Self-expanding Stents Research Articles

Deep Infiltrating Endometriosis of the Left Ureter Managed with Laparoscopic Ureterolysis Combined with Allium Ureteral Self-Expandable Stent: A Case Report

Introduction: In endometriosis, urinary tract involvement occurs in 1–5.5% of cases, where the ureter is affected in 9–23%. Unfortunately, endometriosis may remain asymptomatic even with significant anatomical progression. A delay in the diagnosis and treatment of ureteral endometriosis may result in hydronephrotic kidney damage and functional impairment. Methods: We present a case of a 36-year-old woman with a left ureteral stricture caused by deep infiltrating endometriosis accompanied by severe kidney-induced arterial hypertension. In March 2022, the patient underwent both laparoscopic excision/evaporation of deep infiltrating endometriosis from the left ovarian fossa and left ureterolysis, followed by an ureterorenoscopic dilatation of the left ureter via the placement of an Allium self-expandable stent. Results: This stent was successfully removed 18 months later. A computed tomography check-up confirmed normal ureteral patency with no signs of endometriosis. Elevated blood pressure also resolved. Conclusions: Deep infiltrating endometriosis can lead to asymptomatic yet serious complications. A successful treatment of ureteral endometriosis may require multidisciplinary management, including a simultaneous laparoscopic and ureterorenoscopic approach. Ureteral stent placement is a minimally invasive state-of-the-art solution for ureteral stricture(s) and should be considered the first choice in women of reproductive age suffering from ureteral deep infiltrating endometriosis.

A new domestic self-expanding nitinol stent: in vivo preclinical study

Objective. To evaluate the results of implantation of a new domestic self-expanding nitinol stent in experimental animals. Materials and methods. Experimental implantations of a self-expanding nitinol stent were performed in the common iliac artery of three Vietnamese Pot-bellied pigs. In the postoperative period, all animals received dual antiplatelet therapy for 3 months. Vital signs were also assessed throughout the observation period. After 3 months, the animals underwent control angiography and ultrasound examination of the iliofemoral segment, followed by withdrawal from the experiment by euthanasia. The next step was a macroscopic and histological analysis of the stented areas of the vessels. Results. The observation period of the animals was 3 months. Throughout the entire observation period, vital signs in all animals remained within normal values. The results of control angiography and ultrasound examination after 3 months demonstrated patency, as well as the absence of significant in-stent stenoses in two pigs. One animal showed signs of in-stent restenosis. The results of macroscopic and histological analysis showed signs of damage to the subendothelial layer, as well as myointimal hyperplasia. These changes were especially pronounced in the animal with restenosis. Our analysis showed that the presented results were due to excessive oversizing of the implanted stents (20–30 %). Conclusion. Our proposed self-expanding nitinol stent, in general, showed satisfactory results in the in vivo experiment. Nevertheless, it should be borne in mind that severe stent oversizing can cause excessive neointimal proliferation, which, in turn, will lead to the development of restenosis in the long-term postoperative period. In this regard, it is necessary to carry out an additional series of implantation of the presented stent to the experimental animals with less oversizing in order to determine its optimal values for this particular stent model.

Interventional Management of a Rare Case of Complex Congenital Heart Disease in an Adult Patient: A Case Report

Congenital heart disease (CHD), which accounts for about one-third of all congenital defects and affects approximately 1% of all live births worldwide, has maintained a stable incidence rate while experiencing a decrease in mortality rates since 1990. Despite advancements in fetal cardiac ultrasound examinations and routine pulse oximetry screening of newborns, a significant proportion of CHD patients may still be undiagnosed until adulthood. This oversight can lead to considerable morbidity and mortality due to physical limitations and reduced quality of life. In this case report, we describe a 29-year-old woman who was initially misdiagnosed as having an inoperable case of CHD and was referred to our center with symptoms of palpitations and exertional dyspnea. During her evaluation, she was diagnosed with severe pulmonary hypertension associated with patent ductus arteriosus (PDA), pre-ductal aortic coarctation, ventricular septal defect (VSD), and bicuspid aortic valve, all of which had been overlooked since infancy. Following initial medical treatment for pulmonary hypertension, a simultaneous transcatheter approach was employed, during which the PDA was closed using an occluder device, and the coarctation was repaired concurrently with a self-expanding stent. Eight months later, her VSD was successfully closed using a muscular VSD occluder device through an interventional technique. This case underscores the importance of adult CHD fellowship training, which enables cardiologists specializing in this field to accurately diagnose and treat complex cases of CHD that may have been missed during infancy and early childhood. This timely intervention ultimately led to the complete relief of her symptoms and prevented progression to Eisenmenger syndrome.

The Frozen Elephant Trunk Procedure-8 Years of Experience from Poland.

Background: The frozen elephant trunk method combines the implantation of a Dacron prosthesis with a self-expanding stent graft, which allows for complex repairs of the aortic arch and thoracic aorta in one procedure. Despite the advantages of hybrid treatment for aortic arch aneurysms, in Poland, only a few such surgeries are performed annually compared to in Western countries. The aim of this study was to demonstrate the 8-year outcomes of treatment at the center where the Aortic Team operates, which is one of the centers in Poland with the most extensive experience in hybrid FET treatment. Methods: Patients who underwent frozen elephant trunk surgery for chronic and acute pathologies of the aortic arch and thoracic aorta between March 2016 and March 2024 were comprehensively analyzed retrospectively. Frozen elephant trunk procedures were performed under three consecutive clinical conditions: acute aortic dissection, chronic aortic dissection and redo surgery. Results: A total of 40 patients (median age: 60 years (53-66), 67.5% male) were admitted to our hospital and underwent an FET procedure. The median Euroscore II was 25.9% and the 30-day mortality was 7.5%. The 1-year and 5-year mortalities were the same, equal to 15%, with mortality cases observed only in the first and second groups of consecutive patients during the first two months of follow-up. Spinal cord injury was observed in 2.5% of patients. Conclusions: The FET technique can be successfully used to treat aortic aneurysms with optimal results and low complication rates. The surgery length, including the cardiopulmonary bypass and aortic cross-clamp times, decreased significantly with increasing experience.

Reverse cardiac remodeling induced by endovascular treatment of coarctation of the aorta

Abstract Background Previously, we have showed the 3-year clinical safety and efficacy of balloon expandable versus self-expandable stents in native coarctation of the aorta (CoA) in a randomized clinical trial (RCT). Very few prospective studies have addressed the changes of echocardiographic parameters in mid to long-term follow up of CoA patients treated endovascularly. Purpose We aimed to demonstrate the improvement of echocardiographic parameters among patients undergoing coarctoplasty with stent based on core laboratory-confirmed baseline and 3-year follow up transthoracic echocardiographic (TTE) images. Methods In the index RCT, adult patients with de novo native CoA were randomized into two groups based on stent types. All randomized patients received the 3-year structural follow-up including aortic CT angiography and TTE. The current prospective cohort substudy, included all patients with available baseline and three-year core laboratory TTEs. Results Of 92 patients initially randomized, 71 participated in the 3-year structural follow up. No baseline core lab images were available in 39 patients, and thus, 32 patients (a median age of 32 (24.8 – 37.5) years, (14 women [43.8%]) were included in this subgroup study. One out of the 32 patients presented with recoarctation which was successfully treated before the 3-year evaluation. Peak systolic gradient and end-systolic velocity of the coarctation stenting site were 17.38 ± 6.55 mmHg and 0.93 ± 0.24 m/s respectively in the 3-year follow-up. Septal E’ and lateral E’ velocities were improved significantly (8.6 ± 1.73 cm/s to 9.35 ± 2 cm/s, P = 0.02 and 12.74 ± 2.96 cm/s to 13.92 ± 2.44 cm/s, P = 0.03, respectively). In addition, septal E/E’ ratio (10.84 ± 2.83 to 9.21 ± 3.17, P = 0.02) and lateral E/E’ ratio (7.39 ± 2.24 to 6.29 ± 1.97, P = 0.02) showed significant improvement. Significant reduction in LV mass [160 (130–203) g to 142 (IQR= 121–172) g, P = 0.001], and septal and posterior LV thicknesses were also demonstrated (0.9 (0.8–1.0) cm to 0.81 (0.77–0.93) cm, P = 0.004) and 0.92 ± 0.14 cm to 0.85 ±0.09 cm, P = 0.01, respectively). Twelve (37.5%) patients had baseline LVH which was normalized in 9 (75%). Lastly, 12 (41.3%) of our population had diastolic dysfunction at baseline study which significantly decreased to 4 (13.7%) in the three-year follow-up evaluation. Conclusion In the present core laboratory-based study, coarctoplasty with stent has favorable effects on diastolic function and LV hypertrophy during midterm follow-up in adult population with de novo native aortic coarctation treated with stent.

Failure signal of high orientation Poly(L-lactic acid) monofilament for self-expanding stent during lifetime: Disappeared amorphous connections

The premature failure of bioresorbable self-expanding stents for peripheral arterial disease could lead to form thrombosis and threaten patients′ lives. Predicting the time and cause of mechanical and structural failure is crucial to prevent premature failure of implanted stents. Herein, we report a situ accelerated hydrolysis to investigate the degradation properties of self-expanding stents braided by high-performance Poly(L-lactic acid) (PLLA) monofilaments in an accelerated term over a formal long one. Degradation, microstructure, and mechanical properties were comprehensively evaluated to identify key factors of the failure during lifetime. The results show that the upper temperature limit for accelerated hydrolysis is 50 °C. The mechanical properties undergo multiple stages of functional holding, decreasing, and eventual failure. It is attributed to uneven degradation and distribution of crystalline and amorphous regions. Specifically, the disappearance of amorphous chains between fibrils at 6 months leads to mechanical failure. Further disappearance of amorphous chains within fibrils at 18 months results in structural disintegration. Additionally, the degradation behavior of the stents and potential effects of degradation products on vascular tissues are validated for predictive accuracy. These insights provide valuable experimental references for optimizing design and clinical application of PLLA-based self-expanding stents.

Y Reverse: Modified technique in challenging airway management.

Self-expanding Y-metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y-stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy. This retrospective study included 15 consecutive patients, suffering from tracheal-carina-lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y-stent insertion using the modified technique Y reverse. The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant. Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi.

Series of implantation of a new domestic self-expanding nitinol stent in vivo: prototype development

Series of implantation of a new domestic self-expanding nitinol stent in vivo: prototype development

FUNCTIONAL POSSIBILITIES OF ESOPHAGEAL-GASTIC ANASTOMOSIS IN THE REMOTE POSTOPERATIVE PERIOD ACCORDING TO THE DATA OF THE MORPHO-FUNCTIONAL STUDY

Resume. Purpose: Morpho-functional assessment of the method of endoprosthesis of failure of the esophageal-gastric anastomosis sutures in the distant postoperative period. Introduction. Currently, views on treatment tactics in the case of the inability to suture esophageal anastomoses are contradictory and have diametrically opposite opinions — from extremely gentle to extremely aggressive. Optimism of supporters of palliative resections is due not only to the almost identical mortality with radical operations, which is 4.0-31.6%, but also to the possibility of ensuring 5-year survival of 8.5-15.7% of operated patients. Thus, a number of questions remain relevant, including the study of morpho-functional shifts in tissue cells of the esophageal-gastric anastomosis with the assessment of its functional capabilities in the distant postoperative period based on morphological research. Material and methods. The work was performed in the Department of Surgery of the Gastrointestinal Tract and Esophagus of the State University «IZNG named after V.T. Zaitsev National Academy of Medical Sciences of Ukraine» with the presentation of the results of a morpho-functional study and statistical analysis of the treatment of patients with the development of failure of esophageal-intestinal anastomoses in the postoperative period. All patients were fitted with self-expanding stents, stents from M.I.Tech Co., Ltd. (Korea), covered esophageal HANAROSTENT with an antireflux valve - 14 and Boston Scientific Corp. were used for endoprosthetics. (USA), covered with Ultraflex-2 esophagus. In the long-term period, all patients discharged from the hospital underwent a control X-ray and endoscopic examination every 1-2 months, during which a biopsy was performed and material was taken for the next morphological examination. For light microscopy, tissue fragments of the esophageal-gastric junction were fixed in a 10% solution of neutral formalin for 24 hours at a temperature of +20°C, after which they were dehydrated with ethyl alcohol and embedded in paraffin. Sections were prepared from paraffin blocks and stained with Ehrlich’s hematoxylin and eosin. Research results. The long-term results of endoprosthesis of failed esophageal-gastric anastomosis sutures in 43 stented patients were evaluated. Of great interest is the morpho-functional state of the esophageal-gastric anastomosis in the long term after surgery (3- 24 months), as these terms determine the functional capabilities of the anastomosis. Taking into account that during the research it is possible to detect initial morpho-functional shifts in the tissues of the examined organs, it should be assumed that in the future hypoxia of the stomach and esophagus increases and the degree of expressiveness of these disorders maintains the same sequence. Conclusions. The conducted studies expanded the understanding of the pathogenesis of morpho-functional disorders occurring in the distant postoperative period, confirmed the priority of metabolic disorders in tissue cells in diseases of the gastrointestinal tract, and also allowed to give a prognostic assessment of the functional possibilities of the further development of the gastric process. further tactics of managing patients at the next stage of treatment.

Treatment with a self-expanding endoprosthesis in patients with stenosis or occlusion at the arteriovenous graft: 6-Month outcomes of a post-marketing surveillance study.

To assess 6-month safety and efficacy of a self-expanding stent graft placement to treat stenotic or thrombosed synthetic arteriovenous access graft at the venous anastomoses. This prospective, multicenter, post-market surveillance study assessed the GORE® VIABAHN® Endoprosthesis (stent graft) in Japanese patients with stenotic or thrombosed vascular access grafts. Key efficacy and safety outcomes were primary patency (PP) and secondary patency (SP) of the target lesion and the vascular access circuit, repeat interventions, technical and clinical success, incidence of adverse and serious adverse events, and device deficiencies through 6 months. The 103 enrolled patients (mean age 71.8 years; 57.3% female) had stent grafts placed in the venous anastomosis of arteriovenous access grafts (on-label). The majority of lesions were stenotic (77.1%) and located in the upper arm (91.4%). Mean lesion length was 42.9 ± 23.6 mm and diameter was 6.7 ± 1.9 mm; 28 patients (27.2%) had elephant trunk placements. Technical and clinical success rates were 100%. At 6 months, Kaplan-Meier estimates of target lesion and circuit PP were 75.1% (95% CI: 65.2, 82.6) and 66.8% (95% CI: 56.4, 75.3), and SP rates were 93.8% (95% CI: 86.7, 97.2) and 93.8% (95% CI: 86.7, 97.2), respectively. Mean cumulative number of reinterventions (0.36; 95% CI: 0.20, 0.51) and incidence of device- or procedure-related adverse events were low (⩽3%). No device deficiencies were reported. The 6-month outcomes of the self-expanding stent graft to treat thrombosed venous anastomoses of synthetic hemodialysis vascular access grafts with stenosis demonstrated safety and effectiveness.

Interaction of a self-expandable stent with the arterial wall in the presence of hypocellular and calcified plaques.

Self-expandable stents manufactured from nitinol alloys are commonly utilized alongside traditional balloon-expandable stents to provide scaffolding to stenosed arteries. However, a significant limitation hampering stent efficacy is restenosis, triggered by neointimal hyperplasia and resulting in the loss of gain in lumen size, post-intervention. In this study, a nonlinear finite element model was developed to simulate stent crimping and expansion and its interaction with the surrounding vessel in the presence of a plaque. The main aim was to determine contact pressures and forces induced at the interface between an artery wall with hypocellular and calcified plaques and an expanded stent. The results demonstrated the drawbacks of plaque calcification, which triggered a sharp contact pressure and radial force surge at the interface as well as a significant rise in von Mises stress within the vessel, potentially leading to rupture and restenosis. A regression line was then established to relate hypocellular and calcified plaques. The adjusted coefficient of determination indicated a good correlation between contact pressures for calcified and hypocellular plaque models. Regarding the directionality of wall properties, contact pressure and force observations were not significantly different between isotropic and anisotropic arteries. Moreover, variations in friction coefficients did not substantially affect the interfacial contact pressures.

A clinical case of acute intestinal obstruction as a result of dislocation of the esophageal self-expanding nitinol stent

INTRODUCTION: Covered esophageal self-expanding stents are often used to palliate dysphagia in patients with unresectable esophageal and gastric cardia cancer. Migration of an esophageal stent is a common occurrence in these patients. One of rare complications that can be caused by stent dislocation is intestinal obstruction. The article describes a case of intestinal obstruction in result of migration of a fully covered nitinol esophageal stent. Patient K., 53 years old, was admitted to hospital in a severe condition with complaints of vomiting, abdominal pain and stool retention that had persisted for four days. The patient refused esophagogastroduodenoscopy. A plain abdominal X-ray did not reveal any free gas. In the mesogastrium, numerous pneumatized loops of small intestine with horizontal fluid levels were identified. For life indications, the patient, after preoperative preparation was taken to the emergency operating room; resection of the terminal part of small intestine was performed with placement of an ileostomy and gastrostomy. Taking into account difficulties of diagnosis (refusal of esophagogastroduodenoscopy by the patient and low informative value of X-ray examination), severity of the patient’s condition (due to a malignant neoplasm and intestinal obstruction), anatomical peculiarities (location of the esophageal stent 30 cm from the ileocecal angle, which would complicate potential application of enteroenteroanastomosis), the chosen tactics was to refuse application of enteroenteroanastomosis and exteriorize ileostomy and gastrostomy. CONCLUSION: Acute intestinal obstruction is a threatening complication of migration of an esophageal stent. Patients with placed esophageal stents require careful monitoring, use of a sparing diet and additional methods of stent fixation, which will help reduce the frequency of stent migration and associated complications.

S160 Dexamethasone-Eluting and Self-Expanding Biodegradable Stents Effectively Reduce Fibrosis in Cases of Biliary Stricture

S160 Dexamethasone-Eluting and Self-Expanding Biodegradable Stents Effectively Reduce Fibrosis in Cases of Biliary Stricture

Post Neck Radiation Cancer Carotid Pseudoaneurysm Blowouts with Viabahn Stent Placement

Carotid Blowout Syndrome (CBS) is a critical and often fatal complication associated with head and neck malignancies. CBS is characterized by three stages: threatened, impending, and acute rupture/hemorrhage. The condition is notably linked with a history of radiotherapy for head and neck cancers, with an incidence of approximately 3-4% among those who have received such treatment. Historically, surgical management of CBS has involved open surgical ligation. However, advancements in endovascular techniques, including endovascular destructive procedures (e.g., coil embolization) and reconstructive procedures (e.g., carotid artery stenting), have become increasingly prevalent. This report presents two cases where a self-expandable PTFE-coated nitinol stent with a heparin coating (Viabahn; Gore and Associates) was utilized in the treatment of CBS.

Manufacturing, Processing, and Characterization of Self-Expanding Metallic Stents: A Comprehensive Review.

This paper aims to review the State of the Art in metal self-expanding stents made from nitinol (NiTi), showing shape memory and superelastic behaviors, to identify the challenges and the opportunities for improving patient outcomes. A significant contribution of this paper is its extensive coverage of multidisciplinary aspects, including design, simulation, materials development, manufacturing, bio/hemocompatibility, biomechanics, biomimicry, patency, and testing methodologies. Additionally, the paper offers in-depth insights into the latest practices and emerging trends, with a special emphasis on the transformative potential of additive manufacturing techniques in the development of metal stents. By consolidating existing knowledge and highlighting areas for future innovation, this review provides a valuable roadmap for advancing nitinol stents.

Endoscopic interventions in patients with bronchial tumors

Analysis of the results of endoscopic diagnosis and treatment of patients with bronchial tumors. Material and methods. Endoscopic diagnosis and interventions were perfomed in 56 patients with benign - 39 (70.7%) and malignant - 17 (29.3%) bronchial tumors. There were 38 men and 18 women aged from 17 to 70 years (average age of patients 52.1 ± 14.6 years). Results. In patients with benign bronchial tumors, mechanical removal or excision by using polypectomy share was more often performed. In cases malignant tumors (10 patients) stent insertion was performed to ensure long-term maintenance of the bronchial lumen. In two cases - silicone stents were inserted; in eight cases - metal self-expanding stents were inserted. There were no complications during the intervention or in the postoperative period. Repeated interventions due to tumor recurrence were performed in 3 (5.4%) patients. Conclusion. Endoscopic interventions in patients with benign and malignant bronchial tumors can effectively and relatively safely restore and maintain airway patency. The choice of tumor removal method is multifactorial. It depends on the equipment of the medical institution and the endoscopist preference. To maintain bronchial patency in patients with malignant bronchial tumors, stenting is indicated, which avoids staged endoscopic interventions, each of which can be potentially dangerous due to possible complications.

Hofmeister effect driven dynamic-bond cross-linked dialdehyde xylan hydrogels with rapid response and robust mechanical properties for expanding stent

The biomedical field urgently needs for programmable stent materials with nontoxic, autonomous self-healing, injectability, and suitable mechanical strength, especially self-expanding characteristics. However, such materials are still lacking. Herein, based on gelatin and dialdehyde-functionalized xylan, we synthesized 3D-printable, autonomous, self-healing, and mechanically robust hydrogels with a reversible Schiff base crosslink network. The hydrogels exhibited excellent mechanical properties and automatic healing properties at room temperature. The solid mechanical properties originate from the Schiff base, hydrogen bonding interactions, and xylan nanoparticle reinforcement of the polymer networks. As a proof of concept, the Hofmeister effect enabled the hydrogel to contract in highly concentrated salt solutions. In contrast, the same hydrogel expanded and relaxed in dilute salt solutions (quick response within 10 s), showing ionic stimulus-response and excellent shape memory characteristics, which demonstrated that the prepared hydrogel could be used as self-expanding artificial vascular stents. In particular, good biocompatibility was confirmed by cytotoxicity and compatibility tests, and ex vivo arterial experiments further indicated the feasibility of these artificial vascular scaffolds (the expansion force reached 1.51 N). Combined with its ionic stimuli-responsive shape memory ability, the strong mechanical, self-healing, 3D-printable, and biocompatibility properties make this hydrogel a promising material for artificial stents in various biomedical applications.

Inscription of Complex Stent Profiles on the Polished Surfaces of NiTiCo Shape Memory Alloys by Fiber Lasers: Examining the Impact of Diffuse Reflectance

Drug eluting stents (DES) have become essential to alleviate stenosis with minimally invasive procedures. Nickel-titanium (NiTi) based shape memory alloys (SMAs) are the most suitable materials for self-expanding stents due to their good stability and superior thermo-mechanical properties. This work explains the inscription of complex DES profiles by fiber laser micro-cutting (FLMC) on Nickel-Titanium-Cobalt (NiTiCo) SMA surfaces polished with various grits (1000P, 1500P, 2000P, 2500P, 3000P, and cloth polished) of abrasive sheets. The impact of the SMA surface diffuse reflectance on laser micromachining characteristics was investigated. The Fuzzy PROMETHEE II multi-criteria decision-making (FP II-MCDM) technique was employed to find the best-polished surface that provides the most desired responses (kerf quality, surface roughness, and depth of penetration) for clinical applications. The cloth-polished surface responds better in laser machining without compromising the kerf quality and surface roughness. A significant variation of 18% in kerf quality was found between the 3000P and the cloth-polished surfaces. This indicates that the surface diffuse reflectance has maximum impact when the surfaces are highly polished. For applications where surface roughness and kerf width are not a criterion, then polished surfaces between 1500P and 2000P give the maximum machining rate.

Evaluation of balloon and self-expandable stents for common femoral artery stenosis

BackgroundEndovascular treatment of the common femoral artery (CFA) and its bifurcation is currently recommended for patients with hostile groin (prior femoral bifurcation open surgery, history of radiotherapy) or severe comorbidities (advanced age, frailty, obesity). Preliminary results have shown favorable outcomes. Among the different endovascular techniques (atherectomy, intravascular lithotripsy, plain balloon angioplasty, drug-coated balloon angioplasty, stenting), stents are mainly used but the best type of stent to use is still debated. The aim of this study was to assess the value of balloon-expandable stents (BES) and self-expandable stents (SES) for stenosis of the femoral bifurcation. MethodsConsecutive patients with stenosis of the CFA and its bifurcation were included from 2016 to 2022. Demographic data, the type of stent used, procedural data, and angiographic variables were collected. Groups were defined according to the type of stent implanted. Primary patency was defined as a binary end point based on a duplex ultrasound peak systolic velocity ratio of ≤2.4 as assessed by duplex ultrasound examination, in the absence of clinically driven target lesion revascularization (TLR) or bypass of the target lesion. Secondary outcomes were clinical sustained improvement, freedom from TLR at 12 months, mean ankle-brachial index improvement, primary-assisted patency, and secondary patency. ResultsA total of 90 procedures conducted in 77 patients were included in this study, 26 in the SES group and 64 in the BES group. The most common symptomatology according to the Rutherford classification was class 2, 3, and 4 (28%, 48%, and 8%, respectively). The type of lesions in the CFA, assessed using the Azema classification, were comparable between both groups (SES/BES group type 2: 31%/27%; type 3: 54%/62%). At 12 months, the primary patency rates for SES and BES were 88% (26/26 patients) and 72% (58/64 patients) (P = .10). At 12 months, freedom from TLR rates for SES and BES were 97% vs 81%, respectively (P = .13). ConclusionsSES for CFA stenosis show a trend toward better patency and freedom from TLR rates at 12 months. However, controlled studies are warranted to further investigate the significance of this trend.

Rupture of a calcified right ventricle to pulmonary artery homograft by balloon dilation– emergency rescue by venus P-Valve

BackgroundPercutaneous pulmonary valve implantation (PPVI) is a recognized alternative treatment to surgery for patients with dysfunctional right ventricular outflow tracts. Patient selection is essential to avoid serious complications from attempted treatment, such as rupture or dissection, especially of the calcified outflow tracts. We describe a case with an unexpected rupture of a calcified homograft valve and main pulmonary artery, which was treated successfully by emergency implantation of a self-expanding Venus P-Valve (Venus MedTech, Hangzhou, China) without the need for pre-stenting with a covered stent.Case detailsA 13-year-old boy had two previous operations of tetralogy of Fallot, one a total repair and the other a homograft valved conduit for pulmonary regurgitation. He presented with dyspnea and severe right ventricular outflow tract obstruction (RVOTO) and had a calcified outflow tract and main pulmonary artery. In the catheter laboratory, a non-compliant balloon dilation resulted in a contained rupture of the conduit. The patient remained hemodynamically stable, and the rupture was treated with a self-expandable Venus P-Valve without the need for a covered stent combined with a balloon-expandable valve or a further surgical procedure.DiscussionPreprocedural evaluation with an inflating balloon is necessary to examine tissue compliance and determine suitability for PPVI. However, this condition is accompanied by a risk of conduit rupture. Risk factors of this complication are calcification and homograft use. These ruptures are mostly controlled with a prophylactic or therapeutic covered stent, with a low rate of requiring surgery. However, there are severe ruptures which lead to hemothorax and death. In the available literature, there was no similar reported case of conduit rupture, which a self-expandable Pulmonary valve stent has managed. It seems that fibrosis and collagen tissue around the heart, formed after open surgeries, can contribute to the control of bleeding in these cases.Conclusion (clinical Learning Point)The suitability of patients for the PPVI procedure should be examined more carefully, specifically patients with homograft and calcification in their conduit. Furthermore, conduit rupture might be manageable with self-expandable artificial pulmonary valves, specifically in previously operated patients, and the applicability of this hypothesis is worth examining in future research.