Standard Stent Research Articles

In Situ Antegrade Laser Fenestrations During Endovascular Aortic Repair

The technique and preliminary outcomes are reported for laser fenestrated endografting (LfEVAR), developed as an alternative procedure for endovascular repair of thoraco-abdominal aortic aneurysms (TAAAs), type IA endoleaks (T1AELs), and pararenal aortic aneurysms (PAAAs). Patients with TAAA, T1AEL, and PAAA considered unfit for open repair by a multidisciplinary team and who could not benefit from a custom made device were selected. LfEVAR is a physician modified technique requiring sequential steps. After preliminary stenting of each target artery, a standard stent graft was deployed in the aorta. Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of each target artery ostium. After progressive dilation of the laser fenestration, bridging stents were placed and flared to insure accurate perfusion of the visceral arteries. Between August 2015 and March 2017, 16 consecutive patients were treated using LfEVAR including two TAAAs, four T1AELs, and 10 PAAAs. Thirty-three laser fenestrations were performed with a 94.3% success rate for visceral artery fenestration. The median ischaemic was 7.5minutes for the superior mesenteric artery, 48 and 50minutes for the left and right renal arteries, and 125minutes for the coeliac trunk. Four secondary procedures were required: two endoleaks (type II and III), and two related to fenestrations: one renal stent dislocation, and one renal artery stent stenosis. During a mean follow up of 17 months, no deaths occurred. Follow up computed tomography (CT) scans performed at 30 days, 6, 12, and 18 months were satisfactory (4 endoleaks and two aneurysm enlargements were observed). The follow up CT scan imaging demonstrated 97% primary patency. In situ antegrade LfEVAR is feasible and a safe alternative option for high risk inoperable patients or for those not eligible for custom made device endografting, particularly in emergency cases.

Su1393 CLINICAL IMPACT OF THE INTRA-SCOPE CHANNEL STENT RELEASE TECHNIQUE IN PREVENTING STENT MIGRATION DURING EUS-GUIDED HEPATIICOGASTROSTOMY

Stent migration following EUS-guided hepaticogastrostomy (HGS), may sometimes be fatal because there are no adhesions between the biliary tract and stomach. To prevent stent migration and minimize the stent length in the abdominal cavity, we recently performed EUS-HGS using the technique of releasing the stent within the scope channel. In the present study, we examined the technical feasibility of the intra-scope channel stent release technique. Forty-one consecutive patients who underwent EUS-HGS were enrolled in this study. Between October 2015 and December 2015, EUS-HGS was performed using the standard stent release technique as previously described, while the intra-channel release technique was performed between January 2016 and March 2016. Using CT imaging, the distance between the intrahepatic bile duct and stomach was measured before EUS-HGS. The day after EUS-HGS, the measured point of the intrahepatic bile duct was fixed using CT imaging. The distance between the hepatic parenchyma and the stomach wall was also measured using CT imaging the day after EUS-HGS. This distance reflected the length of the EUS-HGS stent within the abdominal cavity. 20 patients (median age, 70 years; age range, 57-82 years; 14 men, 6 women) underwent EUS-HGS using the intra-scope channel release technique, and 21 patients (median age, 75 years; age range, 57-88 years; 13 men, 8 women) using the intra-scope channel stent release technique. The indications for EUS-HGS, which were mainly related to duodenal obstruction because of which the duodenoscope scope could not be advanced to the ampulla of Vater, were not significantly different between the groups (P=0.48). In addition, the types of diseases, such as pancreatic or biliary cancer, were not significantly different in both groups (P=0.11). Among patients who underwent EUS-HGS using the standard stent release technique, the candy sign on CT performed the day after the procedure was seen in 17 patients. On the other hand, it was not seen in any patients in the intra-scope channel stent release group (P<0.05). The distance between the hepatic parenchyma and the stomach wall after EUS-HGS in the intra-scope channel stent release group was significantly shorter than that in the standard stent release group (0.66 ± 1.25 versus 2.52 ± 0.97, respectively, P<0.05). Late adverse events, such as cholangitis or biloma, were seen in only the standard stent release group. In conclusion, although additional cases and randomized controlled studies using metal stents of various lengths are needed, our technique is likely to be clinically useful for the prevention of early and late stent migration.

Experimental evaluation of homemade distal stent graft fenestration for thoracic endovascular aortic repair of type A dissection by a transapical approach

ObjectiveThe use of off-the-shelf stent grafts for thoracic endovascular aortic repair of type A dissections is limited by variability in both the length of the ascending aorta and the location of the proximal intimal tear. This experimental study aimed to assess the feasibility of using a physician-modified thoracic aortic stent graft to treat acute type A dissection by a transapical cardiac approach. MethodsThe experiments were performed on six cadaveric human heart, ascending aorta, aortic arch, and descending aorta specimens. Fenestration was fashioned in each standard tubular Valiant thoracic stent graft (Valiant Captivia; Medtronic Vascular, Santa Rosa, Calif) to match the anatomy of each specimen. Stent grafts of sufficient length were selected to cover the entire ascending aorta and aortic arch. Stent graft diameters in proximal sealing zones were oversized by 5% to 10%. The length of the fenestration was the distance between the left subclavian artery and the proximal edge of the origin of the brachiocephalic trunk with an additional 10 mm. The diameter of the scallop was that of the brachiocephalic trunk with an additional 5 mm on all sides. The length of the covered portion of the stent graft was the distance between coronary arteries and the proximal edge of the origin of the brachiocephalic trunk. Two lateral radiopaque markers were positioned to delineate the distal and lateral edge of the scallop. Another 3-cm radiopaque marker was sutured onto the sheath to ensure accurate radiologic positioning of the scallop on the outer curve of the aorta. The left ventricle and the thoracic aorta were connected to a benchtop aortic pulsatile flow model. A 5-mm 30-degree lens was introduced through the left subclavian artery to monitor the procedure. The customized stent graft was deployed by a transapical approach under fluoroscopic control. ResultsMedian duration of stent graft modification was 21 minutes (range, 17-40 minutes). All attempts to deploy the homemade proximal scalloped stent graft by a transapical approach were successful. Completion angiography demonstrated patency of the supra-aortic trunks and of the coronary arteries in all cases. Macroscopic evaluation did not identify any deterioration of the customized stent graft. ConclusionsThe use of physician-modified stent grafts is feasible for thoracic endovascular aortic repair of type A dissection by a transapical approach in this model.

Evaluation of a new stent for EUS-guided pancreatic duct drainage: long-term follow-up outcome.

Background and study aims Endoscopic ultrasonography-guided pancreatic duct drainage (EUS-PD) has been reported as an alternative for failed conventional endoscopic retrograde cholangiopancreatography (ERCP). However, there are few dedicated devices for EUS-PD. Recently, we have developed a new plastic stent dedicated to EUS-PD and have conducted a feasibility study to evaluate its efficacy. In the current study, we evaluated the long-term efficacy of this new plastic stent. Patients and methods Thirty patients (61 ± 14.3 years old, 14 men) with acute recurrent pancreatitis caused by a stricture in the main pancreatic duct (MPD) or stenotic pancreatoenterostomy were treated at our institution using our recently developed 7Fr plastic stent between August 2013 and April 2017. Results The stent was placed successfully in all patients (30/30) and early clinical success was achieved in all of them. Early adverse events (AEs) occurred in seven patients (23.3 %), namely, self-limited abdominal pain (n = 5), mild pancreatitis (n = 1), and bleeding which required transcatheter arterial embolization (n = 1). Two patients died of primary disease and three were lost to follow-up. The remaining 25 patients were followed up after initial EUS-PD for a median of 23 months (range, 6 – 44 months). Twenty patients required regular stent exchange (3 times; range, 1 – 12 times). Spontaneous stent dislodgement was observed in six patients. Four patients wanted their stents removed 1 year after the initial intervention. Twelve patients (48 %) had regular stent exchange 1 year after the initial intervention. Three patients converted to standard transpapillary pancreatic duct stenting by conventional ERCP. Finally, nine patients (36 %) had complete stent removal either intentionally or by spontaneous dislodgement without any symptoms. Conclusion The new plastic stent for EUS-PD was associated with not only short-term technical success but also long-term clinical success in the majority of patients evaluated in this study.

Additional flap on plastic stents for improved antimigration effect in the treatment of post-cholecystectomy bile leak.

Background and study aims In plastic stent insertion for treatment of post-cholecystectomy bile leak, stent migration may be more common due to the absence of a shelf to anchor the stent. We evaluated how adding a flap to straight plastic stents for this indication might influence the rate of stent migration when compared to use of conventional plastic stents. Patients and methods This is a retrospective study including patients referred for ERCP for treatment of post-cholecystectomy bile leak. Patients with a customized anti-migration flap stent had the additional flap created on the distal end of straight plastic stents, intended to aid in anchoring in the distal supra-sphincteric biliary duct. The primary endpoint is stent migration events. The secondary endpoint is bile leak resolution after first ERCP session. Results Thirty-two patients were treated with the experimental additional flap stents and 225 patients were treated with standard straight biliary stents. The total failure rate of bile leak resolution after a single endoscopic treatment for all treated was 10.5 % (27/257) and the total stent migration rate for all enrolled was 15.2 % (39/257). Stent migration rate was lower in the additional flap stent group than in the conventional group (3.1 % vs. 16.9 %, respectively, P = 0.04). Furthermore, significantly more patients had resolution of their bile leak after the first ERCP session in the group with the additional flap (100 % vs. 88 %, respectively, P = 0.03). Conclusion A plastic biliary stent with an extra flap may have improved performance with regard to stent migration and resolution of bile leak over standard plastic biliary stents.

Endovascular Management of SVC Syndrome due to Fibrosing Mediastinitis-A Feasibility and Safety Analysis.

To assess the outcomes of endovascular management for superior vena cava (SVC) syndrome secondary to fibrosing mediastinitis (FM). Between January 2004 and December 2016, 10 consecutive patients with endovascularly managed SVC syndrome secondary to FM were identified in an institutional database. Venograms were performed to assess the severity and location of the lesion and allow measurement for stent selection. Standard stenting and angioplasty techniques were utilized to establish luminal patency. The safety, feasibility, clinical success, and the primary and secondary patency were evaluated. Kaplan-Meier survival analysis was used to determine median duration of stent patency. A log-rank test was used to test differences in prior stent use. Our cohort was predominantly female (7/10) with an average age of 42.2 years. Of the 10 patients, 3 had undergone endovascular stenting at an outside institution prior to referral to our institution due to new, recurrent, or worsening symptoms. All patients underwent venography demonstrating stenosis (8/10) or occlusion (2/10) at initial presentation. Stenting or angioplasty was technically successful in 9 (90.0%) patients. Eight of 10 patients had primary stenting, while 1 achieved vascular patency and symptom resolution with angioplasty alone. Median duration of primary patency was 31.3 months (95% confidence interval: 5.9-103). Six (54.5%) patients required secondary revision procedures. Median duration of secondary patency was 6.1 months, with 25% of revisions occurring by 4 months and 75% occurring by 20.9 months. All treated patients (9/9) reported symptomatic relief at 1-month follow-up, establishing a clinical success rate of 100%. There were no 30-day adverse effects related to the procedure. This study demonstrates that endovascular therapy is a safe and feasible approach for managing FM-related SVC syndrome.

Safety and Feasibility of Carotid Artery Stenting with Dual-Echo Technique to Minimize Iodinated Contrast Dose

The aim of this study was to evaluate the safety and feasibility of carotid artery stenting (CAS) employing dual-ultrasound technique and administering a minimal contrast agent in patients with renal insufficiency. Between September 2009 and July 2013, 63 consecutive patients underwent CAS at our institution: dual-echo carotid artery stenting (DECAS) in 7 patients with renal insufficiency and standard carotid artery stenting (STCAS) in the remaining 56 patients. Periprocedural adverse events and outcomes were compared between the 2 groups. Technical success was achieved in all cases. The 3 procedure-related complications were 1 case of transient hemiparesis in the DECAS group and 1 transient and 1 permanent case of hemiparesis in the STCAS group. The rate of positive diffusion-weighted-imaging lesions did not differ significantly between the 2 groups (28.6% versus 12.5%, P = .26). A significantly smaller volume of contrast was used in DECAS (15 versus 163 mL, P < .01). The change in creatinine level remained stable after CAS and did not differ between the 2 groups (.02 versus .03 mg/dL, P = .96). DECAS is safe and feasible for patients with pre-existing renal insufficiency and can provide an alternative for patients with carotid stenosis and renal insufficiency.

Les syndromes aortiques aigus

Acute aortic syndromes include aortic dissections, intramural hematomas, penetrating ulcers, ruptured or contained ruptured aortic aneurysms. In presence of acute thoracic or dorsal pain, elevated D-Dimers and if acute coronary artery syndrome has been ruled out, additional imaging should be performed to detect acute aortic pathologies. Acute type A dissections involve the ascending aorta. Emergent open repair is the preferred treatment. Acute type B dissections involve the thoracic descending aorta. Endovascular treatment using thoracic stent grafts is indicated in complicated cases (malperfusion, rupture, uncontrolled hypertension) or in cases where risk factors of aortic degeneration are identified. Regarding ruptured abdominal aortic aneurysms, optimization techniques recently led to a reduced postoperative mortality. They include adequate treatment of abdominal compartment syndrome, use of aortic stent grafts, endovascular balloon occlusion and permissive hypotension. Symptomatic complex aneurysms encompass renal and visceral arteries. Nowadays, they can be treated in an urgent setting using new endovascular techniques, such as "off-the shelf" branched stent grafts, parallel techniques, home made or in situ fenestrations of standard stent grafts.

A Study Comparing the Outcomes Between the Orsiro Sirolimus Eluting Stent and Xience Everolimus Eluting Stent in the ST-Elevation Myocardial Infarction Population

Background: At present, the Xience everolimus eluting stent (X-EES) is considered the gold standard drug-eluting stent (DES). The Orsiro sirolimus eluting stent (O-SES) with a biodegradable polymer coating has been shown in subanalyses of the BIOSCIENCE trial to have possible improved outcomes compared to Xience in the STEMI population; however, research in this subset remains limited.

Endovascular Treatment with Drug-Coated Balloons in Femoropopliteal Artery Disease

Objectives: In this study, we aimed to evaluate the one-year follow-up findings of endovascular treatment with drug-covered balloon in patients with femoropopliteal artery disease (FAD). Patients and Methods: From June 2012 to March 2015, 43 patients were enrolled in the study. Fifteen patients, 16 limbs and 19 lesions were treated with percutaneous transluminal angioplasty (PTA). Twenty-eight patients, 31 limbs and 36 lesions were treated with drug-coated balloon (DCB). At 12 months, all patients were examined with magnetic resonance angiography. Results: Primary patency was seen in 47.4% of the treated lesions in the PTA group and 80.5% in the DCB group. There was statistically significant difference in primary patency between the groups (P = 0.011). Clinical improvement was seen in 56.3% of the treated limbs in the PTA group and 83.9% in the DCB group. There was no statistically significant difference in clinical improvement between the two groups (P = 0.075). Conclusion: DCB with low restenosis rate can be used safely for endovascular treatment in patients with FAD as an alternative of standard balloon and stent.

Effect of Endovascular Contact Aspiration vs Stent Retriever on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion

The benefits of endovascular revascularization using the contact aspiration technique vs the stent retriever technique in patients with acute ischemic stroke remain uncertain because of lack of evidence from randomized trials. To compare efficacy and adverse events using the contact aspiration technique vs the standard stent retriever technique as a first-line endovascular treatment for successful revascularization among patients with acute ischemic stroke and large vessel occlusion. The Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) study was a randomized, open-label, blinded end-point clinical trial conducted in 8 comprehensive stroke centers in France (October 2015-October 2016). Patients who presented with acute ischemic stroke and a large vessel occlusion in the anterior circulation within 6 hours of symptom onset were included. Patients were randomly assigned to first-line contact aspiration (n = 192) or first-line stent retriever (n = 189) immediately prior to mechanical thrombectomy. The primary outcome was the proportion of patients with successful revascularization defined as a modified Thrombolysis in Cerebral Infarction score of 2b or 3 at the end of all endovascular procedures. Secondary outcomes included degree of disability assessed by overall distribution of the modified Rankin Scale (mRS) score at 90 days, change in National Institutes of Health Stroke Scale (NIHSS) score at 24 hours, all-cause mortality at 90 days, and procedure-related serious adverse events. Among 381 patients randomized (mean age, 69.9 years; 174 women [45.7%]), 363 (95.3%) completed the trial. Median time from symptom onset to arterial puncture was 227 minutes (interquartile range, 180-280 minutes). For the primary outcome, the proportion of patients with successful revascularization was 85.4% (n = 164) in the contact aspiration group vs 83.1% (n = 157) in the stent retriever group (odds ratio, 1.20 [95% CI, 0.68-2.10]; P = .53; difference, 2.4% [95% CI, -5.4% to 9.7%]). For the clinical efficacy outcomes (change in NIHSS score at 24 hours, mRS score at 90 days) and adverse events, there were no significant differences between groups. Among patients with ischemic stroke in the anterior circulation undergoing thrombectomy, first-line thrombectomy with contact aspiration compared with stent retriever did not result in an increased successful revascularization rate at the end of the procedure. clinicaltrials.gov Identifier: NCT02523261.

Magnetic Ureteral Stent Removal Without Cystoscopy: A Randomized Controlled Trial.

Ureteral stenting is a common procedure in urology. The cystoscopic removal of Double-J stents (DJ) causes unpleasant side effects with a negative impact on patient's quality of life. The aim of our study was to evaluate this newly developed magnetic DJ and compare it with a standard DJ regarding quality of life with indwelling DJs as well as discomfort during the removal. The magnetic DJ (Blackstar, Urotech [Achenmühle, Germany]) is a standard 7F ureteral stent with a small magnetic cube fixed through a string on the loop of the distal part of the stent. For DJ removal, a special catheter-like retrieval instrument with a magnetic tip is inserted, the two magnets connect and the retrieval instrument is removed with the DJ. We first tested this DJ in 20 cases. Afterward we evaluated 40 consecutive cases that required a DJ placement after ureterorenoscopy in a prospective randomized manner. The quality of life was assessed by the ureteral stent symptom questionnaire. A visual analogue scale was used to document the pain by DJ removal. There was a significant difference regarding the pain location with the indwelling DJ (p = 0.038). The maximum pain was located in the lower abdomen and/or around the bladder (48%) with the magnetic DJ, whereas the standard DJ caused flank pain in 54% of the patients. The mean time for the magnetic DJ removal including preparation and cleaning as for a transurethral catheter insertion was 9.55 [7-14] minutes, whereas the mean time for the cystoscopic DJ removal was 21.35 [18-30] minutes. The pain caused by the removal of the magnetic DJ was significantly less than that caused by the cystoscopic DJ removal (p = 0.019). The discomfort caused by the indwelling magnetic DJ is comparable with that caused by the standard DJ. However, the magnetic DJ removal is less painful and faster.

Long-term outcome of bioresorbable vascular scaffolds for the treatment of coronary artery disease: a meta-analysis of RCTs

BackgroundCoronary bioresorbable scaffolds (BRS) were developed to overcome the limitations of standard metallic stents, especially to address late events after percutaneous coronary interventions. The aim of this meta-analysis was to evaluate the efficacy and safety of BRS, compared with Everolimus-eluting stents (EES), using the data available from randomized trials, with a focus on long-term outcomes.MethodsPublished randomized trials comparing BRS to EES for the treatment of coronary artery disease were searched for within PubMed, Cochrane Library and Scopus electronic databases up to April 4th 2017. The summary measure used was odds ratio (OR) with 95% confidence intervals.ResultsA total of 5 studies were eligible, including 5219 patients. At 2 years, BRS was associated with higher rates of target lesion failure (9.4% vs 7.2%; OR = 1.33; 95% CI 1.07 to 1.63; p = 0.008) and device thrombosis (2.3% vs 0.7%; OR = 3.22; 95% CI 1.86 to 5.57; p < 0.0001) compared with EES. The incidence of both early (within 30 days after implantation, 1.1% vs 0.5%, OR 1.97, 95% CI 1.02 to 3.81; p = 0.05) and very-late device thrombosis (>1 year, 0.6% vs 0.1%, OR 4.03, 95% CI 1.37 to 11.82; p = 0.01) was higher with BRS compared with EES.ConclusionsBRS may be associated with worse two-years clinical outcomes compared with EES in patients with coronary artery disease.

Tu1478 Comparison of Standard and Pig-Tail Plastic Stents in the Treatment of Residual Common Bile Duct Stones

In the palliative treatment of residual common bile duct stones, stenting is a treatment option. For this purpose standard plastic (Amsterdam type) or pig-tail plastic stents are commonly available. The aim of this study was to compare the effectivity of pig-tail plastic and standard plastic stents in the treatment of patients with dilated common bile duct and large stones which cannot be extracted with balloon and basket.

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review.

Temporary drainage of the upper urinary tract by internal ureteral stents is a routine procedure in endourology. However, it is associated with a clear side-effect profile. Our aim was to evaluate prevention and treatment options of stent-related symptoms. We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using MEDLINE and SCOPUS, and identified 107 appropriate records. A high number of these studies showed clear methodological limitations. Available data clearly support the use of α1 -blockers in patients suffering from stent-related symptoms. It seems that antimuscarinic monotherapy or combination with α1 -blockers might also play an important role, whereas the use of classical analgesics in the treatment of stent-related symptoms has not been assessed systematically within clinical trials so far. Improvements in stent design and material seem to have the potential to reduce stent-related symptoms. However, so far there is no type of stent with outstanding characteristics and clear evidence suggesting fundamental advantages compared with a standard double pigtail stent. Although stent diameter does not seem to influence patients' comfort, it seems to be beneficial to choose a proper stent-length. Coated and drug-eluting stents, as well as intravesical drug application, seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. Furthermore, thorough patient education has the potential to reduce the morbidity associated with ureteral stenting. Further research in the field seems to be mandatory.

Conversion of external percutaneous transhepatic biliary drainage to endoscopic ultrasound-guided hepaticogastrostomy after failed standard internal stenting for malignant biliary obstruction.

Background and study aim Percutaneous transhepatic biliary drainage (PTBD) is a rescue procedure after a failed endoscopic retrograde cholangiopancreatography. As PTBD causes patient discomfort, conversion of the PTBD to internal biliary stenting (PTBDS) may be required; however, PTBDS is sometimes difficult because of the tight stricture. We evaluated the efficacy and safety of conversion of external PTBD to endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) after failed PTBDS. Patients and methods A total of 16 patients with malignant distal biliary obstruction who underwent conversion of external PTBD to EUS-HGS after failed PTBDS were enrolled from two institutions in Korea and Japan. Data were analyzed retrospectively. Results The technical and clinical success rates were 100 % and 81 %, respectively. Early adverse events developed in two patients: proximal stent migration (n = 1), and cholecystitis (n = 1). Stents were occluded or migrated distally in five patients. The mean duration of stent patency was 402 days. Conclusions Conversion of external PTBD to EUS-HGS may be a good rescue option after failed PTBDS.

Ureteric Catheterization Using Infant Feeding Tubes Following Ureteroneocystostomy in a Low Resource Setting

Background: Ureteric catheterization is extensively used in various urological procedures including ureteroneocystostomy. The standard ureteric stents are usually expensive, difficult to access and of variable quality in our setting. Infant feeding tubes have been used in similar low resource setting as ureteral stents. This study seeks to document our experience with the use of infant feeding tubes as ureteric catheters with respect to their complications and outcome. Methods: This is a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, Nigeria from January 2014 to April 2016. The records of 23 women who had ureteroneocystostomy were available for review. Ethical clearance to review casenotes was obtained for the study. Infant feeding tube was improvised as ureteric stents to achieve ureteric patency following ureteroneocystostomy. The infant feeding tube was inserted through the bladder into the neo ureteric orifice in each patient which was then connected to the eye of a urethral catheter. Results: All 23 women reviewed in this study had ureteric fistula. Their mean age was 33.8 ± 8.8 years. A total of 13 patients (56.5%) had right ureteroneocystostomy while 10 (43.5%) had left ureteroneocystostomy. All patients had the infant feeding tube for 7 to 10 days. All 23 patients had successful ureteroneocystostomy and the postoperative period was unremarkable. They were followed up for a period of six months and remained dry. Conclusion: In patients with ureteric fistula, infant feeding tubes which are readily available in our environment appear to be effective when used as modified ureteric stents following ureteroneocystostomy.

Percutaneous Coronary Intervention for Coronary Bifurcation Lesions.

Percutaneous coronary intervention (PCI) of lesions at coronary bifurcations poses a technical challenge. Short-term complications, including periprocedural myocardial infarction, and long-term complications such as in-stent restenosis and stent thrombosis, are higher in patients with bifurcation lesions. Techniques for PCI of bifurcation lesions include stenting of the main branch alone, and the use of two or more stents to cover the main and side branches. Two- or three-stent techniques include T-stenting, crush, culotte, simultaneous kissing stents, V-stenting, and Y-stenting. The goal of these techniques is to minimize areas of vessel that are not covered by stent. Dedicated bifurcation stents exist, including stents with apertures that allow standard stents to be placed within the aperture. Simultaneous kissing balloon angioplasty in the two branches should be performed to optimize angiographic results. Many studies exist comparing the different techniques; however, no consensus exists on the preferred method.

Comparison of through-the-scope stent insertion with standard stent insertion for the management of malignant colorectal obstruction: a prospective study

The aim of the present study was to compare the feasibility, safety and efficacy of the through-the-scope (TTS) stent technique to that of the standard metallic stent technique for the management of malignant colorectal obstruction. Fifty-two patients scheduled to receive stent insertion for the management of acute obstructive colorectal cancer were enrolled in our study and divided into a TTS stent group (n=24) and a standard stent group (n=28). The stent insertion procedure was performed under endoscopic and fluoroscopic guidance in all patients. The success rate, complications, fluoroscopic time, and clinical remission rate were recorded and compared. The technique success rate was 100% (24/24) in the TTS stent group and 78.6% (22/28) in the standard stent group (p=0.03). In five patients in the standard stent group, the stent failed to pass through occlusive lesions because of the stiffness of the stent system. Serious bleeding occurred in one patient in the standard stent group. The fluoroscopy time in the TTS stent group was significantly reduced (12.9±6.6min) compared with that of the standard stent group (24.8±9.8min; p<0.01). Silent perforation occurred in 17.9% (5/28) of the cases in the standard stent group compared with none in the TTS (p=0.03). Clinical remission was achieved in 97.1% (23/24) and 78.6% (22/28) of patients in the TTS and standard stent groups, respectively (p=0.11). The TTS stent is safer and more feasible for the management of malignant colorectal obstructions than the standard stent, and the TTS technique provides a higher success rate, a similar clinical remission rate, and a markedly reduced fluoroscopic time.

Abstract 314: Development of a Nanotube-coated Nitinol Stent for Delivery of Resolvin D1

Introduction: As part of a Vascular Innovation and Therapeutic Advances (VITA) contract from NHLBI, we sought to optimize a nitinol drug eluting stent to deliver a novel bioactive lipid mediator Resolvin D1 (RvD1). Methods: Nitinol stents were secured as the anode in an ethylene glycol-based anodization setup to create nanotubes on the stent surface. Scanning electron microscopy was used to evaluate the quality of the coatings where an iterative process was utilized to optimize anodization conditions (70V, 5min). To ascertain structural integrity of the coatings, stents were observed under SEM after compression in a crimping device followed by self-expansion. Nanotube-coated (NT) and unmodified bare metal (BM) nitinol stents were loaded with RvD1 by dip-coating (with sonication) followed by hanging drop evaporation of RvD1 (in ethanol). Stents were eluted in media and RvD1 levels were analyzed by EIA. An ex vivo model of vascular stent implantation was created using a 3D printer and RvD1 delivery to the vessel wall (segment of rabbit aorta) and circulating flow medium was quantified after 3 hrs of stent implantation. Results: NT stents released significant amounts of RvD1 (1273ng cumulative at day 9), where 1177ng (± 238) of RvD1 was released within 3hr and 0.111ng (± 0.014) of RvD1 was released between day 7 and day 9. Net amount of RvD1 released was 0.2nM - 2000nM, which is physiologically relevant and within the milestone goal. NT stents released much higher levels of RvD1 (9.7 pg/mg vessel; ±1.39) to the vessel wall compared to standard BM stent controls (3.9 pg/mg vessel; ±2.0) and native vessel (1.3 pg/mg vessel; ±0.5). Conclusion: We have developed optimized anodization conditions for creating a uniform coating of titania nanotubes on nitinol stents that is able to survive crimping and self-expansion. NT stents demonstrate improved loading and elution of the lipid mediator RvD1 in an ex-vivo artery flow model.