Metal Stent Implantation Research Articles

Long-term results of endovascular treatment of patients with coronary heart disease using various PCI technologies

Objective: the effectiveness and safety of endovascular treatment of coronary artery disease in coronary artery disease using various technologies of percutaneous coronary intervention (PCI) was evaluated — implantation of drug-coated metal stents, implantation of bioresorbable stenting scaffolds, the use of drug-coated coronary balloon catheters in the long- term period, 10 years after PCI.Materials and methods: data obtained from 324 patients with coronary heart disease after PCI using the previously mentioned treatment methods. The endpoint was the loss of the target vessel lumen (TLF), a combination of cardiac death, myocardial infarction, and revascularization associated with the target vessel.Results: the treatment of patients with coronary heart disease using implantation of drug-coated metal stents, bioresorbable stenting scaffolds or drug-coated coronary balloon catheters is safe and has low rates of cardiac mortality, myocardial infarction and revascularization of the target vessel in the long term. In cases where implantation of stents or scaffolds was contraindicated or impossible due to the small diameter of the artery, diffuse extended lesion and high risk of restenosis, angioplasty with a coronary balloon catheter with an antiproliferative drug coating takes place, showing positive long-term results.

Role of early increase in vascular endothelial growth factor-A levels after coronary stenting in the development of drug-eluting in-stent restenosis

The introduction of drug-eluting stents (DES) into clinical practice has led to a significant reduction in the incidence of in-stent restenosis (ISR) compared to implantation of bare metal stents. However, in 2-4% of cases, the development of angiographic restenosis is observed. Vascular Endothelial Growth Factor-A (VEGF-A) promotes early endothelialization of the stented segment, but in some cases can promote progressive neointimal growth due to proinflammatory effects.Aim. To evaluate the influence of plasma VEGF-A level on ISR after DES implantation.Material and methods. We prospectively examined 49 patients who were implanted with DES due to stable coronary artery disease with ischemia-related arterial stenosis >70% according to a stress test, as well as with a fractional flow reserve <0,8. Plasma VEGF-A level was assessed immediately before the procedure and 24 hours after it. The follow-up period was 11±4 months from the moment of intervention. Subsequently, all study participants underwent repeated coronary angiography to determine whether they had angiographic ISR and to identify patients at risk of recurrent angina pectoris. In 9 patients (18% of participants), angiographic ISR was recorded in the long-term period.Results. The groups of patients with and without long-term restenosis were comparable in terms of initial VEGF-A levels: 481 (259; 674) and 560 (339; 766) pg/ml, respectively (p>0,05). Within 24 hours after stent implantation, a significant increase in VEGF-A level was found in patients who subsequently demonstrated angiographic ISR as follows: from 476 (267; 602) to 1117 (1089; 1573) pg/ml (p<0,05). A positive moderate correlation was established between the plasma VEGF-A content 24 hours after stent implantation and angiographic ISR in the long-term period (r=0,55; p<0,001).Conclusion. Initial plasma VEGF-A levels are not associated with angiographic ISR. Moreover, a sharp increase in VEGF-A level f within 24 hours after coronary stenting is associated with drug-eluting ISR.

X-ray-guided self-expandable metal stent (SEMS) implantation in oesophageal malignancy as an alternative treatment.

<b><br>Indroduction:</b> Significant dysphagia, aspiration pneumonia, and impossible oral nutrition in patients with unresectable or recurrent gastroesophageal malignancy or bronchial cancer invading the oesophagus with a tracheoesophageal fistula lead to cachexia. Dehiscence of the esophago-jejunal or gastroesophageal anastomosis may cause severe oesophageal haemorrhage. We believe that X-ray-guided oesophageal stent implantation (SEMS) is an alternative palliative method for microjejunostomy or full parenteral nutrition.</br> <b><br>Aim:</b> The aim of this paper was to assess the safety and efficacy of a novel X-ray-guided oesophageal stent implantation technique.</br> <b><br>Materials and methods:</b> This retrospective analysis included 54 patients (35 men and 19 women) treated for malignant dysphagia, gastroesophageal/gastrointestinal anastomotic fistula or bronchoesophageal fistula in two Surgical Units between 2010 and 2019, using a modified intravascular approach to oesophageal stent implantation.</br> <b><br>Results:</b> The presented modified intravascular method of oesophageal stent implantation was successfully performed in all described patients requiring oral nutrition restoration immediately following oesophageal stent implantation. Two patients with oesophageal anastomotic dehiscence died on postoperative days 7 and 9 due to circulatory and respiratory failure. One patient was reimplanted due to a recurrent fistula. Two patients with ruptured thoracic aneurysm and thoracic stent graft implantation due to oesophageal haemorrhage, who were implanted with an oesophageal stent, died on postoperative days 4 and 14.</br> <b><br>Conclusions:</b> The modified intravascular X-ray-guided SEMS technique may be a palliative treatment for patients with unresectable oesophageal malignancies.</br&gt.

The Influence of Myocardial Revascularization on the Condition of the Distal Part of Coronary Arteries in Patients with Type 2 Diabetes Mellitus

The aim. To study the dynamics of the internal lumen of the distal part of coronary arteries after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus
 Materials and methods. This retrospective study included 121 patients with coronary artery disease and type 2 diabetes mellitus after revascularization of coronary arteries through PCI or CABG. In order to evaluate the changes in the condition of the distal sections of the coronary arteries after stenting and CABG, we included patients with type 2 diabetes mellitus in whom repeated coronary angiography was performed 12-60 months after PCI or CABG. The quantitative method (quantitative coronary angiography) and semi-quantitative assessment scales were used to assess the dynamics of the distal part of the coronary arteries.
 Results. The mean age of the patients was 56.2 ± 0.4 years for patients who underwent CABG and 54.3 ± 0.4 years for patients who underwent PCI. There were 64.7% men in the CABG group and 54.0% in the PCI group. The use of drug-eluting stents didn’t affect the internal lumen of the distal part of the arteries. After implantation of bare metal stents, progression of diffuse atherosclerotic lesions was detected. The use of arterial grafts during CABG improved the condition of the inner lumen of the bypassed vessel. However, after venous grafts placement, the patency of the distal coronary arteries may deteriorate in the future.
 Conclusions. In people with type 2 diabetes mellitus and coronary artery disease, after cardiac surgery, the smaller branches of the blood vessels can become narrower over the next 1-5 years if a stent without medication or a vein graft is used. However, when a drug-eluting stent or an artery graft is used, the smaller vessel branches stay about the same or even improve over time.

Research progress of drug eluting balloon in arterial circulatory system.

The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.

Metallic Stents for Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplantation and their Therapeutic Effects

Living-donor liver transplantation (LDLT) is established as a standard therapy for end-stage liver disease; however, vessel reconstruction is more demanding due to the short length and small size of the available structures compared with deceased-donor whole liver transplantation. Interventional radiology (IR) has become the first-line treatment for vascular complications after LDLT. Hepatic venous outflow obstruction (HVOO) is a life-threatening complication after LDLT. The aim of this study of 592 adult-to-adult LDLT cases was to investigate the safety and efficacy of stent implantation for HVOO after LDLT. Records of patients who developed HVOO requiring any treatment were collected with special reference to the metallic stent implantation. There were 232 left-side grafts and 360 right-side grafts. Sixteen cases developed HVOO after LDLT with an incidence rate of 2.7%, 5 with a left liver graft (2%), and 11 with a right-side graft (3%). The IR was attempted for 14 cases; among those, 8 cases were treated by stent implantation. The technical success rate of the initial stent implantation was 100%. The pressure gradient at the stenotic site significantly improved from 12.2 (range, 10.9-20.4 cm H2O) to 3.9 cm H2O (range, 1.4-8.2 cm H2O; P=.03). The volume of the congested graft liver decreased significantly from 1448 (range, 788-2170 mL) to 1265 mL (range, 748-1665 mL; P=.01), and the serum albumin level improved significantly from 3.3 (range, 1.7-3.7 g/dL) to 3.7 g/dL (range, 2.9-4.1 g/dL; P=.02). No procedure-related complication was noted, and the long-term stent patency was 100%. Metallic stent implantation for stenotic venous anastomosis after LDLT is a safe and effective treatment.

Colonic stent as a bridge to surgery versus emergency rection for malignant left-sided colorectal obstruction: A systematic review and meta-analysis of randomized controlled trials.

The role of self-expanding metal stent (SEMS) implantation as a bridge to surgery in malignant left-sided colorectal obstruction (MLCO) remains controversial. To evaluate the safety of SEMS implantation versus emergency surgery (ER) in the treatment of MLCO. Four major literature databases (Cochrane Library, Embase, PubMed, and Web of Science) were searched to collect articles published before April 20, 2023. After determining random or fixed-effect models based on heterogeneity tests, odds ratios (RR) or standardized mean differences (SMD) with their respective 95% confidence intervals (CI) were calculated. Nineteen randomized controlled studies were included. The main outcomes included overall tumor recurrence rate, 30-day mortality rate, and overall incidence of complications. Secondary outcomes included mortality-related indicators, tumor recurrence-related indicators, surgery-related indicators, and other relevant indicators. The study found that there was no significant difference in the 30-day mortality rate between the SEMS group and the er group. However, the SEMS group had a lower overall incidence of complications (RR = 0.787, P = .004), lower incision infection rate (RR = 0.472, P = .003), shorter operation time (SMD = -0.591, P = .000), lower intraoperative blood loss (SMD = -1.046, P = .000), lower intraoperative transfusion rate (RR = 0.624, P = .021), lower permanent stoma rate (RR = 0.499, P = .000), lower overall stoma rate (RR = 0.520,P = .000), shorter hospital stay (SMD = -0.643, P = .014), and more lymph node dissections during surgery (SMD = 0.222, 95% CI: 0.021-0.423, P = .031), as well as a higher primary anastomosis rate (RR = 0.472, 95% CI: 0.286-0.7 77, P = .003), among other advantages. However, the SEMS group had a higher overall tumor recurrence rate (RR = 1.339, P = .048). SEMS has significant advantages over er in relieving clinical symptoms and facilitating postoperative recovery in MLCO, but does not reduce the tumor recurrence rate. Neoadjuvant chemotherapy combined with SEMS may provide a new approach to the treatment of MLCO.

Abstract 16581: Impact of Drug Eluting Stent Deployment and Calcification on Worsening Target Lesion Failure in Femoropopliteal Lesions

Introduction: Endovascular therapy (EVT) with drug coated balloon (DCB) has been proven superior to balloon angioplasty only in the patency rate. EVT with drug eluting stent (DES) also has shown to be superior to balloon angioplasty only or implantation of bare metal stents. Primary patency of EVT in femoropopliteal lesions (FP-EVT) for DES and DCB is around 80%-90% at 12 months respectively. Therefore, the use of drug technology for FP-EVT is reasonable and generally accepted. However, in daily clinical practice, some target lesion failure (TLF) cases show worse clinical and/or angiographic conditions than the original before the intervention, and many of those cases have bad outcomes. There are no reports on predictors of the worse condition. Methods: A total of 292 consecutive FP lesions of 194 patients who visited our hospital from April 2017 to March 2021 and underwent FP-EVT with drug technologies (DES: 104, DCB: 188) were retrospectively reviewed. "Worsening target lesion failure (WTLF)" was defined as TLF with acute limb ischemia symptom or occlusion of the lesion which had been stenosis at the initial treatment. We investigated the predictor of WTLF. Results: The mean age of all study patients was 72.5±9.3 years and 68% were male. During the follow-up period (median: 568 days), 13 WTLFs were observed. 9 (8.7%) cases were treated with DES and 4 (2.1%) were with DCB at the initial treatment (p=0.01). Cases with WTLF had severer and longer calcification (bilateral calcification: 84.6% vs. 47.7%, p=0.007; calcium length: 162±74mm vs. 85±11mm, p=0.005). Multivariate Cox regression analysis indicated that DES use (Hazard ratio (HR)=4.66, 95% confidence interval [1.28-16.92], p=0.046) and bilateral calcification (HR=7.21, [1.04-50.14], p=0.020) were independently associated with the occurrence of the WTLF. The prevalence of composite outcome, major amputations and all cause deaths, was 54% in the group with WTLF, which was higher than the group without WTLF (p=0.02). Conclusions: Patients with WTLF had bad outcomes. Bilateral calcification and DES deployment were associated with an increased risk for WTLF. For stenotic lesions with bilateral calcification, it may be better to avoid DES deployment.

Application of metal stent implantation with endoscope and X-ray fluoroscopy combined laparoscopic surgery in the treatment of acute left hemicolon cancer obstruction

BackgroundThis study aimed to conduct a case–control study of endoscopic and fluoroscopic metal stent placement combined with laparoscopic surgery versus conventional open Hartmann’s procedure in treating acute left-sided colon cancer obstruction. Additionally, the study aims to discuss the application value of endoscopic and X-ray-guided metal stent placement combined with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction.MethodsFrom June 2011 to December 2019, 23 patients with acute left-sided colon cancer obstruction who underwent metal stent implantation combined with laparoscopic surgery under endoscopy and X-ray fluoroscopy in Wenzhou Central Hospital were collected, and 20 patients with acute left-sided colon cancer obstruction who underwent traditional emergency open Hartmann’s surgery during the same period were selected as a control group. All patients were diagnosed with left colon obstruction by plain abdominal film and/or CT before the operation and colon adenocarcinoma by colonoscopic biopsy and/or postoperative pathology. The operation time, intraoperative blood loss, postoperative anal exhaust time, the success rate of one-stage anastomosis, postoperative hospital stay, and postoperative complications were compared between the two groups.ResultsThis study showed a significant difference in the therapeutic effect between the two groups. Compared with the traditional Hartmann’s operation group, the success rate of one-stage anastomosis in endoscopic and X-ray-guided metal stent placement combined with the laparoscopic operation group was significantly higher than that in the Hartmann’s operation group (P < 0.05). The overall incidence of postoperative complications and hospital stay were significantly lower in the observation group than in the Hartmann’s group (P < 0.05). Further subgroup analysis of the overall postoperative complication rate of the two groups showed that the traditional Hartmann’s operation group was more likely to have an incomplete intestinal obstruction (P < 0.05). This study also showed no significant differences between the two groups in operation time, intraoperative blood loss, number of harvested lymph nodes, and postoperative anal exhaust time (all P > 0.05). This study also found no significant differences between the two groups in overall survival rates or recurrence-free survival rates (all P > 0.05).ConclusionsThe comparison of the therapeutic effects of the two groups verified the feasibility of endoscopy combined with X-ray fluoroscopy metal stent placement in combination with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction. Compared with the traditional emergency open Hartmann’s procedure, metal stent implantation under endoscopy and X-ray fluoroscopy combined with laparoscopic surgery is more minimally invasive, safe, and effective. It avoids the traditional second or even third surgical trauma to effectively improve the quality of life of patients, so that patients can recover quickly after surgery.

Meta-analysis of outcomes from drug-eluting stent implantation in infrapopliteal arteries.

Percutaneous drug-eluting stent implantation (DESI) is an emerging and promising treatment modality for infrapopliteal artery diseases (IPADs). This systematic review and meta-analysis summarizes and quantitatively analyzes the outcomes of DESI in IPADs considering the hazard ratio (HR), which is a more accurate and appropriate outcome measure than the more commonly used relative risk and odds ratio. To explore the superiority of drug-eluting stents (DESs) vs traditional treatment modalities for IPADs. The following postoperative indicators were the outcomes of interest: All-cause death (ACD)-free survival, major amputation (MA)-free survival, target lesion revascularization (TLR)-free survival, adverse event (AE)-free survival, and primary patency (PP) survival. The outcome measures were then compared according to their respective HRs with 95% confidence intervals (CIs). The participants were human IPAD patients who underwent treatments for infrapopliteal lesions. DESI was set as the intervention arm, and traditional percutaneous transluminal angioplasty (PTA) with or without bare metal stent implantation (BMSI) was set as the control arm. A systematic search in the Excerpta Medica Database (Embase), PubMed, Web of Science, and Cochrane Library was performed on November 29, 2022. All controlled studies published in English with sufficient data on outcomes of interest for extraction or conversion were included. When studies did not directly report the HRs but gave a corresponding survival curve, we utilized Engauge Digitizer software and standard formulas to convert the information and derive HRs. Then, meta-analyses were conducted using a random-effects model. Five randomized controlled trials and three cohort studies involving 2639 participants were included. The ACD-free and MA-free survival HR values for DESI were not statistically significant from those of the control treatment (P > 0.05); however, the HR values for TLR-free, AE-free, and PP-survival differed significantly [2.65 (95%CI: 1.56-4.50), 1.57 (95%CI: 1.23-2.01), and 5.67 (95%CI: 3.56-9.03), respectively]. Compared with traditional treatment modalities (i.e., PTA with or without BMSI), DESI for IPADs is superior in avoiding TLR and AEs and maintaining PP but shows no superiority or inferiority in avoiding ACD and MA.

Observation of the efficacy of autologous mucosal transplantation to prevent esophageal stricture after near-circumferential endoscopic submucosal dissection for early esophageal cancer

Objective: To investigate the efficacy of autologous mucosal transplantation to prevent esophageal stricture after near-circumferential endoscopic submucosal dissection (ESD) for early esophageal cancer. Methods: The case data of 33 patients, who underwent near-circumferential ESD for early esophageal cancer and were followed up regularly in the First Affiliated Hospital of Zhengzhou University from April 2017 to July 2022, were analyzed retrospectively, including 14 males and 19 females, aged (66.4±7.4) (47-77) years. According to the different treatment methods, they were divided into 4 groups: group A (6 cases) were treated with autologous mucosa transplantation and fully covered metal stent implantation, combined with oral, intravenous and local injection of hormone; Group B (8 cases) were treated with autologous mucosa transplantation and fully covered metal stent implantation; Group C (11 cases) were treated with fully covered metal stent implantation combined with oral or intravenous hormone; Group D (8 cases) were treated with fully covered metal stent implantation. After the operation, the growth of the transplanted mucosa, esophageal stricture and surgical complications were observed by endoscopy, so as to understand the efficacy of automucosa transplantation in preventing esophageal stricture after near-circumferential ESD for early esophageal cancer. Results: The gastroscopic operation was successful in 33 patients. The times of expansion in groups B, C and D were more than that in group A, and the times of expansion [M(Q1,Q3)] in group A were 0(0, 1.8) times, while the times of expansion in group B, C and D were 5.5(4.3, 6.8), 4.0(4.0, 7.0) and 5.5(3.5, 10.8) times, respectively, with statistical significance (all P<0.05). There was no significant difference in times of expansion among groups B, C and D (all P>0.05). The stent placement time [M(Q1,Q3)] in group B [7.5(6.3, 8.8) days] was shorter than that in group A [64.5(41.5, 75.5) days] (P=0.006). There was no significant difference in stent placement time between group C [38.0(28.0, 50.0) days] and group D [31.5(27.3, 66.3) days] and group A (both P>0.05). The stent placement time in group C was longer than that in group B (P<0.05).There was no significant difference in stent placement time between group B, C and D (all P>0.05). There was no significant difference in the incidence of complications among the groups (all P>0.05). Conclusions: Autologous mucosal transplantation is safe and effective in preventing stenosis after near-circumferential ESD for early esophageal cancer. The effect of autologous mucosal transplantation combined with fully covered metal stent placement, systemic and local steroid application in preventing esophageal stricture after near-circumferential ESD for early esophageal cancer is better than that of single application.

Acute Coronary Syndrome after Percutaneous Coronary Intervention: State of the Problem and Clinical Practice Data

Aim. To study the prevalence, clinical and endovascular predictors, causes and timing of the development of acute coronary syndrome (ACS) in patients who had previously undergone percutaneous coronary intervention (PCI), as well as the clinical features of the disease and lipid spectrum parameters.Material and methods. The prospective study included 768 patients successively hospitalized from 01.01.2019 to 01.01.2020 in the Regional cardiovascular center, undergoing to emergency coronary angiography.Results. The main group included 768 patients who underwent emergency coronary angiography for ACS. 90 of them had previously undergone PCI (11.7%). Men prevailed (66.7%), the average age was 62 years. 25.5% of patients underwent ACS within a year after coronary stenting, the mean time from PCI to ACS was 43 months. Most often, there was ACS without ST segment elevation (80%). The results of a retrospective analysis of the first PCI showed that 89.7% of patients underwent urgent PCI, 77.8% of patients received bare metal stents. In 67.1% of patients, 1 stent was implanted, the average diameter was 3.2 mm, the average length was 22 mm. Thromboaspiration was performed in 12% of cases, predilatation in 25%, and NC postdilation in 41.3% of cases. Complications of PCI developed in 9% of patients. Stent thrombosis was diagnosed in 7.8% of cases, significant restenosis in 35.6%. Repeated stenting due to ACS was performed in 64.4% of patients, of which 74.6% received 1 stent; average diameter 3.4 mm, average length 24.0 mm. Predilatation was performed in 52.9% of cases, thromboaspiration – in 41.2%, and NC-postdilation – in 86.7% of cases. Complications of PCI developed in 10%. In addition, 99% of patients had significant dyslipidemia. The average cholesterol level was 4.91 mmol/L, the average low-density lipoprotein level was 2.94 mmol/L.Conclusion. Patients after PCI are 12% of group with ACS in clinical practice of the Regional Vascular Center. The most common predictor of recurrent atherothrombotic events is bare metal stent implantation as well as dyslipidemia.

Bending the distal tip of a guidewire aids in cannulation of an occluded uncovered biliary metal stent.

Biliary metal stent implantation is an effective treatment for malignant obstructive jaundice. But it's well known that stents put in for a long time can become occluded and cause jaundice and cholangitis. At this time, endoscopic intervention is usually required to replace the stent or re-insert the stent. Re-cannulation for metal stent occlusion is challenging because the guide wire may pass through the side holes of the uncovered metal stents, resulting in prolonged surgical time and exposure to radiation. Here we present a small tip that may help endoscopists complete the re-cannulation of an uncovered metal stent in a very short time.

The Increased Ischemic Risk During the Early Period After Clopidogrel Noncompliance in Patients with Acute Coronary Syndrome: A Meta-Analysis.

Although dual antiplatelet therapy for secondary prevention in acute coronary syndrome (ACS) is highly recommended by current guidelines, P2Y12 inhibitor non-adherence often occurs and devastates prognosis. To evaluate whether the ischemic risk during the early period of clopidogrel noncompliance was increased among ACS patients, a comprehensive search of PubMed, Embase, and Web of Science was conducted to identify studies reporting early ischemic risk after clopidogrel noncompliance in ACS patients. The primary endpoint was a composite of death or myocardial infarction (MI). Effect sizes were synthesized in patients with or without revascularization. A total of 7 observational studies focusing on clopidogrel noncompliance were included in this meta-analysis, whereas no studies involving ticagrelor or prasugrel were retrieved. A significantly increased risk of death or MI 0 to 90 days after clopidogrel noncompliance was found compared with that during 90 to 180 or 90 to 360 days regardless of revascularization (incidence rate ratio [IRR]: 2.01, 95% confidence interval (CI): 1.62-2.49, P < .001, I2 = 9%) or not (IRR: 1.61, 95% CI: 1.05-2.48, P < .001, I2 = 74%). Patients undergoing percutaneous coronary intervention had a higher risk of death or MI 0 to 90 days after clopidogrel noncompliance compared with 90-180 or 90-360 days irrespective of drug-eluting stent or bare metal stent implantation (P < .05 for both). The early ischemic risk after clopidogrel noncompliance is significantly higher than the late risk in ACS patients. Antiplatelet noncompliance remains a serious concern.

Conservative management of Boerhaave’s syndrome: a case report

The management of esophageal perforation has evolved. The underlying principles of drainage of sepsis, adequate nutrition and repair, or defunctioning of the esophagus remain. We are presenting a case of Boerhaave syndrome, where we have successfully managed conservatively with endoscopic stenting. Endoscopic therapy and VATS are used with increasing frequency and in appropriately selected patients with good results. Careful selection of patients for such procedures are important. Implantation of self-expanding metallic stent in patients with esophageal leak or perforation is a safe and feasible alternative to operative treatment and can lower the interventional morbidity rate.

Design and application of a new type of biliary-intestinal nutrient tube

The establishment of a nutritional pathway is the premise and basis of nutritional therapy for patients with malignant tumor. The nasogastric tube, nasoenteric tube, and percutaneous endoscopic gastric/jejunostomy are commonly used clinical pathways for enteral nutrition (EN) therapy. However, these EN pathways are often difficult to establish in patients with malignant obstructive jaundice (MOJ) with pyloric or duodenum primary obstruction. For this reason, a new type biliary-intestinal nutrient tube placed through percutaneous transhepatic cholangiography drainage (PTCD) pathway was designed by the medical staff of hepatobiliary surgery department of Yinchuan First People's Hospital, and National Utility Model Patent of China were obtained (ZL 2020 2 0283951.5, ZL 2020 2 0288938.9). The new biliary-intestinal nutrient tube has two types: double-lumen tube and single-lumen tube, which consists of tube head, tube body, tail ring and developing ring. The double lumen tube realizes bile internal drainage and EN simultaneously through the double lumen structure of the tube body. The single-lumen tube is used for nutrient infusion after bile duct metal stent implantation, which is not limited by the type of nutrient solution. The tail ring of the two types of nutrient tube is placed in the upper jejunum to reduce retrograde infection and unexpected extubation. Compared with the prior art, the utility model has the advantages of simple structure, reasonable design, safe and effective placement through PTCD pathway, and opens up a new EN path for MOJ patients.

Clinical outcomes of suboptimal stent deployment as assessed by optical coherence tomography: long-term results of the CLI-OPCI registry.

Intraprocedural optical coherence tomography (OCT) is a valuable tool for guidance of percutaneous coronary intervention, but long-term follow-up data are lacking. The aim of this study was to address the long-term (7.5 years) clinical impact of quantitative OCT metrics of suboptimal stent implantation. This retrospective study includes 391 patients with long-term follow-up (mean 2,737 days; interquartile range 1,301-3,143 days) from the multicentre Centro per la Lotta contro l'Infarto - Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) registry. OCT-assessed suboptimal stent deployment required the presence of at least one of the following pre-defined OCT findings: in-stent MLA <4.5 mm2, proximal or distal reference lumen narrowing with lumen area <4.5 mm2, significant proximal or distal edge dissection width ≥200 μm. One hundred and two patients (26.1%) with 138 stented lesions (27.7%) experienced a device-oriented cardiovascular event (DOCE). In-stent MLA <4.5 mm2 (38.1% vs 19.8%, p<0.001), in-stent lumen expansion <70% (29.5% vs 20.3%, p=0.032), proximal reference lumen narrowing <4.5 mm2 (6.5% vs 1.4%, p=0.004), and distal reference lumen narrowing <4.5 mm2 (12.9% vs 3.6%, p=0.001) were significantly more common in the DOCE vs non-DOCE group. OCT-assessed suboptimal stent deployment was an independent predictor of long-term DOCE (HR 2.17, p<0.001), together with bare metal stent implantation (HR 1.73, p=0.003) and prior revascularisation (HR 1.53, p=0.017). The presence of OCT-assessed suboptimal criteria for stent implantation was related to a worse clinical outcome at very long-term follow-up. This information further supports an OCT-guided strategy of stent deployment.

Outcome after percutaneous coronary intervention with contemporary stents in patients with concomitant peripheral arterial disease: A patient-level pooled analysis of four randomized trials

Background and aimsA considerable number of patients who undergo percutaneous coronary intervention (PCI) also have peripheral arterial disease (PAD) – a signal of more advanced atherosclerosis. After bare metal and early-generation drug-eluting coronary stent implantation, PAD patients showed inferior outcome. As stents and medical treatment were further improved, we aimed to assess the impact of PAD on outcome of PCI with contemporary new-generation stents. MethodsWe analyzed 3-year pooled patient-level data from 4 large-scale randomized new-generation stent trials to compare all-comer patients with and without (core lab-verified) history of symptomatic PAD, defined as obstructive lesions in peripheral locations including lower and upper extremities, carotid, vertebral, mesenteric and renal arteries. Main endpoint was target vessel failure: cardiac death, target vessel-related myocardial infarction, or clinically indicated target vessel revascularization. ResultsOf all 9204 patients, 695 (7.6%) had a history of symptomatic PAD. They were older and had more often diabetes, renal failure, hypertension, hypercholesterolemia, and prior stroke. PAD was an independent risk factor for target vessel failure (adjusted-HR:1.42, 95%-CI:1.12–1.73, p = 0.001). Target vessel revascularization (adjusted-HR:1.37, 95%-CI:1.04–1.80, p = 0.026), death (adjusted-HR:1.52, 95%-CI:1.17–1.99, p = 0.002), and major adverse cardiovascular event risks (adjusted-HR:1.36, 95%-CI:1.13–1.64, p = 0.001) were also substantially higher. ConclusionsA history of symptomatic PAD still allows to simply identify patients with increased risk of unfavorable clinical outcome after PCI, including a higher risk of repeated coronary revascularization, despite using contemporary stents. In clinical practice, this knowledge about higher event risks of PAD patients is helpful both during Heart Team discussions and when informing patients about the procedural risk.

Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study

BackgroundAchalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove FCARMS implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. The aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM.MethodsA propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups.ResultsA total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group (p < 0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8 ± 2.4 (vs 2.1 ± 1.8 of POEM) (p = 0.00 < 0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively (p = 0.39), and the 2-year remission rates were 61% and 90%, respectively (p = 0.00).ConclusionsStent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 months) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years), POEM is better than FCARMS. HRMIIis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.

Primary Percutaneous Intervention for ST-Elevation Myocardial Infarction Patients: A State of The Art

Primary PCI is the preferred reperfusion strategy in patients with STEMI within 12 h of symptom onset. Angiographically successful PPCI was defined as less than 30% residual stenosis by visual assessment and grade 3 TIMI flow achievement. Radial access is preferred over femoral access. Drug eluting stent (DES) implantation is more superior than bare metal stent (BMS) implantation or balloon angioplasty. In STEMI patients with cardiogenic shock, non-infarct related artery PCI during the index procedure should be considered.