Radioactive Stents Research Articles

Experimental study on radiational characteristics and nursing care of a novel radioisotope 188Re memory alloy esophageal stent.

Radioactive esophageal stent, known for inhibiting tumor growth and delaying restenosis in malignant esophageal tumors, presents challenges due to potent radiation, leading to side effects. This study aims to support the clinical use of 188Re radioactive esophageal stent. The 188Re stent with 128MBq initial activity was placed in a biomimetic esophageal membrane. Radiation absorption doses were measured by thermoluminescence and calculated using mathematical software. Under simulated positioning, the stent was implanted in the esophagus of an experimental pig, followed by the feeding of Kangfuxin solution and nursing care (KFX-RT). Non-implanted and implanted-only pigs served as normal (CR) and experimental (RT) controls. Blood samples collected on days 7 and 21 were analyzed for inflammatory factors (TGF-β1, TNF-α, IL-6) using enzyme-linked immunosorbent assay. Esophageal tissue cells were assessed for deoxyribonucleic acid index (DI) and subdiploid content through flow cytometry. Absorbed doses at 0.5mm and 5mm reference points were 223.91cGy and 20.55cGy, respectively, with 92.64% absorbed within a 1mm thickness. Radiation dose significantly decreased at 6.5mm, with only 4.72% absorbed at depths ≥6.5mm. On days 7 and 21, levels of inflammatory factors, DI and subdiploid content were significantly increased in the KFX-RT and RT groups compared to the CR group, while all levels in the KFX-RT group were significantly lower than in the RT group. The 188Re esophageal stent exhibits high radiation absorption in superficial tissues and low absorption in deeper tissues. Kangfuxin solution combined with nursing care alleviates radiation-induced inflammatory damage.

Unilateral and bilateral radioactive stent insertion in patients diagnosed with inoperable hilar cholangiocarcinoma: a comparative analysis.

While hilar cholangiocarcinoma (HCCA) patients commonly undergo radioactive stent (RS) insertion treatment, the relative benefits of unilateral versus bilateral RS insertion procedures remain to be established. Accordingly, this study was designed to evaluate the relative safety and efficacy of percutaneous bilateral and unilateral RS insertion for patients with HCCA. In total, 126 HCCA patients who underwent unilateral (n=64) or bilateral (n=62) RS insertion from January 2017 - December 2021 were included in this analysis. Treatment efficacy and long-term outcomes were compared between groups. The primary endpoint was stent patency, and the secondary endpoints included technical success rate, clinical success rate, local control rate, overall survival (OS), and complications. The respective technical success rates in the unilateral and bilateral groups were 90.6% (58/64) and 93.5% (58/62) (P = 0.782). The clinical success rates were 82.8% and 86.2% in unilateral and bilateral groups, respectively (P = 0.608). Both groups exhibited comparable medial post-intervention bilirubin levels (100 vs. 99 μmol/L; P = 0.501), and restenosis occurred in 12 (20.7%) and 15 (25.9%) patients over the follow-up interval (P = 0.510). The stent reintervention rate was significantly higher in the unilateral group than bilateral group (66.7% vs. 0.0%, P < 0.001). The median stent patency in the unilateral and bilateral groups was 189 and 210 days, respectively (P = 0.796), while the median OS interval was 222 and 229 days, respectively (P = 0.969). Comparable cholangitis (17.2% vs. 22.4%, P = 0.485) and cholecystitis (3.4% vs. 3.4%, P = 1.000) rates were also detected in these two groups. In summary, HCCA patients exhibit comparable efficacy when undergoing unilateral and bilateral radioactive stenting, suggesting that unilateral RS can be routinely performed owing to the simpler nature of this procedure.

Stent Insertion for Inoperable Hilar Cholangiocarcinoma: Comparison Between Unilateral Radioactive Stent and Bilateral Normal Stent.

To comparatively analyze the clinical efficacy and safety of unilateral radioactive stent (RS) insertion versus bilateral normal stent (NS) insertion in patients with inoperable hilar cholangiocarcinoma (HC). Patients with inoperable HC were treated in our hospital from January 2016 to December 2020. The treatment approach included the insertion of either unilateral RS or bilateral NS, evaluating the efficacy and safety of therapy in 2 distinct groups. A total of 58 individuals experienced the insertion of a unilateral RS, whereas 57 patients underwent the insertion of bilateral NS. No statistically significant difference between the unilateral RS and bilateral NS groups was seen in the technical success rates (98.3% vs 94.7%, P = 0.598) and clinical success rates (98.2% vs 100%, P = 0.514). While there is no statistically significant difference in the rates of stent restenosis (19.3% vs 9.3%, P = 0.132) between the two groups, the unilateral RS group demonstrated substantially longer stent patency (202 vs 119 d, P = 0.016) and overall survival (229 vs 122 d, P = 0.004) compared with the bilateral NS group. Moreover, 8 patients (14.0%) in the unilateral RS group and 14 patients (25.9%) in the bilateral NS group had postoperative complications with no significant difference ( P = 0.116). When inserting stents for inoperable HC, both unilateral RS and bilateral NS insertion procedures have demonstrated favorable therapeutic efficacy. Nevertheless, inserting a unilateral RS provided a longer duration of stent patency and overall survival than implantation of bilateral NS.

Recent progress in radioactive seed implantation brachytherapy of non-small cell lung cancer: a narrative review.

Brachytherapy, a new form of radiation therapy, has been used to treat lung cancer and consists of two main forms of treatment: endobronchial brachytherapy and radioactive seed implantation brachytherapy (RSI-BT), the latter of which is used to treat non-small cell lung cancer (NSCLC). The use of RSI-BT in the treatment of NSCLC at our centre has yielded some positive results. To more fully consider the context of this application, we conducted a search of PubMed from 2018 to March 5, 2023. The search included a combination of the MeSH terms: "brachytherapy" and "lung neoplasm". The majority of NSCLC patients who received RSI-BT achieved positive benefits. Most patients had a progression-free survival (PFS) of between 12 and 18 months. Additionally, radioactive particle stent implantation as a specific RSI-BT has shown therapeutic potential in the treatment of malignant airway obstruction. With the application of new technologies, RSI-BT will become more precise, efficient and inexpensive. This review demonstrates that RSI-BT can be therapeutic in the treatment of both early and advanced NSCLC with manageable complications. There have also been reports on the combination of RSI-BT with other therapies, but more research is needed on the combination of RSI-BT with them.

Endoscopic Treatment of Malignant Hilar Biliary Obstruction.

Stent implantation is an effective approach for palliative treatment of Bismuth-Corlette type III-IV malignant hilar biliary obstructions (MHBOs). In this article, we reviewed the currently used access methods for biliary stent placement (percutaneous transhepatic biliary drainage, endoscopic biliary drainage, endosonography guided biliary drainage), the available stent types (plastic stent, self-expanding metallic stent, full cover self-expanding metallic stent, radioactive self-expanding metallic stent), major approaches (unilateral, bilateral) and deployment methods (stent-in-stent, stent-by-stent). Finally, this review gives an outlook on perspectives of development in stenting and other palliative methods in MHBO.

The Effect of Iodine-125 Radioactive Particle Stent with Doxorubicin-loaded Nano-tetrahedrons Combined with Transarterial Chemoembolization on Survival and Prognosis of Patients with Cholangiocarcinoma.

This study was to analyze the application of doxorubicin-loaded DNA nano-tetrahedral Iodine-125 (I-125) radioactive particle stent (doxorubicin-loaded 125I stent) combined with transarterial chemoembolization (TACE) in improving the prognosis of patients with cholangiocarcinoma (CC). The doxorubicin-loaded DNA nano-tetrahedrons were constructed, the preparation plan was optimized, and the toxicity test was performed. The prepared doxorubicin-loaded DNA nano-tetrahedrons were applied to 85 cases in the K1 group (doxorubicin-loaded 125I + TACE), 85 cases in the K2 group (doxorubicin-loaded 125I), and 85 cases in K3 group (TACE). It was found that the optimal initial concentration of doxorubicin for the preparation of DNA-loaded nano-tetrahedrons was 200 mmol, and the optimal reaction time was 7 hours. The serum total bilirubin (TBIL) level in the K1 group at 30 days after operation was lower than that in the K2 and K3 groups at 7, 14 and 21 days. (P< 0.05). The alkaline phosphatase (ALP) level in the K1 group was lower in contrast to that in the other two groups at 7, 14, and 21 days after surgery (P< 0.05); and the five-year survival rate of patients in the K1 group was greater in contrast to the rate in K2 and K3 groups (P< 0.05). In short, the implantation of a doxorubicin-loaded 125I stent combined with TACE could effectively improve the five-year survival rate of patients with CC and improve the prognosis effect of the patients.

A narrative review of progress in airway stents.

Background and ObjectiveAirway stents, used to restore airway patency, are mostly utilized by patients with malignant airway strictures, and are occasionally used in a range of other airway related diseases, including conditions which result in benign stenosis, malacia, and fistula. There has been an increasing number of airway stents that are being developed thanks to improvements in interventional therapy. However, the method of promoting airway stents for clinical application remains undetermined. Herein, we describe the recent advances in airway stents by reviewing the published studies, providing the reference for clinical decision-making and further research on airway stents.MethodsRelevant articles between January 1964 and November 2021 were obtained from PubMed, Web of Science, and EMBASE databases. The terms “metallic”, “silicone”, “drug-eluting", “biodegradable”, “radioactive”, “three-dimensional (3D)”, and “stents” were searched in different combinations.Key Content and FindingsIn this review, we focus on the latest evidence in terms of the application of various stents with novel materials and designs including novel metallic, novel silicone, drug-eluting, biodegradable, radioactive, and 3D stents for airway stenosis. Despite reducing the well-known complications of all current commercially available stents, novel stents are still in their infancy without a long track record of utility and safety, and remain some limitations. There are more steps to be taken before such stents enter routine clinical practice.ConclusionsA combination of 3D-printing method and biodegradable material may present a promising avenue of solving the existing problems pertaining to “classic” stents and has potential to become the main trend in the future.

Dosimetric Evaluation and Clinical Application of Radioactive Iodine-125 Brachytherapy Stent in the Treatment of Malignant Esophageal Obstruction.

ObjectiveTo evaluate the dosimetric characteristics and the clinical application of radioactive iodine-125 brachytherapy stent (RIBS) in malignant esophageal obstruction.MethodsThe dose distribution of RIBS with different seed spacing, diameter and length was studied by treatment planning system (TPS) calculation, thermoluminescence dosimeter (TLD) measurement and Monte Carlo (MC) data fitting. And the data of esophageal cancer patients who were treat with this type of RIBS was analyzed retrospectively.ResultsDoses around the RIBS calculated by the TPS lay between those measured by the TLDs and those simulated by the MC, and the differences between the three methods were significant (p<0.05), the overall absolute dose differences among the three methods were small. Dose coverage at 1.5 cm from the center was comprehensive when the activity reached 0.6 mCi. Both the conformability and the uniformity of isodose lines produced by a seed spacing of 1.0 cm were superior to those produced by a seed spacing of 1.5 cm. The data of 50 patients treated with RIBS was analyzed. They were followed up until February 2020 when all of the patients died. The overall improvement rate of dysphagia after RIBS implant was 90%. Moderate and severe complications with an incidence of more than 10% were hematemesis (28%), pain (20%), and lung infection (10%). Stent restenosis occurred in 4 patients at a median interval of 108 days from the procedure. The overall incidence of fatal complications was 38% (including hematemesis, infection and asphyxia). The median survival time of patients with and without a history of radiotherapy were 3.4 months and 6 months, respectively, the difference of which was significant (p=0.021). No other factors affecting survival were identified. For patients with and without a history of radiotherapy, the incidences of fatal complications were 51.7% and 19%, respectively (p=0.019). No correlation between dose and stent restenosis was found.ConclusionTPS calculations are suitable for clinical applications. RIBS can effectively alleviate obstructive symptoms for patients with malignant esophageal obstruction, but the incidence of fatal complications was high, care should be taken when choosing this treatment.

Radioactive stent insertion for inoperable hilar cholangiocarcinoma: a prospective randomized controlled trial.

Hilar cholangiocarcinoma (HC) is the leading cause of hilar biliary obstruction. Radioactive stent insertion has been utilized extensively for inoperable HC patients. To assess the relative clinical outcomes of inoperable HC patients who underwent either normal or radioactive stent insertion. This single-center, prospective, randomized, open-label study enrolled 90 inoperable HC patients from April 2021 to March 2022 and randomly assigned them to normal or radioactive stent groups (n = 45/group), with clinical data then being compared between these groups. Technical success rates in the normal and radioactive stent insertion groups were 93.3% and 97.9%, respectively (p = 1.000), and clinical success rates were similarly consistent in both groups (95.3% vs. 97.7%, p = 0.983). Individuals in the radioactive stent group exhibited significantly longer median stent patency as compared to the normal stent group (195 days vs. 115 days, p < 0.001), and median overall survival (OS) was also significantly increased in the normal stent group (242 days vs. 125 days, p = 0.002). In the normal stent insertion group, 6 (14.3%) and 5 (11.9%) patients experienced early and late postoperative complications, respectively. Additionally, early and late postoperative complications impacted 7 (16.3%) and 8 (18.6%) patients in the radioactive stent insertion group, respectively. Complication rates were comparable in these 2 patient groups. Radioactive stent insertion represents a safe and effective strategy for patients with inoperable HC, potentially contributing to prolonged stent patency and OS relative to normal stent insertion.

Bilateral versus unilateral radioactive stent insertion for hilar cholangiocarcinoma.

Radioactive stent insertion (RSI) is widely used for patients with obstructive hilar cholangiocarcinoma (HC) to increase the stent patency and overall survival (OS). However, one controversy of treating HC patients is determining whether to use unilateral or bilateral stenting. General knowledge on unilateral and bilateral RSI efficacy is still lacking. To evaluate the clinical efficacy and long-term prognoses of unilateral and bilateral RSI in HC patients. Between January 2016 and December 2020, all HC patients who received unilateral and bilateral RSI at our hospital were selected for this study. We compared the treatment efficacy and long-term prognosis of patients undergoing these two procedures. Overall, 65 HC patients received either unilateral (n = 33) or bilateral (n = 32) RSI. There were no significant differences in the technical (both 100%) and functional (97.0% vs. 90.6%, p = 0.584) success rates between the 2 groups. Stent re-obstruction occurred in 6 and 9 patients in the unilateral and bilateral groups, respectively (p = 0.341). Median stent patency was 214 and 233 days in the unilateral and bilateral groups, respectively (p = 0.650). Median OS was 240 and 281 days in the unilateral and bilateral groups, respectively (p = 0.068). Lastly, the total complication rate was significantly lower in the unilateral group, as compared to the bilateral group (12.1% vs. 34.4%, p = 0.033). Unilateral and bilateral RSI provided comparable clinical efficacy and long-term prognoses of HC patients. However, unilateral stenting exhibited a markedly lower complication rate.

The modern approach to esophageal palliative and emergency surgery.

Thoracic surgeons currently have multiple options and strategies to guide treatment in esophageal palliative and emergency conditions. To guide the selection of an individualized palliative approach, physicians, including thoracic surgeons, must take into consideration many factors including prognosis, performance status and comorbidities of patients. For dysphagia more specifically, esophageal stent placement is the most widely used intervention for rapidly relieving dysphagia in inoperable esophageal cancer patients. The combination of esophageal stent placement with other therapies has an impact on palliative care. Innovations including radioactive stents, drug-eluding stents and biodegradable stents will require further evaluation and validation studies. Currently, patients with inoperable esophageal cancer have access to oncological and biological therapies that are improving their prognosis. A shift toward restaging and potential curative intent is occurring in current clinical practice. In acute intrathoracic esophageal perforation cases, high index of suspicion, multidisciplinary team expertise, antibiotics and hybrid treatment strategies, have significantly improved outcomes of patients in recent years. Hybrid treatment strategies denote the combination of minimally invasive interventions for source control and endoluminal procedures to seal the esophageal perforation. Endoluminal procedures as treatment of acute intrathoracic esophageal perforation include stent placement, over-the-scope clip and endoluminal vacuum therapy. Future perspective in the management of esophageal perforation seems to be the combination of endoluminal therapies tailored to the specific clinical scenario. Thoracic surgeons benefit from mastering endoluminal therapies and advanced endoscopic techniques. An understanding of these rapidly evolving therapies, i.e., outcomes, limitations and innovations, is required to optimally manage esophageal palliative and emergency conditions.

131I radioactive self-expandable metallic stents for the therapy of malignant biliary obstruction

Biliary stent implantation has become a standard approach for patients with unresectable malignant biliary obstruction. Unfortunately, in-stent restenosis after stent implantation still occurs because of tumor overgrowth. The majority of studies show that radioactive stents harbor both the obstructed biliary tract-dilating and tumor-suppressing functions. In this study, we designed a kind of novel 131I-labeled radioactive self-expandable metallic stent (SEMS) that combines the mechanical dilation forces induced by stent expansion and 131I intraluminal brachytherapy, which was prepared by first coating the SEMS with poly (diallyl acrylate) (PDA) and then labeling with iodine-131. The designed stents would not only have a longer patency time but also is able to inhibit biliary compression caused by tumor growth. The PDA coating was robust and flexible. The 131I labeling rate was about 60%, and after a 16-day test of radiochemical stability of 131I, the radioactive stability was around 80%. In addition, the radiochemical stability of 131I could be improved by PDA recoating post-131I labeling. In conclusion, we designed and fabricated a kind of novel 131I-labeled radioactive self-expandable metal stents by labeling 131I on the PDA-coated stent. We provide a new idea of radioactive stents design, which would extend the patency time of the stent while reducing the rate of stent restenosis after implantation.

Newer Stents for Unresectable Malignant Distal Biliary Obstruction: Striving for Perfection!

AbstractEndoscopic biliary stenting is one of the most commonly used palliative procedure in patients with unresectable malignant distal biliary obstruction. Biliary stenting can be performed with either plastic or metallic stents. Stent occlusion and migration are important limitations of currently available stents. Variety of newer stents with varying designs and stent materials like stents with antimigratory properties, antireflux stents, drug-eluting stents, radioactive stents, and bioabsorbable stents are being developed to overcome the limitations of currently available stents. In this article, we are discussing two articles on the newer stent designs (plastic and metal stents) for biliary drainage in patients with unresectable malignant distal biliary obstruction.

Radioactive Stent for Malignant Esophageal Obstruction: A Meta-Analysis of Randomized Controlled Trials.

Purpose: To compare the relative clinical efficacies of radioactive and normal stent insertion methods as a means of treating patients suffering from malignant esophageal obstruction (MEO). Materials and Methods: The Pubmed, Embase, and Cochrane Library databases were searched for relevant randomized controlled trials (RCTs) from the date of inception through to July 2020. RevMan v5.3 was used for all data analyses. Results: This meta-analysis included six RCTs that included a total of 194 patients who had undergone radioactive stent insertion and 209 who had normal stent insertion. There were no significant differences in pooled improvement of dysphagia scores (P = .40), rates of stent restenosis (24.7% versus 28.7%, P = .35), stent migration (3.3% versus 4.4%, P = .61), severe chest pain (22.8% versus 20.3%, P = .61), hemorrhage (11.0% versus 9.8%, P = .80), or fistula formation (6.1% versus 4.2%, P = .55) between two groups. The pooled time to restenosis (P < .00001) and survival (P < .00001) were significant longer in the radioactive stent group. Significant heterogeneity was detected in the endpoint of improvement of dysphagia score (I2 = 89%; P = .0002). Funnel plot analyses did not detect any evidence of publication bias pertaining to the selected study endpoints. Conclusions: Our meta-analysis demonstrated that radioactive stent insertion can prolong stent patency and survival for patients with MEO compared with normal stent insertion.

Meta-analysis of efficacy and complications of intraluminal radioactive stent and common covered stent in treatment of advanced esophageal cancer

Meta-analysis of efficacy and complications of intraluminal radioactive stent and common covered stent in treatment of advanced esophageal cancer

Radioactive Stent Insertion for Inoperable Malignant Common Biliary Obstruction.

The purpose of this study was to assess the clinical efficacy and long-term outcomes of radioactive stent insertion in patients with malignant common biliary obstruction (MCBO). This was a retrospective study conducted at a single-center. Consecutive patients with MCBO were treated by normal or radioactive stent insertion between January 2014 and December 2019. The baseline data, instant efficacy records, and the long-term outcome results of these 2 groups were compared. During the experimental duration, at our center 71 patients with inoperable MCBO underwent normal (n=40) or radioactive (n=31) stent insertion. Rates of technical success of normal and radioactive stent insertions were both 100%. No patients exhibited procedure-related complications. All patients achieved improvements in their liver functions at 2 weeks after stent insertion. Stent dysfunction was recorded in 11 and 6 patients from the normal and radioactive stent groups, respectively (P=0.425). The median stent patency was 165 and 222 days with the normal and radioactive stents, respectively (P<0.001). All patients died due to tumor progression at the follow-up. Patients survived for a respective median of 182 and 242 days in the normal and radioactive stent groups (P<0.001). The complication rates were comparable between the 2 groups. Radioactive stent insertion may provide longer patency and overall survival in those exhibiting inoperable MCBO than normal stent insertion.

Covered airway stent loaded with (125)I seeds for tracheal adenoid cystic carcinoma: a clinical observation of 8 cases

Objective: To explore the efficacy and safety of the covered airway stent loaded with (125)I seeds for the treatment of tracheal adenoid cystic carcinoma (TACC). Methods: We retrospectively reviewed the clinical data from 8 patients with TACC who had received placement of the covered stent loaded with (125)I seeds between December 2014 and July 2017 in the endoscopic center of the Second Affiliated Hospital of Xiamen Medical College. We compared the difference in the dyspnea index, the diameter of the airway lumen, and the lesion surrounding the airway wall before and after treatment. The complications were also recorded during follow-up. Results: Eight patients underwent successful placement of a total of 11 radioactive stents (2 straight-type stents, 2 L-shape stents, and 7 Y-shape stents, all loaded a total of 243 radioactive particles). Displacement of stents took place within 2 weeks in 2 patients, who were managed with re-stenting and fixation. No further displacement occurred during follow-up. The median time to stent removal was 2.9(interquartile range: 2.3,3.0) months. After stent placement, the dyspnea index was significantly decreased compared with pre-treatment level (mean: 0.1 vs. 3.4, t=8.881, P<0.001). Bronchoscopic re-assessment showed that the residual tumor within the airway was detected in only one patient and that the tumor completely disappeared in the remaining 7 patients. Treatment with stents loaded with radioactive particles yielded smooth and pale airway mucosa with formation of partial scar formation. Chest computed tomography re-assessment demonstrated significantly larger luminal diameter than that before treatment (mean: 13.1 mm vs. 3.3 mm, t=-7.839, P<0.001). The airway wall thickness was notably reduced after treatment (mean: 4.3 mm vs. 14.4 mm, t=7.620, P<0.001). The lesions surrounding the airway wall completely disappeared in 7 patients and decreased for more than 50% in a single patient. The median duration of follow-up was 28.0(interquartile range: 24.8,31.5) months. Recurrence of tumor was documented in a single case within 2 years. Six patients did not experience recurrence within the 2-year follow-up period. No death or severe complications were recorded during follow-up. Conclusion: The (125)I radioactive stent is effective for dilating the stenotic airway and ameliorating the symptoms, and thus might be an effective and safe method for the treatment of TACC. Further studies that explore the efficacy of stents loaded with (125)I particles are needed.

Case Control Study on Radioactive Stents Versus Conventional Stents for Inoperable Esophageal Squamous Cell Carcinoma.

The purpose of this study was to compare the relative clinical efficacy of radioactive and normal stent insertion for the treatment of inoperable obstructive esophageal squamous cell carcinoma (OESCC). Between January 2014 and December 2018, consecutive OESCC patients were treated via either radioactive or normal stent insertion. A total of 42 and 39 OESCC patients were treated via radioactive and normal stent insertion, respectively. These procedures were both technically and clinically successful in all patients. Massive hemorrhage was observed in 7 (16.7%) and 1 (2.6%) patients in radioactive and normal stent groups, respectively (P=0.080). Median stent patency durations were 175 and 136 days in radioactive and normal stent groups, respectively (P=0.004). Median overall survival were 187 and 145 days in the radioactive and normal stent groups, respectively (P=0.011). Relative to normal stent, radioactive stents showed a higher patency and overall survival in OESCC patients.

Efficacy of a novel fully covered radioactive stent for advanced esophageal and gastric cardia cancer: a retrospective controlled study

Objective: To assess the feasibility, safety, and efficacy of a novel fully covered radioactive stent for the treatment of advanced esophageal and gastric cardia cancer. Methods: Data of 122 patients, who underwent esophageal radioactive stent placement for advanced esophageal or gastric cardia cancer between January 2012 and September 2017 in Zhongda Hospital, were retrospectively analyzed. Patients were divided into the novel stent group (n=59; 45 males, 14 females; mean age 73±10 years old) and the conventional stent group (n=63; 51 males, 12 females; mean age 72±9 years old), according to the types of radioactive stents. No significant difference was found between the two groups in baseline characteristics (all P>0.05). Outcomes were measured in terms of technical success, dysphagia score, stent restenosis, stent migration, major complications, and overall survival. Results: The technical success rate was 98.3% in the novel stent group, and 100.0% in the conventional stent group (P=0.484) . The dysphagia scores 3 days after surgery decreased from 3.27±0.45 and 3.37±0.49 to 1.25±0.66 and 1.32±0.50, respectively (all P<0.01), and the variances were comparable (P=0.709). Compared with conventional stents, novel stents were significantly associated with a decreased in the rate of stent restenosis, 11.9% vs 27.0%; cause-specific hazard ratio 0.387, 95%CI 0.160-0.934 (P=0.035); sub-distributional hazard ratio 0.401, 95%CI 0.167-0.963 (P=0.041), while the stent migration rate was statistically comparable (13.6% vs 6.3%, P=0.181). There was no significant difference between the novel stent group and the conventional stent group in major complications (all P>0.05), including moderate-severe chest pain (22.0% vs 25.4%), hemorrhage (11.9% vs 11.1%), fistula formation (1.7% vs 4.8%), and aspiration pneumonia (5.1% vs 6.3%). The median overall survival was 146(95%CI 115-177) days in the novel stent group, and 147(95%CI 98-196) days in the conventional stent group, and no significant difference was found (P=0.967). Conclusions: In patients with advanced esophageal or gastric cardia cancer,placement of a novel fully covered radioactive stent is safe and effective. This novel stent can relieve dysphagia rapidly and prevent stent restenosis effectively.

Two decades after coronary radiation therapy: A single center longitudinal clinical study.

ObjectivesThe aim of this study was to evaluate the very long‐term clinical outcome after radioactive stent (RS) implantation and intracoronary β radiation brachytherapy (IRBT).BackgroundRadioactive stents (RS) and intracoronary β radiation brachytherapy (IRBT) were introduced to prevent restenosis after percutaneous coronary intervention (PCI). Both techniques were associated with a higher incidence of major adverse cardiac events (MACE) in the short and intermediate‐term follow up as compared to conventional PCI.MethodsOne hundred and thirty‐three patients received radioactive stents (32P) and 301 patients were treated with IRBT adjunctive to PCI. These groups were propensity matched to respectively 266 and 602 control patients who were treated with routine PCI during the same inclusion period. Endpoints were all‐cause mortality and MACE, defined as all‐cause death, any myocardial infarction or any revascularization.ResultsMedian follow‐up duration was 17 years. All‐cause mortality rates were similar in all groups. Adjusted hazard ratios for MACE and mortality in the RS cohort were 1.55 (95% CI 1.20–2.00) and 0.92 (95% CI 0.63–1.34), respectively. Adjusted hazard ratios for MACE and all‐cause mortality in the IRBT cohort were 1.41 (95% CI 1.18–1.67) and 0.95 (95% CI 0.74–1.21), respectively. The difference in MACE rates was predominantly driven by coronary revascularizations in both groups, with a higher MI rate in the IRBT group as well.ConclusionsCoronary radiation therapy was associated with early increased MACE rates, but the difference in MACE rates decreased beyond 2 years, resulting in a comparable long‐term clinical outcome. Importantly, no excess in mortality was observed.