Single Stent Research Articles

Stent-assisted WEB embolization: aneurysm characteristics, outcome and case report of a WEB delivered through a stent

PurposeWoven Endobridge (WEB) embolization has become a well-established endovascular treatment option for wide-necked bifurcation aneurysms. The objective was to analyse cases that required additional stent-implantation.MethodsImages of 178 aneurysms ≤ 11 mm treated by WEB only or by WEB plus stent were retrospectively reviewed, evaluating aneurysm characteristics, procedural specifics, adverse events and angiographic results. Moreover, we report a case of a WEB delivered through a previously implanted stent.ResultsAdditional stent implantation was performed in 15 patients (8.4%). Baseline patient and aneurysm characteristics were comparable between both groups. A single stent was used in 12 cases and 2 stents in Y-configuration in 3. Thromboembolic complications occurred more often with stent assistance (33.3% vs. 8.0%, p = 0.002), while ischemic stroke rates were comparable between both groups (0% vs. 1.8%, p = 1.0). Six-month angiographic follow-up showed complete occlusion, neck remnants and aneurysm remnants in 73.4%, 19.4% and 7.3% after WEB only, respectively, and in 66.7%, 20.0% and 16.7% after WEB plus stent, respectively (p = 0.538). A case report shows that WEB deployment through the struts of a previously implanted standard microstent is feasible, even if a VIA 33 microcatheter is needed.ConclusionIn the present study, stent-assisted WEB embolization had a comparable safety and efficacy profile compared to treatment by WEB only. However, stent-assisted WEB embolization requires long-term anti-platelet medication, which annihilates the advantages of the WEB as a purely intrasaccular device.Clinical Trial registration number: N/A.

Evaluation Of Safety And Effectiveness Of The Biomimics 3D Stent System In The Femoropopliteal Arteries Of Patients With Symptomatic Peripheral Arterial Disease: Single-centre 24 Months Results

Aim: The aim of the study was to evaluate the safety and effectiveness of the BioMimics 3D stent for the treatment of femoropopliteal stenosis or occlusion. The BioMimics 3D stent has a unique 3D helical geometry designed to improve haemodynamics and increase wall shear for a long-term atheroprotective effect. Materials and methods: Between September 2015 and May 2016, 22 patients (12 men, 10 women) were included in the study after giving their written informed consent. The mean age was 69.1 ± 8.4 years. The mean Rutherford category was 2.91 ± 0.42 (2-4). The mean visual estimate of lesion length was 83.2 ± 34.0 mm with an average grade of stenosis of 93.1 ± 8.5%. Complete occlusion was present in 36.4% of patients. A total of 27 stents were implanted, 17 patients received a single stent, and 5 required 2 stents. The total stent length was 102 ± 33 mm. Results: The technical success rate was 100%. The mean degree of residual stenosis after stenting was 9.1 ± 7.7%. No serious complications were observed in the first 30 days. The primary patency rate of the stents was 100% after 30 days, 81.8% after 12 months, and 77.8% after 24 months. On duplex ultrasound, the mean PSVR was 0.71 ± 2.4 immediately after stenting, and 0.80 ± 3.6 and1.03 ± 2.9after 12 and 24 months. One patient (4.5%) had undergone clinically driven target lesion revascularisation after 12 months, and a total of 2 patients after 24 months (9.1%). Clinically, there was a significant increase in ABI from 0.63 ± 0.10 before stenting to 0.93 ± 0.09 after 30 days, 0.90 ± 0.12 after 12 months, and 0.95 ± 0.21 after 24 months. The mean Rutherford category also improved significantly, to 0.95 ± 0.09 after 1 month and 1.19 ± 0.12 and 1.09 ± 0.27 after 12 and 24 months. X-ray imaging after 12- and 24-months follow-up found no stent fracture at either time point. Conclusion: The safety and effectiveness of the BioMimics 3D stent for the treatment of femoropopliteal lesions was confirmed overall; based on the long-term follow-up in particular, the positive effect of the helical stent structure seemed associated with stable patency values.

Endoscopic Retrograde Cholangiopancreatography in Bangladeshi Children: Experiences and Challenges in a Developing Country.

PurposeAlthough endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy.MethodsBetween 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented.ResultsThe median age of the study patients was 10 years (range, 1.7–15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful.ConclusionWe found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.

Percutaneous Y-shape reconstructive biliary stenting in Klatskin cholangiocarcinoma through a single left-sided entry.

Percutaneous Y-shape reconstructive biliary stenting in the Klatskin tumor is typically performed through bilateral biliary access. Single access from a right-side biliary entry is the more commonly used side for biliary access in general. We present a successful Y-shaped biliary stent reconstruction through a single left-side biliary approach. Unilateral single access Y-shaped biliary stenting can be technically challenging; when performed through a left biliary approach, an additional technical challenge may arise due to the unusual combination of Y-shaped biliary stent reconstruction and the single left-side biliary approach. We concluded that percutaneous Y-shaped biliary reconstruction through a left-sided unilateral approach is a technically feasible, less invasive interventional approach in managing Klatskin tumor.SIMILAR CASES PUBLISHED: None.

Toward endovascular treatment of type A aortic dissection with smaller landing zones and more patient eligibility.

Type A or ascending aortic dissection is an acute life-threatening condition with high morbidity and mortality. Open surgery remains the standard of care. The development of minimally invasive endografts for type A aortic dissection (TAAD) will require a detailed understanding of the dissection and aortic root anatomy to determine patient eligibility and optimal device specifications. Computed tomography images of TAAD cases at our institution from 2012 to 2019 were identified, and three-dimensional reconstructions were performed using OsiriX, version 10.0 (Pixmeo SARL, Bernex, Switzerland). We analyzed key anatomic structures, including centerline length measurements, ascending aorta and aortic root dimensions, and the location and extent of dissection in relationship to the coronary ostia. A total of 53 patients were identified (mean± standard deviation age, 60.4± 17.1years; 36 men and 17 women), 46 of whom had undergone surgery for TAAD. Four patients had died within 30days of surgery. In 47 patients (88.7%), the entry tear was distal to the highest coronary ostium. These cases were retrospectively considered for endovascular intervention using a nonbranched, single endograft stent. The proximal landing zone (LZ) was defined as the distance from the highest coronary ostium to the entry tear. Of the 53 patients, 35 (66.0%) had a proximal LZ length of ≥2.0cm, 38 (71.7%) had a proximal LZ length of ≥1.5cm, and 42 (79.2%) had a proximal LZ length of ≥1.0cm. The median proximal and distal LZ diameters of the sinotubular junction (STJ) and distal ascending aorta regions were 3.29cm (interquartile range [IQR], 2.73-4.10cm) and 3.49cm (IQR, 3.09-3.87cm, respectively), with a median length from the STJ to the innominate takeoff of 8.08cm (IQR, 6.96-9.40cm). The median ascending aorta radius of curvature was 6.48cm (IQR, 5.27-8.00cm). Of the 53 patients, 25 (47.2%) could be treated with a straight tube graft with a ≤20% diameter mismatch between the proximal and distal LZs. Almost 80% of the patients with TAAD had had a proximal LZ of ≥1.0cm. Of these patients, 47.2% had anatomy amenable for endovascular therapy with a nontapered straight tube graft using commercially available devices. To increase patient eligibility for TAAD endovascular intervention, enhanced precision deployment with an adequate seal in shorter LZs will be required. Our results can serve as a guide for endovascular device specifications designed to treat this devastating condition.

Unraveling the mystique of left main stenting: A bugaboo of coronary intervention

For many years, CABG has been the gold standard treatment for unprotected Left Main (LM) coronary artery lesions. Because of its high artery size and anatomical accessibility, the LM lesion makes a good PCI candidate. Subset PCI has been broadened by the development of Drug-Eluting Stent (DES) as well as fast advances in procedures, devices, and adjunct pharmacotherapies. PCI and CABG had equivalent results in patients with low or moderate coronary complexity for up to fi ve years, according to current research. Most LM bifurcation lesions may be treated successfully with a single provisional stent rather than the more complex two-stent treatment. The unusual instance of a bifurcation lesion, which requires the use of not one, but two stents from the start, is an exception to the norm. Controlling this unusual species and improving treatment outcomes need an integrated strategy involving specialized procedures, additional physiological and morphologic assessment, and hemodynamic devices.

Bioresorbable magnesium scaffold in the treatment of simple coronary bifurcation lesions: The BIFSORB pilot II study.

ObjectivesTo evaluate the feasibility, safety, and healing response of a magnesium‐based bioresorbable scaffold (BRS) in the treatment of simple bifurcation lesions using the single stent provisional technique.BackgroundBRS may hold potential advantages in the treatment of coronary bifurcation lesions, however low radial strength and expansion capacity has been an issue with polymer‐based scaffolds. The magnesium BRS may prove suitable for bifurcation treatment as its mechanical properties are closer to those of permanent metallic drug‐eluting stents.MethodsThe study was a proof‐of‐concept study with planned inclusion of 20 patients with stable angina pectoris and a bifurcation lesion involving a large side branch (SB) > 2.5 mm with less than 50% diameter stenosis. Procedure and healing response were evaluated by optical coherence tomography (OCT). The main endpoints were a composite clinical safety endpoint and an OCT healing index at 1 month (range: 0–98).ResultsEleven patients were included in the study. The study was prematurely terminated due to scaffold fractures and embolization of scaffold fragments in three cases requiring bailout stenting with drug‐eluting stents. One patient underwent bypass surgery at 3 months due to stenosis proximal to the study segment. All SB were patent for 1 month. One‐month OCT evaluation showed strut coverage of 96.9% and no malapposition. Scaffold fractures and uncovered jailing struts resulted in a less favorable mean OCT healing index score of 10.4 ± 9.0.ConclusionsImplanting a magnesium scaffold by the provisional technique in nontrue bifurcation lesions was associated with scaffold fracture, embolization of scaffold fragments, and a high need for bailout stenting.

Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms.

ObjectivePlacement of a single transverse stent via the nondominant A1 across the anterior communicating artery (AComA) into the contralateral A2 can provide sufficient neck coverage for wide-necked bifurcation AComA aneurysms. The authors described the feasibility, safety and long-term outcomes of this technique. MethodsBetween January 2015 and February 2018, placement of a single transverse stent via the nondominant A1 was attempted in 17 wide-necked bifurcation AComA aneurysms. The authors reviewed the medical records and radiological studies. ResultsThe technical success rate was 94.1% (16/17). Periprocedural thromboembolic complications occurred in one patient (6.3%) without permanent neurological deficits. The mean clinical follow-up duration was 39.9±9.8 months. No deaths or delayed thromboembolic complications occurred. The mean angiographic follow-up duration was 38.9±9.8 months. The immediate and final follow-up complete occlusion rates were 87.4 and 93.7%, respectively. There was no recanalization during the follow-up period. ConclusionPlacement of a single transverse stent via the nondominant A1 across the AComA into the contralateral A2 is a feasible and relatively safe endovascular technique for the treatment of wide-necked bifurcation AComA aneurysms, with good long-term occlusion rates and a reasonable complication rate, if only the nondominant A1 is applicable.

398 Right ventricular cardiogenic shock induced by propafenone intoxication: a case report

Abstract Aims Propafenone is a Class 1C antiarrhythmic drug recommended in the treatment of supraventricular or ventricular tachycardia and paroxysmal atrial fibrillation (AF). Most common cardiological features associated with propafenone intoxication include heart failure and conduction disturbances while other clinical findings range from nausea and vomiting to seizures and coma. Methods We report a case of atypical presentation of propafenone intoxication occurred in 88-year-old woman who presented at Emergency Department with severe ECG abnormalities and prevalent acute right ventricular with massive tricuspidalic regurgitation and cardiogenic shock. The patient underwent urgent coronary angiography that revealed a stable 90% coronary plaque that was treated with a single stent and then brought to Intensive Care Unit where she was successfully treated with inotropic and mechanical circulatory support (intra-aortic balloon pump, IABP). Results The patient progressively achieved hemodynamic stability with complete ECG normalization and biventricular function recovery. Conclusions Our case further expands the vast spectrum of presentations of Class 1c antiarrhythmic drugs overdose. In an emergency setting it is difficult to rule out other causes of cardiogenic shock but propafenone toxicity needs to be suspected in every case of hemodynamic instability in patients in chronical treatment. Patients in chronical treatment with propafenone who have kidney or liver dysfunction might be at higher risk of drug accumulation: in such cases, the real utility of propafenone must be evaluated before therapy initiation.

One-year outcomes of novel BioMime Morph tapered stent in long and multiple coronary artery lesions.

Even with the immense progress achieved in the field of percutaneous coronary interventions (PCIs), treatment of diffuse long atherosclerotic coronary artery disease continues to remain a challenge for durable outcomes. The downstream reduction in diameter along the lesion length of a coronary artery may compel the cardiologist to use either 2 overlapping stents of different diameters or a single long stent leading to stent-vessel mismatch at the edges. Recently, Meril Life Sciences Pvt. Ltd., India, has introduced a long-tapered sirolimus-eluting stent (SES) system, BioMime Morph, which conforms to the normal tapered geometry of coronary arteries along with adequate lesion coverage. In this study, we aimed to provide real world experience regarding the safety and efficacy of the BioMime Morph SES over a follow-up of one year. This was a single center, retrospective study involving 172 participants who underwent PCI with the BioMime Morph SES. Mean length of the target lesion was 34.4±10.4 mm, and mean stent length was 53.2±8.7 mm. The most frequent revascularized vessel was the left anterior descending artery (LAD) in 97 lesions (54.4%). Major adverse cardiac events (MACE) (defined as a composite of target vessel myocardial infarction, target lesion revascularization, and death due to a cardiac cause) at 1, 6, and 12 months were seen in 4 (2.3%), 7 (4.0%), and 8 (4.7%) patients, respectively. Overall, 5 cardiac deaths and 2 definite stent thrombosis were observed in the study. The study suggests that the novel BioMime Morph SES is an effective and a safe option for PCI in the treatment of long diffuse atherosclerotic lesions.

Feasibility and Outcomes of Left Main to Branch Vessel PCI with Novel Tapered Coronary Stent in a Tertiary Care Centre: A Real World Experience.

To assess the safety and efficacy of Novel tapered (BioMime™ Morph) sirolimus- eluting stent (SES) for left main PCI in a real-world scenario. Currently, no data is available on clinical usefulness of tapered ultrathin stents in left main PCI. This was a prospective, non-randomised, single centre study carried out between February 2018 and May 2020 at a tertiary cardiac care centre in southern India. The study included patients treated with BioMime Morph tapered stent for distal de novo LMB lesion or ostial LAD/LCX lesions with significant size disparity between reference segments based on the eligibility criteria. Primary endpoint of the study was the cumulative incidence of major adverse cardiovascular events (MACE) composed of cardiac death, myocardial infarction, and clinically driven target-lesion revascularisation at follow-up. A total of 41 patients (average age of 54.83±9.81 years) were included in the study. Average SS-2 score was 23.17±5.42. Majority of the lesions (n=31; 75.61%) were of medina class (0.1.0). Provisional single stent strategy was adopted for treatment of LMB lesions. TIMI flow-3 was achieved in 40 patients (97.56%). Median clinical follow-up was 20 months (range 6-34 months). There was no periprocedural complication or MACE during follow-up. Tapered stents may be an acceptable alternative for LM intervention in an anatomical subset of patients with tapered vessels.

In-stent restenosis and stent thrombosis rates after left main coronary artery stenting

Purpose: The aim of this study was to evaluate the in-stent restenosis (ISR) and stent thrombosis rates along with one-month and one-year survival rates in patients with left main coronary artery disease (LMCAD) with different methods of stenting, lesion characteristics, and clinical disease presentation. Methods: A total of 297 consecutive patients with unprotected LMCAD were treated by percutaneous coronary intervention (PCI) at University Clinical Center Maribor between January 2008 and October 2016. One hundred and thirty-two (50.8%) eligible patients underwent angiographic follow-up. The majority of patients (86.5%) were treated with a single drug-eluting stent (DES). Results: The overall prevalence of angiographic ISR in unprotected LMCA lesions was 33.3% (44 out of 132 patients with angiographic follow-up). The in-stent restenosis rate was 31.7% (39) in the group initially treated with DES (123). Most patients (63.6%) with ISR underwent repeated PCI, 22.7% had coronary artery bypass graft surgery, and 13.6% were treated conservatively. Only hypertension was shown to be statistically significant as a predictor of ISR in the present study. Stent thrombosis rate was 2.0% (six out of 297 patients). The mortality rate was 12.5% one month after the procedure on the left main coronary artery lesion, and 17.2 % after one year. Conclusion: Patients presenting with acute coronary syndrome had worse outcomes. While the numbers in the present study are higher compared to some other studies, they represent a real-world example of patients with different clinical presentations.

Stent detection with very thick tissue coverage in intravascular OCT.

Coronary stenting or percutaneous coronary intervention (PCI) is widely used to treat coronary artery disease. Improper deployment of stents may lead to post-PCI complication, in-stent restenosis, stent fracture and stent thrombosis. Intravascular optical coherence tomography (OCT) with micron-scale resolution provides accurate in vivo assessment of stent apposition/malapposition and neointima coverage. However, manual stent analysis is labor intensive and time consuming. Existing automated methods with intravascular OCT mainly focused on stent struts with thin tissue coverage. We developed a deep learning method to automatically analyze stents with both thin (≤0.3mm) and very thick tissue coverage (>0.3mm), and an algorithm to accurately analyze stent area for vessels with multiple stents. 25203 images from 56 OCT pullbacks and 41 patients were analyzed. Three-fold cross-validation demonstrated that the algorithm achieved a precision of 0.932±0.009 and a sensitivity of 0.939±0.007 for stents with ≤0.3mm tissue coverage, and a precision of 0.856±0.019 and a sensitivity of 0.874±0.011 for stents with >0.3mm tissue coverage. The correlation between the automatically computed and manually measured stent area is 0.954 (p<0.0001) for vessels with a single stent, and is 0.918 (p<0.0001) for vessels implanted with multiple stents. The proposed method can accurately detect stent struts with very thick tissue coverage and analyze stent area in vessels implanted with multiple stents, and can effectively facilitate the evaluation of stent implantation and post-stent tissue coverage.

Predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs): results from a multicenter study

ObjectiveTo evaluate predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) based on 608 reconstructed lesions in 30 medical centres.MethodsA total of...

Determinants of intracranial aneurysm retreatment following embolization with a single flow-diverting stent.

Flow diverting stents have revolutionized the treatment of intracranial aneurysms through endoluminal reconstruction of the parent vessel. Despite this, certain aneurysms require retreatment. The purpose of this study was to identify clinical and radiologic determinants of aneurysm retreatment following flow diversion. A multicenter flow diversion database was evaluated to identify patients presenting with an unruptured, previously untreated aneurysm with a minimum of 12 months' clinical and angiographic follow-up. Univariate and multivariate logistic regression modeling was performed to identify determinants of retreatment. We identified 189 aneurysms treated in 189 patients with a single flow-diverting stent. Mean age was 54 years, and 89% were female. Complete occlusion was achieved in 70.3% and 83.6% of patients at six and 12 months, respectively. Aneurysm retreatment with additional flow-diverting stents occurred in 5.8% of cases. Univariate analysis revealed that dome diameter 10 mm (p = 0.012), pre-clinoid internal carotid artery location (p = 0.012), distal > proximal parent vessel diameter (p = 0.042), and later dual antiplatelet therapy (DAPT) discontinuation (p < 0.001) were predictive of retreatment. Multivariate analysis identified discontinuation of DAPT 12 months (p = 0.003) as a strong determinant of retreatment with dome diameter 10 mm trending toward statistical significance (p = 0.064). Large aneurysm neck diameter, presence of aneurysm branch vessels, patient age, smoking history, and hypertension were not determinant of retreatment on multivariate analysis. Prolonged DAPT is the most important determinant of aneurysm retreatment following single-device flow diversion. Abbreviating DAPT duration to only six months should be a consideration in this population, especially for patients with a large aneurysm dome diameter.

Unique Method of Transjugular Intrahepatic Portosystemic Shunt Reduction for Refractory Hepatic Encephalopathy

We report the case of a 27-year-old female patient with a history of cryptogenic cirrhosis who was admitted to the hospital due to multiple episodes of hematemesis secondary to bleeding esophageal varices. The varices were persistent and refractory to endoscopic intervention, so an emergent transjugular intrahepatic portosystemic shunt (TIPS) was performed by interventional radiology (IR). Months later, the patient returned to the hospital unresponsive with acute intermittent hepatic encephalopathy which required a TIPS reduction by IR. Once the TIPS reduction was performed, the patient’s hepatic encephalopathy declined, and her symptoms improved. Here, we present a unique method of TIPS reduction utilizing a single Viabahn VBX balloon-expandable stent (W. L. Gore & Associates, Inc; Flagstaff, AZ) to constrain the existing TIPS stent.

Management of bifurcation culprit lesion in the setting of anterior ST elevation myocardial infarction

Abstract Introduction Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndrome (ACS). Aim To compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI Methods This retrospective multi-center study included all consecutive patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation lesion, patients indicated for urgent CABG, or patients in cardiogenic shock were excluded. Included patients were divided into two main groups according to the stenting strategy either single or two stents strategy. Six months of follow up data were collected by telephone calls and the examination of medical records Results Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%± 11.20 and 71.88%±15.05, t=−5.39, p&amp;lt;0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 min) and contrast volume (259.23±59.45 vs 232.58±96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However the angiographic success rates (residual stenosis ≤30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MC p=0.151). There is no significant difference regarding the overall incidence rate of MACCE in both groups 6 months following the index procedure (13.9% vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents Conclusion Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of complications between two groups were comparable on the medium-term follow up Funding Acknowledgement Type of funding sources: None.

Comparative analysis of sequential pot-side-pot and kissing balloon techniques in patients with coronary bifurcation lesions treated with single stent strategy: propensity score analysis

Abstract Objectives It is unknown whether the novel re-POT technique is more effective than commonly preferred kissing balloon inflation (KBI) in patients with non-complex coronary bifurcation lesions (CBL) treated with single-stent strategy. Our aim was to compare the efficacy of re-POT and KBI techniques in one-stent strategy of non-complex CBL. Methods 283 patients were retrospectively analyzed (re-POT group, n=149; KBI group, n=134). Primary end-points of the study were defined as; in-hospital and 30-day mortality, contrast induced acute kidney injury (CI-AKI), stent thrombosis (ST), side branch (SB) dissection and need for SB stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting (IPW). Results Procedure time (minute, 30.6±8.5 vs 34.3±11.6; p=0.003) and contrast volume (mL, 153.7±42.4 vs 171.1±58.2; p=0.004) were significantly lower in re-POT group. Besides, SB residual stenosis and number of patients with &amp;gt;50% SB residual stenosis remained significantly higher in re-POT group both in general and true bifurcation subgroup analysis (20.3±19.8% vs 16.5±16.4%, p=0.02; 11.9% vs 5.7%, p=0.01 and 24.1±23.2% vs 18.8±18.7%, p=0.03; 17.6% vs 6.6%, p=0.005; respectively). Combined clinical adverse outcomes were similar between groups. (Figure 1) SB dissection (10.2% vs 20.1%, p=0.001) and need for SB stenting (12.6% vs 19%, p=0.04) were reached statistically significance in KBI group after adjustment. (Figure 2) Conclusions Re-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse events in non-complex CBL treated with single-stent strategy. Funding Acknowledgement Type of funding sources: None. Adverse clinical outcomes; weighted

Multiple overlapping stent-assisted coiling improves efficacy and safety of treatment for complex intracranial aneurysms: a randomized trial

BackgroundIntracranial aneurysm rupture is the main cause of subarachnoid hemorrhage, leading to high disability and mortality. This study aimed to evaluate the clinical treatment effects of multiple overlapping stent-assisted coiling for complex intracranial aneurysms.MethodsWe conducted a randomized, controlled, single-blinded clinical trial among 168 patients diagnosed with complex intracranial aneurysms. Treatment allocation to either single stent (SS) group or multiple stent (MS) group was randomized at 1:1 ratio using a Web-based platform. The O’Kelly–Marotta (OKM) grading scale was used to evaluate the degree of aneurysm occlusion after operation and during follow-up. Good aneurysm occlusion was defined as OKM grade C–D. The modified Rankin Scale (mRS) was used to evaluate the neurological status and the clinical outcome of patients.ResultsEfficacy comparative analysis demonstrated that major recurrence of aneurysms was significantly reduced in the MS group (P = 0.012). In addition, the MS group displayed significantly reduced number of patients with mRS between 3 and 6 (P = 0.007) and increased number of patients with mRS between 0 and 1 (P = 0.034). Furthermore, the MS group showed increased percentage of patients with OKM grade C–D (P = 0.041). Compared with the SS group, the MS group exhibited decreased mortality (P = 0.037) and morbidity (P = 0.035).ConclusionsMultiple overlapping stent-assisted coiling significantly improved the clinical treatment effects and provided a new method for complex intracranial aneurysms.

S3374 Plastic vs Metal Stents for Anastomotic Biliary Strictures After Orthotopic Liver Transplant (OLT)

Introduction: Biliary anastomotic stricture is the most common complication of orthotopic liver transplantation (OLT) occurring in about 20% of cases. Endoscopic stent placement across the stricture with plastic or metal stents is the first-line treatment strategy. The aim of this study is to investigate the difference between plastic and metal stents in terms of anastomotic biliary stricture resolution and adverse events. Methods: This is a retrospective study of post OLT patients who underwent ERCP over a 3-year period between 2018-2020. Out of 178 post OLT patients who underwent ERCP, 108 were excluded because of only one ERCP performed and repeat ERCP was not indicated or because ERCP was performed for indications other than anastomotic biliary strictures. Data was collected up to 3 consecutive ERCP procedures during the studied period. Results: A total of 70 patients with anastomotic biliary strictures were included in the study. ERCP was performed on a native papilla in 32 (45.7%), advanced cannulation techniques were performed in 5 (7.1%), and prophylactic pancreatic stents were placed in 6 (8.6%) cases. Plastic stents (PS) were used in 53 (75.7%) of which multiple plastic stents were used in 27 cases, whereas 17 (24.3%) cases were treated with fully covered self-expanding metal stents (FCSEMS). Average follow up duration was 2.2 (1-3) months for PS and 3.7 (2-5) months for FCSEMS (P < 0.01). Biliary strictures resolved in 21 (30.0%) patients on repeat ERCP most of which from the FCSEMS group (58.8% vs 20.8%) (P = 0.009). Plastic stents were exchanged to FCSEMS in 11 (20.8%) patients during the second ERCP follow-up. On the third ERCP during the studied period, biliary strictures resolved in 71.4% of the FCSEMS group vs 33.3% of the PS group (P = 0.03). Using multiple plastic stents instead of a single plastic stent didn’t seem to improve biliary stricture resolution rate. Two patients (2.4%) developed post-ERCP pancreatitis, both patients had a native papilla and underwent FCSEMS placement with sphincterotomy and without pancreatic duct manipulation (P = 0.06). There was no difference between the stents used in terms of post-procedural cholangitis or stent migration rates. Conclusion: FCSEMS outperformed PS with respect to the anastomotic biliary stricture resolution rate over 3 endo-therapy sessions. Post-ERCP pancreatitis, although uncommon, occurred exclusively in the FCSEMS group.