Role Of Self-expanding Stents Research Articles

Role of Self-expanding Stents in the Treatment of Intrathoracic Dehiscence After Ivor Lewis Esophagectomy

IntroductionThe role that self-expanding stents play in the treatment of dehiscence after transthoracic esophagectomy is not well defined and controversial. Our aim is to describe the experience in a tertiary care hospital using these devices for treating dehiscence after Ivor Lewis esophagectomy. MethodsDescriptive observational study of patients who suffered anastomotic dehiscence after a transthoracic esophagectomy, and especially those treated with stents, in the period between 2011 and 2016 at our hospital. ResultsTen patients (11.8%) presented anastomotic dehiscence. Eight patients received stents, one of them died due to causes unrelated to the device. Stent migration was observed in one case, and the devices were maintained an average of 47.3 days. The stent was not effective only in one patient who suffered early dehiscence due to acute ischemia of the stomach. The two patients who did not receive stents died after reoperation. ConclusionsStents are safe and effective devices that did not associate mortality in our series. They are especially indicated in intermediate or late-onset dehiscence and in fragile patients. The use of stents, together with mediastinal and pleural drainage, avoid reoperations with morbidity and mortality. Therefore, stents should be part of the usual therapeutic arsenal for the resolution of most suture dehiscences after Ivor Lewis esophagectomy. Randomized prospective studies would help to more precisely determine the role played by these devices in the treatment of dehiscence after transthoracic esophagectomy.

Role of self expandable stents in management of colorectal cancers.

Acute malignant colorectal obstruction is a complication of colorectal cancer that can occur in 7%-29% of patients. Self-expanding metallic stent placement for malignant colorectal obstruction has gained popularity as a safe and effective procedure for relieving obstruction. This technique can be used in the palliation of malignant colorectal obstruction, as a bridge to elective surgery for resectable colorectal cancers, palliation of extracolonic malignant obstruction, and for nonmalignant etiologies such as anastomotic strictures, Crohn's disease, radiation therapy, and diverticular diseases. Self-expanding metallic stent has its own advantages and disadvantages over the surgery in these indications. During the insertion of the self-expanding metallic stent, and in the follow-up, short term and long term morbidities should be kept in mind. The most important complications of the stents are perforation, stent obstruction, stent migration, and bleeding. Additionally, given the high risk of perforation, if a patient is treated or being considered fortreatmentwith antiangiogenic agents such as bevacizumab, it is not recommended to use self-expanding metallic stent as a palliative treatment for obstruction. Therefore, there is a need for careful clinical evaluation for each patient who is a candidate for this procedure. The purpose of this review was to evaluate self-expanding metallic stent in the management of the obstruction of the colon due to the colorectal and extracolonic obstruction.

Commentary: Role of Self-Expanding Stents in Infrapopliteal Artery Disease

Commentary: Role of Self-Expanding Stents in Infrapopliteal Artery Disease

Clinical utility of self-expanding stents in coronary artery disease

The field of percutaneous coronary intervention (PCI) has evolved considerably since the era of percutaneous transluminal coronary angioplasty. Percutaneous transluminal coronary angioplasty with stenting has now become one of the cornerstones of treatment for coronary artery disease. The use of third-generation drug-eluting stents (DES) is currently the preferred method of treatment for different indications in patients with coronary artery disease. Self-expanding stents are routinely used in peripheral arterial disease, like external iliac and femoropopliteal percutaneous interventions. Self-expanding stents have been in use since the beginning of PCI. Although the first stent deployed was of the self-expanding variety, namely the Wallstent, balloon-expandable stents have become the stents of choice in the coronary arteries. The role of self-expanding stents in modern PCI is continuously evolving. This review discusses the utility of self-expanding stents in the treatment of specific subsets of coronary lesions.

The Role of Self-expanding Stents in Patients with Atypical Coronary Anatomy.

Despite advances with new generation stents, there remains some atypical coronary anatomy where optimal stenting continues to be a challenge; such as stent sizing in large, ectatic or aneurysmal vessels; tapered vessels; and in vasoconstricted arteries such as in ST-segment elevation myocardial infarction or chronic total occlusions. Balloon-expandable stents are tubular and cannot easily accommodate vessel diameter variations; thrombotic vessels increase the risk of distal embolisation and no-reflow; positive remodelling and vasodilation often result in subsequent malapposition; and patients with bifurcation lesions have a higher risk of adverse events. The STENTYS BMS and DES(P) stents have a self-expanding design, which enables a better anatomical fit to the vessel, even with diameter variations (up to 6.0 millimetres [mm]), and can adapt to changes in vessel size over time. The stents deploy atraumatically from distal to proximal, which could reduce distal embolisation and contain disconnectable bridges, which can be opened up at a side branch. Self-apposing technology could therefore provide a potential solution to current challenges with balloon-expandable stent technology.

Stenting in the Femoropopliteal Arterial Segment

In the femoropopliteal arterial segment, balloon angioplasty is a recommended treatment strategy for short lesions. Over the past few years, several reports have emerged on the potential role of self-expanding stents for treating longer, more complex disease segments where the patency following balloon angioplasty is notoriously dismal. This paper will attempt to review the emerging role of nitinol stents for treating patients with chronic lower limb ischemia, secondary to severe femoropopliteal arterial disease.