Percutaneous Stent Insertion Research Articles

Bleeding After Dental Extraction in Patients Undergoing Percutaneous Coronary Intervention During Uninterrupted Single and Dual Antiplatelet Therapy.

This study aimed to assess bleeding risk after exodontia in patients with recent percutaneous coronary intervention during uninterrupted single or dual antiplatelet therapy. A total of 100 patients who had a history of percutaneous stent insertion during the past year candidate for extraction of teeth were included in the study. Fifty patients took aspirin 100mg (monotherapy group), and 50 patients took a combination of aspirin 100mg and clopidogrel 75mg (dual therapy group). After exodontia, the bleeding status was categorized as "complete hemostasis," "persistent bleeding," and "delayed bleeding." Personal data, underlying diseases, number of teeth and roots extracted, and type of procedure required for exodontia were statistically analyzed. No significant difference was observed in the status of bleeding between the two groups regarding sex, age, underlying diseases, number of teeth and roots extracted, and type of procedure (p > 0.05). 39/50 (78%) of monotherapy patients and 32/50 (64%) of dual therapy patients achieved complete hemostasis. Persistent bleeding was noted in 11/50 (22%) of monotherapy participants, and 14/50 (28%) of dual therapy patients. Only 4/50 (8%) of dual therapy patients experienced delayed bleeding. However, these differences were not significant (p = 0.08). All persistent and delayed bleeding was easily controlled via local measures. Simple or complicated extraction of multiple teeth can be performed safely during the first year after percutaneous coronary intervention without interruption of antiplatelet therapy.

Radiological Intervention and Imaging Procedures in Management of Patients with Malignant Obstructive Jaundice

AbstractBackground: Malignant biliary obstruction has a bad prognosis and adverse effect on the quality of life, with most of those patients are inoperable at time of diagnosis. Patients who underwent whipple operation may develop anastomotic site (choledocho-jujenostomy) stenosis with subsequent ele-vated bilirubin level and related complications.Aim of Study: This prospective study will be conducted to evaluate the efficacy of different modalities of interventional radiological and imaging procedures as Percutaneous Trans hepatic Cholangiography (PTC), Percutaneous Trans hepatic Drainage (PTD) and biliary stenting in management of patients with malignant obstructive jaundice.Patients and Methods: This study was conducted on 30 patients (19 males and 11 females) with mean age of 56 years, 28 of 30 patients (93.3%) are non operable and the other 2 of 30 patients (6.7%) operated patients for choledocho-jujenostomy stenosis were subjected to intervention techniques. 10 of 30 patients (33.3%) underwent percutaneous external biliary drainage, 15 of 30 patients (50%) underwent percuta-neous stent insertion (8 of 30 patients (26.7%) with metallic stents & 7 of 30 patients (23.3%) with plastic stents), 3 of 30 patients (10%) underwent internal external drainage and 2 of 30 patients (6.66%) underwent biliary drainage through combined (randez-voux) technique.Results: High success rate (86.6%) with reduction of total bilirubin level was observed in metallic stenting group of patients.Conclusion: Biliary intervention procedures help to reduce high bilirubin level, bypass obstruction level and help in dilatation of post-operative stenosis site.

Unprotected left main coronary artery stenting with zotarolimus (Endeavor) drug‐eluting stents

To report the safety and efficacy of zotarolimus eluting stents for treatment of unprotected left main coronary artery disease. Percutaneous stent insertion is an increasingly popular alternative to bypass surgery for the management of left main (LM) coronary artery disease. While data support the use of sirolimus- and paclitaxel-coated stents in the LM coronary artery, there are no published series reporting results with Endeavor (zotarolimus) stents, particularly in the context of unprotected left main (ULM) lesions. We retrospectively identified 40 consecutive patients who had ULM disease treated with Endeavor stents (ZES) and who had follow-up angiography. The primary endpoint was the prevalence of major adverse cardiac events (MACE), including cardiac/unexplained death, nonfatal myocardial infarction (MI), and in-stent restenosis (ISR)/target lesion revascularization (TLR). Angiographic and procedural success was achieved in all cases. Follow-up angiography occurred on average 5.6 ± 0.9 months after the index procedure. There were three incidences of ISR requiring TLR and another patient who had a NSTEMI in the follow-up period. At late follow-up (12.4 ± 1.8 months) three patients underwent CABG (one for RCA stenosis) and four patients died without knowledge of the status of the ULM stent (two cardiovascular and two deaths related to cancer progression). In conclusion, our experience with Endeavor stents for the treatment of ULM disease demonstrates excellent angiographic and clinical outcomes, with a 7.5% ISR/TLR rate and a 15% MACE rate, respectively, at an average clinical follow-up of 12.4 months.

Two Cases of Descending Aortic Dissection with Compromised Visceral Artery, Renal Artery, and Iliac Artery Treated with Percutaneous Stent Insertions

Stanford B형 급성 대동맥 박리 환자에서 대동맥부터 나가는 장간막동맥, ì‹ ìž¥ë™ë§¥, 장골동맥과 같은 중요한 분지혈관의 í˜ˆë¥˜ìž¥ì• ë¡œ 인한 허혈이 동반 시 ìˆ˜ìˆ ì  치료 ëŒ€ì‹ íì‡„ëœ 동맥에 ê²½í”¼ì ìœ¼ë¡œ ìŠ¤í íŠ¸ë¥¼ ì‚½ìž í•˜ì—¬ 대동맥에서부터 분지혈관으로 가는 동맥혈류를 회복시키는 ì¤‘ìž¬ì  치료를 시행하여 좋은 결과를 경험하였기에 ë¬¸í—Œê³ ì°°ê³¼ 함께 ë³´ê³ í•˜ëŠ” 바이다. 중심 단어: 대동맥; 박리; í˜ˆê´€ì„±í˜•ìˆ ; ìŠ¤í íŠ¸; ì‹ ìž¥ë™ë§¥

Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent

Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent

Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent

Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent

Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes.

Renal artery stenosis is a common, progressive cause of hypertension and renal impairment, and is frequently treated with percutaneous transluminal dilatation and stenting. The outcome of this procedure is still being evaluated. The records of 198 consecutive patients who had stents inserted at the Royal Melbourne Hospital were analysed retrospectively, and adequate follow-up information on 148 (75%), in whom a total of 182 renal arteries had been treated was obtained. Technical success was achieved in 144 patients (97%). Complications occurred in 19 patients (13.3%), with major complications occurring in 10 (7.0%) and one death occurring in relation to the procedure. A fall in average systolic blood pressure of 13.2 mmHg (12.1-14.3 mmHg) was seen and a fall in diastolic blood pressure of 10.1 mmHg (9.3-10.9 mmHg), without an increase in the number of antihypertensive drugs used. Renal function remained stable in the majority of patients, particularly those who had minimal baseline renal impairment. Restenosis was common after 6 months, occurring eventually in 29% of screened patients, but was not shown to affect clinical outcomes. Insertion of renal artery stents is a safe and effective treatment for renal artery stenosis.

Self-expanding coil stent with a long delivery system for palliation of unresectable malignant gastric outlet obstruction: a prospective study.

Peroral intubation of a self-expanding metal stent is usually difficult in patients with unresectable malignant gastric outlet obstruction, because the delivery systems currently available are not long enough and cannot easily pass the angulated gastroduodenal structure. We carried out a prospective study to assess the efficacy of a coil stent with a newly developed long delivery system, for palliation of unresectable malignant gastric outlet obstruction. In 29 patients with unresectable malignant gastric outlet obstruction, caused by gastric cancer (26 patients), pancreatic head cancer (two patients), or duodenal cancer (one patient), peroral intubation of a self-expanding nickel-titanium coil stent was attempted, using a lengthened delivery system of 150 cm, under endoscopic and fluoroscopic guidance. Management was successful in 26 of 29 patients (89.7 %) without immediate major complications. In one patient in whom peroral intubation failed, percutaneous intubation of the coil stent via percutaneous endoscopic gastrostomy was done. After insertion of the coil stent, food ingestion with symptomatic improvement with regard to vomiting was achieved in 26 of 27 patients (96.3 %), including the patient with percutaneous stent insertion. During the follow-up period, dysphagia and Karnofsky scores improved significantly. Stent migration occurred in two patients, and tumor ingrowth in another two; re-intervention was done successfully performed in two instances. The mean survival time was 124 days (range 34 - 310 days) in the 22 patients who had no need for re-intervention during follow-up; among these was a patient who experienced stent occlusion by food material, which was easily corrected with endoscopic flushing. Peroral intubation of a self-expanding coil stent using a long delivery system is a safe and effective palliative technique for unresectable malignant gastric outlet obstruction, and significantly improves the quality of life of patients.

Aortic Dissection Complicated with Lower Extremity and Renal Ischemia Treated by Percutaneous Stent Insertion

Aortic Dissection Complicated with Lower Extremity and Renal Ischemia Treated by Percutaneous Stent Insertion

Predicting early mortality following percutaneous stent insertion for malignant biliary obstruction: a multivariate risk factor analysis.

Percutaneous stent placement is an accepted method of palliation in malignant biliary obstruction. Factors predicting early mortality after this procedure have not been identified. We performed a retrospective study of 141 patients with malignant biliary obstruction who underwent percutaneous stent placement for biliary decompression to identify the risk factors associated with early mortality (< or = 30 days). Of 14 clinicopathological and laboratory variables analysed blood urea, albumin, haemoglobin and alkaline phosphatase were found to be significant on univariate analysis. The age and gender of the patient along with cancer type, level of obstruction, presence of pyrexia and bilirubin level had no influence on early mortality. Stepwise logistic regression identified the haemoglobin level and blood urea to be independently significant in predicting early mortality. Overall 30-day mortality was 20.5% (29/141). Patients with blood urea over 4.3 mmol/l and a haemoglobin less than 10.9 g/dl had a mortality rate of 52% (12/23) compared with 14% (17/118) in the remainder. Using these two variables a regression equation has been derived which allows calculation of the probability of survival at 30 days after the percutaneous procedure. Laboratory variables in patients with malignant obstructive jaundice can be used to predict mortality following percutaneous stent insertion.

Treatment of Malignant Superior Vena Cava Obstruction: Metal Stents or Radiation Therapy

The results of treating malignant superior vena cava obstruction by means of percutaneous self-expanding stent insertion or by means of radiation therapy were compared. Seventy-six patients with malignant superior vena cava obstruction who were treated by stent insertion were studied prospectively and 25 patients who were treated by radiation therapy were studied retrospectively. A superior vena cava obstruction score was devised to measure treatment effectiveness. Speed of symptom relief and complications were recorded. End points in the study were recurrent obstruction or death. Asymptomatic survival times were compared by log rank and Mann Whitney tests of significance, as well as Kaplan-Meier analysis. A subgroup of 26 patients who were treated by stent placement only were compared with the radiation therapy group and analyzed separately. There were seven complications in the overall stent group, one in the stent-only group, and 25 in the radiation therapy group. Stent insertion provided faster relief of symptoms and significantly greater improvement in the superior vena cava obstruction score than radiation therapy (P < .001, Mann-Whitney U test). A Kaplan-Meier analysis of asymptomatic survival demonstrated that significantly fewer patients in the overall and stent-only groups developed recurrent symptoms (P = .0005 and .001, respectively, log rank test). This study suggests that percutaneous stent insertion in malignant superior vena cava obstruction fulfills the requirements of a palliative procedure significantly better than radiation therapy and that it should be the procedure of first choice.

Day-case transfer of inpatients for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography

To use facilities flexibly and efficiently, a diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) service was offered to inpatients from referring hospitals on a day-case basis. Patients were transferred by ambulance with a nurse escort and returned to the parent hospital after a short period of recovery. The activity of this service was audited. A total of 188 patients (70 men and 118 women of mean age 63.5 (range 22-94) years) were referred, 55 by physicians or geriatricians and 133 by surgeons from 19 hospitals up to 100 miles distant. Some 109 (58 per cent) had jaundice, 12 (6 per cent) cholangitis, seven (4 per cent) acute pancreatitis and 41 (22 per cent) abdominal pain. All patients arrived between 08:30 and 12:00 hours, all but 16 between 09:30 and 11:00 hours, and all but one with an escort; 129 patients travelled less than 10 miles. The mean time spent in the authors' hospital was 5.9 (range 2.2-9.5) h. The mean time spent away from the parent hospital by patient and escort was 7.0 (range 3.5-10) h. Cannulation failed in 12 patients (6 per cent), two with duodenal tumours. Sphincterotomy was performed in 70 cases, mechanical lithotripsy in seven and stents were inserted in 67. Nine patients were admitted, four for percutaneous stent insertion after failed ERCP and three for abdominal pain (one acute pancreatitis); two patients with sepsis and malignancy died after admission to this hospital. After return to the parent hospital, a further patient died following laparotomy for malignancy and five patients developed abdominal pain (three acute pancreatitis). These findings show that short-stay ERCP can be undertaken on transferred inpatients safely and efficiently without adverse effect on success or complication rates.

Trans-hepatic proximal migration of percutaneous-endoscopic biliary stent presenting as an abdominal wall abscess

Endoscopically placed biliary prostheses or stents are an established method of relieving obstruction of the common bile duct, whether due to gallstones or stricture, with less morbidity than percutaneous placement 1 Speer AG Cotton PB Russell RCG. Randomised trial of endoscopic versus percutaneous stent insertion in malignant jaundice. Lancet. 1987; 2: 57-62 Abstract PubMed Scopus (590) Google Scholar or surgery. 2 Shepherd HA Royle G Ross AP. Endoscopic biliary endoprosthesis in the palliation of malignant biliary obstruction of the distal common bile duct: a randomised trial. Br J Surg. 1988; 75: 1166-1168 Crossref PubMed Scopus (499) Google Scholar In malignant disease, this procedure affords an improved quality of life by relieving obstructive jaundice, but is often technically difficult to perform because of tightness of the stricture or distortion of the anatomy. This may necessitate a percutaneous transhepatically inserted internal-external stent, with the possibility of converting it into an endoscopically inserted biliary stent. 3 Tan PC Lai ECS Hui WM Chan SCH. Pitfalls of percutaneous-endoscopic biliary stent placement. Am J Gastroenterol. 1990; 85: 207-209 PubMed Google Scholar Complications of both types of stent include stent blockage, sepsis, and migration that is usually distal. We report here a case of proximal migration of a percutaneous-endoscopic biliary stent presenting as an abdominal wall abscess.

Pancreatic and Ampullary Carcinoma

Surgery should be the first therapeutic modality considered in patients with pancreatic and ampullary carcinoma. Surgery is the only potentially curative therapy and offers the best form of palliation in patients with impending or overt duodenal obstruction. Patients with clearly unresectable tumors or those considered unfit for surgery should be offered palliative therapy, preferably endoscopically. The difficulty, however, arises in patients who undergo laparotomy and who subsequently are found to have unresectable tumors. The problem of stent occlusion and frequent associated hospital visits has been an argument to proceed to palliative double bypass surgery. Against this is the low mortality and shorter hospital stay of nonsurgical endoscopic palliative therapy. Direct comparisons of surgery versus endoscopic therapy have shown that both are equally effective in the initial relief of jaundice (Table 6). Surgery has a higher initial mortality and complication rate, but more long-term complications and hospital visits were seen in the endoscopic group, suggesting that it offered a poorer long-term palliation. There was no significant difference in the survival of the patients in the two groups. Patient choice is a major factor in the final decision, but current recommendations probably should be that patients with a poor short-term survival outlook should be offered nonsurgical palliative therapy and those with a longer life expectancy may best be handled with surgery. Predicting patient survival, of course, remains a major difficulty. A recent publication of the laparoscopic formation of a cholecystojejunostomy for palliation of malignant biliary obstruction also offers a promising approach that requires further evaluation.

Combined endoscopic and percutaneous stent insertion to overcome a problem of percutaneous stent insertion

Non-operative stent insertion is a well-accepted means of palliating malignant biliary obstruction. The endoscopic approach is often considered the procedure of choice, with the percutaneous technique reserved for endoscopy failures. We recently encountered a patient in whom both techniques proved unsuccessful initially, and in whom palliation was finally achieved by means of a combined endoscopic and percutaneous transhepatic procedure.