Large Stent Research Articles

T-configured Dual Stent Placement in Malignant Biliary Hilar Obstruction: Technique and Clinical Application

Purpose: To evaluate implanting techniques of T-configured dual stents in malignant hilar obstruction and investigate the clinical factors related to stent obstruction. Materials and Methods: The study included 28 patients undergoing T-configured dual stent implantation to palliate malignant biliary hilar obstruction. The unilobar approach was first attempted in the procedure, which progressed to bilobar approach when it was found that the unilobar approach was not feasible. If the stent was again obstructed, clinical palliation was attempted using stent re-insertion or PTBD. Clinical factors associated with T-configured dual stenting were examined in the patients with stent re-obstruction, which was followed by a correlation between these clinical factors and stent obstruction. Results: Eleven of 13 patients were successfully treated by the unilobar approach. The two unsuccessful cases sustained angulation of the central large mesh stent. For the bilobar approach, 14 of 15 patients were successfully treated. For the one unsuccessful patient, the stent failed to pass through the central large mesh. Stent obstruction was revealed in 13 patients during the follow-up period. Balloon-assisted stent re-canalization was successfully performed in 5 patients. The analysis suggests that no definite correlation was found between stent obstruction and the clinical factors associated with dual stent placement. Conversely, bile containing sludge or debris was significantly correlated to early stent obstruction. Conclusion: Technical adoption considering the bile duct anatomy and obstruction pattern is important for Tconfigured dual stent implantation. The prudent evaluation of bile juice characters and cholangiographic findings is required for the appropriate clinical application of the T-configured dual stenting.

Are tradable green certificates a cost-efficient policy driving technical change or a rent-generating machine? Lessons from Sweden 2003–2008

In the European policy debate, tradable green certificates (TGC) have been suggested to be a superior regulatory framework for promoting the diffusion of renewable electricity technologies. The purpose of this paper is to assess the performance of the Swedish TGC system, contributing to the European debate on the suitability of different types of frameworks. The expectations of the TGC system were that it would: (a) be effective in terms of increasing the supply of “green” electricity; (b) do this in a cost effective manner (from both a social and a consumer perspective); (c) generate an equitable distribution of costs and benefits and (d) drive technical change. So far, it has performed adequately in terms of effectiveness and social cost effectiveness. However, consumer costs have been substantially higher than expected, very large rents are generated and, at best, it contributes marginally to technical change. Thus, a TGC framework should be selected if the overriding concern is to minimize short term social costs of reaching a certain goal with a high degree of predictability. However, it cannot be expected to also drive technical change, keep consumer costs down and be equitable. Such trade-offs need to be revealed and not obscured by analysts.

Pilot Data on the Endoscopic Placement of Covered Metal Stents to Treat Gastrojejunal Leaks in a Porcine Model

Placement of stents may be an alternative option to treat gastrojejunal (GJ) anastomotic leaks after Roux-en-Y gastric bypass (RYGB) surgery. The aim was to evaluate the performance of a covered metal stent (Alimaxx-E, 18 x 100 mm) across a GJ leak in a porcine model. In eight pigs, a RYGB was performed and a 1-cm leak was created. A retrogastric and anterogastric GJ was performed equally with four pigs in each group. Stents were placed across the GJ anastomosis using endoscopy and fluoroscopy. The endpoints were position of the stents, healing of the leak, and complications at necropsy. Stent placement was feasible in all pigs it was attempted. In the retrogastric GJ group, pigs without stents survived 2 weeks without complications. Two pigs with stents died on postoperative days (PODs) 4 and 5. In the anterogastric GJ group, one pig with one stent survived 2 weeks with healing of the leak but with stent migration into the Roux limb. The remaining three pigs died between PODs 4 and 6. Pressure necrosis of the Roux limb caused by the distal end of the stent was found in all. Placement of fully covered metal stents is feasible. The use of small pigs with a thin small bowel wall in combination with relatively large stents was most likely the reason for complications found in all stented animals. Further studies of GJ leaks using these stents will require larger pigs or a different species.

Investment dynamics in electricity markets

We investigate the incentives for investments in capacity in a simple strategic dynamic model with random demand growth. We construct non-collusive Markovian equilibria where the firms’ decisions depend on the current capacity stock only. The firms maintain small reserve margins and high market prices, and extract large rents. In some equilibria, rationing occurs with positive probability, so the market mechanism does not ensure ‘security of supply’. Usually, the price cap reflects the value of lost energy or lost load (VOLL) that consumers place on severely reducing consumption on short notice. Our analysis identifies a minimum price cap, unrelated to the VOLL, that allows the firms to recoup their investment and production costs in equilibrium. However, raising the price cap above this minimum increases market prices and reduces consumer surplus, without affecting the level of investment.

Coarctation of the aorta treated with the Advanta V12 large diameter stent: Acute results

To report on the early results of treatment of coarctation of the aorta by dilation with a new polytetrafluoroethylene covered stent. Transcatheter dilation of aortic coarctation carries the risk of aneurysm or rupture. Covered stent implantation reduces this risk but requires a large delivery system. The Advanta V12 LD covered stent is premounted and requires a 9-11 Fr delivery system. Covered stents on balloons of a diameter sufficient to anchor the stent in the coarctation were implanted using the smallest available delivery system. Secondary dilation with larger diameter balloons was performed until the pressure gradient was <20 mm Hg and the stent was opposed to the aortic wall. Twenty-five patients with aortic coarctation underwent stent implantation. Coarctation diameter increased from (6.3 + or - 3.5) mm to (14.4 + or - 2.3) mm (P < 0.0001). Peak pressure gradient decreased from (25.3 + or - 11.6) mm Hg to (2.5 + or - 3.0) mm Hg (P < 0.0001). The stent achieved the desired diameter in all cases. There were no complications. At short-term median follow-up of 4.9 months, all patients are alive and well with no evidence of recoarctation or aneurysm. These initial results show that the covered Advanta V12LD stent is safe and effective in the immediate treatment of coarctation of the aorta through a low profile delivery system of 8-11 Fr. Long term follow up is required.

Stent Implantation for Coarctation of the Aorta in Children

Our aim was to determine key characteristics of stents commonly implanted in the aorta through bench testing and to describe our technique and acute results in patients weighing <30 kg. Despite the increasing use of stents for interventional treatment for coarctation of the aorta (CoA) in larger patients, use of large stents is controversial in small children. Methods included bench testing of large stents, and retrospective review of all patients over 1 year of age who had stent implantation for treatment of CoA. Patients were divided into 2 groups based on weight. Paired comparisons were made before and after stent implantation, and group outcomes were compared. Sixty patients comprised the entire sample, with 22 patients assigned to group I (<30 kg) and 38 patients assigned to group II (>or=30 kg). The mean minimum diameters of the CoA (group I 5.0 to 10.7 mm; group II 8.0 to 15.0 mm) and the ratio of the coarctation diameter to the descending aorta diameter measured at the level of the diaphragm (CoA/DAo ratio) (group I 0.4 to 0.93; group II 0.46 to 0.94) increased significantly in both groups (all p < 0.05). The mean systolic gradient decreased significantly in both groups (group I 23.0 to 2.0 mm Hg; group II 24.0 to 2.8 mm Hg; both p = 0.001). No difference was found between the groups in the CoA/DAo ratio, residual systolic gradients, or the decrease in systolic gradient after stent implantation. There were no significant complications in patients under 30 kg. As in larger patients, use of large stents for treatment of CoA in small children is effective and safe in the short term. In these patients, stent redilations will be required, and follow-up is ongoing.

Management of a patient with a large airway stent in situ

To the Editor, Bronchial stents are being placed more frequently for a diverse range of benign and malignant conditions. These patients may require non-pulmonary surgery and as a part of their preoperative assessment, consideration for displaced stents should be included in the planned airway management technique. We describe the case of a 55-yrold male who was scheduled for elective laparoscopic repair of a recurrent inguinal hernia. The patient’s medical history included a 30-pack year smoking history, recurrent purulent pneumonia, and bronchiectasis. He denied any current respiratory symptoms. Eleven years earlier, the patient underwent a rigid bronchoscopy which demonstrated a proximal left main bronchus stenosis secondary to chronic lingular adenopathy. Flexible bronchoscopy was performed, and two bare metal stents were deployed at the opening and in the proximal portion of the left mainstem bronchus. The patient did not return for follow-up of his bronchial stents. His physical examination was unremarkable, except for a few scattered crackles bibasally in his lung fields. A chest radiograph (Fig. 1) showed that the proximal stent appeared to be positioned at the opening of the left main bronchus and the distal stent at an angle of 30 to the first with some bibasal atelectasis. A lateral chest film demonstrated good antero-posterior alignment of the two stents. Because of the long duration between follow-up and the propensity for metallic stent migration and granulation tissue overgrowth, it was decided to proceed cautiously with flexible fibreoptic bronchoscopy. Following induction of anesthesia and confirmation of easy ventilation, endoscopic examination of the tracheo-bronchial tree demonstrated a proximally migrated stent with soft tissue overgrowth (Fig. 2). A size 7.5 cuffed tracheal tube was mounted on an intubating fibrescope and carefully advanced into position above the carina; bilateral chest ventilation was confirmed. Following uneventful surgery, a repeat endoscopic examination and chest X-ray revealed no movement of the stent or residual pneumothorax. The patient was referred to his respiratory physician for replacement of his bronchial stent. Fig. 1 Magnified postero-anterior (PA) chest radiograph showing left mainstem bronchial stents

Migration of Plastic Biliary Stents and Endoscopic Retrieval

Proximal or distal migration of a plastic biliary stent is uncommon, but its management can be a technical challenge to the pancreatobiliary endoscopist. All cases (n=51) of proximally and distally migrated plastic biliary stents over an 8-year period at 3 referral pancreaticobiliary centers were included in this retrospective study. Indications for stenting, risk factors for migration, presentation of migration, and various techniques used for stent's retrieval are herein analyzed. Twenty-one proximal and 30 distal bile duct-migrated stents were identified. All patients with proximally and 17 (56.7%) with distally migrated stents were symptomatic. Choledocholithiasis, dilated common bile duct, short and large size stent were the main risk factors. The retrieval of proximally migrated stents was successful in 15 patients (71.4%) and in all symptomatic patients with distal migration. The retrieval techniques included forceps, Dormia basket, snare, Soehendra stent retriever, and balloon. One patient died of sepsis due to peritonitis from duodenal perforation from a distally migrated stent. Retrieval of a proximally migrated stent requires experience with different endoscopic devices. Moreover, distal migration needs attention because it can cause severe complications.

Numerical Study of Shear-Induced Thrombus Formation Over Aterial Stent Struts

Thrombosis remains an important problem in both bare-metal and drug eluting stents. Platelet accumulation appears to be highly shear dependent in uniform parallel plate and stenosis models. This study was performed to evaluate thrombus formation location and size with respect to time for a stent. A three-dimensional laminar flow field was modeled via computational fluid dynamics through a stent-containing coronary sized vessel. Platelet deposition and accumulation was then simulated using a shear dependent accumulation function. The platelet deposition rate is given by the function: 3.2γ̇+67 platelets/mm2/s, where γ̇ is the shear rate, which comes from a linear regression to data presented in Ku and Flannery 2007. A three-dimensional stent with a helical strut matrix design and a pitch of 21 mm was designed around a 3 mm diameter vessel. Square strut designs of 0.15mm×0.15mm and 0.30mm×0.30mm were considered, with each strut embedded halfway into the vessel. A 30° section of the stent was modeled because of stent symmetry. The inlet was set at a mean Reynolds number of 200 by specifying a pressure differential across the length of the vessel. Thrombus growth based on shear rate was set through the equation: dΦ/dt=(3.2γ̇+67)(Vplatelet/V)∑n=0MAn. V is volume, Φ is the volume fraction of thrombus, M is the number of surrounding faces that are either a wall face or are neighboring a computational cell denoted as occluded by thrombus, associated with area, A. Each term without a subscript pertains to the local computational cell prescribed as undergoing thrombus growth. Thrombus cell occlusion was assumed to occur when thrombus filled 80% of the cell's volume. Maximum shear rates occur near the edges along the inner blood surface side of the stent struts. Thrombus growth increases more in the axial direction of the stent relative to the radial direction for the larger strut size. Conversely, the thrombus growth is more uniform in all directions along the smaller struts. The difference emanates from the two distinctly localized high shear contours near the edges of the larger stent struts, while the high shear regions were less distinct for the smaller strut size. Quadrupling the cross sectional area of a strut increases the initial maximum shear rate along the strut by 50%, in addition to doubling the available surface area for platelet deposition. Therefore, increasing strut size has a threefold effect on platelet deposition rate, leading to faster vessel occlusion. This computational technique may be extended to approximate where thrombus may grow to completely occlude a blood vessel and the length of time occlusion would take. The CFD modeling technique may also be used to evaluate thrombus deposition on medical devices such as heart valves and ventricular assist devices.

Anaesthesia for endobronchial intervention and tracheobronchial stents

There is an increasing use of large airway stents for non-malignant disease processes. As advances in stent development and manufacture are made, there are more patients being treated with airway stents. Stenting can be short term or long term and can be used for the management of large airway obstruction where surgery carries both morbidity and mortality. Pre-operative assessment is particularly important and may determine which of the wide range of techniques that have been used is most appropriate for the individual case. The anaesthetic management of patients with stents already in situ is becoming more important as the number of patients with stents increases. There are some specific pitfalls and problems associated with anaesthesia and these are reviewed.

Buying Peace? Oil Wealth, Corruption and Civil War, 1985—99

This article argues that, contrary to received wisdom, political corruption is not necessarily associated with a higher risk of civil war in oil-rich states. Political corruption can be used to accommodate opposition and placate restive groups by offering private privilege in exchange for political loyalty. Since oil wealth is associated with large rents accruing in state treasuries, it provides an economic foundation for such clientelist rule. This article thus argues that oil-rich governments can use political corruption to buy support from key segments of society, effectively outspending other entrepreneurs of violence. Based on a logit analysis of civil war onsets, 1985—99, the article finds support for this `co-optation argument'. A negative and statistically significant interaction term between oil production and political corruption is consistent across different models and robust to a number of specifications. While both variables per se increase the risk of conflict overall, higher levels of corruption seem to weaken the harmful impact of oil on the risk of civil war. This finding suggests the need for a more nuanced understanding of the relationship between natural resource wealth, governance and armed conflict. Political corruption has prolonged poverty and bred economic and political inequality in many oil-rich states, but it has also helped cement powerful alliances with a stake in the continuation of the corrupt regimes.

Takayasu's Arteritis Involving the Ostia of Three Large Coronary Arteries

Takayasu's arteritis can involve the ostia of coronary arteries. We report a patient with Takayasu's arteritis involving the ostia of three large coronary arteries who was successfully treated by percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) and had a good clinical outcome after 12 months. A 37-year-old male with unstable angina was admitted to our cardiovascular center. The patient had Takayasu's arteritis and an aortic valve replacement with a metallic valve due to severe aortic regurgitation 7 years previously. Coronary angiography (CAG) showed a 95% discrete eccentric luminal narrowing at the ostia of the large left anterior descending (LAD) and left circumflex (LCX) arteries, and a 99% discrete eccentric luminal narrowing at the ostium of the large right coronary artery (RCA). The patient was treated with prednisolone for 14 days. Two large paclitaxel-eluting stents (PES) were then implanted in the distal left main coronary artery using the kissing stent technique. After 6 months, a CAG did not reveal restenosis or recurrent coronary artery disease. Thus, PCI with a DES for patients with significant coronary involvement secondary to Takayasu's arteritis is an effective and an alternative treatment when coronary bypass grafting is not option.

Long-term benefit-risk balance of drug-eluting vs. bare-metal stents in daily practice: does stent diameter matter? Three-year follow-up of BASKET

To assess the long-term benefit-risk ratio of drug-eluting (DES) vs. bare-metal stents (BMS) relative to stent size. All 826 consecutive BASKET (BAsel Stent Kosten-Effektivitäts Trial) patients randomized 2:1 to DES vs. BMS were followed after 3 years. Data were analysed separately for patients with small stents (<3.0 mm vessel/<4.0 mm bypass grafts, n = 268) vs. only large stents (> or =3.0 mm native vessels, n = 558). Clinical events were related to stent thrombosis. Three-year clinical target-vessel revascularization rates remained borderline reduced after DES [9.9 vs. 13.9% (BMS), P = 0.07], particularly in patients with small stents (10.7 vs. 19.8%, P = 0.03; large stents: 9.5 vs. 11.5%, P = 0.44). Cardiac death/myocardial infarction (MI) rates (12.7 vs. 10.0%, P = 0.30) were similar, however, death/MI beyond 6 months was higher after DES [9.1 vs. 3.8% (BMS), P = 0.009], mainly due to increased late death/MI in patients with large stents (9.7 vs. 3.1%, P = 0.006). The results paralleled findings for stent thrombosis. The clinical benefit of DES was maintained at no overall increased risk of death or death/MI up to 3 years. However, death/MI rates were increased in DES vs. BMS patients beyond 6 months, particularly in patients with large stents, paralleling findings for stent thrombosis. Thus, stent size seems to influence the 3-year benefit-risk ratio after DES implantation.

Invited Commentary

The management of benign esophageal strictures begins with dilation, and depending on the cause of the stricture, often repeated dilations are necessary. When self-expanding metallic stents became available they were used for benign and malignant strictures until it became evident that the inflammation often induced by these stents and the difficulty or inability to remove them made them unsuitable for use in benign disease. The development of the Polyflex self-expanding, removable stent (Boston Scientific, Natick, MA) has once again made stenting an option for patients with benign strictures. The purpose of the study by Martin and colleagues [1Martin R.C.G. Woodall C. Duvall R. Scoggins C.R. The use of self-expanding silicone stents in esophagectomy strictures: less cost and more efficiency.Ann Thorac Surg. 2008; 86: 436-440Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar] was to compare the efficacy and cost associated with repeat dilations versus Polyflex stent placement in patients with a benign stricture. The majority of strictures were at the esophagogastric anastomosis after an esophagectomy, but a number of other causes were also represented. They concluded that early stenting was more cost effective, provided that at least two dilations were avoided. An important issue with removable stents has been migration. In the series reported here by Martin and colleagues [1Martin R.C.G. Woodall C. Duvall R. Scoggins C.R. The use of self-expanding silicone stents in esophagectomy strictures: less cost and more efficiency.Ann Thorac Surg. 2008; 86: 436-440Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar], migration occurred in only 1 patient 2 days after placement. They replaced the migrated stent with a larger one and had no further difficulty. The authors attributed this low rate of migration to the use of a large diameter and long stents. Furthermore, they positioned the stent as high up in the esophagus as possible while still traversing the stricture in patients with esophago-anastomotic strictures in which stent migration has been a particular problem. These results certainly support the use of a Polyflex stent in any patient in which repeated dilations are likely to be necessary. However, an option the authors failed to discuss is the use of home self-dilation by patients. This is a very effective technique for the management of benign strictures, particularly an esophagogastric anastomotic stricture, and undoubtedly it would be more cost effective than either repeated endoscopic dilations or stent placement. In my own practice, this if the preferred approach for proximal esophageal strictures in which Polyflex stent migration is more likely to occur. Most patients can be quickly taught the technique of self-dilation and are sent home with an appropriate-sized (usually 52-French) Maloney dilator with instructions to dilate themselves first thing in the morning on a tapered schedule, such that the majority of patients no longer need dilation after 6 to 8 weeks. They then return the bougie. I have never had a patient who had a complication or perforation from self-dilation, and it is surprisingly well accepted by patients and their families. Teaching self-dilation to a patient takes 15 to 30 minutes, roughly similar to the time it takes to insert a stent; there is no added time for subsequent stent removal, and no need for sedation or fluoroscopy. Certainly the development of removable self-expanding stents has expanded our treatment options for patients with benign strictures. If these excellent results and low migration rates as reported by Martin and colleagues [1Martin R.C.G. Woodall C. Duvall R. Scoggins C.R. The use of self-expanding silicone stents in esophagectomy strictures: less cost and more efficiency.Ann Thorac Surg. 2008; 86: 436-440Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar] are confirmed by others, then early stenting should be able to replace repeated endoscopic dilations. Future studies that compare stenting with home self-dilation, and studies that identify factors predictive of the need for more than two dilations, will help optimize the cost-effective and successful management of patients with benign esophageal strictures.

Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions

Objectives: To define long-term efficacy of different stent types in saphenous vein graft (SVG) interventions. Methods: In BASKET (Basel Stent Cost Effectiveness Trial), major adverse cardiac events (MACE), i.e. cardiac death, myocardial infarction and symptom-driven target vessel revascularization (TVR) were assessed after 18 months comparing drug-eluting stents (DES) versus bare metal stents (BMS), and SVG and large native vessels (≧3.0 mm). Results: Large vessel interventions were performed in 605 patients. Patients with SVG interventions (n = 47, 8%) were older and had more often hypertension, prior myocardial infarction, prior revascularization and multivessel disease and less frequent ST-elevation myocardial infarction than patients with large native vessel interventions (n = 558, 92%). Stent number and length were higher in SVG than in large native vessel interventions. Baseline characteristics were similar for DES and BMS. In SVG stenting, long-term outcome was better in DES- than in BMS-treated patients (MACE 21 vs. 62%, p = 0.007, mainly due to TVR 18 vs. 46%, p = 0.045), but for large native vessel stenting, no significant difference was noted (MACE: 13 vs. 16%, p = 0.40). Conclusions: Among patients with SVG disease, treatment with DES resulted in a better long-term outcome than treatment with BMS. In contrast, no DES benefit was found in similarly sized native vessels regarding MACE.

Usefulness of multislice computed tomography to assess patency of coronary artery stents versus conventional coronary angiography

The aim of the present study was to assess the in-stent restenosis and occlusion of coronary artery stents by multislice computed tomography (MSCT) compared with conventional coronary angiography in patients with atypical chest pain and not practicable/non-conclusive stress test. Between December 2004 and March 2006, 81 patients were scheduled and of these 72 (65 men, mean age 61 years) with 90 stents underwent MSCT angiography using a 16-slice scanner, Toshiba Aquilion 16, 8-12 months after stent placement. Of the 90 stents, 71 (79%) could be assessed and 19 (21%) were excluded because the image quality at the stent level was incompatible with diagnostic assessment. This results in sensitivity, specificity, and positive and negative predictive values for all assessable stents in the identification of occlusion and/or in-stent restenosis of 82, 96, 87, and 94%, respectively. When the 19 uninterpretable stents were included in the analysis, the diagnostic accuracy of MSCT in detecting in-stent restenosis and occlusion resulted in a sensitivity of 82%, specificity of 71%, positive predictive value of 40%, and negative predictive value of 94%. The results of the study suggest that MSCT angiography is a useful method for evaluating patency/occlusion of large (>or=3 mm) coronary stents in symptomatic patients with atypical chest pain and concomitant not practicable/non-conclusive exercise or stress imaging test.

3 Fr Prophylactic Pancreatic Stent: What Is the Optimal Stent Length?

Background & Aims: Pancreatic stenting is an effective method to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients. In a prior study, we reported that small diameter (3Fr), unflanged 6-8 cm pancreatic stents are more effective than larger stents (5-6F) in preventing PEP in high risk settings (Clinical Gastroenterol Hepatol; 2004, 2:322-9); but approximately 12-15% required endoscopic removal. To hopefully improve the spontaneous migration rate, we initiated a new policy by placing a 4 cm 3Fr stent for PEP prophylaxis.

Drug-eluting or bare-metal stents for large coronary vessel stenting? The BASKET-PROVE (PROspective Validation Examination) trial: Study protocol and design

Based on a subgroup analysis of 18-month BAsel Stent Kosten Effektivitäts Trial (BASKET) outcome data, we hypothesized that very late (> 12 months) stent thrombosis occurs predominantly after drug-eluting stent implantation in large native coronary vessel stenting. To prove or refute this hypothesis, we set up an 11-center 4-country prospective trial of 2260 consecutive patients treated with > or = 3.0-mm stents only, randomized to receive Cypher (Johnson & Johnson, Miami Lakes, FL), Vision (Abbott Vascular, Abbott Laboratories, IL), or Xience stents (Abbott Vascular). Only patients with left main or bypass graft disease, in-stent restenosis or stent thrombosis, in need of nonheart surgery, at increased bleeding risk, without compliance/consent are excluded. All patients are treated with dual antiplatelet therapy for 12 months. The primary end point will be cardiac death/nonfatal myocardial infarction after 24 months with further follow-up up to 5 years. By June 12, 229 patients (10% of the planned total) were included with a baseline risk similar to that of the same subgroup of BASKET (n = 588). This study will answer several important questions of contemporary stent use in patients with large native vessel stenting. The 2-year death/myocardial infarction-as well as target vessel revascularization-and bleeding rates in these patients with a first- versus second-generation drug-eluting stent should demonstrate the benefit or harm of these stents compared to cobalt-chromium bare-metal stents in this relevant, low-risk group of everyday patients. In addition, a comparison with similar BASKET patients will allow to estimate the impact of 12- versus 6-month dual antiplatelet therapy on these outcomes.

Endovascular stenting of large popliteal artery aneurysm is feasible!

Endovascular stenting has been successfully employed in management of aortic aneurysms; however, its utility in managing popliteal aneurysms remains questionable. This is because of the non-availability of long term data about graft patency rates. We report a case of large popliteal artery aneurysm stenting in a patient with significant co-morbidities and high risk for open surgical repair. He underwent successful endovascular stenting of a popliteal artery aneurysm measuring 6.4x9.7 cm extending for approximately 11.0 cm in length with Hemobahn grafts. The graft was patent at 12 months of follow up with complete exclusion of the aneurysm. Popliteal stents can be successfully used in treating large popliteal artery aneurysms in patients unfit for open repair.

Early and mid‐term results with the growth stent—A possible concept for transcatheter treatment of aortic coarctation from infancy to adulthood by stent implantation?

Evaluation of the Growth Stent-a stent consisting of two stent halves connected by reabsorbable sutures-for the treatment of aortic coarctation in infants. Surveillance study of 13 Growth Stents implanted in 12 patients aged 1-15 months (median 5 months). Body weight ranged from 3.4-12.8 kg (median 5.4 kg). Eight patients suffered from aortic (re-)coarctation, four of them from stenosis of the aortic anastomosis after a Norwood I procedure. The follow-up period was 24 months (11-51 months). Pressure gradients immediately after stent implantation decreased from 30 mm Hg (range 20-50 mm Hg) to 8 mm Hg (range 0-15 mm Hg). Five patients had one (3 pts) or two (2 pts) balloon dilations 3-28 months (median 12 months) after Growth Stent implantation. The median pressure gradient decreased from 25 mm Hg (range 15-30 mm Hg) to 15 mm Hg (range 5-25 mm Hg). Six patients received a large stent after 19-34 months. Median body weight was 11.8 kg (9.4-15 kg). The Growth Stent is suitable for the acute treatment of aortic coarctation in infants and can be overstented later on--if necessary--with a larger stent without causing restriction.