Stent Group Research Articles

Computational Pressure-Fluid Dynamics Applied to Index of Microcirculatory Resistance, Predicting the Prognosis of Drug-Coated Balloons Compared With Drug-Eluting Stents in STEMI Patients.

Background: The impairment of microvascular injury on prognosis has increasingly drawn extensive awareness along with the high morbidity and mortality of ST-segment elevation myocardial infarction (STEMI) over recent years. The prognostic significance of computational pressure-fluid dynamics applied to index of microcirculatory resistance, derived from coronary angiography (CPFD-caIMR) in microvascular injury evaluation of STEMI patients remained inconclusive. Methods: A total of 213 patients who met the inclusion criteria were selected retrospectively from 1003 STEMI patients from February 2018 to February 2020. Propensity score matching (PSM) was thereafter finished. CPFD-caIMR of all patients was obtained off-line using the software (FlashAngio, Rainmed Ltd., Suzhou, China) after PPCI. The primary endpoint was to compare the CPFD-caIMR and the incidence of major adverse cardiovascular events (MACEs) between drug-coated balloons (DCB) and drug-eluting stents (DES) groups. The correlation between CPFD-caIMR and MACEs was analyzed, and the prognosis of patients with STEMI was evaluated by CPFD-caIMR by multivariate regression analysis. Results: Totally 213 STEMI patients with successful primary percutaneous coronary intervention (PPCI) were included, of whom 84 patients accepted DCB and 129 patients accepted DES respectively. Baseline characteristics and CPFD-caIMR were comparable between DCB and DES groups after PSM (62 patients in each group). CPFD-caIMR was not significantly different between two groups (DES vs. DCB: mean difference: 2.26, 95% CI -4.05 to 8.57, p = 0.45), and so was it when re-grouped by whether CPFD-caIMR > 40U or not (DES vs. DCB: 34.17% vs. 27.16%, p = 0.29). After a follow-up of 1 year, more MACEs occurred in DES group than DCB group (relative risk: 2.50, 95% CI 1.04 to 6.02, p = 0.04). The predictors of MACEs by multi-variate analysis found that, only time from symptom to balloon (p = 0.03) and time from door to balloon (p < 0.01) were independent predictors of MACEs, independent of treatment with DCB or DES intervention. Furthermore, CPFD-caIMR > 40U became an independent predictor of the combined events including cardiovascular deaths or heart failure readmission irrespective of PSM (odds ratio: 4.07, 95% CI: 1.06 to 7.66, p = 0.04). Conclusion: CPFD-caIMR was a promising method for prognosis, which can predict CV death or heart failure readmission in STEMI patients. DCB was a possible strategy in PPCI of STEMI patients, not inferior to DES based on microvascular injury evaluated by CPFD-caIMR.

Use of intraoperative frontal sinus mometasone-eluting stents decreased interleukin 5 and interleukin 13 in patients with chronic rhinosinusitis with nasal polyps.

Mometasone-eluting stents (MES) have demonstrated improvement in short-term endoscopic outcomes and reduce short- to medium-term rescue interventions. Their effect on the local inflammatory environment, longer-term patient-reported outcomes, and radiographic severity have not been studied. Middle meatal mucus and validated measures of disease severity were collected before and 6 to 12 months after endoscopic surgery in 52 patients with chronic rhinosinusitis with nasal polyps (CRSwNPs). Operative findings, type 2 mediator concentrations, intraoperative variables, and disease severity measures were compared between those who did and those who did not receive intraoperative frontal MES. A total of 52 patients with CRSwNPs were studied; 33 received frontal MES and were compared with 19 who did not. Pre-endoscopic sinus surgery (ESS) middle meatus (MM) interleukin (IL) 13 and eosinophil cationic protein (ECP) were higher in the stented group (p<0.05), but pre-ESS clinical measures of disease severity were similar as were surgical extent and post-ESS medical management. Intraoperative eosinophilic mucin was more frequent in the stented group (58% vs 11%, p=0.001). IL-5 (p<0.05) and IL-13 (p<0.001) decreased post-ESS in the stented group, but this was not observed in the nonstented group. Post-ESS IL-4 and IL-13 were higher in the nonstented vs stented group (p<0.05 for both). Although patients who received intraoperative frontal MES had significantly higher pre-ESS MM IL-13 and ECP, patients who received frontal MES had lower concentrations of IL-4 and IL-13 than those who did not at a median of 8 months post-ESS. However, these changes did not correspond to significantly different measures of symptomatic or radiographic disease severity.

Gradual Versus Abrupt Reperfusion During Primary Percutaneous Coronary Interventions in ST-Segment-Elevation Myocardial Infarction (GUARD).

BackgroundIntramyocardial edema and hemorrhage are key pathological mechanisms in the development of reperfusion‐related microvascular damage in ST‐segment–elevation myocardial infarction. These processes may be facilitated by abrupt restoration of intracoronary pressure and flow triggered by primary percutaneous coronary intervention. We investigated whether pressure‐controlled reperfusion via gradual reopening of the infarct‐related artery may limit microvascular injury in patients undergoing primary percutaneous coronary intervention.Methods and ResultsA total of 83 patients with ST‐segment–elevation myocardial infarction were assessed for eligibility and 53 who did not meet inclusion criteria were excluded. The remaining 30 patients with totally occluded infarct‐related artery were randomized to the pressure‐controlled reperfusion with delayed stenting (PCRDS) group (n=15) or standard primary percutaneous coronary intervention with immediate stenting (IS) group (n=15) (intention‐to‐treat population). Data from 5 patients in each arm were unsuitable to be included in the final analysis. Finally, 20 patients undergoing primary percutaneous coronary intervention who were randomly assigned to either IS (n=10) or PCRDS (n=10) were included. In the PCRDS arm, a 1.5‐mm balloon was used to achieve initial reperfusion with thrombolysis in myocardial infarction grade 3 flow and, subsequently, to control distal intracoronary pressure over a 30‐minute monitoring period (MP) until stenting was performed. In both study groups, continuous assessment of coronary hemodynamics with intracoronary pressure and Doppler flow velocity was performed, with a final measurement of zero flow pressure (primary end point of the study) at the end of a 60‐minute MP. There were no complications associated with IS or PCRDS. PCRDS effectively led to lower distal intracoronary pressures than IS over 30 minutes after reperfusion (71.2±9.37 mm Hg versus 90.13±12.09 mm Hg, P=0.001). Significant differences were noted between study arms in the microcirculatory response over MP. Microvascular perfusion progressively deteriorated in the IS group and at the end of MP, and hyperemic microvascular resistance was significantly higher in the IS arm as compared with the PCDRS arm (2.83±0.56 mm Hg.s.cm−1 versus 1.83±0.53 mm Hg.s.cm−1, P=0.001). The primary end point (zero flow pressure) was significantly lower in the PCRDS group than in the IS group (41.46±17.85 mm Hg versus 76.87±21.34 mm Hg, P=0.001). In the whole study group (n=20), reperfusion pressures measured at predefined stages in the early reperfusion period showed robust associations with zero flow pressure values measured at the end of the 1‐hour MP (immediately after reperfusion: r=0.782, P<0.001; at the 10th minute: r=0.796, P<0.001; and at the 20th minute: r=0.702, P=0.001) and peak creatine kinase MB level (immediately after reperfusion: r=0.653, P=0.002; at the 10th minute: r=0.597, P=0.007; and at the 20th minute: r=0.538, P=0.017). Enzymatic myocardial infarction size was lower in the PCRDS group than in the IS group with peak troponin T (5395±2991 ng/mL versus 8874±1927 ng/mL, P=0.006) and creatine kinase MB (163.6±93.4 IU/L versus 542.2±227.4 IU/L, P<0.001).ConclusionsIn patients with ST‐segment–elevation myocardial infarction, pressure‐controlled reperfusion of the culprit vessel by means of gradual reopening of the occluded infarct‐related artery (PCRDS) led to better‐preserved coronary microvascular integrity and smaller myocardial infarction size, without an increase in procedural complications, compared with IS.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02732080.

Preliminary Outcomes of Different Tactics of Ureteral Stent Placement in Patients with Ureteral Stricture Undergoing Balloon Dilatation: Experience from a Large-Scale Center.

PurposeOur aim is to demonstrate the optimal number of ureteral stent placements in patients with a ureteral stricture (US) after balloon dilatation (BD).MethodsA retrospective analysis of 213 patients who underwent BD from 2011 to 2019 was conducted. All statistical analyses were completed by software SPSS 25.0.ResultsOf the patients enrolled, 119 were males and 94 were females. The average age was 44.71 years. One month after stent removal, the overall success rate of ureteral stent placement was 76.99%, and the success rates of single, double, and triple stent groups were 81.7%, 70.3%, and 79.3%, respectively. Six months after stent removal, the overall success rate was 61.9%, and the success rates of the three groups were 61.7%, 52.7%, and 74.1%, respectively. Twelve months after stent removal, the overall success rate was 55.9%, and the success rates of the three groups were 51.9%, 48.6%, and 70.7%, respectively. During indwelling of the stents, the proportions of severe bladder irritation symptoms in the three groups were 13.6%, 16.2%, and 20.7%, respectively. Multivariate analysis indicated the length of US and the time and number of ureteral stent placements were independent risk factors of the treatment effect at 6 months and 12 months after stent removal. Patients in the triple stent group had a better prognosis when compared to those in the single or double stent group.ConclusionThe long-term effect of three stents was better than that of single and double stents, but the success rate of treatment reduced gradually over time.

Comparison of BARD®LIFESTREAM™ covered balloon-expandable stent versus GORE® VIABAHN™ covered self-expandable stent in treatment of aortoiliac obstructive disease: study protocol for a prospective randomized controlled trial (NEONATAL trial)

BackgroundCovered stent has become one of the mainstream therapies for aortoiliac obstructive disease (AIOD), with a higher patency rate than bare metal stent. Covered balloon-expandable (CBE) stent can be placed more accurately with higher a radial support force, while covered self-expanding (CSE) stent has greater elasticity and higher trackability. However, there is no level I evidence regarding the comparison safety and efficacy between the CSE stent and CBE stent in AIOD to date. Therefore, this study aims to compare the efficacy and safety of CBE stent (BARD®LIFESTREAM™) and CSE stent (GORE® VIABAHN™) in AIOD.MethodsThis trial is a prospective, single-center, parallel, noninferiority, randomized controlled trial. A total of 106 patients will be enrolled and these patients will be randomized to either the CBE stent group or the CSE stent group. The primary end point of the study is the occurrence of target lesion revascularization (TLR) at 12 months after the intervention.DiscussionTo our knowledge, the ballooN sElf cOver steNt AorToiliAc occuLusive (NEONATAL) trial is the first RCT to compare CBE and CSE stent in AIOD patients. The main aim is to compare the TLR of the target lesion between CBE stent and CSE stent at 12 months post-procedure. The results of clinical trials may contribute to establishing a strategic guideline for choosing the optimal type of covered stent in the treatment of AIOD patients.Trial registrationChinese Clinical Trials Registry ChiCTR2100046734. Registered on 27 May 2021

Reconstructive Endovascular Treatment of Basilar Trunk and Vertebrobasilar Junction Aneurysms: A Review of 77 Consecutive Cases.

BackgroundBasilar trunk and vertebrobasilar junction (BTVBJ) aneurysms have a poor prognosis and are challenging to treat.ObjectiveThis study aimed to evaluate the efficacy of reconstructive endovascular treatment for BTVBJ aneurysms and explore a treatment selection paradigm.MethodsClinical and angiographic data from 77 patients with 80 BTVBJ aneurysms who underwent endovascular treatment with flow diverters (FDs) or conventional stent-assisted coiling between January 2016 and December 2020 were retrospectively analyzed. Aneurysm characteristics and treatment outcomes were compared between treatment groups.ResultsAmong the 77 study patients, 34 (44.2%) were treated with FDs and 43 (55.8%) with conventional stent-assisted coiling. Overall, 72.7% of patients achieved favorable clinical outcome at follow-up. The rate of procedure-related complications was 23.4%. The aneurysm occlusion rate at last follow-up did not differ between the FD and conventional stent groups (79.2% vs. 77.1%, p = 0.854). Although the occlusion rate immediately after the procedure was lower in the FD group (29.4%), incidence of progressive occlusion was significantly higher (62.5 vs. 5.7%; p < 0.001). The proportion of patients with large and giant aneurysms (≥10 mm) was significantly higher in the FD group (70.6 vs. 34.8%; p = 0.002). In patients with large or giant aneurysms, favorable clinical outcome at last follow-up was achieved in 75% of patients in the FD group but only 43.8% of patients in the conventional stent group (p = 0.046). Moreover, the complication rate was lower in the FD group, but the difference was not significant (20.8 vs. 37.5%; p = 0.247). The same analyses were performed for patients with small aneurysms (<10 mm) but no significant differences between the two groups were observed.ConclusionEndovascular treatment of small BTVBJ aneurysms using either FDs or conventional stents was feasible and effective. In patients with large or giant aneurysms, treatment using FDs achieved higher rates of occlusion and favorable clinical outcome at last follow-up than conventional stent-assisted coiling.

MP31-09 DECREASED URETERAL STENT DURATION AFTER RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION IS ASSOCIATED WITH DECREASED RATE OF 30 AND 90-DAY COMPLICATIONS

You have accessJournal of UrologyCME1 May 2022MP31-09 DECREASED URETERAL STENT DURATION AFTER RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION IS ASSOCIATED WITH DECREASED RATE OF 30 AND 90-DAY COMPLICATIONS David Miller, Danielle Sharbaugh, Cameron Jones, John Myrga, Jennifer Mihalo, Michelle Yu, Tatum Tarin, Robert Turner, Bishoy Gayed, Benjamin Davies, and Bruce Jacobs David MillerDavid Miller More articles by this author , Danielle SharbaughDanielle Sharbaugh More articles by this author , Cameron JonesCameron Jones More articles by this author , John MyrgaJohn Myrga More articles by this author , Jennifer MihaloJennifer Mihalo More articles by this author , Michelle YuMichelle Yu More articles by this author , Tatum TarinTatum Tarin More articles by this author , Robert TurnerRobert Turner More articles by this author , Bishoy GayedBishoy Gayed More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , and Bruce JacobsBruce Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002580.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The rate of complications for patients who undergo radical cystectomy and ileal conduit urinary diversion remains among the highest of all oncologic surgeries. An effort to reduce complication rates is decreased duration of indwelling ureteral stents after urinary diversion. Our objective was to examine the association of stent duration on 30 and 90-day complication and readmission rates among patients with bladder cancer undergoing radical cystectomy and ileal conduit urinary diversion. METHODS: We identified patients who underwent radical cystectomy and ileal conduit diversion for bladder cancer at our institution from February of 2020 to July of 2021. Variation in stent duration within our cohort reflects surgeon practice in addition to initiation of a bladder cancer care protocol for patients undergoing radical cystectomy. Stent duration was stratified into three groups: ≥10 days, <10 days, and no stents. 30 and 90-day readmissions and complications were recorded including urine leak, pyelonephritis, urosepsis, ileus, small bowel obstruction, and other. Kruskal-Wallis, Chi-square and Fisher’s exact tests were used to assess differences between groups. RESULTS: We identified 128 patients with bladder cancer who underwent radical cystectomy with ileal conduit urinary diversion, 45 patients were in the ≥10-day group, 73 in the <10 days group, and 10 in the no stents group. No significant difference in hospital length of stay was seen (p=.34). There was a significant decrease in overall 30-day complication rate (p=.03) and 90-day complication rate (p=.02) as time of stent duration decreased. Specifically, there was a significant decrease in the development of urosepsis (p=.02) and pyelonephritis (p=.05) as duration of stent decreased. There was a significant decrease in the rate of urine leak by stent duration between groups (p=.01), this is explained by ureteral stents remaining in place if a urine leak is identified. No significant differences in rate of the other complications nor rate of readmissions were seen between the groups. CONCLUSIONS: Decreased time of indwelling ureteral stents resulted in significantly decreased overall 30 and 90-day complications. Further research is needed to assess differences in long term complications. Source of Funding: Bruce Jacobs is supported in part by the Shadyside Hospital Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e525 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Miller More articles by this author Danielle Sharbaugh More articles by this author Cameron Jones More articles by this author John Myrga More articles by this author Jennifer Mihalo More articles by this author Michelle Yu More articles by this author Tatum Tarin More articles by this author Robert Turner More articles by this author Bishoy Gayed More articles by this author Benjamin Davies More articles by this author Bruce Jacobs More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP14-20 COMPARISON OF THE EFFECT OF ACTIVE SURGICAL TREATMENT OF UROLITHIASIS IN PREGNANT PATIENTS COMPARED WITH SERIAL URETERAL STENTING ON THE PROBABILITY OF NATURAL DELIVERY

You have accessJournal of UrologyCME1 May 2022MP14-20 COMPARISON OF THE EFFECT OF ACTIVE SURGICAL TREATMENT OF UROLITHIASIS IN PREGNANT PATIENTS COMPARED WITH SERIAL URETERAL STENTING ON THE PROBABILITY OF NATURAL DELIVERY Pavel Nizin, Sergey Kotov, and Perov Roman Pavel NizinPavel Nizin More articles by this author , Sergey KotovSergey Kotov More articles by this author , and Perov RomanPerov Roman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The primary endpoint is to compare the frequency of natural childbirth in the groups undergoing active surgical treatment of urolithiasis and the group of serial ureteral stenting. METHODS: Criteria for inclusion of diagnosed urolithiasis at any stage of pregnancy in patients without abnormalities of the urinary system. Exclusion criteria, independent departure of the stone. The active treatment group underwent endoscopic surgery to get rid of the stone during gestation. The serial stenting group underwent drainage replacement every 4 weeks during the entire period of pregnancy, followed by operations to get rid of the stone after delivery. RESULTS: Active treatment group n=57 average age 27.2 years (±5.2). The average gestation period was 21.1 weeks (±6.8). Distribution by trimester: I-3.6%, II-73.8%, III–22.8%. The average rate of leukocytosis at admission was 10.9*10^9/l (±4.8*10^9/l). Serial stenting group n=56 average age 26.5 years (±6.1). The average gestation period was 20.2 weeks (±7.2). Distribution by trimester: I-3 (5.4%), II-43 (76.8%), III–10 (17.8%). The average rate of leukocytosis at admission was 11.6*10^9/l (±5.1*10^9/l). 7 (12%) patients from the first group were diagnosed with acute obstructive pyelonephritis. These patients were fitted with an internal ureteral stent. In 5 patients, there was an independent discharge of the concretion. These patients were excluded from observation. In the second group, 4 patients were diagnosed with acute obstructive pyelonephritis. An internal ureteral stent was installed in these patients. In 3 patients, against the background of a standing stent, the stone moved away on its own. These patients were excluded from observation. In the first group, the number of delivery was 35, caesarean section-17. In the second group, delivery-23, CS-30.The probability of delivery was estimated using χ2 is 6.070. The critical value of χ2 at the significance level p=0.05 is 3.841. Complications in the first group: grade I-5 (9%), II–7 (13%). Complications in the second group I degree 9 (17%), II – 8 (15%), IIIa - 9 (17%). Comparison of the development of complications was carried out. The value of the criterion χ2 is 12.724. The critical value of χ2 at the significance level p=0.01 is 11.345. CONCLUSIONS: Active disposal of the stone during pregnancy is safe and reduces the likelihood of delivery by cesarean section and the likelihood of developing stent-associated symptoms. Source of Funding: The study was not funded © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e240 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pavel Nizin More articles by this author Sergey Kotov More articles by this author Perov Roman More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP56-12 UPPER TRACT RECURRENCE RISK BASED ON DRAINAGE METHOD FOR URETERAL OBSTRUCTION PRIOR TO RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP56-12 UPPER TRACT RECURRENCE RISK BASED ON DRAINAGE METHOD FOR URETERAL OBSTRUCTION PRIOR TO RADICAL CYSTECTOMY Wesley Yip, Daniel Sjoberg, Nathan Wong, Manuel de Jesus Escano, Song Jiang, Carissa Chu, Nicole Benfante, Sherri Donat, Harry Herr, Guido Dalbagni, Bernard Bochner, and Eugene Cha Wesley YipWesley Yip More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Nathan WongNathan Wong More articles by this author , Manuel de Jesus EscanoManuel de Jesus Escano More articles by this author , Song JiangSong Jiang More articles by this author , Carissa ChuCarissa Chu More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Sherri DonatSherri Donat More articles by this author , Harry HerrHarry Herr More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Bernard BochnerBernard Bochner More articles by this author , and Eugene ChaEugene Cha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002639.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral obstruction by bladder tumors can cause hydronephrosis with the potential for renal dysfunction. Renal drainage can be achieved by either ureteral stent placement or percutaneous nephrostomy tube, but there is a potential risk for upper tract seeding by retrograde manipulation during stent placement and reflux of urine. We aim to determine if retrograde ureteral stent placement prior to radical cystectomy (RC) increases the risk of upper tract recurrence. METHODS: 2475 patients who underwent RC at our institution from January 2000 to June 2016 were included in our analysis. Patients were categorized by: no drainage, nephrostomy tube only, or stent with or without nephrostomy tube. Fine-Gray competing risks regression analysis was used to assess whether ureteral stent placement increased the risk of upper tract recurrence, with recurrence to another region and death from other causes as the competing events. Univariable and multivariable models were then created, with the latter adjusted for pathologic T stage, carcinoma in situ (CIS) in the RC specimen, and prior intravesical therapy. RESULTS: Of 2475 patients who underwent RC, 111 upper tract recurrences were observed with a median follow-up of 6.0 years (IQR 2.5, 9.3) among those without an event. 2203 (89%) patients had no drainage, 88 (3.6%) had a nephrostomy tube only, and 184 (7.4%) had a ureteral stent with or without nephrostomy tube. There were 98 upper tract recurrences in the no drainage group, only 1 in the nephrostomy tube group, and 12 in the ureteral stent group. The probability of upper tract recurrence based on drainage method is displayed in Figure 1. On multivariable analysis, ureteral stent placement was associated with an increased risk of upper tract recurrence (HR 2.32; 95% CI 1.27, 4.22). CONCLUSIONS: Ureteral stent placement for ureteral obstruction prior to radical cystectomy is associated with an increased risk of upper tract recurrence compared to nephrostomy tube placement, although patient selection factors not accounted for in our analyses may be present. This should be considered when weighing the risks and benefits of ureteral stent versus nephrostomy tube placement in these patients. Source of Funding: Ruth L. Kirschstein National Research Service Award T32CA082088 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e977 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Yip More articles by this author Daniel Sjoberg More articles by this author Nathan Wong More articles by this author Manuel de Jesus Escano More articles by this author Song Jiang More articles by this author Carissa Chu More articles by this author Nicole Benfante More articles by this author Sherri Donat More articles by this author Harry Herr More articles by this author Guido Dalbagni More articles by this author Bernard Bochner More articles by this author Eugene Cha More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Predictive Value of the Perivascular Adipose Tissue CT Fat Attenuation Index for Coronary In-stent Restenosis.

ObjectivesTo investigate the association between the perivascular adipose tissue (PVAT) fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) and the prevalence of in-stent restenosis (ISR) in patients with coronary stent implantation.MethodsA total of 117 patients with previous coronary stenting referred for invasive coronary angiography (ICA) were enrolled in this retrospective observational analysis. All patients underwent CCTA between July 2016 and November 2021. The deep learning-based (DL-based) method was used to analyze and measure the peri-stent FAI value. Additionally, the relationship between hematological and biochemical parameters collected from all the patients was also explored. The least absolute shrinkage and selection operator (LASSO) method was applied to the most useful feature selection, and binary logistic regression was used to test the association between the selected features and ISR. The predictive performance for ISR of the identified subgroups was evaluated by calculating the area under the curve (AUC) of receiver operator curves plotted for each model. The Pearson correlation coefficient was used to assess the correlation of peri-stent FAI values with degrees of ISR.ResultsThe peri-stent FAI values in the ISR group were significantly higher than those in the non-ISR group (−78.1 ± 6.2 HU vs. −87.2 ± 7.3 HU, p < 0.001). The predictive ISR features based on the LASSO analysis were peri-stent FAI, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), and high-sensitivity c-reactive protein (hs-CRP), with an AUC of 0.849, 0.632, 0.620, and 0.569, respectively. Binary logistic regression analysis determined that peri-stent FAI was uniquely and independently associated with ISR after adjusting for other risk factors (odds ratio [OR] 1.403; 95% CI: 1.211 to 1.625; p < 0.001). In the subgroup analysis, the AUCs of the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx), and right coronary artery (RCA) stents groups were 0.80, 0.87, and 0.96, respectively. The Pearson's correlation coefficient indicated a term moderately correlation between ISR severity and peri-stent FAI values (r = 0.579, P < 0.001).ConclusionsThe peri-stent FAI can be used as an independently non-invasive biomarker to predict ISR risk and severity after stent implantation.

Efficacy and safety of drug-coated balloon in the treatment of acute myocardial infarction: a meta-analysis of randomized controlled trials

Acute myocardial infarction (AMI) is one of the main causes of death in the world, and the incidence of AMI is increasing in the young population. Drug-coated balloon (DCB) has become an effective concept for the treatment of in-stent restenosis, small vessel disease, bifurcation lesions, high blood risk conditions, and even de novo large vessel disease. To ensure whether DCB can play an alternative role in AMI, we conducted a comprehensive meta‐analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of DCB in the treatment of AMI. Electronic databases were searched for RCTs that compared DCB with stent for AMI. The primary outcome was major adverse cardiac events (MACEs), the secondary outcome was late lumen loss (LLL). RevMan 5.3 software and RStudio software were used for data analysis. Five RCTs involving 528 patients with 6–12 months of follow-up were included. There was no significant difference in the incidence of MACEs between DCB group and stent group (RR, 0.85; 95% CI 0.42 to 1.74; P = 0.66). Lower LLL was shown in DCB group (WMD, − 0.29; 95% CI − 0.46 to − 0.12; P < 0.001). This meta-analysis of RCT showed that DCB might provide a promising way on AMI compared with stents. Rigorous patients’ selection and adequate predilation of culprit lesions are necessary to optimize results and prevent bailout stent implantation.PROSPERO registration number: CRD42020214333.

Cephalic arch stenosis in autologous hemodialysis fistula; to stent or not to stent? Long-term follow up

BackgroundA retrospective study of 44 patients with autologous arteriovenous fistula (AVF) presenting with cephalic arch stenosis was carried out. The aim is to assess the effectiveness of angioplasty and stenting in cephalic arch stenosis in autologous AVF in hemodialysis patients and also to assess the outcome of metal stents at this distinctive anatomical site. All patients were subjected to Doppler examination, where the stenotic lesion and the AVF flow volume were assessed prior to intervention. The follow-up period reached up to 57 months in some patients. All patients were under surveillance and were assessed for patency and flow volume. The primary and secondary stenosis-free rates were calculated. Re-intervention during the follow-up period was recorded.ResultsThe technical success rate was 100%. Twenty-six patients had balloon angioplasty. Eighteen patients had primary and/or secondary stents inserted. The primary patency rate at 6 and 12 months for the balloon angioplasty group was 80% and 60% and for the stent group was 86% and 71%, respectively. The mean primary patency rate in balloon angioplasty patients was 12.9 months, while in the primary stented patients was 19.9 months. Twenty-six patients had secondary intervention. The average secondary patency rate for patients with balloon angioplasty was 25.5 months, while it was 33.6 months in the stented patients.ConclusionCephalic arch angioplasty and stenting is an effective intervention increasing the longevity of the AVF that is crucial for hemodialysis patients. The use of metal stents whether bare metal stents or covered stents is safe and adds significant increase in patency rates.

Asymptomatic Cerebral Emboli Following Carotid Artery Stenting: A Diffusion-Weighted MRI Study

BackgroundSilent cranial embolism due to carotid artery stenting has been demonstrated to cause dementia, cognitive decline, and even ischemic stroke. The purpose of this study was to compare the periprocedural asymptomatic cranial embolism rates of different stent designs used for extracranial carotid stenosis with diffusion-weighted magnetic resonance imaging.MethodsA total of 507 consecutive patients who underwent carotid artery stenting at our center from December 2010 to June 2020 (mean age, 66.4 ± 9.5) were analyzed retrospectively. The patients were divided into 3 groups as open-cell stent (334 patients), closed-cell stent (102 patients), and hybrid-cell stent (71 patients) groups. Diffusion-weighted magnetic resonance imaging was performed for the patients before and after carotid artery stenting and compared. The diffusion limitations of 3 stent groups on cranial diffusion-weighted magnetic resonance imaging were compared with one another.ResultsPeriprocedural asymptomatic same-side microembolism, which was the primary endpoint of our study, was detected in 58 (17.4%) patients in the open-cell stent group, 6 (5.9%) patients in the closed-cell group, and 8 (11.3%) patients in the hybrid cell group, and overall in 72 (14.2%) patients. On diffusion-weighted magnetic resonance imaging, periprocedural asymptomatic same-side cranial embolism was found to be statistically significantly higher in the open-cell group compared to the other two groups (P = .011).ConclusionsThe result of this study showed us that the rate of same-side cranial embolism detected on cranial diffusion-weighted magnetic resonance imaging after carotid artery stenting performed with open-cell stent was higher than those of the carotid artery stenting procedure performed with closed-cell and hybrid-cell stents.

Impact of diabetes on clinical outcomes after revascularization with the dual therapy CD34 antibody-covered sirolimus-eluting Combo stentand the sirolimus-eluting Orsiro stent.

ObjectivesTo compare the efficacy and safety of the dual therapy CD34 antibody‐covered sirolimus‐eluting Combo stent (DTS) and the sirolimus‐eluting Orsiro stent (SES) in patients with and without diabetes mellitus (DM) included in the Scandinavian Organization for Randomized Trials with Clinical Outcome (SORT OUT) X study.BackgroundThe incidence of target lesion failure (TLF) after treatment with modern drug‐eluting stents has been reported to be significantly higher in patients with DM when compared to patients without DM. Thus, whether the results from the SORT OUT X study apply to patients with and without DM remains unknown.MethodsIn total 3146 patients were randomized to stent implantation with DTS (n = 1578; DM: n = 279) or SES (n = 1568; DM: n = 271). The primary end point, TLF, was a composite of cardiac death, target‐lesion myocardial infarction (MI), or target lesion revascularization (TLR) within 1 year.ResultsAt 1 year, the rate of TLF was increased in the DTS group compared to the SES group, both among patients with DM (9.3% vs. 4.8%; risk difference: 4.5%; incidence rate ratio: 1.99, 95% confidence interval [CI]: 1.02–3.90) and without DM (5.7% vs. 3.5%; incidence rate ratio: 1.67, 95% CI: 1.15–2.42). The differences were mainly explained by higher rates of TLR.ConclusionCompared to the SES, the DTS was associated with an increased risk of TLF at 12 months in patients with and without DM. The differences were mainly explained by higher rates of TLR, whereas rates of cardiac death and target lesion MI did not differ significantly between the two stent groups in patients with or without DM.

Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study

Purpose Comparing the two different drainage methods of percutaneous nephrostomy (PCN) versus retrograde ureteral double – J (DJ) stent insertion in patients with obstructive pyelonephritis cases. Material and methods In this retrospective study, patients with obstructive pyelonephritis secondary to urolithiasis who underwent PCN or DJ insertion were included in the study. Patients were divided into two groups according to drainage method. After exclusion criteria, the study included 105 patients. The groups were compared for intraoperative outcomes, duration of fluoroscopy usage, the time needed for normalization of infection parameters (white blood cells (WBC), C – reactive protein (CRP), procalcitonin), and complications were observed. Results From 105 patients, 56 patients were in DJ stent group and 49 patients were in PCN group. According to intraoperative data, operative time and fluoroscopy duration were significantly shorter in the DJ ureteral stent group (P < .001). WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: −0.76–0.21, P = .268). There were no statistically significant differences identified for the duration for CRP, PCT and fever to return to normal range between the drainage methods. The complication rates was 51.8% for DJ stent group and, 30.6% in PCN group (P = .028). Conclusion Both methods are effective and safe in obstructive pyelonephritis. Despite the higher complication rate in DJ stent group, these complications were minor.

Very long-term follow-up of patients with coronary bifurcation lesions treated with bioresorbable scaffolds.

The data concerning the use of bioresorbable vascular scaffolds (BVS) in coronary bifurcation lesions are limited. The objective of the study was to evaluate the early and very long-term clinical outcomes of bifurcation stenting with ABSORB BVS. One hundred consecutive patients with coronary bifurcation lesions treated with BVS were included. A total of 124 BVS were implanted. Provisional side branch stenting was performed in 66 patients, distal main stenting in 14 patients, systematic T stenting in 2, and T with minimal protrusion (TAP) in 5 patients. Side branch ostial stenting was performed in additional 12 patients. The procedural success was achieved in 98% of patients. In long-term follow-up, the rate of cardiac death was 4.0%, target vessel myocardial infarction was 5.0%, and target vessel revascularization (TVR) was 11%. The cumulative incidence of definite/probable scaffold thrombosis (ST) was 2% at long-term follow-up. Comparison with the historical drug-eluting stents (DES) group revealed higher mortality and major adverse cardiac events rate in the ABSORB group. Stenting of coronary bifurcation lesions of low-to-moderate complexity with BVS was feasible with good acute performance and acceptable results. However, the risk of death and major adverse cardiovascular events was higher as compared with DES.

The clinical applicability of percutaneous splenic vein stent implantation for pancreatic portal hypertension

BackgroundPancreatic portal hypertension (PPH) is a type of extrahepatic portal hypertension. We compared the clinical efficacy of different treatment methods for PPH caused by splenic vein stenosis in chronic pancreatitis.MethodsThis article retrospectively analyzed the PPH cases that were caused by splenic vein stenosis after chronic pancreatitis. Patients were divided into three groups according to the different treatments: splenic vein stent implantation (stent group), splenectomy, and only medications (conservative group). The treatment effects from each group were compared.ResultsA total of 33 patients were retrospectively analyzed in this study (9, 12, and 12 patients in each group respectively). All the procedures were successful in the stent and splenectomy groups. During the follow-up, no patient had gastrointestinal bleeding recurrence in the stent and splenectomy groups. However, in the conservative group, the incidence of portal hypertensive gastropathy and upper gastrointestinal bleeding were 50% and 25%. In the stent group, all the varicose veins at the base of the stomach had shrunk by varying degrees, and the red color signs regressed. The stent patency rate was 100%. No major complication occurred. The average platelet count at 1, 3, 6-months postoperatively were all significantly higher than the preoperative value (P < 0.05). The average postoperative hospital stay duration was significantly shorter than that of the splenectomy group (3.1 ± 1.4 days vs. 16.1 ± 8.1 days; P < 0.05). In the splenectomy group, postoperative fever occurred in 4 patients. Postoperative infection occurred in 2 patients (one with abdominal cavity infection and the other with incision infection). Delayed abdominal bleeding occurred in one patient. Portal vein thrombosis occurred in 2 patients during follow up.ConclusionPercutaneous splenic vein stent implantation for PPH treatment reduces the risk of gastrointestinal bleeding with minimal invasive. It has a high safety and reliable efficacy and is worthy of further clinical promotion.

The effect of preoperative biliary stent on postoperative complications after the resection of pancreatic head tumour

Introduction. A preoperative biliary stent is often inserted because of obstructive jaundice due to pancreatic head tumour. However, it can also be the source of complications too. Aim and method. We retrospectively analyzed our operations which were performed between 01.10.2017 and 31.12.2019 for pancreatic tumour in association with stent related mortality and morbidity. The multiresistant bacteria and the spectrum of microorganism of intraoperative bile samples were investigated. Results. 82 patients were operated on with pancreatic tumour. There were 63 pancreatic head resections, and 19 palliative operations. 63 pancreatic head resections were analyzed. There were 36 open and 27 laparoscopic operations. Extended operation was needed in 12 cases (5 portal vein resections, 2 splenectomies, 1 right hepatolobectomy, 1 right hemicolectomy, 2 liver metastasectomies and 1 hepatic artery resection). The average age of 36 stented patients of which 24 were men and 12 women were 65 and 64 years respectively. The average age of 27 non-stented patients of which 14 were men and 13 were women, were 67.9 and 58 years respectively. The bile culture proved to be positive 30/36(83%) in the stented group and 13/27(48%) in the non-stented group (P= 0.005). The 3 most common bacteria were E coli, Enterococcus fecalis andKlebsiella pneumoniaein both groups followed by the yeast of Candida. 8 multiresistant bacteria were noticed in the stented group. 6 were ESBL producing (P= 0.033) and 2 vancomycine resistant (P= 0.5) bacteria. 3 patients of the stented group and 2 patients of the non-stented group were lost during the first 30 days. There were 4/0 wound infections, 6/2 haemorrhages, 2/2 pancreatic fistulas, and 2/3 abdominal abscesses in the stented vs. non stented groups. The average length of stay was 19.47 days in the stented and 14.62 days in the non-stented groups (P= 0.14). Conclusion. With regard to the fact that biliary stent changes the bacterial flora it is important to choose the proper antibiotic prophylaxis to reduce morbidity. On the basis of our own results and the literature an effective antibiotic therapy is suggested against enterococcus and ESBL producing bacteria. The prophylaxis against yeast in particularly in immunocompromised cases should also be considered. Regular antibiotic resistance check-up is essential.

Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension.

Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patients with Idiopathic Intracranial Hypertension (IIH). However, stenting carries risk of in-stent stenosis/thrombosis and cumulative bleeding risk from long-term dual antiplatelet (DAPT) use. Thus, we investigated the potential safety and efficacy of primary balloon angioplasty as an alternative to stenting in IIH. A prospectively maintained single-center registry of IIH patients undergoing endovascular procedures was queried. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012- 2021. Patients were dichotomized into primary balloon angioplasty (Group A) and primary stenting (Group S), comparing clinical outcomes using bivariate analyses. 62 patients were included with median age of 33 [IQR 26-37], 74% females. Group A (9/62) and Group S (53/62) had similar baseline characteristics. Papilledema improvement was higher in Group S at 6 weeks and 6 months (44 vs. 93, p = 0.002 and 44 vs. 92%, p = 0.004), with similar improvements across all symptoms. Group S had higher mean post-procedure venous pressure gradient change (8 vs. 3 mmHg, p = 0.02) and a lower CSF opening pressure at 6 months (23 vs. 36 cmH2O, p < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A. Primary VSS balloon angioplasty provides a marginal and short-lived improvement of IIH symptoms compared to stenting. These findings suggest a cautious and limited role for short-term rescue angioplasty in poor shunting and stenting candidates with refractory IIH.

Distal Biliary Stent Migration in Patients with Irretrievable Bile Duct Stones: Long-Term Comparison Between Straight and Double-Pigtail Stents.

Prolonged biliary stenting may be considered in high-risk patients with irretrievable bile duct stones (IBDS). Distal stent migration (DSM) is a known complication, although data beyond the recommended interval of temporary stenting (3-6months) are lacking. We compared the long-term incidence of DSM between straight and double-pigtail stents in patients with IBDS. Consecutive patients with IBDS undergoing plastic biliary stenting (1/2009-12/2019) were retrospectively reviewed. DSM was confirmed on follow-up examination when the stent was no longer present at the papillary orifice nor fluoroscopically visible in the bile duct. Kaplan-Meier and Cox regression analyses were used to determine estimates and predictors of DSM. Overall, 618 biliary stenting procedures (410 patients) were included: 289 with a straight stent (group A) and 329 with a double-pigtail (group B). By Kaplan-Meier analysis, the DSM rates were 8.4 and 14.6% at 6months, 21.4 and 27.7% at 12months, 27 and 43.5% at 18months, and 37.2 and 60.4% at 24months, for groups A and B, respectively (p = 0.004). Double-pigtail stents were at higher risk for DSM (HR = 7.38, p = 0.04), whereas an inverse correlation was noted with age (HR = 0.97, p = 0.0001). Considering only temporary stenting procedures (≤ 6months; n = 297), the probability of DSM was not significantly different between the two groups (p = 0.07). In a setting of prolonged stenting for IBDS, the probability of DSM appears to be higher when a double-pigtail stent is used and in younger patients. A relative anti-migratory advantage of double-pigtail over straight stents appears negligible in this study.