No-stent Group Research Articles

Impact of biliary-pancreatic double stents on EUS-guided tissue acquisition among patients with solid pancreatic lesions: A multicenter study

ABSTRACT Background and Objective Although the impact of biliary stents on the accuracy of EUS-guided tissue acquisition (EUS-TA) is still controversial, the influence of biliary-pancreatic double stents on EUS-TA is even more inconclusive. The aim of the study was to determine whether the diagnostic yield of EUS-FNA in the diagnosis of solid pancreatic lesions will be affected after placement of biliary-pancreatic double stents. Methods A multicenter retrospective study including patients who underwent EUS-FNA with biliary duct obstruction was performed. Patients were divided into 2 groups according to whether there were biliary-pancreatic double stents before EUS-FNA. The patients' EUS-FNA report, histopathological results, and clinical case data were reviewed and compared. Results Ninety-two patients were included, 42 with biliary-pancreatic double stents and 50 without any stents. The puncture time taken by EUS-FNA was significantly longer in the stent group than the no-stent group (19 vs. 15 min, P < 0.001). No significant differences were observed in accuracy (90.5% vs. 94%), sensitivity (89.5% vs. 93.6%), specificity (100% vs. 100%), NPV (50% vs. 50%), PPV (100% vs. 100%), respectively, in both groups. Patients with larger lesions (OR = 1.600, 95% CI: 1.124–2.277) and those who required more passes had a higher diagnostic yield (OR = 9.376, 95% CI: 1.356–64.819) by multivariate analysis. Conclusions ERCP before EUS-FNA is feasible for the treatment of solid pancreatic lesions causing obstructive jaundice. It will not have a negative impact on the diagnostic accuracy and surgical complications, but the EUS-FNA operation time will be prolonged.

Routine Ureteral Stenting in Kidney Transplant Reduces Postoperative Hydronephrosis and Percutaneous Ureteral Interventions: A Single-Center Experience.

The effect of routine ureteral stenting on postoperative hydronephrosis and percutaneous ureteral intervention in kidney transplant remains unknown. This study aimed to evaluate the effects of routine ureteral stenting on hydronephrosis and percutaneous ureteral intervention and the cost benefit of ureteral stenting in kidney transplant. We retrospectively analyzed patients who underwent kidney transplant at a tertiary institution between 2005 and 2021. We adopted a ureteral stentingprotocol in2017, anda comparisonwas performed with previous patients without stents. In total, 539 patients underwent kidney transplant(271 with stents [51.3%], 268 without stents [49.7%]). Hydronephrosis was detected in 16 cases (5.9%) and 30 cases (11.2%) of groups with and without stents,respectively (P = .041). Among patients with hydronephrosis, the number of patients who underwent percutaneous ureteral intervention was significantly lower in the stent group than in the nostent group (1 [6.25%] vs 10 [33.33%]; P= .014).Twenty patients (3.71%) experienced major urologic complications (19 [7.1%] in the no-stent group, and 1 [0.4%] in the stent group; P = .001). No significant differences between the groups were shown in the incidence of urinary tract infections within 3 months of transplant (24 [8.9%] vs 22 [8.2%]; P = .846). No differences were shown between the groups in ureterovesical anastomosis time (24.4 vs 24.03 min; P = .699) or 1-year graft survival (97% vs 97.8%; P = .803). The healthcare cost was significantly lower in the stent group than in the no-stent group by $1702.05 ($15000.89 vs $16702.95; P < .001). Routine ureteral stenting in kidney transplant significantly decreased the incidence of postoperative hydronephrosis and percutaneous ureteral intervention. Stenting did notlead to increased urinary tract infections and was cost-effective.

Novel additively manufactured tubular scaffold combined with electrospun biomolecules-embedded nanofibers promotes healing of ruptured tendon

Despite the progress made in modern medical technology, the therapy of ruptured tendons continues to be a challenging task. We designed an amalgamated scaffold consisting of an additively manufactured polycaprolactone (PCL) tubular stent and electrospun collagen/drug-embedded poly-D-L-lactide-glycolide (PLGA) nanofibrous mats for the treatment of Achilles tendon rupture. The in vitro drug elution characteristics of pharmaceuticals from electrospun nanofibers was estimated. The in vivo efficacies of PCL stent/biomolecules-biomolecule-eluting nanofibers for the therapy of treatment of tendon rupture were also evaluated on in a rabbit model with histological examinations. The experimental results showed that the PCL stents with diamond pores exhibited the best mechanical properties. Drug-loaded PLGA nanofibers provided sustained discharges of vancomycin and ceftazidime for 40 days and lidocaine for over 10 days in vitro. The in vivo outcomes suggested that the repaired tendon strengths in the no-stent group and stent-only group (without drugs) showed poorer strength than the control (normal tendons with no surgery). Furthermore, the stent/drug group exhibited a higher recovery rate than the stent-only group. The integration of the additively manufactured PCL tubular stent and electrospun drug-eluting PLGA nanofibrous membranes can effectively enhance tendon treatment in a rabbit model.

Do Biliary Stents Affect EUS-Guided Tissue Acquisition (EUS-TA) in Solid Pancreatic Lesions Determining Biliary Obstruction? A Literature Review with Meta-Analysis.

There is a paucity of evidence regarding whether biliary stents influence endoscopic ultrasound-guided tissue acquisition using either fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA), among patients with head of pancreas (HOP) lesions. We aimed at assessing the diagnostic accuracy of endoscopic ultrasound-guided tissue sampling in patients with or without bile duct stents. A total of seven studies with 2458 patients were included. The main aim was to assess overall pooled diagnostic accuracy. A pairwise meta-analysis was performed using a random effects model. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). We found that pooled accuracy was 85.4% (CI 78.8-91.9) and 88.1% (CI 83.3-92.9) in patients with and without stents, respectively. There was no statistically significant difference between the two (OR 0.74; p = 0.07). Furthermore, patients with metal stents demonstrated a significant difference (OR 0.54, 0.17-0.97; p = 0.05), which was not seen with plastic stents. EUS-FNB showed poorer diagnostic accuracy with concurrent biliary stenting (OR 0.64, 0.43-0.95; p = 0.03); however, the same was not observed with EUS-FNA. Compared to plastic stents, metal biliary stenting further impacted the diagnostic accuracy of EUS-guided tissue acquisition for pancreatic head lesions. There was no difference in the rate of procedure-related adverse events between the stent and no-stent groups.

Feasibility of rescue stenting technique in patients with acute ischemic stroke due to middle cerebral artery occlusion after failed thrombectomy: A single-center retrospective experience.

BackgroundDespite remarkable advancements in intra-arterial mechanical thrombectomy (IAT), recanalization failure rates up to 24% have been reported. Recently, permanent stent placement (rescue stent, RS) during IAT has been suggested as an optional modality for better reperfusion and outcomes in these patients. However, previous studies were limited owing to non-standardized procedure protocols and small sample sizes. Here, we aimed to determine the efficacy and safety of RS in patients with acute ischemic stroke (AIS) with middle cerebral artery (MCA) occlusion.MethodsOf the 243 patients in our IAT database (2015–2021), 183 were identified as having MCA occlusion alone. Among them, we extracted 53 patients in whom the IAT failed to show thrombolysis in cerebral ischemia (TICI) scores of 2A or worse. Intraoperatively, RS was deployed in 22 patients (RS group), whereas 31 patients (no-stent group) received IAT without stenting. The baseline characteristics and radiologic and clinical outcomes were reviewed. Comparisons between the groups and multivariate logistic analyses for recanalization and good functional outcomes (modified Rankin Scale 0–2) were performed.ResultsNo baseline differences were noted (RS vs. no-stent); however, the recanalization outcomes (59.1% vs. 25.8%, p = 0.15) and proportion of good modified Rankin Scale scores (45.5% vs. 19.4%, p = 0.041) were better in the RS group. The parameters of symptomatic ICH (9.7% vs. 9.4%) and mortality (6.5% vs. 5.7%) showed no significant difference. In the multivariate analyses, ‘hypertension’ and ‘RS deployment’ were identified as significantly associated factors with recanalization and good prognosis.ConclusionIn select patients with MCA occlusion AIS after failed IAT, the RS technique can be an optional rescue treatment modality for acquiring better functional outcomes and delayed recanalization.

Prophylactic Perioperative Antibiotics in Open Pancreaticoduodenectomy: When Less Is More and When It Is Not. A National Surgical Quality Improvement Program Propensity-Matched Analysis

IntroductionWe hypothesized that first-generation cephalosporins (G1CEP) provide adequate antimicrobial coverage for pancreaticoduodenectomy (PD) when no biliary stent is present but might be inferior to second-generation cephalosporins or broad-spectrum antibiotics (G2CEP/BS) in decreasing surgical-site infection (SSI) rates when a biliary stent is present. MethodsThe National Surgical Quality Improvement Program 2014-2019 was used to select patients who underwent elective open PD. We divided the population into no-stent versus stent groups based on the status of biliary drainage and then divided each group into G1CEP versus G2CEP/BS subgroups based on the choice of perioperative antibiotics. We matched the subgroups per a propensity score match and analyzed postoperative outcomes. ResultsSix thousand two hundred forty five cases of 39,779 were selected; 2821 in the no-stent (45.2%) versus 3424 (54.8%) in the stent group. G1CEP were the antibiotics of choice in 2653 (42.5%) versus G2CEP/BS in 3592 (57.5%) cases. In the no-stent group, we matched 1129 patients between G1CEP and G2CEP/BS. There was no difference in SSI-specific complications (20.3% versus 21.0%; P = 0.677), general infectious complications (25.7% versus 26.9%; P = 0.503), PD-specific complications, overall morbidity, length of stay, or mortality. In the stent group, we matched 1244 pairs. G2CEP/BS had fewer SSI-specific complications (19.9% versus 26.6%; P < 0.001), collections requiring drainage (9.6% versus 12.9%; P = 0.011), and general infectious complications (28.5% versus 34.1%; P = 0.002) but no difference in overall morbidity, mortality, length of stay, and readmission rates. ConclusionsG2CEP/BS are associated with reduced rates of SSI-specific and infectious complications in stented patients undergoing open elective PD. In patients without prior biliary drainage, G1CEP seems to provide adequate antimicrobial coverage.

Pancreaticojejunostomy without pancreatic duct stent after laparoscopic pancreatoduodenectomy: preliminary outcomes from a prospective randomized controlled trial.

Outcomes of pancreaticojejunostomy without pancreatic duct during open pancreaticoduodenectomy (OPD) are unknown and controversial, and corresponding reports in laparoscopic surgery are lacking. Patients were evaluated at West China Hospital, and standard laparoscopic pancreaticoduodenectomy (LPD) was planned. A prospective randomized trial was conducted, in which the patients were randomly assigned to the no-stent and internal-stent groups in a single-center trial. The primary outcomes were the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and 90-day mortality. Preliminary results were reported. From November 2019 to March 2021, we enrolled 90 patients (41 in the no-stent group and 49 in the internal-stent group) in the study. All baseline parameters of both groups, including age, sex ratio, pancreatic duct diameter, and intraoperative blood loss, were comparable between the two groups except for pathological diagnosis and the texture of remnants. Twenty-seven (65.9%) and 19 (38.8%) patients in the no-stent and internal-stent groups, respectively, had soft pancreatic remnants (P = 0.010). The total incidence of CR-POPF was 5.6% and included two patients (4.9%) in the no-stent group and three patients (6.1%) in the internal-stent group (P = 1.000). Only one patient in the internal-stent group died of heart failure within 90days after the operation. No significant difference in other postoperative complications was observed between the groups except for biochemical fistula [no-stent group vs. internal-stent group = 31.7% vs. 12.2%, (P = 0.024)]. In a high-volume LPD center, duct-to-mucosa pancreaticojejunostomy without pancreatic duct stent is safe and reliable. In addition, duct-to-mucosa pancreaticojejunostomy without pancreatic duct stent was more challenge. We recommend using the stent during anastomosis and pulling it out after the procedure.

Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score–Matched Study

ObjectivePercutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis.Materials and MethodsTwo groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated.ResultsThe stent group finally included 100 patients (median age, 65 [interquartile range, 58–71] years; 64 male). The no-stent group included 22 patients (69 [61–75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion–free survival rate was 56% (95% confidence interval, 45%–69%) and 44% (32%–60%), respectively. The median stent occlusion–free survival time was 176 (interquartile range, 70–440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week.ConclusionPercutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.

Endovascular Therapy of Anterior Circulation Tandem Occlusions: Pooled Analysis From the TITAN and ETIS Registries.

Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice. Individual patients’ data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA lesion treatment into stent and no-stent groups. Outcomes were compared between the two treatment groups using propensity score methods. A total of 603 patients were included, of whom 341 were treated with acute cervical ICA stenting. In unadjusted analysis, the stent group had higher rate of favorable outcome (90-day modified Rankin Scale score, 0–2; 57% versus 45%) and excellent outcome (90-day modified Rankin Scale score, 0–1; 40% versus 27%) compared with the no-stent group. In inverse probability of treatment weighting propensity score–adjusted analyses, stent group had higher odds of favorable outcome (adjusted odds ratio, 1.09 [95% CI, 1.01–1.19]; P=0.036) and successful reperfusion (modified Thrombolysis in Cerebral Ischemia score, 2b-3; adjusted odds ratio, 1.19 [95% CI, 1.11–1.27]; P<0.001). However, stent group had higher odds of any intracerebral hemorrhage (adjusted odds ratio, 1.10 [95%, 1.02–1.19]; P=0.017) but not higher rate of symptomatic intracerebral hemorrhage or parenchymal hemorrhage type 2. Subgroup analysis demonstrated heterogeneity according to the lesion type (atherosclerosis versus dissection; P for heterogeneity, 0.01), and the benefit from acute carotid stenting was only observed for patients with atherosclerosis. Patients treated with acute cervical ICA stenting for tandem occlusion strokes had higher odds of 90-day favorable outcome, despite higher odds of intracerebral hemorrhage; however, most of the intracerebral hemorrhages were asymptomatic.

The impact of prophylactic ureteral stenting during kidney transplantation on postoperative surgical outcomes.

BackgroundThe aim of this study was to evaluate the safety and feasibility of prophylactic ureteric stenting during kidney transplantation (KT).MethodsThe authors retrospectively reviewed patients who underwent KT between June 2016 and June 2019. The prophylactic ureteral stenting group (double-J [DJ]) and no-stent group (no-DJ) were compared with respect to the clinical data and surgical outcomes.ResultsA total of 42 patients underwent KT; 17 patients were classified into the DJ group and 25 patients into the no-DJ group. Antithymocyte globulin induction and donor-specific antibody positivity were significantly higher in the DJ group. There were no significant differences between the groups in terms of symptomatic urinary tract infection (UTI). The time to postoperative UTI was significantly shorter in the DJ group than in the no-DJ group (33.5±7.8 vs. 105.3±71.6 days, P=0.013). The development of postoperative BK viremia was significantly higher in the no-DJ group (0.0% vs. 16.0%, P=0.035). Urologic complications were significantly higher in the no-DJ group (0.0% vs. 16.0%, P=0.035). In the no-DJ group, urologic complications occurred in four patients ureteroneocystostomy stenosis in three patients and ureteroneocystostomy leakage in one patient. Percutaneous ureteral interventions were performed for all patients using percutaneous nephrostomy and reno-uretero-vesical stenting. However, there were no postoperative urologic complications in the DJ group.ConclusionsProphylactic ureteric stenting during KT may be safe and feasible without significantly increasing the incidence of UTI and BK viremia. Additionally, prophylactic ureteric stenting may reduce urologic complications after KT.

Prophylactic stents in the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography

The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidence in the high-risk patient population is 14.7%. To analyze 10 years experiences of our working group. We retrospectively analyzed our prospective database of high-risk patients treated with prophylactic pancreatic stents (PPS) including the period between 2009 and 2014. We compared PEP incidence and severity findings with our historical data of pre-PPS period of similarly high-risk patients (no-stent group), furthermore analyzed the complications of PPS insertion and different stent types. PEP was defined and categorized according to the Cotton criteria. In 317 high-risk patients, PPS implantation was successful in 288 cases (90.9%). The no-stent group comprised of 121 patients. Incidence and the severity of PEP in the successfully stented group (all: 10.0%; mild: 8.3%, moderate: 1.4%, severe: 0.3%) were significantly lower compared to the no-stent group (all: 31.4%; mild: 15.7%, moderate: 10.7%, severe: 5.0%) and the unsuccessfully stented group (all: 41.3%; mild: 24.1%, moderate: 13.8%, severe: 3.4%). The difference between the latter two groups was not significant. Only early dislodgment (5/288 patients, 1.74%) and proximal migration (3/288 patients, 1.04%) were observed as stent-related complications. Freeman type (single inner flange, outer pigtail end) stent was the best based on the complication profile. Prophylactic pancreatic stenting effectively lowers the incidence and severity of PEP. We should recognize the proper technic of its application and the importance of proper timing of its extraction and identification of complications. Utilization of PPSs in high-risk patients is strongly recommended in every ERCP center. Orv Hetil. 2021; 162(1): 31-38.

Effect of previous coronary stenting on subsequent coronary artery bypass grafting outcomes

ObjectivesThe effect of previous coronary stenting on subsequent coronary artery bypass graft is inconclusive. MethodsWe used Taiwan's National Health Insurance Database to retrospectively evaluate patients with multivessel coronary artery bypass graft between January 2000 and December 2013. Overall, 32,335 patients who received coronary artery bypass graft were included, of whom 3028 had previous coronary stenting. Propensity-score matching yielded 2977 cases each for evaluation under the previous stenting and no stenting groups. The 30-day mortality and major adverse cardiac events, including all-cause mortality, acute myocardial infarction, and revascularization, were considered primary outcomes. ResultsThe number of coronary artery bypass grafts decreased per year. However, the percentage of patients who had previous coronary stent implantation before coronary artery bypass graft increased steadily (P for trend <.001), and the average number of stents implanted in a patient also increased per year (P for trend <.001). The previous stent group had a significantly greater 30-day mortality rate than did the no-stent group (7.2% vs 5.0%; odds ratio, 1.47; 95% confidence interval, 1.19-1.82). The previous stent group had a greater rate of revascularization (14.4% and 10.0%; subdistribution hazard ratio, 1.50; 95% confidence interval, 1.30-1.74) in the last follow-up at year 13. ConclusionsPrevious coronary stenting before coronary artery bypass graft for multivessel coronary artery disease significantly increased 30-day mortality but did not affect late survival. However, patients who had coronary stenting before coronary artery bypass graft experienced more revascularization events during late follow-up.

Comparison of Primary and Delayed Ureteroscopy for Ureteric Stones: A Prospective Non-Randomized Comparative Study

Background: Primary ureteroscopy (P-URS) has been shown to be as safe and as efficacious as preoperative stent insertion followed by a delayed ureteroscopy (D-URS). However, studies are of limited patient cohort. Methods: A prospective study comparing P-URS and laser fragmentation for ureteric stones to those who received a stent insertion followed by D-URS and stone fragmentation. Results: A total of 367 consecutive patients were included. P-URS was conducted on 235 patients and D-URS on 132 patients. There was no overall difference between patient or stone demographics between the 2 groups, although there were more proximal ureteric and pelvi-ureteric junction stones in the preoperative stent group. The mean operative times were comparable with a stone free rate of 97 and 94% in the preoperative stent and no-stent groups, respectively. The overall complication rates were comparable. Conclusion: The current study provides evidence for the feasibility, safety, and efficacy of P-URS for ureteric calculi in a publicly funded healthcare setting with results comparable to those patients with a preoperative stent and delayed procedure. Therefore, cumulatively, P-URS could lead to less hospitalization, length of stay, stent-related morbidity, and ultimately will be more cost-effective.

Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial.

The role of ureteral stents in living-donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living-donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living-donor kidney transplantations at the Erasmus MC, University Medical Center, Rotterdam. Patients (124 males, 76 females, mean age 54±13) were randomized for suprapubic externalized single J stents (N=100) or no stent (N=100). The primary outcome was the probability of a percutaneous nephrostomy insertion (PCN) during a 12-month follow-up. To assess whether no stenting is noninferior to stenting, we allowed the probability of a PCN to increase by at most 5% (this is the noninferiority margin). Baseline characteristics were comparable between groups. In the no-stent group, there were more PCN insertions, 14% (95% CI 4.3-23.7%); urinary leakages, 12% (95% CI 5.4-21.3%); and surgical re-interventions because of urological complications, 8% (95% CI 1.5-14.5%). The stent group had more hematuria, 26% (95% CI 13.1-38.9%); and graft rejections, 15% (95% CI 2.7-27.3%). Patients in both groups had similar mean GFRs at several time points. Besides a better Euro-Qol-5D in the no-stent group at 2 and 6weeks postoperative, similar quality of life was reported based on SF-36 and Euro-Qol-5D scores. In this trial, noninferiority has not been demonstrated for no-stent placement in relation to the number urological complications.

Repeated Target Vessel Revascularization After Coronary Artery Bypass for In-Stent Restenosis

The purpose of this study was to examine the impact of previous percutaneous coronary intervention with stent on long-term outcomes after off-pump coronary artery bypass grafting (OPCAB). Between January 2001 and December 2014, 1,668 patients with triple-vessel disease undergoing OPCAB were reviewed and divided into 2 groups. The no-stent group (n= 1,409) included patients who underwent OPCAB as a primary revascularization procedure and the stent group (n= 259) included patients with a history of percutaneous coronary intervention with stent. The mean follow-up duration was 5.32 ± 3.39 years. After propensity score matching, characteristics of both groups were comparable (n= 259 in each group). In-hospital mortality (n= 3 [1.2%] in both groups; p > 0.999) was similar. The 14-year overall survival rate (75.6% ± 6.6% in the no-stent group versus 71.9% ± 8.5% in the stent group; p= 0.917) and freedom from major adverse cardiac and cerebrovascular events (MACCEs) rate (68.3% ± 6.6% versus 54.6% ± 8.5%; p= 0.239) were also similar. However, freedom from target vessel revascularization (TVR) rate at 14 years was significantly higher in the no-stent group (97.2% ± 1.7% versus 76.9% ± 6.5%; p < 0.001). The independent risk factor for late TVR was in-stent restenosis (hazard ratio, 3.355; 95% confidence interval, 1.925 to 5.848; p < 0.001) and it also was a risk factor for MACCEs (hazard ratio, 1.645; 95% CI, 1.105 to 2.448; p= 0.014). Previous intracoronary stenting does not increase long-term mortality, but grafting to previously stented target vessels with in-stent restenosis increases the risk of repeat TVR and MACCEs.

Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.

To investigate the efficacy and safety profile of pancreatic duct (PD) stent placement for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). We performed a search of MEDLINE, EMBASE, and Cochrane Library to identify randomized controlled clinical trials of prophylactic PD stent placement after ERCP. RevMan 5 software provided by Cochrane was used for the heterogeneity and efficacy analyses, and a meta-analysis was performed for the data that showed homogeneity. Categorical data are presented as relative risks and 95% confidence intervals (CIs), and measurement data are presented as weighted mean differences and 95%CIs. The incidence rates of severe pancreatitis, operation failure, complications and patient pain severity were analyzed. Data on pancreatitis incidence were reported in 14 of 15 trials. There was no significant heterogeneity between the trials (I(2) = 0%, P = 0.93). In the stent group, 49 of the 1233 patients suffered from PEP, compared to 133 of the 1277 patients in the no-stent group. The results of this meta-analysis indicate that it may be possible to prevent PEP by placing a PD stent. PD stent placement can reduce postoperative hyperamylasemia and might be an effective and safe option to prevent PEP if the operation indications are well controlled.

Previous coronary stents do not increase early and long-term adverse outcomes in patients undergoing off-pump coronary artery bypass grafting: A propensity-matched comparison

The aim of our study was to compare the early and long-term outcomes of patients undergoing off-pump coronary artery bypass grafting (CABG) with and without previous coronary stents. Between September 2004 and September 2011, 269 patients with previous stents underwent first-time isolated off-pump CABG. These patients were compared with 897 patients without previous stent. A propensity score-matching analysis was performed to compare early and late outcomes between the groups. Mean follow-up time was 43.4 months after surgery. Patients with previous stents were more likely to be men (85.9% in the stent group vs 79.4% in the no-stent group; P=.022) and more likely to have prior myocardial infarction (60.2% vs 36.8%; P<.001). Mean number of anastomoses was lower in patients with previous stents than in patients without previous stents (4.0 vs 4.2; P=.037). There was no difference in the use of bilateral internal thoracic artery graft between the groups (88.8% vs 89.1%; P>.999). After propensity adjustment for preoperative characteristics, both operative death (0.7% vs 1.5%; P=.414) and the major complications rates (7.8% vs 7.5%; P=.869) were similar between the groups. The actuarial survival rate at 7 years was not different between the groups (87.2%±3.2% vs 84.8%±2.9%; P=.470). Furthermore, freedom from major adverse cardiac and cerebrovascular events at 7 years were similar between the groups (78.9%±3.8% vs 77.6%±3.3%; P=.811). Previous coronary stents do not increase early and long-term morbidity or mortality in patients undergoing off-pump CABG.

Analysis of Complications and Recurrences of Aneurysm Coiling with Special Emphasis on the Stent-Assisted Technique

Stent-assisted coiling has expanded the treatment of intracranial aneurysms. With the use of continuously compiled data, we reviewed the role and drawbacks of stent-assisted coiling. We compiled data from consecutive patients from 2003-2012 who underwent coiling, with or without stent assistance. Clinical and angiographic results were analyzed retrospectively. Of 1815 saccular aneurysms in 1505 patients, 323 (17.8%) were treated with stents (299 procedures) and 1492 (82.2%) without stents (1400 procedures). Procedure-related complications occurred in 9.4% with stents versus 5.6% without stents (P = .016, relative risk 1.5; 95% CI, 1.1-2.7). Ischemic complications were more frequent in the stent group than in the no-stent group (7.0% versus 3.5%; P = .005; relative risk, 1.7; 95% CI 1.2-2.5), as were hemorrhagic complications (2.3% versus 1.9%, P = .64). Procedure-induced mortality occurred in 2.7% (8/299) with stents versus 1.1% (15/1400) without stents (P = .029; relative risk, 2.0; 95% CI, 1.1-3.5). Logistic regression analysis identified wide-neck aneurysms as the most significant independent predictor of complications. A total of 64.1% (207/323) of aneurysms treated with stents and 70.3% (1049/1492) treated without stents have been followed, disclosing angiographic recurrence in 15.5% (32/207) versus 35.5% (372/1049), respectively (P < .0001). Logistic regression analysis showed that the presence of a stent was the most important factor for the reduction of angiographic recurrence (P < .0001; relative risk, 2.3; 95% CI, 1.6-3.3). The stent-assisted coiling technique is associated with a significant decrease in recurrences but a significant increase in complications. The treatment of wide-neck aneurysms remains hazardous.

Incremental Risk of Prior Coronary Arterial Stents for Pulmonary Resection

Many patients requiring lung cancer resection have concomitant coronary artery disease. Preoperative coronary artery stenting has been associated with increased risk of cardiac events after noncardiac surgery. Our aim was to determine the incidence of major adverse cardiac events (MACE) in patients undergoing pulmonary resection for lung cancer after percutaneous coronary stenting. This study uses Surveillance, Epidemiology, and End Results-Medicare data (1998 to 2005). Patients undergoing lung cancer resection within 1 year after coronary stenting were compared with patients without preoperative coronary intervention. The incidence and predictors of MACE within 30 days after surgery were determined. Five hundred nineteen patients underwent lung cancer resection after coronary stenting (stent), and 21,892 patients underwent lung cancer resection without a preceding coronary intervention (no stent). The stent group had higher comorbidity scores (p<0.0001) and more males (66% versus 50%; p<0.0001). There were no differences in age (74 versus 74 years), tumor size (33.7 versus 33.6 mm), stage (53% versus 54% stage I), and resections of lobectomy or greater (83% versus 80%) between stent and no-stent groups (all p>0.05). Thirty-day MACE and mortality rates were 9.3% and 7.7% in the stent group and 4.9% and 4.6% in the no-stent group (both p<0.0001). Multivariable predictors of MACE were coronary stent, age, male sex, comorbidity score, tumor size, and stage. Patients undergoing lung cancer surgery within 1 year of coronary stenting are at high risk for perioperative MACE. The presence of a coronary stent should be an important component of risk assessment before resection for lung cancer.

Effect of a stent bandage on the likelihood of incisional infection following exploratory coeliotomy for colic in horses: A comparative retrospective study

Incisional infections are common in horses after colic surgery. There is a clinical impression that the use of a stent bandage reduces the prevalence of such infections. To determine the effect of a stent bandage on the likelihood of incisional infection after ventral midline exploratory coeliotomy. It was hypothesised that the use of a stent bandage would reduce the likelihood of incisional infection. Medical records of horses that underwent exploratory coeliotomy for colic between January 2005 and September 2011 were reviewed. Inclusion criteria were animals that had one ventral midline coeliotomy and had survived at least 10 days after surgery. Horses were categorised into 2 groups:no-stent group and stent group. The following data were collected for each case: age, sex, weight, heart rate, packed cell volume, primary lesion, performance of an enterotomy or intestinal resection, surgical classification, use of local antimicrobials, duration of surgery, intra-abdominal administration of sodium carboxymethylcellulose, intravenous administration of lidocaine, surgeon, use of a stent bandage, duration of stent use, and use of a belly band. Factors associated with the outcome measure 'wound infection' vs. 'no wound infection' were analysed using a generalised linear mixed model for logistic regression with surgeon as a random effect. The inclusion criteria were met in 130 horses: 55 were assigned to the no-stent group and 75 to the stent group. In the no-stent group, 12 (21.8%) horses developed incisional infections, whereas only 2 horses (2.7%) in the stent group had incisional infections. In the stent group, no incisional infections were observed during the last 20 months of the study. Statistical analysis showed that only the effect of the use of a stent bandage was significant (P = 0.005). The prevalence of incisional infections when a stent bandage was used was 2.7%, a finding that compared favourably to information in the literature. Use of a stent bandage significantly reduced the likelihood of incisional infections. A stent bandage would reduce the likelihood of incisional infection in horses undergoing exploratory coeliotomy for colic.