Stent Occlusion Rate Research Articles

Characteristics and Outcome of Primary Budd Chiari Syndrome due to Myeloproliferative Disorder in Egyptian Patients, A Single Center Study

Abstract Background Budd–Chiari syndrome (BCS) is a rare life-threatening disorder caused by obstruction of the hepatic venous outflow tract at any level between the small hepatic veins and the right atrium, hence also known as hepatic venous outflow tract obstruction (HVOTO). Primary BCS is often related to multiple thrombophilic conditions, including primary myeloproliferative disorders. Aim of the Work The present study aimed to assess characteristics of Primary Budd Chiari syndrome due to Myeloproliferative disorder in Egyptian patients and the outcome of the radiologic endovascular intervention (TIPS or angioplasty) Patients and Methods This was a retrospective cohort study that was carried out in The Tropical Medicine department, at Ain Shams University Hospitals. A total of 37 patients were enrolled, including 12 males and 25 females, with an age of 15-49 years (mean: 32 years) with primary BCS and MPDs during the interval between January 2006 and March 2023. Results JAK2 was positive in 64.9% of BCS patients, more in ET patients. ET was more frequent in BCS due to MPDs. Furthermore, these results validate routine inclusion of JAK2V617F in the diagnostic workup of BCS. Rate of stent occlusion was high 33.3% due MPDs thrombophilic burden nature. Conclusion MPDs are major aetiology of BCS. TIPS placement is an effective treatment for portal hypertension, but in any case, long-term high intensity anticoagulation treatment is essential in order to prevent recurrent thrombosis.

The role of EUS-guided iodine-125 seed implantation in patients with unresectable ampullary cancer after relief of obstructive jaundice.

Few studies have focused on the management of inoperable ampullary carcinoma (AC), and patients with jaundice suffer from biliary stents replacement frequently. Iodine-125 (125I) brachytherapy has been used in the treatment of malignant tumors owing to its curative effect, minimal surgical trauma, and tolerable complications. The aim of the study was to investigate the role of 125I seed implantation in patients with unresectable ampullary carcinoma after relief of obstructive jaundice. A total of 44 patients with obstructive jaundice resulting from unresectable ampullary carcinoma from January 1, 2010 to October 31, 2020 were enrolled in the study. Eleven patients underwent implantation of 125I seeds under endoscopic ultrasound (EUS) after receiving biliary stent placement via endoscopic retrograde cholangiopancreatography (ERCP) (treatment group), and 33 patients received a stent alone via ERCP (control group). Cox regression model was applied in this single-center retrospective comparison study. The median maximum intervention interval for biliary obstruction was 381 days (interquartile range [IQR]: 204-419 days) in the treatment group and 175 days (IQR: 126-274 days) in the control group (p < 0.05). Stent occlusion rates at 90 and 180 days in the control group were 12.9% and 51.6%, respectively. No stent occlusion occurred in the treatment group. Patients in the treatment group obtained longer survival time (median, 26 vs. 13 months; p < 0.01) and prolonged duodenal obstruction (median, 20.5 vs. 11 months; p < 0.05). No brachytherapy-related grade 3 or 4 adverse events were observed. Longer intervention interval for biliary obstruction and survival as well as better stent patency and prolonged time to duodenal obstruction could be achieved by implanting 125I seeds combined with biliary stent in patients with unresectable ampullary cancer.

PROTOCOL trial – PROTon pump inhibitors and stent OCclusion rate Of Lumen apposing metal stents

PROTOCOL trial – PROTon pump inhibitors and stent OCclusion rate Of Lumen apposing metal stents

Meta-analysis on clinical outcomes of suprapapillary versus transpapillary stent insertion in malignant biliary obstruction.

Endoscopic biliary stenting is an essential treatment for malignant biliary obstruction (MBO). However, the optimal location for the placement of metal stents (MS) or plastic stents (PS) during the management of MBO, whether above (suprapapillary) or across (transpapillary) the sphincter of Oddi (SO), has not been thoroughly evaluated. This meta-analysis aims to compare the clinical outcomes associated with endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stents placed above and across the SO in patients with MBO. A comprehensive search of electronic databases was carried out to identify studies published from inception to April 2022. The clinical outcomes examined including stent patency, stent occlusion, and overall adverse events (AEs) such as cholangitis, post-ERCP pancreatitis (PEP), cholecystitis, stent migration, and bleeding. The selection of a random-effects model or fixed-effects model was based on the presence of heterogeneity. A total of 12 articles involving 751 patients were analyzed. The findings showed that the suprapapillary approach had longer stent patency compared to the transpapillary approach (mean difference: 38.58; 95% confidence interval 16.02-61.14, P < 0.0001). Additionally, the suprapapillary approach was associated with a lower risk of stent occlusion and overall AEs (P = 0.04, P = 0.002, respectively), particularly in the incidence of PEP (P = 0.009). The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. The subgroup analyses indicated that suprapillary PS had a significant decrease in the incidence of stent occlusion and longer stent patency, while suprapillary MS had a significant decrease in the incidence of overall AEs and PEP than the transpapillary approach. Compared with the transpapillary approach, the suprapapillary stent had superiority in longer stent patency, lower rates of stent occlusion and overall AEs, and notably, a lower incidence of PEP. The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. Further large-scale randomized controlled studies are needed to confirm our findings. CRD42022336435.

Outcome of both-bare type nitinol metal stents in distal biliary malignant obstruction: A post-market clinical follow-up study

BACKGROUND&#x0D; Neoplastic stenosis of the distal biliary (DBS) tract is not rare and the most common treatment is an endoscopic stent placement. Partially covered self-expandable metal stents (PC-SEMS) have been recently introduced and preliminary data are controversial in terms of lower stent ingrowth compared to uncovered self-expandable metal stents (SEMS) at expense of higher risk of migration.&#x0D; &#x0D; AIM&#x0D; To confirm the safety and/or clinical performance of partially covered nitinol metal stents (Niti-S- Taewoong Medical Co. Ltd., Korea) in DBS management.&#x0D; &#x0D; METHODS&#x0D; This is a post-market clinical follow-up study which analyzed all consecutive patients from March 2021 to April 2022 who underwent PC-SEMSs [Niti-S Biliary Covered stent (Both Bare Type) - Taewoong Medical Co. Ltd., Korea] placement for drainage of malignant DBS. The follow-up time was 6 mo. The safety of the device was evaluated by occurrence of procedure-related and stent-related adverse events.&#x0D; &#x0D; RESULTS&#x0D; Thirty patients (21 males, median age 75 years) were enrolled: at the time of the procedure 24 patients had pancreatic cancer, 67% of patients had, at the time of the procedure, an advanced inoperable disease. Technical success rate was achieved in 96.7% of patients, while clinical success after 3-6 wk was achieved in 95% of patients and all surviving patients achieved normal bilirubin levels within 10 wk from the procedure. One patient had a mild procedure-related adverse event, and one experienced a moderate stent-related adverse event. Stent occlusion rate was 6.6%: 2 patients had recurrent biliary obstruction endoscopically treated, while stent migration was never recorded.&#x0D; &#x0D; CONCLUSION&#x0D; This PMCF study demonstrates that Niti-S SEMS (Both Bare Type – Taewoong) provides adequate palliation, no migration and fair duration of patency comparable with the best results in reported series of SEMS placement for DBS treatment.

EUS-guided transluminal drainage using lumen-apposing metal stents with or without coaxial plastic stents for treatment of walled-off necrotizing pancreatitis: a prospective bicentric randomized controlled trial.

Lumen-apposing metal stents (LAMSs) have proven to be effective for drainage of pancreatic walled-off necrosis (WON), although associated adverse events (AEs) have been reported. Anchoring coaxial double-pigtail plastic stents (DPSs) within LAMSs have been proposed to prevent LAMS-related AEs but have not been assessed in prospective studies. We aimed to evaluate the utility of such measures with a randomized controlled trial. We randomly assigned consecutive patients with WON indications for drainage to EUS-guided transluminal drainage using LAMSs with (group A) or without (group B) DPSs. All LAMSs were to be removed after 3 weeks had elapsed from the index procedure with a preceding CT to decide whether additional steps needed to be taken (eg, transluminal necrosectomy or placing transluminal plastic stents in patients with incomplete resolution of WON). The main outcomes were failure of the index method, defined as necessity of reintervention (endoscopic, percutaneous, or surgical) before LAMS removal because of LAMS-related AEs and/or clinical deterioration; AE rates; and mortality with LAMS in place. Variables were evaluated using the Mann-Whitney U test, χ2 test, or Fisher exact test as appropriate. P< .05 was considered significant. Sixty-seven patients (37.3% women; mean age, 54 ± 14.4 years) underwent LAMS placement with (n= 34) or without (n= 33) DPS placement in 2 tertiary centers. Baseline characteristics including demographics, etiology, comorbidity, and clinical presentation (sterile vs infected necrosis) were comparable between both groups. The technical success rate in placing LAMSs and DPSs was 100%. The global rate of AEs was significantly lower in group A versus group B (20.7% vs 51.5%, respectively; P= .008). Stent occlusion was the most frequently observed AE (14.7% vs 36.3%, P= .042). Failure of the index method was lower in group A versus group B (29.4% vs 48.5%, respectively; P= .109); however, the difference did not achieve statistical significance. The same applied to the mortality rate with LAMSs in place (2.9% vs 12.1%, P= .197). The addition of a coaxial DPS within a LAMS was associated with a significantly lower global rate of AEs and stent occlusion rate in EUS-guided drainage of WON. (Clinical trial registration number: NCT03923686.).

Uncovered versus fully covered self-expandable metal stents for the management of distal malignant biliary obstruction

Self-expandable metal stents (SEMSs) are widely used for palliation of distal malignant biliary obstruction (dMBO). However, previous studies comparing the outcomes between uncovered SEMSs (UCSEMSs) and fully covered SEMSs (FCSEMSs) report conflicting results. This large cohort study aimed to compare the clinical outcomes between UCSEMSs and FCSEMSs for dMBO. A retrospective cohort study was performed in patients with dMBO who underwent either UCSEMS or FCSEMS placement between May 2017 and May 2021. Primary outcomes were rates of clinical success, adverse events (AEs), and unplanned endoscopic reintervention. Secondary outcomes were types of AEs, intervention-free stent patency, and management and outcomes of stent occlusion. The cohort included 454 patients (364 in the UCSEMS group and 90 in the FCSEMS group). Median follow-up duration was 9.6 months and was similar between the 2 groups. Use of UCSEMSs and FCSEMSs had comparable clinical success (P= .250). However, use of UCSEMSs had significantly higher rates of AEs (33.5% vs 21.1%; P= .023) and unplanned endoscopic reintervention (27.0% vs 11.1%; P= .002). UCSEMSs had a higher rate of stent occlusion (26.9% vs 8.9%; P< .001) and shorter median time to stent occlusion (4.4 months vs 10.7 months; P= .002). Stent reintervention-free survival was higher in the FCSEMS group. FCSEMSs had a significantly higher rate of stent migration (7.8% vs 1.1%; P< .001), but patients in the FCSEMS group had similar rates of cholecystitis (.3% vs 1.1%; P= .872) and post-ERCP pancreatitis (6.3% vs 6.6%; P= .90). When UCSEMSs did occlude, placement of a coaxial plastic stent had a higher rate of stent reocclusion compared with coaxial SEMS placement (46.7% vs 19.7%; P= .007). FCSEMSs should be considered for the palliation of dMBO because of lower rates of AEs, longer patency rates, and lower rates of unplanned endoscopic intervention.

Comparison between Suprapapillary and Transpapillary Uncovered Self-Expandable Metallic Stent Placement for Perihilar Cholangiocarcinoma

PurposeTo compare the effectiveness, adverse events (AEs), stent patency, and patient survival with suprapapillary and transpapillary uncovered self-expandable metallic stent placement for perihilar cholangiocarcinoma. Materials and MethodsA single-center retrospective study of 54 patients with inoperable perihilar cholangiocarcinoma who underwent percutaneous transhepatic biliary stent placement between January 1, 2019, and August 31, 2021, was conducted. According to stent location, the patients were classified into 2 groups: suprapapillary (S) and transpapillary (T). Demographic data, Bismuth-Corlette classification, type and location of the stent, laboratory data, postprocedural AEs, procedural success, stent occlusion, reintervention rate, and mortality were compared between the groups. ResultsStent placement was suprapapillary in 13 (24.1%) patients and transpapillary in 41 (75.9%) patients. Mean age was higher in Group T (78 vs 70.5 years; P = .046). Stent occlusion rates were similar in the 2 groups (Group S, 23.8%; Group T, 19.5%), as were AE rates, the most common being cholangitis (Group S, 23.1%; Group T, 24.4%). There were no significant differences in revision rate (Group S, 7.7%; Group T, 12.2%) and 30-day mortality rate (Group S, 15.4%; Group T, 19.5%). Ninety-day mortality rate was statistically significantly higher in Group T (46.3% vs 15.4%; P = .046). Preprocedural bilirubin level was higher in Group T, as were postprocedural leukocyte and C-reactive protein (CRP) levels. ConclusionsSuprapapillary and transpapillary stent placement procedures were similar in terms of procedural success, occlusion rate, revision rate, postprocedural AEs, and 30-day mortality. Ninety-day mortality rate and postprocedural leukocyte and CRP levels were higher in Group T, although these patients were also older and had higher preprocedural bilirubin levels.

Efficacy and safety of low dose intravenous cangrelor in a consecutive cohort of patients undergoing neuroendovascular procedures

BackgroundCangrelor is an intravenous P2Y12 inhibitor with rapid onset and fast offset of antiplatelet action. Dose adjusted cangrelor based on platelet function testing is suggested to be advantageous for use...

Karotid Arter Darlık Oranı ile Perioperatif Stent Komplikasyonları İlişkisi

Objective: This study aimed to examine complications that may occur after carotid artery stenting (CAS) and their relationships with carotid artery stenosis rate.&#x0D; Materials and Methods: Complications, such as cerebral hyperperfusion, stroke, death, stent thrombosis or occlusion and restenosis, were evaluated on the 30th day after CAS and at the end of the first year. &#x0D; Results: Of the 205 CAS procedures, complications developed in 12 patients. The complication rate for the first 30 days after the procedure was 4,87%, and at the end of the first year, it was 5,85%. Of the 12 patients with complications, 8 had carotid stenosis of ≥90%. Death occurred in 4 of 195 patients with carotid artery stenosis. The mortality rate within the first 30 days and during the 1-year follow-up period was 1,53% and 2,05%, respectively. Ischemic stroke occurred in 6 of 195 patients with carotid artery stenosis. After the first 30 days and one year follow-up, ischemic stroke had occurred in 3,07% of patients. Stent thrombosis and occlusion rate was 4,87% in 205 CAS procedures, and 7 of them occurred in the first 24 hours and another 3 occurred within the first 30 days. Restenosis rates were 0,48% and 0,97% at 6 months and the first year, respectively. &#x0D; Conclusion: The complications of CAS have been associated with the urgency of treatment (emergency), symptom presence (symptomatic patients) and high degree of stenosis (≥90%); whereas bilateral stenosis is not associated with complications. In addition, stent thrombosis and occlusion were observed as the most common CAS complication.

Combined iodine-125 seed strand, portal vein stent, transarterial chemoembolization, lenvatinib and anti-PD-1 antibodies therapy for hepatocellular carcinoma and Vp4 portal vein tumor thrombus: A propensity-score analysis.

To evaluate the safety and efficacy of interventional therapy (iodine-125[125I] seed strand and portal vein stent [PVS] implantation plus transarterial chemoembolization [TACE]) combined with systemic therapy (lenvatinib plus anti-PD-1 antibody) as first-line treatment for hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT). From December 2018 to October 2021, 87 HCC patients with Vp4 PVTT were included in this single-center retrospective study. Forty-seven patients underwent interventional therapy combined with lenvatinib and anti-PD-1 antibody (group A), while 40 cases underwent interventional therapy combined with lenvatinib only (group B). Overall response rate (ORR), stent occlusion rates (SOR), median overall survival (OS), median progression-free survival (PFS) and median stent patency time (SPT) were compared between the 2 groups. The mean intended dose (r = 10 mm; z = 0; 240 days) was 64.9 ± 1.0 Gy and 64.5 ± 1.1 Gy in group A and B, respectively (p = 0.133). ORR and SOR were significantly different between group A and B (ORR, 55.3% vs 17.5%, p < 0.001; SOR, 12.8% vs 35.0%, p = 0.014). In the propensity-score matching (PSM) cohort, the median OS, median PFS and median SPT were significantly longer in group A compared with group B (32 PSM pairs; OS, 17.7 ± 1.7 vs 12.0 ± 0.8 months, p = 0.010; PFS, 17.0 ± 4.3 vs 8.0 ± 0.7 months, p < 0.001; SPT, not-reached vs 12.5 ± 1.1 months, p = 0.028). This interventional therapy combined with lenvatinib and anti-PD-1 antibody is safe and effective for HCC patients with Vp4 PVTT.

Early Stent Patency After Endovascular Therapy for Tandem or Isolated Carotid Steno-Occlusive Disease

Early Stent Patency After Endovascular Therapy for Tandem or Isolated Carotid Steno-Occlusive Disease

Portal Vein Recanalization for Noncirrhotic Portal Vein Cavernous Transformation: Transjugular Intrahepatic Portosystemic Shunt Creation versus Portal Vein Stent Placement

PurposeTo compare the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation versus portal vein stent placement (PVS) in patients with noncirrhotic cavernous transformation of the portal vein (CTPV). Materials and MethodsIn this retrospective study, clinical data from patients with noncirrhotic CTPV who underwent TIPS creation or PVS were compared. A total of 54 patients (mean age, 43.8 years ± 15.8; 31 men and 23 women) were included from January 2013 to January 2021; 29 patients underwent TIPS creation, and 25 patients underwent PVS. Stent occlusion, variceal rebleeding, survival, and postprocedural complications were compared between the 2 groups. ResultsThe mean follow-up time was 40.2 months ± 26.2 in the TIPS group and 35.3 months ± 21.1 in the PVS group. The stent occlusion rate in the PVS group (16%, 4 of 25) was significantly lower than that in the TIPS group (41.4%, 12 of 29) during the follow-up (P = .042). The cumulative variceal rebleeding rates in the TIPS group were significantly higher than those in the PVS group (28% vs 4%; P = .027). The procedural success rate was 69% in the TIPS group and 86% in the PVS group (P = .156). There was a higher number of severe adverse events after TIPS than after PVS (0% vs 24%; P = .012). ConclusionsPortal vein recanalization with PVS may be a preferable alternative to TIPS creation in the treatment of noncirrhotic CTPV because of higher stent patency rates, lower risk of variceal rebleeding, and fewer adverse events.

S91 Management of Biliary Complications in Liver Transplant Recipients Using a Fully Covered Self-expandable Metal Stent With Antimigration Features

Introduction: Following liver transplant (LT) with duct-to-duct anastomosis, biliary strictures and leaks are typically managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting. While multiple plastic stents are typically used for strictures, self-expandable metal stents (SEMS) can be used to decrease the number of ERCPS with longer periods of stent patency. However, their use is limited by stent migration. The use of fully covered SEMS (FCSEMS), with antimigration fins to manage benign biliary complications following LT may provide stricture resolution with limited adverse events. As such we aimed to describe clinical outcomes of FCSEMS in LT recipients using one type of FCSEMS. Methods: This was a single center retrospective study of consecutive adult LT patients undergoing FCSEMS from January 2014 to April 2022. Primary outcomes were stricture resolution and recurrence. Secondary outcomes included rates of stent migration, stent occlusion, and number of ERCPs required. Results: 46 LT patients with anastomotic strictures (n=40), bile leaks (n=4) or both (n=2) (average age 55.8 years, 33% women) were treated with a FCSEMS with antimigration features (Viabil, W.L. Gore, Flagstaff, AZ) approved for malignant strictures. The median time from LT to FCSEMS placement was 132.5 days. Within one year of LT, 32 patients (69.5%) required intervention; early intervention at less than 30 and 90 days was needed in 7 and 20 patients, respectively. At the time of study conclusion there were 3 patients with stents in situ. Stricture resolution was seen in 34 patients (74%) after an average stent dwell time of 134.5 ± 71 days; recurrence was observed in 8 patients (17%). There were three instances of partial proximal stent migration that did not require reintervention or interfere with removability. Procedural details are listed in Table: The total mean number of ERCPS required was 2.48 (range 1-5). Conclusion: The use of a FCSEMS with antimigration features offers an opportunity to enhance stricture resolution with longer stent dwell times and fewer ERCPs. In our cohort there were no instances of clinically significant stent migration, dysfunction, or procedure related adverse events. Furthermore, these stents provide an opportunity reduce procedure related costs. Additional studies are needed to identify suitable patients for FCSEMS placement. Table 1. - Procedure related details and stent outcomes Stent Dwell Time +/- Standard Deviation (days) 134.5 +/- 71.8 Stent Placement transpapillary vs intraductally, n (%) 36 (78.3%) vs 10 (21.7%) Prior Sphincterotomy, n (%) 17 (40%) Stricture Recurrence, n (%) 8 (17%) Average Number ERCPs, n (range) 2.48 (1-5) Stent Migration, n (%) 3 (6.5 %) Stent Occlusion, n (%) 8 (17%)

Assessment of the safety and effectiveness of the first sirolimus stent manufactured in Viet Nam

Objectives: To evaluate the effectiveness and safety of the first sirolimus-eluting stent made in Vietnam (Xplosion stent) on Vietnamese patients via the following outcomes: restenosis rate in the stent and at the two heads of stent, stent occlusion rate, and mortality rate due to myocardial infarction at 6 months and 12 months following stent placement. Methods and Results: The prospective, open-label, non-randomized, longitudinal study enrolled 43 patients diagnosed with stable angina and de novo lesions with a 2.5 – 3.5 mm reference diameter and 24 mm in length. The patients received one stent per branch, and some received stents in multiple branches. All patients were scheduled for angiographic follow-up at 6 months, and if subjects consented, at 12 months. The subjects' mean age was 60.05 +/- 11.07 years, and many had cardiovascular risk factors, such as hypertension (83.72%), dyslipidemia (53.49%), and diabetes mellitus (25.58%). Stenting was performed on 50 lesions with a sirolimus drug-eluting stent (1.16 stent/patient on average). Of the patients, 92% had single-vessel coronary artery disease, and type B lesions (AHA) accounted for the majority (56%), with distribution on the LAD (42%), LCx (24%), and RCA (34%). The technical and procedural success rate of stent placement was 97.67%, with a very low complication rate (0%). The restenosis rate at 6 months was 0%. All patients were followed up to 12 months. Only two patients had recurrent chest pain and underwent coronary angiography; however, there was no in-stent restenosis and no need for revascularization. Therefore, the rate of chest pain recurrence after 12 months was 4.65% (2/43), and the rate of target vessel revascularization at 12 months was 0%. At 6- and 12-month follow-up, we observed no death due to unknown causes, no target-vessel myocardial infarction, and two clinically-driven re-angiographies with no need for revascularization. No additional events were reported beyond the 6-month follow-up. During the entire 12-month follow-up period, none of the patients experienced a definite or probable stent thrombosis. Conclusion: The new sirolimus-eluting stents manufactured in Vietnam use a new technology transferred from the United States. They were placed successfully and showed a sustained favorable safety profile for up to 12 months. These findings suggest that these new stents could be used in many catheterization laboratories in Viet Nam.

Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis

Background and study aims Malignant disease accounts for up to 80 % of gastric outlet obstruction (GOO) cases, which may be treated with duodenal self-expanding metal stents (SEMS), surgical gastrojejunostomy (GJ), and more recently endoscopic-ultrasound-guided gastroenterostomy (EUS-GE). These three treatments have not been compared head-to-head in a randomized trial. Methods We searched the Embase and MEDLINE databases for studies published January 2015−February 2021 assessing treatment of malignant GOO using duodenal SEMS, endoscopic (EUS-GE) or surgical (laparoscopic or open) GJ. Efficacy outcomes assessed included technical and clinical success rates, GOO recurrence and reintervention. Safety outcomes included procedure-related bleeding or perforation, and stent-related events for the duodenal SEMS and EUS-GE arms. Results EUS-GE had a lower rate of technical success (95.3%) than duodenal SEMS (99.4 %) or surgical GJ (99.9%) ( P = 0.0048). For duodenal SEMS vs. EUS-GE vs. surgical GJ, rates of clinical success (88.9 % vs. 89.0 % vs. 92.3 % respectively, P = 0.49) were similar. EUS-GE had a lower rate of GOO recurrence based on limited data ( P = 0.0036), while duodenal SEMS had a higher rate of reintervention ( P = 0.041). Overall procedural complications were similar (duodenal SEMS 18.7 % vs. EUS-GE 21.9 % vs. surgical GJ 23.8 %, P = 0.32), but estimated bleeding rate was lowest ( P = 0.0048) and stent occlusion rate was highest ( P = 0.0002) for duodenal SEMS. Conclusions Duodenal SEMS, EUS-GE, and surgical GJ showed similar clinical efficacy for the treatment of malignant GOO. Duodenal SEMS had a lower procedure-related bleeding rate but higher rate of reintervention.

Impact of a shorter replacement interval of plastic stents on premature stent exchange rate in benign and malignant biliary strictures.

The main disadvantage of plastic stents is the high rate of stent occlusion. The usual replacement interval of biliary plastic stents is 3months. This study aimed to investigate if a shorter interval of 6-8weeks impacts the median premature exchange rate (mPER) in benign and malignant biliary strictures. All cases with endoscopic retrograde cholangiopancreatography (ERCP) and plastic stent placement were retrospectively analyzed since establishing an elective replacement interval of every 6-8weeks at our institution and mPER was determined. A total of 3979 ERCPs (1199 patients) were analyzed, including 1262 (31.7%) malignant and 2717 (68.3%) benign cases, respectively. The median stent patency (mSP) was 41days (range 14-120) for scheduled stent exchanges, whereas it was 17days (1-75) for prematurely exchanged stents. The mPER was significantly higher for malignant (28.1%, 35-50%) compared with benign strictures (15.2%, 10-28%), P<0.0001, respectively. mSP was significantly shorter in cases with only one stent (34days [1-87] vs 41days [1-120]) and in cases with only a 7-Fr stent (28days [2-79]) compared with a larger stent (34days [1-87], P=0.001). Correspondingly, mPER was significantly higher in cases with only one stent (23% vs 16.2%, P<0.0001) and only a 7-Fr stent (31.3% vs 22.4%, P=0.03). A shorter replacement interval does not seem to lead to a clinically meaningful reduction of mPER in benign and malignant strictures. Large stents and multiple stenting should be favored as possible.

Comparison of Interwoven Nitinol and Drug-Eluting Stents for Endovascular Treatment of Femoropopliteal Artery Disease.

Interwoven nitinol stents (INS) and drug-eluting stents (DES) were designed to improve the mid- and long-term results of femoropopliteal (F-P) angioplasty. The aim of this study was to systematically compare these stents. Between 2015 and 2017, 62 patients with symptomatic peripheral artery disease of the F-P segment treated by INS or DES were identified from a prospectively maintained institutional database. The primary outcome measure was one-year primary patency; secondary outcomes were in-stent restenosis (ISR), stent occlusion, target lesion revascularization (TLR) and mortality. The mean follow-up was 26.9 ± 11.2 months. No statistically significant difference in primary patency at one year was observed (88.6% vs. 88.9%). Throughout follow-up, overall rates of ISR (5.7% vs. 11.1%, p = 0.645), stent occlusion (25.7% vs. 7.4%, p = 0.094) and TLR (25.7% vs. 18.5%, p = 0.505) were statistically equivalent between the groups. Mortality reached 14.3% in the INS group and 3.7% in the DES group, but this difference was not statistically significant (p=0.196). Multivariable analysis revealed significant correlations between ISR and stent occlusions; popliteal lesion localization (p = 0.016) and poor below the knee vessel outflow (p < 0.001). In the short- and mid-term, the use of an INS or DES in the F-P arterial segment did not result in a difference in primary patency rate, stent occlusion, restenosis, re-intervention or mortality. The overall data do not provide any evidence to favor one stent over the other.

Outcomes of percutaneous biliary stent placement for malignant hilar biliary obstruction

Abstract Introduction: This study aims to evaluate the effectiveness and safety of the percutaneous biliary stent placement for malignant hilar biliary obstruction (MHBO). Patients and Method: Percutaneous biliary stent was placed in 50 patients with MHBO at Viet Duc University Hospital from June 2019 to July 2020. The patients were monitored during their hospitalization, at 1-month and long-term follow-up on clinical symptoms and laboratory results as well as complications. The effect and safety of this technique were evaluated. Results: Successful rate was 98%. The total serum bilirubin decreased from 280.06 ± 164.65 µmol/L before to 165.09±112.90 µmol/L one week later (p&lt;0.001). Additionally, the AST and ALT significantly decreased (p&lt;0.001). Early complication rate was 22.4%, and late complication rate was 2.0% respectively. The stent occlusion rate was 20.4%. The median survival time was 144.2 days. Conclusion: The percutaneous biliary stent placement is a safe and effective palliative therapy for MHBO, helps to improve liver function and quality of life of patients. Keywords: Biliary stent, hilar biliary obstruction, percutaneous trans-hepatic biliary stent, percutaneous trans-hepatic biliary drainage.

Effectiveness and safety of dual-layer stents in carotid artery disease: a systematic review.

Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to carotid endarterectomy (CEA) in atherosclerotic carotid artery disease, even though the risk for procedural stroke after CAS remains significantly higher. Recently, in order to reduce embolic cerebral events after CAS, a new generation of dual-layer stents (DLS) has been developed. This review aimed to perform a detailed analysis of the available evidence on safety and efficacy of DLS in both symptomatic and asymptomatic atherosclerotic carotid artery stenosis. A systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary endpoint was the 30-day rate of myocardial infarction (MI), stroke and death. Secondary outcomes included rate and timing of stent occlusion/restenosis. A total of 20 articles with 1193 patients were included. Thirty-day MI ranged from 0-5%, 30-day stroke ranged from 0-10.5% and 30-day mortality ranged from 0-10%. Stent occlusion rate ranged from 0-52.4%, the majority of which occurred intraprocedurally (N.=50; 61.7%), in emergency treated patients. The incidence of new ipsilateral cerebral ischemic lesions after CAS with DLS was reported in five studies, ranging from 5.5-37%. Despite the theoretic advantage of reducing the risk for procedural embolic events when compared to conventional stents, high quality evidence is scarce. Also, safety issues regarding DLS in the emergency setting have been raised, particularly for thrombotic complications. Additional data from well-designed Randomized Controlled Trials are needed to assert the true value of DLS.