Different Types Of Stents Research Articles

Variability in Design and Materials of Vaginal Stent or Moulds for Vaginal Agenesis - A Systematic Review

Background: Vaginal stents play a crucial role in both non-surgical and surgical management of vaginal agenesis. Different types of stents with variable designs and materials have been described in the literature. However, a summary of various stents described in the existing data and their outcome measures needs to be studied. Objectives: The objective of the study was to identify and summarise different types of vaginal stents used for patients with vaginal agenesis, to identify the design and material of different vaginal stents and to assess the benefit of using that specific vaginal stent. Materials and Methods: The literature search was conducted in the PubMed database for articles from 2000 to 2024 in the English language. An exploration of grey literature was also included through Google Scholar. The articles were included only if they clearly described vaginal stent, its material, design and advantage of using that particular stent, and any study not directly related to the research question or in which vaginal stent was used for cases other than vaginal agenesis/Mayer–Rokitansky–Kuster–Hauser syndrome/Mullerian aplasia or agenesis were not included in this study. Risk of bias assessment was done using an eight-item tool that included domains of selection, ascertainment, causality and reporting. Results: A total of 133 abstracts appeared in PubMed, of which, 26 titles/abstracts were related to the research question. Based on inclusion and exclusion criteria, seventeen articles were selected for the review. A total of 905 articles were identified from Google Scholar, of which, 7 were chosen to be included. The literature reports the usage of variable vaginal stents which can be hard, soft, solid or hollow with the option of customisation available. Interpretation: Based on the results of this review, soft stents are better than rigid stents due to increased patient compliance, a critical factor contributing to the success of the treatment. The resilient nature, comfort and lightweight of the silicone material are more suitable than commonly used acrylic material. However, the choice in a particular case may vary. Limitations: The majority of articles included in this review were case reports. As the duration and frequency of usage of stents affect the outcome, studies need to be done to evaluate the effectiveness of different types of stents to come to identify the best design and material for vaginal stents. PROSPERO Registration: CRD42024554676.

Comparison of thrombogenicity in different types of drug-eluting stents during transition from DAPT to SAPT.

During the transition from dual antiplatelet therapy (DAPT) to single antiplatelet therapy (SAPT), previous studies have raised concerns about a rebound effect. We compared platelet and inflammatory cell adhesion on different types of stents in the setting of clopidogrel presence and withdrawal. In Experiment 1, three pigs were administered with DAPT, that is, clopidogrel and acetylsalicylic acid (ASA), for 7 days. Each animal underwent an extracorporeal carotid arteriovenous shunt model implanted with fluoropolymer-coated everolimus-eluting stent (FP-EES), biodegradable-polymer sirolimus-eluting stent (BP-SES), and biodegradable-polymer everolimus-eluting stents (BP-EES). In Experiment 2, two pigs were administered DAPT, clopidogrel was then withdrawn at day 7, and SAPT with ASA was continued for next 21 days. Then flow-loop experiments with the drawn blood from each time point were performed for FP-EES, BioLinx-polymer zotarolimus-eluting stents (BL-ZES), and BP-EES. The rebound effect was defined as the statistical increase of inflammation and platelet adhesion assessed with immunohistochemistry on the stent-strut level basis from baseline to day-14 or 28. Both experiments showed platelet adhesion value was highest in BP-EES, while the least in FP-EES during DAPT therapy. There was no increase in platelet or inflammatory cell adhesion above baseline values (i.e., no therapy) due to the cessation of clopidogrel on the stent-strut level. Monocyte adhesion was the least for FP-EES with the same trend observed for neutrophil adhesion. No evidence of rebound effect was seen after the transition from DAPT to SAPT. FP-EES demonstrated the most favorable antithrombotic and anti-inflammatory profile regardless of the different experimental designs.

Medium-Term Outcomes of Stent Therapy for Aortic Coarctation in Children Under 30 kg with New Generation Low-Profile Stents: A Follow-Up Study of a Single Centre Experience

We previously reported short-term outcomes for stenting of aortic coarctation (CoA) (native or re-coarctation) with newer generation low-profile stents (Valeo, Formula, and Begraft stents) in children under 30 kg. We present here the medium-term outcomes of this procedure. Retrospective review of patients weighing under 30 kg who had percutaneous stent treatments for coarctation between 2012 and 2021 was performed. Clinical and procedural data were collected; 19 patients were included. The median age at the time of procedure was 5.1 [4.1–6.4] years and median weight 21.0 [17.3–22.3] kg. One patient had a history of re-coarctation. Thirteen (68%) patients were on anti-hypertensives pre-procedure. Different types of stents were used (14 Valeo™, 4 Formula® 535, 1 BeGraft), which can all be dilated to 18 mm or larger. One patient required a 9 F sheath, all others required a 7 F sheath. The narrowest diameter in the aorta increased from a median of 3.5 [3.0–4.5] to 9.4 [8.9–9.8] mm, p < 0.001; there was a reduction in the median pressure gradient across the coarctation from 35.0 [30.0–43.0] to 5.0 [0–10.0] mmHg, p < 0.001. There were no intra-procedural complications. Follow-up was for a median of 56.0 [13.0–65.0] months. Five (26%) of patients underwent re-intervention after a median time frame of 40.0 [39.5–52.0] months; four had balloon dilation, one had repeat stent implantation. Five (26%) patients were on anti-hypertensive agent(s) post-intervention. Our single centre experience demonstrates that percutaneous stenting for coarctation of aorta in children under 30 kg, with low-profile stents, had no significant complications during the median follow-up time of 56 months. This study demonstrated that the procedure is safe and effective for short and medium-term therapy in this group of patients with a 26% re-intervention rate. A quarter of patients remained on anti-hypertensive medication post stenting, emphasizing the importance of long-term follow-up.

Biological response of degradation products of PEO-modified magnesium on vascular tissue cells, hemocompatibility and its influence on the inflammatory response

Cardiovascular stenting is the most widely used therapy to treat coronary artery disease caused by partial or total obstruction of the artery due to atherosclerotic plaque formation, with potentially fatal effects. There are different types of stents: bare metal stents, drug-eluting stents, bioabsorbable stents and dual therapy stents. However, they can lead to long-term complications, such as in-stent restenosis and late thrombosis. To reduce these adverse effects, research has focused on biodegradable metallic stents, since they retain the mechanical properties necessary to contain the injured artery while it is being repaired and, once their function has been fulfilled, the stent degrades without altering the system or compromising the patient's health. In this work we have evaluated the biological response of the degradation products of a bare Mg based biomaterial surface-modified by the plasma electrolytic oxidation (PEO) method on vascular tissue cells, hemocompatibility and inflammatory response. The results obtained are compatible with a biosafe material for future use as a cardiovascular implant, but it is necessary to continue with in vivo and mechanical properties tests to ensure and guarantee its use. Significance statementThe development of fully bioresorbable stents is a promising alternative for the management of coronary artery disease without causing long-term problems at the implantation site. In this work, the hematological and immunological biocompatibility of bare Mg modified superficially by plasma electrolytic oxidation (PEO-Mg) was evaluated by in vitro and ex vivo assays. PEO-Mg was found to be compatible with blood and immune components surrounding the implantation site with no signs of toxicity to endothelial cells, macrophages, and arterial tissue. In addition, degradation products of PEO-Mg are eliminated by phagocytosis. However, an in-depth study of the physical and mechanical properties and in vivo biocompatibility must be carried out for its future use as a biomedical implant.

Computational modeling of low-density lipoprotein accumulation at the carotid artery bifurcation after stenting.

Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low-density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. The computational model consists of coupled blood flow and LDL transport, with the latter being modeled as a dilute substance dissolved in the blood and transported by the flow through a convection-diffusion transport equation. The endothelial layer was assumed to be permeable to LDL, and the hydraulic conductivity of LDL was shear-dependent. Anatomically realistic geometric models of the carotid bifurcation were built based on pre- and post-stent computed tomography (CT) scans. The influence of stent design was investigated by virtually deploying two different types of stents (open- and closed-cell stents) into the same carotid bifurcation model. Predicted LDL concentrations were compared between the post-stent carotid models and the relatively normal contralateral model reconstructed from patient-specific CT images. Our results show elevated LDL concentration in the distal section of the stent in all post-stent models, where LDL concentration is 20 times higher than that in the contralateral carotid. Compared with the open-cell stents, the closed-cell stents have larger areas exposed to high LDL concentration, suggesting an increased risk of stent restenosis. This computational approach is readily applicable to multiple patient studies and, once fully validated against follow-up data, it can help elucidate the role of stent strut design in the development of in-stent restenosis after CAS.

Prognosis of coronary heart disease after percutaneous coronary intervention: a bibliometric analysis over the period 2004–2022

BackgroundAs the complexity and diversity of the percutaneous coronary intervention (PCI) are being explored and reported, burgeoning research has progressed in this field. However, there is no comprehensive analysis available on PCI-related studies published in the literature. This study aimed to analyze and visualize the changes of scientific output regarding prognosis of coronary heart disease (CHD) after PCI over the past 20 years and to reveal the knowledge domain and development trends in this field by using CiteSpace software.MethodsRelevant articles published over the period 2004–2022 were retrieved from the Web of Science Core Collection database. After manual selection, qualified documents were included and recorded with the information of their title, abstract, keyword, author, descriptor, citation, identifier, publishing year and publishing organization. We transferred the data to CiteSpace V5.8.R2 (Version 5.8.R2) to draw knowledge maps and to conduct co-occurrence analysis, cluster analysis, timeline analysis, burst term detection and citation analysis.ResultsA total of 14,699 literature records were found relating prognosis of CHD after PCI in the past 20 years (2004–2022), including 14,212 original articles and reviews, and they were published in 153 different journals. Publication production has increased annually and a total of 1182 authors, 796 institutes and 147 countries have contributed to these publications. Moreover, the most representative author was Gregg W Stone from the CardioVascular Research Foundation (CVRF) with 368 publications, whose team mainly focused on exploring the efficacy and safety of revascularization and the characteristics of susceptible population. The global productivity ranking was led by the USA with 3326 published papers, followed by Italy (n = 1355), Japan (n = 1080), China (n = 1075) and Germany (n = 937). And the keywords of these publications were “percutaneous coronary intervention” (n = 2271), “outcome” (n = 1756), “mortality” (n = 1730) and “impact” (n = 1334). Other commonly-used words were “predictor” (n = 1324), “intervention” (n = 1310), “angioplasty” (n = 1299), “risk” (n = 1144), “acute myocardial infarction” (n = 1136) and “artery disease” (n = 1098). Cluster analysis showed that 15 high connected clusters were generated with a modularity Q of 0.831 and a weighted mean silhouette of 0.9388 by applying the log-likelihood ratio algorithm, and the top 5 clusters were #0 optical coherence tomography, #1 dual antiplatelet therapy, #2 bleeding, #3 clopidogrel and #4 thrombus aspiration. Furthermore, the frontiers in the field of prognosis of CHD after PCI mainly involved “decision making”, “reperfusion”, “angioplasty”, “balloon”, “unstable angina”, “dual antiplatelet therapy”, “cardiac surgical score”, “restenosis”, “reperfusion”, “thrombolytic therapy”, etc.ConclusionsTo sum up, efficacy and safety of different types of stents, the risk factors of restenosis and thrombotic events after PCI, early risk assessment, and secondary prevention and complications of patients with CHD after PCI were research hotspots and frontier topics in the area by bibliometric analysis. The results could provide a comprehensive overview of the research hotspots and frontier topics relating prognosis of CHD after PCI, promoting a better understanding of the knowledge domain and development trends in this field during the past 20 years.

Faster smooth muscle cell coverage in ultrathin-strut drug-eluting stent leads to earlier re-endothelialization.

Background: The ultrathin-strut drug-eluting stent (DES) has shown better clinical results than thin- or thick-strut DES. We investigated if re-endothelialization was different among three types of DES: ultrathin-strut abluminal polymer-coated sirolimus-eluting stent (SES), thin-strut circumferential polymer-coated everolimus-eluting stent (EES), and thick-strut polymer-free biolimus-eluting stent (BES) to gain insight into the effect of stent design on promoting vascular healing. Methods: After implanting three types of DES in the coronary arteries of minipigs, we performed optical coherence tomography (OCT) at weeks 2, 4, and 12 (n = 4, each). Afterward, we harvested the coronary arteries and performed immunofluorescence for endothelial cells (ECs), smooth muscle cells (SMCs), and nuclei. We obtained 3D stack images of the vessel wall and reconstructed the en face view of the inner lumen. We compared re-endothelialization and associated factors among the different types of stents at different time points. Results: SES showed significantly faster and denser re-endothelialization than EES and BES at weeks 2 and 12. Especially in week 2, SES elicited the fastest SMC coverage and greater neointimal cross-sectional area (CSA) compared to EES and BES. A strong correlation between re-endothelialization and SMC coverage was observed in week 2. However, the three stents did not show any difference at weeks 4 and 12 in SMC coverage and neointimal CSA. At weeks 2 and 4, SMC layer morphology showed a significant difference between stents. A sparse SMC layer was associated with denser re-endothelialization and was significantly higher in SES. Unlike the sparse SMC layer, the dense SMC layer did not promote re-endothelialization during the study period. Conclusion: Re-endothelialization after stent implantation was related to SMC coverage and SMC layer differentiation, which were faster in SES. Further investigation is needed to characterize the differences among the SMCs and explore methods for increasing the sparse SMC layer in order to improve stent design and enhance safety and efficacy.

Zilver stent versus Carotid Wallstent for endovascular treatment of idiopathic intracranial hypertension

BackgroundVenous sinus stenting (VSS) is a promising treatment option for medically refractory idiopathic intracranial hypertension (IIH). There are no published studies comparing the performance of different types of stents employed...

Ionized and non-ionized radiation effects on coronary stent implantation

The purpose of this study is to examine the clinical radiation effects on patients with various stents. Several previous researches focused on the mechanical and physical features of the stents, but there have been few studies that focus on the interaction with radiological and clinical radiation. For stent material analysis, the ANSYS package program was employed. These materials and models are often built in three dimensions for three different types of stents made of three various materials. Estimates of blood pressure and thermal radiation were explored, as were the effects of non-ionizing radiation. Furthermore, the radiation attenuation characteristics of stent samples are investigated. The mass attenuation coefficient values are computed using MATLAB code over a large energy range of 0.015–15 MeV, and the findings are validated using theoretical WinXCom results. To determine the gamma-ray attenuation performances of the studied stent samples, variables such as the mass attenuation coefficient (MAC), half-value layer (HVL), tenth-value layer (TVL), mean free path (MFP), effective atomic number (Zeff), exposure build-up factor (EBF), and energy absorption build-up factor (EABF) are computed. Effective removal cross-sections (ΣR) of stent samples were acquired to determine the capacity of stent samples to stop fast neutrons. Finally, the ability of stent samples to stop charged alpha and proton particles was evaluated utilizing mass stopping power and projected range parameters. The discovery demonstrates that S3 has the best attenuation as well as the best proton, alpha, and gamma radiation attenuation capability.

S1101 Safety and Efficacy of LAMS versus FCSEMS in Endoscopic Ultrasound-Guided Gallbladder Drainage in Acute Cholecystitis: A Meta-Analysis

Introduction: EUS-guided gallbladder drainage (EUS-GBD) is well established as a safe alternative to percutaneous cholecystostomy (PT-GBD) for acute cholecystitis. However, there have been no studies to date comparing the safety and efficacy of the different types of stents for EUS-GBD. Therefore, we conducted a systematic review and meta-analysis to compare the safety and efficacy of lumen-apposing metal stent (LAMS) to Fully covered self-expandable metal stent (FCSEMS) for EUS-GBD. Methods: A comprehensive literature search was conducted from electronic databases, including PubMed, Embase, and Scopus, from inception until 6/2022. A single-arm meta-analysis was performed using a random-effects approach using restricted maximum likelihood (REML) method comparing proportional data. In addition, subgroup analysis was performed based on the type of stent and comparing the outcomes. All the statistical analysis was conducted using Stata16. Results: Pooled data from 463 LAMS and 199 FCSEMS across 11 and 6 studies respectively were included in the final analysis (Table). There was no significant difference in the technical success rate between FCSEMS vs LAMS (97.61% vs 96.45%, I2 = 8.04%, p= 0.36) However, when compared to LAMS, FCSEMS had a 6% higher clinical success rate (99.2 % versus 93.3%, I2 = 43.87%, p = 0.03) FCSEMS had significantly lower adverse rate of 12.7% when compared to 17.7% LAMS, a difference of 5% (I2 = 54.5%, P = 0.0000). There was no significant difference in recurrent cholecystitis rates between the groups (FCSEMS= 1% vs 1.7%, I2= 3.7%, p =0.41). Although there was a lower mortality seen while using FCSEMS compared to LAMS, it was not statistically significant (I2 = 24.2%, p = 0.17) (Figure). Conclusion: Strengths and limitations: To the best of our knowledge, our study is the first meta-analysis to compare the safety and efficacy of LAMS versus FCSEMS for EUS-GBD. Patient factors such as comorbidities, health conditions while undergoing the procedure, etc., could not be compared between the groups. There was inadequate data to classify adverse events as severe or mild-moderate. Moderate heterogeneity was noted. Discussion: FCSEMS had a higher clinical success rate and fewer adverse events than LAMS for EUS-GBD. There was no difference in technical success, recurrent cholecystitis, or mortality among the two groups. RCTs and observational studies comparing LAMS vs. FCSEMS head-to-head are required to further our understanding in this regard.Figure 1.: Forest plots comparing the outcomes of LAMS versus FCSEMS in Endoscopic ultrasound-guided gallbladder drainage in acute cholecystitis. Table 1. - LAMS versus FCSEMS for Endoscopic ultrasound-guided gallbladder drainage in acute cholecystitis FCSEMS LAMS No. of patients (n) 199 463 Technical success rate (%) 99.6 94.4 Clinical success rate (%) 99.2 93.3 Total adverse events (n) 21 84 Bleeding (n) 0 19 Perforation (n) 2 4 Mortality (n) 4 12

ЭКОНОМИЧЕСКАЯ ЭФФЕКТИВНОСТЬ ИСПОЛЬЗОВАНИЯ РАЗЛИЧНЫХ ТИПОВ СТЕНТОВ ПРИ КОРРЕКЦИИ ХРОНИЧЕСКИХ ОККЛЮЗИЙ КОРОНАРНЫХ АРТЕРИЙ

Aim. To study cost-effectiveness of different types of stents in the correction of chronic total occlusion (CTO). Methods. The study included 119 patients after successful coronary artery CTO recanalization in 2009–2012. After 6.1±0.9 months and 12.7±1.6 months a control examination was performed (coronary angiography, intravascular ultrasound, optical coherence tomography). Negative events (in-stent restenosis and thrombosis) were analyzed. Taking into account the obtained data, direct costs were calculated including the cost of implants, and the cost of restenosis and thrombosis treatment. Results. The highest frequency of in-stent restenosis (p &lt; 0.05) was registered after IntrepideTM (in 57.1% cases) and Prolim® (in 47.4% cases) stent implantation while the similar events in cases of Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® stent implantation were registered in 0-11.1% of cases. There weren’t differences in the thrombosis incidence between studied types of implants (p &gt; 0.05). Based on the data obtained, the stents were classified as devices with low rate of adverse events (Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® – LRAE group), and those with a high rate of restenosis and thrombosis (IntrepideTM and Prolim® – HRAE group). The average cost of stents in the LRAE group was 2155.1 US dollars. Endovascular correction of in-stent restenosis were performed in 6.3% of cases, thrombosis – in 1.3%, the average direct treatment cost per patient over 12.7±1.6 months totaled 3906.4 US dollars. In the HRAE group the cheaper devices were implanted (median cost was $1650.8). Repeated PCIs due to restenosis were performed in 52.5% of cases, one patient (2.5%) with verified thrombosis underwent CABG. The average direct treatment cost per patient over 12.7±1.6 months period was 4993.5 US dollars, which was $1,087.1 more than in the LRAE group. Conclusion. The obtained data indicate higher financial cost during 12.7±1.6 months follow-up period after IntrepideTM and Prolim® stent implantation in the recanalized CTO areas. This emphasizes the impotance of using coronary stents with proven minimal risks of in-trastent restenosis and thrombosis in CTO cases.

Prognostic Analysis of Patients with Acute Myocardial Infarction Undergoing Implantation of Different Stents for the First Time.

For patients with acute myocardial infarction scheduled to undergo percutaneous coronary stent implantation, in most cases a drug-eluting stent is recommended as the first choice for treatment. However, there is a lack of research on the effectiveness of bare-metal stents and drug-eluting stents on patients with different types of myocardial infarction. Our objective was to explore the effects of bare-metal stents and drug-eluting stents on patients with different types of myocardial infarction in terms of major cardiovascular incidents. This retrospective cohort study included 934 patients with myocardial infarction undergoing coronary artery stent implantation for the first time at the cardiac catheter room of the Tri-Service General Hospital in the Neihu District between 2014 and 2018. Patients’ information, including demographic data, laboratory data, cardiac echocardiography results, and angiocardiography results, was collected by reviewing medical records. Cox proportional hazards regression was used to adjust the potential confounding factors, and the adjusted data were then used to compare the correlation between different types of stents and major cardiovascular incidents in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. After the confounding factors were adjusted, in patients with ST-elevation myocardial infarction receiving a drug-eluting stent compared with those receiving a bare-metal stent, it was found that the mortality risk was lower in terms of all causes of death (Adj-HR = 0.26, 95% CI = 0.14–0.48, p < 0.001) and cardiogenic death (Adj-HR = 0.20, 95% CI = 0.08–0.55, p = 0.002), the risk of non-fatal myocardial infarction was lower (Adj-HR = 0.17, 95% CI = 0.04–0.73, p = 0.017), and there was no difference in the risk of revascularization at the lesion site (Adj-HR = 0.59, 95% CI = 0.24–1.43, p = 0.243). It terms of the findings in patients with non-ST-elevation myocardial infarction, those receiving a drug-eluting stent had a lower risk of revascularization at the lesion site (Adj-HR = 0.48, 95% CI = 0.24–0.97, p = 0.04); however, there was no difference in the mortality risk in terms of all causes of death (Adj-HR = 0.71, 95% CI = 0.37–1.35, p = 0.296) or cardiogenic death (Adj-HR = 0.59, 95% CI = 0.18–1.90, p = 0.379),or in the risk of non-fatal myocardial infarction (Adj-HR = 0.27, 95% CI = 0.06–1.25, p = 0.093). Compared with bare-metal stents, drug-eluting stents provide better protection against death to receivers with ST-elevation myocardial infarction; however, this protection is decreased in receivers with non-ST-elevation myocardial infarction. It is recommended that for patients with non-ST-elevation myocardial infarction who are indicated to receive a drug-eluting stent, the clinical effectiveness of the treatment must be considered.

1-Month Dual-Antiplatelet Therapy Followed by Aspirin Monotherapy AfterPolymer-Free Drug-Coated StentImplantation: One-Month DAPT Trial.

The aim of this study was to determine whether 1month of dual-antiplatelet therapy (DAPT) followed by aspirin monotherapy after polymer-free drug-coated stent (PF-DCS) implantation is noninferior to 6 to 12months of DAPT after biodegradable-polymer drug-eluting stent (BP-DES) implantation. It is necessary to determine the optimal minimal duration of DAPT followed by aspirin monotherapy after percutaneous coronary intervention (PCI). In this trial, 3,020 patients with coronary artery disease considered for PCI for noncomplex lesions were randomized to 1-month DAPT after PF-DCS (n=1,507) or 6- to 12-month DAPT after BP-DES (n=1,513). The primary endpoint was the 1-year composite of cardiac death, nonfatal myocardial infarction, target vessel revascularization, stroke, or major bleeding (noninferiority hypothesis margin of 3%). The primary endpoint occurred in 88 patients (5.9%) in the 1-month DAPT after PF-DCS group and 98 patients (6.5%) in the 6- to 12-month DAPT after BP-DES group (absolute difference-0.7%; upper limit of 1-sided 97.5% confidence interval: 1.33%; P< 0.001 for noninferiority). The occurrence of major bleeding was not different (1.7% vs 2.5%; P=0.136). There was no difference in the occurrence of stent thrombosis (0.7% vs 0.8%; P=0.842). Among patients who underwent PCI for noncomplex lesions, 1-month DAPT followed by aspirin monotherapy after PF-DCS implantation was noninferior to 6- to 12-month DAPT after BP-DES implantation for the 1-year composite of cardiovascular events or major bleeding. The present findings need to be interpreted in the setting of different types of stents according to antiplatelet strategy. (A Randomized Controlled Comparison Between One Versus More Than Six Months of Dual Antiplatelet Therapy After Biolimus A9-Eluting Stent Implantation; NCT02513810).

The role of stents in hemodialysis vascular access.

Vascular access is the Achilles' heel of dialysis therapy among patient with end stage kidney disease. The development of neointimal hyperplasia and subsequent stenosis is common in vascular access and is associated with significant morbidity. Percutaneous transluminal angioplasty using balloon inflation was the standard therapy of these lesions. However, the balloon-based approaches were associated with poor vascular access patency rate necessitating new inventions. It is within this context that different types of stents were developed in order to improve the overall dialysis vascular access functionality. In this article, we review the available literature regarding the use of stents in treating dialysis vascular access stenotic lesions. Further, we review the major clinical trials of stent use in different anatomic locations and in different clinical scenarios.

Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis

BackgroundSymptomatic pancreatic duct (PD) strictures in chronic pancreatitis refractory to single plastic stenting are usually managed by placement of multiple plastic stents (MPS). Fully covered self-expanding metallic stents (FCSEMS) have also been used in the management of these patients. However, the overall efficacy and safety of different types of stents is unclear from the currently available studies. We performed this meta-analysis to assess the efficacy and complications from MPS and FCSEMS in patients with PD strictures refractory to treatment with single plastic stents. MethodsSeveral electronic databases were searched for all the studies evaluating the outcome of placement of multiple plastic stents and fully covered metal stents in patients with PD strictures refractory to single plastic stenting. We calculated the Weighted Pooled Ratio (WPR) with Confidence Interval (CI) between the MPS and FCSEMS. ResultsA total of 13 studies (including 2 abstracts) were included in the analysis. MPS were placed in 106 patients and FCSEMS in 192 patients. Improvement in pain after stenting (P = 0.794), risk of recurrence of pain after removal of stent (P = 0.48) and stricture recurrence after stent removal (P = 0.52) were comparable between MPS and FCSEMS. Risk of endoscopic re-intervention was also comparable between metal stents and MPS. However, FCSEMS was associated with overall higher risk of adverse events (P < 0.0001). ConclusionFCSEMS are comparable to multiple plastic stents in the treatment of symptomatic refractory PD strictures. However, use of FCSEMS is associated with increased risk of adverse events.

Vascular Wall Reactions to Coronary Stents-Clinical Implications for Stent Failure.

Coronary stents belong to the most commonly implanted devices worldwide. A number of different types of stent exist, with very different mechanical and biochemical characteristics that influence their interactions with vascular tissues. Inappropriate inflammatory reactions are the major cause of the two major complications that follow implantation of stents in a percentage as high as 5–20%. It is therefore important to understand these reactions and how different they are among different generations of stents.

Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article.

BackgroundChoanal Atresia is an obliteration by an atretic plate of the posterior choanae due to a failure of the bucconasal membrane to rupture. The insertion of stents post choanal atresia repair is familiar. Still, there are limited studies in the literature that specify the time to remove it, the best materials, and the effectiveness of each kind.ObjectiveOur study aims to compare different types of choanal atresia stents and flaps and the outcome of different kinds of stents and flaps that use post-operatively. Also, to assess the risk of restenosis post-operatively with varying types of Stent and flaps.MethodsA systematic review via databases for different types of stents and flaps used in choanal atresia, including 31 studies with precise technique, variety of stents, restenosis rates, and risk factors (unilaterality, the component of the atretic plate). And about 10 different approaches to flaps reconstruction were mentioned.ResultsAccording to the data, we observed a successful rate of choanal atresia repair by using the ordinary ETT post-operatively ranged from 28 to 94.2%, which could be explained due to many factors. Post-operative Instructions on care and suctioning provided a good impact. Other types of stents found in case series like steroid eluting stents, Nelaton catheters, Silastic stents, or modified ETT have a promising future during 26 to 39 weeks follow-up. Still, they need further studies with randomization and more data. Flaps with different approaches and techniques showed promising results and fewer complication rates with or without stents, also now have been used in practice providing suitable alternatives for stents.ConclusionThe original types of choanal atresia stents were shown to have a wide variety of results, while innovative materials of stents showed promising results, however, in relatively small case studies. Flaps were now used in practice giving other choices for stents with fewer complications, better healing, and new choana formation.

Bench-Top Comparison of Three Different Types of Stents Used for Treatment of Intracranial Atherosclerotic Stenosis.

PurposeFour key bench-top tests, including trackability, conformability, wall-apposition, and bending stiffness, were performed to understand the mechanical characteristics in 3 different types of stents applicable for treatment of intracranial atherosclerotic stenosis: Balloon-expandable D+Storm, Pro-Kinetic Energy, and self-expandable Wingspan stents.Materials and MethodsTrackability was assessed by measuring the tracking forces of each stent with its delivery systems. Conformability and wall apposition were quantified and analyzed using curved vessel models. A 3-point bending test was employed to evaluate bending stiffness.ResultsD+Storm showed the lowest tracking forces while the conformability of the Wingspan stent was superior to that of the tested stents. Pro-Kinetic Energy and D+Storm had better wall apposition in curved vessels than the Wingspan stent. Bending stiffness of the Wingspan stent was notably lower, whereas no significant differences were found between D+Storm and Energy. Pro-Kinetic Energy and D+Storm not only indicated lower gap ratios between the struts and the vessel wall but also maintained good wall apposition even in the curved model.ConclusionThese bench-top measurements may provide clinicians with useful information in regard to selecting suitable stents for treatment of intracranial atherosclerotic stenosis.

Acute and intermediate-term outcome of endovascular stenting of native aortic coarctation in adolescents and adult patients

Introduction Coarctation of aorta (CoA) is a common form of cardiac lesions requiring intervention. Recently, endovascular management with stent implantation has emerged as the preferred strategy. We aim to report our single-center experience of stenting in a wide range of patients using different types of stents and later on its complications. Patients and methods Between January 2012 and December 2017, 56 patients who underwent treatment with stents for CoA were retrospectively studied. All the patients underwent echocardiography and computed tomography scans at 6–12 months follow-up. Results There were 18 women and 38 men with a mean age of 23.24±15.75 years (range, 9–55 years). The median sheath size and balloon diameter were 12 mm (10–14 mm) and 14 mm (12–25 mm), respectively. We achieved an immediate success rate of 94.6% with only three cases recording major complications in the form of migration of stent, infective endarteritis, and stent fracture. At 1-year follow-up, no complications were noted in the computed tomography scans. Conclusion Stent implantation is a good choice for the treatment of CoA in adolescents and adults. It is associated with a low-residual gradient and a low rate of restenosis, both immediately and at mid-term follow-up. It has a relatively low incidence of complications.

Strategies to Improve Patient Outcomes and QOL: Current Complications of the Design and Placements of Ureteric Stents.

Ureteric stents have played a vital role in relieving urinary obstruction in many urological conditions. Although they are extremely successful, stents have been associated with complications and reduced patients’ health-related quality of life (HRQoL). There are many factors that may affect the quality and longevity of stents. In this review, we have highlighted the journey and innovation of ureteric stents through the modern day. A literature review was conducted to identify relevant articles over the last 20 years. There is a plethora of evidence with various indications for the use of ureteral stents and how they affect QoL. There is still ongoing research to develop the ideal stent with reduced encrustation, one that resists infection and is also comfortable for the patients. Stents made from metal alloys, polymers and biodegradable materials have unique properties in their own right but also have certain deficiencies. These have been discussed along with an overview of newly developed stents. Certain pharmacological adjuncts have also been highlighted that may be useful to improve patient’s tolerance to stents. In summary, this paper describes the features of the different types of stents and the problems that are frequently encountered, including effect on patients’ HRQoL and financial burden to healthcare providers.