Balloon-expandable Stent Research Articles

Outcomes of off-the-shelf preloaded inner branch device for urgent endovascular thoraco-abdominal aortic repair in the ItaliaN Branched Registry of E-nside EnDograft

ObjectiveThe aim of this study was to report the outcomes of endovascular urgent thoracoabdominal aortic (TAAA) repair, using an off-the-shelf preloaded inner branch device (E-nside; Artivion). MethodsData from a physician-initiated national multicenter registry, including patients treated with E-nside endograft (INBREED) were prospectively collected (2020-2024); only urgent cases were included in this study. Primary outcomes were technical success and mortality at 30 days. Secondary outcomes were spinal cord ischemia rate, stroke rate, major adverse events (MAE) as also branch instability at 12 months. ResultsOf 185 patients enrolled in the INBREED, 64 (34.5%) were treated in a urgent setting and were included in the study. Reason for urgent repair was presence of aneurysm-related symptoms in 31 patients (48.4%), a contained rupture in eight (12.5%), and a large aneurysm >80 mm in 25 (39.1%). Extent of repair was I to III in 32 patients (50%) and IV in 32 (50%); 18 (28%) had a narrow (<25 mm) paravisceral aortic lumen. An adjunctive proximal thoracic endograft was deployed in 29 patients (45.3%); a distal bifurcated abdominal endograft was used in 33 (51.5%). Two hundred forty-nine target vessels (97.2%) were successfully incorporated through an inner branch from an upper arm (81.2%) or femoral (18.8%) access. A balloon expandable stent was used in 184 (75.7%) target vessels, a self-expandable stent in 59 (24.3%). Mean time for target vessel bridging was 39.9 ± 28.4 minutes per target vessel. Thirty-day cumulative major adverse event (MAE) rate was 28%, and mortality occurred in five patients (9.1%). There was one postoperative stroke (1.6%), and the spinal cord ischemia (SCI) rate was 8% (n = 5). For the 249 target vessels successfully incorporated through an inner branch, 1-year freedom from target vessel instability was 93% ± 3% after 1 year. ConclusionsThe E-nside represents a valid solution for the urgent treatment of TAAAs, including symptomatic and ruptured TAAAs, as well as large asymptomatic TAAAs that cannot wait for a custom-made device. The preloaded inner branches and available proximal and distal graft diameters might be useful in urgent settings and provided satisfactory early and 1-year results, in terms of both endograft and target vessel stability. Further studies are required to assess the clinical role of E-nside for urgent TAAA repair.

Transfemoral-only transcatheter aortic valve replacement: A single center experience of 400 consecutive patients.

In transcatheter aortic valve replacement (TAVR),transfemoral (TF) access offers several advantages over alternative access routes. Advances in sheaths and valve delivery technology have catalyzed the feasibility of TF-TAVR, even in challenging anatomies. Report procedural characteristics and outcomes of a TAVR program aiming for a 100% TF access rate. Consecutive patients undergoing TAVR were enrolled in a prospective registry. Equipment used to facilitate TF-access in challenging anatomies included low-profile sheaths, dilatators, peripheral balloons, covered and uncovered self-expandingand balloon-expandable stents, and intravascular lithotripsy (IVL). A total of 400 patients with a mean age of 81 ± 6 years (42% female) were analyzed. Minimal iliofemoral artery diameter (MLD) of the main access side was <5 mm in 42 (10.5%), extreme tortuosity was present in 65 (16.3%), and severe calcification in 59 (14.8%). TF-access was successful in 399 (99.8%) patients. A transaxillary access was used in one patient. In multivariable analysis, an MLD < 5 mm was the strongest predictor for vascular complications (11.9% vs. 3.9%, OR: 3.86, 95% CI: 1.38-10.8, p = 0.01). Such patients also had more major/life-threatening bleeding (14.2% vs. 3.1%, p < 0.001) and required more planned and unplanned peripheral interventions to enable TFaccess (35.8% vs. 3.4%, p < 0.001). Our study shows that utilization of dedicated sheaths, peripheral balloons, stents, and IVL enables TAVR via TF access in >99% of patients. However, rates of vascular and bleeding complications in patients with narrow iliofemoral arteries (MLD < 5 mm) were high.

Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction: Medium- to Long-Term Outcomes of a Retrospective Multicenter Study.

Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction. This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed. Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (P=0.018), body surface area (P=0.013), and minimum-to-descending aortic diameter ratio (P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio. Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.

Long-term outcomes of endovascular therapy for right subclavian artery occlusive lesions: A multi-center experience.

To review our multi-institutional experience with endovascular therapy for right subclavian artery occlusive disease and to evaluate the long-term outcomes. We retrospectively evaluated all patients with right subclavian artery stenosis and occlusive disease who underwent endovascular therapy between March 2014 and September 2022 at two institutions. Patient baseline demographics, lesion characteristics, treatment strategies, and in-hospital and follow-up outcomes were prospectively collected and retrospectively analyzed. Between March 2014 and September 2022, 73 patients underwent endovascular treatment at the two institutions. The dominant cause of lesions in this cohort was atherosclerosis. Three different types of lesions were summarized, and the corresponding endovascular strategies were performed. 66 patients (90.4%) underwent successful endovascular treatment, and 62 patients (84.9%) underwent balloon-expandable stent deployment. The mean perioperative in-hospital stay was 4.0days (range, 3-6days). Two patients died due to myocardial infarction, and one died of cerebral hemorrhage resulting from a traffic accident within 30days of the intervention. The median follow-up time was 31.6months (range, 12-96 months). No complications, including death, stroke, stent fractures, or migration, were noted in any patient during the follow-up period. The overall complication rate was 7/73 (9.6%), and 5/7 (6.9%) of the complications required reintervention. Endovascular treatment of right subclavian artery lesions is safe, effective, and technically achievable. The reasonable use of balloon-expandable stents can achieve satisfactory outcomes with accurate orientation and promising patency.

Balloon Expandable Stents Versus Self-expanding Stents for Treatment of Intracranial Arterial Stenosis: A Systematic Review and Meta-analysis (P1-5.022)

Balloon Expandable Stents Versus Self-expanding Stents for Treatment of Intracranial Arterial Stenosis: A Systematic Review and Meta-analysis (P1-5.022)

Probing plastic deformation-related properties in static recrystallized Co–Cr–Fe–Ni–Mo alloy for biomedical applications

40Co–20Cr–16Fe–15Ni–7Mo (mass%, Co–Cr–Fe–Ni–Mo) alloys are currently used in biomedical implants such as balloon-expandable stents. Materials used as balloon-expandable stents are statically recrystallized and subsequently utilized within the body in a plastically deformed state. This study describes the microstructures and the mechanical and corrosive properties related to the plastic deformation of statically recrystallized Co–Cr–Fe–Ni–Mo alloys. The η-phase (M6X-M12X type, M: metallic elements; X: C and/or N) and M23X6-type precipitates were observed. The grain sizes of the recrystallized alloys were 6–92 μm. The mechanical properties were dependent on the grain size: the 0.2% proof strength and ultimate tensile strength increased and plastic elongation decreased with an increase in grain refinement. The stacking fault energy (SFE) of the Co–Cr–Fe–Ni–Mo alloy was determined by the width of partial dislocations, measured as 16 ± 3 mJ⋅m−2. Corresponding to this SFE, the formation of the ε-phase associated with strain-induced martensitic transformation and deformation twins were observed after plastic deformation. This suggests that the Co–Cr–Fe–Ni–Mo alloy exhibited a twinning-induced plasticity-like work-hardening mechanism. The polarization curves of the alloys in a simulated body fluid were not affected by the formation of precipitates (η-phase and M23X6-type) or plastic deformation, thereby suggesting that heat treatment does not deteriorate the corrosive property. The recrystallized alloy with a grain size of 36 μm had the ultimate tensile strength of more than 1000 MPa, 0.2% proof strength of less than 500 MPa, and plastic elongation greater than 70%. This alloy is expected to be applied in low-yield-strength-type balloon-expandable stents.

Early and midterm results of covered balloon-expandable stents (VBX-Gore) for endovascular treatment of chronic aorto-iliac occlusion.

Endovascular treatment is nowadays accepted as first-line treatment for most patients with aorto-iliac obstructive disease (AIOD), including those with Trans-Atlantic Inter-Society Consensus II (TASC-II) lesion types C and D. Aim of the study was to evaluate the role of Viabahn VBX (W. L. Gore and Associates, Flagstaff, AZ, USA), in patients with chronic occlusive aorto-iliac disease (ChO). A retrospective review of patients undergone elective endovascular repair with VBX (W. L. Gore and Associates) for ChO at five referral vascular institutions in Italy from 2018 to 2022 was conducted. Primary endpoints were technical success and the incidence of any early and midterm procedure-related reintervention. Secondary endpoints were clinical success, primary and secondary patency. Among 89 included patients, technical success was obtained in 87 patients (97.8%). Postoperative complication requiring early surgical reintervention was necessary in 5 (6%), all but one for arterial bleeding. Clinical improvement of at least 3 classes was observed in 49 (55%). After a mean follow-up of 24.1 months ±14.1, primary patency and freedom from any procedure-related reintervention at 12, 24 and 36 months was 83.0% and 94.8%, 80.0% and 91.5%, 77.9% and 89.3%, respectively. Secondary patency was 100%. TASC-II D lesion (OR=3.67, 95% CI: 1.1289-11.9823, P=0.03) and Grade III iliac calcification (OR=3.41, 95% CI: 1.0944-10.6428, P=0.03) were identified as independent predictors for procedure-related reintervention. Use of VBX (W. L. Gore and Associates) in ChO was safe and effective with low rate of stenosis/occlusion in the early and mid-term follow-up. TASC-II D and Grade III calcifications resulted as independent predictors for procedure-related reintervention.

Thrombus burden management during primary coronary bifurcation intervention: a new experimental bench model.

Management of thrombus burden during primary percutaneous coronary intervention (pPCI) is a key-point, given the high risk of stent malapposition and/or thrombus embolization. These issues are especially important if pPCI involves a coronary bifurcation. Herein, a new experimental bifurcation bench model to analyze thrombus burden behavior was developed. On a fractal left main bifurcation bench model, we generated standardized thrombus with human blood and tissue factor. Three provisional pPCI strategies were compared (n = 10/group): 1) balloon-expandable stent (BES), 2) BES completed by proximal optimizing technique (POT), and 3) nitinol self-apposing stent (SAS). The embolized distal thrombus after stent implantation was weighed. Stent apposition and thrombus trapped by the stent were quantified on 2D-OCT. To analyze final stent apposition, a new OCT acquisition was performed after pharmacological thrombolysis. Trapped thrombus was significantly greater with isolated BES than SAS or BES+POT (18.8 ± 5.8% vs. 10.3 ± 3.3% and 6.2 ± 2.1%, respectively; p < 0.05), and greater with SAS than BES+POT (p < 0.05). Isolated BES and SAS tended show less embolized thrombus than BES+POT (5.93 ± 4.32 mg and 5.05 ± 4.56 mg vs. 7.01 ± 4.32 mg, respectively; p = NS). Conversely, SAS and BES+POT ensured perfect final global apposition (0.4 ± 0.6% and 1.3 ± 1.3%, respectively, p = NS) compared to isolated BES (74.0 ± 7.6%, p < 0.05). This first experimental bench model of pPCI in a bifurcation quantified thrombus trapping and embolization. BES provided the best thrombus trapping, while SAS and BES+POT achieved better final stent apposition. These factors should be taken into account in selecting revascularization strategy.

Incidence and Risk Factors of Iliac Artery Rupture during Aortoiliac Stenting.

Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to severe claudication or chronic limb-threatening ischemia. Stent placement for AIOD demonstrated excellent outcomes in terms of long-term patency. However, iliac artery rupture is the most fearful complication during the aortoiliac stenting (AIS). This study aimed to evaluate the incidence and risk factors of iliac artery rupture during AIS. A retrospective review of consecutive patients with AIOD treated with AIS from 2009 to 2021 was completed. We excluded patients with instent restenosis. All types of stents, including self-expanding stent (SES), balloon-expandable stent (BES), or balloon-expandable covered stent (CS), were used. Angiographic characteristics and procedural outcomes were analyzed. Procedural success was defined as the residual stenosis <30%. A total of 242 patients (86.8% male; mean age 68.8±10.0 years) with de novo AIOD were treated with AIS. The procedural success rate was 100%. Rupture occurred in six patients (2.5%) and all ruptures were occurred in the external iliac artery (EIA). Stenting of the EIA and less calcified lesion were risk factors for iliac rupture (P=0.028). All cases of iliac artery rupture were successfully treated with the CSs. Overall primary patency rates were 98.0% and 93.4% at 12 and 36 months, respectively. Primary patency rates of SES, BES, and CS were 87.7%, 88.4%, and 100% at 36 months, respectively. The incidence of iliac artery rupture during AIS was 2.5%. Stent placement in the less calcified lesion and EIA was a risk factor for rupture during AIS. Placement of the CS can be the straightforward solution in case of iliac artery rupture during AIS.

Abstract TP174: Balloon Expandable Stents versus Self-Expanding Stents for Treatment of Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis

Background: There is limited data regarding the comparison of balloon-expanding stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. Methods: We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until May 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity of post-procedure stenosis, technical success, stroke and/or mortality, long-term events, and restenosis rates between BES and SES. Results: A total of 20 studies were included. The standardized mean difference (SMD) for post-procedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p &lt; 0.001, 10 studies involving 1515 patients) with BES. The odds for technical success were non-significantly lower (odds ratio [OR]: 0.99, 95% CI 0.43-2.26, p = 0.983, 9 studies involving 1001 patients) with BES. The odds for post-procedure 30-day stroke and/or death were significantly lower (OR 0.68, 95% CI: 0.50-0.94, p = 0.019, 15 studies involving 2431 patients), and stroke and/or death beyond 30 days were non-significantly lower (OR 0.64, 95% CI: 0.30-1.37, p = 0.250, 10 studies involving 947 patients) with BES. The odds for restenosis rate were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = 0.004, 13 studies involving 1115 patients) with BES. Conclusions: Compared with SES, BES was associated with lower rates of post-procedure 30-day stroke and/or death presumably due to less severe post-procedure stenosis in the treatment of symptomatic intracranial arterial stenosis.

Self-expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta-analysis.

There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. We conducted a systematic review to identify studies that compared SES and BES in patients with symptomaticintracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity ofpostprocedure stenosis, technical success, 30-day stroke and/or death, cumulative clinical endpoints, and restenosis rates. A total of 20 studies were included.The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30-day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50-0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow-up were nonsignificantly lower (OR 0.64, 95% CI: 0.30-1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow-up were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = .004, 13 studies involving 1115 patients) with BES. Compared with SES, BES were associated with lower rates of postprocedure 30-day stroke and/or death with lower rates of restenosis during follow up andthe treatment of symptomatic intracranial arterial stenosis.

Serial Vascular Responses of Balloon-Expandable Stent With Biodegradable Film-Type Graft in a Rabbit Iliac Artery Dissection Model (BioGard Study).

Arterial dissection during endovascular therapy rarely occurs but can be lethal. A fabric-based covered graft stents yield poor clinical outcomes. A novel balloon-expandable stent with biodegradable film graft for overcoming these issues was evaluated in a rabbit iliac artery model. Eighteen rabbits with iliac artery dissections were induced by balloon over-inflation on angiography (Ellis type 2 or 3) and treated using the test device (3.0×24 mm). Subsequently, survived twelve animals underwent histologic examinations and micro-computed tomography (CT) at 0, 2, 4, and 8 weeks and 3, 6, 9, and 12 months and angiography at one-year. There were no adverse cardiovascular events during the one-year. Early-stage histologic examination revealed complete sealing of disrupted vessels by the device, exhibiting mural hematoma, peri-stent red thrombi, and dense infiltration of inflammatory cells. Mid- and long-term histologic examination showed patent stents with neointimal hyperplasia over the stents (% area stenosis: 11.8 at 2 weeks, 26.1 at 1 month, 29.7 at 3 months, 49.2 at 9 months, and 51.0 at 1 year), along with mild peri-strut inflammatory response (Grade: 1-2 at mid-term and 0-1 at long-term). The graft film became scarcely visible after six months. Both CT and angiography revealed no instances of thrombotic occlusion or in-stent restenosis (% diameter stenosis: 5.7 at 2 weeks, 12.3 at 1 month, 14.2 at 3 months, 25.1 at 9 months, and 26.6 at 1 year). The novel balloon-expandable stent with a biodegradable film graft demonstrates feasibility in managing severe artery dissection and preventing lethal vascular events in animal model.

Camouflaging endovascular stents with an endothelial coat using CD31 domain 1 and 2 mimetic peptides

ObjectiveImplantation of an endovascular device disrupts the homeostatic CD31:CD31 interactions among quiescent endothelial cells (ECs), platelets, and circulating leukocytes. The aim of this study was to design an endothelial-mimetic coating of nitinol and cobalt-chromium (CoCr) surfaces and stents using synthetic CD31 peptides, to promote device endothelialization and pacific integration within the arterial wall. MethodsPeptides mimicking the domains 1 (D1) and 2 (D2) of CD31 were synthetized and immobilized onto experimental nitinol and CoCr surfaces using a three-step, dip-coating, mussel-inspired protocol using copper-free click chemistry. Human aortic EC phenotype and endothelialization assessment using parallel scratch tests were carried out using five synthetic CD31 peptides coated on 4.8-mm nitinol and CoCr flat disks and were compared with control disks. The CD31 peptide exhibiting the best results in vitro was then immobilized on clinical-grade 3 × 40-mm self-expanding nitinol and 2.5 × 20.0-mm balloon-expandable CoCr stents. Such devices were implanted in native arteries of White New Zealand rabbits, and compared with control uncoated bare metal stents (BMS) and drug-eluting stents 7 and 30 days after implantation using resin cross-sections and scanning electron microscopy (n = 2-3 per group at each time point). ResultsMembrane-distal CD31 D1 and D2 peptides exhibited a distinct capability to foster a healthy endothelial phenotype and to promote endothelialization in vitro. By day 7 after implantation, CD31 nitinol and CoCr stents were evenly covered by wholesome ECs, devoid of thromboinflammatory signs, in contrast with both BMS and drug-eluting stents. Such results were consistent until day 30. ConclusionsMembrane-distal CD31 biomimetic peptides seem to camouflage the device surface effectively, preventing local reactions and promoting rapid and seamless endovascular integration.

Assessment of Bridging Stents in In Situ Laser Fenestrations of Aortic Endografts With Intravascular Ultrasound

ObjectiveTreatment of complex aortic aneurysms with the in situ laser fenestration (ISLF) technique involves implantation of a balloon expandable stent graft (bSG) in the created fenestration. Adequate expansion of this bSG is of importance both to achieve seal and to ensure target vessel stability. This experimental study assessed the expansion rate of different bSGs in the ISLF setting using intravascular ultrasound (IVUS). MethodsA commercially available aortic endograft was used to test the laser fenestration technique (Zenith Alpha, Cook Medical LLC, Bloomington, IN, USA). The ISLF was stented with the following bSGs: two Gore Viabahn VBX balloon expandable endoprostheses (WL Gore & Associates, Bloomington, IL, USA), three BeGraft Peripheral and three BeGraft Plus (Bentley InnoMed GmbH; Hechingen, Germany), and three Advanta V12 (Atrium, Hudson, NH, USA). The bSGs were expanded in three steps: (1) nominal, (2) rated burst pressure, and (3) dilatation with a non-compliant balloon at 15 atmospheres. After each step, an IVUS assessment of the bSG minimal diameter and the area at the fenestration (FA) and in a fully expanded segment distal to the fenestration (SA) was performed. A mean of the three IVUS measurements was used as the value for comparison. An insufficient bSG expansion was defined as a mean of FA/SA of < 0.8 (i.e., < 80% expansion). ResultsThe VBX was the only bSG that could be expanded to its intended diameter (i.e., at least 80%) at nominal pressure. The BeGraft Peripheral and BeGraft Plus showed the lowest expansion degrees after nominal and rated burst pressure. All bSGs that were tested reached a sufficient expansion degree after the use of a higher pressure balloon. ConclusionIn this ex vivo experiment, a dilatation up to nominal pressure showed satisfactory expansion only for the VBX. The consistency of the results when applied to the different types of stent grafts that were analysed reflects structural stent graft specific issues to consider when choosing the right device in cases of ISLF.

Coronary CT Angiography-Based Assessment of Coronary in-Stent Restenosis: A Journey through Past and Present Trends

Treatment of patients with coronary artery disease commonly involves the use of balloon-expandable stent placements, currently recognized as the most prevalent approach for coronary artery revascularization. Nevertheless, the occurrence of restenosis remains a significant complication following percutaneous coronary interventions. The diagnostic role of coronary CT angiography (CCTA) in detecting stent restenosis has limitations primarily attributable to challenges in accurately discerning the lumen, due to issues such as blooming and motion artifacts. As a result, many cases often necessitate a transition to conventional coronary angiography. However, recent advancements in CT technology have led to notable improvements in both sensitivity and specificity, underscoring the growing significance of CCTA as a diagnostic tool. The consistent reporting of high negative predictive value is particularly noteworthy. This review aims to explore the historical context, current status, and recent trends in diagnosing coronary artery stent restenosis using CCTA.

Bilateral Iliac Arteries Stent Compression Following Pelvic Surgery: A Case Report and Review of Literature

Extrinsic compression of iliac arteries stents has been reported from different causes, such as uterine fibroids and orthopedic surgery. Although extrinsic compression of stents in the iliac veins has been widely studied, stent compression in the iliac arteries is less common. Here we presented a case with bilateral common iliac arteries stent compression following pelvic surgery. A patient (65-year-old woman) presented with acute critical right limb ischemia. Computed tomography angiography (CTA) showed occlusion of the right common and external iliac artery, and severe stenosis in the left common iliac artery. In addition, there was evidence of a Brenner tumor originating from the left ovary. The patient underwent endovascular recanalization of the right iliac arteries and bilateral balloon-expandable stent deployment, and the ovarian tumor was removed after three weeks. The control CTA scan showed asymmetric bilateral iliac arteries stent compression more prominent on the right side, then self-expanding stents were implanted bilaterally. In Conclusion although iatrogenic compression of the stent in the iliac artery is rare despite scarcity, it is important to maintain a high index of suspicion in selected cases and choose the proper stent accordingly.

Improvement of Work-Hardening Behavior of Co-Cr-W-Ni Alloy by Adding Mn/Fe for Balloon-Expandable Stents

The Co-20Cr-15W-10Ni (CCWN, mass%) alloy, registered as American society of testing and materials (ASTM) F90, has been widely used as a balloon-expandable stent because of its excellent balance between its mechanical properties and corrosion resistance. To realize a less invasive stent placement, the stent diameter must be reduced, which implies that the stent strut thickness must be reduced. As such, the CCWN alloy must be high in strength and ductility while maintaining a low yield stress to facilitate the expansion and suppression of stent recoil. In this study, we focus on the effects of the adding Mn/Fe on the microstructure, mechanical properties, and corrosive properties of CCWN alloys. A 6 mass% Mn-added CCWN alloy with a grain size of approximately 20 μm prepared in this study exhibits excellent balance between tensile strength and ductility. In addition, it exhibits a lower yield stress while maintaining a high tensile strength compared with the ASTM F90 alloy. Meanwhile, a 6 mass% Fe-added CCWN alloy exhibits a higher ductility compared with the ASTM F90 alloy. The addition of Mn or Fe to the CCWN alloy increases the stacking fault energy of the alloy and suppresses strain-induced martensitic transformation during plastic deformation, thus improving the ductility of the alloy. Results of polarization tests show that the 6 mass% Mn-or Fe-added CCWN alloys exhibit the same corrosion current density as the ASTM F90 alloy. Mn-added Co-Cr-W-Ni alloys are suitable for use in balloon-expandable stents.

Middle Aortic Syndrome in An Advance Age Patient Description of a Surgical Case

Middle Aortic Syndrome : is a rare form of presentation of aortic´s coarctation that represents 0.5-2% of this same entity. It usually occurs in the pediatric or young adult population, which is why the age of this patient is interesting for this case. It mostly affects women with an estimated ratio of 4:1. Renal involvement is the most prevalent and idiopathic etiology is the most frequent. This pathology presents clinically as difficult-to-control hypertension together with intermittent claudication. This article includes the case of an 81-year-old female patient with a history of hypertension, sedentary lifestyle, smoking, osteoporosis, cholecystectomy in 2010 and appendectomy in childhood. On this occasion, the patient presented a stenosis of the infrarenal abdominal aorta and a superficial femoral artery lesion simultaneously, for which she was approached in a hybrid manner with a straight balloon-expandable stent and a suprapatellar femoral-popliteal bypass.

AngioJetTM rheolytic thrombectomy with covered balloon-expandable stent deployment in a superior vena cava syndrome: a case report

The Superior Vena Cava Syndrome (SVCS) is a rare mediastinal syndrome, frequently due to compression by a mediastinal malignant leading to venous flow obstruction through the Superior Vena Cava (SVC) towards the heart. The symptoms may consist of edema of the upper body and distended veins, dyspnea up to a life-threatening condition. Restoring the SVC flow by endovascular means can be beneficial in order to achieve a rapid relief of the clinical symptoms. A 51-year-old male with a recent diagnosis of squamous cell lung tumor diagnosis presented to the emergency department with persistent cough, neck and face swelling, and distended jugular veins on clinical examination. No dyspnea and normal vital parameters were reported. Computed Tomography angiography (CT) examination demonstrated thrombosis of subclavian veins and SVC due to compression by malignancy. Compression also involved the right upper lobar bronchus. Through a percutaneous transvenous right humeral access, phlebography confirmed total occlusion of the right subclavian vein, brachiocephalic venous trunk, and superior vena cava. We performed AngioJetTM (Boston Scientific, Marlborough, MA, USA) rheolytic endovascular thrombectomy. The phlebography demonstrated the unlying hemodynamic stenosis due to the ab-extrinsic compression and underwent stenting with a covered balloon-expandable stent. The final phlebography confirmed the patency of the stent and restoration of venous flow. Although there was a complete recovery of the symptoms, the patient died from respiratory complications caused by malignancy involvement. AngioJetTM mechanical thrombectomy and covered balloon-expandable stent deployment is a useful solution for SVCS to quickly achieve relief of the clinical symptoms. There are few case series where thrombectomy and primary stent placement are studied. Further follow-up studies are needed to understand the patency of treated vessels better.

Mid-term Follow-up of Arch Vessel Angioplasty in Patients with Takayasu Arteritis

Background: We performed a prospective longitudinal study to report the mid-term follow-up of arch vessel angioplasty in patients with Takayasu’s arteritis following the use of self-expanding stents (SES) or balloon-expandable stents (coronary drug-eluting stents [DES] or peripheral bare metal stents). Methods: Eighteen consecutive Takayasu’s arteritis patients with arch vessel involvement undergoing angioplasty were included in the study. Ostial lesions were treated with DES; other lesions were treated with SES. Twelve patients were treated with 15 SES and eight patients were treated with 14 DES. Lesions were quantified by quantitative angiography before and after the procedure and during check-up angiography at 6 months to compare lumen dimensions with the immediate post-procedural results. Check-up angiography was performed in 10 patients with 13 SES and in six patients with DES. Results: SES had an immediate mean (±SD) lumen gain of 2.95 ± 1.1 mm. At 6 months, although there was a lumen loss of 2.01 ± 1.13 mm, there was a persistent mean lumen gain of 0.94 ± 1.16 mm. Similarly, DES resulted in an immediate mean lumen gain of 2.01 ± 1.13 mm, with a lumen loss of 1.6 ± 0.8 mm, but a persistent mean lumen gain of 0.40 ± 1.26 mm, at 6 months. Conclusion: We showed that both SES and DES may be used to treat patients with arch vessel involvement, with comparable results at the 6-month follow-up, and could provide these patients with significant and persistent symptom relief.