Percutaneous Endovascular Stent Research Articles

Long-term outcome of percutaneous endovascular stenting in external iliac artery endofibrosis.

External iliac artery endofibrosis (EIAE) is a rare vascular disease which has been traditionally seen in avid cyclists. The conventional approach has been surgery, although no high-quality evidence suggests superiority of surgery over percutaneous endovascular intervention. There are limited data on the efficacy of stenting in EIAE. Over a 14-year period, we treated 10 patients (13 limbs) with EIAE with stents. These patients had declined surgery. The mean follow up was 8.4 ± 3.3 years. There were eight women. Five patients were competitive runners, three were cyclists, and two were triathletes. The mean age was 40.7 ± 2.9 years and body mass index was 19.46 ± 1.6. Intravascular ultrasound (IVUS) was used in eight limbs. Procedural success was achieved in all. The recurrence of symptoms occurred in three patients at a mean of 9.3 ± 2.1 months postindex intervention. The other seven patients remained symptom free. IVUS revealed a pathognomonic finding which we termed 'perfect circle appearance'. It results from symmetric or asymmetric hypertrophy of one or more layers of the arterial wall leading to negative remodeling, which creates a distinct echo dense structure contrasting itself from the luminal blood's echoluscent appearance. It is identical to IVUS images of diffuse venous stenosis with important implications in the treatment technique. We conclude that stenting in EIAE is safe and effective with a good long-term outcome. It can be an alternative to surgery, particularly in those patients who refuse a surgical approach. The IVUS image is pathognomonic and 'sine qua non' of EIAE.

Endovascular Treatment of Infrainguinal Peripheral Arterial Disease (PAD): Update on Stent Technology

Peripheral artery disease (PAD) is a progressive vascular disease affecting millions of individuals and is a considerable cause of morbidity and mortality worldwide. While balloon angioplasty remains the cornerstone option for endovascular management of arterial stenosis, advances in percutaneous endovascular stent technology have broadened the toolbox of therapeutic options for PAD and have significantly improved function and quality of life. Indeed, covered stents, bioabsorbable stents and drug eluting stents are several of the innovations in stent technology made since the advent of nitinol bare metal stents in the 1980s. The indications for use, technical considerations, treatment outcomes, and current concerns regarding current stent devices will herein be discussed in this review.

In vitro study of the deployment performance of 3D printed stents in the diseased artery with the lipid arterial plaques

Atherosclerotic plaque is one of the arterial diseases which builds up in the arterial wall and can be identified by the composition of the plaque. Atherosclerosis causes the narrowing or occlusions of the arterial lumen leading to cardiovascular event. Percutaneous (keyhole) endovascular stenting has become the most common revascularisation method due to its minimum invasive nature and low complication rate. The stents, mostly fabricated by laser machines, have uniform geometries which are not ideal to treat the diseased arteries with lesion-specific properties. In addition, the effect of arterial plaque compositions on the performance of stents is not fully investigated. In this study, the deployment performance of the stents with the varied design, made of the 316L stainless steel and fabricated by additive manufacturing (AM) technology, were investigated. An in vitro experiment was conducted to test the influence of the atherosclerotic plaque compositions at 55% stenosis on the commercial and AM fabricated stents. Two artificial plaques (lipid and calcified) were prepared manually, and their mechanical testing were conducted using an unconfined compression test. Two types of stents, printed and commercial stents, were used to treat the diseased artificial artery, and the data of the pressure and diameter were collected simultaneously when the stent inflation pressure was applied. The results show that the mechanical property of the artificial lipid plaques was very similar to the real lipid plaque that observed from clinical study. From the deployment performance test for these two types of stents, it was observed that as the pressure inside of balloon increases, the diameters measured at the external wall of the artificial artery also increase when the pressure is above 4 atm. Overall, there is a close linear relationship between pressure and arterial wall movement with lipid plaque in both printed and commercial stents though that the stent made of AM technology is less flexible and has lower elastic property than the commercial one

Percutaneous transluminal stenting for superior vena cava syndrome caused by malignant tumors: a single-center retrospective study

ObjectivesTo evaluate the efficacy of percutaneous stent placement in the treatment of superior vena cava syndrome caused by malignant tumors.MethodsWe retrospectively analyzed the clinical data of 32 patients with superior vena cava syndrome who underwent percutaneous endovascular stent treatment in our department from 2015 to 2019 due to malignant tumors and summarized the patient’s sex, age, tumor type, endovascular treatment plan, complications and postoperative follow-up.ResultsAll patients successfully underwent percutaneous intraluminal stent placement with digital subtraction angiography (DSA). Thirty-seven endovascular stents were implanted in 32 patients, including 21 Eluminexx stents, 12 Wallstent stents and 4 covered stents. The technical success rate was 100%, and there were no serious surgery-related complications. The remission rate of clinical symptoms was 53.1% (17/32) at 24 h and 84.4% (27/32) at 48 h. After 48 h, the symptoms of the remaining patients were slowly relieved, and the symptom relief rate was 100% at 7 days. The follow-up period was 1.5–24 months, with an average follow-up period of 6.5 months. During the follow-up, 3 patients had restenosis and 1 patient had secondary thrombosis in the stent. Their symptoms were relieved after the second treatment.ConclusionFor superior vena cava syndrome caused by malignant tumors, percutaneous endoluminal stent therapy can quickly and effectively relieve the clinical symptoms of patients, and the incidence of complications is low.

Endovascular treatment of visceral aneurysms and pseudoaneurysms.

Visceral artery aneurysm (VAA) is a rare and potentially life-threatening condition, defined as true artery aneurysms and pseudoaneurysms of splanchnic circulation and renal artery. This study reports our experience in the diagnosis and endovascular treatment of visceral artery aneurysms (VAAs) over a 10-year period. Between 2008 and 2018, a total of 24 VAAs in 21 patients were diagnosed by clinical symptoms and a combination of imaging techniques, such as Doppler ultrasound, computed tomography angiogram, and catheter angiogram. All patients underwent endovascular treatment to exclude aneurysms. Oral antiplatelet medicine was administered, and imaging examination was performed during follow-up. Technical success was achieved in all 21 patients, and no periprocedural complications occurred. Endovascular coiling alone was employed in 10 aneurysms. Coiling was combined with gelfoam in 2 aneurysms. Coiling was assisted by stent in 4 aneurysms. Covered stents were deployed in 8 aneurysms individually. Clinical symptoms disappeared or highly improved in all patients after treatment. None of the patients showed recurrent symptoms after discharge. However, two cases with new aneurysms after 6 and 8 months, respectively, and one case with in-stent thrombosis after 12 months were reported during follow-up. This study may justify the efficacy of percutaneous endovascular coil embolization and stent deployment. It also provides beneficial experience about how to choose appropriate various endovascular strategies based on both clinical symptoms and aneurysm anatomy condition.

Ruptured axillary artery pseudoaneurysm following an anterior glenohumeral dislocation: A case report.

Vascular injuries following anterior shoulder dislocations are rare, with an estimated incidence of 1-2%. The formation of an axillary artery pseudoaneurysm secondary to vascular trauma is a possible late complication and frequently underdiagnosed since it may remain asymptomatic for many years. A rupture of a pseudoaneurysm may occur either from the dislocation itself or after forceful reduction attempts. A ruptured pseudoaneurysm of the axillary artery is a medical emergency and may result in significative upper-limb morbidity or even patient mortality. Nowadays, endovascular techniques have progressively gained ground for the treatment of such lesion, especially in an emergency context. In the present article, the authors present the case of a 77-years-old male patient with a rupture of a pseudoaneurysm of the left axillary artery after repeated forceful reductions of an anterior glenohumeral dislocation and its treatment with percutaneous endovascular stenting.

OUTCOME OF ENDOVASCULAR PROCEDURES ON OCULAR FINDINGS IN TAKAYASU ARTERITIS.

To evaluate the outcome of endovascular procedures on ocular findings in patients with Takayasu arteritis. Retrospective study of patients who underwent percutaneous endovascular stenting of aortic arch arteries for Takayasu arteritis (TA) and who had documented retinopathy findings before and after the procedure. Change in visual acuity, regression of retinopathy, and development of complications after endovascular procedure were studied over a follow-up of 6 months. Ten eyes of five patients were included. Eyes which had Stage II or less of retinopathy before the endovascular procedure had favorable outcome; however, those with advanced stage of retinopathy at presentation had poor outcomes. Patients who underwent revascularization of both-sided arteries within 1 month had better anatomical and functional outcomes as compared with those who underwent sequential endovascular procedures on their arteries after a gap of 3 months or more. Percutaneous endovascular stenting of aortic arch arteries, affected in TA, can lead to reversal of retinopathy changes and restoration of vision if done before neovascular complications set in.

Endovascular stenting of spontaneous isolated dissection of superior mesenteric artery

Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare condition often presenting with vague signs and symptoms. Although the disease entity is rare, the potential for morbidity and mortality is high. Computed tomographic angiography is the preferred imaging modality for identification of SID-SMA. It may be managed by conservative, surgical, or endovascular treatment based on clinical presentation, but there is no general consensus regarding the treatment strategy. Here, we describe a case of SID of SMA treated successfully with percutaneous endovascular stent placement.

Intravascular Ultrasound-Guided Percutaneous Stenting for Treatment of LVAD Outflow Graft Obstruction

Introduction Left ventricular assist device (LVAD) outflow graft obstruction is a well-known and significant complication. The typical management involves treatment of presumed thrombosis of the graft with intensified anticoagulation or surgery. More recently, endovascular stenting has been reported as a possible treatment option. We describe the management of a LVAD outflow cannula obstruction with never reported intravascular ultrasound (IVUS)-guided covered endovascular stenting. Case report A 68 year-old female with non-ischemic cardiomyopathy status-post LVAD implantation in March 2016 presented with persistent symptomatic low flow alarms and clinical signs of heart failure. Symptoms seemed to worsen when she laid on her right side. She was compliant with her anticoagulation and lactate dehydrogenase level was found to be near her baseline. A CT scan with IV contrast revealed intraluminal obstruction of the LVAD outflow graft secondary to a kinked portion of the outflow cannula near the bend relief with a possible thrombotic component. The severe angulation of the cannula likely developed due to the patient's gradual weight gain of 28kg in the 24 months since LVAD implantation. Given the patient's risk profile, a percutaneous endovascular stenting approach was taken. IVUS was used to visualize the obstruction and kinking of the graft. A balloon-expandable covered stent was deployed at the stenotic site while the LVAD was briefly stopped to avoid stent/balloon migration. A covered stent was used to minimize the risk of thrombus migration/extrusion. IVUS was used again after post-dilation of the stent to confirm placement with no thrombus extrusion. Several hours later the patient had recurrent low-flow alarms. A repeat CT scan revealed that the kink had migrated and been transmitted within the outflow cannula towards the LVAD. The patient returned to the angiography suite where 2 balloon expandable stents were deployed more proximally within the outflow cannula and in an overlapping fashion with the original covered stent. Non-covered stents were used for the second procedure as there was no suspected thrombotic component. IVUS showed no significant residual kinking post-stenting. This was confirmed with a repeat CT scan. The patient recovered without any hemodynamic or neurologic sequelae. Conclusion Percutaneous endovascular stenting is an emerging option for treatment of outflow tract obstruction in LVAD patients that are not candidates for surgery. IVUS can be a valuable tool during intervention to confirm proper stent position, thrombus isolation, and outflow cannula geometry.

Man with sudden upper abdominal pain

A 52-year-old man without systemic disease presented to the emergency department with sudden-onset epigastric pain for 2 h. He had vomiting for several times without fever, diarrhea, or recent abdominal trauma. Point-of-care ultrasound revealed flap in the superior mesenteric artery. Percutaneous endovascular stent placement was arranged due to refractory upper abdominal pain and poor response to medical treatment.

Single Lung Transplant Complicated by Anastomotic Pulmonary Artery Stenosis

SESSION TITLE: Transplantation SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Anastomotic pulmonary artery stenosis after lung transplantation is a rare complication. Endovascular stenting appears to be a safe and efficacious treatment modality1. CASE PRESENTATION: A 43-year-old female with COPD underwent a single left lung transplant. Four months post-transplant, she presented with progressive hypoxic respiratory failure. CT chest showed a new ill-defined 2.2 x 2.1 cm nodular opacity in the left lower lobe graft shown in Figure 1. Transbronchial biopsy was negative for rejection. Bronchoalveolar lavage showed Aspergillus antigen index of 7.56 and culture grew 1 colony of non-sporulating filamentous fungus. CT-guided biopsy of the lesion showed necrotic lung parenchyma. She was treated empirically with intravenous and inhaled Amphotericin B. Despite treatment, her respiratory failure worsened and she became heated high flow oxygen dependent. Quantitative nuclear lung perfusion scan showed an overall perfusion to the right native lung was calculated to be 77.04% with overall perfusion to the left graft lung calculated to be 22.96%. Right heart angiography confirmed significant stenosis of the left pulmonary artery shown in Figure 2. Placement of a 26 mm x 12 mm LD Mega stent resulted in minimal residual stenosis. Repeated nuclear lung perfusion showed overall perfusion of left graft lung increased to 57.34%. She was eventually discharged home on room air. DISCUSSION: Pulmonary artery stenosis is a rare complication after lung transplantation. It requires a high index of suspicion especially after ruling out rejection and infection etiologies. Open repair carries high mortality and morbidity risk. To date, there have been a few case reports and retrospective studies to support the safety and efficacy of percutaneous endovascular stent placement2. Our patient tolerated the procedure well and had significant clinical improvement. CONCLUSIONS: Percutaneous endovascular stent placement is gaining acceptance as the first choice treatment for pulmonary artery stenosis following lung transplant since it is better tolerated than open repair. It appears to be safe and efficacious. However, long-term outcomes are not clear at this point. Reference #1: Grubstein A et al. Angioplasty using covered stents in five patients with symptomatic pulmonary artery stenosis after single-lung transplantation. Cardiovasc Intervent Radiol, 2014; 37: 686-690. Reference #2: Anaya-Ayala JE et al. Endovascular management of early lung transplant-related anastomotic pulmonary artery stenosis. J Vasc Interv Radiol, 2015; 26: 878-882. DISCLOSURE: The following authors have nothing to disclose: Van Le, Amy Pope-Harman No Product/Research Disclosure Information

Endovascular repair of subclavian artery aneurysms: results from a single-center experience

To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.

Superior Mesenteric Artery Thrombosis and Partial Dissection Managed Medically

A 44-year old male presented to the ED complaining of abdominal pain. CT angiography of the abdomen showed thrombus extend from the proximal superior mesenteric artery (3 cm distal to the origin), with partial dissection of the superior mesenteric artery. He was given intravenous fluid and was started on intravenous heparin. All hypercoagulable workup was done to rule out the causes of thrombosis or dissection was negative. The patient’s abdominal pain was decreasing, and heparin was bridged with Coumadin. The patient was discharged to home, and advised to check INR regularly and follow up with the vascular surgery department. Conservative management is generally the preferred treatment. For more serious cases, aggressive approaches such as percutaneous endovascular stent placement or surgery would be considered.

CRT-200.17 Optimal Aorto-ostial Lesion Treatment With Flash Ostial Balloon Is Feasible and Safe

The anatomic challenges of percutaneous endovascular stenting of aorto-ostial lesions remain a difficult task with low technical success, higher complication rates and increased target vessel restenosis rates. We sought to evaluate feasibility, efficacy, and safety of the Ostial Flash (Access

Computerized tomographic angiography in patients having eSVS Mesh(R) supported coronary saphenous vein grafts: intermediate term results

With recent advancement in percutaneous endovascular interventions, angioplasty and stenting of axillary artery lesions could become the treatment of choice vs. surgical intervention owing to its lower complication and mortality rates and shorter hospital stay.We report a Caucasian female case with axillary artery chronic total occlusion (CTO) with dual etiology (atherosclerotic and radiation induced), which was successfully managed with stent angioplasty. The strategy used was right radial retrograde approach with contralateral injections from left radial catheter. Two year follow-up revealed widely patent axillary stents.

Recent Advances in Endovascular Treatment of Aortoiliac Occlusive Disease

The rate of endovascular interventions for iliac occlusive lesions is continuously growing. The evolution of the technology supporting these therapeutic measures improves the results of these interventions. We performed a review of the literature to report and appreciate short- and long-term results of endovascular stenting of iliac artery occlusive lesions. The Medline database was searched to identify all the studies reporting iliac artery stenting for aortoiliac occlusive disease (Trans Atlantic Inter-Society Consensus [TASC] type A, B, C, and D) from January 2006 to July 2012. The outcomes were technical success, long-term primary and secondary patency rates, early mortality, and complications. Technical success was achieved in 91% to 99% of patients as reported in all the analyzed articles. Early mortality was described in 5 studies and ranged from 0.7% to 3.6%. The most common complications were access site hematomas, distal embolization, pseudoaneurysms, and iliac artery ruptures. The complications were most often treated conservatively or using percutaneous techniques. The 5-year primary and secondary patency rates ranged from 63% to 88% and 86% to 93%, respectively; and the 10-year primary patency rates ranged from 68% to 83%. In this article, combined percutaneous endovascular iliac stenting and infrainguinal surgical reconstructions and new techniques in the treatment of iliac stent restenosis are discussed. Iliac stenting is a feasible, safe, and effective method for the treatment of iliac occlusive disease. Initial technical and clinical success rates are high; early mortality and complication rates are low. Long-term patency is comparable with that after bypass surgery.

Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery

To present our experience of the clinical management of spontaneous isolated dissection of superior mesenteric artery (SIDSMA) and analyse the clinical features, imaging findings, and treatment outcomes. In this retrospective study, eight consecutive patients with symptomatic SIDSMA were treated in Chang Gung Memorial Hospital between April 2007 and April 2010; among these patients, six underwent endovascular stent placement. The clinical manifestations, imaging findings, endovascular stent placement outcome, and follow-up results of the patients were retrospectively analysed. Eight patients were diagnosed with SIDSMA by contrast-enhanced computer tomography. One patient died due to comorbidity before angiography. Six patients underwent percutaneous endovascular stent placement in the superior mesenteric artery (SMA): four patients with bare stents and two with stent grafts. Because it was not appropriate to perform stent implantation in the remaining patient, he received only conservative treatment. All seven patients had an uneventful recovery and the follow-up period was 16 month, ranging from 1 to 35 months. For patients with symptomatic SIDSMA, endovascular repair is a feasible treatment choice with a high success rate and good clinical outcome.

Endovascular Management for Isolated Spontaneous Dissection of the Superior Mesenteric Artery: Report of Two Cases and Literature Review

The clinical course and treatment strategies of isolated superior mesenteric artery (SMA) dissection have not been fully investigated. Two cases of uncontrolled abdominal pain caused by isolated SMA dissection were successfully treated with percutaneous endovascular stent placement. At follow-up 6 months later, computed tomography confirmed that the lesions had stabilized. The patients remained symptom free at 14- and 13-month follow-up, respectively. The present report describes these two cases of isolated SMA dissection treated successfully with percutaneous endovascular stent placement, along with a review of the related literature.

Pulmonary Artery Stenosis Secondary to Fibrosing Mediastinitis: Management with Cutting Balloon Angioplasty and Endovascular Stenting

Cutting balloon angioplasty is a common treatment modality in the pediatric population for pulmonary artery stenosis. We present an adult with histoplasmosis induced fibrosing mediastinitis resulting in pulmonary artery stenosis that was successfully treated with cutting balloon angioplasty and subsequent stent deployment. Percutaneous endovascular stent placement has be shown to effectively alleviate pulmonary artery stenosis, however in-stent restenosis does limit durability. Pharmacologic therapy is indicated with either mediastinal adenitis or mediastinal granuloma with anti-fungal agents such as amphotericin B and itraconazole. Surgical intervention for histoplasmosis induced fibrosing mediastinitis is rarely indicated and may result in fatal complications that stem from mediastinal fibrosis due to resultant destruction of surgical planes. To our knowledge, this is the first reported case of utilizing cutting balloon angioplasty and stent insertion for the treatment of histoplasmosis induced fibrosing mediastinitis complicated by pulmonary artery stenosis.

Robot-Assisted Treatment of Splenic Artery Aneurysms

Although splenic artery aneurysms (SAAs) are relatively uncommon, they are clinically relevant because of the risk of rupture. Optimal management is a matter of debate and involves the use of percutaneous endovascular stenting, which has limitations, versus theopen surgical approach which can lead to significant morbidity. The present study reports the outcomes of robot-assisted surgery for SAA and its role in overcoming many of the limitations of laparoscopy. A total of nine patients with incidentally detected SAAs underwent a surgery between September 2001 and November 2007. Six of these nine patients underwent a robot-assisted splenic aneurysm resection with vascular reconstruction. The remaining three cases included one robotic arterial ligation, one robotic partial splenectomy, and one laparoscopic splenectomy. The mean operating time was 212 ± 61 minutes (range: 90-300), mean intraoperative blood loss was 186.6 ± 202.4 mL (range: 0-500), and mean hospital stay was 7.1 ± 3.7 days (range: 3-14). The morbidity rate was 11.1% and no mortality was reported. Doppler-ultrasonography surveillance showed regular organ perfusion in all patients with vascular reconstruction. Robot-assisted surgery for SAA represents one of the most advanced developments among minimally invasive procedures and can become an important option for the treatment of this disease.