatless tethering of adenoviral gene vectors to stents based on a reversible binding of the adenoviral particles to polyallylamine bisphosphonate (PABT)-modified stainless steel surface via hydrolysable cross-linkers (HC). A family of bifunctional (amine- and thiol-reactive) HC with an average t1/2 of the in-chain ester hydrolysis ranging between 5 and 50 days were used to link the vector with the stent. The vector immobilization procedure is typically carried out within 9 hr and consists of several steps: 1) incubation of the metal samples in an aqueous solution of PABT (4 hr); 2) deprotection of thiol groups installed in PABT with tris(2-carboxyethyl) phosphine (20 min); 3) expansion of thiol reactive capacity of the metal surface by reacting the samples with polyethyleneimine derivatized with pyridyldithio (PDT) groups (2 hr); 4) conversion of PDT groups to thiols with dithiothreitol (10 min); 5) modification of adenoviruses with HC (1 hr); 6) purification of modified adenoviral particles by size-exclusion column chromatography (15 min) and 7) immobilization of thiol-reactive adenoviral particles on the thiolated steel surface (1 hr). This technique has wide potential applicability beyond stents, by facilitating surface engineering of

  3. Modification of an endovascular stent graft for abdominal aortic aneurysm

    NASA Astrophysics Data System (ADS)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  4. Rescue Stenting in Endovascular Treatment of Acutely Ruptured Cerebral Aneurysms

    PubMed Central

    Mahmoud, M.

    2013-01-01

    Summary Thromboembolic events and major artery occlusion following cerebral aneurysm coiling may lead to serious complications and even death if not treated. The use of an intracranial stent in the setting of subarachnoid hemorrhage (SAH) is risky due to the need for antiplatelet therapy. However in some conditions it could be an effective solution for this major problem. This study describes a revascularization technique using a Solitaire stent for treatment of anterior cerebral artery (ACA) occlusion following coiling of anterior communicating artery (Acom) aneurysms. Three cases of ruptured Acom aneurysms treated during the course of SAH underwent unplanned deployment of an intracranial stent. Complete occlusion of the ACA at the origin of the A2 segment developed during or shortly after coiling. Emergent CT brain scan was done in two cases to exclude rebleeding. Follow-up CT or MRI scans were performed 24 hours after stenting. Technical success was achieved in all cases. Complete revascularization of the Acom was achieved post stent deployment (TIMI grade 3). Time from onset of symptoms to full revascularization in the three cases was 35 minutes, one hour 50 minutes and two hours 40 minutes respectively. No intracranial bleeding occurred in any case following the procedure. No neurological changes occurred in case 1; mild neurological and radiological changes occurred in cases 2 and 3. Deployment of an intracranial stent achieved complete revascularization of the occluded Acom. Its use in a context of SAH is relatively risky but the technique resulted in a significant improvement of symptoms following flow restoration and probably helped prevent symptoms worsening, major disability or even death. A study on a larger patient sample with long-term follow-up will be of value. PMID:23472719

  5. Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm

    PubMed Central

    Anderloni, Andrea; Attili, Fabia; Carrara, Silvia; Galasso, Domenico; Di Leo, Milena; Costamagna, Guido; Repici, Alessandro; Kunda, Rastislav; Larghi, Alberto

    2017-01-01

    Background Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS) mounted on an electrocautery-enhanced delivery system has been developed to perform endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however, release of the proximal flange of the stent has mostly been done using endoscopic view guidance to ensure proper positioning. Aim We describe a new technique that we have named the Intra-Channel Stent Release Technique (ICSRT) to perform stent placement under complete EUS control, without the use of either fluoroscopic or endoscopic views. Material and methods Data on all consecutive patients who underwent EUS-guided drainage using the new ICSRT between June 2014 and April 2016 were retrospectively retrieved from two institution databases. All EUS procedures were performed by experienced endoscopists with the patient under conscious or deep sedation. The total procedure and stent deployment time, and adverse events related to stent positioning with the ICSRT were evaluated. Results One hundred consecutive patients (51 women; mean age ± SD, 66 ± 15.2 years, range 34 – 95) underwent EUS-guided transluminal drainage with the Hot AXIOS™ device using the new ICSRT. The procedure was technically successful in all but one patient (1 %). The mean total procedural time was 21.9 minutes (range 7 – 50), while the mean time for stent placement was 3.2 minutes (range 1 – 15). No major adverse events occurred. Discussion The ICSRT has been used to deploy the newly developed lumen-apposing FCSEMS under complete EUS guidance without fluoroscopic and/or endoscopic assistance. The technique appears to be safe and highly effective and should be learned by all interventional endosonographers in order to be able to perform drainage in all clinical scenarios.

  6. Mechanical Interaction of an Expanding Coiled Stent with a Plaque-Containing Arterial Wall: A Finite Element Analysis.

    PubMed

    Welch, Tré R; Eberhart, Robert C; Banerjee, Subhash; Chuong, Cheng-Jen

    2016-03-01

    Wall injury is observed during stent expansion within atherosclerotic arteries, related in part to stimulation of the inflammatory process. Wall stress and strain induced by stent expansion can be closely examined by finite element analysis (FEA), thus shedding light on procedure-induced sources of inflammation. The purpose of this work was to use FEA to examine the interaction of a coiled polymer stent with a plaque-containing arterial wall during stent expansion. An asymmetric fibrotic plaque-containing arterial wall model was created from intravascular ultrasound (IVUS) images of a diseased artery. A 3D model for a coil stent at unexpanded state was generated in SolidWorks. They were imported into ANSYS for FEA of combined stent expansion and fibrotic plaque-distortion. We simulated the stent expansion in the plaqued lumen by increasing balloon pressure from 0 to 12 atm in 1 atm step. At increasing pressure, we examined how the expanding stent exerts forces on the fibrotic plaque and vascular wall components, and how the latter collectively resist and balance the expansive forces from the stent. Results show the expanding coiled stent creates high stresses within the plaque and the surrounding fibrotic capsule. Lower stresses were observed in adjacent medial and adventitial layers. High principal strains were observed in plaque and fibrotic capsule. The results suggest fibrotic capsule rupture might occur at localized regions. The FEA/IVUS method can be adapted for routine examination of the effects of the expansion of selected furled stents against IVUS-reconstructed diseased vessels, to improve stent deployment practices.

  7. Colorectal Stents: Current Status

    PubMed Central

    Lee, Jeong-Mi

    2015-01-01

    A self-expandable metal stent (SEMS) is an effective and safe method for the decompression of colon obstruction. Based on recent evidence, colorectal SEMS is now recommended for the palliation of patients with colonic obstruction from incurable colorectal cancer or extracolonic malignancy and also as a bridge to surgery in those who are a high surgical risk. Prophylactic SEMS insertion in patients with no obstruction symptoms is not recommended. Most colorectal SEMS are inserted endoscopically under fluoroscopic guidance. The technical and clinical success rates of colorectal SEMS are high, and the complication rate is acceptable. Advances in this technology will make the insertion of colorectal SEMS better and may expand the indications of colorectal SEMS in the future. PMID:26064818

  8. Percutaneous cholangioscopy in obstructed biliary metal stents

    SciTech Connect

    Hausegger, Klaus A.; Mischinger, Hans J.; Karaic, Radenko; Klein, Guenther E.; Kugler, Cristian; Kern, Robert; Uggowitzer, Martin; Szolar, Dieter

    1997-05-15

    Purpose. To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. Methods. Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethane-covered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope. Results. In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n=1) to subtotal (n=8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them. Conclusion. PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months.

  9. Forgotten Ureteral Stents: An Avoidable Morbidity.

    PubMed

    Murtaza, Badar; Alvi, Sarwar

    2016-03-01

    To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents. Observational study. Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to June 2011. Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients' opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition. The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ±12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ±33.435 years). Seven patients (18.4%) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6%), calculus formed over the stents in 20 cases (52.6%), and stent fragmented in 5 patients (13.1%). Majority of patients, (n = 23, 60.5%), were not even aware of the placement of these stents while 8 (21.0%) knew but were reluctant about its removal. In 3 cases (7.8%), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2%), but the other broken fragment was missed. One case (2.6%) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ. Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives regarding the stent.

  10. Biliary Stent Migration with Duodenal Perforation

    PubMed Central

    Yaprak, Muhittin; Mesci, Ayhan; Colak, Taner; Yildirim, Bulent

    2008-01-01

    Intestinal perforation from a migrated biliary stent is a known complication of endoscopic biliary stent placement. We present a case of stent migration and resultant duodenal perforation after stent placement for a malignant biliary stricture in a 52-year-old woman. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic stent placement for biliary strictures. A plain abdominal radiograph is necessary for early diagnosis of biliary stent migration. If a stent becomes lodged in the gastrointestinal tract, endoscopic or operative extraction of the stent is necessary to prevent subsequent intestinal perforation and peritonitis. Intestinal perforation secondary to biliary stent dislocation should be considered in all patients presenting with fever and abdominal pain after biliary stent insertion. Any abnormality that prevents stent migration through the intestinal tract such as gastroenterostomy, abdominal wall hernia, extensive adhesions or colonic divertucula may be a contraindication for insertion of a plastic biliary stent because of increased perforation risk. PMID:25610053

  11. Retrograde aorto-mesenteric by-pass grafting as treatment option of recurrent chronic mesenteric ischemia after thrombosed superior mesenteric artery stenting. Report of a case.

    PubMed

    Nano, G; Dalainas, I; Bianchi, P; Stegher, S; Casana, R; Malacrida, G; Tealdi, D G

    2006-12-01

    We report a case of early stent failure in a patient with chronic mesenteric ischemia and its treatment with a retrograde aorto-mesenteric by-pass. The patient was initially treated with angioplasty and stenting. Seven months after the procedure complete thrombosis of the stent was achieved. A retrograde aorto-mesenteric by-pass was performed. After two years the patient remains asymptomatic and color Duplex scan confirm the patency of the graft.

  12. Assessment of coronary stents by 64-slice computed tomography: in-stent lumen visibility and patency.

    PubMed

    Kong, Ling-Yan; Jin, Zheng-Yu; Zhang, Shu-Yang; Zhang, Zhu-Hua; Wang, Yi-Ning; Song, Lan; Zhang, Xiao-Na; Zhang, Yun-Qing

    2009-09-01

    To assess lumen visibility of coronary stents by 64-slice computed tomography (CT) coronary angiography, and determine the value of 64-slice CT in non-invasive detecting of in-stent restenosis after coronary artery stent implantation. Totally, 60 patients (54 males, aged 57.0+/-12.7 years) and 105 stents were investigated by 64-slice CT at a mean interval of 20.0+/-16.6 months after coronary stents implantation. Axial multi-planar reconstruction images of the stents and curved-planar reconstruction images through the median of the stents were reconstructed for evaluating stent image quality on a 5-point scale (1=excellent, 5=non-assessable), and stent lumen diameter was detected. Conventional coronary angiography was performed in 18 patients, and 32 stents were evaluated. Image quality was good to excellent on average (score 1.71+/-0.76). Stent image quality score was correlated to heart rate (r=0.281, P<0.01) and stent diameter (r=-0.480, P<0.001). All the stents were assessable in lumen visibility with an average visible lumen diameter percentage of 60.7%+/-13.6%. Visible lumen diameter percentage was correlated to heart rate (r=-0.193, P<0.05), stent diameter (r=0.403, P<0.001), and stent image quality score (r=-0.500, P<0.001). Visible lumen diameter percentage also varied depending on the stent type. In comparison with the conventional coronary angiography, 4 of 6 in-stent stenoses were correctly detected. The sensitivity and specificity for the detection of in-stent stenosis were 66.7% and 84.6%, respectively. Using a 64-slice CT, the stent lumen is partly visible in most of the stents. And 64-slice CT may be useful in the assessment of stent patency.

  13. Randomized clinical trial comparing abluminal biodegradable polymer sirolimus-eluting stents with durable polymer sirolimus-eluting stents

    PubMed Central

    Zhang, Haijun; Wang, Xiangfei; Deng, Wei; Wang, Shenguo; Ge, Junbo; Toft, Egon

    2016-01-01

    Abstract Background: The biodegradable polymer drug-eluting stents (DES) were developed to improve vascular healing. However, further data and longer-term follow-up are needed to confirm safety and efficacy of these stents. This randomized clinical trial aimed to compare safety and efficacy of 2 sirolimus-eluting stents (SES): Cordimax—a novel abluminal biodegradable polymer SES and Cypher Select—a durable polymer SES, at 9 months angiographic and 5-year clinical follow-up. Methods: We randomized 402 patients with coronary artery disease to percutaneous coronary intervention with Cordimax (n = 202) or Cypher select (n = 200). Angiographic follow-up was performed at 9 months after the index procedure and clinical follow-up annually up to 5 years. The primary endpoint was angiographic in-stent late luminal loss (LLL). Secondary endpoints included angiographic restenosis rate, target vessel revascularization (TVR), and major adverse cardiac events (MACEs; defined as cardiac death, myocardial infarction, or TVR) at 5-year follow-up. Results: Cordimax was noninferior to Cypher select for in-stent LLL (0.25 ± 0.47 vs 0.18 ± 0.49 mm; P = 0.587) and in-stent mean diameter stenosis (22.19 ± 12.21% vs 19.89 ± 10.79%; P = 0.064) at 9 months angiographic follow-up. The MACE rates were not different at 1 year (5.9% vs 4.0%, P = 0.376); however, MACE rates from 2 to 5 years were lower in the Cordimax group (6.8% vs 13.1%; P = 0.039). Conclusion: Abluminal biodegradable polymer SES is noninferior to durable polymer SES at 9-month angiographic and 1-year clinical follow-up. However, MACE rates from 2 to 5 years were less in the abluminal biodegradable polymer group. PMID:27661023

  14. Primary stenting of occluded native coronary arteries: final results of the Primary Stenting of Occluded Native Coronary Arteries (PRISON) study.

    PubMed

    Rahel, Braim M; Suttorp, Maarten J; Laarman, Gert J; Kiemeneij, Ferdinand; Bal, Egbert T; Rensing, Benno J; Ernst, Sjef M P G; ten Berg, Jurriën M; Kelder, Johannes C; Plokker, H W Thijs

    2004-05-01

    Primary intracoronary stent placement after successfully crossing chronic total coronary occlusions may decrease the high restenosis rate at long-term follow-up compared with conventional balloon angioplasty. In a prospective, randomized trial, balloon angioplasty was compared with stent implantation for the treatment of chronic total occlusions. Patients were followed for 12 months with angiographic follow-up at 6 months. Quantitative coronary analysis was performed by an independent core lab. A total of 200 patients were enrolled. Baseline characteristics were evenly distributed. After the procedure the mean minimal luminal diameter in the conventional group was 2.34 +/- 0.46 mm versus 2.90 +/- 0.41 mm in the stented group (P <.0001). The 6-month angiographic follow-up showed a mean minimal luminal diameter of 1.57 +/- 0.74 mm in the conventional group versus 1.93 +/- 0.85 mm in the stented group (P =.009) and a mean diameter stenosis of 44.7% +/- 25.0% versus 35.5% +/- 26.5% (P =.036). Binary angiographic restenosis (>50% diameter stenosis) was seen in 33% in the conventional group versus 22% in the stented group (P =.137). The reocclusion rates were 7.3% and 8.2%, respectively (P = 1.00). At 12 month follow-up, the rate of target lesion revascularization was significantly higher in the conventional group (29% versus 13%, P <.0001). These data demonstrate that stenting of chronic total occlusions is superior to balloon angioplasty alone with a statistically significant reduction in the need for target lesion revascularization and a lower, but not significant, restenosis rate.

  15. Development of a dynamic in vitro model of a stented blood vessel to evaluate the effects of stent strut material selection and surface coating on smooth muscle cell response

    NASA Astrophysics Data System (ADS)

    Winn, Bradley Huegh

    Cardiovascular disease is the leading cause of mortality in The United States and Europe, accounting for approximately half of all deaths. The most common form of cardiovascular disease is atherosclerosis, which is characterized by the formation of fatty atheromatous plaques that can grow to occlude the vessel lumen, thus causing ischemia distal to the occlusion. This is commonly treated using balloon angioplasty, which is usually done in conjunction with the deployment of a stent. Stent deployment helps hold the vessel open following the local injury caused by balloon inflation and prevents elastic recoil and subsequent negative remodeling. Stenting has been shown to significantly reduce restenosis rates from approximately 20-50% without a stent to about 10-30% with stent deployment. However, restenosis still remains the main cause of long-term stent failure. In basic terms, a balloon angioplasty procedure is a forceful displacement of an atherosclerotic lesion serving to widen the vessel lumen to increase blood flow. This procedure causes stretching of the vessel wall, tears in the atherosclerotic plaques, and general damage to the vessel in turn signaling a complex cascade of thrombosis, inflammation, intimal thickening, and vascular remodeling. Stent deployment also further complicates the immunological response by triggering a foreign body response from the implantation of a biomaterial into the body. When performing an angioplasty procedure, particularly in conjunction with stent deployment, a certain degree of vascular injury is inevitable. However, the initial injury can be further complicated by the body's local reaction to the implanted biomaterial, the severity of which can ultimately dictate the degree of restenosis and subsequently affect procedural success. The proliferative response of VSMCs to the various afore mentioned stimuli results in the formation of often copious amounts of neointimal tissue, generally known as intimal hyperplasia. The

  16. Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: A prospective Japanese multicenter study

    PubMed Central

    Sasaki, Reina; Sakai, Yuji; Tsuyuguchi, Toshio; Nishikawa, Takao; Fujimoto, Tatsuya; Mikami, Shigeru; Sugiyama, Harutoshi; Yokosuka, Osamu

    2016-01-01

    AIM: To determine the safety and efficacy of endoscopic duodenal stent placement in patients with malignant gastric outlet obstruction. METHODS: This prospective, observational, multicenter study included 39 consecutive patients with malignant gastric outlet obstruction. All patients underwent endoscopic placement of a nitinol, uncovered, self-expandable metal stent. The primary outcome was clinical success at 2 wk after stent placement that was defined as improvement in the Gastric Outlet Obstruction Scoring System score relative to the baseline. RESULTS: Technical success was achieved in all duodenal stent procedures. Procedure-related complications occurred in 4 patients (10.3%) in the form of mild pneumonitis. No other morbidities or mortalities were observed. The clinical success rate was 92.3%. The mean survival period after stent placement was 103 d. The mean period of stent patency was 149 d and the patency remained acceptable for the survival period. Stent dysfunction occurred in 3 patients (7.7%) on account of tumor growth. CONCLUSION: Endoscopic management using duodenal stents for patients with incurable malignant gastric outlet obstruction is safe and improved patients’ quality of life. PMID:27076769

  17. Forgotten Reminders: an Experience with Managing 28 Forgotten Double-J Stents and Management of Related Complications.

    PubMed

    Sohrab, Arora; Aneesh, Srivastava; Sureka, Sanjoy Kumar; Varun, Mittal; Nitesh, Patidar; Manoj, Kumar; Rakesh, Kapoor

    2015-12-01

    Combinations of extracorporeal shockwave lithotripsy (ESWL) and endourological and open surgery have been used for management of forgotten double-J (DJ) stents; however, there are only a few case reports or case series in literature. We present our experience of managing 28 cases of forgotten ureteric stents of whom three patients died because of complications after intervention. We retrospectively reviewed the hospital records of 28 cases of forgotten DJ stents from 2000 to 2013. The details reviewed included indications for stent placement, indwelling time, presenting complaints, laboratory, radiographic, nuclear scan findings, management techniques, and complications. Extensive review of literature was done. Mean patient age was 37.7 ± 14 years. Mean indwelling time was 102.9 months. The commonest presenting complaints were irritative voiding symptoms and hematuria. Nineteen (67.8 %) of the stents were complicated. The complicated stents were managed by a combination of endourological techniques and ESWL. Six (21.5 %) patients presented with renal failure. Three patients died of complications. Forgotten DJ stent can be a lethal yet entirely preventable complication. Preoperative imaging with a noncontrast CT is essential especially in long indwelling time, especially to evaluate stone burden at the upper end of the stent. A stepwise approach should be used for management. Where long operative times are expected, the procedure must be staged. Combined endourological procedures are almost always successful in managing these challenging cases.

  18. Two Cases of Immediate Stent Fracture after Zotarolimus-Eluting Stent Implantation

    PubMed Central

    Lee, Pil Hyung; Lee, Seung-Whan; Lee, Jong-Young; Kim, Young-Hak; Lee, Cheol Whan; Park, Duk-Woo; Park, Seong-Wook

    2015-01-01

    Drug-eluting stent (DES) implantation is currently the standard treatment for various types of coronary artery disease. However, previous reports indicate that stent fractures, which usually occur after a period of time from the initial DES implantation, have increased during the DES era; stent fractures can contribute to unfavorable events such as in-stent restenosis and stent thrombosis. In our present report, we describe two cases of zotarolimus-eluting stent fracture: one that was detected six hours after implementation, and the other case that was detected immediately after deployment. Both anatomical and technical risk factors contributed to these unusual cases of immediate stent fracture. PMID:25653706

  19. Stent-in-stent through a side hole to prevent biliary metallicstent migration.

    PubMed

    Ridtitid, Wiriyaporn; Rerknimitr, Rungsun; Amornsawadwattana, Surachai; Ponauthai, Yuwadee; Kullavanijaya, Pinit

    2011-03-16

    The covered self-expandable metallic stent (SEMS) has been developed to overcome the problem of tissue in-growth, However, stent migration is a well-known com--plication of covered SEMS placement. Use of a double pigtail stent to lock the movement of the SEMS and prevent migration has been advised by many ex-perts. Unfortunately, in our case this technique led to an in-cidental upward migration of the SEMS. We used APC to create a side hole in the SEMS for plastic stent insertion as stent-in-stent. This led to a successful pre-ven-tion of stent migration.

  20. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention

    PubMed Central

    Kwon, Chang-Il; Lehman, Glen A.

    2016-01-01

    Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, we will discuss basic mechanisms of plastic stent occlusion, along with a systematic summary of previous efforts and related studies to improve stent patency and potential new techniques to overcome existing limitations. PMID:27000422

  1. Anatomic Results and Complications of Stent-Assisted Coil Embolization of Intracranial Aneurysms

    PubMed Central

    Kim, S.-R.; Vora, N.; Jovin, T.G.; Gupta, R.; Thomas, A.; Kassam, A.; Lee, K.; Gologorsky, Y.; Jankowitz, B.; Panapitiya, N.; Aleu, A.; Sandhu, E.; Crago, E.; Hricik, A.; Gallek, M.; Horowitz, M.B.

    2008-01-01

    Summary The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed. Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n=17, 13.4%) were the most common complications, followed by intraoperative rupture (n=8, 6.3%), coil herniation (n=5, 3.9%), and postoperative rupture (n=4, 3.1%). For thromboembolic events, acute intra-procedural in-stent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic follow-up at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found. Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage

  2. Surface Conditioning of Cardiovascular 316L Stainless Steel Stents: a Review

    NASA Astrophysics Data System (ADS)

    Navarro, Lucila; Luna, Julio; Rintoul, Ignacio

    2017-07-01

    Cardiovascular disease is the leading cause of death worldwide and 90% of coronary interventions consists in stenting procedures. Most of the implanted stents are made of AISI 316L stainless steel (SS). Excellent mechanical properties, biocompatibility, corrosion resistance, workability and statistically demonstrated medical efficiency are the reasons for the preference of 316L SS over any other material for stent manufacture. However, patients receiving 316L SS bare stents are reported with 15-20% of restenosis probability. The decrease of the restenosis probability is the driving force for a number of strategies for surface conditioning of 316L SS stents. This review reports the latest advances in coating, passivation and the generation of controlled topographies as strategies for increasing the corrosion resistance and reducing the ion release and restenosis probability on 316L SS stents. Undoubtedly, the future of technique is related to the elimination of interfaces with abrupt change of properties, the elimination of molecules and any other phase somehow linked to the metal substrate. And leaving the physical, chemical and topographical smart modification of the outer part of the 316L SS stent for enhancing the biocompatiblization with endothelial tissues.

  3. Use of Micropatterned Thin Film Nitinol in Carotid Stents to Augment Embolic Protection

    PubMed Central

    Shayan, Mahdis; Jankowitz, Brian T.; Shridhar, Puneeth; Chun, Youngjae

    2016-01-01

    Stenting is an alternative to endarterectomy for the treatment of carotid artery stenosis. However, stenting is associated with a higher risk of procedural stroke secondary to distal thromboembolism. Hybrid stents with a micromesh layer have been proposed to address this complication. We developed a micropatterned thin film nitinol (M-TFN) covered stent designed to prevent thromboembolism during carotid intervention. This innovation may obviate the need or work synergistically with embolic protection devices. The proposed double layered stent is low-profile, thromboresistant, and covered with a M-TFN that can be fabricated with fenestrations of varying geometries and sizes. The M-TFN was created in multiple geometries, dimensions, and porosities by sputter deposition. The efficiency of various M-TFN to capture embolic particles was evaluated in different atherosclerotic carotid stenotic conditions through in vitro tests. The covered stent prevented emboli dislodgement in the range of 70%–96% during 30 min duration tests. In vitro vascular cell growth study results showed that endothelial cell elongation, alignment and growth behaviour silhouettes significantly enhance, specifically on the diamond-shape M-TFN, with the dimensions of 145 µm × 20 µm and a porosity of 32%. Future studies will require in vivo testing. Our results demonstrate that M-TFN has a promising potential for carotid artery stenting. PMID:27983574

  4. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas.

    PubMed

    Pérez Roldán, F; González Carro, P; Villafáñez García, M C; Aoufi Rabih, S; Legaz Huidobro, M L; Sánchez-Manjavacas Múñoz, N; Roncero García-Escribano, O; Ynfante Ferrús, M; Bernardos Martín, E; Ruiz Carrillo, F

    2012-03-01

    Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present an additional option--biodegradable stents--for the treatment of colonic strictures and fistulas that have proven refractory to other endoscopic interventions. We analyzed the results from 10 patients with either a postsurgical colorectal stricture (n =7) or rectocutaneous fistula (n =3) treated with the biodegradable SX-ELLA esophageal stent (covered or uncovered). Stents were successfully placed in nine patients, although early migration subsequently occurred in one. Placement was impossible in one patient due to deformity of the area and the fact that the stricture was approximately 30cm from the anus. The fistulas were successfully closed in all patients, although symptoms reappeared in one patient. In the six patients who received stents for strictures, symptoms resolved in five; in the remaining patient, the stent migrated shortly after the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable stents is an effective alternative in the short-to-medium term. The stent does not have to be removed and is subject to very few complications. The drawbacks of this approach are the need to repeat the procedure in some patients and the lack of published series on efficacy.

  5. Mechanical properties and biocompatibility of plasma-nitrided laser-cut 316L cardiovascular stents.

    PubMed

    Arslan, Erdem; Iğdil, Mustafa C; Yazici, Hilal; Tamerler, Candan; Bermek, Hakan; Trabzon, Levent

    2008-05-01

    The effect of surface modification of laser-cut 316L cardiovascular stents by low-T plasma nitriding was evaluated in terms of mechanical properties and biocompatibility of the stents. The plasma nitriding was performed at 400, 450 or 500 degrees C using various ratios of nitrogen-hydrogen gas mixtures. The flexibility and radial strength were measured in crimped and expanded state of the stents, respectively. The mechanical properties could be adjusted and improved by plasma nitriding conducted at temperatures lower than 450 degrees C and/or nitrogen content less than 10% in the treatment gas. An osteoblast cell culture model system was utilized to investigate the effect of plasma nitriding of the stents on the biological response towards the stents, using biological criteria such as cell viability, alkaline phosphatase and nitric oxide production. In terms of cell viability and alkaline phosphatase production, the plasma nitriding procedure did not appear to negatively affect the biocompatibility of the 316L steel stents. However, in terms of nitric oxide production that was slightly increased in the presence of the plasma-nitrided stents, an indirect improvement in the biocompatibility could possibly be expected.

  6. Heating stents with radio frequency energy to prevent tumor ingrowth: modeling and experimental results

    NASA Astrophysics Data System (ADS)

    Ryan, Thomas P.; Lawes, Kate; Goldberg, S. Nahum

    1998-04-01

    Stents are often inserted into internal orifices to treat blockage due to tumor ingrowth. Stents are favored due to their minimally invasive nature, possible avoidance of a surgical procedure, and their ability to palliate surgically non-resectable disease. Because of rapid tumor growth however, a treatment means to prevent overgrowth through the stent and resultant blockage is required. To further this goal, experiments were performed in which a stent was placed in tissue and heated with radiofrequency (RF) energy to coagulate a cylinder of tissue, thereby eradicating viable tissue in the proximity of the stent. Temperatures were measured at the central stent surface and edges over time during a 5 - 10 minute heating in phantom and in fresh tissue. In addition, a finite element model was used to simulate the electric field and temperature distribution. Blood flow was also introduced in the model by evaluating RF application to stents to determine effectiveness of the energy applications. Changing perfusion and tissue electrical conductivity as a function of temperature was applied as the tissue was heated to 100 degree(s)C. Results from the electric field model will be shown as well as the thermal distribution over time from the simulations. Lastly, results from the damage integral will be discussed.

  7. [Possibilities of endoscopic stenting in the treatment of gastrointestinal and biliary system diseases].

    PubMed

    Sarian, I V; Solovĭov, V V

    2011-06-01

    The efficacy of endoscopic treatment of patients for stenosis and stricture of the gut organs and biliary ducts, using stents, was analyzed. In 48 patients, suffering tumoral and inflammatory diseases of the gut, biliary ducts and respiratory ways, selfexpanding metal stents, produced by firm Sooho M.I.-Tech. Co, Diagmed (Southern Korea), were introduced to reduce the severity of dysphagia, jaundice and the intestinal passability restoration. This had promoted the passability disorders elimination and the organs wall integrity restoration. In 16.6% of patients the immediate postinterventional period was complicated by occurrence of a short-term pain syndrome. In 6.2% of patients in 5-6 months the additional stenting intervention "stent into the stent" was performed for the stent restenosing. In 7-8 months the recurrent dysphagia have had occurred in 4.2% of patients. Endoscopic treatment of stenosis and stricture of the gut organs and biliary ducts, using self-expanding metal stents, is an effective, safe and secure procedure.

  8. Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy.

    PubMed

    Keswani, Rajesh N; Azar, Riad R; Edmundowicz, Steven A; Zhang, Qin; Ammar, Tarek; Banerjee, Bhaskar; Early, Dayna S; Jonnalagadda, Sreenivasa S

    2009-03-01

    Self-expandable metal stent placement for palliation of malignant colonic obstruction for colorectal cancer (CRC) is safe and efficacious. In contrast, outcomes of stent placement for extracolonic malignancy (ECM) are unclear. To compare the success and complication rates of colorectal stenting in patients with CRC versus those with ECM. Retrospective chart review. Tertiary-care academic medical center. Between September 2000 and December 2007, all patients with malignant colon obstruction in whom endoscopy was performed with the intention of placing a colonic metal stent. Technical and clinical success rates, surgical interventions, and procedure-related complications. Colonic stenting was performed for CRC in 34 patients and for ECM in 15 patients. Patients with CRC were more likely to have clinical success after all endoscopic therapy (94.1%) than those with ECM (20.0%) (P < .0001). Surgical diversion to relieve persistent obstructive symptoms was required in significantly more patients with ECM. Five patients with ECM (33.3%) had at least one complication, including 2 deaths, compared with 3 patients with CRC (8.8%) (P = .046). Only underlying ECM was predictive of failed colon stent placement by multivariate analysis (hazard ratio 21.0, P = .0013). A history of radiation therapy was the sole predictor of complications (hazard ratio 7.8, P = .048). Single institution, retrospective analysis, relatively small sample size. Colon stenting for large-bowel obstruction from ECM is infrequently successful and is associated with a significantly higher risk of complications in comparison with patients with CRC.

  9. Evolution of covered stents in the contemporary era: clinical application, materials and manufacturing strategies using nanotechnology.

    PubMed

    Farhatnia, Yasmin; Tan, Aaron; Motiwala, Aamir; Cousins, Brian G; Seifalian, Alexander M

    2013-01-01

    Endovascular stents have revolutionised the field of interventional cardiology. Despite their excellent clinical outcome complications associated with percutaneous stent implantation following the procedure have remained a major drawback in their widespread use. To overcome such limitations, a number of novel endovascular stents have emerged including a covered stent wrapped in a thin membrane sleeve. As well as prevention of complications associated with stenting, covered stents owing to their physical barrier are used as the treatment option of choice for trauma devices during emergency situations and to treat a number of pathological disease states. The aim of this review is to provide the reader with an overall objective outlook in the use of covered stents as a treatment option in a number of vascular complications and addresses their design and materials used in the manufacturing process. In addition, new strategies are highlighted and future prospects with the emergence of novel smart alloys for 3D scaffolds and the use of nanotechnology in the development of nanocomposite materials.

  10. Shortening and Migration of Wallstents after Stenting of Central Venous Stenoses in Hemodialysis Patients

    SciTech Connect

    Verstandig, Anthony G.; Bloom, Allan I.; Sasson, Talia; Haviv, Y.S.; Rubinger, D.

    2003-02-15

    Purpose: To report our results for the placement of central venous stents in patients undergoing hemodialysis. Methods: Ten Wallstents (Schneider,Buelach, Switzerland) were placed in 10 patients with shunt thrombosis, shunt dysfunction or arm swelling associated with central vein stenosis or occlusion. Technical success, patency and complications were evaluated. Results: Stent deployment was successful in all cases. In seven cases (70%) there was significant delayed stent shortening. In two of these cases there was also stent migration. All these cases required additional stents.Primary patency rates at 6, 12 and 24 months were 66%, 25% and 0.Twenty-three additional procedures (percutaneous transluminal angioplasty or stenting) were required to achieve secondary patency rates at 6, 12 and 24 months of 100%, 75% and 57%. Conclusion: Stent placement in the central veins of dialysis patients has a high technical success rate resulting in symptomatic relief and preservation of access. Repeat interventions are required to maintain patency. Significant delayed shortening of the Wallstent occurred in 70% of patients which may have affected the patency rates.Strategies are suggested to avoid this problem.

  11. Image-based analysis of blood flow modification in stented aneurysms

    NASA Astrophysics Data System (ADS)

    Cebral, Juan; Mut, Fernando; Appanaboyina, Sunil; Löhner, Rainald; Miranda, Carlos; Escrivano, Esteban; Lylyk, Pedro; Putman, Christopher

    2009-02-01

    Currently there is increased interest in the use of stents as flow diverters for the treatment of intracranial aneurysms, especially wide necked aneurysms that are difficult to treat by coil embolization or surgical clipping. This paper presents image-based patient-specific computational models of the hemodynamics in cerebral aneurysms before and after treatment with a stent alone, with the goal of better understanding the hemodynamic effects of these devices and their relation to the outcome of the procedures. Stenting of cerebral aneurysms is a feasible endovascular treatment option for aneurysms with wide necks that are difficult to treat with coils or by surgical clipping. However, this requires stents that are capable of substantially modifying the intra-aneurysmal flow pattern in order to cause thrombosis of the aneurysm. The results presented in this paper show that the studied stent was able to change significantly the hemodynamic characteristics of the aneurysm. In addition, it was shown that patient-specific computational models constructed from medical images are capable of realistically representing the in vivo hemodynamic characteristics observed during conventional angiography examinations before and after stenting. This indicates that these models can be used to better understand the effects of different stent designs and to predict the alteration in the hemodynamic pattern of a given aneurysm produced by a given flow diverter. This is important for improving current design of flow diverting devices and patient treatment plans.

  12. Safety and efficacy of self-expandable metallic stents in malignant small bowel obstructions

    PubMed Central

    Tsuboi, Akiyoshi; Kuwai, Toshio; Nishimura, Tomoyuki; Iio, Sumio; Mori, Takeshi; Imagawa, Hiroki; Yamaguchi, Toshiki; Yamaguchi, Atsushi; Kouno, Hirotaka; Kohno, Hiroshi

    2016-01-01

    In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent (SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time (stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction. PMID:27833393

  13. The Development of Carotid Stent Material

    PubMed Central

    He, Dongsheng; Liu, Wenhua; Zhang, Tao

    2015-01-01

    Endovascular angioplasty with stenting is a promising option for treating carotid artery stenosis. There exist a rapidly increasing number of different stent types with different materials. The bare-metal stent is the most commonly used stent with acceptable results, but it leaves us with the problems of thrombosis and restenosis. The drug-eluting stent is a breakthrough as it has the ability to reduce the restenosis rate, but the problem of late thrombosis still has to be addressed. The biodegradable stent disappears after having served its function. However, restenosis and degradation rates remain to be studied. In this article, we review every stent material with its characteristics, clinical results and complications and point out the standards of an ideal carotid stent. PMID:26019710

  14. Cocaine-induced very late stent thrombosis.

    PubMed

    Shah, Priyank; Vasudev, Rahul; Abuarqoub, Ahmad Hisham; Shamoon, Fayez

    2016-10-12

    Cocaine misuse is a known cause of acute coronary syndrome (ACS). Management of these patients has always been a challenge due to medication compliance and eventual risk of stent thrombosis. However, even cocaine misusers who are compliant with dual antiplatelet therapy have been reported to have stent thrombosis. All cases of cocaine-induced stent thrombosis reported in the literature have occurred within first year of stent placement (acute, subacute or late). We report a first case of very late stent thrombosis in a 54-year-old active cocaine misuser who presented with ST segment elevation myocardial infarction, which was successfully managed with percutaneous transluminal coronary angioplasty. A review of all the reported cases of cocaine-induced stent thrombosis is also discussed. Given the high mortality associated with stent thrombosis, treatment option for cocaine misusers presenting with ACS should be conservative when possible. If percutaneous coronary intervention is needed, bare metal stent should be preferred.

  15. Ureteric stents: investigating flow and encrustation.

    PubMed

    Waters, S L; Heaton, K; Siggers, J H; Bayston, R; Bishop, M; Cummings, L J; Grant, D M; Oliver, J M; Wattis, J A D

    2008-05-01

    Blockages of the ureter, e.g. due to calculi (kidney stones), can result in an increase in renal pelvic pressure. This may be relieved by inserting a stent (essentially a permeable hollow tube). However, a number of complications are associated with stent use. Stents can result in reflux (backflow of urine along the ureter), which will promote recurrent urinary infection and possible renal parenchymal damage. Furthermore, long-term stent use is associated with infection and precipitation of salts from the urine, which can lead to a build-up of crystalline deposits on the stent surface, making stent removal difficult and painful. This paper examines factors governing urine flow in a stented ureter, the implications for reflux, and the processes by which the stent surface encrusts, in particular focusing on the influence of bacterial infection. An interdisciplinary approach is adopted, involving a combination of theoretical investigations and novel experiments.

  16. Management for Prostate Cancer Treatment Related Posterior Urethral and Bladder Neck Stenosis With Stents

    PubMed Central

    Erickson, Bradley A.; McAninch, Jack W.; Eisenberg, Michael L.; Washington, Samuel L.; Breyer, Benjamin N.

    2013-01-01

    Purpose Prostate cancer treatment has the potential to lead to posterior urethral stricture. These strictures are sometimes recalcitrant to dilation and urethrotomy alone. We present our experience with the Urolume® stent for prostate cancer treatment related stricture. Materials and Methods A total of 38 men with posterior urethral stricture secondary to prostate cancer treatment were treated with Urolume stenting. Stents were placed in all men after aggressive urethrotomy over the entire stricture. A successfully managed stricture was defined as open and stable for greater than 6 months after any necessary secondary procedures. Results The initial success rate was 47%. After a total of 31 secondary procedures in 19 men, including additional stent placement in 8 (18%), the final success rate was 89% at a mean ± SD followup of 2.3 ± 2.5 years. Four cases (11%) in which treatment failed ultimately requiring urinary diversion (3) or salvage prostatectomy (1). Incontinence was noted in 30 men (82%), of whom 19 (63%) received an artificial urinary sphincter a mean of 7.2 ± 2.4 months after the stent. Subanalysis revealed that irradiated men had longer strictures (3.6 vs 2.0 cm, p = 0.003) and a higher post-stent incontinence rate (96% vs 50%, p <0.001) than men who underwent prostatectomy alone but the initial failure rate was similar (54% vs 50%, p = 0.4). Conclusions Urolume stenting is a reasonable option for severe post-prostate cancer treatment stricture when patients are unwilling or unable to undergo open reconstructive surgery. Incontinence should be expected. The need for additional procedures is common and in some men may be required periodically for the lifetime of the stent. PMID:21074796

  17. Organ transplantation and drug eluting stents: Perioperative challenges

    PubMed Central

    Dalal, Aparna

    2016-01-01

    Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyNow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs

  18. Acute and long-term outcome after Palmaz-Schatz stenting: analysis from the New Approaches to Coronary Intervention (NACI) registry.

    PubMed

    Carrozza, J P; Schatz, R A; George, C J; Leon, M B; King, S B; Hirshfeld, J W; Curry, R C; Ivanhoe, R J; Buchbinder, M; Cleman, M W; Goldberg, S; Ricci, D; Popma, J J; Safian, R D; Baim, D S

    1997-11-20

    The randomized Stent Restenosis Study (STRESS) and Belgium Netherlands Stent (Benestent) trials established that elective use of Palmaz-Schatz stents (PSSs) in native coronary arteries with de novo lesions is associated with increased procedural success and reduced restenosis. However there are other clinical indications for which stents are commonly used (unplanned use, vein grafts, restenosis lesions) that are not addressed in these studies. From 1990-1992, 688 lesions in 628 patients were treated with PSSs in the New Approaches to Coronary Intervention (NACI) registry. Angiographic core laboratory readings were available for 543 patients (595 lesions, of which 106 were stented for unplanned indications, 239 were in saphenous vein bypass grafts, and 296 were previously treated). The cohort of patients in whom stents were placed for unplanned indications had more women, current smokers, and had a higher incidence of recent myocardial infarction (MI). Patients who underwent stenting of saphenous vein grafts were older, had a higher incidence of diabetes mellitus, unstable angina, prior MI, and congestive heart failure. Lesion success was similar in all cohorts (98%), but procedural success was significantly higher for planned stenting (96% vs 87%; p < 0.01). Predictors of adverse events in-hospital were presence of a significant left main stenosis and stenting for unplanned indication. The incidence of target lesion revascularization by 30 days was significantly higher for patients undergoing unplanned stenting due to a higher risk for stent thrombosis. Recent MI, stenting in native lesion, and small postprocedural minimum lumen diameter independently predicted target lesion revascularization at 30 days. Independent predictors of death, Q-wave myocardial infarction, or target lesion revascularization at 1 year included severe concomitant disease, high risk for surgery, left main disease, stenting in the left main coronary artery, and low postprocedure minimum lumen

  19. Impact of Clinical Trial Results on the Temporal Trends of Carotid Endarterectomy and Stenting From 2002 to 2014

    PubMed Central

    Hussain, Mohamad A.; Mamdani, Muhammad; Tu, Jack V.; Saposnik, Gustavo; Khoushhal, Zeyad; Aljabri, Badr; Verma, Subdoh

    2016-01-01

    Background and Purpose— Randomized trials provide conflicting data for the efficacy of carotid-artery stenting compared with endarterectomy. The purpose of this study was to examine the impact of conflicting clinical trial publications on the utilization rates of carotid revascularization procedures. Methods— We conducted a population-level time-series analysis of all individuals who underwent carotid endarterectomy and stenting in Ontario, Canada (2002–2014). The primary analysis examined temporal changes in the rates of carotid revascularization procedures after publications of major randomized trials. Secondary analyses examined changes in overall and age, sex, carotid-artery symptom, and operator specialty–specific procedure rates. Results— A total of 16 772 patients were studied (14 394 endarterectomy [86%]; 2378 stenting [14%]). The overall rate of carotid revascularization decreased from 6.0 procedures per 100 000 individuals ≥40 years old in April 2002 to 4.3 procedures in the first quarter of 2014 (29% decrease; P<0.001). The rate of endarterectomy decreased by 36% (P<0.001), whereas the rate of carotid-artery stenting increased by 72% (P=0.006). We observed a marked increase (P=0.01) in stenting after publication of the SAPPHIRE trial (Stenting and Angioplasty With Protection in Patients at High Risk for Endarterectomy) in 2004, whereas stenting remained relatively unchanged after subsequent randomized trials published in 2006 (P=0.11) and 2010 (P=0.34). In contrast, endarterectomy decreased after trials published in 2006 (P=0.04) and 2010 (P=0.005). Conclusions— Although the overall rates of carotid revascularization and endarterectomy have fallen since 2002, the rate of carotid-artery stenting has risen since the publication of stenting-favorable SAPPHIRE trial. Subsequent conflicting randomized trials were associated with a decreasing rate of carotid endarterectomy. PMID:27834754

  20. Outcome of intracranial arterial stenting of symptomatic atherosclerotic disease: A single center experience from Saudi Arabia

    PubMed Central

    Said, Youssef Al; Kurdi, Khalil; Baeesa, Saleh S.; Najjar, Ahmed; Almekhlafi, Mohammed; Hassan, Ahmed

    2016-01-01

    Objectives: To present our local experience with intracranial angioplasty and stenting used for the treatment of symptomatic intracranial stenosis to assess its safety, efficacy, and outcome. Methods: This is a retrospective review of all the patients with symptomatic intracranial atherosclerotic disease who underwent endovascular treatment in King Faisal Specialist Hospital and research center, Jeddah, Kingdom of Saudi Arabia from January 2003 to December 2014. Clinical, procedural, and outcome variables were gathered. Results: We identified 22 patients who were referred for stenting of symptomatic intracranial atherosclerotic stenosis. In all but 3, the stents were deployed successfully (86% procedural success rate). The procedure was carried out under conscious sedation in 32%. Excellent flow was restored immediately in all successfully-stented cases. Post procedural strokes occurred in 4 patients (17.4%). One non-neurological death was identified in a patient who suffered a major post procedural stroke (4.3%). Conclusion: Intracranial atherosclerotic disease is not uncommon in our population. Angioplasty and stenting might be a valid option for the treatment of patients with recurrent symptoms despite optimal medical treatment. PMID:27744470

  1. Is routine ureteral stenting really necessary after retrograde intrarenal surgery?

    PubMed

    Ozyuvali, Ekrem; Resorlu, Berkan; Oguz, Ural; Yildiz, Yildiray; Sahin, Tolga; Senocak, Cagri; Bozkurt, Omer Faruk; Damar, Erman; Yildirim, Murat; Unsal, Ali

    2015-03-31

    To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double- J stent after RIRS constituted Group 2. Patients' age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time.