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Sample records for angioplastia con stent

  1. ANGIOPLASTIA PERCUTÁNEA CON STENT EN EL TRONCO PRINCIPAL DE LA ARTERIA CORONARIA IZQUIERDA / Percutaneous angioplasty with stent in the left main coronary artery

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    Javier Almeida Gómez

    2012-10-01

    Full Text Available ResumenIntroducción y objetivos: La afectación significativa del tronco común izquierdo, es la más letal de las presentaciones de la enfermedad arterial coronaria. El tratamiento de elección, es la cirugía de derivación aorto-coronaria. En varios estudios multicéntricos, se sugiere la posibilidad de tratar la enfermedad de tronco mediante el intervencionismo coronario percutáneo con implantación de prótesis endoluminal o stent. El objetivo de esta investigación fue caracterizar la angioplastia percutánea con stent en el tronco principal de la arteria coronaria izquierda. Método: Se realizó un estudio observacional, descriptivo y transversal en 21 pacientes con angioplastia percutánea con stent en el tronco principal de la arteria coronaria izquierda, realizadas en el laboratorio de Hemodinámica y Cardiología Intervencionista del Hospital "Hermanos Ameijeiras", entre enero 2010 y julio 2011. Resultados: No existió diferencia significativa en el sexo. Predominó el grupo de edad entre 50-64 años (47,6 % y el color de la piel blanca (76,19 %. El factor de riesgo cardiovascular más encontrado fue la HTA (85,71 %, seguido de dislipidemia (47,61 %. El diagnóstico más observado fue la angina de esfuerzo estable, 14 casos (66,66 %. La lesión en el cuerpo del tronco (12 pacientes, 57,1 %, fue la más encontrada, seguida de la ostial (8 casos. El tipo de stent más utilizado fue el liberador de fármacos (61,9 %, y solamente 4 pacientes presentaban troncos protegidos quirúrgicamente. Conclusiones: La mayor cantidad de casos fueron electivos, con predominio de los troncos no protegidos. El factor de riesgo coronario más encontrado fue la HTA. Se encontró asociación significativa entre la diabetes mellitus y la localización ostial de la lesión tratada. / AbstractIntroduction and Objectives: Significant impairment of the left main coronary artery is the most lethal presentation of coronary artery disease. The treatment of choice

  2. Efecto de los fármacos utilizados tras angioplastia coronaria con stent

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    Rigla Cros, Joan

    2003-01-01

    Objetivos: A pesar de las mejoras en los resultados y en la técnica de los procedimientos de revascularización percutánea coronaria, existen pocos estudios que validen los resultados clínicos de la aplicación de los nuevos diseños de stents, las características de la lesión y los fármacos empleados. En nuestro estudio, los objetivos principales son los siguientes: 1. Evaluar los resultados del stent estudiado (NIR). Confirmar la influencia de los factores de riesgo coronario sobre la evoluci...

  3. Angioplastia del tronco de la arteria coronaria izquierda no protegido en pacientes con alto riesgo quirúrgico

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    Victor Mauro

    2008-01-01

    Full Text Available IntroducciónEl tratamiento de elección de la enfermedad del tronco de la coronaria izquierda (TCI es la cirugía de revascularización miocárdica (CRM. Un número creciente de pacientes presenta comorbilidades y/o inestabilidad clínica que condicionan un alto riesgo quirúrgico.ObjetivosEvaluar los resultados de la angioplastia (ATC del TCI no protegido en pacientes con alto riesgo para CRM (EUROSCORE = 6.Material y métodosDe 59 pacientes con ATC de TCI no protegido se excluyeron 8 con infarto agudo de miocardio (IAM en shock cardiogénico y 12 sin características de alto riesgo; de los restantes pacientes de alto riesgo fueron objeto de este estudio los 32 tratados con stents convencionales.Se comparó la mortalidad hospitalaria predicha por EUROSCORE logístico con la observada, así como la incidencia de complicaciones mayores y su evolución alejada.ResultadosLa mediana de edad fue de 76,5 años, el 41% tenía 80 años o más, el 22% eran mujeres, el 28% diabéticos, el 56% tenía disfunción ventricular moderada a grave, el 31% insuficiencia renal crónica, el 50% vasculopatía periférica, el 53% angina refractaria, el 22% IAM reciente, el 28% procedimientos de emergencia y la mediana de EUROSCORE fue de 10,5 puntos.El 41% de los pacientes presentaban compromiso del TCI distal. El éxito angiográfico fue del 94%. Se utilizaron inhibidores IIb/IIIa en el 47%, cutting balloon en el 28%, Rotablator® en el 3% y balón de contrapulsación en el 31%. En todos se implantó un stent y en el 50% se trataron otras obstrucciones.La mortalidad hospitalaria fue del 3,1% (intervalo de confianza del 95% 0,2%-14,5%, p = 0,003, en tanto que la predicha era del 23,8%. Ningún paciente presentó déficit neurológico, IAM transmural ni requirió diálisis. Un paciente debió ser sometido a CRM electiva por fracaso del procedimiento.La mediana de seguimiento fue de 15,5 meses, período en el que se registraron 6 muertes (2 cardiovasculares y 4

  4. Angioplastia coronaria en centros con residencia de cardiología en la Argentina. Estudio CONAREC XIV - Área de Investigación de la SAC

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    Bruno Linetzky

    2007-01-01

    Full Text Available IntroducciónLos nuevos tratamientos médicos y los avances técnicos, junto con la mayor experiencia adquirida en cardiología intervencionista, hicieron necesaria la realización de este nuevo registro, el protocolo CONAREC XIV, sobre empleo de angioplastia coronaria (ATC, un procedimiento que es seguro y eficaz para el tratamiento de la enfermedad coronaria.ObjetivoEvaluar las características de los pacientes, las indicaciones y los resultados de la ATC en nuestro país.Material y métodosSe realizó un registro prospectivo y consecutivo durante 6 meses de pacientes tratados con ATC en centros con residencia de cardiología. Se determinaron antecedentes, cuadro clínico de ingreso, tratamiento, resultados y complicaciones intrahospitalarias.ResultadosSe registraron 1.500 pacientes. La edad promedio fue de 62,8 ± 10,8 años y el 78,3% eran hombres. Antecedentes: 72% hipertensión arterial, 56,6% dislipidemia, 19,2% diabetes y 22,4% tabaquismo. Los cuadros clínicos de presentación fueron: 20% asintomáticos, 16,2% angina crónica estable, 45% síndrome coronario agudo sin supradesnivel del ST (SCA-SST, 19% síndrome coronario agudo con supradesnivel del ST (IAM-ST. En el 74,7% de los casos se realizó ATC de un vaso. Se utilizaron stents en el 94,5% de los casos y en el 18,7%, stents liberadores de drogas. El uso de pruebas funcionales previas a la ATC en cuadros estables fue del 53,9%, mientras que en el SCA-SST fue del 31,6%. La mediana de tiempo de evolución hasta la ATC en el SCA-SST fue de 1 día con un rango intercuartil 25-75% (RIC de 0 a 3. En el IAM-ST, el tiempo puerta-balón fue de 60 minutos (RIC 40-105 y la mortalidad fue del 8%.ConclusionesLa ATC se utiliza principalmente para el tratamiento de síndromes coronarios agudos. Se evidenció una tasa alta de uso de stents y de stents liberadores de drogas. El empleo de pruebas funcionales fue bajo. La tasa de complicaciones fue similar a la de los registros internacionales.

  5. Utilização da técnica do varal para angioplastia de estenose de veia central com stent-graft Utilization of the through-and-through technique for central vein angioplasty using stent-graft

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    Ricardo Wagner da Costa Moreira

    2012-09-01

    Full Text Available A estenose de veia central é uma das situações mais frequentes em pacientes com insuficiência renal crônica em hemodiálise. A angioplastia com o uso de stent-graft tem obtido bons resultados nestes casos. O sistema de liberação dos stents é de calibre maior, podendo dificultar sua navegabilidade em áreas de estenose ou tortuosidade acentuadas. A técnica do varal é comumente utilizada para o tratamento endovascular do aneurisma de aorta, permitindo atingir bom mecanismo de estiramento e facilitando a navegação do sistema de entrega da endoprótese. Descrevemos o caso de uma angioplastia de veia central com stent-graft na qual foi utilizada a técnica do varal para permitir a transposição da área de estenose.The central vein stenosis is one of the most common conditions in patients with chronic kidney failure in a hemodialysis program. In these cases, angioplasty using stent-grafts has obtained good results. The stent-graft delivery system is generally of large diameter what can hinder its navigability in very severe stenosis or tortuosities. The through-and-through technique is commonly used for endovascular treatment of aortic aneurysms, making possible to achieve a good mechanism of stretch and easy navigation of the endograft delivery system. We report a case of a central venous stenosis in wich a stent-graft was inserted using the through-and-through technique in order to cross the lesion.

  6. Demoras en la realización de la angioplastia primaria en los pacientes trasladados con infarto agudo de miocardio: un problema médico-asistencial

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    Rodrigo Blanco

    2009-01-01

    Full Text Available IntroducciónEn el infarto agudo de miocardio (IAM está comprobado que cuanto más tempranamente se realice la reperfusión, mejores serán sus resultados a corto y a largo plazos, por lo que el tiempo entre el inicio de los síntomas y la reperfusión coronaria es un elemento de gran importancia en la estrategia de su tratamiento. Este lapso se encuentra conformado por dos períodos: “tiempo paciente” y “tiempo médico-asistencial”. En la angioplastia primaria, el análisis de estos tiempos y sus intervalos es el paso obligado para lograr una reducción de la demora a la reperfusión.ObjetivosAnalizar los tiempos en cada etapa del proceso traslado-realización de una angioplastia, ya sea primaria o de rescate, en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMEST que debieron ser trasladados desde un hospital derivador a un centro de referencia en el ámbito de la ciudad de Buenos Aires para someterse al procedimiento, como primer paso para un programa de optimización de los tiempos.Material y métodosEstudio prospectivo, observacional, de pacientes derivados al Hospital General de Agudos “Dr. Cosme Argerich” con diagnóstico de IAMEST e indicación de ATC. Se analizaron los tiempos parciales desde el inicio de los síntomas hasta la reperfusión coronaria, para lo cual se consideró “tiempo paciente” desde el inicio de los síntomas hasta la llegada al hospital derivador y “tiempo médico-asistencial” al comprendido entre la llegada al hospital derivador y la insuflación del balón.ResultadosSe incluyeron 313 pacientes, 225 (72% con angioplastia primaria (ATCP y 88 (28% con angioplastia de rescate (ATCR. Las medianas (cuartiles de tiempo en ATCP fueron: tiempo paciente: 90’ (40-240, llegada al hospital derivador-llamada al Equipo de Hemodinamia Cardiovascular de Urgencia (EHCU: 80’ (35-150, llamada EHCU-ingreso hemodinamia: 75’ (55-100, ingreso hemodinamia-balón: 35’ (23-52, tiempo m

  7. Análise morfométrica da carótida de suínos submetidos a angioplastia com ou sem implante de stent de cromo-cobalto Morphometric analysis of swine carotid artery angioplasty with or without cobalt-chromium stent implantation

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    João Luiz de Lara Elesbão

    2010-06-01

    Full Text Available Contexto: A hiperplasia intimal é a reação tardia mais comum decorrente da angioplastia. O uso de stents de cromo-cobalto é bem estudado na circulação coronariana, porém não há muitos estudos que abordem o uso desses stents nas circulações carotídea e periférica. Objetivo: Analisar mediante morfometria a reação intimal presente na artéria carótida de suínos submetidos a angioplastia isoladamente e a angioplastia seguida de implante de stent de cromo-cobalto. Materiais e métodos: Em oito suínos, foi realizada angioplastia da artéria carótida comum direita e angioplastia seguida de implante de um stent de cromo-cobalto na artéria carótida comum esquerda. Após 4 semanas, os animais foram submetidos a eutanásia para a retirada de amostras de tecido arterial e preparo de lâminas histológicas. As imagens das lâminas foram digitalizadas e analisadas por programa de morfometria digital. A análise estatística foi realizada através da média e desvio padrão das áreas em cada grupo, utilizando-se o Teste t de Student. O valor de p Background: Intimal hyperplasia is the most common delayed response to angioplasty. The use of cobalt-chromium stents is well studied in the coronary circulation; however, there are few studies on their use in the carotid and peripheral circulation. Objective: To analyze the intimal reaction in a swine carotid artery undergoing simple angioplasty and angioplasty followed by implantation of cobalt-chromium stent. Materials and methods: We carried out angioplasty in the right common carotid artery and angioplasty with cobalt-chromium stent in the left common carotid artery in eight swine. Four weeks later, all animals were sacrificed for arterial tissue sampling and preparation of histological slides. Slide images were scanned and analyzed using a digital morphometry program. Statistical analysis was performed by mean values and standard deviations of the areas in each group, using the Student's t

  8. EVOLUCIÓN CLÍNICA DE PACIENTES CON INFARTO AGUDO DE MIOCARDIO TRATADOS CON ANGIOPLASTIA PRIMARIA / Clinical evolution of patients with acute myocardial infarction treated with primary angioplasty

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    Ernesto del Pino Sánchez

    2012-07-01

    Full Text Available ResumenIntroducción y objetivos: La angioplastia primaria restablece de manera rápida y mantenida la permeabilidad de la arteria coronaria responsable del infarto agudo de miocardio, disminuye significativamente la mortalidad, y mejora el pronóstico y la calidad de vida a largo plazo. El objetivo fue describir la evolución clínica de los pacientes con infarto agudo de miocardio tratados con angioplastia primaria. Método: Estudio descriptivo, longitudinal y prospectivo con 69 pacientes, recepcionados de 8:00 am a 4:00 pm, tratados con angioplastia primaria en el Instituto de Cardiología y Cirugía Cardiovascular, desde el 1 de julio de 2007 hasta el 31 de diciembre de 2008. Se realizó seguimiento clínico durante 180 días, donde se evaluó la frecuencia de sucesos clínicos mayores: muerte, reinfarto, angina postinfarto e inestable, necesidad de nueva revascularización y hemorragia mayor. Resultados: El tabaquismo y la hipertensión arterial tuvieron una prevalencia elevada. La localización inferior del infarto y la enfermedad de un vaso fueron las más frecuentes. Prevaleció el resultado inmediato exitoso. Los casos fallidos se relacionaron, con la coronaria derecha, el flujo TIMI 0 - 1 y el tiempo de evolución mayor de seis horas. Los sucesos clínicos mayores en el seguimiento fueron escasos y más frecuentes durante los primeros 30 días de seguimiento. Conclusiones: La angioplastia primaria realizada durante las primeras seis horas después del comienzo de los síntomas, es un procedimiento eficaz para tratar el infarto agudo de miocardio, debido al predominio del resultado exitoso y la escasa frecuencia de sucesos clínicos mayores durante seis meses de seguimiento clínico. / AbstractIntroduction and Objectives: Primary coronary angioplasty reestablishes fast and sustained way the permeability of acute myocardial infarction related artery. It decreases the mortality, improves the prognosis and quality of life to long-term. The

  9. Stent intracoronario. Intracoronary stent.

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    Lorenzo D. Llerena Rojas; Luis Roberto Llerena Rojas

    2000-01-01

    Diez años después de introducida la angioplastia coronaria por vía transluminal percutánea (ACTP), fue implantada la primera prótesis metálica intracoronaria en el hombre con lo que se redujeron 2 de los inconvenientes de la ACTP: la oclusión súbita del vaso recién dilatado y la reestenosis que aparece en los 6 meses que siguen a una ACTP exitosa y que se presenta aproximadamente en el 30 % de los pacientes. El uso del stent se ha difundido rápidamente en el mundo incluyendo nuestro país dond...

  10. Estudio comparativo en pacientes con implante de stent liberador de droga y stent convencional. Resultados clínicos e indicaciones

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    Mariano Albertal; Fernando Cura; Lucio Padilla; Pablo Pérez Baliño; Alfonsina Candiello; Belardi, Jorge A.

    2006-01-01

    Antecedentes Estudios aleatorizados demostraron la superioridad del uso de stents liberadores de droga (SL) sobre el stent convencional (SC). La información en nuestro medio sobre el implante de SL es escasa. Objetivo Comparar los resultados clínicos obtenidos en pacientes sometidos a implante de SL versus SC en un centro terciario de la Argentina. Material y métodos Se incluyeron todos los pacientes sometidos a angioplastia electiva desde abril de 2003 hasta junio de 2005 y se dividieron en ...

  11. FACTORES DE RIESGO CARDIOVASCULAR Y CALIDAD DE VIDA EN MUJERES REVASCULARIZADAS CON STENT CORONARIOS / Cardiovascular risk factors and quality of life in women who under-went revascularization with coronary stenting

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    José C. Castillo Núñez

    2013-10-01

    Full Text Available Resumen Introducción: Los factores de riesgo cardiovascular son responsables directos de la elevada mortalidad por enfermedad coronaria aterosclerótica en la mujer. Objetivo: Describir dichos factores, la evolución clínica y la calidad de vida en las féminas tras realizarle angioplastia coronaria. Método: Estudio descriptivo, longitudinal y prospectivo en 62 mujeres revascularizadas con angioplastia e implante de stent en el período de enero a junio de 2011. Se realizó seguimiento clínico durante 180 días a través de las consultas médicas. Resultados: La edad media fue de 52,8 años y el factor de riesgo cardiovascular más frecuente, la hipertensión arterial (66,1 %, y la diabetes (24,2 %, el menos prevalente. La enfermedad coronaria aterosclerótica de un vaso fue la de mayor frecuencia (87,1 % y la de tres vasos (1,6 %, la menos representada. En 75,8 % de los pacientes se utilizó un stent, solo uno requirió de tres. El 83,9 % de ellos valoraron su calidad de vida como buena, 14,5 % la consideraron aceptable y uno la estimó como pobre. En 93,5 % de los pacientes no se evidenciaron acontecimientos cardiovasculares durante el seguimiento clínico. La diabetes y la categoría calidad de vida pobre, mostraron una asociación estadísticamente significativa con la extensión de la enfermedad coronaria aterosclerótica, el número de stents utilizados y los acontecimientos cardiovasculares. Conclusiones: Las mujeres con enfermedad coronaria aterosclerótica, revascularizadas con stents coronarios, tienen una elevada frecuencia de factores de riesgo, una evolución clínica favorable y un predominio de las percepciones positivas sobre su calidad de vida. / Abstract Introduction: Cardiovascular risk factors are directly responsible for the high mortality from atherosclerotic coronary artery disease in women. Objective: To describe these risk factors, the clinical course and quality of life in women after coronary angioplasty. Method: A

  12. La demora en la realización de la angioplastia primaria, ¿una causa relacionada con el paciente o con el sistema médico-asistencial?

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    Patricia Arce

    2009-01-01

    Full Text Available IntroducciónUno de los inconvenientes en la utilización generalizada de la angioplastia primaria (ATCP es el retraso en su aplicación. La mayoría de los datos actuales proceden de ensayos clínicos de otros países, en tanto que en nuestro medio existe poco conocimiento respecto de su aplicación en la práctica habitual.ObjetivosAnalizar los tiempos involucrados en cada etapa de la realización de una ATCP en un centro donde constituye el tratamiento de elección, como primer paso para un programa de optimización de los tiempos y determinar si la demora obedece a una situación vinculada al paciente o al sistema médico-asistencial.Material y métodosEl presente es un estudio prospectivo observacional en pacientes con IAM de menos de 12 horas. Se consideró “tiempo paciente” desde el inicio de los síntomas hasta el arribo al hospital y “tiempo médico-asistencial” desde la llegada al hospital hasta la insuflación del balón.v Resultados Se realizó ATCP en 224 pacientes ingresados con diagnóstico de IAM. Las medianas (percentiles 25-75 fueron “tiempo paciente”: 60 minutos (40-150, “tiempo médicoasistencial”: 93 minutos (72-128. Este último comprende: tiempo 1 (llegada al hospitalllamada al equipo de hemodinamia: 20 minutos (10-45, tiempo 2 (llamada al equipo de hemodinamia-ingreso en sala de hemodinamia: 38 minutos (23-52, tiempo 3 (ingreso en sala de hemodinamia-primer balón insuflado: 31 minutos (21-45.ConclusionesEl “tiempo paciente” constituye menos de la mitad del tiempo total empleado. El “tiempo médico-asistencial” determina el mayor retraso al procedimiento; por lo tanto, inicialmente, el mayor énfasis debe dirigirse a corregir este último, dentro del cual el tiempo llamadaprimer balón constituye un factor fundamental.REV ARGENT CARDIOL 2009;77:14-20.

  13. FACTORES CLÍNICOS Y DEL PROCEDIMIENTO RELACIONADOS CON LA TROMBOSIS DE STENT / Clinical and procedural factors related to stent thrombosis

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    Ronald Aroche Aportela

    2012-03-01

    Full Text Available Resumen Introducción y objetivos: La trombosis del stent es una de las complicaciones posterior al intervencionismo coronario percutáneo, asociada a una elevada mortalidad y morbilidad. A pesar del uso de la doble terapia antiplaquetaria (aspirina y clopidogrel y la optimización de la técnica, su incidencia no ha desaparecido. El objetivo de esta investigación fue determinar los factores de riesgo de trombosis de los stent metálicos convencionales. Método: Se realizó un estudio descriptivo-retrospectivo. De las 2.014 arterias revascularizadas en el Centro de Investigaciones Médico-Quirúrgicas de La Habana, Cuba; entre agosto de 1997 y febrero de 2009, se seleccionaron las 289 reestudiadas. Resultados: La trombosis de los stent metálicos convencionales estuvo presente en 20 arterias, de las cuales 11 resultaron ser la descendente anterior, y su mayor incidencia se presentó en las primeras 24 horas y después de los 30 días. La diabetes mellitus se comportó como un factor de riesgo de trombosis (OR* = 3,06, así como la presión de liberación de menos de 10 atmósferas (OR = 3,70 y las lesiones complejas de los tipos B2 y C (OR = 8,80, todos con significación estadística (p < 0,05. Conclusiones: La mayor incidencia de trombosis de los stent metálicos convencionales fue en el primer día de la revascularización, después de la terminación de la doble terapia de antiagregación plaquetaria y en la arteria descendente anterior. La diabetes mellitus, las lesiones complejas y las bajas presiones de liberación del stent, se comportaron como factores de riesgo de trombosis con resultados estadísticamente significativos. Abstract Introduction and Objectives: Stent thrombosis is a complication after percutaneous coronary intervention associated with high mortality and morbidity. Despite the use of dual antiplatelet therapy (aspirin and clopidogrel and optimization of the technique, its incidence has not disappeared. The objective of

  14. Angioplastia coronaria en la República Argentina. Comparación de los resultados en la fase hospitalaria de los estudios CONAREC V y CONAREC XIV

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    Sergio Baratta

    2007-01-01

    Full Text Available La angioplastia coronaria (ATC es una técnica para el tratamiento de la enfermedad coronaria que se encuentra en constante evolución. El registro CONAREC V relevó características de pacientes sometidos a angioplastia durante el año 1996. Diez años después publicamos los resultados del estudio CONAREC XIV. ObjetivoComparar las características demográficas y clínicas, la utilización de dispositivos y de pruebas funcionales, los resultados y las complicaciones de la ATC en el estudio CONAREC V con el estudio CONAREC XIV. Material y métodosSe unificaron las bases de datos de ambos protocolos. Se compararon las variables continuas por medio de la prueba de la t y las categóricas con la prueba de chi cuadrado. Se construyó un modelo de regresión logística para determinar si disminuyó la tasa de complicaciones en el año 2005, ajustando por confundidores.ResultadosLos pacientes del CONAREC XIV fueron más añosos (62,8 ± 10,8 versus 60,6 ± 10,9 años, con mayor prevalencia de hipertensión arterial (72,4% versus 61,3%; p < 0,001 y diabetes (19,2% versus 16,9%; p = 0,017 y menor de tabaquismo (22% versus 38%; p < 0,001; presentaron enfermedad de tres vasos (20,2% versus 14,8%; p < 0,001 y ATC de más de un vaso con mayor frecuencia (25,3% versus 11,8%; p < 0,001; se incrementaron el uso de stents (94,5% versus 48%; p < 0,001 y la indicación por cuadros estables (36,3% versus 18,2%; p < 0,001. El uso de pruebas funcionales en este contexto fue menor en el año 2005 (54% versus 65%; p < 0,001.En pacientes con infarto agudo de miocardio, en el CONAREC XIV se observó una prevalencia menor de infarto anterior (46% versus 57,8%; p < 0,005 y de shock cardiogénico (7,3% versus 13,5%; p = 0,017. La tasa de complicaciones mayores fue menor en el último protocolo, CONAREC XIV (3,1% versus 8,9%; p < 0,001. En el modelo multivariado, pertenecer al último estudio disminuyó el riesgo de padecer eventos (OR 0,41, IC 95% 0,26-0,64; p < 0

  15. Predictores de reperfusión miocárdica tisular luego de la angioplastia en el infarto agudo de miocardio

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    Jorge Thierer

    2009-01-01

    Full Text Available IntroducciónLa angioplastia primaria tiene una eficacia limitada ya que deja a un grupo considerable de pacientessin lograr una reperfusión miocárdica tisular adecuada. Los factores clínicos, angiográficosy terapéuticos que influyen en el grado de reperfusión no han sido claramente establecidos.ObjetivosIdentificar los factores independientes asociados con la ausencia de reperfusión tisular luegode la angioplastia primaria.Material y métodosSe analizaron 140 pacientes incluidos prospectivamente en el estudio aleatorizado Protectionof Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation MyocardialInfarction Trial (PREMIAR. Este estudio evaluó la utilización de un filtro de proteccióndistal durante la angioplastia en el infarto agudo de miocardio con supradesnivel del segmentoST en pacientes de alto riesgo trombótico (solamente incluyendo flujo coronario basalTIMI 0-2. El punto final primario fue la resolución completa del segmento ST a los 60minutos, definida como disminución del ST ≥ 70% con el empleo de monitorización continuadel segmento ST. Se desarrolló un modelo de regresión logística para identificar los predictoresindependientes.ResultadosSe observó resolución completa del segmento ST a los 60 minutos luego de la angioplastiaen 82 pacientes (63%, mientras que 53 pacientes (37% presentaron resolución incompletaque se asoció con una tasa de mortalidad, reinfarto y/o insuficiencia cardíaca a los 30 díasdel 8,5% y 18,9%, respectivamente (p = 0,07. Los pacientes que no lograron una reperfusióntisular adecuada tuvieron con más frecuencia compromiso de localización anterior (79%versus 33%; p = 0,001, mayor frecuencia cardíaca (81 ± 20 versus 70 ± 15; p 1 (30%versus 17%; p = 0,07, respectivamente. El análisis multivariado demostró que el infarto delocalización anterior (OR 8,22, IC 95% 3,67-18,4; p < 0,001 se asoció con ausencia dereperfusión completa, mientras que el uso de inhibidores

  16. Evaluación económica del stent medicado vs. convencional para pacientes con infarto agudo de miocardio con elevación del ST en Colombia

    OpenAIRE

    Mateo Ceballos

    2014-01-01

    Objetivo: Analizar la costo-efectividad y el valor esperado de la información perfecta del stent medicado con sirolimus comparado con el convencional para pacientes con infarto agudo de miocardio con elevación del ST en Colombia. Métodos: Se construyó un modelo de Markov bajo la perspectiva del pagador y un horizonte temporal de diez años. Las probabilidades de transición se extrajeron de estudios clínicos identificados a partir de revisiones de la literatura. Los costos se estimaron mediante...

  17. Uso de stent liberador de droga para el tratamiento de la reestenosis intrastent en la práctica diaria. Resultados de un centro de alto volumen de la Argentina

    Directory of Open Access Journals (Sweden)

    Mariano Albertal

    2007-01-01

    Full Text Available IntroducciónLos estudios aleatorizados han demostrado la superioridad del uso de los stents liberadores de droga (SL sobre los stents convencionales (SC. La información en nuestro medio sobre el implante de SL en lesiones de tipo reestenosis intrastent (RIS es escasa.ObjetivoComparar los resultados clínicos obtenidos en pacientes sometidos a implante de SL versus SC o angioplastia con balón (grupo convencional en un centro de alto volumen de la Argentina.Material y métodosSe incluyeron todos los pacientes sometidos a angioplastia electiva por RIS desde enero de 2002 hasta julio 2006 y se dividieron en dos grupos: grupo SL (n = 116 y grupo convencional (n = 102.ResultadosNo hubo diferencias en las características basales, excepto por una incidencia menor de infarto previo y una presentación mayor con síndrome coronario agudo en el grupo SL. En este grupo se observó un porcentaje mayor de lesiones difusas, con el resultado de un número superior de stents implantados (1,1 ± 0,3 versus 0,5 ± 0,4; p < 0,001 y mayor longitud total del stent que en el grupo convencional (35,5 ± 16,5 versus 9,9 ± 7,6 mm; p < 0,001. Se observó una tasa similar de muerte, infarto y revascularización de urgencia a los 30 días de seguimiento. En el seguimiento alejado, en el grupo SL hubo menos necesidad de nuevo procedimiento de revascularización (12,9% versus 24,5%; p = 0,02. No se observaron diferencias significativas en la tasa de muerte e infarto en el seguimiento alejado.ConclusiónLos resultados del estudio sugieren que el uso de SL en un centro de alto volumen de la Argentina es seguro y eficaz, en comparación con las técnicas convencionales.

  18. Impacto da insuficiência renal crônica na eficácia de stents farmacológicos: estudo de seguimento de longo prazo Impacto de la insuficiencia renal crónica en la eficacia de Stents farmacológicos: estudio de seguimiento de largo plazo Impact of chronic kidney disease on the efficacy of drug-eluting stents: long-term follow-up study

    Directory of Open Access Journals (Sweden)

    Vitor Osório Gomes

    2011-05-01

    Full Text Available FUNDAMENTO: Pacientes com Insuficiência Renal Crônica (IRC submetidos à angioplastia coronária apresentam maiores taxas de revascularização da lesão alvo (RLA e mortalidade. Os stents farmacológicos (SF estão associados com taxas menores de reestenose, quando comparados aos stents não farmacológicos (SNF, embora em pacientes com IRC os dados da eficácia e segurança do SF sejam limitados. OBJETIVO: Buscamos avaliar a segurança e eficácia dos SF em pacientes com IRC significante, quando comparados a pacientes com função renal normal em um registro da "vida real". MÉTODOS: 504 pacientes submetidos à intervenção coronariana percutânea com SF em dois centros foram incluídos. Os desfechos foram estratificados baseados na presença de IRC, definida como taxa de filtração glomerular basal FUNDAMENTO: Pacientes con Insuficiencia Renal Crónica (IRC sometidos a angioplastia coronaria presentan mayores tasas de revascularización de la lesión blanco (RLB y mortalidad. Los stents farmacológicos (SF están asociados con tasas menores de reestenosis, cuando son comparados a los stents no farmacológicos (SNF, aunque en pacientes con IRC los datos de la eficacia y seguridad del SF sean limitados. OBJETIVO: Buscamos evaluar la seguridad y eficacia de los SF en pacientes con IRC significativa, cuando fueron comparados a pacientes con función renal normal en un registro de la "vida real". MÉTODOS: 504 pacientes sometidos a intervención coronaria percutánea con SF en dos centros fueron incluidos. Los desenlaces fueron estratificados basados en la presencia de IRC, definida como tasa de filtración glomerular basal BACKGROUND: Patients with chronic kidney disease (CKD submitted to coronary angioplasty have higher rates of target lesion revascularization (TLR and mortality. Drug-eluting stents (DES are associated with a lower rate of restenosis, compared to bare metal stents (BMS, although data on DES efficacy and safety is limited in

  19. Angioplastia coronaria vs terapia trombolítica en infarto agudo de miocardio. Clínica Marshfield-Hospital St Joseph, Wisconsin, EE.UU, 1999

    Directory of Open Access Journals (Sweden)

    Juan Pulido

    2001-04-01

    Full Text Available El tratamiento del infarto agudo de miocardio (IAM está en
    investigación por sus implicaciones en la práctica médica y por la
    comprensión más detallada de la fisiopatología. El objetivo del estudio es comparar clínica y angiográficamente la angioplastia coronaria con la trombolisis aguda en pacientes con IAM de menos de 24 horas de evolución. La administración de agentes trombolíticos después de una oclusión coronaria aguda ha disminuido la mortalidad intrahospitalaria, el tamaño del infarto y el número de complicaciones asociadas.

  20. Esophagoenteral stents in patients with recurrent gastric adenocarcinoma Prótesis esofagoenterales en pacientes con recidiva de adenocarcinoma gástrico

    Directory of Open Access Journals (Sweden)

    F. Pérez-Roldán

    2006-05-01

    Full Text Available One of the problems that can appear in patients with total gastrectomy for adenocarcinoma with esophagoenteral anastomosis is the appearance of a stenosis of the anastomosis. These stenosis are frequently malignant due to relapse of neoplasia. The therapeutic possibilities available are the surgical bypass or palliative treatment. There is very little experience described in the literature (21 cases on the placing of self-expandable metal stents as a palliative treatment for the symptoms of stenosis. We present our experience of 3 patients, in whom 4 esophageal stents were fitted (1 covered and 3 uncovered with good results. The dysphagia disappeared or improved, it allowed the ingestion of a soft diet and meant an improvement in the quality of life and at the same time stopped the weight loss. It seems an effective palliative treatment as a treatment for dysphagia in patients with tumoral relapse in the anastomosis of total gastrectomies.Uno de los problemas que puede aparecer en los pacientes con gastrectomía total por adenocarcinoma con anastomosis esofagoenteral es la aparición de estenosis de la anastomosis o próxima a ella. Estas estenosis con frecuencia son malignas debido a la aparición de recidiva en la neoplasia. Las posibilidades terapéuticas de las que disponemos son el bypass quirúrgico o bien el tratamiento paliativo. Existe muy poca experiencia descrita en la literatura (21 casos sobre la colocación de prótesis metálicas autoexpandibles como tratamiento paliativo de los síntomas de la estenosis. Presentamos nuestra experiencia en 3 pacientes, en los que se colocaron 4 prótesis esofágicas (1 recubierta y 3 no recubiertas con buenos resultados. Desapareció o mejoró la disfagia, permitió la ingesta de dieta blanda y supuso una mejora en la calidad de vida a la vez que impide la pérdida ponderal. Parece un tratamiento paliativo eficaz como tratamiento de la disfagia en pacientes con recidiva tumoral en la anastomosis

  1. Desfechos clínicos por região geográfica em pacientes com implante de stent eluidor de Zotarolimus Desenlaces clínicos por región geográfica en pacientes con implante de Stent liberador de Zotarolimus Clinical outcomes by geographic region for patients implanted with the zotarolimus-eluting stent

    Directory of Open Access Journals (Sweden)

    Chaim Lotan

    2011-05-01

    Full Text Available FUNDAMENTO: Diferenças entre regiões geográficas em relação à características de pacientes e desfechos, particularmente em síndromes coronarianas agudas, tem sido demonstradas em testes clínicos. Os desfechos clínicos após intervenções coronarianas percutâneas com o stent eluidor de Zotarolimus em uma população real foram analisados com o tempo. OBJETIVO: A influência da localização geográfica sobre os desfechos clínicos com o stent eluidor de Zotarolimus foi avaliada em três regiões: Pacífico Asiático, Europa e América Latina. MÉTODOS: Um total de 8.314 pacientes (6.572 da Europa, 1.522 do Pacífico Asiático e 220 da América Latina foram acompanhados por 1 ano; 2.116 desses (1.613, 316, e 187, respectivamente foram acompanhados por 2 anos. Características dos pacientes e lesões, terapia antiplaquetária dupla e desfechos clínicos foram comparados entre a América Latina e as outras duas regiões. RESULTADOS: Os pacientes da América Latina apresentavam a maior proporção de fatores de risco e infarto do miocárdio prévio. O uso da terapia antiplaquetária dupla declinou rapidamente na América Latina, de 44,9% em 6 meses para 22,5% em 1 ano e 7,8% em 2 anos (Europa: 87,4%, 61,5%, 19,7%; Pacífico Asiático: 82,4%, 67,0%, 45,7%, respectivamente. Não houve diferenças significantes entre a América Latina e a Europa ou Pacífico Asiático para qualquer desfecho em qualquer ponto do tempo. A incidência de trombose de stent provável e definitiva pelo Academic Research Consortium foi baixa (FUNDAMENTO: Las diferencias entre las regiones geográficas en relación con las características de pacientes y desenlaces, sobre todo en los síndromes coronarios agudos se ha demostrado en ensayos clínicos. Los desenlaces clínicos después de las intervenciones coronarias percutáneas con stent liberador de zotarolimus en una población real se analizaron a través del tiempo. Objetivos: La influencia de la ubicaci

  2. Bronchial stents

    Directory of Open Access Journals (Sweden)

    Ibrahim Emad

    2006-01-01

    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  3. Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico Volumetric assessment of neointimal hyperplasia in iliac arteries after metal stent implantation

    OpenAIRE

    Samuel Martins Moreira; Antonio Massamitsu Kambara; Sergio Ajzen; José de Ribamar Costa Junior

    2009-01-01

    OBJETIVO: Quantificar a hiperplasia neointimal em artérias ilíacas após stent, correlacionando fatores clínicos, arteriais e materiais dos stents. MATERIAIS E MÉTODOS: De junho de 2003 a agosto de 2005, 60 pacientes realizaram angioplastia transluminal percutânea e stent. Desses, 30 foram reestudados com ultrassonografia intravascular. Os dados foram analisados no laboratório de análise quantitativa. RESULTA-DOS: Dezesseis pacientes eram do sexo masculino (53,3%) e 14 (46,7%), do sexo feminin...

  4. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... of the bare metal stent versus the drug-coated stents is an ongoing debate. And I think ... that with putting in a bunch of drug-coated stents, and it looks very pretty when we’ ...

  5. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... paves the path so we can pass the metal stent. And then we take a stent and ... open up that balloon, and it expands that metal stent, which is generally stainless steel in compound, ...

  6. Longitudinal stent deformation during coronary bifurcation stenting.

    Science.gov (United States)

    Vijayvergiya, Rajesh; Sharma, Prafull; Gupta, Ankush; Goyal, Praveg; Panda, Prashant

    2016-03-01

    A distortion of implanted coronary stent along its longitudinal axis during coronary intervention is known as longitudinal stent deformation (LSD). LSD is frequently seen with newer drug eluting stents (DES), specifically with PROMUS Element stent. It is usually caused by impact of guide catheter tip, or following passage of catheters like balloon catheter, IVUS catheter, guideliner, etc. We hereby report a case of LSD during coronary bifurcation lesion intervention, using two-stents technique. Patient had acute stent thrombosis as a complication of LSD, which was successfully managed. PMID:26811144

  7. Symptomatic stent cast.

    LENUS (Irish Health Repository)

    Keohane, John

    2012-02-03

    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.

  8. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... put in, versus medicated or what’s known as drug-eluding stents. And there has been a lot ... Both bare metal stents and medicated stents, or drug-eluting stents, have their role, and we often ...

  9. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... from the heart, and then there are other issues as well. It 5 could be a pinched ... prevents these stents from clotting off. The real issue between a bare metal stent and a drug- ...

  10. Qualidade de vida após revascularização cirúrgica do miocárdio, angioplastia ou tratamento clínico Quality of life after surgical myocardial revascularization, angioplasty or medical treatment

    OpenAIRE

    Myrthes Emy Takiuti; Whady Hueb; Shirley Borghetti Hiscock; Célia Regina Simões da Rocha Nogueira; Priscyla Girardi; Fabio Fernandes; Desiderio Favarato; Neuza Lopes; Jorge Chiquie Borges; Aécio Flávio Teixeira de Góis; José Antonio Franchini Ramires

    2007-01-01

    FUNDAMENTO: Ainda que os benefícios clínicos das intervenções coronarianas parecem confirmados, seus efeitos na qualidade de vida (QV) permanecem pouco estudados. OBJETIVO: Avaliar a qualidade de vida (QV) na doença multiarterial coronariana em pacientes submetidos randomicamente a cirurgia, angioplastia ou tratamento clínico. MÉTODOS: Foi utilizando Short-Form Health Survey (SF36) questionnaire em 483 pacientes. Desses, 161 foram revascularizados; 166 receberam angioplastia e 153 tiveram tra...

  11. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... and very difficult to get to the target lesion. Now with the stents being as flexible as they are, we can pretty much get to anywhere we want. The issue of the bare metal stent versus the drug-coated stents is an ongoing debate. And I ...

  12. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... target lesion. Now with the stents being as flexible as they are, we can pretty much get to anywhere we want. The issue of the bare metal stent versus the drug-coated stents is an ongoing debate. ...

  13. Disección de arterias coronarias asociada con el consumo de cocaína

    OpenAIRE

    Guillermo Marchetti; Juan Arellano; Flavio Salvaggio; Luis Gariglio; Gabriel Pérez Baztarrica; Alejandro Botbol; Rafael Porcile

    2008-01-01

    La disección espontánea de arterias coronarias es en extremo rara y escasamente documentada en la bibliografía mundial. Una de las causas en pacientes jóvenes es la adicción a la cocaína. Se presenta el caso de un paciente con historia de consumo reciente de cocaína que ingresa derivado por infarto de miocardio para cinecoronariografía y angioplastia. En la cinecoronariografía se evidencia una disección espontánea de la arteria descendente anterior con flujo TIMI III. Debido al contexto clíni...

  14. Carotid stenting

    International Nuclear Information System (INIS)

    Full text: The annual incidence of stroke is estimated around 2 cases per 1000 in the general population and 80% of strokes are ischemic. [1] Atherosclerotic disease resulting in stenosis of common and/or internal carotid arteries is an established risk factor for acute cerebrovascular events. [2] In the majority of the cases ischemic stroke is caused by atherosclerotic plaque rupture and subsequent thrombus formation resulting in carotid occlusion or/and distal thromboembolization. Today, two invasive methods are available in order to reduce the risk of severe ischemic events: surgical carotid artery endarterectomy (CEA) and percutaneous carotid artery stenting (CAS). More recently amassed high-level scientific data coming from randomized controlled trials (RCTs) and meta-analysis comparing CAS with CEA have emerged. [3] Initial RTCs included the French EVA 3S, which investigated 527 symptomatic patients in 30 different centers, the German SPACE investigating 1.200 patients and the International ICSS which randomized 1710 patients. In EVA 3S the 30-day rate of any stroke death was significantly lower in the CEA group (3.9 vs. 9.6%, HR: 2.5). However the trial was prematurely stopped and severely criticized. [4] The SPACE trial resulted in a similar rate of ipsilateral stroke or death at 30-days and 2 years follow-up (6.8% CAS vs. 6.3% CEA), while in the ICSS trial the primary endpoint of all strokes, death and myocardial infarction (MI) was significantly lower in the CAS group (5.2% vs. 8.5%). Finally, the most recent CREST (Carotid Revascularization Endarterectomy vs. Stenting) trial randomized 2.502 patients (1.321 symptomatic). The composite primary endpoint of any stroke, death and MI was similar between the two methods (CAS: 7.2% vs. CEA: 6.8%; HR=1.11), while both methods demonstrated similar short- and longer-term outcomes. However significant differences between the components were detected (stroke 4.1% vs. 2.3%, P=0.012; and MI 1.1% vs. 2.3%, p=0.032, CAS

  15. Aortic stenting.

    Science.gov (United States)

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  16. Biocompatibility of Coronary Stents

    Directory of Open Access Journals (Sweden)

    Thamarasee M. Jeewandara

    2014-01-01

    Full Text Available Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES. Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.

  17. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar;

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... favorable for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic...... design was obtained via laser cutting, and surface treatment was performed with acid pickling and electropolishing, followedby an annealing process. In vitro mechanical analysis was performed to analyze the mechanical performance of the auxetic coronary stent. Scanning electronic microscopy (SEM) was...

  18. An Update to Hepatobiliary Stents

    OpenAIRE

    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 simpl...

  19. Metal or plastic stent for malignant biliary obstruction: what's got the most bang for your buck?

    Science.gov (United States)

    Moparty, Bhavani; Carr-Locke, David L

    2007-12-01

    Malignant biliary obstruction is most commonly managed by the endoscopist. Various plastic and metal stents are currently available. It is important to be aware of the pros and cons of each. The identifying factors that determine the prognosis for the patient might also help determine which type of stent to place. This month's article by Moss et al., is a meta-analysis of seven randomized controlled trials analyzing the cost-effectiveness of plastic and metal stents. This meta-analysis helps guide the endoscopist in deciding what type of stent would be most beneficial and cost effective for their patients. PMID:17998825

  20. La glucemia en ayunas como predictor de mortalidad intrahospitalaria en pacientescon infarto agudo de miocardio sometidos a angioplastia primaria

    OpenAIRE

    Gerardo Nau; Mariano Albertal; Jorge Thierer; Fernando Botto; Fernando Cura; Lucio Padilla; Alfonsina Candiello; Samir Jozami; Jorge Belardi

    2009-01-01

    RESUMENIntroducciónEl pronóstico de los pacientes que sufren un infarto agudo de miocardio con supradesniveldel ST (IAMST) ha mejorado notoriamente, en particular como resultado de la terapia dereperfusión. A pesar de estos avances, los pacientes con diabetes mellitus (DM) constituyenun grupo de alto riesgo. La hiperglucemia en pacientes con IAMST se asocia con peor pronóstico, independientemente del diagnóstico previo de DM.ObjetivoEvaluar el valor pronóstico de la glucemia en ayunas (GA) du...

  1. Spectral Imaging for Intracranial Stents and Stent Lumen.

    Directory of Open Access Journals (Sweden)

    Chi-Lun Weng

    Full Text Available Application of computed tomography for monitoring intracranial stents is limited because of stent-related artifacts. Our purpose was to evaluate the effect of gemstone spectral imaging on the intracranial stent and stent lumen.In vitro, we scanned Enterprise stent phantom and a stent-cheese complex using the gemstone spectral imaging protocol. Follow-up gemstone spectral images of 15 consecutive patients with placement of Enterprise from January 2013 to September 2014 were also retrospectively reviewed. We used 70-keV, 140-keV, iodine (water, iodine (calcium, and iodine (hydroxyapatite images to evaluate their effect on the intracranial stent and stent lumen. Two regions of interest were individually placed in stent lumen and adjacent brain tissue. Contrast-to-noise ratio was measured to determine image quality. The maximal diameter of stent markers was also measured to evaluate stent-related artifact. Two radiologists independently graded the visibility of the lumen at the maker location by using a 4-point scale. The mean of grading score, contrast/noise ratio and maximal diameter of stent markers were compared among all modes. All results were analyzed by SPSS version 20.In vitro, iodine (water images decreased metallic artifact of stent makers to the greatest degree. The most areas of cheese were observed on iodine (water images. In vivo, iodine (water images had the smallest average diameter of stent markers (0.33 ± 0.17mm; P < .05 and showed the highest mean grading score (2.94 ± 0.94; P < .05 and contrast/noise ratio of in-stent lumen (160.03 ±37.79; P < .05 among all the modes.Iodine (water images can help reduce stent-related artifacts of Enterprise and enhance contrast of in-stent lumen. Spectral imaging may be considered a noninvasive modality for following-up patients with in-stent stenosis.

  2. Tracheomalatia, to stent or not to stent

    Directory of Open Access Journals (Sweden)

    Irena Perić

    2015-01-01

    Full Text Available Benign thyroid disorders such as goiter, especially retrosternal, can cause tracheostenosis by extrinsic tracheal compression, which is due to the lack of specific symptoms often misdiagnosed. Tracheomalatia develops as a result to long term tracheal compression and refers to weakness of the trachea characterized by softness of the tracheal cartilage arches and by loss of regular tracheal structure. Tracheomalatia is characterized by reduction of the endotracheal lumen and may affect the entire trachea or may be localized to one portion of it. We present the case of a 72-year old patient with distinct tracheostenosis and tracheomalatia, caused by long term pressure by the retrosternal goiter. We have been monitoring the patient for last 20 years after the second endotracheal stent had been placed. The first one was placed 34 years ago, in 1981. On both occasions granulation tissue and colonization of bacteria occurred. In the end the placed stents were rejected and migrated to the main carina. Despite the tracheal diameter narrower than 5 mm the patient has been living normally without the stent for 17 years, with the exception of no hard physical labor. He had a few short term antibiotic therapies and bronchial toilets during symptomatic deteriorations. Diagnosing retrosternal goiter and surgical treatment on time is of crucial importance in cases such as this one. Considering the complications caused by the stent, our opinion is that the majority of patients may require conservative treatment with closely monitoring during respiratory infections.

  3. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... But there is clearly a huge body of data that shows that tobacco use is associated with ... medicated stents. I hear they’re bad.” The data that has come out since then has showed ...

  4. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... the equipment that we use from the early days has undergone a sea change. The catheters that ... the stent design has improved from the early days when they were very difficult to deploy and ...

  5. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available Coronary Angioplasty Stent Placement Shawnee Mission Heart & Vascular Center, Shawnee Mission, Kansas February 19, 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center ...

  6. Coronary Angioplasty Stent Placement

    Science.gov (United States)

    ... 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center in Merriam, ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ...

  7. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... 2009 Welcome to this OR-Live westbound cast presentation, live from Shawnee Mission Medical Center in Merriam, ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ...

  8. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ... a stress test in a year, with the knowledge that this last stress test was a false ...

  9. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... a big artery, a bare metal stent will work, a smaller artery or in some of the ... the equipment that we use from the early days has undergone a sea change. The catheters that ...

  10. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... have accessed the femoral artery, which is the big blood vessel in the leg, through which we ... getting to the point where if it’s a big artery, a bare metal stent will work, a ...

  11. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... not to just ignore any kind of symptoms. Diabetics, in particular, are a subclass of patients who ... vessel disease or multiple vessel blockages, or a diabetic, we think that the drug-eluting stents are ...

  12. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... against the wall, but what happens is scar tissue forms, so it’s literally scarring in there. That ... secreted from the metal stent and prevents scar tissue from forming. So at one time it was ...

  13. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... long-term,” that has changed as a moving target. But at one point it was a year. ... deploy and very difficult to get to the target lesion. Now with the stents being as flexible ...

  14. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... metal stent, which is generally stainless steel in compound, and it opens it up, and we take ... wire and pass a little tiny ultrasound catheter down where we can actually look at the plaque ...

  15. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... care of the intravenous medications and any other medicines that need to be administered in monitoring his ... put in, versus medicated or what’s known as drug-eluding stents. And there has been a lot ...

  16. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... putting in a bare metal stent. The whole theory behind that is you have a lesser chance ... time, very important. Oh, I think in the interest of the patient who has been laying on ...

  17. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... is associated with accelerated hardening of the arteries. Diabetes Mellitus is a very serious cause of particularly ... one that came in from Art. He said, “Two weeks ago I had a drug-eluting stent ...

  18. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... the opening of the blood vessel. It’s a collagen plug, and that will help seal the opening. ... stent should be on Plavix or a similar type of anti-platelet drug lifelong. One of the ...

  19. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... you can have a lesser plaque, 30 percent, 40 percent, which does not reduce blood flow, which ... That occurs in anywhere from 20 up to 40 percent of lesions. That’s why Medicated stents were ...

  20. Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico Volumetric assessment of neointimal hyperplasia in iliac arteries after metal stent implantation

    Directory of Open Access Journals (Sweden)

    Samuel Martins Moreira

    2009-08-01

    Full Text Available OBJETIVO: Quantificar a hiperplasia neointimal em artérias ilíacas após stent, correlacionando fatores clínicos, arteriais e materiais dos stents. MATERIAIS E MÉTODOS: De junho de 2003 a agosto de 2005, 60 pacientes realizaram angioplastia transluminal percutânea e stent. Desses, 30 foram reestudados com ultrassonografia intravascular. Os dados foram analisados no laboratório de análise quantitativa. RESULTA-DOS: Dezesseis pacientes eram do sexo masculino (53,3% e 14 (46,7%, do sexo feminino. A média de idade foi de 60,3 anos. Apresentaram hipertensão arterial 22 pacientes (73,3%, tabagismo, 18 (62,1%, hiperlipidemia, 20 (66,7%, e diabetes, 9 (30%. Foram implantados 20 stents de nitinol (66,7% e 10 de aço inoxidável (33,3%. Quatro pacientes eram TASC A (13,3%, 15 eram TASC B (50% e 11, TASC C (36,7%. O volume da hiperplasia variou de 49,02 mm³ a 112,87 mm³ (média de 80,33 mm³. O percentual de obstrução intra-stent variou de 18% a 47% (média de 27,4%. Os resultados clínicos obtidos com stent se mantiveram até o reestudo. CONCLUSÃO: A hiperplasia neointimal sempre ocorre após a angioplastia transluminal percutânea e stent, porém os percentuais de obstrução não foram superiores a 50% em nenhum caso. Não houve diferença estatisticamente significante dos percentuais de obstrução intra-stent quanto aos materiais dos stents, aos fatores clínicos e aos fatores arteriais.OBJECTIVE: To quantify neointimal hyperplasia in iliac arteries after stent implantation, correlating clinical, arterial factors and stent material. MATERIALS AND METHODS: In the period from June/2003 to August/ 2005, 60 patients were submitted to percutaneous transluminal angioplasty and stenting. Among these patients, 30 were followed-up with intravascular ultrasonography. Data were analyzed in a laboratory of quantitative analysis by means of a specific software. RESULTS: Sixteen (53.3% patients were men, and 14 (46.7%, women, and the mean age was 60

  1. Hemodynamics in Idealized Stented Coronary Arteries: Important Stent Design Considerations

    OpenAIRE

    Beier, Susann; Ormiston, John; Webster, Mark; Cater, John; Norris, Stuart; Medrano-Gracia, Pau; Young, Alistair; Cowan, Brett

    2015-01-01

    Stent induced hemodynamic changes in the coronary arteries are associated with higher risk of adverse clinical outcome. The purpose of this study was to evaluate the impact of stent design on wall shear stress (WSS), time average WSS, and WSS gradient (WSSG), in idealized stent geometries using computational fluid dynamics. Strut spacing, thickness, luminal protrusion, and malapposition were systematically investigated and a comparison made between two commercially available stents (Omega and...

  2. Nanomaterial coatings applied on stent surfaces.

    Science.gov (United States)

    Bagheri, Mahsa; Mohammadi, Marzieh; Steele, Terry Wj; Ramezani, Mohammad

    2016-05-01

    The advent of percutaneous coronary intervention and intravascular stents has revolutionized the field of interventional cardiology. Nonetheless, in-stent restenosis, inflammation and late-stent thrombosis are the major obstacles with currently available stents. In order to enhance the hemocompatibility of stents, advances in the field of nanotechnology allow novel designs of nanoparticles and biomaterials toward localized drug/gene carriers or stent scaffolds. The current review focuses on promising polymers used in the fabrication of newer generations of stents with a short synopsis on atherosclerosis and current commercialized stents, nanotechnology's impact on stent development and recent advancements in stent biomaterials is discussed in context. PMID:27111467

  3. Future developments in biliary stenting

    Directory of Open Access Journals (Sweden)

    Hair CD

    2013-06-01

    Full Text Available Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: 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.Keywords: plastic stents, self-expandable metal stents, drug eluting stents, bioabsorbable stents, malignant biliary strictures, benign biliary strictures

  4. La glucemia en ayunas como predictor de mortalidad intrahospitalaria en pacientescon infarto agudo de miocardio sometidos a angioplastia primaria

    Directory of Open Access Journals (Sweden)

    Gerardo Nau

    2009-01-01

    Full Text Available RESUMENIntroducciónEl pronóstico de los pacientes que sufren un infarto agudo de miocardio con supradesniveldel ST (IAMST ha mejorado notoriamente, en particular como resultado de la terapia dereperfusión. A pesar de estos avances, los pacientes con diabetes mellitus (DM constituyenun grupo de alto riesgo. La hiperglucemia en pacientes con IAMST se asocia con peor pronóstico, independientemente del diagnóstico previo de DM.ObjetivoEvaluar el valor pronóstico de la glucemia en ayunas (GA durante un IAMST tratado conangioplastia primaria.Material y métodosDe 227 pacientes con diagnóstico de IAMST se excluyeron 31 con DM y 7 derivados paraterapia de rescate tardío. Se registraron la glucemia en la admisión (GAd y la GA; la población se dividió según la GA en: grupo A ³ 110 mg/dl (hiperglucémicos y grupo B < 110 mg/dl (normoglucémicos.ResultadosLa población en estudio quedó conformada por 189 pacientes. La edad fue de 62,1 ± 10,5años, sexo masculino 82%, tabaquistas 40%, el tiempo dolor-balón fue de 2,75 horas (25-75% intercuartiles 2-4,75, el porcentaje con clasificación de Killip & Kimball (KK ³ 3 fuedel 12,1% y el 38% presentaron localización anterior. Se registraron 15 (7,9% muertesintrahospitalarias, todas en pacientes hiperglucémicos. Por análisis multivariado, lospredictores independientes de mortalidad intrahospitalaria fueron la edad (p = 0,048 y laGA como variable continua (p = 0,002. Para los eventos cardíacos mayores (muerte, reIAMe insuficiencia cardíaca, la clasificación de KK ³ 3 (p = 0,001, la GA (p = 0,001 y eldeterioro moderado/grave de la función sistólica (p = 0,016 fueron sus únicos predictoresindependientes. La GAd no resultó predictora independiente de muerte o de eventos cardíacosmayores.ConclusionesLos resultados del presente estudio sugieren que la GA posee valor pronóstico a corto plazoen pacientes no diabéticos que cursan un IAMST. La GA identifica tempranamente y enforma sencilla a

  5. Esophageal stents: when and how.

    Science.gov (United States)

    Kachaamy, Toufic; Pannala, Rahul

    2016-06-01

    Esophageal stents are devices used to alleviate dysphagia and treat leaks and perforations. Successful esophageal stenting requires definition of the abnormal anatomy such as stricture length or location of the leak, proper stent selection and deployment. This requires detailed knowledge of characteristics of the currently available stents. Self-expanding metal stents whether fully or partially covered have become the mainstay of treatment of esophageal cancer-related dysphagia as they provide quick relief of symptoms and have a favorable safety and efficacy profile, compared to other modalities such as radiation, laser, and argon plasma coagulation. They are also the initial treatment of choice for both malignant and benign fistulae. Stents are also used in benign refractory strictures but long-term stricture resolution rates are low in this setting. Fully covered metal stents are relatively easier to remove compared to partially covered stents; optimal time interval for removal depends on the indication for stenting and the clinical status of the patient. Stent related adverse events include chest pain, reflux, migration, and recurrent obstruction. Serious adverse events occur in less than 5% with procedure-related mortality of less than 2%. Techniques such as placement of hemostatic clips, Over The Scope clips, and endoscopic suturing are being used to decrease the migration risk but the optimal approach has not been defined. Antireflux measures are needed when a stent is placed across the gastroesophageal junction. Stents with antireflux designs do not appear to offer additional benefit compared to the conventional stent designs. Newer stent designs including biodegradable, drug eluting and radioactive stents are currently being investigated. PMID:26824424

  6. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Kosonen, Petteri; Vikman, Saila; Jensen, Lisette Okkels; Lassen, Jens Flensted; Harnek, Jan; Olivecrona, Göran K; Erglis, Andrejs; Fossum, Eigil; Niemelä, Matti; Kervinen, Kari; Ylitalo, Antti; Pietilä, Mikko; Aaroe, Jens; Kellerth, Thomas; Saunamäki, Kari; Thayssen, Per; Hellsten, Lars; Thuesen, Leif; Niemelä, Kari

    2012-01-01

    This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST is a...

  7. Pronóstico a corto y largo plazo de los pacientes con infarto agudo de miocardio y bloqueo de rama

    OpenAIRE

    Jaulent Huertas, Leticia

    2015-01-01

    En estudios de la era pre-reperfusión la presencia de bloqueo de rama (BR) asociado a infarto agudo de miocardio (IAM) se asoció a altas tasas de mortalidad a corto y largo plazo. Los cambios terapéuticos que se han producido en los últimos años, especialmente la aplicación de la terapia de reperfusión, fibrinolisis y angioplastia primaria, se asocian a un beneficio en el pronóstico de los pacientes con IAM. Objetivos Conocer las características clínicas y el pronóstico a corto y largo...

  8. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... be more difficult to open up, and that leads to more techniques that we’ll discuss. 6 ... ahead with stenting?” And I think that may lead to some of the questions. We don’t ...

  9. Coronary Angioplasty Stent Placement

    Medline Plus

    Full Text Available ... There’s a thing we call “balanced ischemia.” Ischemia meaning lack of blood flow, and sometimes those tests ... most patients that have a drug-eluting stent should be on Plavix or a similar type of ...

  10. Mechanical Characteristics of Composite Knitted Stents

    International Nuclear Information System (INIS)

    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 180o. 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 90o 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 180o, regardless of loop length. However, the N-N stent clearly produced kinks, causing blockage of the

  11. Self-expandable metalic endotracheal stent

    International Nuclear Information System (INIS)

    Six bare stents and six covered stents were inserted in the trachea of 12 dogs under general anesthesia. After 1-10 weeks of observation, the dogs were killed, and the trachea and lung were examined grossly and histologically. Pneumonia and stent migration were observed more frequently at covered stent group. Inflammatory change of the trachea was more severe at covered stent group. In conclusion, we believe that it is inadequate to insert silicone covered stent in the tracheobronchial tree. (Author)

  12. Successive breaks in biliary stents.

    Science.gov (United States)

    Espinel, Jesús; Pinedo, Eugenia; Ojeda, Vanesa; Guerra, María

    2016-04-01

    A 64 year-old male, was diagnosed with obstructive jaundice due to a well-differentiated pancreatic neuroendocrine tumor with liver metastases. The patient underwent endoscopic placement of covered self-expanding biliary stent (10x60 mm, Hanaro) by ERCP. He was admitted with cholangitis one year later. The following ERCP revealed a fractured stent with loss of the distal end (duodenal) and partial migration of the remaining stent to the common bile duct. The fragmented stent was removed from the common bile duct and a new, similar one was inserted. Four months later the patient was admitted with cholangitis. A new ERCP was done and biliary stent was also fragmented. It was removed and an uncovered stent (Wallflex) was inserted. PMID:27065248

  13. Disección de arterias coronarias asociada con el consumo de cocaína

    Directory of Open Access Journals (Sweden)

    Guillermo Marchetti

    2008-01-01

    Full Text Available La disección espontánea de arterias coronarias es en extremo rara y escasamente documentada en la bibliografía mundial. Una de las causas en pacientes jóvenes es la adicción a la cocaína. Se presenta el caso de un paciente con historia de consumo reciente de cocaína que ingresa derivado por infarto de miocardio para cinecoronariografía y angioplastia. En la cinecoronariografía se evidencia una disección espontánea de la arteria descendente anterior con flujo TIMI III. Debido al contexto clínico del paciente se decide tratamiento farmacológico (aspirina, clopidogrel, heparina de bajo peso molecular y nitritos, entre otros y nuevo estudio en 7 días, que evidenció la resolución de la disección del vaso.

  14. Future developments in biliary stenting

    OpenAIRE

    Hair CD; Sejpal DV

    2013-01-01

    Clark D Hair,1 Divyesh V Sejpal21Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA; 2Department of Medicine, Section of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USAAbstract: 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...

  15. Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent)

    Energy Technology Data Exchange (ETDEWEB)

    Drescher, Robert; Mathias, Klaus D.; Jaeger, Horst J.; Bockisch, Georg; Demirel, Eren; Gissler, Martin H.; Hauth, Elke [Department of Radiology, Staedtische Kliniken Dortmund, Beurhausstrasse 40, 44139 Dortmund (Germany); Department of Radiology and Microtherapy, University Witten/Herdecke (Germany)

    2002-10-01

    Our objective was to assess the technical feasibility and the clinical results of internal carotid artery (ICA) stenting using a nitinol self-expanding stent (SMART stent). In 13 patients 13 high-grade stenoses of the internal carotid artery were treated via an implantation of a SMART stent. In all cases a predilation of the stenosis and a postdilation within the stent were performed. Follow-up examinations were carried out in all patients after a period of 6 months. In each case the implantation of the stent was performed without technical complications. In 12 of 13 cases the stent was placed in the patients' internal carotid artery, in 1 case from the internal to the common carotid artery (CCA). The average degree of stenosis of 78% (70-95%) was reduced to an average of 2.8% (0-21%). The 6-month follow-up angiography showed an average degree of restenosis of 11.8% (0-29%) in 8 of 13 patients. Duplex sonography in the remaining 5 patients demonstrated patent stents. One patient showed brief neurological symptoms during the intervention. No further complications occurred during follow-up time. Treatment of internal carotid artery stenosis with the SMART stent seems technically feasible, safe, and promises long-term patency. (orig.)

  16. Carotid stenting and endarterectomy.

    Science.gov (United States)

    Yip, Hon-Kan; Sung, Pei-Hsun; Wu, Chiung-Jen; Yu, Cheuk-Man

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. PMID:27061654

  17. Incidence of definite stent thrombosis or in-stent restenosis after drug-eluting stent implantation for treatment of coronary in-stent restenosis

    DEFF Research Database (Denmark)

    Jensen, Jesper Khedri; Jensen, Lisette Okkels; Terkelsen, Christian Juhl; Lassen, Jens Flensted; Tilsted, Hans-Henrik; Hansen, Knud Noerregaard; Maeng, Michael; Thuesen, Leif; Thayssen, Per

    2013-01-01

    There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis or...... restenosis after DES implantation for treatment of restenosis....

  18. Are Aortic Stent Grafts Safe in Pregnancy?

    OpenAIRE

    Nader Khandanpour; 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.

  19. Percutaneous biliary drainage and stenting

    International Nuclear Information System (INIS)

    Full text: Percutaneous transhepatic cholangiography (PTC) is an X-ray or US guided procedure that involves the injection of a contrast material directly into the bile ducts inside the liver to produce pictures of them. If a blockage or narrowing is found, additional procedures may be performed: 1. insertion of a catheter to drain excess bile out of the body or both - internal and external; 2. plastic endoprothesis placement; 3. self-expandable metal stents placement to help open bile ducts or to bypass an obstruction and allow fluids to drain. Current percutaneous biliary interventions include percutaneous transhepatic cholangiography (PTC) and biliary drainage to manage benign and malignant obstructions. Internal biliary stents are either plastic or metallic, and various types of each kind are available. Internal biliary stents have several advantages. An external tube can be uncomfortable and have a psychological disadvantage. An internal stent prevents the problems related to external catheters, for example, pericatheter leakage of bile and the need for daily flushing. The disadvantages include having to perform endoscopic retrograde cholangiopancreatography (ERCP) or new PTC procedures to obtain access in case of stent obstruction. Better patency rates are reported with metallic than with plastic stents in cases of malignant obstruction, though no effect on survival is noted. Plastic internal stents are the cheapest but reportedly prone to migration. Metallic stents are generally not used in the treatment of benign disease because studies have shown poor long-term patency rates. Limited applications may include the treatment of patients who are poor surgical candidates or of those in whom surgical treatment fails. Most postoperative strictures are treated surgically, though endoscopic and (less commonly) percutaneous placement of nonmetallic stents has increasingly been used in the past few years. Now there are some reports about use of biodegradable biliary

  20. Polymers for Cardiovascular Stent Coatings

    Directory of Open Access Journals (Sweden)

    Anne Strohbach

    2015-01-01

    Full Text Available Polymers have found widespread applications in cardiology, in particular in coronary vascular intervention as stent platforms (scaffolds and coating matrices for drug-eluting stents. Apart from permanent polymers, current research is focussing on biodegradable polymers. Since they degrade once their function is fulfilled, their use might contribute to the reduction of adverse events like in-stent restenosis, late stent-thrombosis, and hypersensitivity reactions. After reviewing current literature concerning polymers used for cardiovascular applications, this review deals with parameters of tissue and blood cell functions which should be considered to evaluate biocompatibility of stent polymers in order to enhance physiological appropriate properties. The properties of the substrate on which vascular cells are placed can have a large impact on cell morphology, differentiation, motility, and fate. Finally, methods to assess these parameters under physiological conditions will be summarized.

  1. Technical overview on the MiStent coronary stent.

    Science.gov (United States)

    McCLAIN, James B; Carlyle, Wenda C; Donohoe, Dennis J; Ormiston, John A

    2016-10-01

    Drug-eluting stents (DES) have dramatically improved the long-term efficacy of percutaneous coronary intervention (PCI). Over the last decade there have been numerous advances in DES platforms, however, all but one currently approved DES in the United States and many of the approved DES worldwide still have 3 common features: a metal stent platform, an anti-proliferative drug, and a permanent polymer. In this context, the polymer is critical to control drug release, but the polymer serves no purpose after the drug is eluted. While designed to be completely biocompatible, synthetic polymers have the potential to illicit an inflammatory response within the vessel including but not limited to delayed healing and hypersensitivity. Adverse vascular reactions to these polymers have been implicated as a cause of very late stent thrombosis, ongoing intimal hyperplasia and late "catch-up" in addition to neoatherosclerosis. To avoid the long-term risks associated with prolonged polymer exposure, DES with bioabsorbable polymers have been developed. The MiStent® Sirolimus-Eluting Absorbable Polymer Coronary Stent System (MiStent SES) (MiCell Technologies, Durham, NC, USA) combines crystalline sirolimus, a rapidly absorbing polylactide-co-glycolic acid (PLGA) coating and a thin-strut cobalt chromium alloy stent platform (Genius MAGIC® Stent System, EuroCor GmbH, Germany). MiCell's supercritical fluid technology allows a rigorously controlled, solvent-free drug and polymer coating to be applied to a bare-metal stent. This solvent-free application of drug uniquely allows a crystalline form of sirolimus to be used on the MiStent SES potentially providing improved clinical benefits. It avoids the uncontrolled burst of drug seen with other DES, provides uniform drug delivery around and between the stent struts, and allows the anti-inflammatory and anti-restenotic drug (sirolimus) to be present in the tissue through the entire polymer absorption period and for months after the

  2. Current Status of Biliary Metal Stents

    OpenAIRE

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-01-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. ...

  3. Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming

    OpenAIRE

    Cho, Nam Jun; Lee, Tae Hoon; Park, Sang-Heum; Lee, Han Min; Hyun, Kyung Hee; Lee, Suck-Ho; Chung, Il-Kwun; Kim, Sun-Joo

    2013-01-01

    Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent remov...

  4. Carotid artery stenting

    International Nuclear Information System (INIS)

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  5. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  6. Minimonoka Stent for Canalicular Reconstruction

    Directory of Open Access Journals (Sweden)

    Sunil G Biradar,

    2015-04-01

    Full Text Available Objective: Canalicular injuries are relatively common and accounts for 16-26% of all lid tears. There are different techniques for reconstructing traumatic canalicular lacerations. The most favorable intervention would be one that is simple, less invasive with reduced postoperative complications/recovery time. The aim of this study is to report the surgical outcome with the Mini-Monoka monocanalicular stent. Material and Methods: Patients with traumatic canalicular lacerations who underwent surgical reconstruction using the Mini-Monoka monocanalicular stent were included. The surgical outcome was based on subjective (epiphora and objective (tear meniscus level, and lacrimal irrigation findings after stent removal. Result: Ten patients (mean age: 9.7 years of lower canaliculus injury were included. Successful stenting was accomplished in all cases. Postoperative eyelid position was satisfactory in most patients. The mean postoperative follow-up period was 6 months. There were no cases of premature stent extrusion. Functional drainage after stent removal was normal in all of patients. Syringing showed full patency. Conclusion:The MiniMonoka monocanalicular stent is an effective tool in reconstructing traumatic canalicular lacerations. Easy to use, carries a minimal risk of infection and injury to the non-lacerated canaliculus, and results in high anatomical and functional success rates.

  7. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention

    OpenAIRE

    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, ...

  8. Endothelial cell repopulation after stenting determines in-stent neointima formation: effects of bare-metal vs. drug-eluting stents and genetic endothelial cell modification.

    OpenAIRE

    Douglas, G; van Kampen, E.; Hale, AB; McNeill, E; Patel, J.; Crabtree, MJ; Ali, Z; Hoerr, RA; Alp, NJ; Channon, KM

    2013-01-01

    Aims Understanding endothelial cell repopulation post-stenting and how this modulates in-stent restenosis is critical to improving arterial healing post-stenting. We used a novel murine stent model to investigate endothelial cell repopulation post-stenting, comparing the response of drug-eluting stents with a primary genetic modification to improve endothelial cell function. Methods and results Endothelial cell repopulation was assessed en face in stented arteries in ApoE−/− mice with end...

  9. Percutaneous cholangioscopy in obstructed biliary metal stents

    International Nuclear Information System (INIS)

    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

  10. Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention.

    Science.gov (United States)

    Kwon, Chang-Il; Lehman, Glen A

    2016-03-01

    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

  11. Very late coronary aneurysm formation with subsequent stent thrombosis secondary to drug-eluting stent

    Institute of Scientific and Technical Information of China (English)

    Ibrahim Akin,; Stephan Kische; Tim C Rehders; Henrik Schneider; G(o)kmen R Turan; Tilo Kleinfeldt; Jasmin Ortak; Christoph A. Nienaber; Hüseyin Ince

    2011-01-01

    Drug-eluting stents have changed the practice in interventional cardiology.With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed.While the majority of attention was focused on stent thrombosis,the formation of coronary aneurysm was only described in anecdotal reports.We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent.

  12. Preventive role of palladium-103 radioactive stent on in-stent restenosis in rabbit iliac arteries

    Institute of Scientific and Technical Information of China (English)

    LUO Quan-Yong; CHEN Li-Bo; YUAN Zhi-Bin; LU Han-Kui; ZHU Rui-Sen

    2005-01-01

    The abilility of γ-emitting palladium-103 stent implantation to inhibit in-stent restenosis in rabbit iliac arteries was investigated. Quantitative histomorphometry of the stented iliac segments 28 days after the implantation indicated that palladium-103 stents made a significant reduction in neointimal area and percent area stenosis compared with the nonradioactive stents. Lumen area in the palladium-103 stents treatment group was larger than the control group. However, the reduction of neointima formation by palladium-103 stents implantation was in a non-dose-dependent fashion. Low ionizing radiation doses via γ-emitting palladiurn-103 stent are effective in preventing neointimal hyperplasia in iliac arteries of rabbits. Palladium-103 stents can be employed as a possible novel means to prevent in-stent restenosis.

  13. Myocardial bridging is a potential risk factor of very late stent thrombosis of drug eluting stent

    OpenAIRE

    Jiang, Qixia; Liang, Chun; Wu, Zonggui

    2012-01-01

    Summary Drug eluting stents have been implanted worldwide and used in nearly 90% of percutaneous coronary interventions in China. Although many randomized trials have confirmed the efficacy and safety profile of drug eluting stents, they were not powered to detect or exclude the effect of drug eluting stents on rare events such as stent thrombosis. Several mechanisms of very late stent thrombosis have been postulated, but are not widely accepted. Virchow’s triad describes the 3 main factors o...

  14. Acute stent recoil in the left main coronary artery treated with additional stenting.

    Science.gov (United States)

    Battikh, Kais; Rihani, Riadh; Lemahieu, Jean Michel

    2003-01-01

    We report a case of acute stent recoil occurring after the stenting of an ostial left main coronary artery lesion. The marked recoil after high-pressure balloon inflation confirmed that the radial force of the first stent was unable to ensure vessel patency. The addition of a second stent provided the necessary support to achieve a good final result. This case illustrates a possible complication of aorto-ostial angioplasty that could be treated with double stenting. PMID:12499528

  15. Late Stent Thrombosis Associated with Heavy Exercise

    OpenAIRE

    Simsek, Ziya; Arslan, Sakir; Gundogdu, Fuat

    2009-01-01

    Bare-metal stents are commonly used in the treatment of coronary artery disease. Stent thrombosis usually occurs within the first 48 hours after stent deployment. After a week, the incidence of thrombosis is low. Late stent thrombosis (after 30 days) is rarely seen; however, its clinical outcomes are severe 30-day mortality rates of 20% to 48% and myocardial infarction rates of 60% to 70%. Herein, we present the case and discuss the treatment of a patient who, after heavy exercise, experience...

  16. Visualization of stent lumen in MR imaging. Relationship with stent design and RF direction

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) visualization of metallic stent lumens is possible if the stent structure counteracts eddy currents in the lumen induced by the radio frequency magnetic field, B1. To examine the effectiveness of various stent designs in counteracting eddy currents, we anchored eight copper stent models and 2 commercially available nickel-titanium alloy (Nitinol) stents in a gel phantom, perpendicular or parallel to the direction of B1. A mesh stent lumen showed hypointensity irrespective of its alignment relative to B1. A solenoid stent lumen showed hypointensity with the stent axis parallel to B1, but it had the same signal intensity as outside the lumen when perpendicular to B1. A Moebius stent lumen showed no signal reduction, irrespective of alignment relative to B1. Lumens of the commercially available stents showed hypointensity regardless of alignment relative to B1. Computer simulation revealed that the signal intensities of the stents corresponded to magnetic flux densities of B1 in the stents, which are modified by the structure of the stent. While in vivo MRI viewing of a Moebius stent lumen is likely possible regardless of axis alignment, inherent structural weakness may be problematic. As a more practical choice, the solenoid stent is easier to manufacture and generates no hypointensive signal when the axis is parallel to B0. (author)

  17. Incidence and predictors of coronary stent thrombosis

    DEFF Research Database (Denmark)

    D'Ascenzo, Fabrizio; Bollati, Mario; Clementi, Fabrizio;

    2013-01-01

    Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent...

  18. Geometrical deployment for braided stent.

    Science.gov (United States)

    Bouillot, Pierre; Brina, Olivier; Ouared, Rafik; Yilmaz, Hasan; Farhat, Mohamed; Erceg, Gorislav; Lovblad, Karl-Olof; Vargas, Maria Isabel; Kulcsar, Zsolt; Pereira, Vitor Mendes

    2016-05-01

    The prediction of flow diverter stent (FDS) implantation for the treatment of intracranial aneurysms (IAs) is being increasingly required for hemodynamic simulations and procedural planning. In this paper, a deployment model was developed based on geometrical properties of braided stents. The proposed mathematical description is first applied on idealized toroidal vessels demonstrating the stent shortening in curved vessels. It is subsequently generalized to patient specific vasculature predicting the position of the filaments along with the length and local porosity of the stent. In parallel, in-vitro and in-vivo FDS deployments were measured by contrast-enhanced cone beam CT (CBCT) in idealized and patient-specific geometries. These measurements showed a very good qualitative and quantitative agreement with the virtual deployments and provided experimental validations of the underlying geometrical assumptions. In particular, they highlighted the importance of the stent radius assessment in the accuracy of the deployment prediction. Thanks to its low computational cost, the proposed model is potentially implementable in clinical practice providing critical information for patient safety and treatment outcome assessment. PMID:26891065

  19. Graft occlusion after coronary artery bypass grafting and stent deformation and in-stent restenosis after succedent stenting in a patient with deep position myocardial bridging

    OpenAIRE

    Zou, Yi-Xi; Huang, Fang-Jiong; Wu, Qiang; Zhu, En-jun

    2012-01-01

    We present a case of deep position myocardial bridging in a patient who had early graft occlusion after coronary artery bypass grafting and had stent deformation and in-stent restonesis after succedent stenting.

  20. Current Status of Biliary Metal Stents.

    Science.gov (United States)

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-03-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed. PMID:26911896

  1. Recent Advances of Biliary Stent Management

    International Nuclear Information System (INIS)

    Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.

  2. Current Status of Biliary Metal Stents

    Science.gov (United States)

    Nam, Hyeong Seok; Kang, Dae Hwan

    2016-01-01

    Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed. PMID:26911896

  3. Recent advances of biliary stent management.

    Science.gov (United States)

    Kida, Mitsuhiro; Miyazawa, Shiro; Iwai, Tomohisa; Ikeda, Hiroko; Takezawa, Miyoko; Kikuchi, Hidehiko; Watanabe, Maya; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2012-01-01

    Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations. PMID:22563289

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

    Science.gov (United States)

    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

  5. Ureteral Stent Coatings: What's Here and What's Coming

    Science.gov (United States)

    Razvi, Hassan

    2008-09-01

    Ureteral stents have become an indispensable tool to the urologist in the management of various disorders afflicting the urinary tract. While the ideal stent remains elusive, novel technical advances in stent coating technology offer the potential of enhancing stent biocompatibility and clinical application. Currently available stent coatings as well as new and emerging devices will be reviewed.

  6. Stenting in Malignant Biliary Obstruction.

    Science.gov (United States)

    Almadi, Majid A; Barkun, Jeffrey S; Barkun, Alan N

    2015-10-01

    Decompression of the biliary system in patients with malignant biliary obstruction has been widely accepted and implemented as part of the care. Despite a wealth of literature, there remains a significant amount of uncertainty as to which approach would be most appropriate in different clinical settings. This review covers stenting of the biliary system in cases of resectable or palliative malignant biliary obstruction, potential candidates for biliary drainage, technical aspects of the procedure, as well as management of biliary stent dysfunction. Furthermore, periprocedural considerations including proper mapping of the location of obstruction and the use of antibiotics are addressed. PMID:26431598

  7. A case report of very late stent thrombosis after bare-metal stent implantation

    Directory of Open Access Journals (Sweden)

    Mustafa Adem Tatlısu

    2014-03-01

    Full Text Available Stent thrombosis is undesirable complication after percutaneous coronary interventions (PCI, despite contemporary concepts of stents and antiplatelet therapy. Stent thrombosis (ST is defined by the Academic Research Concortium as: early (1 year. Risk of very late stent thrombosis is considerably higher in patients with drug-eluting stents (DES, owing to delayed endothelialization. There are several cases very late ST after bare-metal stent (BMS implantation. Our patient presented with ST-elevation myocardial infarction on account of BMS thrombosis 14 years after the implantation.

  8. Drug eluting biliary stents to decrease stent failure rates: A review of the literature.

    Science.gov (United States)

    Shatzel, Joseph; Kim, Jisoo; Sampath, Kartik; Syed, Sharjeel; Saad, Jennifer; Hussain, Zilla H; Mody, Kabir; Pipas, J Marc; Gordon, Stuart; Gardner, Timothy; Rothstein, Richard I

    2016-01-25

    Biliary stenting is clinically effective in relieving both malignant and non-malignant obstructions. However, there are high failure rates associated with tumor ingrowth and epithelial overgrowth as well as internally from biofilm development and subsequent clogging. Within the last decade, the use of prophylactic drug eluting stents as a means to reduce stent failure has been investigated. In this review we provide an overview of the current research on drug eluting biliary stents. While there is limited human trial data regarding the clinical benefit of drug eluting biliary stents in preventing stent obstruction, recent research suggests promise regarding their safety and potential efficacy. PMID:26839648

  9. Eventos adversos e motivos de descarte relacionados ao reuso de produtos médicos hospitalares em angioplastia coronária Adverse events and reasons for discard related to the reuse of cardiac catheters in percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Margarete Ártico Batista

    2006-09-01

    Full Text Available OBJETIVO: Descrever os eventos adversos ocorridos durante e após angioplastia coronária (ATC, possivelmente relacionados ao reuso de produtos médico-hospitalares, além de quantificar e identificar os motivos de descarte em relação ao primeiro uso e ao reuso. MÉTODO: Foram estudados 60 pacientes, sendo que 29 (48,3% apresentavam angina instável, 27 (45% IAM e quatro (6,7% outros diagnósticos. Durante o procedimento e na permanência na Unidade Intensiva Coronariana, atentou-se à possibilidade de ocorrência dos eventos adversos febre, hipertensão, hipotensão, calafrios, sudorese, sangramento, náuseas e vômitos. Foram avaliados sete produtos médico-hospitalares: introdutor, cateter-guia, fio-guia 0.35, fio-guia 0.014, cateter- balão para angioplastia, seringa com manômetro para insuflar balão (indeflator e torneira de três vias (manifold. No total de produtos (76 de primeiro uso e 410 reprocessados, verificou-se se houve descarte e se isto ocorreu antes ou durante o procedimento e quais os motivos para tanto. Utilizou-se o teste Qui Quadrado, admitindo-se erro alfa de 5%. RESULTADOS: Vinte e seis pacientes apresentaram eventos adversos. A hipotensão foi o evento mais prevalente e ocorreu em 11(18,3% casos. Não houve, porém, significância estatística entre o evento adverso hipotensão e reuso ou não dos produtos médico-hospitalares. Por não estarem íntegros, foram descartados três produtos de primeiro uso e 55 produtos dos reutilizados. CONCLUSÃO: Os eventos adversos apresentados pelos pacientes submetidos à angioplastia não estão associados ao reuso dos produtos médico-hospitalares. A integridade e funcionalidade foram os motivos principais de descarte.OBJECTIVE: To describe the adverse effects that occur during and after percutaneous transluminal coronary angioplasty (PTCA possibly related to the reuse of medical equipment. An additional objective is to quantify and identify the reasons of discard in respect to

  10. An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

    Directory of Open Access Journals (Sweden)

    Jing Lin

    2016-02-01

    Full Text Available Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.

  11. Stent malapposition, as a potential mechanism of very late stent thrombosis after bare-metal stent implantation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Higuma, Takumi, E-mail: higuma@cc.hirosaki-u.ac.jp; Abe, Naoki; Hanada, Kenji; Yokoyama, Hiroaki; Tomita, Hirofumi; Okumura, Ken

    2014-04-15

    A 90-year-old man was admitted to our hospital with acute ST-segment elevation myocardial infarction. He had a history of post-infarction angina pectoris 79 months ago and had a bare-metal stent (BMS) implanted in the proximal left anterior descending artery at our hospital. Emergent coronary angiography demonstrated thrombotic occlusion in the previously stented segment. After catheter thrombectomy, antegrade flow was restored, but 90% stenosis with haziness persisted in the proximal and distal portions of the previously stented segment. Intravascular ultrasound imaging showed interstrut cavities or stent malapposition at the proximal and distal sites of stented segment. In close proximity to the sites, residual thrombi were also observed. Optical coherence tomography (OCT) demonstrated neither lipid-laden neointimal tissue nor rupture but clearly demonstrated residual thrombus adjacent to the malapposed region in addition to the stent malapposition. PCI with balloon was successfully performed and stent apposition was confirmed by OCT. Stent malapposition is an unusual mechanism of very late stent thrombosis after BMS implantation. OCT can clearly reveal the etiology of stent thrombosis.

  12. Intravascular Stenting in Microvascular Anastomoses

    DEFF Research Database (Denmark)

    Assersen, Kristine; Sørensen, Jens

    2015-01-01

    Background The effect of intravascular stenting (IVaS) on microvascular anastomoses has given adverse results. For experienced microsurgeons the benefit of IVaS is doubtful. We have investigated the potential benefit of the IVaS technique for two groups of inexperienced microsurgeons with differe...

  13. Stent placement for tracheobronchial disease

    Energy Technology Data Exchange (ETDEWEB)

    Walser, Eric M. [Department of Radiology, Rt 0709, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0709 (United States)]. E-mail: emwalser@utmb.edu

    2005-09-01

    Early treatment for airway stenoses or occlusions involved open repair with the attendant risks of thoracotomy or sternotomy. With the advent of rigid and, more recently, flexible bronchoscopy, the placement of airway stents has come to the forefront in the treatment of benign and malignant tracheobronchial disease. This paper describes the history of surgical and endoluminal treatment of airway disease and discusses the indications and contraindications for airway stent placement. The advantages and limitations of such therapy are reviewed as well as the procedural details and the imaging evaluation and follow-up of patients undergoing endoluminal treatment. Although the placement of tracheobronchial stents is now primarily performed by interventional pulmonologists, imaging anatomically complex airway disease also requires the skills of an accomplished cross-sectional radiologist. Additionally, interventional radiologists using fluoroscopic guidance and alternative access routes to the airways can salvage failed bronchoscopic procedures and primarily treat selected cases. Due to the importance of pre- and post-procedural imaging in these patients, radiologists should be aware of airway anatomy suitable for stent placement and the appearance of various complications of this procedure.

  14. Polymeric Biodegradable Stent Insertion in the Esophagus

    Directory of Open Access Journals (Sweden)

    Kai Yang

    2016-04-01

    Full Text Available Esophageal stent insertion has been used as a well-accepted and effective alternative to manage and improve the quality of life for patients diagnosed with esophageal diseases and disorders. Current stents are either permanent or temporary and are fabricated from either metal or plastic. The partially covered self-expanding metal stent (SEMS has a firm anchoring effect and prevent stent migration, however, the hyperplastic tissue reaction cause stent restenosis and make it difficult to remove. A fully covered SEMS and self-expanding plastic stent (SEPS reduced reactive hyperplasia but has a high migration rate. The main advantage that polymeric biodegradable stents (BDSs have over metal or plastic stents is that removal is not require and reduce the need for repeated stent insertion. But the slightly lower radial force of BDS may be its main shortcoming and a post-implant problem. Thus, strengthening support of BDS is a content of the research in the future. BDSs are often temporarily effective in esophageal stricture to relieve dysphagia. In the future, it can be expect that biodegradable drug-eluting stents (DES will be available to treat benign esophageal stricture, perforations or leaks with additional use as palliative modalities for treating malignant esophageal stricture, as the bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.

  15. Treatment of malignant and benign biliary obstructions with metal stents

    International Nuclear Information System (INIS)

    The palliative treatment of malignant bilary tract obstructions using a metal stent is now an established procedure in clinical practice. An endoscopic, transpapillary approach is the first choice for implantation of the stent. If it is not possible to insert the stent in this way, which is often the case with high obstructions, a percutaneous approach is chosen. It appears to be beneficial to use a metal stent with a finemeshed net such as, for example, the Wall stent. Metal stents have a higher patency rate than plastic stents so that the primary choice of a metal stent is justified. Coated stents have not yet shown any major advantages. In cases of stent occlusion the coaxial implantation of a plastic stent seems to be the most efficient. In cases of benign biliary tract stenoses, a metal stent should only be implanted after a careful evaluation of all possible surgical modalities and exploitation of balloon dilatation and long-term splinting methods. (orig.)

  16. Stents liberadores de droga en el tratamiento de la reestenosis intrastent difusa:predictores clínicos y angiográficos de eventos

    OpenAIRE

    Jorge Leguizamón; Gustavo Schipani; Dionisio Chambre; Fabián Azzari; Gustavo Andersen; Alejandro Fernández; Gonzalo Romero; Ricardo Nauwerk; Ernesto Torresani; Guillermo Martino

    2009-01-01

    RESUMENIntroducciónEl tratamiento de la reestenosis intrastent (RIS) difusa con balón, stent o aterectomía tieneuna tasa alta de recurrencia (~35-80%). Por ello, los stents liberadores de droga (SLD)constituyen la primera elección para su tratamiento. Sin embargo, hay escasa informaciónsobre predictores de eventos a largo plazo.ObjetivoEvaluar la relación entre las variables clínicas y angiográficas con la ocurrencia de eventosalejados en el tratamiento de las RIS difusas con SLD en una pobla...

  17. Reestenosis “muy tardía”, sintomática, de un stent coronario

    Directory of Open Access Journals (Sweden)

    Luis A. Kortsarz

    2007-01-01

    Full Text Available Un paciente de sexo masculino, de 50 años, luego de ocho años y medio del implante de un stent coronario metálico presenta reestenosis sintomática.Los stents coronarios se reestenosan debido a un proceso de proliferación neointimal seguido de retracción tardía. Los eventos clínicos relacionados con reestenosis ocurren, en general, durante el primer año. La reestenosis sintomática “muy tardía” es poco frecuente. Hay sólo unos pocos casos comunicados en la literatura. La reestenosis angiográfica “muy tardía” es más común. Este proceso se debe, probablemente, al desarrollo de enfermedad aterosclerótica dentro del stent

  18. Peri-stent contrast staining, major evaginations and severe malapposition after biolimus-eluting stent implantation

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2014-01-01

    Peri-stent contrast staining and late acquired malapposition represent pathological vessel wall healing patterns following percutaneous coronary intervention with stent implantation. Earlier studies have described these abnormal vessel wall responses commonly present after implantation of first...

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

    OpenAIRE

    Saheb, Hady

    2014-01-01

    Kim Le, Hady Saheb Department of Ophthalmology, McGill University, Montreal, QC, Canada Abstract: 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 phacoemulsif...

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

    OpenAIRE

    Le K; Saheb H

    2014-01-01

    Kim Le, Hady Saheb Department of Ophthalmology, McGill University, Montreal, QC, Canada Abstract: 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 phacoemulsificat...

  1. Influence of strut cross-section of stents on local hemodynamics in stented arteries

    Science.gov (United States)

    Jiang, Yongfei; Zhang, Jun; Zhao, Wanhua

    2016-04-01

    Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics (CFD) methods are performed to study how the shape and the aspect ratio (AR) of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress (WSS) in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.

  2. Frecuencia, causas y momento de suspensión prematura de doble antiagregación tras implante de stents farmacoactivos

    OpenAIRE

    Fernández Cimadevilla, Oliva Concepción

    2014-01-01

    Factores predictores de la suspensión de doble antiagregación tras implantación de stents farmacoactivos. Introducción La utilización de stents farmacoactivos ha cambiado de forma importante los resultados clínicos durante los procedimientos de revascularización coronaria percutánea reduciendo la tasa de restenosis en comparación con los stents coronarios de metal. Las guías clínicas de las sociedades Americanas y Europeas de Cardiologia recomiendan 1 año de doble terapia antiagregante ...

  3. [Drug-eluting stents: long-term safety].

    Science.gov (United States)

    Karpov, Iu A; Samko, A N; Buza, V V

    2009-01-01

    The review concerns the problem of late thromboses of drug-eluting stents and their influence on late prognosis of the patients; presents long-term results of the trial of sirolimus-eluting stents implanted to patients with coronary heart disease; analyses mechanisms of development of late stent thrombosis, data from different meta-analyses and registers comparing long-term outcomes in patients with implanted sirolimus-eluting stents and metallic stents; suggests risk factors of late thromboses of drug-eluting stents; presents original evidence on 3.5-year follow-up of patients with implanted sirolimus-eluting stents and metallic stents. PMID:19537584

  4. Bare metal stenting of the iliac arteries.

    Science.gov (United States)

    Kim, Tanner I; Schneider, Peter A

    2016-06-01

    A significant subset of patients with peripheral artery disease (PAD) has iliac artery involvement that requires treatment. The development of bare metal stents has improved the short- and long-term outcomes of endovascular repair and has become first line therapy. Open surgical bypass has been reserved for extremely complex anatomic morphologies or endovascular failures. It is unclear whether primary stenting is superior to angioplasty with provisional stenting but if angioplasty is used alone, it is likely only appropriate for the most focal lesions. Self-expanding and balloon-expandable stents have unique characteristics that are suitable to different lesion morphologies. Both stent-types have demonstrated similar outcomes. Herein, we review the practice and results of bare metal stents in the iliac arteries. PMID:27035892

  5. Esophageal stent migration leads to intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Oguzhan Karatepe

    2009-07-01

    Full Text Available Background: Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of esophagus. Stent migration is a well-known complication of this procedure. Aims: We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used. Methods: A 65-year-old woman, who had a medical history of gastric cancer operation and esophageal stent application admitted to our emergeny department with a 48-hour history of abdominal pain, nausea and vomiting. An emergeny laparotomy was performed and the migrated stent leading to intestinal obstruction was removed. Results: The patient recovered without incident and was discharged on postoperative day 3. Conclusion: This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

  6. Rapid Virtual Stenting for Intracranial Aneurysms

    Science.gov (United States)

    Zhao, Liang; Chen, Danyang; Chen, Zihe; Wang, Xiangyu; Paliwal, Nikhil; Xiang, Jianping; Meng, Hui; Corso, Jason J.; Xu, Jinhui

    2016-01-01

    The rupture of Intracranial Aneurysms is the most severe form of stroke with high rates of mortality and disability. One of its primary treatments is to use stent or Flow Diverter to divert the blood flow away from the IA in a minimal invasive manner. To optimize such treatments, it is desirable to provide an automatic tool for virtual stenting before its actual implantation. In this paper, we propose a novel method, called ball-sweeping, for rapid virtual stenting. Our method sweeps a maximum inscribed sphere through the aneurysmal region of the vessel and directly generates a stent surface touching the vessel wall without needing to iteratively grow a deformable stent surface. Our resulting stent mesh has guaranteed smoothness and variable pore density to achieve an enhanced occlusion performance. Comparing to existing methods, our technique is computationally much more efficient.

  7. Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

    International Nuclear Information System (INIS)

    Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention

  8. Photodynamic therapy for occluded biliary metal stents

    Science.gov (United States)

    Roche, Joseph V. E.; Krasner, Neville; Sturgess, R.

    1999-02-01

    In this abstract we describe the use of photodynamic therapy (PDT) to recanalize occluded biliary metal stents. In patients with jaundice secondary to obstructed metal stents PDT was carried out 72 hours after the administration of m THPC. Red laser light at 652 nm was delivered endoscopically at an energy intensity of 50 J/cm. A week later endoscopic retrograde cholangiogram showed complete recanalization of the metal stent.

  9. Basic Knowledge about Metal Stent Development

    OpenAIRE

    Jeong, Seok

    2016-01-01

    Biliary self-expandable metal stents (SEMS), a group of non-vascular stents, have been used in the palliative management of biliary obstruction around the world. However, there are still unmet needs in the clinical application of biliary SEMS. Comprehensive understanding of the SEMS is required to resolve the drawbacks and difficulties of metal stent development. The basic structure of SEMS, including the materials and knitting methods of metal wires, covering materials, and radiopaque marker...

  10. Very Late Bare Metal Stent Thrombosis

    Directory of Open Access Journals (Sweden)

    Mariana Soto Herrera

    2013-01-01

    Full Text Available Very late stent thrombosis is a rare and not-well-understood complication after bare metal stent implantation. It usually presents as an ST elevation acute coronary syndrome and it is associated with high rates of morbidity and mortality. Pathophysiologic mechanisms are not well defined; nevertheless, recent studies have proposed a neoatherosclerotic process as the triggering mechanism. We present the case of a patient with bare metal very late stent thrombosis 12 years after implantation.

  11. Very Late Bare Metal Stent Thrombosis

    Science.gov (United States)

    Soto Herrera, Mariana; Restrepo, José A.; Felipe Buitrago, Andrés; Gómez Mejía, Mabel; Díaz, Jesús H.

    2013-01-01

    Very late stent thrombosis is a rare and not-well-understood complication after bare metal stent implantation. It usually presents as an ST elevation acute coronary syndrome and it is associated with high rates of morbidity and mortality. Pathophysiologic mechanisms are not well defined; nevertheless, recent studies have proposed a neoatherosclerotic process as the triggering mechanism. We present the case of a patient with bare metal very late stent thrombosis 12 years after implantation. PMID:24829831

  12. Update on Pancreatobiliary Stents: Stent Placement in Advanced Hilar Tumors

    OpenAIRE

    Jang, Sung Ill; Lee, Dong Ki

    2015-01-01

    Palliative drainage is the main treatment option for inoperable hilar cholangiocarcinoma to improve symptoms, which include cholangitis, pruritus, high-grade jaundice, and abdominal pain. Although there is no consensus on the optimal method for biliary drainage due to the paucity of large-scale randomized control studies, several important aspects of any optimal method have been studied. In this review article, we discuss the liver volume to be drained, stent type, techniques to insert self-e...

  13. In vitro Coronary Stent Implantation: Vessel Wall-Stent Interaction

    Czech Academy of Sciences Publication Activity Database

    Horný, L.; Chlup, Hynek; Vesely, J.; Gultová, E.; Kronek, J.; Žitný, R.; Voňavková, T.; Adámek, T.; Lanzer, P.; Hromádka, D.

    Berlín : Springer, 2011 - (Jobbágy, Á.), s. 795-798 ISBN 978-3-642-23507-8. ISSN 1680-0737. [European Conference of the International Federation for Medical and Biological Engineering /5./. Budapest (HU), 14.09.2011-18.09.2011] R&D Projects: GA ČR(CZ) GA106/08/0557 Institutional research plan: CEZ:AV0Z20760514 Keywords : edge detection * coronary stent * over-stretching Subject RIV: JJ - Other Materials

  14. Stenting:84 Cases of Clinical Application

    Institute of Scientific and Technical Information of China (English)

    GUANG Yongsong

    2002-01-01

    Objective To evaluate clinical application of therapeutic stenting. Methods 84 cases were managed with stents clinically, 136 procedures of intervention in all. The cases were suffering from portal hypertension of cirrhosis, stricture of inferior vana cava, superior vana cava syndrome, post- operative esophageal stricture, narrowig of femoral, common carotid, renal, superior mesentery arteries and biliary tract, etc. Results Therapeutic stenting achieves clinical effects completely different from conventional intemal medicine and surgery. Conclusion Therapeutic stenting is clinically unique, dramatically effective, with minor risks and worthy promoting.

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

    International Nuclear Information System (INIS)

    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 (χ2 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

  16. Delayed cerebral infarction due to stent folding deformation following carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Kwon Duk; Lee, Kyung Yul; Suh, Sang Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.

  17. Aorta Segmentation for Stent Simulation

    CERN Document Server

    Egger, Jan; Setser, Randolph; Renapuraar, Rahul; Biermann, Christina; O'Donnell, Thomas

    2011-01-01

    Simulation of arterial stenting procedures prior to intervention allows for appropriate device selection as well as highlights potential complications. To this end, we present a framework for facilitating virtual aortic stenting from a contrast computer tomography (CT) scan. More specifically, we present a method for both lumen and outer wall segmentation that may be employed in determining both the appropriateness of intervention as well as the selection and localization of the device. The more challenging recovery of the outer wall is based on a novel minimal closure tracking algorithm. Our aortic segmentation method has been validated on over 3000 multiplanar reformatting (MPR) planes from 50 CT angiography data sets yielding a Dice Similarity Coefficient (DSC) of 90.67%.

  18. Re-stenting treatment for esophagotracheal fistula caused by intrathoracic gastroesophageal anastomosis stent

    International Nuclear Information System (INIS)

    Objective: To evaluate the curative effect of stent replacement for the treatment of esophagotracheal fistula which occurred after the stent implantation for stenosis of intrathoracic gastroesophageal anastomotic stoma. Methods: Six patients with esophagotracheal fistula occurred after stent placement for stenosis of intrathoracic gastroesophageal anastomotic stoma were enrolled in this study. Under X-ray monitoring, the previous stent was taken out and a new, longer, covered stent was inserted into the esophagus in such a way that the stent would not be angled with the esophagus. Results: The previous stent was successfully taken out in all patients. No serious complications such as esophageal rupture, mediastinal abscess, hemorrhage, apnoea or dyspnea occurred. The replacement of the covered stent, which was 20-40 mm longer than the previous one, was also successfully performed. All the patients complained different degrees of, but tolerable, pharyngeal pain after the stenting procedure, however, the pain was markedly relieved after symptomatic treatment. Conclusion: Esophagotracheal fistula occurred after the stent implantation for stenosis of intrathoracic gastroesophageal anastomotic stoma can be effectively treated by replacing a longer covered stent. (authors)

  19. Iliocaval Confluence Stenting for Chronic Venous Obstructions

    Energy Technology Data Exchange (ETDEWEB)

    Graaf, Rick de, E-mail: r.de.graaf@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Wolf, Mark de, E-mail: markthewolf@gmail.com [Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands); Sailer, Anna M., E-mail: anni.sailer@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Laanen, Jorinde van, E-mail: jorinde.van.laanen@mumc.nl; Wittens, Cees, E-mail: c.wittens@me.com [Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands); Jalaie, Houman, E-mail: hjalaie@ukaachen.de [University Hospital Aachen, Department of Surgery (Germany)

    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.

  20. Risk Factors and Clinical Evaluation of Superficial Femoral Artery Stent Fracture: Prote'ge'GPS Stent

    International Nuclear Information System (INIS)

    To evaluate the occurrence of superficial femoral artery stent fractures, the risk factors of stent fracture, and the relationship between fractures and clinical findings. Of the 38 patients who underwent treatment with Prote'ge'GPS stenting due to arterial occlusions on the superficial femoral artery, 17 also underwent a clinical analysis. Forty-three stents were inserted in the 17 superficial femoral arteries, ranging between 15 and 50 cm in length, with a mean treated length of 26.4 cm (15-50 cm). A fracture was evaluated by taking a PA and lateral simple radiography, as well as a follow-up evaluation accompanied with a CT angiography, DSA, and a color Doppler sonography. The examination involved the assessment of the difference between bone fractures due to length, placement, and frequency. Fractures occurred in 13 of 43 stents (30.2%). A total of 10 (71.4%) occurred in the upper third, compared to 4 (28.6%) in the lower third of the superficial femoral artery. In addition, 10 stents (71.4%) had a single strut fracture, whereas 4 (28.6%) had multiple strut fractures. A stent fracture occurred more frequently when the stents and lesions were longer (p=0.021, 0.012) and the stents were inserted near the joint. However, there was no significant relationship between stent numbers and the fractures (p=0.126). When the stents were inserted along the popliteal artery, a stent fracture occurred more frequently in the lower third of the artery. The stent fractures did not significantly influence the patency rate of the stented artery (p=0.44) Prote'ge'GPS stents in the superficial femoral artery revealed a considerable number of fractures and the fracture frequency showed a significant relationship with the length of stents and lesions. The closer stent insertion was to the joints, the more frequently fractures occurred. There were no evident significant relationships between the presence of stent fractures and the patency of the stented arteries

  1. Removal of an embedded "covered" biliary stent by the "stent-in-stent" technique

    OpenAIRE

    Menon, Shyam

    2013-01-01

    A 46-year-old man was admitted with obstructive jaundice and cross-sectional imaging with computed tomography suggested distal biliary obstruction. A distal common bile duct stricture was found at endoscopic retrograde cholangiopancreatography (ERCP) and cytology was benign. A 6 cm fully covered self-expanding metal stent (SEMS) was inserted across the stricture to optimize biliary drainage. However, the SEMS could not be removed at repeat ERCP a few months later. A further fully covered SEMS...

  2. Crush stenting in treating coronary bifurcate lesions: paclitaxel eluting stents versus sirolimus eluting stents

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; SUN Xue-wen; HU Da-yi; Tak W. Kwan; ZHANG Jun-jie; YE Fei; CHEN Yun-dai; ZHU Zhong-sheng; LIN Song; TIAN Nai-liang; LIU Zhi-zhong; FANG Wei-yi

    2008-01-01

    Background Because no data regarding the comparison of crush stenting with pactitaxel(PES)or sirolimus eluting stents(SES)for coronary bifurcate lesions have been reported,we compared the clinical outcomes of these two types of stents.Methods Two hundred and thirty patients with 242 bifurcate lesions were enrolled in a prospective,nonrandomized trial.Primary endpoints included myocardial infarction,cardiac death and target vessel revascularization at 8 months.Results All patients were followed up clinically and 82%angiographically at 8 months.Final kissing balloon inflation was performed in 72%in the PES and 75%in the SES groups(P>0.05).Compared to the SES group,PES group had a higher late loss and incidence of restenosis(P=0.04)in the prebifurcation vessel segment.The postbifurcation vessel segment in the PES group had a greater late loss((0.7+0.6)mm vs(0.3±0.4)mm,P<0.001)and higher restenosis in the side branch(25.5%vs 15.6%,P=0.04)when compared to the SES group.There was significant difference of insegment restenosis in the entire main vessel between PES and SES groups (P=0.004).Target lesion revascularization was more frequently seen in the PES group as compared to the SES group(P=0.01).There was significant difference in the accumulative MACE between these two groups(P=0.01).The survival rate free from target lesion revascularization was significantly higher in the SES group when compared to the PES group(P<0.001).Conclusion SES is superior to PES in reducing restenosis and target lesion revascularization by 8-month follow-up after crush stenting for bifurcate lesions.

  3. Rescue coronary stenting in acute myocardial infarction

    Science.gov (United States)

    Barbieri, Enrico; Meneghetti, Paolo; Molinari, Gionata; Zardini, Piero

    1996-01-01

    Failed rescue coronary angioplasty is a high risk situation because of high mortality. Coronary stent has given us the chance of improving and maintaining the patency of the artery. We report our preliminary experience of rescue stenting after unsuccessful coronary angioplasty.

  4. Stent Graft in Managing Juxta-Renal Aortoiliac Occlusion

    International Nuclear Information System (INIS)

    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

  5. Direct coronary stenting in reducing radiation and radiocontrast consumption

    International Nuclear Information System (INIS)

    Coronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation. In a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation. Fluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation. If the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation

  6. Basic Knowledge about Metal Stent Development.

    Science.gov (United States)

    Jeong, Seok

    2016-03-01

    Biliary self-expandable metal stents (SEMS), a group of non-vascular stents, have been used in the palliative management of biliary obstruction around the world. However, there are still unmet needs in the clinical application of biliary SEMS. Comprehensive understanding of the SEMS is required to resolve the drawbacks and difficulties of metal stent development. The basic structure of SEMS, including the materials and knitting methods of metal wires, covering materials, and radiopaque markers, are discussed in this review. What we know about the physical and mechanical properties of the SEMS is very important. With an understanding of the basic knowledge of metal stents, hurdles such as stent occlusion, migration, and kinking can be overcome to develop more ideal SEMS. PMID:27000423

  7. Stent graft placement for dysfunctional arteriovenous grafts

    International Nuclear Information System (INIS)

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency

  8. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  9. Call for standards in technical documentation of intracoronary stents.

    Science.gov (United States)

    Lanzer, Peter; Gijsen, Frank J H; Topoleski, L D Timmie; Holzapfel, Gerhard A

    2010-01-01

    At present, the product information of intracoronary stents provided by the industry contains only limited technical data restricting judgments on the in vivo performance of individual products. Available experimental and clinical evidence suggests that interventional target sites display highly heterogeneous biomechanical behavior needed to be matched by specific stent and stent delivery system characteristics. To allow individualized stent-lesion matching, both, understanding of biomechanical properties of the atherosclerotic coronary artery lesions and expert knowledge of the intracoronary stent systems, are required. Here, the authors review some of the initial data on mechanical properties of coronary artery lesions potentially relevant to stenting and suggest standards for technical documentation of intracoronary stents. PMID:20140786

  10. Impacto da insuficiência renal crônica na eficácia de stents farmacológicos: estudo de seguimento de longo prazo

    Directory of Open Access Journals (Sweden)

    Vitor Osório Gomes

    2011-05-01

    Full Text Available FUNDAMENTO: Pacientes com Insuficiência Renal Crônica (IRC submetidos à angioplastia coronária apresentam maiores taxas de revascularização da lesão alvo (RLA e mortalidade. Os stents farmacológicos (SF estão associados com taxas menores de reestenose, quando comparados aos stents não farmacológicos (SNF, embora em pacientes com IRC os dados da eficácia e segurança do SF sejam limitados. OBJETIVO: Buscamos avaliar a segurança e eficácia dos SF em pacientes com IRC significante, quando comparados a pacientes com função renal normal em um registro da "vida real". MÉTODOS: 504 pacientes submetidos à intervenção coronariana percutânea com SF em dois centros foram incluídos. Os desfechos foram estratificados baseados na presença de IRC, definida como taxa de filtração glomerular basal < 60 ml/min/1,73 m². RESULTADOS: O acompanhamento médio foi de 22,7 meses. A IRC estava presente em 165 pacientes (32,7%. Pacientes com IRC eram mais velhos, tinham mais hipertensão e diabete. Pacientes com IRC apresentaram maior incidência de morte (12,3% vs 2,4%, p < 0,001 e infarto do miocárdio (IM (7,4% vs 3,3%, p = 0,04, quando comparados aos pacientes sem IRC. Taxas de RLA foram similares entre os grupos (4.8% vs 5.6%, p = 0,7, pacientes com e sem IRC, respectivamente. Preditores independentes de morte foram a IRC (HR 6,93; 2,4 - 19,5, p < 0,001, tabagismo atual (HR 3,66; 1,20 - 11,10, p = 0,02 e diabete (HR 2,66; 1,3 - 6,60, p = 0,045. CONCLUSÃO: Neste registro, a intervenção coronariana com SF em pacientes com IRC foi associada com RLA similar comparada aos pacientes sem IRC, demonstrando a eficácia dos FS na prevenção da reestenose intra-stent nessa população de pacientes. A IRC foi relacionada a um aumento significativo das taxas de IM e mortalidade.

  11. Stent insertion in patients with malignant biliary obstruction: problems of the Hanaro stent

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jae Hyun; Seong, Chang Kyu; Shin, Tae Beom; Kim, Yong Joo [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of); Jung, Gyoo Sik [School of Medicine, Kosin National Univ., Pusan (Korea, Republic of); Park, Byeung Ho [School of Medicine, Donga National Univ., Pusan (Korea, Republic of)

    2002-07-01

    To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. Among the five patients who encountered problems, breakage of the olive tip occourred in three, upward displacement of the stent in two, and improper expansion of the distal portion of the stent, unrelated with the obstruction site, in one. The broken olive tip was pushed to the duodenum in two cases and to the peripheral intrahepatic duct in one. Where the stent migrated during withdrawal of its introduction system, an additional stent was inserted. In one case, the migrated stent was positioned near the liver capsule and the drainage catheter could not be removed. Although the number of patients in this study was limited, some difficulties were encountered in withdrawing the stent's introduction system. To prevent the occurrence of this unusual complication, the stent should be appropriately expansile, and shape in the olive tip should be considered.

  12. Stent insertion in patients with malignant biliary obstruction: problems of the Hanaro stent

    International Nuclear Information System (INIS)

    To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. Among the five patients who encountered problems, breakage of the olive tip occourred in three, upward displacement of the stent in two, and improper expansion of the distal portion of the stent, unrelated with the obstruction site, in one. The broken olive tip was pushed to the duodenum in two cases and to the peripheral intrahepatic duct in one. Where the stent migrated during withdrawal of its introduction system, an additional stent was inserted. In one case, the migrated stent was positioned near the liver capsule and the drainage catheter could not be removed. Although the number of patients in this study was limited, some difficulties were encountered in withdrawing the stent's introduction system. To prevent the occurrence of this unusual complication, the stent should be appropriately expansile, and shape in the olive tip should be considered

  13. Functional Self-Expandable Metal Stents in Biliary Obstruction

    OpenAIRE

    Kwon, Chang-Il; Ko, Kwang Hyun; Hahm, Ki Baik; Kang, Dae Hwan

    2013-01-01

    Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each st...

  14. Indications and Problems of Intracranial Stenting: Report of Two Cases

    OpenAIRE

    Deguchi, J.; Kuroiwa, T; Nagasawa, S; Satoh, G.; T. Ohta

    2000-01-01

    There have been few reports of stenting in the intracranial arteries. We used coronary stents in the chronically occluded intracranial vertebral artery and stenosis of internal carotid artery by the external force, and good blood flow were resumed. Stenosis in the intracranial arteries is also a good indication for stent placement when it is due to chronic total occlusion or artery compression by external force. But stent placement in the intracranial arteries has some problems. Stent placeme...

  15. New stent developments for peripheral arterial occlusive disease

    International Nuclear Information System (INIS)

    Infrainguinal peripheral occlusive disease is increasingly being treated by endovascular techniques. Bare metal stainless steel, self-expanding nitinol stents, drug-eluting and covered stents (stent grafts) are becoming increasingly more important adjuncts to percutaneous translumninal angioplasty in the treatment of peripheral artery disease. In this article the available evidence supporting the use of stents in the femoropopliteal and tibial arteries will be described as well as their limitations. Future stent developments will also be discussed. (orig.)

  16. Qualidade de vida após revascularização cirúrgica do miocárdio, angioplastia ou tratamento clínico Quality of life after surgical myocardial revascularization, angioplasty or medical treatment

    Directory of Open Access Journals (Sweden)

    Myrthes Emy Takiuti

    2007-05-01

    Full Text Available FUNDAMENTO: Ainda que os benefícios clínicos das intervenções coronarianas parecem confirmados, seus efeitos na qualidade de vida (QV permanecem pouco estudados. OBJETIVO: Avaliar a qualidade de vida (QV na doença multiarterial coronariana em pacientes submetidos randomicamente a cirurgia, angioplastia ou tratamento clínico. MÉTODOS: Foi utilizando Short-Form Health Survey (SF36 questionnaire em 483 pacientes. Desses, 161 foram revascularizados; 166 receberam angioplastia e 153 tiveram tratamento clínico. RESULTADOS: Na internação, 86% referiam angina; 34%, infarto; e 32% fumavam. Tratamento clínico: 12 pacientes (7,7% tiveram infarto agudo do miocárdio (IAM; 24 (15,3% receberam cirurgia; e 19 (12,1% morreram. Além disso, cinco (3,2% sofreram AVC e 40 (25,6% tinham angina. No componente mental, 64,1% melhoram e 30,8% pioram a condição. No componente físico, 70,5% melhoram e 27,6% pioram a condição. Cirurgia: 13 pacientes (8,1% tiveram IAM, dois (1,2% receberam cirurgia; 12 (7,4% morreram. Em adição, nove (5,6% sofreram AVC e 30 (18,6% sofriam angina. No componente mental, 72,7% melhoram e 25,5% pioram a condição. No componente físico, 82,6% melhoram e 16,1% pioram a condição. Angioplastia: 18 pacientes (10,9% tiveram IAM, 51 (30,7% receberam intervenções e 18 (19,9% morreram. Além disso, seis (3,6% sofreram AVC e 35 (21% relatavam angina. No componente mental, 66,9% melhoram e 26,5% pioram a condição No componente físico, 77,1% melhoram e 20,5% pioram a condição. CONCLUSÃO: Observou-se melhora em todos os domínios e nas três opções terapêuticas. Comparativamente, a cirurgia ofereceu melhor qualidade de vida após quatro anos de seguimento.BACKGROUND: Although the clinical benefits of coronary interventions seem to be confirmed, their effects on quality of life (QoL are still scarcely studied. OBJECTIVE: To assess the QoL in multivessel coronary disease in patients randomly undergoing surgery, angioplasty or

  17. ANGIOPLASTIA DE RESCATE EN MUJER DE 33 AÑOS CON ANTICONCEPCIÓN ORAL Y CORONARIOPATÍA DILATADA / Rescue angioplasty in a 33-year old woman with oral contraception and dilated coronariopathy

    Directory of Open Access Journals (Sweden)

    Francisco L Moreno-Martínez

    2009-09-01

    Full Text Available Coronary angioplasty is recognized nowadays as the first-choice therapeutic strategy for acute coronary syndrome with ST-segment elevation. Atherosclerotic disease is still the main cause ofthis sickness; however, other disturbances, such is dilated coronariopathy, may favor this coronary event. Although some authors raise that atherosclerosis is the main cause of coronary dilation, it is uncommon that this lipid disorder promotes consequences early in life. We present the case of a 33-year-old female (oral contraceptive user - etinor who had not any apparent coronary risk factor but suffered from inferior acute myocardial infarction. The thrombolysis failed, and fortunately we could perform the angioplasty. Intracoronary thrombosis with distal embolism occurred, that waswhy we administered streptokinase. Possible mechanisms that involve oral contraceptives and dilated coronariopathy are discussed, and angiographic images are shown.

  18. The Supralimus sirolimus-eluting stent.

    Science.gov (United States)

    Lemos, Pedro A; Bienert, Igor

    2013-05-01

    The use of biodegradable polymeric coatings has emerged as a potential bioengineering target to improve the vascular compatibility of coronary drug-eluting stents (DESs). This review summarizes the main features and scientific facts about the Supralimus sirolimus-eluting stent (Sahajanand Medical Technologies Ltd, Surat, India), which is a biodegradable polymer-based, sirolimus-eluting metallic stent that was recently introduced for routine use in Europe. The novel stent is built on a stainless steel platform, coated with a blend of biodegradable polymers (poly-l-lactide, poly-dl-lactide-co-glycolide and polyvinyl pyrrolidone; coating thickness is 4-5 µm). The active agent is the antiproliferative sirolimus in a dose load of 1.4 µg/mm(2), which is released within 48 days. The Supralimus stent was initially evaluated in the single-arm SERIES-I study, which showed binary angiographic restenosis rates of 0% (in-stent) and 1.7% (in-segment) and an in-stent late lumen loss of 0.09 ± 0.28 mm. The multicenter randomized PAINT trial compared two DESs with identical metallic platforms and biodegradable polymer carriers, but different agents (Infinnium [Sahajanand Medical Technologies Pvt Ltd] paclitaxel-eluting stent or Supralimus sirolimus-eluting stent) against bare stents. After 3 years, the pooled DES population had similar rates of cardiac death or myocardial infarction (9 vs 7.1%; p = 0.6), but a lower risk of repeat interventions (10 vs 29.9%; p < 0.01) than controls with bare stents. The incidence of definite or probable stent thrombosis in the pooled DES group was 2.3% (1st year: 1.8%; 2nd year: 0.4% and 3rd year: 0%). These results demonstrate that the novel Supralimus stents are effective in reducing reintervention, while potentially improving the safety profile by decreasing the risk of late-term thrombosis, even though further studies would be necessary to confirm these findings. PMID:23597097

  19. Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice

    Science.gov (United States)

    Weinandy, Stefan; Schreiber, Fabian; Megens, Remco T. A.; Theelen, Wendy; Smeets, Ralf; Jockenhövel, Stefan; Gries, Thomas; Möller, Martin; Klee, Doris; Weber, Christian; Zernecke, Alma

    2016-01-01

    Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG), and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal) were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs) and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches. PMID:27192172

  20. Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice.

    Directory of Open Access Journals (Sweden)

    Sakine Simsekyilmaz

    Full Text Available Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG, and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches.

  1. Acute stent thrombosis after bifurcation stenting with the crush technique visualized with 64-slice computed tomography

    DEFF Research Database (Denmark)

    Kristensen, T.S.; Engstrom, T.; Kofoed, Klaus Fuglsang

    2008-01-01

    Acute stent thrombosis remains a potential complication after stent implantation. With the introduction of electrocardiographic gated multidetector row computed tomography (MDCT), a new nonnvasive imaging modality has become available that may contribute to the detection of complications after co...... complex interventional procedures. We present a case where CT angiography was performed just prior to the clinical presentation of acute stent thrombosis in a 55-year-old male who was treated with the crush technique in a bifurcation lesion Udgivelsesdato: 2008/7...

  2. Biolimus-eluting stents with biodegradable polymer versus bare-metal stents in acute myocardial infarction

    DEFF Research Database (Denmark)

    Räber, Lorenz; Kelbæk, Henning; Taniwaki, Masanori;

    2014-01-01

    BACKGROUND: This study sought to determine whether the 1-year differences in major adverse cardiac event between a stent eluting biolimus from a biodegradable polymer and bare-metal stents (BMSs) in the COMFORTABLE trial (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Meta......, BES continued to improve cardiovascular events compared with BMS beyond 1 year. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NTC00962416....

  3. Is provisional stenting the effective option? The WIDEST study (Wiktor stent in de novo stenosis)

    OpenAIRE

    Fluck, D.; Chenu, P; Mills, P; Davies, A; Street, J.; Paul, E; Balcon, R; Layton, C; Investigators', G

    2000-01-01

    AIM—To compare the immediate and late outcomes of patients treated by a policy of routine stent implantation with routine balloon angioplasty and the use of stents only when an ideal result has not been obtained.
METHODS—A nine centre, multinational, randomised study of 300 patients with coronary artery disease thought suitable for treatment of a single lesion by balloon angioplasty or stent implantation. Only new lesions in patients who had not undergone previous bypass surgery were included...

  4. Treatment of Post-Stent Gastroesophageal Reflux by Anti-Reflux Z-Stent

    International Nuclear Information System (INIS)

    Severe symptoms of heartburn and retrosternal pain consistent with gastro-esophageal reflux (GER) developed in a patient following placement of a conventional self-expanding 16-24-mm-diameter x 12-cm-long esophageal stent across the gastroesophageal junction to treat an obstructing esophageal carcinoma. A second 18-mm-diameter x 10-cm-long esophageal stent with anti-reflux valve was deployed coaxially and reduced symptomatic GER immediately. Improvement was sustained at 4-month follow-up. An anti-reflux stent can be successfully used to treat significant symptomatic GER after conventional stenting

  5. Clinical application of mouth-retrofitted stent in prevention of esophageal restenosis after esophageal stent implantation

    International Nuclear Information System (INIS)

    Objective: to evaluate the mouth-retrofitted stent in preventing esophageal restenosis after esophageal stent implantation, and to discuss its safety in clinical use. Methods: Mouth-retrofitted stent implantation was carried out in 10 patients with pathologically and radiologically confirmed esophageal carcinoma. The mouth part of the stent used in the treatment was covered with silica gel membrane. After the treatment, the patients were followed up monthly to determine the severity of dysphagia, which was assessed by using Stooler's score, X-ray. Chest CT scanning and esophagography were performed to observe the location of the stent and to clarify if there was any obstruction. The gastroscopy was bimonthly performed in all patients to see whether or not stent restenosis occurred. If stent restenosis occurred, biopsy examination was used in order to determine its etiology. During the follow-up period, the related complications such as serious chest pain, hemorrhage, pneumonia, trancheoesophageal fistula, etc. were closely observed. Results: All the 10 patients were followed up for 4∼10 months. The Stooler's score for dysphagia was 0 to 1 grade in 9 cases. The severity of dysphagia was gradually increased in one case and its grade reached 3 at 5 months after the procedure. After operation, no stent migration occurred in 9 cases; in 1 case who had received treatment with the stent loaded with 125I seeds the stent migrated into the stomach after 8 months although both esophagography and gastroscopy showed that the esophageal inner wall of the former stenotic lumen was smooth with no stenosis. In the patient who had gradual increased dysphagia, chest CT scanning showed that the lesion exceeded the superior edge of stent, and both esophagography and gastroscopy confirmed that the restenosis was caused by tumor proliferation. In the remaining 8 patients, the length of lesions was not obviously increased, and the mouth part of the stent showed no stenosis

  6. Self-expanding stents in transjugular intrahepatic portosystemic shunt: experience with nitinol Strecker stents.

    Science.gov (United States)

    Rossi, P; Bezzi, M; Salvatori, F M; Broglia, L; Maccioni, F; Pizzi, G; Abbondanza, S; Bonomo, G

    1996-01-01

    The aim of our study was to evaluate the performance and efficacy of a new self-expanding stent (nitinol Strecker stent) in the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We have successfully placed 64 nitinol Strecker stents in 48 patients. The average portosystemic gradient decreased from 22 to 11 mm Hg. Balloon dilatation was necessary in 12 of 35 angiographically controlled cases at 5 days (34%), because of incomplete stent expansion, small thrombi within the stent or obstruction. At 1-6 months stent malfunctions occurred in 8 of 23 patients who underwent control angiography (34%) and at 6-24 months in 6 of 7 patients (85%). Rebleeding occurred in 2 of 39 patients (follow-up > 1 month) (5%) and temporary crises of de novo encephalopathy were observed in 11 of 48 patients (23%). Refractory ascites completely resolved in 4 of 6 patients (66%) and improved in the remaining 2 cases. Compared with other self-expanding stents, nitinol Strecker stents seem to be equally effective in TIPS; no increase in complication rate was observed, either clinical or stent-related. PMID:8934143

  7. Development and assessment of 316LVM cardiovascular stents

    Energy Technology Data Exchange (ETDEWEB)

    Raval, Ankur [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India)]. E-mail: ankur.med@sahmed.com; Choubey, Animesh [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India); Engineer, Chhaya [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India); Kothwala, Devesh [Research and Development Division, Sahajanand Medical Technologies, Surat 395003 (India)

    2004-11-25

    One of the most common causes for heart failure is vasoconstriction. The medical procedure for alleviating vasoconstriction, angioplasty, calls for intracoronary stents. And the manufacture of intracoronary stents demands absolutely unmatched precision. Current study investigates CNC controlled pulsed Nd:YAG (neodymium:yttrium aluminium garnet) laser for cutting complex geometry of a stent on 316LVM tubings. It has been shown that surface quality of cardiovascular stents has a significant influence on biocompatibility. Therefore, optimal method and parameters for acid pickling of these slotted tube laser cut stents were explored, as a pretreatment for electropolishing. Pickling was necessary prior to electropolishing for removing the oxide films covering the stent surface. An optimal condition for electrochemical polishing could also be established and it caused a smooth stent surface. Passivation of these electropolished stents was done. Furthermore, materials characterization of stents was performed by means of composition and microstructural analysis.

  8. Implante de stents farmacológicos na artéria descendente anterior: indicadores de eventos tardios Implante de Stents farmacológicos en la arteria descendente anterior: indicadores de eventos tardíos Pharmacological stent deployment in the left anterior descending artery: late event indicators

    Directory of Open Access Journals (Sweden)

    Marcelo de Freitas Santos

    2009-01-01

    ógicos en las lesiones ateroscleróticas de la arteria descendente anterior e identificar, entre las características clínicas, angiográficas y de ultrasonido intravascular, cuales son las que permiten predecir riesgos de eventos cardiacos MÉTODOS: De mayo de 2002 a agosto de 2005, se trataron a 205 pacientes con implante de 236 stents farmacológicos guiados por ultrasonido intravascular. RESULTADOS: Con un seguimiento promedio de 711 días, la tasa de trombosis del stent fue del 0,48%, la misma que se observó para infarto agudo de miocardio o cirugía de revascularización. La tasa de revascularización de la lesión tratada fue del 7,31% y la tasa global de eventos fue del 10,24%. Los indicadores de eventos, conforme análisis multivariada, fueron el implante de más de un stent en la misma arteria, lesiones concéntricas y área mínima intrastent medida por el ultrasonido intravascular menor que 3,88 mm². CONCLUSIÓN: Tomando como base los datos obtenidos con esta investigación, concluimos que la revascularización de la arteria descendente anterior con implante de stents farmacológicos, elegidos y optimizados por el ultrasonido intravascular, presenta un bajo índice de eventos tardíos. El implante de dos stents farmacológicos para el tratamiento de las lesiones largas fue el principal factor independiente para la ocurrencia de eventos tardíos. El área luminal final mayor que 3,88 mm², obtenida en los segmentos de pequeños diámetros de referencia es un indicador independiente de evolución libre de eventos.BACKGROUND: The efficacy of pharmacological stents in decreasing the incidence of cardiac events is not homogeneous for all lesions or patient subgroups. OBJECTIVE: 1 To evaluate the late clinical evolution of patients submitted to pharmacological stent implantation in atherosclerotic lesions of the left anterior descending artery; 2 to identify, among the clinical, angiographic and intravascular ultrasonographic characteristics, the ones predictive of

  9. Renal artery stent angioplasty for renovascular hypertension

    International Nuclear Information System (INIS)

    Objective: To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods: 15 patients (10 men and 5 women, 41-75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent angioplasty including renal arterial stenosis 89%(n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of fluoroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinical and angiographic follow up. Results: Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up (6-15 months; mean, 8 ± 4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12 ± 3.09 kPa to 18.62 ± 3.12 kPa and the average diastolic blood pressure decreased from 17.73 ± 1.92 kPa to 11.12 ± 2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60% (n=9) patients with improvement in 33% (n=5) and worsened in 6% (n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions: Percutaneous transluminal stent placement is highly beneficial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals wide prospects for interventional method. (authors)

  10. Vessel wall reactions to endovascular stent implantation

    OpenAIRE

    van Beusekom, Heleen

    1993-01-01

    textabstractIn order to gain insight in the effects of stenting, we studied the process of wound healing and the short- and long-term effect of these permanently present foreign bodies. Both thrombogenic and less thrombogenic metals were evaluated with respect to thrombogenicity and tissue response. Synthetic polymers were evaluated with respect to improving the haemocompatibility and tissue-compatibility profile of these devices. Stenting of normal porcine arteries. In Chapter 2, a balloon-e...

  11. Bilateral Metallic Stenting in Malignant Hilar Obstruction

    OpenAIRE

    Lee, Tae Hoon; Moon, Jong Ho; Park, Sang-Heum

    2014-01-01

    Endoscopic palliative biliary drainage is considered as a gold standard treatment in advanced or inoperable hilar cholangiocarcinoma. Also, metal stents are preferred over plastic stents in patients with >3 months life expectancy. However, the endoscopic intervention of advanced hilar obstruction is often more challenging and complex than that of distal malignant biliary obstructions. In this literature review, we describe the issues commonly encountered during endoscopic unilateral (single) ...

  12. Malignant biliary obstruction treated with metallic stents

    International Nuclear Information System (INIS)

    Purpose: The outcome of 33 patients with malignant biliary obstruction treated with metallic stents is presented. Materials and methods: Thirty-eight biliary metallic stents were placed in 33 patients with malignant biliary obstruction. They were 52-71 years old (mean = 61.7); 23 were male and 10 were female. The biliary obstruction was caused by biliary carcinoma (n = 16), pancreatic carcinoma (n = 2), hepatoma (n = 2), metastasis in liver (n = 3) and lymph node metastasis (n = 10). Six types and 38 metallic stents were used. After stentering, 3 cases were treated with intrastent brachytherapy, 7 cases treated with external radiotherapy and 2 patients treated with interventional radiology. Patients were followed for 6-28 months, mean 11 months. Results: Stent placement was successful in all 33 cases. The same time, 4 patients were treated with plastic tube for external drainage only. The successful rate was 90%. Twenty-nine patients were placed in one time, 4 cases began with plastic tube which was replaced with metallic stents after 1-2 weeks. Nine had metallic stents and plastic tube, because of complicated obstruction. The external drainage catheters were removed after 15-200 days. Three patients had stents crossing the ampulla. In 28 cases (84.85%), jaundice was reduced satisfactorily while in 5 cases with complicated biliary obstruction, the result was unsatisfactory. The median survival was 7 months. After stentering, 12 cases were treated with locat chemotherapy, brachytherapy or radiotherapy. The median survival period was 10 months. Conclusion: The metallic stent provides good palliative drainage and is well tolerated by patients. It improves the survival rate when combined with radiotherapy, brachytherapy and chemotherapy in patients with malignant biliary obstruction

  13. Nasolacrimal Polyurethane Stent: Complications with CT Correlation

    International Nuclear Information System (INIS)

    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

  14. Intracoronary stents: clinical and angiographic results.

    Science.gov (United States)

    Popma, J J; Ellis, S G

    1990-10-01

    Limitations of current forms of coronary angioplasty including abrupt vessel closure and delayed restenosis have led to the development of alternative nonsurgical methods of coronary revascularization. By scaffolding the arterial dissection and smoothing the endoluminal surface, intracoronary stenting may obviate the need for emergency coronary bypass surgery in patients who develop abrupt vessel closure following coronary angioplasty. As primary therapy, its use may prevent or delay restenosis in high-risk patients; however, due to potential patient selection bias, controlled studies are needed. Currently available intracoronary stents are limited by varying degrees of inflexibility, radiolucency, and thrombogenicity. These limitations have resulted in the development of innovative stent designs using radioopaque tantalum filaments and aggressive pharmacologic treatment with antiplatelet and anti-thrombotic therapy following stent deployment. Current experimental investigation into the feasibility of intracoronary stent coating with genetically engineered endothelial cells or slow release antiproliferative agents, such as colchicine or methotrexate, may further serve to lessen the frequency of late restenosis. The optimal patient selection criteria for the use of the intracoronary stent is currently the subject of intense clinical investigation. PMID:2227766

  15. 4D phase contrast flow imaging for in-stent flow visualization and assessment of stent patency in peripheral vascular stents – A phantom study

    International Nuclear Information System (INIS)

    Purpose: 4D phase contrast flow imaging is increasingly used to study the hemodynamics in various vascular territories and pathologies. The aim of this study was to assess the feasibility and validity of MRI based 4D phase contrast flow imaging for the evaluation of in-stent blood flow in 17 commonly used peripheral stents. Materials and methods: 17 different peripheral stents were implanted into a MR compatible flow phantom. In-stent visibility, maximal velocity and flow visualization were assessed and estimates of in-stent patency obtained from 4D phase contrast flow data sets were compared to a conventional 3D contrast-enhanced magnetic resonance angiography (CE-MRA) as well as 2D PC flow measurements. Results: In all but 3 of the tested stents time-resolved 3D particle traces could be visualized inside the stent lumen. Quality of 4D flow visualization and CE-MRA images depended on stent type and stent orientation relative to the magnetic field. Compared to the visible lumen area determined by 3D CE-MRA, estimates of lumen patency derived from 4D flow measurements were significantly higher and less dependent on stent type. A higher number of stents could be assessed for in-stent patency by 4D phase contrast flow imaging (n = 14) than by 2D phase contrast flow imaging (n = 10). Conclusions: 4D phase contrast flow imaging in peripheral vascular stents is feasible and appears advantageous over conventional 3D contrast-enhanced MR angiography and 2D phase contrast flow imaging. It allows for in-stent flow visualization and flow quantification with varying quality depending on stent type

  16. Computational Study of Axial Fatigue for Peripheral Nitinol Stents

    Science.gov (United States)

    Meoli, Alessio; Dordoni, Elena; Petrini, Lorenza; Migliavacca, Francesco; Dubini, Gabriele; Pennati, Giancarlo

    2014-07-01

    Despite their success as primary treatment for vascular diseases, Nitinol peripheral stents are still affected by complications related to fatigue failure. Hip and knee movements during daily activities produce large and cyclic deformations of the superficial femoral artery, that concomitant to the effects of pulsatile blood pressure, may cause fatigue failure in the stent. Fatigue failure typically occurs in cases of very extended lesions, which often require the use of two or more overlapping stents. In this study, finite element models were used to study the fatigue behavior of Nitinol stents when subjected to cyclic axial compression in different conditions. A specific commercial Nitinol stent was chosen for the analysis and subjected to cyclic axial compression typical of the femoral vascular region. Three different configurations were investigated: stent alone, stent deployed in a tube, and two overlapping stents deployed in a tube. Results confirm that stent oversizing has an influence in determining both the mean and amplitude strains induced in the stent and plays an important role in determining the fatigue response of Nitinol stents. In case of overlapping stents, numerical results suggest higher amplitude strains concentrate in the region close to the overlapping portion where the abrupt change in stiffness causes higher cyclic compression. These findings help to explain the high incidence of stent fractures observed in various clinical trials located close to the overlapping portion.

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

    Directory of Open Access Journals (Sweden)

    Le K

    2014-09-01

    Full Text Available Kim Le, Hady Saheb Department of Ophthalmology, McGill University, Montreal, QC, Canada Abstract: 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. Keywords: iStent, trabecular micro-bypass, glaucoma, MIGS, ab interno, surgery

  18. Current status of radioactive stents for the prevention of in-stent restenosis

    International Nuclear Information System (INIS)

    Purpose: The objective of this paper was to provide an update on the clinical and experimental evaluation of radioactive stents for the prevention of restenosis. Materials and Methods: Direct ion implantation of 32P onto the surface of a 15-mm length balloon expandable stainless-steel Palmaz-Schatz stent was employed to render this commercially available vascular stent radioactive. 32Phosphorous, a pure beta-particle-emitting radioisotope, was selected because of its short half-life (14.3 days) and limited range of tissue penetration (3-4 mm). The vascular response to radioactive 7-mm length Palmaz-Schatz stents with activities 0.14 to 23 μCi of 32P were evaluated in animal models of arterial injury and restenosis. The Phase-1 isostent for restenosis intervention study (IRIS trial) was a nonrandomized safety trial designed to evaluate the use of a low activity 32P (0.5 to 1.5 μCi) 15-mm length Palmaz-Schatz stent for the treatment of de novo or restenosis native coronary arterial lesions. Results: In the porcine coronary restenosis model, at ≤0.5 μCi and ≥3.0 μCi stent activities, there was a 30% reduction in the neointimal and percent area stenosis as compared to nonradioactive stents. The 1.0 μCi stents, however, had nearly 2-fold greater neointimal formation and more luminal narrowing than the control stents. In the Phase 1 IRIS trial, 57 patients with symptomatic de novo or restenosis native coronary lesions have been treated with low activity (0.5 to 1.5 μCi) 32P Palmaz-Schatz coronary stents. Fifty-seven stents were successfully implanted without a major procedural complication (death, urgent coronary bypass, Q-wave myocardial infarction). There were no cases of stent thrombosis, target vessel revascularization, or other adverse events in the first 30 days after implant. Conclusion: The early clinical results with a low-activity 32P Palmaz-Schatz radioactive stent demonstrate sufficient procedural and 30-day event-free survival to warrant

  19. Fracture of Memotherm Metallic Stents in the Biliary Tract

    International Nuclear Information System (INIS)

    In a series of 66 patients who had palliation of malignant obstructive jaundice by percutaneous placement of Memotherm expanding metal stents, we report four cases of stent fracture. This has not been reported previously

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

    International Nuclear Information System (INIS)

    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

  1. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available INNOVATIONS IN STROKE PREVENTION: AN UPDATE ON CAROTID STENTING NEW YORK-PRESBYTERIAN HOSPITAL NEW YORK, NY July ... MD: Good evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. ...

  2. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... important thing also is that with the current role of using carotid stent angioplasty, we can get ... study results are pending, which will determine the role of carotid stenting in the healthier patients, the ...

  3. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... called a sheath, we can then place a filter, or cerebral protection device, to prevent any small ... very stable environment to pass balloon stents and filters during the carotid stent angioplasty. The cerebral protection ...

  4. Very late bare-metal stent thrombosis, rare but stormy!

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2011-08-01

    Recurrent in-stent thrombosis is rarely reported, with catastrophic clinical consequences of either acute coronary syndrome or death. We present a case of recurrent in-stent thrombosis with its outcome and a concise literature review.

  5. Stents

    Science.gov (United States)

    ... Topics Aneurysm Carotid Artery Disease Coronary Heart Disease Percutaneous Coronary Intervention Peripheral Artery Disease Send a link to NHLBI ... an artery as part of a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty. PCI restores ...

  6. Radiotherapy Prolongs Biliary Metal Stent Patency in Malignant Pancreatobiliary Obstructions

    OpenAIRE

    Park, Semi; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Chung, Jae Bock; Song, Si Young

    2013-01-01

    Background/Aims Biliary stenting is the most effective decompressive method for treating malignant biliary obstructive jaundice. Although the main cause of stent occlusion is tumor growth, few studies have investigated whether stent patency is affected by the combination of cancer-treatment modalities. The aim of this study was to evaluate the effects of local radiotherapy on metal-stent patency in patients with malignant biliary obstruction. Methods Patients who underwent self-expandable bil...

  7. Evaluation of different percutaneous modalities for managing malfunctioning biliary stents

    OpenAIRE

    M. Alwarraky; A. Aljaky; E. Tharwa; Aziz, A.

    2015-01-01

    Background: There is no consensus regarding optimal management of biliary metal stent occlusion. Aim: To evaluate the efficacy of different percutaneous methods for managing biliary metal stent occlusion. Patients and methods: Thirty-eight patients were included in the study. Metal biliary stent occlusions were managed by insertion of another metal stent in 18 patients (group 1), insertion of an internal–external catheter in 15 patients (group 2), and mechanical cleaning in 5 patients (...

  8. Metal stents: a bridge to surgery in hilar cholangiocarcinoma

    OpenAIRE

    Grünhagen, Dirk J.; Dunne, Declan FJ; Sturgess, Richard P; Stern, Nick; Hood, Stephen; Fenwick, Stephen W; Poston, Graeme J; Malik, Hassan Z

    2012-01-01

    Background Obstructive jaundice in patients with hilar cholangiocarcinoma is a known risk factor for hepatic failure after liver resection. Plastic stents are most widely used for preoperative drainage. However, plastic stents are known to have limited patency time and therefore, in palliative settings, the self-expanding metal stent (SEMS) is used. This type of stent has been shown to be superior because it allows for rapid biliary decompression and a reduced complication rate after insertio...

  9. Monitoring the Wall Mechanics During Stent Deployment in a Vessel

    OpenAIRE

    Steinert, Brian D.; Zhao, Shijia; Gu, Linxia

    2012-01-01

    Clinical trials have reported different restenosis rates for various stent designs1. It is speculated that stent-induced strain concentrations on the arterial wall lead to tissue injury, which initiates restenosis2-7. This hypothesis needs further investigations including better quantifications of non-uniform strain distribution on the artery following stent implantation. A non-contact surface strain measurement method for the stented artery is presented in this work. ARAMIS stereo optical su...

  10. A Migrated Aortic Stent Graft Causing Erosive Spondylopathy

    Energy Technology Data Exchange (ETDEWEB)

    Gestrich, Christopher, E-mail: christopher.gestrich@ukb.uni-bonn.de; Probst, Chris, E-mail: chris.probst@ukb.uni-bonn.de [Universitaetsklinikum Bonn, Department of Cardiac Surgery (Germany); Wilhelm, Kai, E-mail: kai.wilhelm@ek-bonn.de [Johanniterkrankenhaus Bonn, Department of Radiology (Germany); Schiller, Wolfgang, E-mail: wolfgang.schiller@ukb.uni-bonn.de [Universitaetsklinikum Bonn, Department of Cardiac Surgery (Germany)

    2013-12-15

    We report about a patient presenting with back pain 4 months after an uneventful endovascular implantation of an aortic stent graft. Computed tomography scan revealed a migration of the stent with consecutive endoleakage, kink formation, and movement of the stent toward the spine, which caused destruction of the aortic wall as well as vertebral necrosis. Explantation of the stent and replacement of the native aorta relieved the patient of his symptoms.

  11. Simulation of stent deployment in a realistic human coronary artery

    OpenAIRE

    van der Steen Anton FW; Wentzel Jolanda J; Thury Attila; Petrini Lorenza; Socci Laura; Schievano Silvia; Migliavacca Francesco; Gijsen Frank JH; Serruys Patrick WS; Dubini Gabriele

    2008-01-01

    Abstract Background The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis. Methods 3D recon...

  12. Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

    OpenAIRE

    Rademakers, L. M.; Dewilde, W.; van de Kerkhof, D

    2011-01-01

    A 57-year-old male patient without cardiovascular history suffered an acute myocardial infarction and underwent drug-eluting stent implantation in the left anterior descending artery. A few days later, the right coronary artery was also stented (drug-eluting stent). Three days later, he was re-admitted to our hospital in cardiogenic shock. Emergent coronary angiography showed total occlusion of both stents. Platelet function analysis (PFA) showed attenuated platelet inhibition in response to ...

  13. Metallic Stents for Tracheobronchial Pathology Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Serrano, Carolina, E-mail: carolina.serrano@unizar.es [University of Zaragoza, Surgical Pathology Unit, Animal Pathology Department (Spain); Laborda, Alicia, E-mail: alaborda@unizar.es [University of Zaragoza, Minimally Invasive Techniques Research Group (GITMI) (Spain); Lozano, Juan M., E-mail: juamauloz@gmail.com [Marly Clinic, Radiology Department (Colombia); Caballero, Hugo, E-mail: hugocaballero2007@gmail.com [Marly Clinic, Pulmonology Department (Colombia); Sebastian, Antonio, E-mail: antonio.sebastian@ono.es [Lozano Blesa Clinical University Hospital, Pulmonology Department (Spain); Lopera, Jorge, E-mail: lopera@uthscsa.edu [Health Science Center, Interventional Radiology Deparment (United States); Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [University of Zaragoza, Minimally Invasive Techniques Research Group (GITMI) (Spain)

    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.

  14. Flow disturbances in stent-related coronary evaginations

    DEFF Research Database (Denmark)

    Radu, Maria D; Pfenniger, Aloïs; Räber, Lorenz; de Marchi, Stefano F; Obrist, Dominik; Kelbæk, Henning; Windecker, Stephan; Serruys, Patrick W; Vogel, Rolf

    2014-01-01

    Aims: Angiographic ectasias and aneurysms in stented segments have been associated with late stent thrombosis. Using optical coherence tomography (OCT), some stented segments show coronary evaginations reminiscent of ectasias. The purpose of this study was to explore, using computational fluid-dynamic...

  15. Modelling and simulating in-stent restenosis with complex automata

    NARCIS (Netherlands)

    A.G. Hoekstra; P. Lawford; R. Hose

    2010-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata Model for in-stent restenosis, coupling bulk flow, drug diffusion, and s

  16. Biocompatibility of phosphorylcholine coated stents in normal porcine coronary arteries

    NARCIS (Netherlands)

    D.M. Whelan (Deirdre); S.C. Krabbendam; P.D. Verdouw (Pieter); P.W.J.C. Serruys (Patrick); E.A. van Vliet (Erwin); W.J. van der Giessen (Wim); H.M.M. van Beusekom (Heleen)

    2000-01-01

    textabstractOBJECTIVE: To improve the biocompatibility of stents using a phosphorylcholine coated stent as a form of biomimicry. INTERVENTIONS: Implantation of phosphorylcholine coated (n = 20) and non-coated (n = 21) stents was performed in the coronary arteries of 25 pigs. The an

  17. Treatment of ureterovaginal fistula using a Memokath stent

    DEFF Research Database (Denmark)

    Mohammad, Wael; Fode, Mikkel Mejlgaard; Azawi, Nessn Htum

    2014-01-01

    with the insertion of a Memokath 051 stent (PNN Medical A/S, Denmark), which is a thermoexpandable, nickel-titanium alloy stent. The patient has been totally continent during a follow-up period of 3 years. The Memokath stent has been changed twice within this period due to dysfunction....

  18. Intraluminal tracheal stent fracture in a Yorkshire terrier

    OpenAIRE

    WOO, Heung-Myong; Kim, Mi-Jeong; Lee, Seung-Gon; Nam, Hyun-Sook; Kwak, Ho-Hyun; Lee, Joon-Seok; Park, In-Chul; Hyun, Changbaig

    2007-01-01

    An 8-year-old Yorkshire terrier was presented with tracheal collapse. Two intraluminal nitinol stents were implanted. The implanted stents were found to be fractured 4 weeks after implantation. The fractured stents were removed. To restore the collapsed trachea, ring prostheses were applied. However, the dog was euthanized because of a bad outcome following surgery.

  19. Intraluminal tracheal stent fracture in a Yorkshire terrier.

    Science.gov (United States)

    Woo, Heung-Myong; Kim, Mi-Jeong; Lee, Seung-Gon; Nam, Hyun-Sook; Kwak, Ho-Hyun; Lee, Joon-Seok; Park, In-Chul; Hyun, Changbaig

    2007-10-01

    An 8-year-old Yorkshire terrier was presented with tracheal collapse. Two intraluminal nitinol stents were implanted. The implanted stents were found to be fractured 4 weeks after implantation. The fractured stents were removed. To restore the collapsed trachea, ring prostheses were applied. However, the dog was euthanized because of a bad outcome following surgery. PMID:17987968

  20. Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas

    OpenAIRE

    Tsuyuguchi, Toshio; Takada, Tadahiro; Miyazaki, Masaru; Miyakawa, Shuichi; Tsukada, Kazuhiro; Nagino, Masato; Kondo, Satoshi; Furuse, Junji; Saito, Hiroya; Suyama, Masafumi; Kimura, Fumio; Yoshitomi, Hideyuki; Nozawa, Satoshi; Yoshida, Masahiro; Wada, Keita

    2008-01-01

    Together with biliary drainage, which is an appropriate procedure for unresectable biliary cancer, biliary stent placement is used to improve symptoms associated with jaundice. Owing to investigations comparing percutaneous transhepatic biliary drainage (PTBD), surgical drainage, and endoscopic drainage, many types of stents are now available that can be placed endoscopically. The stents used are classified roughly as plastic stents and metal stents. Compared with plastic stents, metal stents...

  1. Tratamiento de estenosis sintomática de venas pulmonares secundaria a ablación por radiofrecuencia

    Directory of Open Access Journals (Sweden)

    Adolfo Ferrero Guadagnoli

    2014-08-01

    Full Text Available El aislamiento de las venas pulmonares mediante la aplicación de radiofrecuencia es un tratamiento efectivo de la fibrilación auricular. Una de las complicaciones potenciales y de mayor compromiso clínico de esta técnica invasiva es la estenosis de una o varias venas pulmonares. Esta complicación puede ser tratada mediante angioplastia con o sin colocación de stent, logrando una adecuada mejoría clínica, aunque con un alto índice de recurrencia por re-estenosis.

  2. Local drug-delivery balloon for proliferative occlusive in-stent restenosis after drug-eluting stent

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Fabio Dell'Avvocata; Massimo Giordan

    2011-01-01

    Drug-coated balloon has been developed as an alternative to drug-eluting stents for in-stent restenosis but the performance of drug infusion balloon in such setting has not been previously described. We present a case of particularly aggressive in-stent restenosis after drug eluting stent implantation treated with a new kind of drug infusion balloon developed in order to overcome the impossibility to inflate regular drug-coated balloon for several dilatation.

  3. Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Koichiro Tsutsumi; Hironari Kato; Takeshi Tomoda; Kazuyuki Matsumoto; Ichiro Sakakihara; Naoki Yamamoto; Yasuhiro Noma

    2012-01-01

    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice.Recently,therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective,even in patients with surgically altered anatomies.On the other hand,endoscopic partial stent-in-stent (PSIS) placement of selfexpandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible,safe and effective.We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success.This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization,even in patients with surgically altered anatomies.

  4. Metallic stents in malignant biliary obstruction

    International Nuclear Information System (INIS)

    Purpose. Retrospective analysis of our results with metallic stent placement for malignant biliary strictures. We sought to determine parameters that influence stent patency. Methods. A total of 95 Wallstents were implanted in 65 patients (38 men, 27 women; mean age, 65.1 years) with malignant biliary obstruction. Serum bilirubin levels were assessed in 48 patients; the mean value prior to intervention was 15.0 mg/dl. Results. In 12 patients (21%) complications occurred as a result of percutaneous transhepatic drainage. Stent implantation was complicated in 13 patients, but was possible in all patients. A significant decrease in bilirubin level was seen in 83.3% of patients following stent implantation. Approximately 30% of patients developed recurrent jaundice after a mean 97.1 days. In 9 patients (15%) the recurrent jaundice was caused by stent occlusion due to tumor growth. The mean follow-up was 141.8 days, the mean survival 118.7 days. Patients with cholangiocarcinomas and gallbladder carcinomas had the best results. Worse results were seen in patients with pancreatic tumors and with lymph node metastases of colon and gastric cancers. Conclusions. The main predictive factors for occlusion rate and survival are the type of primary tumor, tumor stage, the decrease in bilirubin level, and the general condition of the patient

  5. Mechanical characteristics of self-expandable metallic stents: in vitro study with three types of stress

    International Nuclear Information System (INIS)

    To obtain objective and comparable data for mechanical characteristics of self-expandable metallic stents widely used in the treatment of biliary obstruction. The stents tested were the 6 and 8 mm-band Hanaro spiral stent, Gianturco-Rosch Z stent, Wallstent, Ultraflex stent, and Memotherm stent. Each was subjected to three types of load:point, area, and circular. We analyzed their mechanical characteristics (resistance force, expansile force, and elasticity) according to these three types of stress. With regard to point loads, the Memotherm stent showed the highest resistance force and expansile force. The 8 mm-band Hanaro stent showed the lowest resistance force and the Gianturco-Rosch Z stent and Ultraflex stent showed lower expansile force. With regard to area loads, the Ultraflex stent showed the highest resistance force. The 6 mm-band Hanaro stent, Gianturco-Rosch Z stent, and Ultraflex stent showed higher expansile force. The 8 mm-band Hanaro stent showed the lowest value in both resistance force and expansile force. For circular loads, the Memotherm stent showed the highest resistance force and the Ultraflex stent and Wallstent showed lower value. Under all types of stress, the Hanaro stent and Memotherm stent were completely elastic, and the Ultraflex stent and Wallstent showed a wide gap between resistance force and expansile force. In clinical practice, awareness of the mechanical characteristics of each stent might help in choosing the one which is most suitable, according to type of biliary obstruction. =20

  6. Very late stent thrombosis of bare-metal coronary stent nine years after primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Đurić Predrag

    2016-01-01

    Full Text Available Introduction. Stent thrombosis (ST in clinical practice can be classified according to time of onset as early (0–30 days after stent implantation, which is further divided into acute ( 30 days and very late (> 12 months. Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, in-stent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, un-covered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of bare-metal stent (BMS is quite different from those following drug-eluting stent (DES implantation. Case report. We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI with implantation of DES into the pre-viously implanted two stents to solve the in-stent restenosis. Conclusion. Very late stent thrombosis, although fortu-nately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be connected with neointimal plaque rupture, followed by thrombotic events.

  7. Multilink stent promotes less platelet and leukocyte adhesion than a traditional stainless steel stent : An in vitro experimental study

    NARCIS (Netherlands)

    Amoroso, G; van Boven, AJ; Volkers, C; Crijns, HJGM; van Oeveren, W

    2001-01-01

    Background: Platelet and Leukocyte deposition onto metallic struts can be a crucial factor in the outcome of a coronary stenting procedure. By means of an in vitro, closed-loop circulation model, me aimed to assess blood-stent interaction patterns for a new stainless steel stent (MultiLink, Guidant

  8. Stent assisted angioplasty in intracranial atherosclerotic severe stenoses. Efficacy of CT angiography in evaluation of the stented vessels

    International Nuclear Information System (INIS)

    Our aim was to determine whether CT angiography (CTA) is suitable for the evaluation of patency and in-stent restenoses in small vessel stents for intracranial angioplasty. From June, 2000 to February, 2006, 26 patients received stent-assisted angioplasty for intracranial atherosclerotic lesions. The procedure was successfully performed in all patients. Multi plannar reconstruction (MPR) was evaluated for image quality on three groups with I-E (Internal-External diameter) ratios, as follows: Group A=I-E ratio>0.5 (Possible to evaluate stent lumen, high certainty), Group B=0.31≤I-E ratio≤0.5 (Possible to evaluate stent lumen, low certainty), Group C=I-E ratio≤0.31 (Uninterpretable). We examined the possibility of evaluating the stent lumen, maching the identity with the angiographical findings, and finding a predictor of favorable CTA findings. CTA was performed in 19 patients. It was possible to evaluate the visible stent lumen in 14 patients (73.7%); 10 patients comprised group A, 4 patients group B, 5 patients group C. Nine patients were evaluated with both CTA and angiography after the stenting. CTA findings were identical with angiographical findings in 8 of 9 patients. Stent diameter was associated with CTA findings, all of the patients who received 4.0 mm stents were in group A. The stent lumen may be visualized and evaluated in most stents using CTA, but tend to only be interpretable in the small vessels. (author)

  9. A Case of In-Stent Neoatherosclerosis 10 Years after Carotid Artery Stent Implantation: Observation with Optical Coherence Tomography and Plaque Histological Findings

    OpenAIRE

    Matsumoto, Hiroyuki; YAKO, Rie; Masuo, Osamu; HIRAYAMA, Katsuhisa; Uematsu, Yuji; Nakao, Naoyuki

    2013-01-01

    We report a patient's case of slow progressive in-stent restenosis 10 years after bare-metal stent implantation to his carotid artery. We treated the patient with an additional stent placement under a distal filter protection device. Optical coherence tomographic assessment and plaque histology during the carotid artery stenting (CAS) revealed atheromatous change at in-stent neointima, which contained lipid-rich plaque and calcification deposits. These findings suggest that in-stent neoathero...

  10. Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques

    OpenAIRE

    Seo, Jae-Bin; Park, Kyung Woo; Lee, Hae-Young; Kang, Hyun-Jae; Koo, Bon-Kwon; Kim, Sang-Hyun; Kim, Hyo-Soo

    2015-01-01

    Although the favored strategy for coronary bifurcation intervention is stenting main vessel with provisional side branch (SB) stenting, we occasionally use two-stent strategy. The objective of this study was to investigate the angiographic outcome of SB ostium in two-stent group, compared with one-stent group. We analyzed 199 patients with bifurcation lesion who underwent percutaneous coronary intervention (PCI) with drug-eluting stent and follow up angiography. The patients were divided into...

  11. Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture

    International Nuclear Information System (INIS)

    Objective: This study was designed to compare the clinical effectiveness of intraluminal radioactive stent loaded with iodine-125 seeds implantation versus covered stent alone insertion in patients with malignant esophageal stricture. Methods: We studied two groups of patients with malignant esophageal stricture. Group A comprised 28 patients (19 men and 9 women) who underwent intraluminal radioactive stent loaded with iodine-125 seeds implantation and were followed prospectively. Group B comprised 30 patients (18 men and 12 women) who had previously received covered stent alone insertion; these patients were evaluated retrospectively. There was no crossover between the two groups during follow-up. Informed consent was obtained from each patient, and our institutional review board approved the study. The dysphagia score, overall survival rates, complication rates, and reintervention rates were compared in the two groups. Results: There were no significant differences between the two groups in terms of baseline characteristics. Stent placement was technically successful and well tolerated in all patients. The dysphagia score was improved in both groups after stent placement. The median survival was significantly longer in group A than in group B: 11 versus 4.9 months, respectively (P < 0.001). The complications of chest pain, esophageal reflux, and stent migration was more frequent in group B, but this difference did not reach statistical significance. There was no statistical difference in reintervention between two groups. Conclusions: Intraluminal radioactive stent loaded with iodine-125 seeds implantation was a feasible and practical management in treating malignant esophageal stricture and was superior to covered stent alone insertion, as measured by survival.

  12. Clinical outcomes and prognosis of patients with stent fracture after successful drug-eluting stent implantation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, In Soo [Cadiovascular center, Chonnam National University Hospital, Gwangju (Korea, Republic of); Han, Jae Bok; Jang, Seong Joo [Dept. of Radiology, Dongshin University, Naju (Korea, Republic of)

    2014-06-15

    Many studies have suggested that in the era of Drug Eluting Stents (DES) are one of the causes of In-Stent Restenosis (ISR) of Stent Fracture (SF). The present study sought to evaluate clinical characteristics of patients with stent fracture after successful DES implantation. The 4,701 patients were selected for analysis who underwent a follow-up coronary angiography irrespective of ischemic symptoms. The overall incidence of SF was 32 patients(male:female=19:13, Av. age 62.44±9.8 year, 0.68%). Fractures of Sirolimus-Eluting Stents (SES), Paclitaxel-Eluting Stents (PES), Biolimus A9-Eluting Stents (BES), Everolimus-Eluting Etents (EES), Endothelial Progenitor Cell Capture Stent (EPC) and Zotarolimus-Eluting Stents (ZES) are accounted for 19 (59.4%), 9 (28.1%), 2 (6.3%), 1 (3.1%), 1 (3.1%) and 0 (0%) respectively. SF developed in the left Anterior Dscending (LAD) artery in 16 patients (50%) and in complex(type B2, C) lesions in 25 patients (69.4%). Ten patients were treated with heterogenous DES, the rest being treated with either homogenous DES (3 patients), plain old balloon angioplasty (3 patients), or conservative medical treatment (17 patients). None of the patients with SF suffered from cardiac death during a follow-up period of 32.9±12.4 months. The overall rate of DES fracture over up to 3.7 years of follow-up was 0.68% with higher incidence in SES than in PES. SF frequently occurred in the LAD artery and in complex lesions. Of the patients with SF, coronary intervention was performed only when the binary restenosis lesion was significant. During the follow-up, patients with SF have continued on combination antiplatelet therapy. There is a very low rate of major adverse cardiac events(post-detection of SF), especially cardiac death associated with SF.

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

    Science.gov (United States)

    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

    2016-01-01

    Background: 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. Methods: 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. Results: 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. Conclusions: 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. PMID:26929781

  14. Malignant duodenal obstructions: palliative treatment with covered expandable nitinol stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Chul; Jung, Gyoo Sik; Lee, Sang Hee; Kim, Sung Min; Oh, Kyung Seung; Huh, Jin Do; Cho, Young Duk [College of Medicine, Kosin Univ, Pusan (Korea, Republic of); Song, Ho Young [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ten patients, and no procedural complications occuured. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the palcement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstruction (n=1) recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died a mean 14 (median, 9) weeks after stent placement. The placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible, safe and effective for the palliative treatment of malignant

  15. Metallic stent and stereotactic conformal radiotherapy for hilar cholangiocarcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the effect of metallic stent combined with stereotactic conformal radiotherapy (SCRT) for hilar cholangiocarcinoma. Methods: Fifty-four patients with hilar cholangiocarcinoma were analyzed, including 31 treated with stent plus stereotactic conformal radiotherapy (combined group) and 23 with metallic stent alone (control group). Results: The mean survival time of combined group was 11.1 ± 4.6 months, compared with 5.1 ± 2.8 months of the control group, giving a significant difference between the two groups (P<0.01). Conclusion: The combination of metallic stent and stereotactic conformal radiotherapy is more effective than metallic stent alone for unresectable hilar cholangiocarcinoma. (authors)

  16. Treatment Approaches to Urinary Stones Caused by Forgotten DJ Stents

    Directory of Open Access Journals (Sweden)

    Ergun Alma

    2015-03-01

    Full Text Available Ureteral DJ stents have been used widely for years in urology practice. With increased use, complications have been increased and forgotton stents have started to cause problems. The most common complications are early pain and irritative symptoms. Late complications are bacterial colonization and stone formation because of the biofilm covering the stents. Treatment for a forgotten stent varies on many factors, such as stent localization and stone formation. In this article, we aimed to discuss our clinic approach on two different cases in light to current literature. [Cukurova Med J 2015; 40(Suppl 1: 58-63

  17. [Placement of intraluminal stents for treating tracheal collapse in dogs].

    Science.gov (United States)

    Glaus, T M; Matos, J M; Baloi, P; Wenger, M

    2011-11-01

    Tracheal collapse is a progressive disease particularly of small breed dogs. In the terminal stage, when dyspnea becomes the dominating sign and is no longer manageable with medical treatment, a surgical procedure is necessary. With increasing frequency intraluminal tracheal stents are implanted minimal-invasively. In individual animals this is a lifesaving procedure, leading to immediate elimination of dyspnea. In most dogs cough for some time has to be anticipated as the stent acts as a foreign body, but severe complications like excessive formation of granulation tissue, stent migration or stent fracture are rare. Stents represent an attractive treatment modality for tracheal collapse in dogs with dyspnea. PMID:22045455

  18. Accidente cerebrovascular isquémico asociado con ablación por radiofrecuencia de reentrada nodal Ischemic stroke associated with radio frequency ablation for nodal reentry

    Directory of Open Access Journals (Sweden)

    Juan C Díaz Martínez

    2010-04-01

    Full Text Available La taquicardia por reentrada nodal es la causa más común de taquicardia supraventricular paroxística; en aquellos pacientes en quienes el manejo farmacológico no es efectivo o deseado la ablación por radiofrecuencia es un excelente método terapéutico dada su alta tasa de curación. Aunque en términos generales dichos procedimientos son rápidos y seguros, se han descrito varias complicaciones entre las que sobresale el accidente cerebrovascular isquémico. Se presenta el caso de una paciente de 41 años con episodios de taquicardia por reentrada nodal a repetición, que fue llevada a ablación por radiofrecuencia. En el post-operatorio inmediato se evidenció déficit neurológico focal con isquemia en el territorio de la arteria cerebral media derecha, tras lo cual se realizó angiografía con intento de angioplastia y abxicimab y posteriormente infusión local de activador de plasminógeno tisular (rtPA con adecuado resultado clínico y angiográfico.Atrioventricular nodal reentry tachycardia is the most common type of paroxismal supraventricular tachycardia. In those patients in whom drug therapy is not effective or not desired, radio frequency ablation is an excellent therapeutic method. Although overall these procedures are fast and safe, several complications among which ischemic stroke stands out, have been reported. We present the case of a 41 year old female patient with repetitive episodes of tachycardia due to nodal reentry who was treated with radiofrequency ablation. Immediately after the procedure she presented focal neurologic deficit consistent with ischemic stroke in the right medial cerebral artery territory. Angiography with angioplastia and abxicimab was performed and then tissue plasminogen activator (rtPA was locally infused, with appropriate clinical and angiographic outcome.

  19. Stenting of the SFA - indications, techniques,

    International Nuclear Information System (INIS)

    Aggressive risk factor modification, change of eating habits, exercise programs, and forceful antiplatelet therapy are the most important tools for the treatment of PAOD in symptomatic patients suffering from intermittent claudication. There are however no guidelines for revascularization at this stage. Endovascular treatment has been increasingly utilized over the last decade and increasingly displaced vascular surgery. Amongst numerous endovascular techniques beside PTA, stents meanwhile play the most important role due to constant technical progress. Results regarding the rate of restenosis or patency rates still remain worse compared to other vascular beds. This paper gives a review over recent results, currently available stent techniques, and possible indications for the endovascular therapy of an artery, which has turned out to be the biggest ordeal for material and construction of stents. (orig.)

  20. Brachial access technique for aortoiliac stenting revisited

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a modified technique to perform iliac artery stenting through the brachial artery access. A 6F Brite tip sheath (Cordis, Jonhson & Jonhson Medical, Miami Lakes, FL, USA) is inserted into either brachial artery and a standard 4F Judkins Right diagnostic catheter was inserted over a 260 cm 0.038" Terumo Stiff wire (Terumo Corp, Tokyo, Japan) through the sheath. The catheter is navigated down to the aortic bifurcation, and after selecting the common iliac artery ostium, the wire is navigated through the lesion and advanced to the ipsilateral superficial femoral arteries. The catheter should be then moved forward over the wires beyond the lesion and the Terumo guidewire is replaced by two 0.038" 260 cm Supracor wires (Boston Scientific Corporation, San Jose, CA, USA). In order to facilitate advancement of the stent without risk of dislodgement as well as to check the position with low contrast dose injection, a 6 F (or 7F if large stent is selected) 90cm Shuttle Flexor introducer long sheath (Cook Group, Bloomington, IN, USA) should be advanced over the Supracor wire until it reaches the common iliac artery ostium. A road-map technique can be used to check the ostium position in order to properly deploy the selected stent. This technique promises to be safe and effective offering more support than guiding catheter technique; moreover it reduces the stress on the arterial vessel at the subclavian site and enables a stiff balloon or stent catheter to be advanced even through a very elongated and calcified aorta without the risk of stent dislodgement.

  1. Management of complications during percutaneous implementation of biliary stents

    International Nuclear Information System (INIS)

    Objective: To retrospectively analyze the complications and management of complications during percutaneous implementation of biliary stents in 17 patients. Methods: Percutaneous biliary drainage and implementation of biliary stents for malignant biliary obstruction under fluoroscopic guidance was performed in 64 patients. 17 cases developed complications. Bradycardia and hypotension was seen in 5 cases, slipping of the stent into the duodenum in 1, bile duct perforation in 2, the fine guidewire broken in the hepatic parenchyma in 2, malposition of the stent in 3, hepato-renal failure leading to hemorrhage in 2, exchanging guidewire broken in the duodenum in 1, and balloon broken leading to stent dislocation in 1, respectively. Results: Bradycardia and hypotension in the 5 cases was treated medically and the procedure was interrupted. Slipping of the stent into the duodenum was passed off spontaneously. Broken of the fine guidewire in the liver did not present any complaints until the death of the patients. Perforation of bile duct was treated conservatively with a clinical successful outcome. Malposition of the stent was treated by reimplementation of shorter stents. The broken exchanging guidewire in the duodenum during implementation was removed with the gastroscope. The hepato-renal failure leading to hemorrhage had poor prognosis. The broken balloon caused stent dislocation was treated by reimplementation of stent. Conclusion: Percutaneous implementation of stent is effective and safe for elderly patients with proximal stenosis of the biliary tract. However, one must be very careful to avoid the complications

  2. An in vitro study of silk stent morphology

    Energy Technology Data Exchange (ETDEWEB)

    Aurboonyawat, Thaweesak [University of Paris 7 Bichat School of Medicine, Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, Paris (France); Siriraj Hospital, Mahidol University, Division of Neurosurgery, Department of Surgery, Bangkok (Thailand); Blanc, Raphael; Piotin, Michel; Spelle, Laurent; Moret, Jacques [University of Paris 7 Bichat School of Medicine, Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, Paris (France); Schmidt, Paul [University of Paris 7 Bichat School of Medicine, Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, Paris (France); The Duluth Clinic Ltd, Duluth, MN (United States); Nakib, Amir [Universite de Paris 12, Laboratoire Images, Signaux et Systemes Intelligents (LISSI, E. A. 3956), Creteil (France)

    2011-09-15

    Morphology of the Silk stent (Balt, Montmorency, France) after deployment is not fully understood, especially in tortuous vessels. An in vitro study was conducted to study morphology and flow-diverting parameters of this stent. Two sets of different-sized and curved polytetrafluoroethylene tubes were studied. To simulate the aneurysm neck, a small hole was created in a tube. A stent was placed in each of the different tubes. Angiographic computerized tomography and macroscopic photography were then obtained. The images were analyzed to calculate a Percentage of Area Coverage (PAC). Good stent conformability was observed. The PAC was 21% in the straight model with matched stent and vessel diameter. In the straight model with an oversized stent, the PAC was increased. In the curved models, dynamic wire repositioning occurred. The repositioning was affected by the size of the stent and the angle of the vessel curve. Compared to the straight model, this increased the PAC in two instances: on the convexity (oversized stent), and on the concavity (matched stent and vessel diameter). The PAC did not significantly change at the sides of the curve. By design, the wires of the silk stent move relative to each other. In a curved model, the PAC is different at the convexity, concavity, and lateral walls. The stent diameter affects the PAC. These results are clinically relevant because it is desirable to maximize and minimize the PAC across the aneurysm neck and branch vessel orifice, respectively. (orig.)

  3. Initial experience with a reversal-of-flow cerebral protection device in carotid angioplasty Experiência inicial com dispositivo de reversão de fluxo para proteção cerebral na angioplastia carotídea

    Directory of Open Access Journals (Sweden)

    Sidnei José Galego

    2013-03-01

    Full Text Available PURPOSE: To report initial findings with the GORE Flow Reversal System®, with a focus on major/minor adverse events in the 30 first postoperative days. METHODS: The first 24 patients submitted to carotid angioplasty using the GORE system, from June 2010 to May 2012, were retrospectively assessed with regard to indications, anatomic details, technical difficulties, and early clinical outcomes, including major (stroke, death, acute myocardial infarction and minor (hematoma adverse events. RESULTS: Systemic hypertension was present in 100% of the patients, diabetes mellitus in 58.3%, and coronary disease in 37.5%. Type II aortic arch was encountered in 62.5% of the patients and atherosclerotic lesion predominantly at the carotid bifurcation affecting the internal and common carotid arteries in 79.2%. Angiographic data revealed contralateral carotid arteries with OBJETIVO: Relatar os achados iniciais da utilização do GORE Flow Reversal System® (Sistema de Fluxo de Reversão, com foco em eventos adversos maiores/menores nos primeiros 30 dias do pós-operatório. MÉTODOS: Os primeiros 24 pacientes submetidos a angioplastia carotídea com a utilização do sistema GORE, de junho de 2010 a maio de 2012, foram avaliados retrospectivamente com relação a indicações, detalhes anatômicos, dificuldades técnicas e desfechos clínicos imediatos, incluindo eventos adversos maiores (acidente vascular cerebral, morte, infarto agudo do miocárdio e menores (hematoma. RESULTADOS: Hipertensão sistêmica estava presente em 100% dos pacientes, diabete melito em 58,3% e doença coronariana em 37,5%. Arco aórtico tipo II foi encontrado em 62,5% dos pacientes e lesão de aterosclerose predominantemente na bifurcação carotídea que afeta as artérias carótidas internas e comuns em 79,2%. Dados angiográficos revelaram artérias carótidas contralaterais com estenose <50% em 95,8% de casos e preservação de fluxo sanguíneo cerebral em 95,8%. Todos os

  4. Spontaneous Solitaire™ AB Thrombectomy Stent Detachment During Stroke Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Akpinar, Suha, E-mail: akpinarsuha@hotmail.com; Yilmaz, Guliz, E-mail: glz.yilmaz@hotmail.com [Near East University Hospital, Department of Radiology, Faculty of Medicine (Turkey)

    2015-04-15

    Spontaneous Solitaire™ stent retriever detachment is a rarely defined entity seen during stroke treatment, which can result in a disastrous clinical outcome if it cannot be solved within a critical stroke treatment time window. Two solutions to this problem are presented in the literature. The first is to leave the stent in place and apply angioplasty to the detached stent, while the second involves surgically removing the stent from the location at which it detached. Here, we present a case of inadvertent stent detachment during stroke treatment for a middle cerebral artery M1 occlusion resulting in progressive thrombosis. The detached stent was removed endovascularly by another Solitaire stent, resulting in the recanalization of the occluded middle cerebral artery.

  5. Drug-eluting stents in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M. [Marienhospital Stuttgart, Department of Radiology, Stuttgart (Germany); Pattynama, P.M.T. [Erasmus MC-University Medical Center Rotterdam, Rotterdam (Netherlands); Talen, A. [genae associates nv, Antwerp (Belgium); Sapoval, M. [Hopital Europeen Georges Pompidou, Service de Radiologie Cardio-Vasculaire, Paris (France); Inserm U 780 epidemiologie Cardio Vasculaire, Paris (France)

    2008-04-15

    Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication. (orig.)

  6. Surface conditioning of 316LVM slotted tube cardiovascular stents.

    Science.gov (United States)

    Raval, Ankur; Choubey, Animesh; Engineer, Chhaya; Kothwala, Devesh

    2005-01-01

    The surface quality of coronary stents has a significant influence on its biocompatibility. Therefore, surface polishing is of paramount importance in the production and application of stents. In the present study, electropolishing is performed on 316LVM steel slotted tube coronary stents. Additionally, acid pickling, as a pretreatment of electropolishing, is also conducted. Gravimetric analysis of the stents (weight loss and strut width change) in the process of acid pickling and electropolishing are done. Qualitative roughness measurements are made to evaluate the stent surface. Electropolished stents are passivated causing chromium enrichment on the surface of the material, thereby enhancing its corrosion resistance. Passivated and electropolished samples are examined using energy dispersive spectrometry. Balloon expanded and crimped profiles of the passivated stents are qualitatively analyzed. PMID:15613380

  7. Spontaneous Solitaire™ AB Thrombectomy Stent Detachment During Stroke Treatment

    International Nuclear Information System (INIS)

    Spontaneous Solitaire™ stent retriever detachment is a rarely defined entity seen during stroke treatment, which can result in a disastrous clinical outcome if it cannot be solved within a critical stroke treatment time window. Two solutions to this problem are presented in the literature. The first is to leave the stent in place and apply angioplasty to the detached stent, while the second involves surgically removing the stent from the location at which it detached. Here, we present a case of inadvertent stent detachment during stroke treatment for a middle cerebral artery M1 occlusion resulting in progressive thrombosis. The detached stent was removed endovascularly by another Solitaire stent, resulting in the recanalization of the occluded middle cerebral artery

  8. Role of stents and laser therapy in biliary strictures

    Science.gov (United States)

    Chennupati, Raja S.; Trowers, Eugene A.

    2001-05-01

    The most frequent primary cancers causing malignant obstructive jaundice were pancreatic cancer (57%), hilar biliary cancer (19% including metastatic disease), nonhilar biliary cancer (14%) and papillary cancer (10%). Endoscopic stenting has widely replaced palliative surgery for malignant biliary obstruction because of its lower risk and cost. Self-expandable metal stents are the preferred mode of palliation for hilar malignancies. Plastic stents have a major role in benign biliary strictures. Major complications and disadvantages associated with metallic stents include high cost, cholangitis. malposition, migration, unextractability, and breakage of the stents, pancreatitis and stent dysfunction. Dysfunction due to tumor ingrowth can be relieved by thermal methods (argon plasma coagulator therapy). We present a concise review of the efficacy of metallic stents for palliation of malignant strictures.

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

    International Nuclear Information System (INIS)

    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

  10. Covered stent placement for the treatment of malignant superior vena cava syndrome: Is unilateral covered stenting and effective?

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Hoon; Gwon, Dong Il; Ko, Gi Young; Ko, Heung Kyu; Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Sung, Kyu Bo [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2014-02-15

    To evaluate the safety and efficacy of unilateral covered stent placement in patients with malignant superior vena cava (SVC) syndrome. Between October 2008 and November 2012, expanded polytetrafluoroethylene-covered stent placement for malignant SVC syndrome was performed in 40 consecutive patients (35 men and five women; mean age, 61.4 years; range, 35-81 years). All covered stents were unilaterally placed within the SVC or across the venous confluence when needed to relieve venous obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins. Stent placement was technically successful in all patients. There were no major complications. Of the 37 patients symptomatic prior to stent placement, 34 (92%) experienced complete symptomatic relief 1-8 days after stent placement. Of the 29 patients who underwent covered stent placement across the venous confluence, nine patients had patent contralateral brachiocephalic veins prior to stent placement. However, no sign of SVC obstruction or contralateral upper extremity venous thrombosis was observed during the follow-up period. Kaplan-Meier analysis revealed median patient survival of 163 days. Stent occlusion occurred in four (10%) of 40 patents. Cumulative stent patency rates at 1, 3, 6, and 12 months were 95%, 92%, 86%, and 86%, respectively. Unilateral covered stent placement appears to be a safe and effective method for treating malignant SVC syndrome, despite the location of SVC occlusion.

  11. Optimal Stent Expansion by Stent Balloon Multiple Inflation at Nominal Pressure in Resistant Lesions: A New Technique

    Directory of Open Access Journals (Sweden)

    Amir Hossein Khosh Nasab

    2015-09-01

    Full Text Available Introduction: This study aimed to evaluate the effects of four-time inflation of the stent balloon at nominal pressure on optimal stent expansion in resistant lesions. Materials and Methods: This interventional study was conducted on 39 patients with coronary artery lesions, in whom Zotarolimus-eluting stents (N=20, Paclitaxel-eluting stents (N=11 and other stents (N=8 were deployed four times at nominal inflation pressure and increased inflation times (5, 15, 30 and 45 seconds. After the deployments, enhanced stent visualization imaging technique (IC stent was used to assess stent placement and artery expansion. Results: In this study, early success rate was estimated at 79.5% using the enhanced stent visualization imaging technique. In addition, major adverse cardiac event (MACE was determined at 2.6%. Also, conventional methods resulted in lower success rate and higher MACE in resistant lesions. Conclusion: According to the results of this study, four-time stent balloon inflation at nominal pressure could allow adequate stent expansion in resistant lesions leading to lower MACE.

  12. Metallic stents provide better QOL than plastic stents in patients with stricture of unresectable advanced esophageal cancer

    International Nuclear Information System (INIS)

    The aim of this study was to elucidate the utility and safety of treatment with esophageal stents (plastic and metallic stents) for unresectable advanced esophageal cancer. Between 1992 and 2002, 14 cases of unresectable advanced esophageal cancer were treated with esophageal stents (the plastic stent group, 7 cases; and the metallic stent group, 7 cases). Of these, 10 cases had a history of chemotherapy and or radiotherapy. An improvement in oral intake and performance status (PS), survival time, periods at home, and adverse events were compared between the two groups. After stenting, oral intake and PS were significantly improved in the metallic stent group. Follow-up at home was possible in 71.4%. There was no significant difference in survival or duration of time at home between the two groups. All adverse events were controllable and there was no difference between the two groups. Stenting not only improved oral intake and PS but also allowed a stay at home, resulting in a marked improvement in patients' quality of life (QOL). Stenting was performed safely even in cases with a history of radiotherapy. There was no difference in survival, ratios of staying at home, and safety between the two groups, but QOL was significantly improved in the metallic stent group. These outcomes indicate that placement of metallic stents should be actively considered to treat stricture due to advanced esophageal cancer. (author)

  13. Covered stent placement for the treatment of malignant superior vena cava syndrome: Is unilateral covered stenting and effective?

    International Nuclear Information System (INIS)

    To evaluate the safety and efficacy of unilateral covered stent placement in patients with malignant superior vena cava (SVC) syndrome. Between October 2008 and November 2012, expanded polytetrafluoroethylene-covered stent placement for malignant SVC syndrome was performed in 40 consecutive patients (35 men and five women; mean age, 61.4 years; range, 35-81 years). All covered stents were unilaterally placed within the SVC or across the venous confluence when needed to relieve venous obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins. Stent placement was technically successful in all patients. There were no major complications. Of the 37 patients symptomatic prior to stent placement, 34 (92%) experienced complete symptomatic relief 1-8 days after stent placement. Of the 29 patients who underwent covered stent placement across the venous confluence, nine patients had patent contralateral brachiocephalic veins prior to stent placement. However, no sign of SVC obstruction or contralateral upper extremity venous thrombosis was observed during the follow-up period. Kaplan-Meier analysis revealed median patient survival of 163 days. Stent occlusion occurred in four (10%) of 40 patents. Cumulative stent patency rates at 1, 3, 6, and 12 months were 95%, 92%, 86%, and 86%, respectively. Unilateral covered stent placement appears to be a safe and effective method for treating malignant SVC syndrome, despite the location of SVC occlusion.

  14. Past, Present, and Future of Gastrointestinal Stents: New Endoscopic Ultrasonography-Guided Metal Stents and Future Developments.

    Science.gov (United States)

    Lee, Hee Seung; Chung, Moon Jae

    2016-03-01

    Innovations in stent technology and technological advances in endoscopic ultrasonography have led to rapid expansion of their use in the field of gastrointestinal diseases. In particular, endoscopic ultrasonography-guided metal stent insertion has been used for the management of pancreatic fluid collection, bile duct drainage, gallbladder decompression, and gastric bypass. Endoscopic ultrasonography-guided drainage of intra-abdominal fluid collections using a plastic or metal stent is well established. Because of the various limitations-such as stent migration, injury and bleeding in the lumen-recently developed, fully covered self-expanding metal stents or lumen-apposing metal stents have been introduced for those fluids management. This article reviews the recent literature on newly developed endoscopic ultrasonography-guided metal stents and the efficacy thereof. PMID:27000424

  15. Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer

    OpenAIRE

    Decker, Christopher; Christein, John D.; Phadnis, Milind A.; Mel Wilcox, C.; Varadarajulu, Shyam

    2011-01-01

    Background It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression. Methods This was a retrospective study of all patients with obstructive jaundice secondary to pancreatic head cancer who underwent their...

  16. Computational simulation of platelet interactions in the initiation of stent thrombosis due to stent malapposition

    Science.gov (United States)

    Chesnutt, Jennifer K. W.; Han, Hai-Chao

    2016-02-01

    Coronary stenting is one of the most commonly used approaches to open coronary arteries blocked due to atherosclerosis. Stent malapposition can induce thrombosis but the microscopic process is poorly understood. The objective of this study was to determine the platelet-level process by which different extents of stent malapposition affect the initiation of stent thrombosis. We utilized a discrete element model to computationally simulate the transport, adhesion, and activation of thousands of individual platelets and red blood cells during thrombus initiation in stented coronary arteries. Simulated arteries contained a malapposed stent with a specified gap distance (0, 10, 25, 50, or 200 μm) between the struts and endothelium. Platelet-level details of thrombus formation near the proximal-most strut were measured during the simulations. The relationship between gap distance and amount of thrombus in the artery varied depending on different conditions (e.g., amount of dysfunctional endothelium, shear-induced activation of platelets, and thrombogenicity of the strut). Without considering shear-induced platelet activation, the largest gap distance (200 μm) produced no recirculation and less thrombus than the smallest two gap distances (0 and 10 μm) that created recirculation downstream of the strut. However, with the occurrence of shear-induced platelet activation, the largest gap distance produced more thrombus than the two smallest gap distances, but less thrombus than an intermediate gap distance (25 μm). A large gap distance was not necessarily the most thrombogenic, in contrast to implications of some computational fluid dynamics studies. The severity of stent malapposition affected initial stent thrombosis differently depending on various factors related to fluid recirculation, platelet trajectories, shear stress, and endothelial condition.

  17. Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side-by-side versus stent-in-stent techniques.

    Science.gov (United States)

    Moon, Jong Ho; Rerknimitr, Rungsun; Kogure, Hirofumi; Nakai, Yousuke; Isayama, Hiroyuki

    2015-09-01

    Endoscopic management of unresectable hilar malignant biliary stricture (MBS) is currently challenging, and the best approach is still controversial. Liver volume is the key to adequate biliary drainage in hilar MBS and multiple stenting is mandatory to drain over 50% of liver volume in most cases. The self-expandable metallic stent (SEMS) has shown superior patency to plastic stents in recent reports. There are two methods of multiple stenting for hilar MBS: stent-in-stent (SIS) and side-by-side (SBS). Advantages of SIS include multiple SEMS placement in one stent caliber at the common bile duct (CBD), which is considered physiologically ideal. The through-the-mesh (TTM) technique with guidewires and the SEMS delivery system can be technically difficult in SIS, although the recent development of dedicated SEMSs having a loose portion facilitating the TTM technique makes SIS technically feasible both at stent deployment and re-interventions. Conversely, the SBS technique, if placed across the papilla, is technically simple at initial placement and re-intervention at stent occlusion. However, SBS has potential disadvantages of overexpansion of the CBD because of parallel placement of multiple SEMS, which can lead to portal vein thrombosis. Given the limited evidence available, a well-designed randomized controlled trial comparing these two techniques is warranted. PMID:26136361

  18. Influence of the size effect on the mechanical behaviour of stents

    Directory of Open Access Journals (Sweden)

    Gachon Carine

    2006-01-01

    Full Text Available Un intracoronario stent es una pequeña malla metálica cilíndrica y expandible que abre y sostiene árterias abiertas que han sido obstruidas. La manufactura de los stents requiere el corte con láser de diseños específicos en tubos de acero inoxidable. Para caracterizar el comportamiento mecánico de los stents, se efectúan ensayos de tracción. Las probetas son vigas rectas cortadas en los mismos tubos que se usan para la manufactura de los stents. Las curvas esfuerzo-deformacíon obtenidas demuestran que el esfuezo de fluencia aumenta cuando la anchura de las vigas disminuye, mientras que la deformación de ruptura incrementa cuando la anchura aumenta. Para comprender el fénomeno, el corte con láser es estudiado. Se utiliza el método de elemento finito para demonstrar que las curvas esfuerzo-deformación obtenidas no están relacionadas con el inexactitud del corte con láser. La geometría de las vigas no explica las curvas, entonces el comportamiento mecánico depende de las dimensiones. Después se investiga la microstructura y la zona afectada por el calor generado por el láser se examina. El tamaño de la zona afectada por el calor es insignificante para las probetas anchas, pero es significante para las pequeñas probetas. Para caracterizar completamente el comportamiento mecánico se necessita un ensayo de compresíon. Las mismas probetas son utilizadas y el ensayo elegido es el método de los tres apoyos. Las fuerzas que se evaluan son muy pequeñas, entonces se emplea una máquina de DMA (Dynamic Mechanical Analyzer. Se utiliza el método del elemento finito para la identificación inversa del comportamiento mecánico.

  19. Experiment Study of The Preventive Effects of Valsartan Eluting Stent on In- stent Restenosis

    Institute of Scientific and Technical Information of China (English)

    陈津; 陈纪言; 周颖玲; 李光; 罗建方; 余丹青; 张励庭; 黄文晖

    2003-01-01

    Objectives Background -Neointima hyperplasia and arterial re modeling are themain mechanisms of restenosis after percutaneoustransluminal coronary angioplasty. The successful useof coronary stents neutralizes the ac ute elastic recoiland improves the remodeling mode with reducingrestenosis rate by 10 % . But the in - stent neointimahyperplasia becomes more severe. This study aims toset up model of in - stent restenosis in vivo, and to e-valuate the preventive role of implantation of valsartaneluting stent for restenosis. Methods and ResultsTwenty -two male New Zealand white rabbits were di-vided into control group and valsartan group. In-travascular ultrasonic (IVUS) results showed the in-trastent neointimal areas of the control group werelarger than those of the valsartan group ( P < 0.01 ) .The minimal lumen area of control group was smallerthan that of the valsartan group ( P < 0.01). Angiog-raphy results showed the normal lumen diameters weresimilar between two groups ( P> 0.05) . The lumenstenosis rates compared with the normal diameters ofthe valsartan group were significantly improved overthat of the control group ( P < 0. 05) . It was compa-rable to the IVUS analysis. There were no cases of a-neurysm or thrombosis. Conclusions Valsartan e-luting stents produced a significant inhibition ofneointimal hyperplasia and luminal encroachment inrabbits without obviously producing any serious side -effects. These results demonstrate the potential thera-peutic benefit of valsartan eluting stents in the pre-vention and treatment of human coronary restenosis.

  20. Comparison of in vivo acute stent recoil between the bioabsorbable everolimus-eluting coronary stent and the everolimus-eluting cobalt chromium coronary stent: insights from the ABSORB and SPIRIT trials

    DEFF Research Database (Denmark)

    Tanimoto, Shuzou; Serruys, Patrick W; Thuesen, Leif;

    2007-01-01

    OBJECTIVES: This study sought to evaluate and compare in vivo acute stent recoil of a novel bioabsorbable stent and a metallic stent. BACKGROUND: The bioabsorbable everolimus-eluting coronary stent (BVS) is composed of a poly-L-lactic acid backbone, coated with a bioabsorbable polymer containing ...

  1. Risk Factors and Clinical Evaluation of Superficial Femoral Artery Stent Fracture: Prote'ge'GPS Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Da Un; Kim, Jae Kyu; Jung, Hye Doo; Huh, Tae Wook; Yim, Nam Yeol; Oh, Hyun jun; Choi, Soo Jin Na [Chonnam National University Hospital, Chonnam National University, Medical School, Gwangju (Korea, Republic of); Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Chonnam National University, Medical School, Hwasun (Korea, Republic of)

    2010-12-15

    To evaluate the occurrence of superficial femoral artery stent fractures, the risk factors of stent fracture, and the relationship between fractures and clinical findings. Of the 38 patients who underwent treatment with Prote'ge'GPS stenting due to arterial occlusions on the superficial femoral artery, 17 also underwent a clinical analysis. Forty-three stents were inserted in the 17 superficial femoral arteries, ranging between 15 and 50 cm in length, with a mean treated length of 26.4 cm (15-50 cm). A fracture was evaluated by taking a PA and lateral simple radiography, as well as a follow-up evaluation accompanied with a CT angiography, DSA, and a color Doppler sonography. The examination involved the assessment of the difference between bone fractures due to length, placement, and frequency. Fractures occurred in 13 of 43 stents (30.2%). A total of 10 (71.4%) occurred in the upper third, compared to 4 (28.6%) in the lower third of the superficial femoral artery. In addition, 10 stents (71.4%) had a single strut fracture, whereas 4 (28.6%) had multiple strut fractures. A stent fracture occurred more frequently when the stents and lesions were longer (p=0.021, 0.012) and the stents were inserted near the joint. However, there was no significant relationship between stent numbers and the fractures (p=0.126). When the stents were inserted along the popliteal artery, a stent fracture occurred more frequently in the lower third of the artery. The stent fractures did not significantly influence the patency rate of the stented artery (p=0.44) Prote'ge'GPS stents in the superficial femoral artery revealed a considerable number of fractures and the fracture frequency showed a significant relationship with the length of stents and lesions. The closer stent insertion was to the joints, the more frequently fractures occurred. There were no evident significant relationships between the presence of stent fractures and the patency of the stented arteries

  2. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents

    Science.gov (United States)

    Chow, Po-Ming; Chiang, I-Ni; Chen, Chia-Yen; Huang, Kuo-How; Hsu, Jui-Shan; Wang, Shuo-Meng; Lee, Yuan-Ju; Yu, Hong-Jeng; Pu, Yeong-Shiau; Huang, Chao-Yuan

    2015-01-01

    Background Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort. Methods Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated. Results A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration. Conclusions Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure

  3. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    International Nuclear Information System (INIS)

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  4. Endovascular stenting for vertebrobasilar artery stenosis

    International Nuclear Information System (INIS)

    Objective: To summarize the experiences in endovascular stenting for vertebrobasilar artery stenosis, and to discuss its indications, technique, and perioperative management. Methods: Twenty cases presented with recurrent transient ischemic attack or with the history of infarction of posterior circulation territory. Thirteen cases complained of dizziness or headache. The locations of the stenoses were originated at vertebral artery in 13 cases, extracranial segment of vertebral artery in 3 cases, intracranial segment of vertebral artery in 5 cases, and basilar artery in 12 cases. All stenoses were more than 70% in diameter, with 2-12 mm in length. Balloon expended stents (BX, AVES670, EXPRESS, BIODIVESO) were introduced across the stenosis with the support of guide wire. Stents were deployed by inflation of the balloon slowly. Results: There were no procedural and periprocedural complications, and angiographic results showed that the stenoses returned to normal size in 29 cases, while reduced by more than 80% in 4 cases. The patients were asymptomatic and neurologically intact at the clinical follow-up for 3-10 months. Ten cases were followed by angiography, and there was no restenosis. Conclusion: Endovascular stenting for vertebrobasilar artery stenosis is effective and safe. But long-term results need further investigation

  5. Hyperperfusion syndrome after carotid stent angioplasty

    International Nuclear Information System (INIS)

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  6. Restenosis begets restenosis : implications for stent selection

    NARCIS (Netherlands)

    Wijpkema, J. S.; Anthonio, R. L.; Jessurun, G. A. J.; Dijk, W. A.; Tio, R. A.; Zijlstra, F.

    2008-01-01

    Background: Identifying the risk for restenosis is of critical importance in the stent selection process of patients undergoing percutaneous coronary intervention (PCI). Therefore, we sought to determine if a history of clinical recurrence (CR) after PCI increases the risk of CR after treatment of a

  7. Oesphageal Stenting for palliation of malignant mesothelioma

    Directory of Open Access Journals (Sweden)

    Rahamim Joseph

    2008-01-01

    Full Text Available Abstract Dyspahgia in patients with malignant mesothelioma is usually due to direct infiltration of the eosophagus by the tumour. It can be distressing for the patient and challenging for the physician to treat. We describe three cases in which this condition has been successfully palliated with self expanding esophageal stents.

  8. Hyperperfusion syndrome after carotid stent angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Reith, W.; Krick, C.; Karp, K.; Zimmer, A.; Struffert, T.; Kuehn, A.L.; Papanagiotou, P. [University of the Saarland, Department for Interventional and Diagnostic Neuroradiology, Homburg (Germany); Roth, C.; Haass, A. [University of the Saarland, Clinic for Neurology, Homburg (Germany)

    2009-03-15

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  9. Surgical stent for dental implant using cone beam CT images

    International Nuclear Information System (INIS)

    The purpose of this study is to develop a surgical stent for dental implant procedure that can be easily applied and affordable by using cone beam computerized tomography (CBCT). Aluminum, Teflon-PFA (perfluoroalkoxy), and acetal (polyoxymethylene plastic) were selected as materials for the surgical stent. Among these three materials, the appropriate material was chosen using the CBCT images. The surgical stent, which could be easily placed into an oral cavity, was designed with chosen material. CBCT images of the new surgical stent on mandible were obtained using Alphard-3030 dental CT system (Asahi Roentgen Co., Ltd., Kyoto, Japan). The point of insertion was prescribed on the surgical stent with the multiplanar reconstruction software of OnDemand3D (CyberMed Inc., Seoul, Korea). Guide holes were made at the point of insertion on the surgical stent using newly designed guide jig. CBCT scans was taken for the second time to verify the accuracy of the newly designed surgical stent. Teflon-PFA showed radiologically excellent image characteristics for the surgical stent. High accuracy and reproducibility of implantation were confirmed with the surgical stent. The newly designed surgical stent can lead to the accurate implantation and achieve the clinically predictable result.

  10. Self-made Palmaz stent: an experimental swine model study

    International Nuclear Information System (INIS)

    Objective: To investigate the histologic changes and physicochemical stability of self-made Palmaz stent placed in swine arteries. Methods: The self-made Palmaz stent was made of 316L stainless steel wire. Nine stents were respectively placed within internal carotid, renal and iliac arteries of six pigs. Pigs were euthanized at intervals of 0.5, 1 and 3 months respectively and angiography were performed. Immediately followed by light and electro scanning microscopy for the stent zones. Results: All stents were successfully implanted in the target arteries and were patent shown in the angiographic examination immediately after the stent placement. Eight stents (8/9) remained patent at the time before euthanasia. No migration of stent were shown in the follow-up angiography. Light and electron scanning microscopy showed that the surface of the stents was covered by a thin layer of endothelial cells 2 weeks after the procedure and completely covered after 4 weeks. No inflammation occurred. Conclusions: The self-made Palmaz stent has good physicochemical stability and histocompatibility with easy placement, rather long term patency, histopathologic stability and thus the promising for clinical application

  11. Thin film nitinol covered stents: design and animal testing.

    Science.gov (United States)

    Levi, Daniel S; Williams, Ryan J; Liu, Jasen; Danon, Saar; Stepan, Lenka L; Panduranga, Mohanchandra K; Fishbein, Michael C; Carman, Greg P

    2008-01-01

    Interventionalists in many specialties have the need for improved, low profile covered stents. Thin films of nitinol (<5-10 microns) could be used to improve current covered stent technology. A "hot target" sputter deposition technique was used to create thin films of nitinol for this study. Covered stents were created from commercially available balloon-inflatable and self-expanding stents. Stents were deployed in a laboratory flow loop and in four swine. Uncovered stent portions served as controls. Postmortem examinations were performed 2-6 weeks after implantation. In short-term testing, thin film nitinol covered stents deployed in the arterial circulation showed no intimal proliferation and were easily removed from the arterial wall postmortem. Scanning electron microscopy showed a thin layer of endothelial cells on the thin film, which covered the entire film by 3 weeks. By contrast, significant neointimal hyperplasia occurred on the luminal side of stents deployed in the venous circulation. Extremely low-profile covered stents can be manufactured using thin films of nitinol. Although long-term studies are needed, thin film nitinol may allow for the development of low-profile, nonthrombogenic covered stents. PMID:18496269

  12. Surgical stent for dental implant using cone beam CT images

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyung Soo; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Department of Oral and Maxillofacial Radiology, School of Dentistry, Kung Hee University, Seoul (Korea, Republic of)

    2010-12-15

    The purpose of this study is to develop a surgical stent for dental implant procedure that can be easily applied and affordable by using cone beam computerized tomography (CBCT). Aluminum, Teflon-PFA (perfluoroalkoxy), and acetal (polyoxymethylene plastic) were selected as materials for the surgical stent. Among these three materials, the appropriate material was chosen using the CBCT images. The surgical stent, which could be easily placed into an oral cavity, was designed with chosen material. CBCT images of the new surgical stent on mandible were obtained using Alphard-3030 dental CT system (Asahi Roentgen Co., Ltd., Kyoto, Japan). The point of insertion was prescribed on the surgical stent with the multiplanar reconstruction software of OnDemand3D (CyberMed Inc., Seoul, Korea). Guide holes were made at the point of insertion on the surgical stent using newly designed guide jig. CBCT scans was taken for the second time to verify the accuracy of the newly designed surgical stent. Teflon-PFA showed radiologically excellent image characteristics for the surgical stent. High accuracy and reproducibility of implantation were confirmed with the surgical stent. The newly designed surgical stent can lead to the accurate implantation and achieve the clinically predictable result.

  13. Ferromagnetic Bare Metal Stent for Endothelial Cell Capture and Retention.

    Science.gov (United States)

    Uthamaraj, Susheil; Tefft, Brandon J; Hlinomaz, Ota; Sandhu, Gurpreet S; Dragomir-Daescu, Dan

    2015-01-01

    Rapid endothelialization of cardiovascular stents is needed to reduce stent thrombosis and to avoid anti-platelet therapy which can reduce bleeding risk. The feasibility of using magnetic forces to capture and retain endothelial outgrowth cells (EOC) labeled with super paramagnetic iron oxide nanoparticles (SPION) has been shown previously. But this technique requires the development of a mechanically functional stent from a magnetic and biocompatible material followed by in-vitro and in-vivo testing to prove rapid endothelialization. We developed a weakly ferromagnetic stent from 2205 duplex stainless steel using computer aided design (CAD) and its design was further refined using finite element analysis (FEA). The final design of the stent exhibited a principal strain below the fracture limit of the material during mechanical crimping and expansion. One hundred stents were manufactured and a subset of them was used for mechanical testing, retained magnetic field measurements, in-vitro cell capture studies, and in-vivo implantation studies. Ten stents were tested for deployment to verify if they sustained crimping and expansion cycle without failure. Another 10 stents were magnetized using a strong neodymium magnet and their retained magnetic field was measured. The stents showed that the retained magnetism was sufficient to capture SPION-labeled EOC in our in-vitro studies. SPION-labeled EOC capture and retention was verified in large animal models by implanting 1 magnetized stent and 1 non-magnetized control stent in each of 4 pigs. The stented arteries were explanted after 7 days and analyzed histologically. The weakly magnetic stents developed in this study were capable of attracting and retaining SPION-labeled endothelial cells which can promote rapid healing. PMID:26436434

  14. Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach Incidencia de complicaciones vasculares en pacientes sometidos a angioplastía coronaria transluminal percutánea por vía arterial transradial y transfemoral Incidência de complicações vasculares em pacientes submetidos a angioplastia coronariana transluminal percutânea por via arterial transradial e transfemoral

    Directory of Open Access Journals (Sweden)

    Marinez Kellermann Armendaris

    2008-03-01

    Full Text Available OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA. METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%, (17.14%; bruising (17.66%, (14.27%; urinary retention (2.43%, (25.71%; loss of vessel permeability (8.53%, (0%. CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.OBJETIVO: Describir complicaciones vasculares relacionadas a punciones arteriales transradial y transfemoral en pacientes sometidos a angioplastía coronaria transluminal percutánea (ACTP. MÉTODOS: Se trata de un estudio de cohorte prospectivo realizado con pacientes sometidos a ACTP. Se llevó a cabo una entrevista y aplicó un instrumento para obtener factores de riesgo/predictores. Fue realizado un examen físico, medición de signos vitales y se evaluó el lugar de punción. RESULTADOS: Fueron incluidos 199 pacientes, edad 64±10 años. Las complicaciones encontradas para vía radial y femoral respectivamente, fueron: esquimosis (18,29%, (17,14%; hematoma (17,66%, (14,27%; retención urinaria (2,43%, (25,71%; pérdida de permeabilidad de vaso (8,53%, (0%. CONCLUSIÓN: Las complicaciones fueron consideradas menores o secundarias conforme clasificación literaria. Existe una mayor incidencia de complicaciones vasculares relacionadas a punciones

  15. Biocompatibility of coronary stent materials: effect of electrochemical polishing

    Energy Technology Data Exchange (ETDEWEB)

    Scheerder, I. de [University Hospital Leuven (Belgium). Dept. of Cardiology; Sohier, J.; Froyen, L.; Humbeeck, J. van [Louvain Univ. (Belgium). Dept. of Metallurgy and Materials Engineering; Verbeken, E. [University Hospital Leuven (Belgium). Dept. of Pathology

    2001-02-01

    Percutaneous Transluminal Coronary Revascularization (PTCR) is now a widely accepted treatment modality for atherosclerotic coronary artery disease. Current multicenter randomized trials comparing PTCR with the more invasive Coronary Artery Bypass Grafting could not show long-term significant survival differences. During the last two decades progress has been made to further optimize PTCR. The most logic approach to treat atherosclerotic coronary narrowings is to remove the atherosclerotic material using especially developed devices. Several trials, however, could not show a significant beneficial outcome after use of these devices compared to plain old balloon angioplasty. Another approach was to implant a coronary prothesis (stent), scaffolding the diseased coronary artery after PTCA. This approach resulted in a decreased restenosis rate at follow-up. The beneficial effects of stenting, however, was not found to be related to the inhibition of the neointimal cellular proliferation after vascular injury, but simply to be the mechanical result of overstretching of the treated vessel segment. The most important remaining clinical problem after stenting remains the neointimal hyperplasia within the stent, resulting in a significant stent narrowing in 13 to 30% of patients. Further efforts to improve the clinical results of coronary stenting should focus on the reduction of this neointimal hyperplasia. Neointimal hyperplasia after stent implantation results from (1) a healting response to the injury caused by the stent implantation and (2) a foreign body response to the stent itself. Factors that seem to influence the neointimal hyperplastic response are genetic, local disease related, stent delivery related and stent related factors. Biocompatibilisation of coronary stents by looking for more biocompatible metal alloys, optimized surface characteristics and optimized stent designs should result in a better late patency. Furthermore drug eluting and radioactive stents

  16. Vascular Gene Transfer from Metallic Stent Surfaces Using Adenoviral Vectors Tethered through Hydrolysable Cross-linkers

    OpenAIRE

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

    2014-01-01

    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 r...

  17. Biolimus-eluting biodegradable polymer-coated stent versus durable polymer-coated sirolimus-eluting stent in unselected patients receiving percutaneous coronary intervention (SORT OUT V)

    DEFF Research Database (Denmark)

    Christiansen, Evald Høj; Jensen, Lisette Okkels; Thayssen, Per;

    2013-01-01

    Third-generation biodegradable polymer drug-eluting stents might reduce the risk of stent thrombosis compared with first-generation permanent polymer drug-eluting stents. We aimed to further investigate the effects of a biodegradable polymer biolimus-eluting stent compared with a durable polymer-...

  18. Intracranial stents past, present and the future trend: stents made with nano-particle or nanocomposite biomaterials.

    Science.gov (United States)

    Zhao, Junjie; Kalaskar, Deepak; Farhatnia, Yasmin; Bai, Xiaoxin; Bulter, Peter E; Seifalian, Alexander M

    2014-01-01

    Stroke or cerebral vascular accidents are among the leading causes of death in the world. With the availability of Digital Subtraction Angiography, transluminal angioplasty has become feasible in many situations and the role of intracranial stents is becoming ever more important in the management of cerebral vascular diseases. In current review, we outline the chronological development of various stents namely; balloon expandable stent, self-expandable open cell stent, self-expandable close cell stent and the flow diverting stent. Further we discuss their advantages and limitations in terms of stent migration, thromboemboli, damage to vessels during procedure, in-stent stenosis and hyper-perfusion damage. We also discuss the importance of in-situ endothelialization, controlled expandability and hemodynamic manipulation in stent design. Further, we summarized the role and need for further development in the areas of bio-compatible materials, endothelial progenitor cell capture technique, bio-functionalized-magnetic-nano-particles and nanotechnology which are significant in intracranial stent development. PMID:25039772

  19. Detection of Postcoronary Stent Complication: Utility of 64-Slice Multidetector CT

    Directory of Open Access Journals (Sweden)

    Alpa Bharati

    2012-01-01

    Full Text Available Coronary stent fracture is a known complication of coronary arterial stent placements. Multiple long-term risks are also associated with drug eluting stents. 64-slice multidetector CT (MDCT coronary angiography has been shown to detect poststent complications such as instent stenosis, thrombosis, stent migration and stent fractures. We report a case of stent fracture in a patient who underwent RCA stenting with associated RCA perforation and almost complete thrombosis of the RCA and peristent fibrinoid collection. This is a rare case of stent fracture with perforation of the RCA. The paper highlights the role of 64-row multidetector computed tomography (MDCT in evaluation of such poststent placement complications.

  20. Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

    LENUS (Irish Health Repository)

    Given, M F

    2008-12-01

    To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement\\/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.

  1. Optical coherence tomography to evaluate coronary stent implantation and complications.

    Science.gov (United States)

    Hayat, Umair; Thondapu, Vikas; Ul Haq, Muhammad Asrar; Foin, Nicolas; Jang, Ik-Kyung; Barlis, Peter

    2015-08-01

    Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice to examine the interaction between stents and the vessel wall. This review focuses on the application of OCT to examine coronary stents, the mechanisms of stent complications, and future directions of OCT-guided intervention. PMID:26247272

  2. Endeavour zotarolimus-eluting stent reduces stent thrombosis and improves clinical outcomes compared with cypher sirolimus-eluting stent : 4-year results of the PROTECT randomized trial

    NARCIS (Netherlands)

    Wijns, William; Steg, Ph. Gabriel; Mauri, Laura; Kurowski, Volkhard; Parikh, Keyur; Gao, Runlin; Bode, Christoph; Greenwood, John P.; Lipsic, Erik; Alamgir, Farqad; Rademaker-Havinga, Tessa; Boersma, Eric; Radke, Peter; van Leeuwen, Frank; Camenzind, Edoardo

    2014-01-01

    Aims To compare the long-term clinical safety between two drug-eluting stents with different healing characteristics in the Patient Related Outcomes with Endeavour (E-ZES) vs. Cypher (C-SES) Stenting Trial (PROTECT). At 3 years, there was no difference in the primary outcome of definite or probable

  3. Fabrication of a Knitted Biodegradable Stents for Tracheal Regeneration

    Institute of Scientific and Technical Information of China (English)

    李毅; 张佩华; 冯勋伟

    2004-01-01

    Endoluminal stents for reinforcement and regeneration of human trachea have been developed by weft-knitting method on a small-diameter circular knitting machine. The constituent materials of the stent are Polyglactin, Polypropylene and Chitosan with Polyglactin and Polypropylene plate-stitched fabric acting as backbone while chitosan as matrix, respectively. The fabrication procedures including knitting and coating are described in this paper. Mechanical and animal tests have been carried out to evaluate the mechanical properties of the stents.

  4. PREVENTION OF BIOFILM FORMATION ON NORFLOXACINMETRONIDAZOLE TREATED URETERAL LATEX STENTS

    OpenAIRE

    B. ELAYARAJAH; R. RAJENDRAN,; B. VENKATRAJAH,; WEDA SREEKUMAR,; ASASUDHAKAR,; P. K. JANIGA

    2011-01-01

    Biomaterial-associated bacterial infections present common and challenging complications with medical implants. The purpose of this study was to determine the antibacterial properties of latex rubber stents with integrated norfloxacin-metronidazole (synergistic antibacterial agent combinations) for the first time in order to prevent the colonization and biofilm formation on the surface of ureteral stents. Treating of latex rubber stents were carried out by adding the norfloxacin-metronidazole...

  5. An investigation into stent expansion using numerical and experimental techniques

    OpenAIRE

    Toner, Deborah

    2009-01-01

    Extensive finite element analyses have been carried out by researchers to investigate the difference in the mechanical loading induced in vessels stented with various different stent designs and the influence of this loading on restenosis outcome. This study investigates the experimental validation of these numerical stent expansions using compliant mock arteries. The development of this in-vitro validation test has the prospect of providing a fully validated preclinical testing tool which ca...

  6. LASER MICROMACHINING OF CORONARY STENTS FOR MEDICAL APPLICATIONS

    OpenAIRE

    Muhammad, Noorhafiza Binti

    2012-01-01

    This PhD thesis reports an investigation into medical coronary stent cutting using three different types of lasers and associated physical phenomena. This study is motivated by a gap in the current knowledge in stent cutting identified in an extensive literature review. Although lasers are widely used for stent cutting, in general the laser technology employed is still traditionally based on millisecond pulsed Nd:YAG lasers. Although recent studies have demonstrated the use of fibre lasers, p...

  7. Drug eluting stents: are human and animal studies comparable?

    OpenAIRE

    Virmani, R; Kolodgie, F D; Farb, A.; Lafont, A

    2003-01-01

    Animal models of stenting probably predict human responses as the stages of healing are remarkably similar. What is characteristically different is the temporal response to healing, which is substantially prolonged in humans. The prevention of restenosis in recent clinical trials of drug eluting stents may represent a near absent or incomplete phase of intimal healing. Continued long term follow up of patients with drug eluting stents for major adverse cardiac events and angiographic restenos...

  8. Cervical carotid pseudoaneurysm: A carotid artery stenting complication

    OpenAIRE

    Raso, Jair; Darwich, Rogerio; Ornellas, Carlos; Cariri, Gustavo

    2011-01-01

    Background: As carotid artery stenting becomes increasingly used, more complications are likely to occur. We present a case of Staphylococcus septicemia and pseudoaneurysm arising in the neck portion of the carotid artery after stenting. Case Description: A 51-year-old man was admitted with mild left hemiparesis. CT and MRI showed right hemisphere ischemia. Duplex Scan and MRA showed bilateral severe stenosis of the carotid arteries in the neck. A percutaneous angioplasty with stenting of the...

  9. Midterm Outcome of Femoral Artery Stenting and Factors Affecting Patency

    OpenAIRE

    Yu, Jae Seoung; Park, Keun-Myoung; Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun; Shin, Woo Young; Choe, Yun-Mee; Shin, Seok-Hwan; Kim, Kyung Rae

    2015-01-01

    Purpose: The purpose of this study was to evaluate the early and midterm results of superficial femoral artery (SFA) stenting with self-expanding nitinol stents and to identify the factors affecting patency. Materials and Methods: SFA stenting was performed in 165 limbs of 117 patients from January 2009 to December 2013. Patients were followed-up for the first occurrence of occlusion or stenosis based on computed tomography and duplex scan results and a decrease in ankle brachial index of >15...

  10. Platelet Activation and Inhibition in Connection with Vascular Stents

    OpenAIRE

    Christensen, Kjeld

    2007-01-01

    This thesis describes the Chandler loop, which makes it possible to conduct studies in vitro of molecular and cellular interactions between whole blood and stents. It was possible to monitor activation and inhibition of the cascades systems, leukocytes and platelets by combining different platelet inhibitors and heparin coating of stents. The clinical study was performed on patients with ACS undergoing PCI and stent implantation. In this study platelet activation markers P-selectin, and αIIb/...

  11. Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study

    DEFF Research Database (Denmark)

    Erglis, Andrejs; Kumsars, Indulis; Niemelä, Matti;

    2009-01-01

    BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and...... angiographic end-points. METHODS AND RESULTS: A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after...... 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of...

  12. Comparison of sirolimus-eluting stent versus polyzene-F polymer-coated stent in terms of early inflammatory response and long term outcomes

    OpenAIRE

    Murat Yuksel; Zeki Şimşek; Göksel Açar; Ulaankhuu Batgerel; Hacı Murat Güneş; Ali Metin Esen; Mehmet Muhsin Türkmen

    2015-01-01

    Objective: The intra-coronary stents provided great benefit after percutaneous transluminal coronary angioplasty (PTCA); however, high in-stent restenosis rates, even up to 25-30%, is the the main concern. Cytotoxic drug-eluting stents were developed to overcome this challenge. Whereas, they interfered vessel healing and endothelization process which led to increased risk of stent thrombosis. A bioinert molecule, polyzene-F(PzF), was applied to the surface of a new generation stent to provide...

  13. Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Torguson, Rebecca; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-04-15

    Objective: The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. Background: The optimal treatment for bare-metal in-stent restenosis remains controversial. Methods: The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES = 3.5%, PES = 4.6%, SES = 4.2%; p = 0.94), MI (EES = 3.5%, PES = 6.3%, SES = 2.1%; p = 0.31), TLR (EES = 9.8%, PES = 9.5%, SES = 5.7%; p = 0.42), TVR (EES = 14.3%, PES = 11.1%, SES = 11.3%; p = 0.74), definite ST (EES = 0.9%, PES = 3.1%, SES = 3.5%; p = 0.38) and MACE (EES = 14.0%, PES = 15.4%, SES = 10.5%; p = 0.54). Male gender (hazard ratio = 0.47; 95% confidence interval = 0.25–0.88) and number of treated lesions (hazard ratio = 1.47; 95% confidence interval = 1.06–2.05) were found to be independent predictors of MACE. Conclusion: The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis.

  14. Evaluación económica e impacto presupuestario del stent recubierto Endeavor® en España Economic evaluation and budget impact analysis of the Endeavor® drug-eluting stent in Spain

    Directory of Open Access Journals (Sweden)

    José Moreu

    2009-12-01

    Full Text Available Objetivo: Endeavor® es un stent recubierto de fármaco (DES, drug-eluting stent con resultados superiores a los stents metálicos (BMS, bare metal stent y eficacia similar a los otros DES, en revascularización. El objetivo del estudio fue comparar los costes y beneficios de Endeavor®, otros DES, BMS y bypass coronario en España. Métodos: Se construyó un modelo de Markov a cinco años que refleja el tratamiento de los pacientes con lesiones coronarias de novo. Las probabilidades se derivaron de revisiones sistemáticas y de los ensayos clínicos con Endeavor®. El uso de recursos y los costes se obtuvieron de datos locales y validados por expertos. Los resultados se expresaron como revascularizaciones evitadas, coste por acontecimientos adversos cardíacos mayores (MACE, major adverse coronary event evitados y años de vida ajustados por calidad (AVAC ganados. Resultados: Endeavor® tuvo unos costes superiores al BMS; un coste por revascularización evitada con Endeavor® de 6851 € (1 año y 10.831 € (5 años; un coste por MACE evitado de 7003 € y 11.322 €, respectivamente, y un coste por AVAC ganado de 132.877 €, 34.229 € y 10.505 € a 1, 2 y 5 años, respectivamente. El impacto presupuestario de la introducción progresiva de Endeavor® será prácticamente nulo, representando un 0,4% sobre el coste de las intervenciones coronarias percutáneas a los 5 años. Conclusiones: En comparación con BMS y bypass coronario, el empleo de Endeavor® representa un uso eficiente de los recursos en pacientes coronarios, con razones de coste-efectividad por debajo del umbral de eficiencia definido para el Sistema Nacional de Salud español.Objectives: Endeavor® is a drug-eluting stent (DES with superior results to the bare metal stent (BMS and similar efficacy to other DES in terms of revascularization. The aim of this study was to assess the costs and benefits of Endeavor®, other DES, BMS and coronary artery bypass grafts (CABG in Spain

  15. Primary stent placement for recanalization of iliac artery occlusions: Using a self-expanding spiral stent

    International Nuclear Information System (INIS)

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

    International Nuclear Information System (INIS)

    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

  17. Stenting plus coiling: dangerous or helpful?; Stenting plus Coiling bei akut rupturierten intrakraniellen Aneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Wanke, I.; Gizewski, E.; Doerfler, A.; Stolke, D.; Forsting, M. [Essen Univ. (Germany). Inst. fuer Radiologie und Neuroradiologie

    2005-09-01

    Purpose: the purpose of this study was to evaluate the procedural risk of treating acute ruptured aneurysms with a stentcoil combination. Material and methods: between August 2001 and January 2004 we treated nine acute subarachnoid hemorrhage (SAH) patients with a combination of stents and platinum coils. Results: six aneurysms were 100% eliminated; the residual three aneurysms had a 95% to 99% occlusion. A transient thrombosis in the stent in one patient could be recanalized by intravenous application of ReoPro {sup registered}. In another patient an occlusive vasospasm at the distal end of the stent was successfully treated with intraarterial Nimotop {sup registered}. Neurological complications occurred in none of the patients. Conclusion: in broad-based aneurysms which cannot be clipped or in which any neurosurgical treatment presents an unacceptably high risk (posterior circulation and paraophthalmic aneurysms), treatment using a combination of stent and platinum coils might be an option even in the acute phase of an SAH. Platelet aggregation can be treated with Aspirin registered and Plavix {sup registered} after placement of the first coil, vasospasms with intraarterial Nimotop {sup registered}, and acute stent thrombosis with GP IIa/IIIb-antagonists. (orig.)

  18. Incidence of hemodynamic depression after carotid artery stenting using different self-expandable stent types

    International Nuclear Information System (INIS)

    The rates of hemodynamic depression (HD) and thromboembolism were compared in 95 carotid artery stenting (CAS) procedures performed in 87 patients with severe carotid artery stenosis using self-expandable braided Elgiloy stents (Wallstent) in 52 and slotted-tube Nitinol stents (Precise) in 43 procedures. The blood pressure, pulse rate, and neurological signs were recorded at short intervals during and after CAS. All patients underwent diffusion-weighted magnetic resonance imaging within 5 days after the procedure. The incidences of hypotension, bradycardia, and both were 17.9%, 3.2%, and 11.6%, respectively. The rate of postprocedural HD was 23.1% with Wallstent and 44.2% with Precise; the difference was significant (p=0.025). No patient manifested major cardiovascular disease after CAS. Diffusion-weighted magnetic resonance imaging revealed thromboembolism after 26.9% and 34.9% of Wallstent and Precise stent placement procedures, respectively; the difference was not significant. The type of self-expandable stent placed may affect the risk of procedural HD in patients undergoing CAS. Postprocedural HD was resolved successfully by the administration of vasopressors and by withholding antihypertensive agents. (author)

  19. Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events

    DEFF Research Database (Denmark)

    Valgimigli, Marco; Sabaté, Manel; Kaiser, Christoph;

    2014-01-01

    eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. PRIMARY OUTCOMES: The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite...... a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P... coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. CONCLUSIONS: This meta-analysis offers evidence that compared with bare metal stents the use of cobalt...

  20. The prompt CT scan features following cerebrovascular stenting

    International Nuclear Information System (INIS)

    Objective: To evaluate the features of the brain CT scans following cerebrovascular stenting so as to guide the anticoagulant and antiplatelet treatment after cerebrovascular stenting. Methods: Eighty-seven patients with symptomatic cerebrovascular stenosis were scanned with brain CT after cerebrovascular stenting. The therapy of intracranial cerebrovascular stenting was conducted in 71 cases, and extracranial cerebrovascular stenting in 16 cases. According to the CT findings, the patients were divided into 3 types. Type I was diagnosed as normal, type II was thought that the lesions of cerebral infarctions were enhanced, and type III was diagnosed as intracranial hemorrhage. Results: In type I (normal CT scans), there were 74 (85.1%) patients. There were 8 (9.2%) cases in type II. All the infarctions were found enhanced within 35-78 days (mean 50 days). There were 5(5.7%) cases in type III. 2 patients were diagnosed as subarachnoid hemorrhage after MCA stenting, and 2 with headache were diagnosed as subarachnoid hemorrhage and cerebral hemorrhage after MCA stenting. One died of serious subarachnoid hemorrhage. The others fully recovered and were discharged. Conclusion: It is necessary to perform the prompt brain CT scan after the placement of cerebrovascular stent. The findings of high density in the cerebral infarctions within two months indicate that it is enhanced lesions, and high density in subarachnoid space in the side of stent placement indicates subarachnoid hemorrhage. (authors)

  1. Metallic stents for management of malignant biliary obstruction

    International Nuclear Information System (INIS)

    In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction

  2. Biocompatibility of phosphorylcholine coated stents in normal porcine coronary arteries

    OpenAIRE

    Whelan, Deirdre; Krabbendam, S.C.; Verdouw, Pieter; Serruys, Patrick; van Vliet, Erwin; Giessen, Wim; Van Beusekom, Heleen

    2000-01-01

    OBJECTIVE—To improve the biocompatibility of stents using a phosphorylcholine coated stent as a form of biomimicry.
INTERVENTIONS—Implantation of phosphorylcholine coated (n = 20) and non-coated (n = 21) stents was performed in the coronary arteries of 25 pigs. The animals were killed after five days (n = 6), four weeks (n = 7), and 12 weeks (n = 8), and the vessels harvested for histology, scanning electron microscopy, and morphometry.
MAIN OUTCOME MEASURES—Stent performance was assessed by ...

  3. Comparison of two stents in modifying cerebral aneurysm hemodynamics.

    Science.gov (United States)

    Kim, Minsuok; Taulbee, Dale B; Tremmel, Markus; Meng, Hui

    2008-05-01

    There is a general lack of quantitative understanding about how specific design features of endovascular stents (struts and mesh design, porosity) affect the hemodynamics in intracranial aneurysms. To shed light on this issue, we studied two commercial high-porosity stents (Tristar stent and Wallstent) in aneurysm models of varying vessel curvature as well as in a patient-specific model using Computational Fluid Dynamics. We investigated how these stents modify hemodynamic parameters such as aneurysmal inflow rate, stasis, and wall shear stress, and how such changes are related to the specific designs. We found that the flow damping effect of stents and resulting aneurysmal stasis and wall shear stress are strongly influenced by stent porosity, strut design, and mesh hole shape. We also confirmed that the damping effect is significantly reduced at higher vessel curvatures, which indicates limited usefulness of high-porosity stents as a stand-alone treatment. Finally, we showed that the stasis-inducing performance of stents in 3D geometries can be predicted from the hydraulic resistance of their flat mesh screens. From this, we propose a methodology to cost-effectively compare different stent designs before running a full 3D simulation. PMID:18264766

  4. Protein losing enteropathy secondary to a pulmonary artery stent

    International Nuclear Information System (INIS)

    A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE). He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE

  5. Percutaneous Endoluminal Bypass of Iliac Aneurysms with a Covered Stent

    International Nuclear Information System (INIS)

    To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed

  6. Endoscopic dacryocystorhinostomy with and without silicone stenting: A comparative study

    Directory of Open Access Journals (Sweden)

    K. Shashidhar

    2014-07-01

    Full Text Available Background and objectives: The objective of the present study is to compare the results of performing endonasal dacryocystorhinostomy for primary nasolacrimal duct obstruction with and without silicone stenting. Methods: This is a prospective randomized study including 57 patients who underwent 62 endonasal DCR procedures. 32 eyes underwent DCR with bicanalicular silicone stenting which was kept for 6 weeks. 30 eyes underwent DCR without stenting. Follow up was done for 6 months. Outcome of the surgery was noted as success in terms of complete relief from epiphora, patency of the ostium assessed by nasal endoscopy and lacrimal sac syringing. Results: The overall success rate for endoscopic endonasal DCR was 90.3%. Success rates were 93.7% with stenting and 86.7% without stenting. There was no statistical difference in the outcome of the two groups (p=0.4180. Complications noted were granulations, synechiae, periorbital edema and punctal trauma, with no difference in the frequency of occurrence in the two groups. Conclusion: There is no significant increase in the success rates of DCR on using silicone stenting. A selective stenting approach may be advocated, using stenting for specific indications. With proper technique and good follow up, stenting is not associated with any significant complications.

  7. [Finite Element Analysis of Intravascular Stent Based on ANSYS Software].

    Science.gov (United States)

    Shi, Gengqiang; Song, Xiaobing

    2015-10-01

    This paper adopted UG8.0 to bulid the stent and blood vessel models. The models were then imported into the finite element analysis software ANSYS. The simulation results of ANSYS software showed that after endothelial stent implantation, the velocity of the blood was slow and the fluctuation of velocity was small, which meant the flow was relatively stable. When blood flowed through the endothelial stent, the pressure gradually became smaller, and the range of the pressure was not wide. The endothelial shear stress basically unchanged. In general, it can be concluded that the endothelial stents have little impact on the flow of blood and can fully realize its function. PMID:26964302

  8. RECENT TRENDS IN BIOMATERIALS USED FOR CARDIOVASCULAR STENTING

    Directory of Open Access Journals (Sweden)

    Sona Ann Sunny

    2013-06-01

    Full Text Available During the last decade, biodegradable metal stents have been established and examined as substitutes for the currently-used long-lasting cardiovascular stents. Degradable metallic substances could theoretically change corrosion-resistant metals presently used for stent application as it has been presented that the role of stenting is short-term and inadequate to duration of 6–12 months after joining during which arterial makeover and curing occur. Even though corrosion is usually measured as a failure in metallurgy, the corrodibility of guaranteed metals can be an advantage for their use as degradable implants. The applicant materials for such function should have automatic properties preferably close to those of 316L stainless steel. Non-toxicity of the metal itself and its ruin products is another condition as the stuff is immersed by blood and cells. Based on the mentioned necessities, iron-based and magnesium-based alloys have been the investigate candidate for biodegradable stents. Carotid angioplasty and stenting (CAS has become known as a useful substitute to carotid endarterectomy and Nitinol stents are normally helpful in CAS. This article reviews the recent developments in the design and assessment of metallic material for biodegradable stents. It also introduces the new metallurgical process which could be practical for the manufacture of metallic biodegradable stents and their consequence on the properties of the metals.

  9. Mechanical properties and in vitro degradation of bioresorbable knitted stents.

    Science.gov (United States)

    Nuutinen, Juha-Pekka; Välimaa, Tero; Clerc, Claude; Törmälä, Pertti

    2002-01-01

    The aim of this study was to characterize the mechanical properties and in vitro degradation of bioresorbable knitted stents. Each stent was knitted using a single self-reinforced fibre made out of either PLLA or 96L/4D PLA or 80L/20G PLGA. The mechanical and physical properties of the fibres and stents were measured before and after gamma sterilization, as well as during in vitro degradation. The mechanical properties of the knitted stents made out of bioresorbable fibres were similar to those of commercially available metallic stents. The knitting geometry (loop height) had a marked effect on the mechanical properties of the stents. The rate of in vitro degradation in mechanical and physical properties for the PLLA and 96L/4D PLA stents was similar and significantly lower than that of the 80L/20G PLGA stents. The 80L/20G PLGA stents lost about 35% of their initial weight at 11 weeks. At this time, they had lost all their compression resistance strength. These data can be used as a guideline in planning further studies in vivo. PMID:12555898

  10. Protein losing enteropathy secondary to a pulmonary artery stent

    Directory of Open Access Journals (Sweden)

    Narayanswami Sreeram

    2012-01-01

    Full Text Available A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE. He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE.

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

    International Nuclear Information System (INIS)

    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

  12. Metallic stents for management of malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hee; Do, Young Soo; Byun, Hong Sik; Kim, Kie Hwan; Chin, Soo Yil [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1992-11-15

    In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction.

  13. Usefulness of surgical closure following intraoperative endoscopic additional stenting of duodenal perforation by stent: Report of a case

    OpenAIRE

    Shimizu, Kenji; Takamori, Hiroshi; Baba, Hideo

    2016-01-01

    Introduction Malignant duodenal stenosis occurs in patients with advanced periampullary cancer. Insertion of a self-expanding metal stent for the treatment of this condition carries the risk of subsequent perforation of the duodenum. We report successful treatment of duodenal perforation induced by a stent. Presentation of case An 80-year-old woman suffering from stenosis caused by advanced periampullary cancer underwent metallic stent placement and her symptoms improved. While attempting bil...

  14. A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

    OpenAIRE

    Choi, Jae Myoung; Kim, Jin Hong; Kim, Soon Sun; Yu, Jun Hwan; Hwang, Jae Chul; Yoo, Byung Moo; Park, Sang Heum; Kim, Ho Gak; Lee, Dong Ki; Ko, Kang Hyun; Yoo, Kyo Sang; Park, Do Hyun

    2012-01-01

    Background/Aims The placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent. Methods We retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the techn...

  15. Systematic review: Temporary stent placement for benign ruptures or anastomotic leaks with special emphasis on stent type

    OpenAIRE

    Van Boeckel, Petra G.A.; Sijbring, Alette; Vleggaar, Frank Paul; Siersema, Peter D

    2011-01-01

    Background: Placement of self-expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign esophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim & Methods: A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clin...

  16. Past, Present, and Future of Gastrointestinal Stents: New Endoscopic Ultrasonography-Guided Metal Stents and Future Developments

    OpenAIRE

    Lee, Hee Seung; Chung, Moon Jae

    2016-01-01

    Innovations in stent technology and technological advances in endoscopic ultrasonography have led to rapid expansion of their use in the field of gastrointestinal diseases. In particular, endoscopic ultrasonography-guided metal stent insertion has been used for the management of pancreatic fluid collection, bile duct drainage, gallbladder decompression, and gastric bypass. Endoscopic ultrasonography-guided drainage of intra-abdominal fluid collections using a plastic or metal stent is well es...

  17. Black hole restenosis after drug-eluting stent implantation for in-stent restenosis: potential mechanism and optimal strategy.

    Science.gov (United States)

    Otsuka, Yoritaka; Murata, Takashi; Kono, Michiaki; Imoto, Hiroki; Koyama, Taku; Nakamura, Keita; Kadama, Sunao; Noguchi, Hiroo; Saito, Taro

    2015-09-01

    In-stent restenosis (ISR) has long remained as the major limitation of coronary stenting. The use of drug-eluting stent (DES) reduces the risk of repeat revascularization without an increase of death and myocardial infarction, compared to the standard bare metal stents. DES has also demonstrated markedly to reduce ISR for complex lesions. However, ISR after DES implantation still occurs and optimal treatment for ISR after DES has not been established. Herein, we report 3 cases with black hole restenosis confirmed by intravascular ultrasound at the site of overlapped DES and discuss potential mechanism and optimal strategy for this phenomenon. PMID:24906987

  18. Successful treatment of coronary artery pseudoaneurysm by graft stent, which developed after the implantation of bare metal stent

    Directory of Open Access Journals (Sweden)

    Utku Şenol

    2013-03-01

    Full Text Available Although coronary artery pseudoaneurysm which couldoccur following percutaneous coronary interventions is arare complication, it can be mortal. As soon as the pseudoaneurysmis diagnosed, it should be treated by percutaneousintervention or surgery. Graft stent implantationis a preferred treatment for appropriate patients. In thiscase report, we presented a successful treatment of coronaryartery pseudoaneurysm by graft stent; which developedafter the implantation of bare metal stent into theleft anterior descending coronary artery. J Clin Exp Invest2013; 4 (1: 126-129Key words: Coronary artery, pseudoaneurysm, graft stent

  19. Rapid development of late stent malappositon and coronary aneurysm following implantation of a paclitaxel-eluting coronary stent

    Institute of Scientific and Technical Information of China (English)

    ZHANG Feng; QIAN Ju-ying; GE Jun-bo

    2007-01-01

    @@ Late stent malapposition (LSM), an unusual intravascular ultrasound (IVUS) finding at follow-up, has been reported to be more common after drug-eluting stent (DES) implantation than after bare metal stent(BMS) implantation.1-3 However, there has been no clear elucidation of time course and mechanism. We reported a case who developed LSM and coronary aneurysm very early after paclitaxel-eluting stent (PES) implantation. A review of the literature reveals no previous report describing rapid development of LSM and coronary aneurysm after PES implantation.

  20. Coated stents to prevent restenosis in coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2005-11-01

    Full Text Available Background: In-stent-restenosis (ISR is considered to be an essential limiting factor of stenting in coronary heart disease (CHD. The development of coated stents has raised expectations on substantial lowering restenosis after stenting with decreasing the rate of restenosis and a reduction in the rate of clinical events. Objectives: The present analysis addresses the questions on medical effectiveness and cost-effectiveness of the use of various coated stent types in CHD. Methods: The literature was searched in December 2004 in the most relevant medical and economic databases. The medical evaluation was conducted on the basis of published RCT. The data from the studies regarding various angiographic, sonographic and clinical endpoints were checked for methodical quality and summarised in meta-analyses. Within the scope of economic evaluation the primary studies were analysed and modelling was performed, applying clinical effect estimates from the meta-analyses of the medical evaluation and current estimates of German costs. Results: Medical evaluation: Ten different stenttypes were used in the included 26 RCT. The results for heparin, silicon-carbide, carbon and PTFE coated stenttypes could not reveal any significant differences between the medical effectiveness of coated and uncoated stents. The application of sirolimus, paclitaxel, everolimus and 7-hexanoyltaxol eluting stents showed a significant lower restenosis at 6-9 months with decrease in the rate of restenosis for polymer-based sirolimus, paclitaxel and 7-hexanoyltaxol eluting stents. In contrast, the use of gold-coated and actinomycin-D eluting stents was associated with a significantly higher restenosis. The polymer-based sirolimus and paclitaxel eluting stents also showed a significant and considerable reduction in the rate of repeated percutaneous revascularisations at 6-12 months (3.5% vs. 19.7%; p<0.0001, RR=0.19 [95%CI: 0.11; 0.33] and 3.5% vs. 12.2%; p<0.0001, RR=0.30 [95%CI: 0

  1. Mechanics of laser cut stent grafts

    Czech Academy of Sciences Publication Activity Database

    Major, Štěpán; Kocour, Vladimír; Hubálovský, Š.

    Prague: Institute of theoretical and applied mechanics, Academy of Sciences of the Czech Republic, v. v. i., 2015 - (Náprstek, J.; Fischer, C.), s. 186-187 ISBN 978-80-86246-42-0. ISSN 1805-8248. [Engineering mechanics 2015 /21./. Svratka (CZ), 11.05.2015-14.05.2015] Institutional support: RVO:68378297 Keywords : stent-grafts * nitinol * finite element analysis * fatigue * fracture Subject RIV: JJ - Other Materials

  2. Reperfusion hemorrhage following superior mesenteric artery stenting.

    LENUS (Irish Health Repository)

    Moore, Michael

    2012-02-03

    Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

  3. Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

    2007-10-15

    Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

  4. Postoperative ureteral injury treated by percutaneous nephrostomy and ureteral stent

    International Nuclear Information System (INIS)

    To evaluate percutaneous nephrostomy and ureteral stent placement in patients with postoperative ureteral injury. Percutaneous nephrostomy and antegrade ureteral stent placement were attempted in 12 patients with postoperative ureteral injuries. The previous operations which caused ureteral injuries included ureteroscopic extraction of ureteral stones(7), total abdominal hysterectomy due to uterine myoma(2), ureteroscopic biopsy in a patient with ureteral tuberculosis(1), open ureteroplasty due to retroperitoneal fibrosis(1), and ureterocystostomy during renal transplantation(1). After percutaneous nephrostomy, a 7.0 F ureteral stent was inserted in each patient. The stent was removed under cystoscopic guidance four to six weeks after this procedure. Urinalysis was performed to evaluate the presence of urinary tract infection after ureteral stent placement. Ultrasonography and/or intravenous urography were performed three weeks after stent placement, and every six months after the stent removal. Percutaneous nephrostomy and placement of an antegrade ureteral stent were successfully performed in all 12 patients. In three patients, the diagnosis of ureteral injuries was made immediately and in nine was delayed for between two and nineteen days. The ureteral stents remained in position for 25-95 days (average, 51);no evidence of urine leakage or ureteral stricture was seen on the follow-up examinations carried out from six months to several years after removal of the stent and no case required reintervention. Percutaneous nephrostomy and antegrade ureteral stenting are easy to perform, provide for the drainage of urine, cause no significant complication and show a successful therapeutic effect, and are this effective non-operative interventional techniques for patients with postoperative ureteral injury

  5. Radiation dosimetry in developing a radioactive stent for therapeutic use

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Hee; Kim, Jang Hee; Chung, Wee Sup; Woo, Kwang Sun [Korea Cancer Center Hospital , Seoul (Korea, Republic of)

    1997-09-01

    Research Goal: A new radioation therapy protocol of the esophageal carcinoma has been proposed. A metal stent coated with beta-emitting radioisotope would be inserted into the lesion of malignant esophageal obstruction and irradiate it. In this study, dose to the esophageal wall is estimated to suggest the selection of radioisotope, total activity, and the activity distribution pattern over the stent. Result: Dose distribution of the esophageal wall is determined by the energy spectrum of beta particles emitted from the radioisotope used in the stent activation. The endpoint energy of the beta spectrum corresponds to a range in liquid water, which determines the depth into the esophageal wall where the dose is significant. With a stent of constant areal activity density, dose to the esophageal wall increases with an increasing stent height until reaching a saturation value. Dose is maximum at the esophageal wall surface. The degree of dose decreasing as the target moves into the esophageal wall varies among different radioisotopes. However, dose decreases by similar degree among different radioisotopes as the target moves from the stent central height toward the stent end. For a stent of 2 cm in diameter, more than 4 cm in heigh, and 10 {mu}Ci/cm{sup 2} in activity, dose at the esophageal wall surface and at the stent central height is {approx}70 Gy, {approx}60 Gy, {approx}50 Gy, {approx}50 Gy, {approx}25 Gy, and {approx}15 Gy for {sup 90}Y, {sup 188}Re, {sup 166}Ho, {sup 32}P, {sup 186}Re, and {sup 192}Ir, respectively. Applications: Dose estimates provided in this study and the experimental results from the researchers at Yonsei University, who applied the radioactive stent to animals, will be used to analyze the relationship between the stent design and the corresponding therapeutic effect. This helps utilizing the new protocol of treating the esophageal carcinoma. 37 refs., 18 tabs., 27 figs. (author)

  6. Coronary Stent Materials and Coatings: A Technology and Performance Update.

    Science.gov (United States)

    O'Brien, Barry; Zafar, Haroon; Ibrahim, Ahmad; Zafar, Junaid; Sharif, Faisal

    2016-02-01

    This paper reviews the current state of the art for coronary stent materials and surface coatings, with an emphasis on new technologies that followed on from first-generation bare metal and drug-eluting stents. These developments have been driven mainly by the need to improve long term outcomes, including late stent thrombosis. Biodegradable drug-eluting coatings aim to address the long term effects of residual durable polymer after drug elution; the SYNERGY, BioMatrix, and Nobori stents are all promising devices in this category, with minimal polymer through the use of abluminal coatings. Textured stent surfaces have been used to attached drug directly, without polymer; the Yukon Choice and BioFreedom stents have some promising data in this category, while a hydroxyapatite textured surface has had less success. The use of drug-filled reservoirs looked promising initially but the NEVO device has experienced both technical and commercial set-backs. However this approach may eventually make it to market if trials with the Drug-Filled Stent prove to be successful. Non-pharmacological coatings such as silicon carbide, carbon, and titanium-nitride-oxide are also proving to have potential to provide better performance than BMS, without some of the longer term issues associated with DES. In terms of biological coatings, the Genous stent which promotes attachment of endothelial progenitor cells has made good progress while gene-eluting stents still have some practical challenges to overcome. Perhaps the most advancement has been in the field of biodegradable stents. The BVS PLLA device is now seeing increasing clinical use in many complex indications while magnesium stents continue to make steady advancements. PMID:26139297

  7. Characteristic mechanical properties of balloon-expandable peripheral stent systems

    International Nuclear Information System (INIS)

    Purpose: To measure in vitro geometric-mechanical characteristics of balloon-expandable peripheral stent systems for determining suitability for specific vascular regions. Materials and Methods: Balloon-expandable stents including their delivery systems manufactured by Guidant (OTW MegalinkTM), Inflow Dynamics (Antares), Medtronic (AVE BridgeTM), Biotronik (PeironTM) and Cordis (Corinthian IQTM) were selected for this study. When expanded, all stents had a nominal diameter of 8 mm. The length was 38-40 mm. Stent profile, trackability, length change on expansion, stiffness, elastic recoil, and radio-opacity in the crimped and expanded state of these stent systems were determined with specially developed test methods. Results: The Corinthian IQTM, MegalinkTM and PeironTM required the smallest force to pass through the vascular model. While the BridgeTM system had the largest profile with a diameter of 2.430 mm, all other stent systems had a significantly smaller diameter ranging from 1.970 mm for the PeironTM to 2.078 mm for the Corinthian IQTM. In the distal region of the stent delivery system, the MegalinkTM was the most flexible and the BridgeTM system the stiffest. Elastic recoil for all stents was in the range of 2.5% to 3.5%, with the exception of the BridgeTM stent, which had an elastic recoil of 4.79%. The Corinthian IQTM stent had noticeably the highest radial stiffness. In the expanded condition, the PeironTM was the most flexible while the Corinthian IQTM and AntaresTM were found to be the stiffest. Length change (shrinkage on expansion) ranged from 0.54 to 6.57%, with the exception of the Corinthian IQ, which shrunk >7 mm (18.5%) on expansion. All stent systems in the crimped and expanded state were readily visible radiographically. (orig.)

  8. Endoscopic management of occluded metal biliary stents:Metal versus 10F plastic stents

    Institute of Scientific and Technical Information of China (English)

    Won; Jae; Yoon; Ji; Kon; Ryu; Jung; Won; Lee; Dong-Won; Ahn; Yong-Tae; Kim; Yong; Bum; Yoon; Sang; Myung; Woo; Woo; Jin; Lee

    2010-01-01

    AIM:To compare the efficacy of self-expandable metal stents(SEMSs) with 10F plastic stents(PSs) in the endoscopic management of occluded SEMSs.METHODS:We retrospectively reviewed the medical records of 56 patients who underwent SEMS insertion for palliation of unresectable malignant biliary obstruction between 2000 and 2007 and subsequent endoscopic retrograde biliary drainage(ERBD) with SEMS or PS for initial SEMS occlusion between 2000 and 2008.RESULTS:Subsequent ERBD with SEMS was performed in 29 patient...

  9. Innovation in aortoiliac stenting: an in vitro comparison

    Science.gov (United States)

    Groot Jebbink, E.; Goverde, P. C. J. M.; van Oostayen, J. A.; Reijnen, M. M. P. J.; Slump, C. H.

    2014-03-01

    Aortoiliac occlusive disease (AIOD) may cause disabling claudicatio, due to progression of atherosclerotic plaque. Bypass surgery to treat AIOD has unsurpassed patency results, with 5-year patency rates up to 86%, at the expense of high complication rates (local and systemic morbidity rate of 6% and 16%). Therefore, less invasive, endovascular treatment of AOID with stents in both iliac limbs is the first choice in many cases, however, with limited results (average 5-year patency: 71%, range: 63-82%). Changes in blood flow due to an altered geometry of the bifurcation is likely to be one of the contributing factors. The aim of this study is to compare the geometry and hemodynamics of various aortoiliac stent configurations in vitro. Transparent vessel phantoms mimicking the anatomy of the aortoiliac bifurcation are used to accommodate stent configurations. Bare Metal Kissing stents (BMK), Kissing Covered (KC) stents and the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) configuration are investigated. The models are placed inside a flow rig capable of simulating physiologic relevant flow in the infrarenal area. Dye injection reveals flow disturbances near the neobifurcation of BMK and KC stents as well. At the radial mismatch areas of the KC stents recirculation zones are observed. With the CERAB configuration no flow reversal or large disturbances are observed. In conclusion, dye injection reveals no significant flow disturbances with the new CERAB configuration as seen with the KC and BMK stents.

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the vessel -- in the vessel for the stent delivery system to be placed. And I think that it's -- ... can't get the stent-retracting device out, delivery system out because you just don't have enough ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available INNOVATIONS IN STROKE PREVENTION: AN UPDATE ON CAROTID STENTING NEW YORK-PRESBYTERIAN HOSPITAL NEW YORK, NY July 15, 2008 00:00: ... evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. I'm ...

  12. Stent placement in arteriovenous fistula : an experimental study

    International Nuclear Information System (INIS)

    To determine the efficacy of metallic stents in the treatment of experimentally created carotid-jugular fistulas. Materials and Methods : Carotid-jugular fistulas were constructed surgically in four mongrel swines. Three Wallstents (Schneider, Bulbanch, Switzerland), 6mm in diameter and 23mm in length, and one Nir stent (Boston Scientific Corporation, Boston, U.S.A.), 3-5mm in diameter and 16mm in length, were placedendovascularly across the fistula holes within the carotid artery. Carotid angiography was performed before,immediately after, and 1-3 months after stent placement. Fistula specimens were obtained after final angiography and gross and microscopic examination was performed. Results : Angiography demonstrated decreased flow through the fistula immediately after stent placement. During follow-up, flow through the fistula decreased progressively but complete closure did not occur. Carotid arteries p in which Wallstents were placed were patent throughout the follow-up period. A carotid artery in which a Nir stent was used showed no decreased flow during follow-up angiography lasting two months. Pathologically, a thin layer of endothelium covered the stent wires; there was a transitional zone between the fibrous connective tissue of organizing thrombus, and endothelial proliferation occurred in the overlying fistula hole. Conclusions : Stent placement effectively reduced flow through the fistulas but during the ensuing three months closure did not occur. Occlusion was then progressive.Pathologically, intimal proliferation arose from the organizing thrombus on the surface of the stent mesh

  13. Transhepatic approach for extracardiac inferior cavopulmonary connection stent fenestration.

    LENUS (Irish Health Repository)

    Kenny, Damien

    2012-02-01

    We report on a 3-year-old male who underwent transcatheter stent fenestration of the inferior portion of an extracardiac total cavopulmonary connection in the setting of hypoplastic left heart syndrome. Transhepatic approach, following an unsuccessful attempt from the femoral vein facilitated delivery of a diabolo-shaped stent.

  14. Biodegradable Metals for Cardiovascular Stent Application: Interests and New Opportunities

    Directory of Open Access Journals (Sweden)

    Maryam Moravej

    2011-06-01

    Full Text Available During the last decade, biodegradable metallic stents have been developed and investigated as alternatives for the currently-used permanent cardiovascular stents. Degradable metallic materials could potentially replace corrosion-resistant metals currently used for stent application as it has been shown that the role of stenting is temporary and limited to a period of 6–12 months after implantation during which arterial remodeling and healing occur. Although corrosion is generally considered as a failure in metallurgy, the corrodibility of certain metals can be an advantage for their application as degradable implants. The candidate materials for such application should have mechanical properties ideally close to those of 316L stainless steel which is the gold standard material for stent application in order to provide mechanical support to diseased arteries. Non-toxicity of the metal itself and its degradation products is another requirement as the material is absorbed by blood and cells. Based on the mentioned requirements, iron-based and magnesium-based alloys have been the investigated candidates for biodegradable stents. This article reviews the recent developments in the design and evaluation of metallic materials for biodegradable stents. It also introduces the new metallurgical processes which could be applied for the production of metallic biodegradable stents and their effect on the properties of the produced metals.

  15. Coronary artery and myocardial inflammatory reaction induced by intracoronary stent

    Directory of Open Access Journals (Sweden)

    Gomes Walter J.

    2002-01-01

    Full Text Available BACKGROUND: Intra-coronary stents have been extensively employed in percutaneous coronary revascularization. However, despite breakthroughs and developments associated to this new technology, novel complications and findings have emerged compelling the cardiac surgeon to cope with this new scenario. The presence of an intra-coronary foreign body (stent might induce an inflammatory reaction carrying functional and structural repercussions of the coronary artery and surrounding cardiac muscle. METHOD:Patients, who had previously undergone stent implantation (6 to 18 months and were submitted to coronary artery bypass surgery, had biopsies taken from the grafted coronary artery distal to the stent and from the adjacent muscle. The collected samples were processed and stained with hematoxylin-eosin and histologically studied. RESULTS:The histology of the coronary artery distal to the stent revealed chronic inflammatory processes and an intimal acute inflammatory infiltrate, with polymorphonuclear leukocytes even at long term follow-up, 12 months after stent implantation, disclosing an ongoing inflammatory process. The myocardium adjacent to the stent implantation site exhibited a significant chronic inflammatory infiltrate and fibrosis compatible with myocarditis. CONCLUSION:The presence of an intra-coronary stent induces an acute and chronic inflammatory reaction, even over the long term, with involvement of the distal coronary artery and surrounding myocardium. Further studies are necessary to assess the inflammatory process extension and its consequences.

  16. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... length of stent, and then closed-cell versus open-cell. Jim? 00:50:24 JAMES F. McKINSEY, MD: I like the tapered stents, I think, aesthetically, but I don't have any data whatsoever that says that's the right thing to ...

  17. Stenting in the treatment of acute ischemic stroke: literature review.

    Directory of Open Access Journals (Sweden)

    EdgarASamaniego

    2011-12-01

    Full Text Available Recanalization of acute large artery occlusions is a strong predictor of good outcome. The development of thrombectomy devices resulted in a significant improvement in recanalization rates compared to thrombolytics alone. However, clinical trials and registries with these thrombectomy devices in acute ischemic stroke (AIS have shown recanalization rates in the range of 40-81%. The last decade has seen the development of nickel titanium self-expandable stents (SES. These stents, in contrast to balloon-mounted stents, allow better navigability and deployment in tortuous vessels and therefore are optimal for the cerebral circulation. SES were initially used for stent-assisted coil embolization of intracranial aneurysms and for treatment of intracranial stenosis. However, a few authors have recently reported feasibility of deployment of SES in AIS. The use of these devices yielded higher recanalization rates compared to traditional thrombectomy devices. Encouraged by these results, retrievable SES systems have been recently used in AIS. These devices offer the advantage of resheathing and retrieving of the stent even after full deployment. Some of these stents can also be detached in case permanent stent placement is needed. Retrievable SES are being used in Europe and currently tested in clinical trials in the United States. We review the recent literature in the use of stents for the treatment of AIS secondary to large vessel occlusion.

  18. A novel biodegradable esophageal stent: results from mechanical and animal experiments.

    Science.gov (United States)

    Liu, Jin; Shang, Liang; Liu, Jiyong; Qin, Chengyong

    2016-01-01

    Biodegradable esophageal stents eliminate stent retrieval, but usually induce hyperplasia. This study investigated the properties of a novel biodegradable stent in vitro and in vivo. The degradation of the novel stent was observed in phosphate buffered saline (PBS) for 8 weeks. The radial forces, pH values, morphology, and retention rate of the intrinsic viscosity (R[η]) of the new biodegradable stent were all evaluated. In vitro, the pH values remained constant for 4 weeks and declined from weeks 4 to 8. The biodegradable threads degraded and ruptured at 6 weeks. Consequently, the radial force of the stent decreased to zero at that time. The curve of R[η] decreased with time linearly in PBS. To study the stents in vivo, we used a stricture model in which the middle esophagus of rabbits was damaged by alkali burn. Stents were inserted 2 weeks after injury and observed for 8 weeks. We assessed complications related to stent insertion, degradation of the stent, and survival of the rabbits. Two stents migrated, and one rabbit died. In the other rabbits, two stents degraded and moved into the stomach during the sixth week, five during the seventh week and one during the eighth week, respectively. One stent remained in position until the end of the study. In conclusion, our newly designed stent retained the strong radial force of self-expandable metal stents (SEMSs) and maintained the biodegradable properties of biodegradable (BD) stents. PMID:27158397

  19. Finite element analyses for design evaluation of biodegradable magnesium alloy stents in arterial vessels

    International Nuclear Information System (INIS)

    Biodegradable magnesium alloy stents (MAS) can provide a great benefit for diseased vessels and avoid the long-term incompatible interactions between vessels and permanent stent platforms. However, the existing MAS showed insufficient scaffolding to the target vessels due to short degradation time. In this study, a three dimensional finite element model combined with a degradable material model of AZ31 (Al 0.03, Zn 0.01, Mn 0.002 and Mg balance, mass percentage) was applied to three different MAS designs including an already implanted stent (Stent A), an optimized design (Stent B) and a patented stent design (Stent C). One ring of each design was implanted through a simulation in a vessel model then degraded with the changing interaction between outer stent surface and the vessel. Results showed that a proper stent design (Stent B) can lead to an increase of nearly 120% in half normalized recoil time of the vessel compared to the Stent A; moreover, the expectation that the MAS design, with more mass and optimized mechanical properties, can increase scaffolding time was verified numerically. The Stent C has more materials than Stent B; however, it only increased the half normalized recoil time of the vessel by nearly 50% compared to the Stent A because of much higher stress concentration than that of Stent B. The 3D model can provide a convenient design and testing tool for novel magnesium alloy stents.

  20. Finite element analyses for design evaluation of biodegradable magnesium alloy stents in arterial vessels

    Energy Technology Data Exchange (ETDEWEB)

    Wu Wei [Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan (Italy); Gastaldi, Dario, E-mail: dario.gastaldi@polimi.it [Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan (Italy); Yang Ke; Tan Lili [Division of Specialized Materials and Devices, Institute of Metal Research, Chinese Academy of Sciences, Shenyang (China); Petrini, Lorenza; Migliavacca, Francesco [Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan (Italy)

    2011-12-15

    Biodegradable magnesium alloy stents (MAS) can provide a great benefit for diseased vessels and avoid the long-term incompatible interactions between vessels and permanent stent platforms. However, the existing MAS showed insufficient scaffolding to the target vessels due to short degradation time. In this study, a three dimensional finite element model combined with a degradable material model of AZ31 (Al 0.03, Zn 0.01, Mn 0.002 and Mg balance, mass percentage) was applied to three different MAS designs including an already implanted stent (Stent A), an optimized design (Stent B) and a patented stent design (Stent C). One ring of each design was implanted through a simulation in a vessel model then degraded with the changing interaction between outer stent surface and the vessel. Results showed that a proper stent design (Stent B) can lead to an increase of nearly 120% in half normalized recoil time of the vessel compared to the Stent A; moreover, the expectation that the MAS design, with more mass and optimized mechanical properties, can increase scaffolding time was verified numerically. The Stent C has more materials than Stent B; however, it only increased the half normalized recoil time of the vessel by nearly 50% compared to the Stent A because of much higher stress concentration than that of Stent B. The 3D model can provide a convenient design and testing tool for novel magnesium alloy stents.

  1. Experimental results with endovascular irradiation via a radioactive stent

    International Nuclear Information System (INIS)

    Purpose: The objective of this article is to describe the methods used to manufacture a radioactive stent and to review the experimental data on this therapy designed to improve arterial patency rates after stent placement. Materials and Methods: Surface activation in a cyclotron and ion implantation techniques are used to render commercially available vascular stents radioactive. β-Particle-emitting stents, most commonly 32P, were employed because of their short half-life (14.3 days) and limited range of tissue penetration (3-4 mm). The function and vascular response to these 32P radioactive stents with varying activities (range 0.14-23 μCi) was evaluated in several animal models of arterial injury and restenosis. Results: In porcine iliac arteries, β-particle-emitting stents with an initial activity of 0.14 μCi reduced neointimal formation 37% at 28 days after implant. On histology, the neointima consisted of smooth muscle cells and a proteoglycan-rich matrix. Scanning electron microscopy demonstrated complete endothelialization of the stent. β-Particle-emitting stents with an initial activity of 3-23 μCi inhibited neointimal smooth muscle cell proliferation at 28 days in a porcine coronary restenosis model. The neointima within these high-activity stents consisted of fibrin, erythrocytes, and only rare smooth muscle cells. Studies with 1-year follow-up after implantation of a radioactive stent with a composition of γ- and β-particle-emitting radionuclides 55,56,57Co, 52Mg, and 55Fe and an initial activity of 17.5 μCi demonstrated almost complete inhibition of neointimal proliferation in a rabbit model. Conclusion: Endovascular irradiation delivered via a radioactive stent reduces neointimal formation and improves luminal patency without increasing the risk for stent thrombosis in experimental models of restenosis. The optimal radiation dose is unknown. At stent activities >3 μCi of 32P, the inhibition of neointimal formation is due to direct radiation

  2. Endovascular stenting for treatment of vertebral arterial stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate our short-term results in endovascular treatment of symptomatic vertebral arterial stenosis with stents. Methods: Balloon-expanded stents were utilized to pass across the vertebral arterial stenosis, and then the balloons were inflated for the deployment of stents, outcoming with restoration of the stenosis to normal size. Results: Forty five patients presented with posterior circulation ischemic symptoms and refractory to medical therapy were undertaken with endovascular stenting, showing technically successful in forty three of them. The mean degrees of preoperative and postoperative stenosis were 75.7% and 10.3%, respectively. Follow up data showed disappearance of clinical symptoms in 35 patients, clinical improvement and stabilization in 2. There were no intimal dissection and distal embolization. Short-term follow-up angiogram revealed no restenosis and intimal hyperplasia. Conclusions: Endovascular stenting may be a favorable alternative for the treatment of vertebral arterial stenosis, but long-term follow-up is necessary

  3. Endoscopic removal of a proximal urethral stent using a holmium laser: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Francisco Botelho

    2012-01-01

    Full Text Available Urethral stents were initially developed for the management of urethral strictures and obstructive voiding disorders in select patients. Urethral stent complications are common and may require stent explantation, which is often quite challenging. We present our experience with endoscopic removal of an encrusted UroLume proximal urethral stent in a 72-year-old male using a holmium laser. The literature on various management options and outcomes for urethral stent removal is reviewed. Endoscopic removal of proximal urethral stents is feasible and safe and should be considered as the primary treatment option in patients requiring stent extraction.

  4. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography.

    Science.gov (United States)

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Arena, Monica; Iabichino, Giuseppe; Consolo, Pierluigi; Opocher, Enrico; Luigiano, Carmelo

    2016-02-10

    Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents. PMID:26862364

  5. The Integrity bare-metal stent made by continuous sinusoid technology.

    Science.gov (United States)

    Turco, Mark A

    2011-05-01

    The Integrity Coronary Stent System (Medtronic Vascular, CA, USA) is a low-profile, open-cell, cobalt-chromium-alloy advanced bare-metal iteration of the well-known Driver/Micro-Driver Coronary Stent System (Medtronic Vascular). The Integrity stent is made with a process called continuous sinusoid technology. This process allows stent construction via wrapping a single thin strand of wire around a mandrel in a sinusoid configuration, with laser fusion of adjacent crowns. The wire-forming process and fusion pattern provide the stent with a continuous preferential bending plane, intended to allow easier access to, and smoother tracking within, distal and tortuous vessels while radial strength is maintained. Continuous sinusoid technology represents innovation in the design of stent platforms and will provide a future stent platform for newer technology, including drug-eluting stent platforms, drug-filled stents and core wire stents. PMID:21542702

  6. Type D personality predicts death or myocardial infarction after bare metal stent or sirolimus-eluting stent implantation

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Lemos, Pedro A; van Vooren, Priya R;

    2004-01-01

    We investigated the effect of Type D personality on the occurrence of adverse events at nine months in patients with ischemic heart disease (IHD) after percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SESs) or bare stents. Type D patients experience increased negative...... emotions and tend not to express these emotions in social interactions....

  7. Virtual stenting workflow with vessel-specific initialization and adaptive expansion for neurovascular stents and flow diverters.

    Science.gov (United States)

    Paliwal, Nikhil; Yu, Hongyu; Xu, Jinhui; Xiang, Jianping; Siddiqui, Adnan H; Yang, Xinjian; Li, Haiyun; Meng, Hui

    2016-10-01

    Endovascular intervention using traditional neurovascular stents and densely braided flow diverters (FDs) have become the preferred treatment strategies for traditionally challenging intracranial aneurysms. Modeling stent and FD deployment in patient-specific aneurysms and its flow modification results prior to the actual intervention can potentially predict the patient outcome and treatment optimization. We present a clinically focused, streamlined virtual stenting workflow that efficiently simulates stent and FD treatment in patient-specific aneurysms based on expanding a simplex mesh structure. The simplex mesh is generated using an innovative vessel-specific initialization technique, which uses the patient's parent artery diameter to identify the initial position of the simplex mesh inside the artery. A novel adaptive expansion algorithm enables the acceleration of deployment process by adjusting the expansion forces based on the distance of the simplex mesh from the parent vessel. The virtual stenting workflow was tested by modeling the treatment of two patient-specific aneurysms using the Enterprise stent and the Pipeline Embolization Device (commercial FD). Both devices were deployed in the aneurysm models in a few seconds. Computational fluid dynamics analyses of pre- and post-treatment aneurysmal hemodynamics show flow reduction in the aneurysmal sac in treated aneurysms, with the FD diverting more flow than the Enterprise stent. The test results show that this workflow can rapidly simulate clinical deployment of stents and FDs, hence paving the way for its future clinical implementation. PMID:26899135

  8. Vascular brachytherapy revisited for in-stent restenosis in the drug-eluting stent era: current status and future perspective

    Institute of Scientific and Technical Information of China (English)

    LI Xiong-jie; Seung-Woon Rha; Sunil-P Wani; WANG Lin; Kanhaiya-L Poddar; Dong-Joo Oh

    2009-01-01

    @@ Percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has revolutionized the management of atherosclerotic coronary artery disease. However, in-stent restenosis (ISR) has been the downside of all coronary interventions with the devices that have been tested so far, even in the DES era.

  9. Clinical application of stent-graft using gianturco stent and poly-tetra-fluoro ethylene (PTFE) in aortic aneurysm

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of treatment of aortic aneurysm with endoluminal stent-grafts using Gianturco stent and poly-tetra-fluoro ethylene (PTFE). In ten patients with aortic aneurysm, eleven procedures were performed using tubular (n=7) or bifurcated (n=4) Gianturco Z-stents covered with PTFE to treat aortic disease (six atherosclerotic aortic aneurysms, four pseudoaneurysms of abdominal aorta in three patients with Behcet's disease, and one penetrating atherosclerotic ulcer). Spiral CT angiography was used for follow-up from 14 days to 31 months (mean, 12 months). The effectiveness of stent-grafts was evaluated during follow-up. In all cases, implantation of stent-grafts was technically successful ; in five, perigraft leakage was detected on completion of aortography. On initial post-procedural CT images obtained 4-24 days after insertion of the stent-graft, complete thrombosis of the aneurysm was seen in seven cases and perigraft leakage in four. Two of the four cases in which leakage was seen on initial CT improved spontaneously during follow-up. Procedure-related thromboembolism occurred in one case, which was managed by thrombolytic therapy without residual sequelae. During follow-up CT, the size of aortic aneurysms of atherosclerotic disease did not change. The pseudoaneurysms of Behcet's disease decreased and eventually completely disappeared, with only residual periaortic soft tissue. For the treatment of aortic diseases, stent grafting using a Gianturco stent PTFE is clinically feasible, safe, and effective

  10. Clinical application of stent-graft using gianturco stent and poly-tetra-fluoro ethylene (PTFE) in aortic aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Song, Soon Young; Chung, Jin Wook; Song, Chi Sung; Kim, Sang Joon; Ha, Chong Won; Ahn, Hyuk; Park, Young Bae; Oh, Byung Hee [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-01-01

    To evaluate the effectiveness of treatment of aortic aneurysm with endoluminal stent-grafts using Gianturco stent and poly-tetra-fluoro ethylene (PTFE). In ten patients with aortic aneurysm, eleven procedures were performed using tubular (n=7) or bifurcated (n=4) Gianturco Z-stents covered with PTFE to treat aortic disease (six atherosclerotic aortic aneurysms, four pseudoaneurysms of abdominal aorta in three patients with Behcet's disease, and one penetrating atherosclerotic ulcer). Spiral CT angiography was used for follow-up from 14 days to 31 months (mean, 12 months). The effectiveness of stent-grafts was evaluated during follow-up. In all cases, implantation of stent-grafts was technically successful ; in five, perigraft leakage was detected on completion of aortography. On initial post-procedural CT images obtained 4-24 days after insertion of the stent-graft, complete thrombosis of the aneurysm was seen in seven cases and perigraft leakage in four. Two of the four cases in which leakage was seen on initial CT improved spontaneously during follow-up. Procedure-related thromboembolism occurred in one case, which was managed by thrombolytic therapy without residual sequelae. During follow-up CT, the size of aortic aneurysms of atherosclerotic disease did not change. The pseudoaneurysms of Behcet's disease decreased and eventually completely disappeared, with only residual periaortic soft tissue. For the treatment of aortic diseases, stent grafting using a Gianturco stent PTFE is clinically feasible, safe, and effective.

  11. Dual-Design Expandable Colorectal Stent for a Malignant Colorectal Obstruction: Preliminary Prospective Study Using New 20 mm Diameter Stents

    International Nuclear Information System (INIS)

    To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.

  12. Ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy.

    Science.gov (United States)

    Chen, I-Hsuan; Tsai, Jeng-Yu; Yu, Chia-Cheng; Wu, Tony; Huang, Jong-Khing; Lin, Jen-Tai

    2014-05-01

    The aim of this study was to examine the feasibility of ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy and to evaluate the effects of retrograde ureteroscopic access exerted on the sutured ureterotomy site. From January 2002 to December 2011, 30 patients with proximal ureteral stone underwent ureteroscopic double-J stenting of the ureter following retroperitoneal laparoscopic ureterolithotomy. Patient demographics and perioperative parameters, including the degree of hydronephrosis, urine leakage, and drainage time, were retrospectively reviewed. These data were compared with those of 30 consecutive patients who received open ureterolithotomy and intracorporeal ureteral double-J stenting. In addition, a PubMed search was conducted and the related literature on the placement of a ureteral stent was reviewed. Twenty-eight patients successfully underwent ureteral double-J stenting with ureteroscopic access. No malposition of the ureteral stent was identified in the ureteroscopic group, but two patients in the intracorporeal group required postoperative adjustment of the stent. Residual stone fragments were found during stent placement in three patients in the ureteroscopic group and holmium:yttrium-aluminum-garnet laser lithotripsy was immediately performed. There was no significant difference in postoperative outcomes or complication rates between the two groups. Ureteroscope-assisted ureteral double-J stenting is a simple and safe alternative allowing intraluminal navigation along the entire ureter, correct stent placement, and prompt treatment of residual stone fragments, without radiation exposure. In addition, ureteral disruption and urinary extravasation may not be concerns for ureteroscopic access with continuous normal saline irrigation. PMID:24751387

  13. In vivo Evaluation of Cenderitide-Eluting Stent (CES) II.

    Science.gov (United States)

    Huang, Yingying; Ng, Xu Wen; Lim, Soon Ghim; Chen, Horng Haur; Burnett, John C; Boey, Yin Chiang Freddy; Venkatraman, Subbu S

    2016-02-01

    The use of drug-eluting coronary stents has led to significant reduction in in-stent restenosis (ISR), but led to delayed endothelialization, necessitating the prolonged use of expensive anti-thrombotic drugs with their side-effects. Cenderitide (CD-NP) is a novel anti-proliferative chimeric peptide of semi-endothelial origin. Our previous work in vitro has demonstrated; that the smooth muscle cells were inhibited significantly more than endothelial cells which is the desirable feature of an anti-restenosis drug. This work reports the effects of implantation of a centeritide-eluting stent (CES) on ISR and endothelialization in an in vivo model. CESs were produced by coating bare metallic stents with CD-NP entrapped in biodegradable poly(ε-caprolactone) using an ultrasonic spray coater. A total of 32 stents were successfully implanted into 16 pigs, and all animal survived for 28 days. The plasma levels of CD-NP were significantly higher in the CES group than in the control group (bare metal stents and polymer-coated stent) at post-stenting, indicating the successful release of CD-NP from the stent in vivo. Furthermore, SEM analysis results showed the greater endothelial coverage of the stent struts, as well as between the struts in CES group. Moreover, histological results showed mild inflammation, and low fibrin score at 28 days. However, plasma cGMP (second messenger, cyclic 3',5' guanosine monophosphate) does not show a significant difference, and the CES is also unable to show significant difference in terms on neointimal area and stenosis, in comparison to BMS at 28 days. PMID:26178873

  14. Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina Intracoronary brachytherapy. Treatment of in-stent restenosis with the Beta-Cath system: initial experience in Latin America

    Directory of Open Access Journals (Sweden)

    Juan Simon Muñoz

    2004-07-01

    Full Text Available OBJETIVO: Avaliar a segurança e eficácia da braquiterapia intracoronariana usando o sistema Beta-CathTM na prevenção da recorrência de restenose intra-stent (RIS, por meio da análise dos resultados clínicos, angiográficos e pelo ultra-som intracoronariano (USIC. MÉTODO: Foram submetidos à angioplastia com cateter-balão, seguida de beta-radiação intracoronariana com o sistema Beta-CathTM (90Sr/Y 30 pacientes com RIS em artérias coronárias nativas e, posteriormente, avaliados. RESULTADOS: Incluíram-se lesões reestenóticas complexas (77% do tipo difuso-proliferativo com extensão elevada (18,66±4,15 mm. O sucesso da braquiterapia foi de 100%. A dose média utilizada foi de 20,7±2,3 Gy, liberada em um período médio de 3,8±2,1 min. No seguimento tardio, o diâmetro luminal mínimo (DLM intra-stent diminuiu discretamente (1,98±0,30mm para 1,84±0,39 aos 6 meses, p=0,13, com uma perda tardia de 0,14±0,18 mm. O DLM intra-segmentar foi significativamente menor do que o intra-stent (1,55±0,40mm vs.1,84±0,39mm, p=0,008, associando-se à perda tardia (0,40±0,29mm vs. 0,14±0,18mm; p=0,0001. No USIC, observou-se discreto incremento do tecido neointimal em 6,8±14,3 mm³ aos 6 meses (p=0,19 e a percentagem de obstrução volumétrica aumentou em 4,7±7,5%. A reestenose binária e a revascularização do vaso-alvo recorreram em 17% dos casos; houve 1 caso (3% de oclusão tardia, associada a infarto do miocárdio. A sobrevida livre de eventos foi de 80%. CONCLUSÃO: O manejo da reestenose intra-stent com a beta-radiação intracoronariana mostrou-se procedimento seguro e eficaz, com alta taxa de sucesso imediato, representando uma opção terapêutica para a inibição da hiperplasia neointimal.OBJECTIVE: To assess the safety and efficacy of intracoronary brachytherapy using the Beta-Cath systemTM for preventing recurrence of in-stent restenosis (ISR, by analyzing clinical, angiographic, and intracoronary ultrasound (ICUS results

  15. “Bilateral Double J Stent Removal: The way to do it!”

    Science.gov (United States)

    Yadav, Rahul; Dalela, Divakar; Goyal, Neeraj K.; Nagathan, Deepak; Sankhwar, Satya N.

    2012-01-01

    There are many urological and non-urological indications which require bilateral double J stenting. We describe a point of technique for simultaneous removal of both the Double J stents. Both the stents are held by stent removing forceps at a point where they cross each other and then removed in one go with the help of cystoscope. Medline search did not reveal any techniques of removing two DJ stents in one go. PMID:23741597

  16. Coil Migration through a Neuroform 3 Stent during Endovascular Coiling. A Case Report.

    LENUS (Irish Health Repository)

    O'Hare, A

    2009-07-29

    Summary: A 43-year-old woman attended for stent assisted coiling. A Neuroform 30 x 4.5 mm stent had been successfully placed over the left periophthalmic aneurysm. During the coiling the first coil migrated through the crowns in the stent, lodging at the MCA bifurcation. We believe that the coil herniated through the overlying stent due to the carotid siphon curvature and the open cell design. Furthermore the distal markers of the stent impeded coil extraction with a MERCI device.

  17. Poly lactic acid based biodegradable stents and functionalization techniques: brief review

    OpenAIRE

    Rebelo, Rita; Vila, Nívea Taís; Rana, Sohel; Fangueiro, Raúl

    2015-01-01

    Commercial stents, especially metallic ones, present several disadvantages, and this gives rise to the necessity of producing or coating stents with different materials, like natural polymers, in order to improve their biocompatibility and minimize the disadvantages of metallic ones. This review paper discusses some applications of natural-based polymers in stents, namely polylactic acid (PLA) for stent development and chitosan for biocompatible coatings of stents . Furthermore...

  18. Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient.

    Science.gov (United States)

    Pane, B; Spinella, G; Salcuni, M; Palombo, D

    2013-08-01

    The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients. PMID:24013540

  19. Silicon Carbide Coating Ñ A Semiconducting Hybrid Design of Coronary Stents Ñ A Feasibility Study.

    Science.gov (United States)

    Heublein; Pethig; Elsayed

    1998-06-01

    OBJECTIVE: To determine the rates of subacute and acute thrombotic stent occlusion in patients with normal and high risk for stent thrombosis and to assess the 6 month follow-up with respect to in-stent restenosis, using a new principle of semiconductor coating (active passivating as metallic hybrid design). DESIGN: Open, non-randomized, prospective, observational, feasibility study. PATIENTS: One hundred sixty-five patients (215 stents) were scheduled consecutively with respect to lesions suitable for slotted tube stent implantation. Two subgroups of patients (stents) were identified based on the local thrombotic risk (common indications for stent implantation Ñ group I; lesions with high(er) risk for stent implantation (group II). A closed clinical 3Ð12 (mean 6.5 +/- 2.3) months follow-up was done in 126 (92.6%) eligible patients [164 (97.6%) stents]. Angiographic and/or IVUS data were available in 96 of 136 eligible patients (70.6%) after stenting 6.0 +/- 2.1 months). STENT-MATERIAL/MEDICATION: Balloon expandable tantalum three segment slotted tube stents which were coated with silicon carbide, diameter ranged from 2.5 to 4.0 mm were used. Stent deployment was limited by inflation pressure (12Ð16 Bar). Apart from patients with acute myocardial infarction (n = 15 stents) patients received heparin loading dose during the procedure only, no oral anticoagulation except aspirin (300 mg p.d.) and ticlopidine (250Ð500mg p.d.) given over 1 month. RESULTS: Acute complications. No in-hospital mortality occurred, stent-related myocardial infarction was 1.9%; major bleedings 0.5% of implanted stents. Acute stent thrombosis 1.4%, subacute stent thrombosis occurred in 0.5% (no significant difference between group I and II). Late events: From 136 eligible patients (range 15 daysÐ14 months) (187 stents) 92 patients (67.6%) with 142 stents (75.9%) were event-free. In-stent restenosis. Thirty-six percent (biased group of patients with events) resp. 26.8% (including negative

  20. Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques.

    Science.gov (United States)

    Seo, Jae-Bin; Park, Kyung Woo; Lee, Hae-Young; Kang, Hyun-Jae; Koo, Bon-Kwon; Kim, Sang-Hyun; Kim, Hyo-Soo

    2015-07-01

    Although the favored strategy for coronary bifurcation intervention is stenting main vessel with provisional side branch (SB) stenting, we occasionally use two-stent strategy. The objective of this study was to investigate the angiographic outcome of SB ostium in two-stent group, compared with one-stent group. We analyzed 199 patients with bifurcation lesion who underwent percutaneous coronary intervention (PCI) with drug-eluting stent and follow up angiography. The patients were divided into one-stent group (167 lesions, 158 patients) and two-stent group (41 lesions, 41 patients). Prior to intervention, SB ostium minimal luminal diameter (MLD) was smaller in two-stent group than in one-stent group (1.08±0.55 mm vs. 1.39±0.60 mm; P=0.01). But, immediately after PCI, SB MLD of two-stent group became greater than that of one-stent group (2.41±0.40 mm vs. 1.18±0.68 mm; Pstrategy than after one-stent strategy. PMID:26130951

  1. Subacute coronary stent thrombosis in a patient with angina treated with double antiplatelet drugs for six days

    Institute of Scientific and Technical Information of China (English)

    XUE Feng; YANG Xiang-jun; CHENG Xu-jie; HUI Jie; JIANG Ting-bo; CHEN Tan; LIU Zhi-hua; SONG Jian-ping; JIANG Wen-ping

    2009-01-01

    @@ Stent implantation has been a great advance in percutaneous coronary intervention (PCI), decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regardless of the stent type: bare-metal stent (BMS) and drug-eluting stent (DES).

  2. The effect of stent structure changes on the hemodynamics and the formation of in-stent restenosis

    International Nuclear Information System (INIS)

    Objective: To investigate the effect of stent structure changes on the formation of in-stent restenosis by studying the influence of these changes on the shear force to the vascular wall, on the velocity of flow and on the flow pattern. Methods: Five stent models were established by using Pro/engineer wildfire 3.0. Model A was regarded as control structure. On the base structure of model A, transverse link component was added to form model B, and vertical link component was added to form model C. The thickness of model D was twice than that of model A, and the meshes density of model E was twice than that of model A. Fluid models were built up by importing these stent models into computational fluid dynamics (CFD) software ansys11.0-CFX, then, CFD analysis was proceeded to study the effect of stent structure on hemodynamics. Results: After the stents were implanted, the percentage of low wall shear stress on the surface of model A, B, C, D and E was 7.78%, 6.65%, 1.48%, 16.52% and 12.12%, respectively. The percentage of D and E was obviously larger than that of A, while the percentage of B was markedly smaller than that of A. The velocity vector on the cross-sectional planes showed that the low velocity and eddy areas in D and E were much larger than that in A, while this area in C was smaller than that in A. Conclusion: The stent structure changes can cause obvious changes in hemodynamics in the implanted vessels. The increase in the thickness and meshes density of the stent is the main factor that induces the formation of low wall shear stress, which will precipitate the development of in-stent restenosis. The added vertical link component will reduce the area of low wall shear stress as well as the occurrence of in-stent restenosis. (authors)

  3. Development of biodegradable magnesium alloy stents with coating

    Directory of Open Access Journals (Sweden)

    Lorenza Petrini

    2014-07-01

    Full Text Available Biodegradable stents are attracting the attention of many researchers in biomedical and materials research fields since they can absolve their specific function for the expected period of time and then gradually disappear. This feature allows avoiding the risk of long-term complications such as restenosis or mechanical instability of the device when the vessel grows in size in pediatric patients. Up to now biodegradable stents made of polymers or magnesium alloys have been proposed. However, both the solutions have limitations. The polymers have low mechanical properties, which lead to devices that cannot withstand the natural contraction of the blood vessel: the restenosis appears just after the implant, and can be ascribed to the compliance of the stent. The magnesium alloys have much higher mechanical properties, but they dissolve too fast in the human body. In this work we present some results of an ongoing study aiming to the development of biodegradable stents made of a magnesium alloy that is coated with a polymer having a high corrosion resistance. The mechanical action on the blood vessel is given by the magnesium stent for the desired period, being the stent protected against fast corrosion by the coating. The coating will dissolve in a longer term, thus delaying the exposition of the magnesium stent to the corrosive environment. We dealt with the problem exploiting the potentialities of a combined approach of experimental and computational methods (both standard and ad-hoc developed for designing magnesium alloy, coating and scaffold geometry from different points of views. Our study required the following steps: i selection of a Mg alloy suitable for stent production, having sufficient strength and elongation capability; ii computational optimization of the stent geometry to minimize stress and strain after stent deployment, improve scaffolding ability and corrosion resistance; iii development of a numerical model for studying stent

  4. An experimental study on Hanaro self-expanding metallic stent in porcine carodid arteries

    International Nuclear Information System (INIS)

    To evaluate the patency of the Hanaro self-expanding stainless steel stent in the common carotid artery of the pig. Sixteen stents(6mm in diameter/3.5mm in length) were inserted in one or both common carotid arteries of none pigs. Carotid angiography was performed before and after stent insertion, and at the end of the follow-up period(which ranged from 4 to 13 weeks), to evaluate stent patency and change of stent location. Histopathologic study was carried out to assess the endothelial proliferation. Of nine pigs with 16 successfully-inserted stents, follow-up angiography was obtained in seven pigs with 3 stents. The stents inserted were patent in 12 cases and occluded in one. Stenosis was noted in nine of the 12 stents. In three stents, there was angiographic evidence of recanalization such as non-filling or collateral filling of the rate. In no case was there any change of stent location. Endothelial proliferation was more severe in two of four occluded stents(mean thickness : 0.43 mm) than in the other 11 stents(mean thickness : 0.08 mm). Because the Hanaro stent was successfully inserted in porcine carotid arteries and showed a rather good patency(92%), the stent can be used in the small arteries. However, before it is used clinically, further study and development appear to be necessary

  5. Cell Area and Strut Distribution Changes of Bent Coronary Stents: A Finite Element Analysis

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yang; WU Wei; YANG Da-zhi; QI Min

    2009-01-01

    Coronary stents are metal coils or mesh tubes delivered to blocked vessels through catheters, which are expanded by balloons to reopen and scaffold target vessels. Recently,special drugs are carried by stents (drug-eluting stents) to further reduce in-stent restenosis rate after stenting procedure. However,continual study on biomechanical characteristics of stents is necessary for better interactions between stents and tissue, or to provide a more suitable drug loading platform for drug-eluting stents. The purpose of this paper is to show how finite element methods can be used to study cell area and strut distribution changes of bent coronary stents. A same bending deformation was applied to two commercial coronary stent models by a rigid curved vessel. Results show that the stent design influenced the changes of cell area and strut distribution under bending situation. The stent with links had more cell area changes at outer curvature, and the stent with peak-peak (><) strut design could have strut contact and overlapping at inner curvature. In conclusion, this finite element method can be used to study and compare cell area and strut distribution changes of bent stents,and to provide a convenient tool for designers in testing and improving biomechanical characteristics of new stents.

  6. An experimental study on Hanaro self-expanding metallic stent in porcine carodid arteries

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Dae Chul; Yoon, Kwon Ha; Song, Ho Young; Sung, Kyu Bo; Lee, Ho Kyu; Choi, Choong Gon; Auh, Yong Ho [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Choe, Ghee Young [Seoul City Boramae Hospital, Seoul (Korea, Republic of)

    1996-06-01

    To evaluate the patency of the Hanaro self-expanding stainless steel stent in the common carotid artery of the pig. Sixteen stents(6mm in diameter/3.5mm in length) were inserted in one or both common carotid arteries of none pigs. Carotid angiography was performed before and after stent insertion, and at the end of the follow-up period(which ranged from 4 to 13 weeks), to evaluate stent patency and change of stent location. Histopathologic study was carried out to assess the endothelial proliferation. Of nine pigs with 16 successfully-inserted stents, follow-up angiography was obtained in seven pigs with 3 stents. The stents inserted were patent in 12 cases and occluded in one. Stenosis was noted in nine of the 12 stents. In three stents, there was angiographic evidence of recanalization such as non-filling or collateral filling of the rate. In no case was there any change of stent location. Endothelial proliferation was more severe in two of four occluded stents(mean thickness : 0.43 mm) than in the other 11 stents(mean thickness : 0.08 mm). Because the Hanaro stent was successfully inserted in porcine carotid arteries and showed a rather good patency(92%), the stent can be used in the small arteries. However, before it is used clinically, further study and development appear to be necessary.

  7. Next generation coronary CT angiography: in vitro evaluation of 27 coronary stents

    Energy Technology Data Exchange (ETDEWEB)

    Gassenmaier, Tobias; Bley, Thorsten A. [University Hospital Wuerzburg, Department of Diagnostic and Interventional Radiology, Wuerzburg (Germany); Petri, Nils; Voelker, Wolfram [University Hospital Wuerzburg, Department of Internal Medicine I, Wuerzburg (Germany); Allmendinger, Thomas; Flohr, Thomas [Siemens Healthcare, Forchheim (Germany); Maintz, David [University of Cologne, Department of Radiology, Cologne (Germany)

    2014-11-15

    To evaluate in-stent lumen visibility of 27 modern and commonly used coronary stents (16 individual stent types, two stents at six different sizes each) utilising a third-generation dual-source CT system. Stents were implanted in a plastic tube filled with contrast. Examinations were performed parallel to the system's z-axis for all stents (i.e. 0 ) and in an orientation of 90 for stents with a diameter of 3.0 mm. Two stents were evaluated in different diameters (2.25 to 4.0 mm). Examinations were acquired with a collimation of 96 x 0.6 mm, tube voltage of 120 kVp with 340 mAs tube current. Evaluation was performed using a medium-soft (Bv40), a medium-sharp (Bv49) and a sharp (Bv59) convolution kernel optimised for vascular imaging. Mean visible stent lumen of stents with 3.0 mm diameter ranged from 53.3 % (IQR 48.9 - 56.7 %) to 73.9 % (66.7 - 76.7 %), depending on the kernel used at 0 , and was highest at an orientation of 90 with 80.0 % (75.6 - 82.8 %) using the Bv59 kernel, strength 4. Visible stent lumen declined with decreasing stent size. Use of third-generation dual-source CT enables stent lumen visibility of up to 80 % in metal stents and 100 % in bioresorbable stents. (orig.)

  8. Infarto Agudo de Miocardio: Certezas e Incertidumbres con las Nuevas Estrategias de Reperfusión

    Directory of Open Access Journals (Sweden)

    Dr. Ricardo Mario Iglesias

    2007-01-01

    Full Text Available Las enfermedades cardiovasculares representan la primera causa de morbimortalidad a nivel mundial. El infarto agudo de miocardio es la expresión más dramática dentro del síndrome coronario agudo y el accidente de placa coronario, el mecanismo fisiopatológico involucrado con mayor frecuencia. El objetivo del tratamiento ha variado en los últimos años, desde obtener permeabilidad en las arterias epicárdicas hasta alcanzar un decuado nivel e perfusión n el ircuito microvascular. La optimización de la estrategia terapéutica se obtiene a través de una reperfusión precoz y efectiva (fibrinolíticos y/o angioplastia y la selección adecuada de múltiples fármacos coadyuvantes (B bloqueantes, aspirina, clopidogrel, anticoagulantes que han demostrado beneficios clínicos en diversos ensayos clínicos.The first cause of morbidity-mortality all over the world is represented by the cardiovascular diseases. The acute infarct of myocardium is the most dramatic expression within the acute coronary syndrome and the coronary plaque rupture, the most frequently physiopathology mechanism involved. In the last few years the objective of the treatment has changed, from obtaining permeability in the epicardial arteries to reaching a suitable level of perfusion in the microvascular circuit. The optimization of the therapeutic strategy obtains through a precocious and effective reperfusion (fibrinolytic and/or angioplasty and the suitable helping drug selection (aspirin, clopidogrel and anticoagulants that has demonstrated clinical benefits in clinical trials

  9. Carotid angioplasty and stenting in the elderly

    International Nuclear Information System (INIS)

    To investigate the technical success rate as well as the procedural and mid-term complication rates of carotid angioplasty and stenting in elderly patients, a group excluded from large randomized endarterectomy trials given their perceived high surgical risk. Of 200 consecutive carotid angioplasty and/or stenting procedures performed between March 1996 and March 2005, 21 procedures were performed without cerebral protection devices in 20 patients over the age of 79 years (mean age: 83 years, 12 men, eight women). These patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and mid-term complication rates were calculated and compared to a previously published cohort of 133 consecutive patients ≤79 years of age who also underwent endovascular treatment at our institution. Carotid stenosis was reduced from a mean of 82% to no significant stenosis in all procedures. The procedural stroke rate was zero of 21 procedures. The procedural transient ischemic attack rate (TIA) was one of 21 procedures (4.8%). Mean follow-up was 24.6 months (range: 1.0-79.5 months) with at least a 30-day follow-up for 20 of the 21 procedures (95.2%). There were no new strokes. There was one recurrent ipsilateral TIA at 1.9 months. In five cases with follow-up carotid ultrasonography, no hemodynamically significant restenosis had occurred. There were three myocardial infarctions (MI) occurring at 0.5, 2.1, and 15.2 months, of which the last MI was fatal. The composite 30-day stroke and death rate was zero of 21 procedures (95% confidence interval: 0-14%). No significant difference was found in the 30-day rate of stroke, TIA, MI, or death between the elderly and younger patients. Carotid angioplasty and stenting in elderly patients can be performed successfully with acceptable procedural and mid-term complication rates comparable to younger patients. (orig.)

  10. Mid-Term Follow-Up of Drug-Eluting Stenting for In-Stent Restenosis: Bare-Metal Stents versus Drug- Eluting Stents

    Directory of Open Access Journals (Sweden)

    Negar Faramarzi

    2015-10-01

    Full Text Available Background: Despite major advances in percutaneous coronary intervention (PCI, in-stent restenosis (ISR remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent (DES implantation (“DES sandwich” technique with DES placement in the bare-metal stent (DES-in-BMS in a "real world" setting.Methods: We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization (TVR.Results: Of the 194 study participants, 130 were men (67.0% and the mean ± SD of age was 57.0 ± 10.4 years, ranging from37 to 80 years. In-hospital events (death and Q-wave myocardial infarction occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively (p value = 0.702. Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group (0.9% BMS vs. 5.2% DES; p value = 0.16.Conclusion: Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up.

  11. Mid-Term Follow-Up of Drug-Eluting Stenting for In-Stent Restenosis: Bare-Metal Stents versus Drug-Eluting Stents

    Science.gov (United States)

    Faramarzi, Negar; Salarifar, Mojtaba; Kassaian, Seyed Ebrahim; Zeinali, Ali Mohammad Haji; Alidoosti, Mohammad; Pourhoseini, Hamidreza; Nematipour, Ebrahim; Mousavi, Mohammad Reza; Goodarzynejad, Hamidreza

    2013-01-01

    Background: Despite major advances in percutaneous coronary intervention (PCI), in-stent restenosis (ISR) remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent (DES) implantation (“DES sandwich” technique) with DES placement in the bare-metal stent (DES-in-BMS) in a “real world” setting. Methods: We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization (TVR). Results: Of the 194 study participants, 130 were men (67.0%) and the mean ± SD of age was 57.0 ± 10.4 years, ranging from 37 to 80 years. In-hospital events (death and Q-wave myocardial infarction) occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively (p value = 0.702). Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group (0.9% BMS vs. 5.2% DES; p value = 0.16). Conclusion: Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up. PMID:23646043

  12. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study) : an interim analysis of a randomised controlled trial

    NARCIS (Netherlands)

    Ederle, Joerg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Fell, G.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. H.; Van Schil, P.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; De Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; DeJaegher, L.; Peeters, A.; Verbist, J.; Blair, J-F; Caron, J. L.; Daneault, N.; Giroux, M-F; Guilbert, F.; Lanthier, S.; Lebrun, L-H; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Alback, A.; Harno, H.; Ijas, P.; Kaste, M.; Lepantalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van Urk, H.; Verhagen, H. J. M.; Bruininckx, C. M. A.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S. P.; van Hasselt, B. A. A. M.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C. A. de Mol; de Vries, A. C.; Nieholt, G. J. Lycklama A.; van der Kallen, B. F. W.; Blankensteijn, J. D.; De Leeuw, F. E.; Kool, L. J. Schultze; van der Vliet, J. A.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; van der Worp, H. Bart; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sorensen, K.; Skjelland, M.; Tennoe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gimenez Gaibar, A.; Perendreu, J.; Bjorses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T-B; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Bonati, L. H.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E-W; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, N.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Adam, D.; Bell, J.; Bradbury, A. W.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nasser, H-C; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dolman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Beard, J.; Cleveland, T.; Dodd, D.; Gaines, P.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Clifton, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Brown, M. M.; Jaeger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Wong, J.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.

    2010-01-01

    Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid

  13. Optical coherence tomography at follow-up after percutaneous coronary intervention: relationship between procedural dissections, stent strut malapposition and stent healing

    DEFF Research Database (Denmark)

    Radu, Maria; Jørgensen, Erik; Kelbæk, Henning;

    2011-01-01

    To analyse the relationship between strut apposition as visualised with optical coherence tomography (OCT) at follow-up and clinical and procedural characteristics at stent implantation, and to examine the relationship between strut apposition and stent healing....

  14. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2010-03-20

    Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.

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

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, Andreas H., E-mail: mahnken@med.uni-marburg.de [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic Radiology (Germany); Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M., E-mail: anneke.damberg@rwth-aachen.de [University Hospital RWTH Aachen, Department of Thoracic, Cardiac and Vascular Surgery (Germany)

    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.

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

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

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

    2011-03-01

    Full Text Available 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.

  18. Gastric and Duodenal Stents: Follow-Up and Complications

    International Nuclear Information System (INIS)

    Purpose: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered.Methods: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy.Results: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE ± 4.6).Conclusions: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications

  19. Shrinking the Supply Chain for Implantable Coronary Stent Devices.

    Science.gov (United States)

    Moore, Sean S; O'Sullivan, Kevin J; Verdecchia, Francesco

    2016-02-01

    Stenting treatments for the management of disease in the heart, arterial and venous systems, biliary ducts, urethras, ureters, oesophageal tract and prostate have made enormous technical advances since their introduction into clinical use. The progression from metallic to polymer based bio-absorbable stents, coupled with the advances in additive manufacturing techniques, present a unique opportunity to completely re-envision the design, manufacture, and supply chain of stents. This paper looks at current stenting trends and proposes a future where the stent supply chain is condensed from ~150 days to ~20 min. The Cardiologist therefore has the opportunity to become a designer, manufacturer and user with patients receiving custom stents specific to their unique pathology that will be generated, delivered and deployed in the Cath-lab. The paper will outline this potentially revolutionary development and consider the technical challenges that will need to be overcome in order to achieve these ambitious goals. A high level overview of the generating eluting stents in situ program-GENESIS-is outlined including some early experimental work. PMID:26438449

  20. Therapeutic evaluation of retrievable esophageal covered stent in treating achalasia

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical effect of retrievable esophageal covered metal internal stent in treating patients with achalasia. Methods: Under DSA guidance, peroral 'Z-type' double horn covered metal internal stent implantation was performed in 16 patients with achalasia. Esophagography was carried out about 28 days after the procedure and the stent was retrieved. Results: Of 16 cases, the stent fell off into the stomach two weeks after the operation in one. And the stent was successfully replaced after it was taken out. The placed stent was successfully retrieved in all cases 28 days after the treatment. No serious complications occurred. All the patients were followed up for 3 months to 3 years. During the follow-up period restenosis of the esophagus developed in two cases (at one and 1.5 years respectively), and the restenosis degree was relived after balloon dilation. Clinically, no esophageal symptoms, such as dysphagia, occurred in all patients. Conclusion: As a simple and safe technique, the retrievable esophageal covered metal internal stent implantation is very effective with fewer complications for the treatment of achalasia. Moreover, the technique carries lower restenosis occurrence. (authors)

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

    International Nuclear Information System (INIS)

    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. 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. 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. This palliative approach is warranted in carefully selected patients. Long-term follow-up is required

  2. Abdominal aortic aneurysms: treatment with Zenith endoluminal stent-graft

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of Zenith transrenal stent-graft in repairing the abdominal aortic aneurysms. Methods: Endoluminal stent-grafts repair was performed in 5 male patients with abdominal aortic aneurysms. Their age ranged from 52 years to 73 years with a mean of 65 years. Three-dimensional CT angiography demonstrated Blum type B in 4 cases and Blum type C in 1 case. The diameter of aneurysmal neck was between 21 mm and 25 mm (mean 22.8 mm), and the length of aneurysmal neck was between 16.5 mm and 32.8 mm (mean 25.6mm). Stent-grafts were inserted through surgically exposed femoral arteries in general anesthesia with the fluoroscopic guidance. The Zenith transrenal bifurcated stent-grafts were applied in all 5 patients. Results: The endoluminal stent-graft repair was successful in all 5 patients with operational duration of 1.8-3.0 hours. The hospitalization duration was 7-14 days following the procedure. No endoleaks occurred in the 5 cases following the contrast-enhanced CT scans seven days after the interventions. Still no endoleaks or stent-grafts migration recurred in 2 patients followed up at the 2nd and 11th month, respectively. During the follow-up from 6 months to 55 months (mean 26.6 months), five patients were still asymptomatic. Conclusion: Zenith aortic stent-graft repair of abdominal aortic aneurysms is an effective and safe treatment method

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

    International Nuclear Information System (INIS)

    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).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

  4. Silver-nanoparticle-coated biliary stent inhibits bacterial adhesion in bacterial cholangitis in swine

    Institute of Scientific and Technical Information of China (English)

    Wei Wen; Li-Mei Ma; Wei He; Xiao-Wei Tang; Yin Zhang; Xiang Wang; Li Liu; Zhi-Ning Fan

    2016-01-01

    BACKGROUND: One of the major limitations of biliary stents is the stent occlusion, which is closely related to the over-growth of bacteria. This study aimed to evaluate the feasibility of a novel silver-nanoparticle-coated polyurethane (Ag/PU) stent in bacterial cholangitis model in swine. METHODS: Ag/PU was designed by coating silver nanopar-ticles on polyurethane (PU) stent. Twenty-four healthy pigs with bacterial cholangitis using Ag/PU and PU stents were ran-domly divided into an Ag/PU stent group (n=12) and a PU stent group (n=12), respectively. The stents were inserted by standard endoscopic retrograde cholangiopancreatography. Laboratory assay was performed for white blood cell (WBC) count, alanine aminotransferase (ALT), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) at baseline time, 8 hours, 1, 2, 3, and 7 days after stent placements. The segment of bile duct containing the stent was examined histologically ex vivo. Implanted bili-ary stents were examined by a scan electron microscope. The amount of silver release was also measured in vitro. RESULTS: The number of inflammatory cells and level of ALT, IL-1β and TNF-α were significantly lower in the Ag/PU stent group than in the PU stent group. Hyperplasia of the mucosa was more severe in the PU stent group than in the Ag/PU stent group. In contrast to the biofilm of bacteria on the PU stent, fewer bacteria adhered to the Ag/PU stent. CONCLUSIONS: PU biliary stents modified with silver nanoparticles are able to alleviate the inflammation of pigs with bacterial cholangitis. Silver-nanoparticle-coated stents are resistant to bacterial adhesion.

  5. A method for investigating the mechanical properties of intracoronary stents using finite element numerical simulation.

    Science.gov (United States)

    Tan, L B; Webb, D C; Kormi, K; Al-Hassani, S T

    2001-03-01

    The proliferation of stent designs poses difficult problems to clinicians, who have to learn the relative merits of all stents to ensure optimal selection for each lesion, and also to regulatory authorities who have the dilemma of preventing the inappropriate marketing of substandard stents while not denying patients the benefits of advanced technology. Of the major factors influencing long-term results, those of patency and restenosis are being actively studied whereas the mechanical characteristics of devices influencing the technical results of stenting remain under-investigated. Each different stent design has its own particular features. A robust method for the independent objective comparison of the mechanical performance of each design is required. To do this by experimental measurement alone may be prohibitively expensive. A less costly option is to combine computer analysis, employing the standard numerical technique of the finite element method (FEM), with targeted experimental measurements of the specific mechanical behaviour of stents. In this paper the FEM technique is used to investigate the structural behaviour of two different stent geometries: Freedom stent geometry and Palmaz-Schatz (P-S) stent geometry. The effects of altering the stent geometry, the stent wire diameter and contact with (and material properties of) a hard eccentric intravascular lesion (simulating a calcified plaque) on stent mechanical performance were investigated. Increasing the wire diameter and the arterial elastic modulus by 150% results in the need to increase the balloon pressure to expand the stent by 10-fold. Increasing the number of circumferential convolutions increases the pressure required to initiate radial expansion of mounted stents. An incompressible plaque impinging on the mid portion of a stent causes a gross distortion of the Freedom stent and an hour-glass deformity in the P-S stent. These findings are of relevance for future comparative studies of the

  6. Complications of stent placement for benign stricture of gastrointestinal tract

    Institute of Scientific and Technical Information of China (English)

    Ying-Sheng Cheng; Ming-Hua Li; Wei-Xiong Chen; Ni-Wei Chen; Qi-Xin Zhuang; Ke-Zhong Shang

    2004-01-01

    AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment.METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients.RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively.For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesics was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurredin 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients.CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain,reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures according to the specific conditions.

  7. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients

    OpenAIRE

    Liberato Manuel José; Canena Jorge Manuel

    2012-01-01

    Abstract Background Endoscopic biliary drainage of hilar cholangiocarcinoma is controversial with respect to the optimal types of stents and the extent of drainage. This study evaluated endoscopic palliation in patients with hilar cholangiocarcinoma using self-expandable metallic stents (SEMS) and plastic stents (PS).We also compared unilateral and bilateral stent placement according to the Bismuth classification. Methods Data on 480 patients receiving endoscopic biliary drainage for hilar ch...

  8. Fully covered self-expandable metal stents (SEMS, partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks

    Directory of Open Access Journals (Sweden)

    van Boeckel Petra GA

    2012-02-01

    Full Text Available Abstract Background Benign esophageal ruptures and anastomotic leaks are life-threatening conditions that are often treated surgically. Recently, placement of partially and fully covered metal or plastic stents has emerged as a minimally invasive treatment option. We aimed to determine the clinical effectiveness of covered stent placement for the treatment of esophageal ruptures and anastomotic leaks with special emphasis on different stent designs. Methods Consecutive patients who underwent placement of a fully covered self-expandable metal stent (FSEMS, a partially covered SEMS (PSEMS or a self-expanding plastic stent (SEPS for a benign esophageal rupture or anastomotic leak after upper gastrointestinal surgery in the period 2007-2010 were included. Data on patient demographics, type of lesion, stent placement and removal, clinical success and complications were collected Results A total of 52 patients received 83 esophageal stents (61 PSEMS, 15 FSEMS, 7 SEPS for an anastomotic leak (n = 32, iatrogenic rupture (n = 13, Boerhaave's syndrome (n = 4 or other cause (n = 3. Endoscopic stent removal was successful in all but eight patients treated with a PSEMS due to tissue ingrowth. Clinical success was achieved in 34 (76%, intention-to-treat: 65% patients (PSEMS: 73%, FSEMS: 83%, SEPS: 83% after a median of 1 (range 1-5 stent and a median stenting time of 39 (range 7-120 days. In total, 33 complications in 24 (46% patients occurred (tissue in- or overgrowth (n = 8, stent migration (n = 10, ruptured stent cover (all Ultraflex; n = 6, food obstruction (n = 3, severe pain (n = 2, esophageal rupture (n = 2, hemorrhage (n = 2. One (2% patient died of a stent-related cause. Conclusions Covered stents placed for a period of 5-6 weeks may well be an alternative to surgery for treating benign esophageal ruptures or anastomotic leaks. As efficacy between PSEMS, FSEMS and SEPS is not different, stent choice should depend on expected risks of stent migration

  9. Reduction of Late In-Stent Stenosis in a Porcine Coronary Artery Model by Cobalt Chromium Stents with a Nanocoat of Polyphosphazene (Polyzene-F)

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate the potential of nanoscale coating with the highly biocompatible polymer Polyzene-F (PZF), in combination with cobalt chromium and stainless steel stents, to reduce in-stent stenosis, thrombogenicity, and vessel wall injury and inflammation. One bare cobalt chromium, PZF-nanocoated stainless steel or PZF-nanocoated cobalt chromium stent was implanted in right coronary artery of 30 mini-pigs (4- or 12-week follow-up). Primary study end points were in-stent stenosis and thrombogenicity. Secondary study end points were vessel wall injury and inflammation as evaluated by microscopy and a new immunoreactivity score applying C-reactive protein (CRP), tumor-necrosis factor alpha (TNFα), and TGFβ. At 12 weeks, angiography showed a significantly lower average loss in lumen diameter (2.1% ± 3.05%) in PZF-nanocoated cobalt chromium stents compared with stents in the other groups (9.73% ± 4.93% for bare cobalt chromium stents and 9.71% ± 7% for PZF-nanocoated stainless steel stents; p = 0.04), which was confirmed at microscopy (neointima 40.7 ± 16 μm in PZF-nanocoated cobalt chromium stents, 74.7 ± 57.6 μm in bare cobalt chromium stents, and 141.5 ± 109 μm in PZF-nanocoated stainless steel stents; p = 0.04). Injury and inflammation scores were low in all stents and were without significant differences. PZF-nanocoated cobalt chromium stents provided the highest efficacy in reducing in-stent stenosis at long-term follow-up. The PZF nanocoat proved to be biocompatible with respect to thromboresistance and inflammation. Our data suggest that its combination with cobalt chromium stents might provide an interesting passive stent platform.

  10. Tracheo-esophageal fistula: Successful palliation after failed esophageal stent

    Directory of Open Access Journals (Sweden)

    Rakesh K Chawla

    2012-01-01

    Full Text Available The incidence of tracheo-esophageal (TO fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea.

  11. Endotracheal stenting therapy in dogs with tracheal collapse.

    Science.gov (United States)

    Sun, Fei; Usón, Jesús; Ezquerra, Javier; Crisóstomo, Verónica; Luis, Laura; Maynar, Manuel

    2008-02-01

    Tracheal collapse in dogs is a common respiratory disorder, typically presenting with a history of chronic cough, increasing respiratory difficulties, and episodes of dyspnoea. Medical treatment is the therapy of choice and surgical repair is considered when patients do not respond well. Minimally invasive endotracheal stenting is a promising new therapy under investigation, but there remain significant challenges to overcome potential complications. The purpose of this article is to provide a comparative overview of intra-luminal stenting of the trachea in human and veterinary medicine. The currently available stents and their potential clinical application to the veterinary patient will be discussed. PMID:17368061

  12. Endophthalmitis associated with Glaucoma Shunt Intraluminal Stent Exposure

    Science.gov (United States)

    Kerr, Nathan M; Ruddle, Jonathan B; Ang, Ghee Soon

    2016-01-01

    ABSTRACT Endophthalmitis post glaucoma drainage implant (GDI) surgery is rare, often associated with tube or plate exposure. We report a case of endophthalmitis following glaucoma shunt intraluminal stent exposure in a patient who underwent Baerveldt glaucoma implant surgery. Endophthalmitis following manipulation of intraluminal stents is a rare complication of GDIs but potentially vision threatening condition that needs to be carefully screened for and treated immediately. How to cite this article: Kwon HJ, Kerr NM, Ruddle JB, Ang GS. Endophthalmitis associated with Glaucoma Shunt Intraluminal Stent Exposure. J Curr Glaucoma Pract 2016;10(1):36-37.

  13. Cognitive changes after carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Struffert, T.; Krick, C.; Backens, M. [University of the Saarland, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Supprian, T.; Falkai, P.; Reith, W. [University of the Saarland, Clinic for Psychiatry and Psychotherapy, Homburg (Germany)

    2006-05-15

    We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9{+-}1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

  14. Cognitive changes after carotid artery stenting

    International Nuclear Information System (INIS)

    We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9±1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

  15. Characterization and in vivo evaluation of a bio-corrodible nitrided iron stent.

    Science.gov (United States)

    Feng, Qimao; Zhang, Deyuan; Xin, Chaohua; Liu, Xiangdong; Lin, Wenjiao; Zhang, Wanqian; Chen, Sun; Sun, Kun

    2013-03-01

    A bio-corrodible nitrided iron stent was developed using a vacuum plasma nitriding technique. In the nitrided iron stents, the tensile strength, radial strength, stiffness and in vitro electrochemical corrosion rate were significantly increased compared with those of the control pure iron stent. To evaluate its performance in vivo, the deployment of the nitrided iron stents in juvenile pig iliac arteries was performed. At 3 or 6 months postoperatively, the stented vessels remained patent well; however, slight luminal loss resulting from intimal hyperplasia and relative stenosis of the stented vessel segment with piglets growth were observed by 12 months; no thrombosis or local tissue necrosis was found. At 1 month postoperatively, a nearly intact layer of endothelial cells formed on the stented vessel wall. Additionally, a decreased inflammation scoring, considerably corroded struts and corrosion products accumulation were seen. These findings indicate the potential of this nitrided iron stent as an attractive biodegradable stent. PMID:23183963

  16. Unusual balloon rupture during direct stenting with a TaxusExpress stent in a venous graft complicated by vessel rupture: a device-related fatal event

    DEFF Research Database (Denmark)

    Christiansen, Evald H

    2007-01-01

    distal anastomoses, had two significant stenoses. Percutaneous coronary intervention with distal protection, and direct stenting with a drug-eluting stent, was planned. A 3.00 x 16 mm TaxusExpress (Boston Scientific) was used. At an inflation pressure of 10 atm the stent balloon seemed to extend 20 mm...

  17. [Assessment of the course of ischemic heart disease after placement of stents with drug covering and uncovered metal stents: data of 3 years follow-up].

    Science.gov (United States)

    Buza, V V; Karpov, Iu A; Samko, A N; Deev, A D; Lopukhova, V V; Levitskiĭ, I V; Sozykin, A V

    2009-01-01

    The placement of sirolimus-eluting stents decreases the frequency of repeat revascularization procedures in patients undergoing percutaneous coronary intervention (PCI) in randomized clinical trials. However, there is uncertainty about the effectiveness of sirolimus-eluting stents, and increasing concern about their safety in routine clinical practice. From the prof. Samko PCI laboratory in Moscow, Russia, we identified 426 patients, who received either bare-metal stents alone or sirolimus-eluting stents alone during an index PCI procedure between March 1, 2002, and September 31, 2004.The primary outcomes of the study were the rates of target-lesion revascularization, myocardial infarction, death, late stent thrombosis. The 3-year rate of target-lesion revascularization was significantly lower among patients who received sirolimus-eluting stents than among those who received bare-metal stents (3.1% vs. 19 %, p=0.001). The 3-year mortality rate was not different between the bare-metal stent group and the sirolimus eluting stent group (5.9% vs. 7.2%, p=0.68), the 3-year rate of all ARC late stent thrombosis was similar in the two groups (5.9% and 7.2%, respectively; p=0.95). Sirolimus-eluting stents are effective in reducing the need for target-vessel revascularization without significantly increased rates of death, late stent thrombosis, myocardial infarction. PMID:19166395

  18. Evaluation of stent visibility by flat panel detector CT in patients treated for intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Clarencon, Frederic [Groupe Hospitalier Pitie-Salpetriere, Paris (France); Pitie-Salpetriere Hospital, Department of Neuroradiology, Paris (France); Piotin, Michel; Pistocchi, Silvia; Blanc, Raphael [Fondation A. de Rothschild, Paris (France); Babic, Drazenko [Philips Healthcare, Best (Netherlands)

    2012-10-15

    This study aimed to evaluate the visibility of stents using high-resolution computed tomography (CT) acquisitions acquired with flat panel detector (XperCT, Allura series, Philips Healthcare, The Netherlands) for endovascular treatment of intracranial aneurysms. On a 24-month period, 48 patients endovascularly treated by coiling and stenting (59 stents) for intracranial aneurysms were explored by flat panel detector CT technique. A sequence of 620 2D images was acquired over an angle of 240 using a 1,024 x 1,024 pixel matrix detector within a 48-cm field of view. The images were retrospectively analyzed independently by two neuroradiologists. Evaluation criteria were percentage of visualization of the stents and stent deployment (kinking or unsatisfactory deployment of the stent). Evaluation of the stent was feasible for all the patients. Stent visibility by XperCT was overall estimated at 76% of the stent length. Difficulties to analyze the stents were related to coil artifacts but not to packing density or aneurysm location. Stent length visualization was higher when the acquisition was performed before additional coiling (P < 0.0001). Mild kinking/misdeployment was noticed in 22% of the cases. XperCT technique provides multiplanar and 3D reconstructions that allows for a satisfying visualization of intracranial stents. This CT-like acquisition should be performed after the stent deployment and before coiling, in order to obtain better stent visualization. (orig.)

  19. Timing of silicone stent removal in patients with post-tuberculosis bronchial stenosis

    Directory of Open Access Journals (Sweden)

    Jung Seop Eom

    2013-01-01

    Full Text Available Context: In patients with post-tuberculosis bronchial stenosis (PTBS, the severity of bronchial stenosis affects the restenosis rate after the silicone stent is removed. In PTBS patients with incomplete bronchial obstruction, who had a favorable prognosis, the timing of stent removal to ensure airway patency is not clear. Aims: We evaluated the time for silicone stent removal in patients with incomplete PTBS. Settings and Design: A retrospective study examined PTBS patients who underwent stenting and removal of a silicone stent. Methods: Incomplete bronchial stenosis was defined as PTBS other than total bronchial obstruction, which had a luminal opening at the stenotic segment on bronchoscopic intervention. The duration of stenting was defined as the interval from stent insertion to removal. The study included 44 PTBS patients and the patients were grouped at intervals of 6 months according to the duration of stenting. Results: Patients stented for more than 12 months had a significantly lower restenosis rate than those stented for less than 12 months (4% vs. 35%, P = 0.009. Multiple logistic regression revealed an association between stenting for more than 12 months and a low restenosis rate (odds ratio 12.095; 95% confidence interval 1.097-133.377. Moreover, no restenosis was observed in PTBS patients when the stent was placed more than 14 months previously. Conclusions: In patients with incomplete PTBS, stent placement for longer than 12 months reduced restenosis after stent removal.

  20. Recanalization of the lower leg. PTA or stent?; Rekanalisation am Unterschenkel. PTA oder Stent

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S. [Medizinischer Klinikverbund Flensburg, Ev.-Luth. Diakonissenanstalt zu Flensburg, Zentrum fuer Gesundheit und Diakonie, Abt. Diagnostische und Interventionelle Radiologie/Neuroradiologie, Flensburg (Germany)

    2010-01-15

    Percutaneous transluminal angioplasty (PTA) and stent placement are currently accepted methods for endovascular treatment of critical limb ischemia, if infragenual vessels are involved. Outcome results in high technical success and satisfactory clinical results for treatment of infrapopliteal lesions with regard to patency rates and amputation-free survival. These treatment modalities are also safe for the patients. The question whether PAT alone or additional stent placement is the better choice, is still unanswered due to limited data. (orig.) [German] Die perkutane transluminale Angioplastie (PTA) und die Stentimplantation stellen inzwischen akzeptierte Methoden zur Behandlung der kritischen Extremitaetenischaemie bei Beteiligung infragenualer Gefaesse dar. Diese Behandlungsmodalitaeten haben eine hohe technische Erfolgsrate, sind sicher fuer den Patienten und erbringen zufrieden stellende klinische Ergebnisse zur Therapie infrapoplitealer Laesionen hinsichtlich Offenheitsrate und amputationsfreiem Ueberleben. Die Frage, ob eine alleinige PTA oder die Stentimplantion besser ist, kann anhand der begrenzten derzeitigen Datenlage zur Zeit noch nicht hinreichend beantwortet werden. (orig.)

  1. Drug-eluting stents and bare metal stents in patients with NSTE-ACS

    DEFF Research Database (Denmark)

    Pedersen, Sune Haahr; Pfisterer, Matthias; Kaiser, Christoph;

    2014-01-01

    endpoint, and clinically indicated target vessel revascularisation (TVR) and stent thrombosis. Compared to patients with BMS, those treated with SES and EES had a strong trend towards lower two-year rates of the primary endpoint (HR: 0.31 [CI: 0.11-0.90], p=0.03, and HR: 0.74 [CI: 0.44-1.24], p=0.25), and...... implantation in large vessels was associated with a reduction in both TVR and the combined endpoint consisting of cardiovascular death/MI. Thus, DES use improves both efficacy and safety. These findings support the use of DES in NSTE-ACS patients.......AIMS: The use of drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet endorsed in clinical guidelines. METHODS AND RESULTS: This was an a priori planned post hoc analysis involving 754 NSTE-ACS patients from the...

  2. Oclusão arterial aguda de stent fêmoro-poplíteo Acute femoropopliteal artery stent obstruction

    OpenAIRE

    Fabio Henrique Rossi; Milton Kiyonory Uehara; Juliana Chen; Thiago Emilio Burza Maia; Eduardo Mulinari Darold; Andréia Silveira Martins; Akash Kuzhiparambil Prakasan; Nilo Mitsuro Izukawa

    2009-01-01

    A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro.Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best the...

  3. Tissue Responses to Stent Grafts with Endo-Exo-Skeleton for Saccular Abdominal Aortic Aneurysms in a Canine Model

    OpenAIRE

    Kim, Young Il; Choi, Young Ho; Chung, Jin Wook; Kim, Hyo-Cheol; So, Young Ho; Kim, Hyun Beom; Min, Seung-Kee; Park, Jae Hyung

    2014-01-01

    Objective We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Materials and Methods Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly an...

  4. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the majority of the disease occurs. We will use special magnifying glasses to feather out the plaque ... stent angioplasty. In special cases, we may actually use a distal occluding balloon as seen in the ...

  5. Cerebral foreign body reaction after carotid aneurysm stenting

    DEFF Research Database (Denmark)

    Lorentzen, Anastasia Orlova; Nome, Terje; Bakke, Søren Jacob; Scheie, David; Stenset, Vidar; Aamodt, Anne Hege

    2016-01-01

    distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization - a multifocal inflammation...

  6. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with stroke per year. Stroke is the third leading cause of death in the U.S.A., and ... carotid stenting in stroke had to have 20 leading cases. Next. And then a patient -- then a ...

  7. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the collateral circuit may be important for procedural planning purposes. We may choose a filter in one ... that's shorter than the stent that I'm planning to use, because most of the time I ...

  8. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a failure of your carotid stent if you haven't treated it appropriately. And if you talk ... trials. One of the other issues that we haven't really talked about here but we all ...

  9. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a surgical incision in the neck and many times general anesthesia. Carotid stent angioplasty is the topic ... reallowing restoration of flow to the brain. Many times during these procedures, there may be signs of ...

  10. Subclavian Arteritis and Pseudoaneurysm Formation Secondary to Stent Infection

    International Nuclear Information System (INIS)

    Technically uncomplicated percutaneous angioplasty and stent placement of a left subclavian artery stenosis was performed in a 56-year-old man for treatment of subclavian steal syndrome and vertebrobasilar insufficiency. Six days later the patient was readmitted with Staphylococcus aureus bacteremia and stigmata of septic emboli isolated to the ipsilateral hand. Nine days later he had computed tomography (CT) evidence of a contrast-enhancing phlegmon surrounding the stent. Despite clinical improvement and resolution of bacteremia on intravenous antibiotic therapy, the phlegmon progressed, and at day 21 a pseudoaneurysm was angiographically confirmed. The patient underwent surgical removal of the stented arterial segment and successful autogenous arterial reconstruction. The possible contributory factors leading to stent infection were prolonged right femoral artery access and an infected left arm venous access. Although the role of prophylactic antibiotics remains to be defined, it may be important in cases where the vascular access sheath remains in place for a prolonged period of time

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the contrast load, if your patient is in renal insufficiency. I always image the contralateral side. It will, ... will also eventually develop atherosclerotic disease and potentially cause a failure of your carotid stent if you ...

  12. Endovascular stent graft repair of multiple tuberculous thoracoabdominal aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Jung; Won, Je Hwan [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2014-05-15

    We describe a case of multiple tuberculous aneurysms of the descending thoracic aorta and abdominal aorta repaired with endovascular stent graft. The case was a 47-year-old man who presented with three saccular pseudoaneurysms of aortoiliac bifurcation at computed tomography (CT) scan. Despite of antimycobacterial treatment, these aneurysms grew rapidly and saccular pseudoaneurysm of the descending thoracic aorta was newly seen. A bifurcated stent graft was successfully implanted in the aortoiliac bifurcation. Subsequently, endovascular stent graft was placed well in the descending thoracic aorta. Fourteen months after the procedure, the patient was stable and serial CT images showed regression of aneurysms with ongoing antimycobacterial treatment. Therefore, endovascular stent graft repair with antimycobacterial therapy may be a treatment option in patients with multiple tuberculous aneurysms.

  13. Coronary bifurcation lesions treated with simple or complex stenting

    DEFF Research Database (Denmark)

    Behan, Miles W; Holm, Niels R; de Belder, Adam J;

    2016-01-01

    from two large bifurcation coronary stenting trials with similar methodology: the Nordic Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study: old, new, and evolving strategies (BBC ONE). METHODS AND RESULTS: Both multicentre randomized trials compared simple (provisional T...

  14. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... risk of stroke in the high-risk patient population. The most common complication was a neck hematoma ... safer than carotid stenting, at least in this population of patients. And the risk of cerebral vascular -- ...

  15. Standardization of the reports for carotid artery stenting

    International Nuclear Information System (INIS)

    Objective: Stroke is one of the leading causes of death. Carotid occlusive disease is responsible for 25% of the ischemic strokes. Surgical carotid endarterectomy has been accepted as the best management for the extracranial caroid occlusive disease. However, in recent years, with the development of the endovascular technology, carotid artery stenting becomes more and more popular accompanied by increase of articles in this field correspondingly. The practical difficulty exists in comparison between the carotid stenting and endarterectomy through randomized controlled trials. Standardized report including trial design, patient selection, outcomes, statistical disposition thus become extremely necessary. This article gives a detailed description concerning about the patient selection, pretreatment evaluation, treatment description, curative effect evaluation and complications of carotid artery stenting. The purpose of this article is to standardize the reports of carotid stenting so that the descriptive and statistical data from different authors and agents can be compared. (authors)

  16. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... the flow divider. So where the carotid actually splits to go to the brain or go to ... stent deployment. A little more contrast, just to double-check, and then here comes the deployment. It's ...

  17. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... work from that and keep a very stable environment to pass balloon stents and filters during the ... circle is constructed of both the anterior and middle cerebral artery portions as well as the anterior ...

  18. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... could be a loss of speech or the ability to name objects, especially the -- in the left ... an external carotid artery does not negate your ability to do carotid stent angioplasty. 00:37:59 ...

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... ten seconds, the patient may have loss of consciousness or seizure related to that, but I'm ... vessel -- in the vessel for the stent delivery system to be placed. And I think that it's -- ...

  20. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a minimally invasive approach in which we will access from the groin and treat the carotid artery ... carotid stent angioplasty is multifactorial. First is the access is generally done, performed, from a groin access, ...

  1. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... that's important, I think, as we get new technologies having to do with flow reversal or flow ... the common carotid. I think the current stent technology, I prefer a closed-cell technique, but I ...

  2. FORMATION OF SIX SIGMA INFRASTRUCTURE FOR THE CORONARY STENTING PROCESS

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2013-10-01

    Full Text Available The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality.

  3. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... an important thing also is that with the current role of using carotid stent angioplasty, we can ... for us. And the various access techniques. The current access techniques are, as Jim mentioned, usually from ...

  4. Successful treatment of an infected thoracic endovascular stent graft.

    Science.gov (United States)

    Sueda, Taijiro; Takahashi, Shinya; Katayama, Keijiro; Imai, Katsuhiko

    2016-05-01

    A 70-year-old man with a chronic type B aortic dissection was treated with two stent grafts deployed in the descending thoracic aorta. The patient was re-admitted to the hospital at 16 months after thoracic endovascular stent grafting because of a high fever. A blood culture showed sepsis due to a Staphylococcus species. A CT scan showed an increase in the size of the thrombosed false lumen. Complete excision of the infected descending aortic wall and infected stent graft were performed. The descending thoracic aorta was reconstructed using a rifampicin-bonded Dacron graft and omental wrapping. The combination of in situ graft replacement using a rifampicin-bonded graft and omental wrapping is considered an effective treatment for thoracic stent graft infection. PMID:24990657

  5. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... you found that there wasn't an adequate circulatory collateral to that segment, if it was isolated? ... vessel -- in the vessel for the stent delivery system to be placed. And I think that it's -- ...

  6. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with a five-millimeter balloon typically? 00:48:40 Y. PIERRE GOBIN, MD: I will -- before placing ... patients, carotid artery stenting versus carotid endarterectomy in 40 centers. And the trial was stopped early for ...

  7. Which criteria demand additive stenting during catheter-directed thrombolysis?

    DEFF Research Database (Denmark)

    Bækgaard, N; Just, S; Foegh, P

    2014-01-01

    Many factors are necessary for obtaining satisfactory results after catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT). Selections of patients, composition of the thrombolytic fluid, anticoagulation per- and post-procedural, recognition and treatment of persistent...... obstructive lesions of the iliac veins are the most important contributors. Stenting has been known for 15 to 20 years. The first publication on CDT in 1991 was combined with ballooning the iliac vein, an additive procedure which has been abandoned as an isolated procedure. This chapter will discuss selection......, indication, such as an iliac compression syndrome, and outcome of iliac stenting in combination with CDT. The reported frequency of stenting used after CDT is very inconsistent, therefore this will be discussed in details. It is concluded that selection for stenting is of the greatest importance, when CDT is...

  8. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... variety, and then others have an open cell, meaning there's breaks between the connections of the stent ... as Pierre alluded to, but the great vessels, meaning the ones coming to the carotid arteries as ...

  9. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... incision in the neck and many times general anesthesia. Carotid stent angioplasty is the topic of tonight, ... significant coronary artery disease. Again, many times general anesthesia is required, though we can do it under ...

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... of stents we can use. Some have closed cell, as seen on the top, of a stainless steel variety, and then others have an open cell, meaning there's breaks between the connections of the ...

  11. 2-year patient-related versus stent-related outcomes

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Christiansen, Evald Høj;

    2012-01-01

    , comparing the EES with the SES in patients with coronary artery disease, the EES was noninferior to the SES at 9 months. METHODS: The primary endpoint was a composite: cardiac death, myocardial infarction (MI), definite stent thrombosis, or target vessel revascularization. Safety and efficacy outcomes at 2......, and 1,384 patients were assigned to receive the SES. RESULTS: At 2 years, the composite primary endpoint occurred in 8.3% in the EES group and in 8.7% in the SES group (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.73 to 1.22). The patient-related outcome: 15.0% in the EES group versus 15......OBJECTIVES: There are limited head-to-head randomized data on patient-related versus stent-related outcomes for everolimus-eluting stents (EES) and sirolimus-eluting stents (SES). BACKGROUND: In the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) trial...

  12. Newly Developed Fully Covered Metal Stent for Unresectable Malignant Biliary Stricture

    Directory of Open Access Journals (Sweden)

    Kei Ito

    2010-01-01

    Full Text Available We herein report two patients with unresectable malignant biliary stricture who underwent stenting with a newly developed fully-covered metal stent. In the first case of lower-middle bile duct cancer, a stent was placed through the stenosis. In the second case of middle bile duct stricture due to lymph node metastases from gallbladder cancer, a stent was placed in the bile duct across the stenosis. No procedure-related complications were observed. Unevenness of the outer surface and a low shortening ratio are expected to lessen the occurrence of complications characteristic of covered metal stents such as stent migration and bile duct kinking.

  13. Drug-eluting stents and acute myocardial infarction:A lethal combination or friends?

    Institute of Scientific and Technical Information of China (English)

    Shuji; Otsuki; Manel; Sabaté

    2014-01-01

    Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction(STEMI). First generation drug-eluting stents(DES),(sirolimus drug-eluting stents and paclitaxel drug-eluting stents), reduce the risk of restenosis and target vessel revascularization compared to bare metal stents. However, stent thrombosis emerged as a major safety concern with first generation DES. In response to these safety issues, second generation DES were developed with different drugs, improved stent platforms and more biocompatible durable or bioabsorbable polymeric coating. This article presents an overview of safety and efficacy of the first and second generation DES in STEMI.

  14. Numerical investigation of pulsatile flow in endovascular stents

    Science.gov (United States)

    Rouhi, A.; Piomelli, U.; Vlachos, P.

    2013-09-01

    The flow in a plane channel with two idealized stents (one Λ-shaped, the other X-shaped) is studied numerically. A periodic pressure gradient corresponding to one measured in the left anterior descending coronary artery was used to drive the flow. Two Reynolds numbers were examined, one (Re = 80) corresponding to resting conditions, the other (Re = 200) to exercise. The stents were implemented by an immersed boundary method. The formation and migration of vortices that had been observed experimentally was also seen here. In the previous studies, the compliance mismatch between stent and vessel was conjectured to be the reason for this phenomenon. However, in the present study we demonstrate that the vortices form despite the fact that the walls were rigid. Flow visualization and quantitative analysis lead us to conclude that this process is due to the stent wires that generate small localized recirculation regions that, when they interact with the near-wall flow reversal, result in the formation of these vortical structures. The recirculation regions grow and merge when the imposed waveform produces near-wall flow reversal, forming coherent quasi-spanwise vortices, that migrate away from the wall. The flow behavior due to the stents was compared with an unstented channel. The geometric characteristics of the Λ-stent caused less deviation of the flow from an unstented channel than the X-stent. Investigating the role of advection and diffusion indicated that at Re = 80 advection has negligible contribution in the transport mechanism. Advection plays a role in the generation of streamwise vortices created for both stents at both Reynolds numbers. The effect of these vortices on the near-wall flow behavior is more significant for the Λ-stent compared to the X-stent and at Re = 200 with respect to Re = 80. Finally, it was observed that increasing the Reynolds number leads to early vortex formation and the creation of the vortex in a stented channel is coincident with

  15. Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction

    OpenAIRE

    Kim, Jin Hong

    2011-01-01

    Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be...

  16. PREVENTION OF BIOFILM FORMATION ON NORFLOXACINMETRONIDAZOLE TREATED URETERAL LATEX STENTS

    Directory of Open Access Journals (Sweden)

    B. ELAYARAJAH

    2011-01-01

    Full Text Available Biomaterial-associated bacterial infections present common and challenging complications with medical implants. The purpose of this study was to determine the antibacterial properties of latex rubber stents with integrated norfloxacin-metronidazole (synergistic antibacterial agent combinations for the first time in order to prevent the colonization and biofilm formation on the surface of ureteral stents. Treating of latex rubber stents were carried out by adding the norfloxacin-metronidazole with the fresh latex during polymerization (polymerization method. Polymerization was facilitated by adding water and formic acid to the latexantibacterialagents solution mixture. The numbers of adhered bacteria on treated and untreated stents were calculated. Difference in the number of viable bacteria adhered on the surface of treated and untreated stentswere statistically calculated using chi square testing procedure with P < 0.05 considered significant. Tests for persistence were carried out using serial plate transfer method to determine withstanding ability of antibacterial agentss in the stents. A primary skin irritation test was performed on a laboratory animal to determine thehypersensitivity reaction of antibacterial agents treated latex rubber discs. Numbers of adhered bacteria on the surface of antibacterial agents treated and untreated stents were calculated. In the polymerization method, the number of adhered bacteria on the surface of treated stents was reduced to a significant level (P<0.05.Persistence test showed the antibacterial activity of antibacterial agents treated stents till 5 days for polymerization method. In primary skin irritation test no significant erythema and edema was detected over the skin of lab animal according to the standard skin irritation scoring.

  17. Delivery of large biopharmaceuticals from cardiovascular stents: a review

    OpenAIRE

    Takahashi, Hironobu; Letourneur, Didier; Grainger, David W.

    2007-01-01

    This review focuses on the new and emerging large-molecule bioactive agents delivered from stent surfaces in drug-eluting stents (DES) to inhibit vascular restenosis in the context of interventional cardiology. New therapeutic agents representing proteins, nucleic acids (small interfering RNAs and large DNA plasmids), viral delivery vectors and even engineered cell therapies require specific delivery designs distinct from traditional smaller molecule approaches on DES. While small molecules a...

  18. Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication?

    Science.gov (United States)

    Köklü, Erkan; Yüksel, İsa Öner; Bayar, Nermin; Arslan, Şakir

    2015-10-01

    The most serious complication of carotid artery stenting (CAS) is acute carotid artery stent thrombosis (ACAST). ACAST is a very rare complication, but it may lead to dramatic and catastrophic consequences. The most important cause is inadequate or ineffective antiaggregant therapy. It is very important to identify, before CAS, those patients who might be candidates for ACAST and to start antiplatelet therapy for them. Testing patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may prevent this complication. PMID:26303788

  19. Stenting the ductus arteriosus: Case selection, technique and possible complications

    International Nuclear Information System (INIS)

    Ductal stenting is an attractive alternative to conventional shunt surgery in duct dependent congenital heart disease as it avoids thoracotomy and its related problems. With today's generation of coronary stents which have better profile, flexibility and trackability, ductal stenting may be achieved safely and with considerably less difficulty than previously described. As in Blalock-Taussig (BT) shunt, ductal stenting is indicated mainly in duct-dependent cyanotic lesions chiefly in the neonatal period. Unlike the Patent ductus arteriosus (PDA) as an isolated lesion, the ductus in cyanotic heart disease has a remarkable morphologic variability. The ductus tends to arise more proximally under the aortic arch, giving rise to a vertical ductus or occasionally it may arise from the subclavian artery. It also tends to be long and sometimes very tortuous, rendering stent implantation technically impossible. The ductus in these patients may also insert onto one of the branch pulmonary arteries with some stenosis at the site of insertion. The ductus in Tetralogy of Fallot with pulmonary atresia (TOF-PA) tend to exhibit these morphologic features and to a lesser degree in transposition of great arteries with ventricular septal defect and pulmonary atresia (TGA-VSD-PA) and the more complex forms of univentricular hearts. In the preliminary angiographic evaluation, it is important to delineate these morphologic features as the basis for case selection. Ductal stenting may be done by the retrograde femoral artery route or the antegrade transvenous route depending on the ductus morphology and the underlying cardiac lesion. The detailed techniques and essential hardware are described. Finally, major potential complications of the procedure are described. Acute stent thrombosis is the most serious and potentially catastrophic. Emergent treatment with thrombolytic therapy and mechanical disruption of thrombus are required. With proper case selection, appropriate technique

  20. Usefulness of Eosinophil-Lymphocyte Ratio to Predict Stent Restenosis

    OpenAIRE

    Mehmet Zihni Bilik; Mehmet Ata Akıl; Halit Acet; Murat Yüksel; Mustafa Oylumlu; Nihat Polat; Adem Aktan; Sait Alan

    2016-01-01

    Objective: Stent restenosis (SR) is an important compli­cation of percutaneous coronary intervention. There are many studies explored the relation of eosinophils with SR, however, there is no data about relationship between eo­sinophil-lymphocyte ratio (ELR) and SR. In this study we aimed to investigate the relationship between the value of ELR on admission and SR. Methods: The study was included 314 patients who had been applied a coronary stent implantation and they were admitted to car...

  1. Development of biodegradable magnesium alloy stents with coating

    OpenAIRE

    Lorenza Petrini; Wei Wu; Dario Gastaldi; Lina Altomare; Silvia Farè; Francesco Migliavacca; Ali Gökhan Demir; Barbara Previtali; Maurizio Vedani

    2014-01-01

    Biodegradable stents are attracting the attention of many researchers in biomedical and materials research fields since they can absolve their specific function for the expected period of time and then gradually disappear. This feature allows avoiding the risk of long-term complications such as restenosis or mechanical instability of the device when the vessel grows in size in pediatric patients. Up to now biodegradable stents made of polymers or magnesium alloys have been propose...

  2. Successful stent-in-stent insertion of an expandable metallic stent covered with polyuretane placed to obliterate a large bronchial fistula after chemoradiotherapy for inoperable lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Minami, Hiroya; Tsubota, Noriaki; Miyamoto, Yoshifumi; Yoshimura, Masahiro; Obayashi, Kayoko; Takada, Yoshiki [Hyogo Medical Center for Adults, Akashi (Japan)

    1999-10-01

    Bronchial fistulas in cases of inoperable lung cancer caused by radiochemotherapy are quite refractory and generally cannot be surgically closed. A 45-year-old man with squamous cell carcinoma in the right lung underwent two courses of induction chemotherapy (135 mg CDDP, 5 mg VDS, 13.5 mg MMC) and radiation therapy (2 Gy x 22 times) for invasion of the right main bronchus, the pulmonary artery and superior vena cava. Just before the end of the second course, the empyem second to the bronchial fistula caused by tumor necrosis developed in the right upper bronchus, and fenestration was performed. After the operation, his condition improved remarkably, however the fistula enlarged into the right main bronchus and the purulent discharge flowed into the left lung. An expandable metallic stent (EMS) covered with polyuretane was inserted in the trachea and the left main bronchus to break aspiration pneumonia. As the covered EMS was too unstable to be fixed, a bare EMS was inserted in a stent-in-stent fashion. After the procedure he was followed at the O.P.D. and lived a relatively comfortable life for 9 months until his death due to tumor. We inserted the covered EMS in a stent-in-stent fashion to successfully obliterate a large bronchial fistula. (author)

  3. Experimental research of covered stent implanted in canine hepatic artery

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of success rate of implantation, post-procedure stenosis rate, apposition ability and endothelialization level, etc. for implantation with balloon-expandable covered stent in canine hepatic artery. Methods: 8 adult canines were implanted with balloon-expendable stents covered by expandable poly Teflon ester membrane (e-PTFEM). Follow-up DSA was performed immediately, 2, 4 and 12 wk after the procedure. The canines were sacrificed for histopathologic examination and statistical analysis with correlation of implantation manenvor and angiographic manifestations. Results: 8 cases were all implanted with the covered stents in proper hepatic artery/right hepatic artery successfully; showing good apposition ability and non-opacification of the separated branches. 2 cases showed intraluminal obvious stenosis( > 50%)of the stent at 2 weeks follow-up, so did 3 cases at 12 weeks follow-up, and the total stenosis rate was 37.5% and 5 cases manifested full endothelialization (3 different locations of the sample all manifested full endothelialization), 3 cased manifested partial endothelialization (at least 1 location of the sample didn't show full endothelialization), and the two terminal parts were easier to get endothelialization than the central part. Before and after the stent implantation, hepatic function of all cases didn't demonstrate any obvious changes. Conclusions: Balloon-expandable covered stent can be implanted in canine hepatic artery. successfully, with good apposition ability, full endothelialization, and no influence on hepatic function. (authors)

  4. Vascular Response to Experimental Stent Malapposition and Under-Expansion.

    Science.gov (United States)

    O'Brien, Caroline C; Lopes, Augusto C; Kolandaivelu, Kumaran; Kunio, Mie; Brown, Jonathan; Kolachalama, Vijaya B; Conway, Claire; Bailey, Lynn; Markham, Peter; Costa, Marco; Ware, James; Edelman, Elazer R

    2016-07-01

    Up to 80% of all endovascular stents have malapposed struts, and while some impose catastrophic events others are inconsequential. Thirteen stents were implanted in coronary arteries of seven healthy Yorkshire pigs, using specially-designed cuffed balloons inducing controlled stent malapposition and under-expansion. Optical coherence tomography (OCT) imaging confirmed that 25% of struts were malapposed (strut-wall distance 51 ± 0.05 mm vs. apposed group 0.09 ± 0.05 mm, p = 2e-3). Imaging at follow-up revealed malapposition acutely resolved (areas (slope = 0.86, p area and lumen area (R (2) = 0.96) suggesting all lumen loss was related to contraction of elastic lamina with negligible plaque/intimal hyperplasia growth. Simulation showed this vascular recoil could be partially explained by the non-uniform strain environment created from sub-optimal expansion of device and balloon, and the inability of stent support in the malapposed region to resist recoil. Malapposition as a result of stent under-expansion is resolved acutely in healthy normal arteries, suggesting existing animal models are limited in replicating clinically observed persistent stent malapposition. PMID:26732391

  5. Oclusão arterial aguda de stent fêmoro-poplíteo Acute femoropopliteal artery stent obstruction

    Directory of Open Access Journals (Sweden)

    Fabio Henrique Rossi

    2009-09-01

    Full Text Available A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro.Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best therapeutic approach in this group of patients. We report a clinical case in which stent fragmentation and endarterectomy enabled femoropopliteal below knee bypass and limb revascularization.

  6. Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement.

    Directory of Open Access Journals (Sweden)

    Fabrice Paganin

    Full Text Available BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\\-8 years of age with esophageal stenting indication were investigated. Seven patients (group 1 were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression. Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2: stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication. Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks than in group 2 (28+/-11 weeks, p<0.001. Scheduled double stenting significantly improved symptoms (95% at day 7 with a low complication rate (13%, and achieved a specific cancer treatment (84% in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased

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

    International Nuclear Information System (INIS)

    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.

  8. Coronary stent occlusion: reverse attenuation gradient sign observed at computed tomography angiography improves diagnostic performance

    International Nuclear Information System (INIS)

    To evaluate the incidence and diagnostic performance of reverse attenuation gradient (RAG) sign in patients with coronary stent occlusion. We retrospectively included patients with suspected restenosis who underwent both coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within 2 weeks. Stent occlusion at CCTA was defined as (1) complete contrast filling defect of large calibre stents (at least 3 mm), or (2) presence of RAG sign in patients with small calibre stents (less than 3 mm) or (3) presence of RAG sign in patients with non-diagnostic image quality of stents. The diagnostic performance of RAG sign was further assessed by comparison to ICA results. A total of 162 patients with 231 implanted stents were included. ICA confirmed stent occlusion in 59 patients (99 stents). RAG sign was present in 59.3 % (35/59) of all stent occlusions. As shown by patient-based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of our diagnostic criteria for detection of stent occlusion were 79.7 % (47/59), 100 % (103/103), 100 % (47/47) and 89.6 % (103/115) respectively. Superior diagnostic performance was confirmed by receiver operating characteristic (ROC) analysis with an area under the curve of 0.898. RAG sign observed at CCTA in patients with coronary stenting represents reverse collateral flow distal to stents and is highly specific to indicate stent occlusion. (orig.)

  9. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

    Directory of Open Access Journals (Sweden)

    Vleggaar Frank P

    2009-12-01

    Full Text Available Abstract Background Benign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Stents are increasingly being used for this indication, however it is not completely clear which stent type should be preferred. Methods A systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data were pooled and evaluated for technical success, clinical success and complications. Results In total, 47 studies (1116 patients on outcome of stent placement were identified. No randomized controlled trials (RCTs, one non-randomized comparative studies and 46 case series were found. Technical success was 98,9% for uncovered self-expandable metal stents (uSEMS, 94,8% for single plastic stents and 94,0% for multiple plastic stents. Overall clinical success rate was highest for placement of multiple plastic stents (94,3% followed by uSEMS (79,5% and single plastic stents (59.6%. Complications occurred more frequently with uSEMS (39.5% compared with single plastic stents (36.0% and multiple plastic stents (20,3%. Conclusion Based on clinical success and risk of complications, placement of multiple plastic stents is currently the best choice. The evolving role of cSEMS placement as a more patient friendly and cost effective treatment for benign biliary strictures needs further elucidation. There is a need for RCTs comparing different stent types for this indication.

  10. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients

    Directory of Open Access Journals (Sweden)

    Liberato Manuel José

    2012-08-01

    Full Text Available Abstract Background Endoscopic biliary drainage of hilar cholangiocarcinoma is controversial with respect to the optimal types of stents and the extent of drainage. This study evaluated endoscopic palliation in patients with hilar cholangiocarcinoma using self-expandable metallic stents (SEMS and plastic stents (PS.We also compared unilateral and bilateral stent placement according to the Bismuth classification. Methods Data on 480 patients receiving endoscopic biliary drainage for hilar cholangiocarcinoma between September 1995 and December 2010 were retrospectively reviewed to evaluate the following outcome parameters: technical success (TS, functional success (FS, early and late complications, stent patency and survival. Patients were followed from stent insertion until death or stent occlusion. Patients were divided into 3 groups according to the Bismuth classification (Group 1, type I; Group 2, type II; Group 3, type > III. Results The initial stent insertion was successful in 450 (93.8% patients. TS was achieved in 204 (88.3% patients treated with PS and in 246 (98.8% patients palliated with SEMS (p P P  Conclusions SEMS insertion for the palliation of hilar cholangiocarcinoma offers higher technical and clinical success rates in the ITT analysis as well as lower complication rates and a superior cumulative stent patency when compared with PS placement in all Bismuth classifications. The cumulative patency of bilateral SEMS or PS stents was significantly higher than that of unilateral SEMS or PS stents, with lower occlusion rates in Bismuth II patients.

  11. Crush implantation of a self-expanding interwoven stent over a subintimally recanalized standard stent in a TASC D lesion of the superficial femoral artery.

    Science.gov (United States)

    Vogel, B; Strothmeyer, A; Cebola, R; Katus, H; Blessing, E

    2012-11-01

    We demonstrate feasibility of implantation of a self-expanding interwoven nitinol stent in a claudicant, where recanalization attempt of a heavily calcified, occluded superficial femoral artery (TASC D lesion) was complicated by a previously implanted, fractured standard stent. Wire passage through the occlusion and beyond the fractured stent could only be achieved through the subintimal space. A dedicated reentry device was used to allow distal wire entry into the true lumen at the level of the popliteal artery. Despite crushing of the fractured stent with a series of increasingly sized standard balloons, a significant recoil remainded in the area of the crushed stent. To secure patency of the femoro-popliteal artery we therefore decided to implant the novel self-expanding interwoven nitinol stent (Supera Veritas (TM), IDEV), whose unique feature is an exceptional high radial strength. Patient presented asymptomatic without any impairment of his walking capacity at three month follow up and duplex ultrasound confirmed patency of the stent. Subintimal recanalizations can be complicated by previously implanted stents, in particular in the presence of stent fracture, where intraluminal wire passage often can not be achieved. Considering the high radial strength and fracture resistance, interwoven nitinol stents represent a good treatment option in those challenging cases and they can be used to crush standard nitinol and ballonexpandable stents. PMID:23129042

  12. Bioresorbable stent restenosis: new devices, novel situations.

    Science.gov (United States)

    Núñez-Gil, Iván J; Echavarría, Mauro; Escaned, Javier; Biagioni, Corina; Feltes, Gisela; Fernández-Ortiz, Antonio

    2014-12-01

    A 58-year-old man presented to our hospital with effort angina. Ten months prior, he was treated with a Bioresorbable vascular scaffold (BVS). During the current admission, an image angiographically compatible with in-BVS restenosis at the circumflex ostium with a radiolucent image in the ostial left anterior descending artery was shown. BVS failure is very infrequent and this is one of the first cases of BVS restenosis described. Thus, data on the best management option are scarce. We treated it like a drug-eluting stent restenosis, performing first an intracoronary optical coherence tomography scan in order to identify the left descending radiolucent image and to prepare the best treatment strategy. PMID:25480999

  13. Long-Term Clinical Outcome after Sirolimus-Stent Implantation for in Sirolimus-Eluting Stent Restenosis

    Directory of Open Access Journals (Sweden)

    Alain Guidon

    2008-01-01

    Full Text Available Restenosis after sirolimus-eluting stents (SES remains a clinical problem. We report our experience with the use a second SES in the fi rst SES to treat in-SES restenosis. Twenty-seven patients with in-SES restenosis were included in the registry. In-SES restenosis was focal in 34%, diffuse in 59% and proliferative in 7%. The procedure was successful in all patients without any acute in-hospital complications. During a mean follow-up of 14 ± 7 months MACE occurred in 8 patients (30%, (1 death, 1 myocardial infarction, 4 target lesion revascularisation, 1 target vessel revascularisation and 1 patient underwent CABG. Nineteen patients (70% had an event-free outcome. In conclusion SES placement to treat in-SES is safe and feasible and could be considered as a therapeutic option. However the incidence of MACE remains high on a long-term period. The use of stents has significantly improved the outcome of percutaneous coronary interventions (PCI (1,2. However, despite major advances in angioplasty and stenting, in-stent restenosis remains a major limitation. Recently, drug-eluting stents and especially sirolimus-eluting stents (SES have emerged as a very promising approach in preventing restenosis, and several different compounds have been shown to have a major impact on both the angiographic and the clinical outcome (6–9. However, even after drug eluting stents implantation in-stent restenosis (ISR remains and represents a clinical challenge. Several approaches have been proposed to deal with ISR like plain old balloon angioplasty (POBA, rotational atherectomy, brachytherapy (1–3. Few reports are actually available about the use of SES in SES for ISR treatment. We report our experience about the use SES for treating an ISR after SES implantation.

  14. Partially Covered Self-Expandable Metal Stents versus Polyethylene Stents for Malignant Biliary Obstruction: A Cost-Effectiveness Analysis

    OpenAIRE

    Barkun, Alan N; Viviane Adam; Myriam Martel; Khalid AlNaamani; Moses, Peter L

    2015-01-01

    BACKGROUND/OBJECTIVE: Partially covered self-expandable metal stents (SEMS) and polyethylene stents (PES) are both commonly used in the palliation of malignant biliary obstruction. Although SEMS are significantly more expensive, they are more efficacious than PES. Accordingly, a cost-effectiveness analysis was performed.METHODS: A cost-effectiveness analysis compared the approach of initial placement of PES versus SEMS for the study population. Patients with malignant biliary obstruction unde...

  15. Simultaneous endovascular stent and renal stent placement for acute type B aortic dissection with malperfusion of kidney

    OpenAIRE

    Dagdelen, Sinan; Aydın, Ebuzer; Karabulut, Hasan

    2012-01-01

    Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Surgery for acute dissection with organ malperfusion is known to carry a high morbidity and mortality; however endovascular treatment is becoming an alternative form of treatment. We report a clinical case of emergency percutaneous thoracal aorta endovascular stenting and renal artery stenting in a patient who had renal malperfusion and acut...

  16. Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Cheng-Hung [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China); Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Jhong, Guan-Heng [Graduate Institute of Medical Mechatronics, Chang Gung University, Tao-Yuan, Taiwan (China); Hsu, Ming-Yi; Wang, Chao-Jan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan (China); Liu, Shih-Jung, E-mail: shihjung@mail.cgu.edu.tw [Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Hung, Kuo-Chun [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China)

    2014-05-28

    The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ≧70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

  17. Maximizing benefit of drug-eluting stent by direct coronary stenting because of further reduction of inflammatory response

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun; GAO Run-lin

    2009-01-01

    @@ Coronary stents have been used as standard mechanical devices for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD).1-3 They provide vessel wall scaffolding and prevent early elastic recoil and restenosis, which are major limitations of balloon angioplasty.4,5 Consequently, coronary stenting has a higher successful rate of PCI and improves the clinical outcome of the patients with CAD.6

  18. Tratamento de uma coorte de pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST Tratamiento de una cohorte de pacientes con infarto agudo de miocardio con supradesnivel del segmento ST Treatment of a cohort of patients with acute myocardial infarction and ST-segment elevation

    Directory of Open Access Journals (Sweden)

    Jamil da Silva Soares

    2009-06-01

    Full Text Available FUNDAMENTO: Trombólise e angioplastia transluminal coronariana (ATC primária são técnicas bem estabelecidas, mas grande parte dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM com SST não as recebem quando do atendimento hospitalar. OBJETIVO: Descrever tratamentos inicial e final e desfechos de uma coorte com IAM com SST. MÉTODOS: Analisados, da internação até a alta, 158 pacientes com IAM com SST, de uma população total de 351 pacientes internados com (SCA nos hospitais de Campos dos Goytacazes, entre 2004 e 2006. RESULTADOS: Dos 158 pacientes com IAM com SST, 67,7% chegaram ao hospital nos primeiros 180 minutos, 81,3% em 360 minutos e 8,4% após doze horas. Realizados 148 estudos cinecoronariográficos (93,7%. Observadas lesões de mais de 70% em 266 territórios arteriais. Tratamento inicial foi ATC em 41(26%, trombolíticos em 50 (32%, com 80% de sucesso. Tratamento clínico em 67 (42%. Cerca de 35% dos pacientes deveriam ser trombolizados mas não o foram. No tratamento final foram 93 ATCs, 89 delas com sucesso angiográfico (95,7, sangramento 2 (2,2, oclusão subaguda 2 (2,2%, dissecção tronco 1 (1,1, pseudo aneurisma 1 (1,1. Nenhum óbito durante angioplastia; na evolução, houve dois óbitos (2,1%. Doze pacientes submetidos a cirurgia de revascularização miocárdica (CRM. Tratamento clínico 53 (33%, com 11 óbitos (20,7%. Letalidade global 9,5%, consideradas as três formas de tratamento. CONCLUSÃO: Pacientes atendidos em tempo adequado para reperfusão, porém 1/3 deles não recebeu o procedimento. Tratamento predominante foi ATC, com baixa morbidade. Dois óbitos na evolução. Baixa letalidade global.FUNDAMENTO: La trombólisis y la angioplastia transluminal coronaria (ATC primaria son técnicas bien establecidas, sin embargo gran parte de los pacientes con infarto agudo de miocardio con supradesnivel del segmento ST (IAM con SST no las reciben cuando de la atenci

  19. Efetividade e segurança dos stents farmacológicos em um serviço de cardiologia em Curitiba-PR Efectividad y seguridad de los Stents farmacológicos en un servicio de cardiología en Curitiba-PR Effectiveness and safety of drug-eluting stents in a cardiology clinic in Curitiba, PR, Brazil

    Directory of Open Access Journals (Sweden)

    Chiu Yun Yu Braga

    2010-07-01

    . De esos pacientes, 85 (41,87% eran asintomáticos, y 146 (71,92%, multiarteriales. En las características de las lesiones, 77,45% fueron B2/C (AHA/ACC. Taxus fue implantado en 73,62% de los pacientes. En 381 (81,96%, se constataron stents con diámetro > 2,5 mm. El largo del stent era de BACKGROUND: The effectiveness and safety of drug-eluting stents (DES have still been questioned. OBJECTIVE: The objective of this study was to evaluate the effectiveness and safety of these stents, as well as the incidence of target lesion revascularization (TLR, in addition to identifying possible variables influencing the need for TLR. METHODS: A total of 203 patients from Hospital Costantini who were clinically followed up for one to 3 years were selected. RESULTS: The sample characteristics were as follows: 470 lesions; 171 (84.24% male patients; 54 (26.6% had diabetes; 131 (64.35% had hypertension; 127 (62.56%, dyslipidemia; 40 (19.70% were smokers; and 79 (38.92% had a family history of coronary artery disease. Also: 49 (24.14% patients presented with stable angina; 58 (28.57%, unstable angina; and 6 (2.96%, myocardial infarction. Eighty five (41.87% patients were asymptomatic, and 146 (71.92%, had multivessel disease. As for the characteristics of the lesions, 77.45% were B2/C (AHA/ACC. Taxus was implanted in 73.62% of the patients. Stents with diameter > 2.5 mm were used in 381 (81.96% patients. The stent length was < 30 mm in 67.87% of the lesions, with a mean of 2.3 stents per patient. After follow-up, 19 patients (9.3% underwent TLR. Four patients died (1.97%, two of them of MI (0.98%, one of stroke (0.49%, and one of abdominal aneurysm (0.49%. Also, one patient died of late thrombosis (0.49%, and one of reinfarction (0.49%. In the statistical analysis carried out, only the bifurcation lesions variable reached values close to the statistical significance level, with p < 0.06. CONCLUSION: In conclusion, drug-eluting stents have good effectiveness and safety profiles; the

  20. Delayed colonic perforation following stent placement for colorectal obstruction: a description of two cases with stent palliation.

    Directory of Open Access Journals (Sweden)

    Jalal Vahedian Ardakani

    2013-10-01

    Full Text Available Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.

  1. Meta-analysis of stent thrombosis after drug-eluting stent implantation: 4-year follow-up

    Institute of Scientific and Technical Information of China (English)

    Nata(s)a M Mili(c); Biljana J Parapid; Miodrag (C) Ostoji(c); Milan A Nedeljkovi(c); Jelena M Marinkovi(c)

    2010-01-01

    Background Drug-eluting stents (DES) are the most common device used in percutaneous treatment of coronary artery disease. Recently, there has been an increased concern regarding their safety profile, in particular the late and very late stent thrombosis rate compared to bare metal stents (BMS). The aim of the study was to compare the reported incidence of late and very late stent thrombosis of DES and BMS in patients from published clinical studies with an extended follow-up period to four years.Methods A search strategy was developed to identify publications reporting on late or very late thrombosis of BMS and DES available through MEDLINE and Cochrane Library databases. Two independent reviewers appraised eligible studies and extracted data. Odds ratios (OR) were calculated for each outcome and presented with 95% confidence intervals (CI).Results Fourteen randomized controlled trials, which were at least single blinded, were identified. There was no difference in the incidence of late and very late stent thrombosis in patients treated with DES compared with patients treated with BMS (late OR 0.55, 95%Cl 0.23-1.31 and late/very late OR=1.08, 95%CI 0.61-1.91).Conclusions The safety profile of DES was similar to BMS in terms of stent thrombosis. We found no evidence of increased risk of late and very late thrombosis for DES.

  2. Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lindefjeld, Dante S., E-mail: dslindef@puc.cl [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Guarda, Eduardo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Méndez, Manuel [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Martínez, Alejandro [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Pérez, Osvaldo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Fajuri, Alejandro; Marchant, Eugenio [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Aninat, Mauricio; Torres, Humberto [Hospital Dr. Gustavo Fricke, Viña del Mar-Chile (Chile); Dussaillant, Gastón [Hospital Clínico Universidad de Chile, Santiago-Chile (Chile)

    2013-01-15

    Background: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Objective: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Methods: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). Results: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up. Conclusions: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

  3. Effect of achalasia with temporary metal internal stent dilation on esophageal motility

    International Nuclear Information System (INIS)

    Objective: To explore the effect of achalasia with temporary metal internal stent dilation on esophageal motility. Methods: Twenty nine patients with achalasia were undertaken temporary metal internal stent placement under X-ray control (stents were of 20-25 mm in diameters). After stent dilation 3-7 days, the stents were removed by endoscopy. We measured the lower esophageal sphincter (LES) residual pressure and carried out 24 h pH value monitor on the patients, and only LES pressure with relaxation rate for 12 healthy subjects (HS). Results: LES residual pressure before stent dilation were markedly higher than that after stent dilation (P0.05). Conclusions: Temporary metal internal stent dilation shows LES pressure and higher rate of GER for achalasia

  4. Process of prototyping coronary stents from biodegradable Fe-Mn alloys.

    Science.gov (United States)

    Hermawan, Hendra; Mantovani, Diego

    2013-11-01

    Biodegradable stents are considered to be a recent innovation, and their feasibility and applicability have been proven in recent years. Research in this area has focused on materials development and biological studies, rather than on how to transform the developed biodegradable materials into the stent itself. Currently available stent technology, the laser cutting-based process, might be adapted to fabricate biodegradable stents. In this work, the fabrication, characterization and testing of biodegradable Fe-Mn stents are described. A standard process for fabricating and testing stainless steel 316L stents was referred to. The influence of process parameters on the physical, metallurgical and mechanical properties of the stents, and the quality of the produced stents, were investigated. It was found that some steps of the standard process such as laser cutting can be directly applied, but changes to parameters are needed for annealing, and alternatives are needed to replace electropolishing. PMID:23665503

  5. Self-Expanding Metal Stenting for Palliation of Patients with Malignant Colonic Obstruction

    DEFF Research Database (Denmark)

    Meisner, Søren; González-Huix, Ferran; Vandervoort, Jo G;

    2012-01-01

    Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery. Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures. Design. Two prospective, one Spanish and...

  6. Antegrade jj stenting after percutaneous renal procedures: The ‘pull and push’ technique

    OpenAIRE

    Ratkal, Jaideep M.; Sharma, Elias

    2014-01-01

    A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL.

  7. Cuidados con el anciano con tos productiva.

    OpenAIRE

    Costa de Moura, María Lucia

    2005-01-01

    A partir de las informaciones y con la motivación para hacer un estudio dirigido a los cuidados con el anciano, sigue la necesidad del desarrollo de acciones pertinentes para la práctica de cuidar, o sea, la asistencia de enfermería prestada directamente al anciano, principalmente a aquellos que llegan a la unidad de salud quejándose de tos. El objeto de este estudio es la asistencia de enfermería basándome en las cuestiones que rodean la percepción del enfermero y cómo el...

  8. Cifrado con cubos marcados

    OpenAIRE

    Coriat, Moisés; María C. Cañadas

    2011-01-01

    Con cuatro de los 8 tetracubos y con la ayuda de la noción de cubo mínimo (cubo formado por dos tetracubos), introducimos los “cubo marcados”. A su vez, usamos esta idea para generar claves con las que cabe transmitir mensajes cifrados. Damos ejemplos de claves y mencionamos algunas posibilidades más de cifrado con dichos cubos marcados. En la introducción presentamos algunas facetas del cifrado. Después, describimos algunos policubos y prestamos especial atención a los cuatro tetracubo...

  9. Patient with Recent Coronary Artery Stent Requiring Major Non Cardiac Surgery

    OpenAIRE

    Usha Kiran; Neeti Makhija

    2009-01-01

    Summary Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implantation and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should ...

  10. Acute Coronary Stent Thrombosis in Cancer Patients: A Case Series Report

    OpenAIRE

    Lee, Joo Myung; Yoon, Chang-Hwan

    2012-01-01

    There have been a growing numbers of patients diagnosed with malignancy and coronary artery disease simultaneously or serially. In the era of percutaneous coronary intervention (PCI), stent thrombosis has been a rare but challenging problem. Recently, we experienced two unique cases of acute stent thrombosis in patients with malignancy. The first case showed acute and subacute stent thrombosis after PCI. The second case revealed simultaneous thromboses in stent and non-treated native coronary...

  11. An Unusual Case of Stent Migration After Celiac Trunk Endovascular Revascularization

    International Nuclear Information System (INIS)

    A 61-year-old woman underwent celiac trunk stenting to treat abdominal angina. Three months later, she was readmitted for recurrent symptoms. Computed tomography control revealed the migration of the stent into the splenic artery. No sign of vessel injury or end-organ ischemia was detected. Repeat stenting of the celiac trunk was performed; the postoperative course was uneventful. 12 months later, the patient was asymptomatic with the second stent in its correct position, and she was asymptomatic for mesenteric ischemia.

  12. Biliary small intestinal submucosa covered Z-stents. Preliminary results in an animal model

    International Nuclear Information System (INIS)

    Background. Purpose of the study was to test the function and biological response of metallic stents covered with small intestinal submucosa (SIS) in the swine biliary system. Materials and methods. A total of 9 SIS-covered single Z-stents were placed in the common bile duct (CBD) in 6 pigs. Stents were delivered into the CBD at laparotomy via the gall bladder and the cystic duct. Animals were sacrificed or died at 2 weeks (n=1), 4 weeks (n=1), 8 weeks (n=2), and 10 weeks (n=2) after stenting and histological studies were performed. Results. Nine stents were deployed in 6 animals. During follow-up, 3 stents in 3 animals (2, 4, and 10 weeks) remained stable, while one stent shifted distally in CBD and 5 of them turned sideways. All stents remained patent. Duct dilatation and bile slugging were noted at 10 weeks. The SIS-membrane was present at 2 weeks, but was not histologically distinct at 4 weeks and later. Histological study showed no significant inflammatory changes in the bile duct in any pig. Mucosal hyperplasia was absent in 2 of 3 stable stents at 2 and 10 weeks, and 1 distally shifted stent at 10 weeks. Mild mucosal hyperplasia was seen at the distal stent end in 1 stable stent at 4 weeks and in 5 dislodged stents at 8 and 10 weeks. Conclusions. Even when the study is limited by dislodgment of high percentage of placed stents, the results in stable stents conducting the bile flow suggest that SIS helps to prevent bile duct inflammation and mucosal hyperplasia typical for uncoated stents. Further studies, particularly with improved wet SIS are warranted. (author)

  13. Trimming of a Broken Migrated Biliary Metal Stent with the Nd:YAG Laser

    OpenAIRE

    Zuber-Jerger, I.; F. Kullmann

    2009-01-01

    Biliary metal stents are a permanent solution for bile duct stenosis. Complications can arise when the stent migrates, breaks or is overgrown by tumour. The following case demonstrates how a Nd:YAG laser can be used to solve these problems. A 93-year-old man presented with jaundice and fever. Two years earlier a 6-cm metal stent had been implanted into a postinflammatory stenosis of the common bile duct after recurrent cholangitis and repetitive plastic stenting. Duodenoscopy showed that the ...

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

    OpenAIRE

    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. ...

  15. Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography

    OpenAIRE

    Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Arena, Monica; Iabichino, Giuseppe; Consolo, Pierluigi; Opocher, Enrico; Luigiano, Carmelo

    2016-01-01

    Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered l...

  16. Primary Patency of Wallstents in Malignant Bile Duct Obstruction: Single vs. Two or More Noncoaxial Stents

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the primary patency of two or more noncoaxial self-expanding metallic Wallstents (Boston Scientific, Natick, MA) and to compare this with the primary patency of a single stent in malignant bile duct obstruction. From August 2002 to August 2004, 127 patients had stents placed for malignant bile duct obstruction. Forty-five patients were treated with more than one noncoaxial self-expanding metallic stents and 82 patients had a single stent placed. Two patients in the multiple-stent group were lost to follow-up. The primary patency period was calculated from the date of stenting until the first poststenting intervention for stent occlusion, death, or the time of last documented follow-up. The patency of a single stent was significantly different from that of multiple stents (P = 0.0004). In the subset of patients with high bile duct obstruction, the patency of a single stent remained significantly different from that of multiple stents (P = 0.02). In the single-stent group, there was no difference in patency between patients with high vs. those with low bile duct obstruction (P = 0.43). The overall median patency for the multistent group and the single-stent group was 201 and 261 days, respectively. In conclusion, the patency of a single stent placed for malignant low or high bile duct obstruction is similar, and significantly longer than, that of multiple stents placed for malignant high bile duct obstruction. Given the median patency of 201 days, when indicated, percutaneous stenting of multiple bile ducts is an effective palliative measure for patients with malignant high bile duct obstruction.

  17. Tissue Responses to Endovascular Stent Grafts for Saccular Abdominal Aortic Aneurysms in a Canine Model

    OpenAIRE

    Kim, Hyun Beom; Choi, Young Ho; So, Young Ho; Min, Seung-Kee; Kim, Hyo-Cheol; Kim, Young Il; Park, Jae Hyung; Chung, Jin Wook

    2012-01-01

    We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at...

  18. Endovascular treatment of superficial femoral artery occlusive disease with stents coated with diamond-like carbon

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, O. E-mail: schaefer@mrs1.ukl.uni-freiburg.de; Lohrmann, C.; Winterer, J.; Kotter, E.; Langer, M

    2004-12-01

    A major consideration in the reduction of early stent thrombosis and in-stent restenosis is the improvement of biocompatibility of the devices. Diamond-like carbon is a novel material for coating stent surfaces in order to increase biocompatibility. The authors report on the endovascular treatment of two individuals with superficial femoral artery occlusions, using stents coated with diamond-like carbon. Technical and clinical success was achieved in both cases, with primary patency rates of 100% 12 months after intervention.

  19. Endovascular treatment of superficial femoral artery occlusive disease with stents coated with diamond-like carbon

    International Nuclear Information System (INIS)

    A major consideration in the reduction of early stent thrombosis and in-stent restenosis is the improvement of biocompatibility of the devices. Diamond-like carbon is a novel material for coating stent surfaces in order to increase biocompatibility. The authors report on the endovascular treatment of two individuals with superficial femoral artery occlusions, using stents coated with diamond-like carbon. Technical and clinical success was achieved in both cases, with primary patency rates of 100% 12 months after intervention

  20. Symptom relief and quality of life after stenting for malignant bile duct obstruction.

    OpenAIRE

    Ballinger, A B; M. McHugh; Catnach, S M; Alstead, E M; Clark, M L

    1994-01-01

    Palliative treatment is appropriate for most patients with cancer of the head of pancreas. Insertion of a biliary stent relieves jaundice and pruritus but it is not known if stenting affects other symptoms or changes the quality of life. Nineteen patients have completed a standard questionnaire to assess symptom relief and quality of life after stent insertion. After stenting there was complete relief of jaundice and pruritus. Furthermore, there was also considerable improvement in anorexia a...

  1. Double-J ureteric stenting in pregnancy: A single-centre experience from Iraq

    OpenAIRE

    Ngai, Ho-Yin; Salih, Hawre Qadir; Albeer, Ayad; Aghaways, Ismaeel; Buchholz, Noor

    2013-01-01

    Objectives To evaluate the safety and effectiveness of ureteric stenting with a JJ stent in pregnant women, to relieve renal obstruction and intractable flank pain. Patients and methods All pregnant patients presenting with intractable flank pain, with or without complications, to a tertiary national teaching hospital in Kurdistan/Iraq, and necessitating ureteric stenting with a JJ stent, were prospectively assessed for this study between March 2008 and March 2010. Results In all, 30 pregnant...

  2. Carotid artery stenting versus endarterectomy: a systematic review.

    Science.gov (United States)

    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 Health-sponsored 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

  3. Fully Covered Self-Expandable Metal Stents for Treatment of Both Benign and Malignant Biliary Disorders

    OpenAIRE

    Lorenz Theilmann; Ahmed Abdel Samie

    2012-01-01

    Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following...

  4. Baclofen-responsive hiccups after esophageal stenting for malignancy-related dysphagia.

    Science.gov (United States)

    Sharma, Vishal; De, Arka; Lamoria, Sandeep; Lamba, Brinder Mohan Singh

    2016-04-01

    Hiccups can have multiple causes, including esophageal lesions. Hiccups after insertion of self-expanding metallic stents have been reported occasionally following stenting for lesions of the gastroesophageal junction. We report a patient who developed hiccups after insertion of a stent for squamous cell carcinoma of the proximal esophagus. The hiccups responded only to the initiation of baclofen therapy. PMID:27034549

  5. Fabrication and In Vitro Deployment of a Laser-Activated Shape Memory Polymer Vascular Stent

    Energy Technology Data Exchange (ETDEWEB)

    Baer, G M; Small IV, W; Wilson, T S; Benett, W J; Matthews, D L; Hartman, J; Maitland, D J

    2007-04-25

    Vascular stents are small tubular scaffolds used in the treatment of arterial stenosis (narrowing of the vessel). Most vascular stents are metallic and are deployed either by balloon expansion or by self-expansion. A shape memory polymer (SMP) stent may enhance flexibility, compliance, and drug elution compared to its current metallic counterparts. The purpose of this study was to describe the fabrication of a laser-activated SMP stent and demonstrate photothermal expansion of the stent in an in vitro artery model. A novel SMP stent was fabricated from thermoplastic polyurethane. A solid SMP tube formed by dip coating a stainless steel pin was laser-etched to create the mesh pattern of the finished stent. The stent was crimped over a fiber-optic cylindrical light diffuser coupled to an infrared diode laser. Photothermal actuation of the stent was performed in a water-filled mock artery. At a physiological flow rate, the stent did not fully expand at the maximum laser power (8.6 W) due to convective cooling. However, under zero flow, simulating the technique of endovascular flow occlusion, complete laser actuation was achieved in the mock artery at a laser power of {approx}8 W. We have shown the design and fabrication of an SMP stent and a means of light delivery for photothermal actuation. Though further studies are required to optimize the device and assess thermal tissue damage, photothermal actuation of the SMP stent was demonstrated.

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

    International Nuclear Information System (INIS)

    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

  7. Angiographic predictors of recurrence of restenosis after Wiktor stent implantation in native coronary arteries

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); V. Wiegand; J.F. Marquis; M. Vrolicx; J. Piessens; B. Valeix; G. Kober; J.J.R.M. Bonnier (Hans); W.R. Rutsch (Wolfgang); R. Uebis; P.P.T. de Jaegere (Peter)

    1993-01-01

    textabstractIntracoronary stenting has been proposed as an adjunct to balloon angioplasty to improve the immediate and long-term results. However, late luminal narrowing has been reported following the implantation of a variety of stents. One of the studies conducted with the Wiktor stent is a prosp

  8. Spontaneous fracture of indwelling polyurethane ureteral stents: A case series and review of literature

    OpenAIRE

    Chua, Michael E.; Morales, Marcelino L.

    2012-01-01

    Polyurethane, due to its low cost, high versatility and availability, it commonly used for ureteral stents. Spontaneous fracture of these stents is rare, and the most dreaded complication. We present four cases of spontaneous fracture of indwelling polyurethane ureteral stents and review the literature to identify potential factors and preventive strategies.

  9. Relation of body mass index to risk of stent thrombosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle; Torp-Pedersen, Christian; Gislason, Gunnar H;

    2012-01-01

    Stent thrombosis is a devastating complication after percutaneous coronary intervention (PCI), but the influence of obesity on risk of stent thrombosis is unclear, and it is unknown if this relation is dependent on stent type. The objective of this study was to examine the relation between body...

  10. Fabrication and in vitro deployment of a laser-activated shape memory polymer vascular stent

    Directory of Open Access Journals (Sweden)

    Matthews Dennis L

    2007-11-01

    Full Text Available Abstract Background Vascular stents are small tubular scaffolds used in the treatment of arterial stenosis (narrowing of the vessel. Most vascular stents are metallic and are deployed either by balloon expansion or by self-expansion. A shape memory polymer (SMP stent may enhance flexibility, compliance, and drug elution compared to its current metallic counterparts. The purpose of this study was to describe the fabrication of a laser-activated SMP stent and demonstrate photothermal expansion of the stent in an in vitro artery model. Methods A novel SMP stent was fabricated from thermoplastic polyurethane. A solid SMP tube formed by dip coating a stainless steel pin was laser-etched to create the mesh pattern of the finished stent. The stent was crimped over a fiber-optic cylindrical light diffuser coupled to an infrared diode laser. Photothermal actuation of the stent was performed in a water-filled mock artery. Results At a physiological flow rate, the stent did not fully expand at the maximum laser power (8.6 W due to convective cooling. However, under zero flow, simulating the technique of endovascular flow occlusion, complete laser actuation was achieved in the mock artery at a laser power of ~8 W. Conclusion We have shown the design and fabrication of an SMP stent and a means of light delivery for photothermal actuation. Though further studies are required to optimize the device and assess thermal tissue damage, photothermal actuation of the SMP stent was demonstrated.

  11. The effects of post coronary stenting triple antiplatelet therapies on platelet functions

    Institute of Scientific and Technical Information of China (English)

    韩雅玲

    2006-01-01

    Objective To explore the effects of triple antiplatelet therapy on platelet aggregation and activation in patients who underwent coronary stenting. Methods 120 inhospital coronary heart disease patients with coronary stenting were randomized into two groups receiving either triple antiplatelet drugs of aspirin and clopidogrel combined with cilostazol or dual antiplatelet drugs of aspirin and clopidogrel. On the first day after stenting cilostazol

  12. Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients

    NARCIS (Netherlands)

    M.J.B.M. van den Brand (Marcel); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); D.P. Foley (David); W.J. van der Giessen (Wim); P.P.T. de Jaegere (Peter); R.T. van Domburg (Ron); H.L. Hamburger (Hans)

    1999-01-01

    textabstractOBJECTIVE: To describe the long term clinical outcome (up to 11 years) after coronary stenting. DESIGN: A single centre observational study encompassing 1000 consecutive patients with a first stent implantation (1560 stents) between 1986 and 1996, who were followed for

  13. Intimal hyperplasia and vascular remodeling after everolimus-eluting and sirolimus-eluting stent implantation in diabetic patients the randomized diabetes and drug-eluting stent (DiabeDES) IV intravascular ultrasound trial

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Maeng, Michael; Thayssen, Per; Christiansen, Evald Høj; Hansen, Knud Nørregaard; Kaltoft, Anne; Hansen, Henrik Steen; Thuesen, Leif; Lassen, Jens Flensted; Jensen, Lisette Okkels

    2013-01-01

    OBJECTIVE: To evaluate the effects of the everolimus-eluting Xience™/Promus™ stent (EES) and the sirolimus-eluting Cypher™ stent (SES) on intimal hyperplasia (IH) in diabetic patients. BACKGROUND: Patients with diabetes mellitus have increased risk of in-stent restenosis after coronary stent impl...

  14. Placement of Endovascular Stent across the Branching Arteries: Long-term Serial Evaluation of Stent-tissue Responses Overlying the Arterial Orifices in an Experimental Study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Il; Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of); Kim, Hyun Beom [National Cancer Center of Korea, Department of Radiology and Center for Liver Cancer, Research Institute and Hospital (Korea, Republic of); Park, Jae Hyung [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of); Seo, Jeong Wook [Seoul National University College of Medicine, Department of Pathology (Korea, Republic of); Kim, Hyo-Cheol; Jae, Hwan Jun; Lee, Whal [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of)

    2012-10-15

    PurposeThis study was designed to investigate the effects of stenting across the branching arteries on the patency and stent-tissue responses over the branching arterial orifices. Methods: Thirteen dogs were observed after placing aortic stents across the celiac arteries (CA), superior mesenteric arteries (SMA), and renal arteries (RA). The animals were grouped according to stent types: large-cell group (n = 6) and small-cell group (n = 7). Angiography was performed to evaluate the branching artery patency at 2, 6, and 12 months after stent insertion, and the stent-tissue responses covering the orifices were evaluated on histopathologic examination. Results: All branching arteries were patent on follow-up angiography; however, three patterns of stent-tissue responses over the orifices were observed: neointimal layering, bridging septa, and papillary hyperplasia. Although neointimal layering and bridging septa were evenly observed, severe papillary hyperplasia was more frequent at SMA and CA than RA. Four RA showed less than 50% ostial patency, and localized infarct was observed in six kidneys (24%). The ostial patency tended to decrease with small-cell stent during the follow-up period. Conclusions: Various stent-tissue responses over the branching artery orifices are induced by the aortic stent covering the branching arteries and may not be easily detected by conventional angiography. Subclinical renal infarct also may occur despite patent renal angiography.

  15. Gender differences in patients undergoing coronary stenting in current stent era

    Institute of Scientific and Technical Information of China (English)

    Max Woo; FAN Chang-qing; Chen Yung-Lung; Hesham Husein; Fang Hsiu-Yu; Lin Cheng-Jui; Wu Chiung-Jen

    2011-01-01

    Background Prior studies have demonstrated worse results of women in both hospital and short-term outcomes post-percutaneous coronary intervention. However, with advanced devices like drug-eluting stents (DESs) available,there are no consistent data revealing gender impact in outcome. This study examined whether gender affected hospital outcome and showed one-year single-center patient results of coronary stenting.Methods The study group included 969 consecutive patients (250 women and 719 men) undergoing coronary stenting for stable or unstable angina. Clinical events were assessed for at least 1 year post-procedure.Results Compared to men, women were older, presented more often with diabetes, hypertension, dyslipidemia, and lower creatinine clearance rate (Ccr); they had less percutaneous transluminal coronary angioplasty (PTCA) history,smaller vessel size, and shorter lesions. The hospital major adverse cardiovascular event (MACE) rate was 2.8% of women and 0.97% of men (P=0.037). The one-year MACE rate was 10.0% of women and 10.4% of men (P=0.874). After adjusting other covariates, women still had significantly higher hospital MACE rates (P=0.034) and odds ratios (0.18;95% confidence interval: 0.036-0.874). In women (n=250), there was no statistically significant difference in hospital or one-year MACE between bare metal stent (BMS) and DES groups. Meanwhile, in men (n=719), DES had a significant one-year improvement of MACE compared to BMS (P=0.004). The female hospital MACE rate was five times greater than male results. However, there were similar one-year outcomes between women and men. DES currently have an advantage in long-term outcome.Conclusions Currently, with the use of BMS and DES, adverse hospital post-procedure cardiovascular event rate has occurred more often in women than in men. However, the MACE rate differences between women and men resolved with one year follow-up.

  16. Experimental 16-row CT evaluation of in-stent restenosis using new stationary and moving cardiac stent phantoms: experimental examination

    International Nuclear Information System (INIS)

    Purpose: The aim of this study was to evaluate in-stent restenosis using a newly developed stationary and moving cardiac stent phantom with three built-in artificial stenoses and a 16-row MDCT. Materials and Methods: A newly developed coronary stent phantom with three artificial stenoses - low (approx. 30%), medium (approx. 50%) and high (approx. 70%) - was attached to a moving heart phantom and used to evaluate the ability of 16-row MDCT to visualize in-stent restenosis. High resolution scans (16 x 0.75 mm, 250 mm FOV) were made to identify the baseline for image quality. The non-moving phantom was scanned (16 x 0.75 mm, routine cardiac scan protocol) first without and then with implementation of an ECG signal at various simulated heart rates (HR 40 to 120 bpm) and pitches (0.15 to 0.3). The moving cardiac phantom was scanned at the same simulated heart rates but at a pitch of 0.15. Images were reconstructed at every 10% of the RR interval using a multi-cycle real cone-beam reconstruction algorithm. Multi-planar reformations (MPR) were made for the image evaluation. The image quality was assessed using a three-point scale, and stent patency and stenoses detection were evaluated using a four-point scale. To evaluate the image quality and to grade the stent stenoses, the median values were calculated while considering the reconstruction interval. Results: The image quality for the static phantom was adequate in 97% of the measurements. In this phantom, every stenosis was detected independent of the pitch and heart rate used. The dynamic stent phantom yielded the best results at 0%, 40%, and 50% of the RR interval at a pitch of 0.15. The low stenosis was visible at a simulated heart rate of up to 80 bpm. Patency can be detected at heart rates greater than 80 bpm. (orig.)

  17. Stem cell impregnated nanofiber stent sleeve for on-stent production and intravascular delivery of paracrine factors.

    Science.gov (United States)

    Hwang, Chao-Wei; Johnston, Peter V; Gerstenblith, Gary; Weiss, Robert G; Tomaselli, Gordon F; Bogdan, Virginia E; Panigrahi, Asmi; Leszczynska, Aleksandra; Xia, Zhiyong

    2015-06-01

    Stem cell therapies for atherosclerotic diseases are promising, but benefits remain modest with present cell delivery devices in part due to cell washout and immune attack. Many stem cell effects are believed mediated by paracrine factors (PFs) secreted by the stem cells which potentiate tissue repair via activation and enhancement of intrinsic host repair mechanisms We therefore sought to create an "intravascular paracrine factor factory" by harnessing stem cells on a stent using a nanofiber (NF) stent sleeve, and thus providing a sheltered milieu for cells to continuously produce PFs on-stent. The NF sleeve acts as a substrate on which stem cells grow, and as a semi-permeable barrier that protects cells from washout and host immune response while allowing free outward passage of PFs. NF stent sleeves were created by covering stents with electrospun poly-lactic-co-glycolic acid nanofibers and were then uniformly coated with mesenchymal stem cells (MSCs). NF sleeves blocked cell passage but did not hamper MSC attachment or proliferation, and did not alter MSC morphology or surface markers. NF sleeve MSCs continued to secrete PFs that were biologically active and successfully induced tubulogenesis in human endothelial cells. NF stent sleeves seeded with allogeneic MSCs implanted in pigs remained patent at 7 days without thrombotic occlusion or immune rejection. Our results demonstrate the feasibility of creating an intravascular PF factory using a stem cell impregnated NF stent sleeve, and pave the way for animal studies to assess the efficacy of local PF production to treat ischemic artery disease. PMID:25818438

  18. Treatment of symptomatic intracranial arterial stenosis with Wingspan stent system

    International Nuclear Information System (INIS)

    Objective: To discuss the safety of Gateway-Wingspan stent system in treating symptomatic intracranial atherosclerotic stenosis and its effect of preventing and treating cerebral ischemic events. Methods: Interventional treatment by using Gateway-Wingspan sent system was carried out in 36 patients with symptomatic intracranial atherosclerotic arterial stenosis (a total of 38 lesions) who had failed to response the medication. Of the 32 cases, elective surgery was performed in 32 and emergent surgery in 4. Of the total 38 stenotic sites, 22 were located at the posterior cerebral blood circulation region, while 16 at the anterior circulation region. Results: The average degree of stenosis before stenting procedure was 72.6%±12.6%, the residual stenosis degree after balloon dilatation and stenting was 33.8%±15.2% and 23.6%±13.9%, respectively. The successful rate of treatment was 97.4%. Perioperative complications occurred in 4 patients, two from 32 cases who received elective surgery and other two from 4 cases who received emergent stent implantation. In cases receiving elective surgery, one suffered from perforating arterial branch occlusion and one occurred cerebral bleeding due to the rupture of middle cerebral artery caused by guide-wire. In patients receiving emergent stent implantation, acute stent thrombosis occurred in 2 cases during the interventional management (n=1) or 24 hours after stent placement (n=1). The overall complication rate was 11.1% (4/36). The 30-day composite ipsilateral stroke rate was 5.5% and the frequency of ipsilateral stroke within 30 days or ipsilateral stroke between 30 days and 12 months was 11.1% (4/36) during a mean follow-up time of 9.6 months (ranged between 1-24 months). DSA check-up was conducted in 10 cases and restenosis at the middle cerebral artery was detected in 2 cases. Conclusion: It is quite safe to use Gateway-Wingspan stent system for the treatment of symptomatic intracranial stenosis and its short-term clinical

  19. The clinical application of domestic biliary metallic stents

    International Nuclear Information System (INIS)

    Objective: To determine the clinical efficacy and safety of domestic biliary metallic stents in the management of biliary obstruction. Methods: 75 domestic biliary metallic stents were implanted in 66 of 72 patients with obstructive jaundice due to malignant (n=70) and benign stenoses (n=2). Results: The technical successful rate was 92.7% (64/66). Palliation with rid of jaundice was achieved in 96.9% (64/66) within 1 month. The 30-day mortality rate was 3% (2/66). Early complications occurred in 7.6% (5/66). 44 patients were followed from 2 to 24 months after treatment. 33 (33/42) of 42 patients with malignancy died after a median survival of 5.3 months (range 2-23 months). The remaining 9 patients (9/42) remained alive with a mean follow-up of 11.6 months. The stent patency rates were 92.8%, 89.9% and 79.4 % at 3, 6, 12 months respectively. 6 patients (6/42) presented stent occlusion within a median period of 3 months. One of two patients with benign stenoses sustained a patency duration time of 24 months. One patient died 3 months after treatment. Conclusions: The domestic biliary metallic stent implantation is efficacy and safety in the management of biliary obstruction. (authors)

  20. Venous sinus stenting for pseudotumour cerebri with venous sinus stenosis

    International Nuclear Information System (INIS)

    Objective: To explore the relation between venous sinus stenosis and pseduotumour cerebri and to discuss the efficacy and strategy of venous sinus stenting for its treatment. Methods: Venous sinus stenting was performed in a total of 9 patients with pseudotumour cerebri accompanied by dural sinus stenosis. The clinical data, including the clinical presentations, intracranial pressure, angiographic findings, pressure of dural sinus,methods of treatment and the therapeutic results, were retrospectively analyzed. Results: Bilateral disc edema was seen in all patients. The pressure gradient in the lateral sinuses was obviously high before stenting (22.67±7.25)mmHg in all patients and a reduction in intra-sinus pressure and pressure gradient was also found (5.78±3.77)mmHg. The symptoms associated with intracranial hypertension were gradually improved or disappeared in two weeks after the placement of the stent in all cases, and the intracranial pressure dropped evidently (12.78±5.97)cm H2O. Vision was improved in 7 cases at three months, whereas it remained poor in 2 cases despite normalized intracranial pressure. There was no other permanent procedure-related morbidity. The patients were followed up for 3 months to 5 years, and no recurrence developed. Conclusion: Lateral sinus stenting is an effective method for the treatment of pseudotumour cerebri with dural sinus stenosis. (authors)

  1. Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus

    Directory of Open Access Journals (Sweden)

    Róbert Novotný

    2016-01-01

    Full Text Available 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.

  2. Finite element analysis of a percutaneous aortic valve stent design

    Directory of Open Access Journals (Sweden)

    Lazar Mathew

    2009-06-01

    Full Text Available Aim: This paper discusses the design and Finite Element Analysis (FEA of a Percutaneous Aor-tic Valve Stent. The aim of this study was to model a percutaneous aortic valve stent and subject it to finite element analysis. The design process was carried out to meet the functional and surgical requirements. Methods and Results: Analysis was done with different materials with loads ranging from 50 kgf/mm² to 73 kgf/mm². These forces were selected because these val-ues are far greater than the normal human blood pressure which ranges from 10kPa to 16kPa. It was also to understand the mechanical behavior of different stent materials under such high pressures. A stent model was generated and its physical, mechanical and behavioral properties were studied. Finite element analysis and simulation of the model enhanced the designer to optimize the geometry suitable for perform-ance during and after implantation. The design objective for the stent is to have long term du-rability, low thrombogenicity, resistance to mi-gration and paravalvular leak. Conclusion: The analysis performed in this paper may aid in understanding the stent’s tolerable pressures ranges in comparison with the physiological pressures exerted by the heart and cardiac blood flow during abnormal cardiovascular conditions.

  3. Covered stent implantation for the treatment of intracranial arterial disorders

    International Nuclear Information System (INIS)

    The coronary covered s tents have been more and more used to treat intracranial arterial diseases for recent years, and the hot point in study has gradually changed from clinical application of coronary covered stents to the fundamental and clinical trial of specially-designed intracranial covered stents. The covered stents are mainly employed for the treatment of intracranial arterial disorders, including giant, wide-necked or minute cerebral aneurysms, intracranial pseudoaneurysms caused by a variety of reasons, fusiform or dissecting aneurysms of vertebral-basic artery, and internal carotid cavernous fistula, etc. It is very difficult for current surgical or endovascular treatment, both materially and technically, to deal with the above mentioned intracranial disorders. The covered stent can restore the anatomic shape of artery by direct sealing the aneurysmal neck and the fistula. The complications of covered stent treatment include defect of cranial nerves, occlusion of parent artery or branches. This article aims to review the related medical literature published both at home and abroad, to make a retrospective analysis of the therapeutic results, and to put forward some issues of common interest. (authors)

  4. Engineering Radioactive Stents for the Prevention of Restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Bruce Thomadsen; Robert J. Nickles; Larry DeWerd; Douglass Henderson; Jonathan Nye; Wes Culberson; Stephen Peterson; Michael Meltsner; Liyong Lin

    2004-09-10

    Radiation has become an accepted treatment for the prevention of restenosis (re-blockage) of coronary arteries following angioplasty. Radioactive stents could be the easiest method of delivery for the radiation, although clinical trials were disappointing. One likely reason was the choice of P-32 as the radionuclide, which fails to match the biological needs of the problem. What radionuclide would perform best remains unknown. This project established the physical infrastructure necessary for a rational investigation to determine the optimum radiological characteristics for radioactive stents in the prevention of restenosis following angioplasty. The project investigated methods to activate coronary stents with radionuclides that spanned a range of energies and radiation types that could provide a mapping of the biological response. The project also provided calibration methods to determine the strength of the stents, an a process to calculate the dose distribution actually delivered to the patient's artery--quantities necessary for any future scientific study to improve the effectiveness of radioactive stents. Such studies could benefit the thousands of patients who receive angioplasty each year.

  5. Which criteria demand additive stenting during catheter-directed thrombolysis?

    Science.gov (United States)

    Bækgaard, N; Just, S; Foegh, P

    2014-05-19

    Many factors are necessary for obtaining satisfactory results after catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT). Selections of patients, composition of the thrombolytic fluid, anticoagulation per- and post-procedural, recognition and treatment of persistent obstructive lesions of the iliac veins are the most important contributors. Stenting has been known for 15 to 20 years. The first publication on CDT in 1991 was combined with ballooning the iliac vein, an additive procedure which has been abandoned as an isolated procedure. This chapter will discuss selection, indication, such as an iliac compression syndrome, and outcome of iliac stenting in combination with CDT. The reported frequency of stenting used after CDT is very inconsistent, therefore this will be discussed in details. It is concluded that selection for stenting is of the greatest importance, when CDT is used for iliofemoral DVT, but strict criteria for stenting are not available in the existing literature. The potential value of intravascular ultrasound (IVUS) is also discussed. PMID:24843096

  6. Clinical observation on coronary heart disease treated with carbon stent

    International Nuclear Information System (INIS)

    Objective: To discuss the security of carbon stent in the percutaneous coronary intervention, especially the effectiveness of preventing thrombus formation in the carbo stent and effect on reducing the rate of restenosis. Methods: 10 cases with coronary heart disease. 6 cases suffered from acute myocardial infarction (AMI), including 2 on the anterior wall, 4 on the inferior and 4 with unstable angina pectoris. 8 cases were undergone emergent direct PCI and other 2 with rescue PCI. There were 12 diseased blood vessels and 13 lesions of pathologic changes. The ratio of the diameter of selective stent and target blood vessel was 1.0-1.1:1. The authors began to expend the diseased vascular lumen with the lower pressure and gradually increased the pressure to obtain only 5% of the original narrowing. Results: The authors used 13 carbo stents. After the procedure, all of diseased blood vessles reached forward TIMI III grade of blood flow. Anticoagulants were carried on continuously after the procedure. The follow-up survey continued for 2-18 months (average 10.3±6.33 months) without any cardiovascular events. Conclusion: Carbo stent covered with a layer of carbofilm separates the metal from contact with blood and tissues, and thus reduced the rate of acute thrombus formation and the re-narrowing rate. The exact therapeutic effect is still in need of further research and observation. (authors)

  7. Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Li Youxiang; Jiang Chuhan; Yang Xinjian [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, 100050 Hebei, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.com [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, 100050 Hebei, Beijing (China)

    2011-08-15

    Objective: The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms. Methods: Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale. Results: Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose. Conclusion: The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.

  8. Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms

    International Nuclear Information System (INIS)

    Objective: The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms. Methods: Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale. Results: Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose. Conclusion: The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.

  9. A randomized, prospective, two-center comparison of sirolimus-eluting stent and zotarolimus-eluting stent in acute ST-elevation myocardial infarction: The SEZE trial

    Institute of Scientific and Technical Information of China (English)

    Woo-Young Chung; Sang-Hyun Kim; In-Ho Chae; Joo-Hee Zo; Myung-A Kim; Dong-Ju Choi; Jeehoon Kang; Young-Seok Cho; Hae-Jun Park; Han-Mo Yang; Jae-Bin Seo; Jung-Won Suh; Kwang-Il Kim; Tae-Jin Youn

    2012-01-01

    Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies.However,this has not been thoroughly evaluated in ST elevation myocardial infarction.Methods This was a prospective,randomized,controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction,treated with zotarolimus-eluting stents or sirolimus-eluting stents.From March 2007 to February 2009,122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion.The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography,and secondary endpoints were percent diameter stenosis,binary restenosis rate,major adverse cardiac events (a composite of cardiac death,non-fatal myocardial infarction,and target vessel revascularization),and late-acquired incomplete stent apposition.Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs.(0.10±0.46) mm,P=0.001).Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)% vs.(17.6±14.0)%,P <0.001).In-segment analysis showed similar findings.There were no significant differences in binary restenosis rate,major adverse cardiac events,and late-acquired incomplete stent apposition.Conclusions Compared to sirolimus-eluting stents,the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction.Although there was no significant difference in 1-year clinical outcomes,the clinical implication of increased late lumen loss should be further studied.

  10. Limited Role for Biliary Stent as Surrogate Fiducial Marker in Pancreatic Cancer: Stent and Intratumoral Fiducials Compared

    Energy Technology Data Exchange (ETDEWEB)

    Horst, Astrid van der, E-mail: a.vanderhorst@amc.uva.nl [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Lens, Eelco; Wognum, Silvia; Jong, Rianne de [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Hooft, Jeanin E. van [Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Tienhoven, Geertjan van; Bel, Arjan [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2014-07-01

    Purpose: Because of low soft-tissue contrast of cone beam computed tomography (CBCT), fiducial markers are often used for radiation therapy patient setup verification. For pancreatic cancer patients, biliary stents have been suggested as surrogate fiducials. Using intratumoral fiducials as standard for tumor position, this study aims to quantify the suitability of biliary stents for measuring interfractional and respiratory-induced position variations of pancreatic tumors. Methods and Materials: Eleven pancreatic cancer patients with intratumoral fiducials and a biliary stent were included in this study. Daily CBCT scans (243 in total) were registered with a reference CT scan, based on bony anatomy, on fiducial markers, and on the biliary stent, respectively. We analyzed the differences in tumor position (ie, markers center-of-mass position) among these 3 registrations. In addition, we measured for 9 patients the magnitude of respiratory-induced motion (MM) of the markers and of the stent on 4-dimensional CT (4DCT) and determined the difference between these 2 magnitudes (ΔMM). Results: The stent indicated tumor position better than bony anatomy in 67% of fractions; the absolute difference between the markers and stent registration was >5 mm in 46% of fractions and >10 mm in 20% of fractions. Large PTV margins (superior-inferior direction, >19 mm) would be needed to account for this interfractional position variability. On 4DCT, we found in superior-inferior direction a mean ΔMM of 0.5 mm (range, –2.6 to 4.2 mm). Conclusions: For respiratory-induced motion, the mean ΔMM is small, but for individual patients the absolute difference can be >4 mm. For interfractional position variations, a stent is, on average, a better surrogate fiducial than bony anatomy, but large PTV margins would still be required. Therefore, intratumoral fiducials are recommended for online setup verification for all pancreatic patients scheduled for radiation therapy, including

  11. Limited Role for Biliary Stent as Surrogate Fiducial Marker in Pancreatic Cancer: Stent and Intratumoral Fiducials Compared

    International Nuclear Information System (INIS)

    Purpose: Because of low soft-tissue contrast of cone beam computed tomography (CBCT), fiducial markers are often used for radiation therapy patient setup verification. For pancreatic cancer patients, biliary stents have been suggested as surrogate fiducials. Using intratumoral fiducials as standard for tumor position, this study aims to quantify the suitability of biliary stents for measuring interfractional and respiratory-induced position variations of pancreatic tumors. Methods and Materials: Eleven pancreatic cancer patients with intratumoral fiducials and a biliary stent were included in this study. Daily CBCT scans (243 in total) were registered with a reference CT scan, based on bony anatomy, on fiducial markers, and on the biliary stent, respectively. We analyzed the differences in tumor position (ie, markers center-of-mass position) among these 3 registrations. In addition, we measured for 9 patients the magnitude of respiratory-induced motion (MM) of the markers and of the stent on 4-dimensional CT (4DCT) and determined the difference between these 2 magnitudes (ΔMM). Results: The stent indicated tumor position better than bony anatomy in 67% of fractions; the absolute difference between the markers and stent registration was >5 mm in 46% of fractions and >10 mm in 20% of fractions. Large PTV margins (superior-inferior direction, >19 mm) would be needed to account for this interfractional position variability. On 4DCT, we found in superior-inferior direction a mean ΔMM of 0.5 mm (range, –2.6 to 4.2 mm). Conclusions: For respiratory-induced motion, the mean ΔMM is small, but for individual patients the absolute difference can be >4 mm. For interfractional position variations, a stent is, on average, a better surrogate fiducial than bony anatomy, but large PTV margins would still be required. Therefore, intratumoral fiducials are recommended for online setup verification for all pancreatic patients scheduled for radiation therapy, including

  12. con marcos extradensos

    Directory of Open Access Journals (Sweden)

    Manuel Rodríguez

    2007-01-01

    Full Text Available El cultivo del plátano vianda al igual que el de la papaya, en la región occidental del país, son fuertemente atacados por enfermedades que hacen que las plantaciones, por el grado de deterioro que estas les producen, no duren más de un ciclo de cultivo. Sembrar una misma área, un año tras de otro con el mismo cultivo, trae consigo el establecimiento en el suelo de elementos parásitos dañinos al mismo, que pueden ser eliminados o atenuados con una rotación con otro cultivo. El presente trabajo expone los resultados experimentales de dos años de trabajo de la rotación de estos cultivos, plantados con dos marcos de plantación de alta densidad, 2 x 4 x 1 m y 3 x 1 m, con una densidad de 3333 plantas/ha y regados con la técnica de riego por goteo. Se obtuvieron rendimientos de 40,73 t/ha en plátano y de 71,42 t/ha en papaya, con una relación beneficio costo de 1,15, tasa interna de retorno de 36,27 %, valor actual neto de 21,47 y plazo de recuperación de la inversión de 3,01 años.

  13. To Stent or Not to Stent? Update on Revascularization for Atherosclerotic Renovascular Disease.

    Science.gov (United States)

    Noory, Elias; Sritharan, Kaji; Zeller, Thomas

    2016-06-01

    Renal artery stenosis (RAS) is increasingly encountered in clinical practice. The two most common etiologies are fibromuscular dysplasia (FMD) and atherosclerotic renal artery disease (ARAS), with the latter accounting for the vast majority of cases. Significant RAS activates the renin-angiotensin-aldosterone system and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. Over the past two decades, advancements in diagnostic and interventional techniques have led to improved detection and the widespread use of endovascular renal artery revascularization strategies in the management of ARAS. However, renal artery stenting for ARAS remains controversial. Although several studies have demonstrated some benefit with renal artery revascularization, this has not been to the extent anticipated or predicted. Moreover, these trials have significant flaws in their study design and are hampered with inherent bias which make their interpretation challenging. In this review, we evaluate the existing body of evidence and offer an approach to the management of patients with ARAS in light of the current literature. From the data provided, identification of subgroup of patients, namely, those with a hemodynamically significant RAS in the context of progressive renal insufficiency and/or deteriorating arterial hypertension, seems possible and may derive clinical benefit from ARAS stent revascularization. Appropriate patient selection is therefore the key and more robust studies are required. PMID:27130448

  14. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

    International Nuclear Information System (INIS)

    We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

  15. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon; Beak, Jung Hwan; Oh, Yeon Mok; Ha, Eun Ju; Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2013-10-15

    We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

  16. The Evolution and Current Utility of Esophageal Stent Placement for the Treatment of Acute Esophageal Perforation.

    Science.gov (United States)

    Herrera, Argenis; Freeman, Richard K

    2016-08-01

    Esophageal stent placement was used primarily for the treatment of malignant strictures until the development of a new generation of biomaterials allowed the production of easily removable, occlusive stents in 2001. Since then, thoracic surgeons have gained experience using esophageal stents for the treatment of acute esophageal perforation. As part of a hybrid treatment strategy, including surgical drainage of infected spaces, enteral nutrition, and aggressive supportive care, esophageal stent placement has produced results that can exceed those of traditional surgical repair. This review summarizes the evolution of esophageal stent use for acute perforation and provides evidence-based recommendations for the technique. PMID:27427525

  17. Treatment of cuff-related tracheal stenosis with a fully covered retrievable expandable metallic stent

    International Nuclear Information System (INIS)

    Aim: To investigate the clinical effectiveness, complications, and optimal duration of use of covered retrievable expandable metallic stents in the management of cuff-related tracheal stenosis. Materials and methods: Twenty-one patients with cuff-related tracheal stenosis, Meyer–Cotton grade II (29%) and III (71%), who underwent fluoroscopically guided placement of covered retrievable expandable metallic stents were studied. Sixty-four-section computed tomography (CT) and bronchovideoscopy were performed prior to stent insertion, 1 month after stent insertion, in the case of stent-related complications, and after stent removal. Clinical manifestations, Hugh–Jones classification, and forced expiratory volume in 1 s (FEV1) were used to evaluate respiratory function before and after stent insertion and removal. The diameter of the stricture and FEV1 changes before insertion and after removal were analysed using the paired samples t-test. A p-value of ≤0.05 was considered statistically significant. Results: Twenty-one patients had 27 covered retrievable expandable metallic stents placed. Stents were electively removed from 20 patients. The median duration of stent placement was 5 months (range 4–12 months). One stent was not removed due to mucopolysaccharidosis type II (MPS II or Hunter syndrome) with tracheomalacia. After stent removal, airway dimensions increased and airway occlusion was symptomatically relieved in all patients. CT and bronchovideoscopy showed patent lumens with increased dimensions. Stent-related complications occurred in 19 (91%) patients, including granulation tissue formation (n = 18, 86%), stent migration and stent expectoration (n = 2, 10%), mucus plugging (n = 1, 5%), and halitosis (n = 6, 29%). Some patients experienced multiple complications, which were all managed effectively while the stent was still in place. There was a statistically significant difference in the diameter of the stricture and FEV1 between the time of stent

  18. Randomised comparison of coronary stenting with and without balloon predilatation in selected patients

    OpenAIRE

    Le Breton, H; Boschat, J; Commeau, P; Brunel, P.; Gilard, M; Breut, C; Bar, O.; Geslin, P; Tirouvanziam, A; Maillard, L.; Moquet, B; Barragan, P.; Dupouy, P.; Grollier, G; Berland, J.

    2001-01-01

    BACKGROUND—The SWIBAP (stent without balloon predilatation) prospective randomised trial was designed to compare direct coronary stenting with stenting preceded by lesion predilatation with an angioplasty balloon.
OBJECTIVE—To determine the feasibility and safety of direct stenting in non-complex coronary lesions in a prospective study.
PATIENTS AND DESIGN—All patients  3.0 mm, who granted their informed consent, were randomised into the trial. In group I, the stent was placed without balloon...

  19. Treatment of abdominal aortic and peripheral aneurysms with stent grafts

    International Nuclear Information System (INIS)

    The implantation of stent grafts is a relatively new method for the treatment of aneurysms of the aorta or peripheral aneurysms. Before the implantation precise measurements are mandatory to obtain the necessary information about the aneurysm. The numerous contraindications must be observed strictly to successfully exclude the aneurysmal sac. The stent graft is inserted via a percutaneous puncture or, in the case of an aortic graft, through a surgical arteriotomy. After the implantation rigorous follow-up is mandatory to detect complications such as leaks or thrombi: Spiral CT angiography is the method of choice. Some of the complications require secondary interventions such as the implantation of additional stent grafts. The results are encouraging, with a secondary exclusion rate of the aneurysm of up to more than 95%; however, long-term results are not available. (orig.)

  20. Forgotten long-term indwelling double "J" stent

    Directory of Open Access Journals (Sweden)

    Bhushan Wani

    2012-01-01

    Full Text Available A poor, uneducated patient from a rural background presented to us with burning micturition and colicky pain in the loin. He had undergone surgery for pelvi-ureteric junction (PUJ obstruction on the right side four years earlier. Following surgery, the patient was irregular in his follow-up and, as such, he did not get the double "J" (DJ stent, which was placed during surgery, removed. Ultrasonography performed during the present admission revealed mild hydronephrosis of the right kidney with a tiny calculus in the urinary bladder. Intravenous urography revealed mild hydronephrosis with the DJ stent in situ in the right kidney. After an unsuccessful attempt with cystoscopy, the stent was removed successfully by suprapubic cystostomy. The post-operative course was uneventful and the patient was discharged in seven days.