Additional Stent Research Articles

416 Redefining Treatment Expectations: Exploring Long-Term Outcomes of Venous Sinus Stenting in Idiopathic Intracranial Hypertension

INTRODUCTION: Idiopathic intracranial hypertension (IIH) is a condition characterized by various symptoms such as pulsatile tinnitus, chronic headaches, and papilledema. Venous sinus stenosis has been associated with IIH, and venous sinus stenting (VSS) has emerged as a potential treatment option. However, there is a lack of standardized outcome definitions and limited long-term data on the effectiveness of VSS in current literature. METHODS: In this study, we analyzed the long-term outcomes of 178 patients with medically-refractory IIH who underwent VSS by the senior author. Demographic information, pressure gradients, symptom improvement, recurrence, and persistence were recorded. Quality of life and symptom severity scores were assessed using standardized HIT-6, WHO-BREF, and pulsatile tinnitus surveys. Follow-up duration and patient-reported outcomes were also considered. RESULTS: Among the VSS cohort, 52.8% reported initial symptom relief followed by recurrence, and 13.5% experienced persistent symptoms without improvement. Overall failure rate of VSS was found to be 66.3%. Repeat procedures, such as lumbar puncture or additional stenting occurred in many patients. Survey data showed varying degrees of improvement in symptom severity and quality of life, and these changes were found to be statistically insignificant long-term. CONCLUSIONS: Our study challenges the prevailing notion of favorable outcomes in VSS suggests a need for reevaluation of the procedure as a long-term treatment option for severe IIH. High rates of symptom recurrence, persistence, and the need for repeat interventions indicate limitations in the efficacy of VSS. Improved understanding of the underlying factors contributing to poor outcomes and the development of alternative interventions are essential for better management of this debilitating condition.

Novel technique of additional anchor plastic stent placement during endoscopic ultrasound-guided gallbladder drainage.

Novel technique of additional anchor plastic stent placement during endoscopic ultrasound-guided gallbladder drainage.

Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis

BackgroundAcute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities.MethodsPatients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected.Results176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome.ConclusionIn our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.

Role of intravascular ultrasound for the technical assessment of endovascular reconstruction of the aortic bifurcation

ObjectiveThe aim of this study was to evaluate the role of intravascular ultrasound (IVUS) for the technical assessment of kissing stents (KSs) and covered endovascular reconstruction of the aortic bifurcation (CERAB) in the treatment of aortoiliac obstructive disease involving the aortic bifurcation. MethodsWe conducted a single-center retrospective review of patients undergoing endovascular treatment of severe aorto-iliac obstructive disease (2019-2023). IVUS was performed in patients treated by KSs or CERAB according to preoperative indications, in cases of moderate/severe calcifications, mural thrombus, total occlusions, and lesion extension towards the proximity of renal or hypogastric arteries. Indications for IVUS-guided intraoperative revisions were residual stenosis or compression >30%, incomplete stent-to-wall apposition, or flow-limiting dissection at the landing site. Follow-up assessment was performed at 6 and 12 months, and then yearly. Thirty-day outcomes and 2-year patency rates were evaluated. Logistic regression was used to identify factors associated with significant technical defects detected by IVUS needing intraoperative revision. ResultsIVUS was used for the technical assessment of 102 patients treated by KSs (n = 57; 56%) or CERAB (n = 45; 44%) presenting with severe intermittent claudication (39%), rest pain (39%), or ischemic tissue loss (25%). Twenty-nine significant technical defects were identified by IVUS in 25 patients (25%) who then had successful intraoperative correction by additional ballooning (n = 23; 80%) or stenting (n = 6; 20%). Patients with a severely calcified chronic total occlusion (odds ratio, 1.85; 95% confidence interval, 1.01-5.27; P = .044) or severely calcified narrow aortic bifurcation with <12 mm diameter (odds ratio, 2.34; 95% confidence interval, 1.10-8.64; P = .032) were at increased risk for IVUS-guided intraoperative revision. There were no postoperative deaths and no major adverse events. Two-year primary patency was 100%. ConclusionsIVUS was used for the technical assessment of KSs/CERAB in a selected cohort of patients with severe aorto-iliac obstructive disease. This allowed the identification and intraoperative correction of a significant technical defect not detected by completion angiogram in one-quarter of patients, achieving optimal 2-year results. IVUS assessment of KSs/CERAB may be considered especially in patients with a calcified total occlusion or narrow aortic bifurcation.

Technical considerations and long-term results of endovascular venous stenting to control venous hypertension from meningiomas invading intracranial venous sinuses.

Meningiomas invading the intracranial venous sinuses may cause intracranial venous hypertension, papilledema, and visual compromise. Sinus resection and graft reconstructions, however, add significant complexity to tumor surgery, with the potential for increased morbidity. In this study, the authors explored whether venous sinus stenting might provide an alternative means of controlling venous hypertension that would be sustainable over the long term. The authors performed a retrospective review of all 16 patients with intracranial meningiomas who underwent stenting at their institution for venous sinus compromise. At presentation, all had headache and 9 had papilledema. Thirteen patients had 1 meningioma and 3 had 2 or more. Three patients had had previous tumor resection and radiotherapy. One patient had been treated with a lumboperitoneal shunt and radiotherapy. The median length of clinical follow-up was 8 years (range 4 months-18 years). Venous sinus narrowing was often not confined to the site of meningioma, and bilateral transverse sinus narrowing, reminiscent of that seen in idiopathic intracranial hypertension, was present in 7 patients with sagittal sinus meningiomas. Eleven patients had stents placed solely across sinus narrowing caused by meningioma. Five patients had additional stents placed at other sites of venous narrowing at the same time: in one of these patients, a stent was placed across a defect in the sagittal sinus caused by previous surgery, and in the 4 other patients, stents were placed across nontumor narrowings of the transverse sinuses. In 1 patient, the jugular vein was also stented. Nine patients developed symptomatic in-stent restenosis at the meningioma site. Eight had further stenting procedures with variable success in restoring the in-stent lumen. The remaining patient, with a late partial relapse, is being reinvestigated. Papilledema resolved in all patients after stenting. Six patients experienced prolonged and very substantial relief of all symptoms. Five patients had persistent headache despite restoration of the sinus lumen. Five had persistent symptoms associated with resistant in-stent stenosis. There were no significant complications from any of the diagnostic or therapeutic procedures. In patients who are symptomatic with meningiomas obstructing the venous sinuses, successful stenting of the affected segment can give a good outcome, especially in terms of relieving papilledema. However, further procedures are often necessary to maintain stent patency, other areas of venous compromise frequently coexist, and some patients remain symptomatic despite apparently successful treatment of the index lesion. Long-term surveillance is a requirement.

Optical coherence tomography findings of balloon angioplasty/stenting for in-stent restenosis after carotid artery stenting.

The optimal therapeutic methods for in-stent restenosis (ISR) after carotid artery stenting (CAS) remains controversial. This study aimed to use optical coherence tomography (OCT) to evaluate the in-stent architectures during endovascular angioplasty/stenting for ISR. Six lesions of ISR after CAS were evaluated by OCT during endovascular angioplasty/stenting. In one lesion, the OCT system could not be crossed because of elongation distal to the ISR lesion. In five lesions, pre-procedural OCT clearly revealed neointimal hyperplasia or neoatherosclerosis. The mean in-stent area stenosis was 84%. After regular balloon angioplasty, tissue compression and dissection of various sizes and layers were detected. After balloon angioplasty (with a mean balloon size of 5.4 mm), the minimum lumen area (from 1.7 ± 0.6 to 11.4 ± 5.3 mm2, p < 0.01) and the minimum in-stent area (12.7 ± 2.6 to 21.8 ± 5.0 mm2, p < 0.01) showed a significant increase. Additional stent was placed in one lesion that developed into a flap by dissection after balloon angioplasty. In another lesion in which sufficient dilatation was not achieved by balloon angioplasty, a major stroke occurred by acute occlusion of the ISR lesion 10 months later. OCT can detect the in-stent architecture of ISR lesions after balloon angioplasty and additional stent placement. However, which dissection should be treated by additional stent remain problematic.

Cutting Balloon Angioplasty for Severe In-Stent Restenosis after Carotid Artery Stenting: Long-Term Outcomes and Review of Literature.

Cutting balloon-percutaneous transluminal angioplasty (CB-PTA) is a feasible treatment option for in-stent restenosis (ISR) after carotid artery stenting (CAS). However, the longterm durability and safety of CB-PTA for ISR after CAS have not been well established. We retrospectively reviewed medical records of patients with ISR after CAS who had been treated with CB-PTA from 2012 to 2021 in our center. Detailed information of baseline characteristics, periprocedural and long-term outcomes, and follow-up imaging was collected. During 2012-2021, a total of 301 patients underwent CAS. Of which, CB-PTA was performed on 20 lesions exhibiting severe ISR in 18 patients following CAS. No patient had any history of receiving carotid endarterectomy or radiation therapy. These lesions were located at the cervical segment of the internal carotid artery (n=16), proximal external carotid artery (n=1), and distal common carotid artery (n=1). The median time interval between initial CAS and detection of ISR was 390 days (interquartile range 324-666 days). The follow-up period ranged from 9 months to 9 years with a median value of 21 months. Four patients (22.2%) were symptomatic. The average of stenotic degree before and after the procedure was 79.2% and 34.7%, respectively. Out of the 18 patients receiving CB-PTA, 16 (88.9%) did not require additional stenting, and 16 (88.9%) did not experience recurrent ISR during the follow-up period. Two patients who experienced recurrent ISR were successfully treated with CB-PTA and additional stenting. No periprocedural complication was observed in any case. Regarding favorable periprocedural and long-term outcomes in our single-center experience, CB-PTA was a feasible and safe option for the treatment of severe ISR after CAS.

Nonspecific Presentation of an Infected Aorto-Iliac Artery Stent Following Endovascular Revision and Stent Insertion.

Over the last few decades, the use of covered stent grafts became increasingly popular; as it plays a pivotal role in the management of various atherosclerotic diseases that are rising in both incidence and prevalence. Subsequently, vascular stent infections, although rare, are becoming a well-recognized complication with possibly devastating consequences, owing to the difficulties associated with its diagnosis and treatment. This has prompted significant interest in the condition regarding its pathophysiology, modifiable and non-modifiable risk factors, diagnostic and therapeutic approaches, and the possible implementation of prophylactic measures. We herein present a case of a patient with an infected aortoiliac stent 4weeks after endovascular revision with atherectomy and additional stent insertion. The patient initially developed nonspecific symptoms and later developed a life-threatening hemorrhage, which was urgently controlled using a percutaneously inserted covered stent at the infected site. Definitive treatment using extraanatomical bypass implantation and an explantation of the infected stents was performed with excellent clinical response.

Combined stent retriever angioplasty and continuous intra-arterial nimodipine infusion as salvage therapy for cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage: illustrative case.

Delayed cerebral ischemia (DCI) and cerebral vasospasm (CV) are severe complications of spontaneous subarachnoid hemorrhage (SAH) contributing to an inferior outcome. Rescue therapies include intra-arterial balloon angioplasty and repetitive and finally continuous intra-arterial nimodipine infusion. In the presented case, a young female patient with fulminant refractory DCI and CV, despite induced hypertension and nimodipine application, was treated with three-vessel continuous intra-arterial infusion and additional repetitive angioplasty of the basilar and middle cerebral arteries using a stent retriever, leading to a good clinical outcome. Additional stent retriever dilatation to continuous intra-arterial nimodipine application in three vessel territories may represent a further escalation step in the rescue therapy for severe CV and DCI after SAH. Montreal Cognitive Assessment and SF-36 testing showed satisfactory results 3 months after initial treatment with intra-arterial nimodipine catheters in three vessel territory circulations and additional stent retriever vasodilation of severe CV. We report a unique rescue strategy involving implantation of an additional intra-arterial catheter into the vertebral artery and repetitive stent retriever dilatations of the middle cerebral and basilar arteries as an extra therapy for continuous intra-arterial nimodipine vaspospasmolytic therapy in three vessel territories, resulting in a very good clinical outcome.

Delayed Migration of Tapered Open-Cell Design Carotid Stent: A Case Report.

We present a case of delayed migration of an open-cell design carotid stent, which is a rare complication following carotid artery stenting (CAS). A 65-year-old patient with carotid artery stenosis underwent CAS with an open-cell stent, initially achieving successful deployment. However, 4 months later, the stent migrated and resulted in restenosis. The patient underwent balloon angioplasty and received an additional stent, leading to improved blood flow. The rarity of stent migration, particularly in the absence of risk factors, highlights the need for clinicians to be vigilant and consider early imaging follow-up for patients at risk of this complication after CAS.

Rare Case of Chronic Limb-Threatening Ischemia in a 32-Year-Old Patient with Nephrotic Syndrome: A Case Report

AbstractChronic limb-threatening ischemia represents the end stage of peripheral artery disease (PAD), primarily affecting individuals over 60 years old. While quite rare, nephrotic syndrome (NS) is recognized for increasing the susceptibility to arterial thromboembolism (ATE). A 32-year-old male complained of resting pain in his left leg and pain after walking 50 meters with his right leg. He had a 9-year history of NS confirmed through biopsy and was on a daily regimen of 2 × 360 mg mycophenolic acid and 1 × 8 mg methylprednisolone. He had no history of hypertension, diabetes, or smoking. Atrophy and ulcers were observed on his left leg. Laboratory tests revealed elevated D-dimer and borderline high cholesterol levels. The right ankle-brachial index was 0.5, and for the left, it was 0.33. Computed tomography angiography identified occlusion in the left external iliac artery and right superficial femoral artery (SFA). The patient underwent percutaneous transluminal angioplasty with a plain balloon on both legs and an additional drug-eluting stent on the left SFA. He was discharged on rivaroxaban, clopidogrel, aspirin, simvastatin, mycophenolic acid, and methylprednisolone, with no complaints. The mechanism behind NS-caused ATE remains unclear, although it is associated with the loss of anticoagulants in urine, increased procoagulant activity, altered fibrinolytic systems, thrombocytosis, and enhanced platelet activation. Prolonged corticosteroid therapy in NS management also amplifies the risk of thromboembolism by promoting a hypercoagulable state. We suspected NS and the prolonged use of corticosteroids as risk factors for ATE, manifested as PAD in our patient. While optimal NS therapy may reduce the risk of PAD, prolonged corticosteroid use should be closely monitored.

Early stent fractures in superficial femoral artery resulting multiple pseudoaneurysm formation within one year: a case report

BackgroundThough fracture is known complication of stenting, pseudoaneurysm asscoiated with stent fracture is an extremely rare complication. This has previoulsy been described to occur at least one or more years following initial stent placement. Here we present a case of multi-site stent fracture leading to two separate SFA pseudoaneurysms within one year of placement, successfully treated with covered stents.Case presentationA 72-year-old male presented with severe claudication of his left lower extremity (Rutherford 3), found to have long segment SFA chronic total occlusion (CTO). Patient successfully underwent endovascular revascularization. Follow-up duplex ultrasound (US) at one year demonstrated a focus of severe in-stent restenosis (ISR). During repeat angiogram for treatment of the stenosis, stent fracture and pseudoaneurysm was seen in the distal SFA, which was treated successfully with a self-expanding covered stent. Additional stent fractures and pseudoanerusyms were subseuqently identified on follow-up, necessitating a third angiogram, and these were successfully repaired using overlapping covered stents, without further recurrence.ConclusionsSuperficial femoral artery stent fractures leading to pseudoaneurysms are extremely rare, particularly within first year of stent placement. Endovascular repair with covered stents has proven to be an effective treatment option with decreased procedural morbidity compared to surgical repair.

Early results of endovascular treatment using percutaneous vacuum-assisted thromboaspiration in acute lower limb ischemia

Introduction. Open balloon thrombectomy and embolectomy remain the preferred initial option in the management of acute lower limb ischemia (ALI), but various endovascular techniques have become accessible and are growing in popularity. The aim of the study was to assess our early experience with percutaneous vacuum-assisted thromboaspiration using the Penumbra/Indigo® system for non-traumatic ALI. Material and methods. The study group comprised 13 patients with ALI who received treatment between September 2022 and June 2023; with 7 (53.8%) being males. The median age was 71 years (25%-75%IQR 62.5-77.5). ALI cases were classified according to the Rutherford scale: grade I – 2 (15.3%), grade IIA – 7 (53.8%), and grade IIB – 4 (30.7%). In 10 (76.9%) cases, ischemia was classified as “acute-on-chronic.” The occluded native vascular segment, determined through preoperative computer tomography angiography (n=4; 30.7%), duplex scanning (n=5; 38.4%), or both examinations (n=4; 30.7%), were as follows: superficial femoral artery (n=7) and popliteal artery (n=2). In two patients, thrombosis of the below-knee femoropopliteal bypass with autogenous vein was identified, while two others presented with femoral artery stent thrombosis. An embolic etiology of ALI was observed in 4 (30.7%) cases, and thrombotic etiology in 9 (69.2%) cases. Endovascular access was established via the ipsilateral common femoral artery (n=10), crossover (n=2), or brachial artery (n=1). Thromboaspiration was carried out using dedicated CAT6™ and CAT8™ catheters. Results. The technical success rate of vacuum-assisted thromboaspiration was 92.3%. Subsequent angiography revealed accompanying occlusive-stenotic lesions in all instances, necessitating transluminal angioplasty, and in 8 (61.5%) patients, additional stenting was required. Catheter-directed thrombolysis was utilized as an adjunct in one patient. There were 2 (15.3%) instances of distal embolization, both addressed within the same surgical session. Survival and limb salvage rates at the 30th-day follow-up stood at 100%. Conclusions. Utilizing the Penumbra/Indigo® system, percutaneous vacuum-assisted thromboaspiration appears to be a safe and effective minimally invasive technique for treating ALI. This method allows for the concurrent correction of coexisting chronic peripheral arterial lesions.

Clinical outcomes of a dedicated bifurcation stent system

IntroductionPercutaneous coronary intervention (PCI) of bifurcation lesions is technically challenging and associated with higher rates of complications such as stent thrombosis or in-stent restenosis. In this paper, we present the clinical outcomes of BiOSS LIM C (Balton, Poland), a dedicated bifurcation stent. MethodsIn this retrospective single-center study we analyzed the outcome of patients with bifurcation coronary artery disease treated with the BiOSS LIM C stent system. The primary endpoint was the cumulative rate of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI) and target lesion revascularisation (TLR) at the longest available follow-up. ResultsThe study population consisted of 25 patients (mean age 73.6 ± 9.7 years, 25 % females). In 80 % of the cases (n = 20) BiOSS LIM C stent was implanted in the left main coronary artery. Intravascular imaging was used in 70 % of the cases and an additional regular drug-eluting stent (DES) was deployed in the side branch in 24 % of the cases. The device success rate was 100 % and we observed no in-hospital adverse events. At a median follow-up of 15 ± 6 months, the MACE rate was 56 %, cardiac death was 4 %, and clinically driven TLR was 55 %. One patient died in the LM subgroup, 5 months after the index PCI, due to NSTEMI complicated by cardiogenic shock. Two patients died due to non-cardiac causes. ConclusionsIn this consecutive series of patients treated with BiOSS LIM C in major coronary bifurcation lesions, mostly in the left main stem, the mid-term clinical outcomes demonstrated a high incidence of major adverse events, mainly caused by TLR, despite an adequate implantation technique.

Safety and feasibility of intravascular ultrasound-guided robotic percutaneous coronary intervention.

Previous studies have demonstrated the benefit of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for preventing longitudinal geographic miss (LGM). However, it is yet unclear whether IVUS guidance is useful for robotic-PCI (robotic-assisted perctaneous coronary intervention [R-PCI]). A total of 58 consecutive patients with stable angina who underwent IVUS-guided R-PCI were enrolled. The stent landing position was angiographically marked using a balloon marker before stenting, followed by measurements of the expected stent length using balloon pullback. Subsequently, prestenting IVUS was performed to determine stent landing. All pre-PCI IVUS images were assessed for lesion length and percent plaque volume (%PV) using both IVUS and angiographic marking. LGM was defined as a residual %PV >50% at either the distal or proximal stent edge, any stent edge dissection, or additional stent deployment immediately after stenting. The included patients had an average age of 67.1 ± 10.1 years. IVUS guidance had significantly longer lesion lengths compared with angiographic marking. Based on IVUS-guided stent deployment, nine cases exhibited LGM immediately after stenting. IVUS-marked landing points had a significantly smaller %PV and significantly larger lumen area compared with those for angiography. IVUS-guided R-PCI was well-tolerated and may be better at preventing LGM compared with angiography-guided R-PCI.

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results.

We aimed to characterize the performance and safety of percutaneous coronary intervention (PCI) in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients at a 4-year follow up. We included all consecutive patients who underwent PCI with the sirolimus-eluting coronary stent Alex Plus (Balton, Poland) between July 2015 and March 2016. We analyzed various baseline demographic and clinical characteristics, laboratory data, and clinical outcomes. We enrolled 232 patients in whom 282 stents were implanted, including 81 patients meeting the CHIP criteria and 76 patients meeting the HBR criteria. In the whole population, the mean age was 68 ± 11 years, and 23.7% were females. Most procedures were performed from radial access (83.2%) using a 6F guiding catheter (95.7%). The lesions were mostly predilated (61.6%), and postdilatation was performed in 37.9%. The device success was 99.6% (in one case, a second stent was required due to heavy calcifications). Additional stents were deployed in 39% of cases due to edge dissection (6.9%), side branch stenting (5.2%), or diffuse disease (26.9%). Myocardial infarction (MI) type 4a was revealed in 2.2% of cases. At 4 years, the MACE rates for the whole population and for CHIP and HBR patients were 23.3%, 29.6%, and 27.6%, respectively. CHIP patients had a higher risk of MACEs (29.6% vs. 19.9%, HR 1.69, p = 0.032) and cardiac death (11.1% vs. 4.6%, HR 2.50, p = 0.048). There were no differences for MI (7.4% vs. 6.6%, p = 0.826) and TLR (18.5% vs. 12.6%, p = 0.150). HBR patients were also characterized by a higher risk of MACEs (27.6% vs. 21.2%, HR 1.84, p = 0.049) and cardiac death (17.1% vs. 1.9%, HR 9.61, p < 0.001). There were no differences for MI (7.9% vs. 6.4%, p = 0.669) and TLR (11.8% vs. 16.0%, p = 0.991). PCI in CHIP and HBR patients is feasible with a low rate of periprocedural complications. Nevertheless, CHIP and HBR patients are at a high risk of future adverse events and require strict surveillance to improve outcomes.

Percutaneous insertion of long-covered biliary stents in patients with malignant duodenobiliary stricture.

To investigate the technical feasibility, safety, and efficacy of a long-covered biliary stent in patients with malignant duodenobiliary stricture. This retrospective study enrolled 57 consecutive patients (34 men, 23 women; mean age, 64years; range, 32-85years) who presented with malignant duodenobiliary stricture between February 2019 and November 2020. All patients were treated with a long (18 or 23cm)-covered biliary stent. The biliary stent deployment was technically successful in all 57 patients. The overall adverse event rate was 17.5% (10 of 57 patients). Successful internal drainage was achieved in 55 (96.5%) of 57 patients. The median patient survival and stent patency times were 99days (95% confidence interval [CI], 58-140days) and 73days (95% CI, 60-86days), respectively. Fourteen (25.5%) of the fifty-five patients presented with biliary stent dysfunction due to sludge (n = 11), tumor overgrowth (n = 1), collapse of the long biliary stent by a subsequently inserted additional duodenal stent (n = 1), or rapidly progressed duodenal cancer (n = 1). A univariate Cox proportional hazards model did not reveal any independent predictor of biliary stent patency. Percutaneous insertion of a subsequent biliary stent was technically feasible after duodenal stent insertion. Percutaneous insertion of a long-covered biliary stent was safe and effective in patients with malignant duodenobiliary stricture. In patients with malignant duodenobiliary stricture, percutaneous insertion of a long-covered biliary stent was safe and effective regardless of duodenal stent placement. • Percutaneous insertion of long-covered biliary stents in patients with malignant duodenobiliary stricture is a safe and effective procedure. • Biliary stent deployment was technically successful in all 57 patients and successful internal drainage was achieved in 55 (96.5%) of 57 patients. • The median patient survival and stent patency times were 99days and 73days, respectively, after placement of a long-covered biliary stent in patients with duodenobiliary stricture.

Comparison of the Contour Neurovascular System and Woven EndoBridge device for treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall.

The authors compared the Contour Neurovascular System (Contour) with the Woven EndoBridge (WEB) device for the treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall. Prospective clinical and radiological data were collected for all patients treated with either the Contour or WEB at a tertiary university hospital from May 2018 to June 2022. In patients who had at least 3 months of follow-up data available (median patient age 60.0 [IQR 51.8-67.0] years, male/female ratio 1:1.4), the authors compared 40 aneurysms in 34 patients treated with the Contour and 30 aneurysms in 30 patients treated with the WEB. Overall, 26 middle cerebral artery, 24 anterior communicating artery, 9 basilar artery tip, 4 posterior communicating artery, 4 internal carotid artery, 1 anterior cerebral artery, 1 posterior inferior cerebellar artery, and 1 superior cerebellar artery aneurysm were treated. In the Contour cohort, complete occlusion at last follow-up was achieved for 30 aneurysms (75%) and a small neck remnant was seen in 6 aneurysms (15%), summing up to an adequate occlusion rate of 90%. One aneurysm (2.5%) had to be retreated, and 1 symptomatic thromboembolic event (2.5%) was observed with complete remission at discharge. Three adjunctive stents (10%) had to be used due to branch occlusion. In the WEB cohort, adequate occlusion was also seen in 90% of aneurysms (complete occlusion in 19 [63.3%] and remnant neck in 8 [26.7%], with a retreatment rate of 20%). Four WEBs (13.3%) needed additional stent placement due to device protrusion into a branch, 2 asymptomatic thromboembolic events (6.7%) were noted, and 1 major ischemic event (3.3%) due to M2 occlusion was noted. One patient treated with the WEB died between follow-ups of causes unrelated to the aneurysm, treatment, or device. Time from first measurement to deployment and thus total treatment time was significantly shorter in the Contour group (p = 0.004), regardless of whether a prior angiogram was available for aneurysm measurement and device sizing. Results for the Contour were promising, although longer follow-up is necessary to draw more solid conclusions on the utility and risk profile of this new device compared with the already widely used WEB device. Adequate occlusion at last follow-up was the same for both devices, whereas the probability of complete occlusion at last follow-up was significantly higher for the Contour, and the WEB showed a significantly higher retreatment rate. Median deployment times were significantly shorter with the Contour than the WEB.

Distal stent graft – induced new entry after frozen elephant trunk procedure for type a aortic dissection: two cases report

Objectives: We report two clinical cases that wherein stent graft-induced new entry (dSINE) after frozen elephant trunk (FET) procedure for type A aortic dissection were resolved successfully by additional stent graft placement.&#x0D; Methods: Describe rare clinical cases.&#x0D; Results: Two patients were hospitalized after FET procedure for type A aortic dissection treatment. The former had refractory abdominal pain and the latter had sudden chest pain; both their abdominal thoracic CT scanner showed dSINE. We decided to place additional stent grafts to cover the new entry. Both patients recovered well and were discharged after 5 and 12 days, respectively, without any significant complications.&#x0D; Conclusions: Supplemental stent graft placement is an effective and safe treatment choice for dSINE post-FET procedure.

WEB (Woven EndoBridge) device for intracranial aneurysm treatment: technical, radiological, and clinical findings in a consecutive North American cohort.

Utilization of Woven EndoBridge (WEB) for treatment of intracranial aneurysms has increased due to increasing operator experience. We aimed to report our contemporary series of a North American center with the WEB, examining factors associated with occlusion rates. Consecutive patients (2019-2022) with intracranial aneurysms treated with WEB device were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (RR1/RR2) were examined. Procedural and clinical results were reported. A total of 104 consecutive aneurysms/patients (25 men/79 women; median age, 63years, IQR: 55-71) were treated with single-layer WEB-SL in our institution. Seventeen patients (16%) had a ruptured aneurysm. The median aneurysm dome size was 5.5mm (IQR = 4.5-6.5), and the most common locations were AcomA (36/104 = 34.6%), MCA bifurcation (29/104 = 27.9%), and BT (22/104 = 21.2%). The rate of technical failure was 0.9%. The median intervention time was 32min (IQR = 25-43). Overall, 8 (7.6%) cases needed additional interventions: 4 (3.8%) additional stenting, 3 cases (3.8%) of intravenous tirofiban infusion (because of the excessive WEB protrusion), and one case (0.9%) of additional coiling (need to complete the neck occlusion). At 12-month follow-up, 67 patients were available showing 59/67 (88%) and 6/67 (9%) of complete occlusion and neck remnant, respectively on dual-energy CTA. There were no cases necessitating retreatment. Ruptured presentation (OR = 0.09, 95% CI = 0.008-0.9, p = .024), undersized WEB (OR = 15, 95% CI = 1.2-50, p = .006), WEB shape change (OR = 0.07, 95% CI = 0.001-0.6, p = .05), aneurysm neck diameter (OR = 0.4, 95% CI = 0.2-0.9, p = .05), and angle between the parent artery and the aneurysm dome (OR = 0.2, 95% CI = 0.01-0.8, p = .008) were significantly associated with occlusion status (RR1-2) at follow-up. However, in the multivariate logistic regression, these factors did not reach the statistical significance. The overall rate of morbidity was 0.9%. Our contemporary North American experience on consecutive intracranial aneurysms treated with WEB confirms the medium-term efficacy of this strategy, with low procedural time and morbidity. Further research is needed to demonstrate long-term occlusion rates.