Stenting Procedure Research Articles

Choledochal stenting for treatment of extrahepatic biliary obstruction in cats

BackgroundLimited information currently exists regarding the clinical progression and outcomes of cats that undergo choledochal stenting as a treatment for extrahepatic biliary obstruction (EHBO).Hypothesis/ObjectivesDescribe clinical characteristics, indications for choledochal stent placement, procedure, and outcomes in a cohort of cats undergoing choledochal stenting and evaluate risk factors associated with survival as well as recurrence of EHBO in affected cats.AnimalsTwenty‐three client‐owned cats undergoing choledochal stent placement.MethodsRetrospective study. Medical records from 6 academic institutions were reviewed, and data were extracted and analyzed statistically.ResultsMedian age of cats was 10.1 years (range, 2‐16), and all cats had at least 2 clinical signs. Most common clinical signs were vomiting in 20/22 (90.9%), inappetence in 19/22 (86.4%), and lethargy in 19/23 (82.6%). Procedural complications were uncommon and rarely related to the stenting procedure. Clinical signs improved postoperatively in 15/20 (75.0%) cats and serum total bilirubin concentration decreased postoperatively in 13/19 (68.4%) cats. Eighteen (78.3%) cats survived to discharge. Recurrence of EHBO was documented in 7/18 (38.9%) cats that survived to discharge. Cholelithiasis was associated with recurrence of EHBO. Median survival time for cats that survived to discharge was 931 days (range, 19‐3034). Absence of peritoneal effusion was associated with survival to discharge.Conclusions and Clinical ImportanceCholedochal stenting was an effective treatment modality in cats with EHBO with few procedural complications and potential for prolonged survival, but substantial risk for recurrence of EHBO was identified.

Inferior Mesenteric Artery Revascularization for Salvage of Mesenteric Ischemia

Often sacrificed in favor of the celiac and superior mesenteric arteries, the inferior mesenteric artery (IMA) can provide crucial inflow to the abdominopelvic viscera and spinal cord, especially in the presence of concomitant celiac or superior mesenteric artery (SMA) disease. We sought to elucidate the presentation and course of patients who had undergone IMA-specific revascularization. A retrospective analysis was performed of IMA revascularization procedures performed at an urban quaternary center from 2010 to 2020. Patients were included if concomitant renal artery, celiac artery, or SMA revascularization had been performed. Angioplasty, stenting, and open procedures were included. The patient characteristics, indications, and perioperative and long-term outcomes were analyzed. From 2010 to 2020, 10 patients had met the inclusion and exclusion criteria. Of the 10 patients, 9 were women (90%). Their median age was 71 years (range 47-88), and 80% had a history of smoking. Six patients had undergone elective IMA revascularization for chronic disease. Of the remaining four patients with acute symptoms, two had presented with an acute-on-chronic exacerbation of symptoms. All four patients with acute symptoms had presented as hospital transfers and had undergone intervention within 12 hours of transfer. However, two patients had had symptoms lasting >8 days before transfer. The 10 patients had undergone 16 procedures. Of the 10 patients, 8 had undergone IMA stenting, 1 had undergone percutaneous transluminal angioplasty alone, and 1 had undergone open IMA and aortic endarterectomy with patch angioplasty. Four patients had received concomitant celiac artery or SMA revascularization, with a large meandering mesenteric artery determining the choice to revascularize the IMA. In the six patients without celiac artery or SMA revascularization, three patients had had known SMA and celiac artery occlusions, and one had had a known occluded celiomesenteric trunk. In the four patients with acute symptoms, three small bowel resections and two laparotomies without bowel resection were performed. Six patients had required intensive care unit admission. Seven patients had had >1 year patency or had been lost to follow-up without known failure of IMA revascularization. Two patients died within 30 days with patent IMAs after withdrawal of care because of necrotic small bowel requiring resection. Two patients had undergone aortovisceral bypass after IMA occlusion—one patient on the day after IMA stenting and one patient at 17 months after IMA stenting. Revascularization of the IMA can serve as a reliable salvage option for patients with chronic or acute-on-chronic mesenteric ischemia, and should be considered for patients with high-grade stenosis or occlusion of the celiac artery and SMA.

PD35-10 ALLIUM URETERAL STENT FOR THE TREATMENT OF URETERAL STRICTURE AND FISTULA AFTER ABDOMINAL SURGERY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-10 ALLIUM URETERAL STENT FOR THE TREATMENT OF URETERAL STRICTURE AND FISTULA AFTER ABDOMINAL SURGERY Massimiliano Di Marco, Antonio Luigi Pastore, Yazan Al Salhi, Andrea Fuschi, Raniero Parascani, Matteo Sampalmieri, Alessia Fraioli, Cristina Avitabile, Saleh Abuorouq, Fabio Maria Valenzi, and Antonio Carbone Massimiliano Di MarcoMassimiliano Di Marco More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al SalhiYazan Al Salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Raniero ParascaniRaniero Parascani More articles by this author , Matteo SampalmieriMatteo Sampalmieri More articles by this author , Alessia FraioliAlessia Fraioli More articles by this author , Cristina AvitabileCristina Avitabile More articles by this author , Saleh AbuorouqSaleh Abuorouq More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral injuries are well-known complications of abdominal surgery. The aim of the study is to evaluate the safety and feasibility of Allium ureteral prosthesis in patients with distal and upper ureteral injuries after abdominal surgery. METHODS: The Allium URS is a new-developed ureteral stent made of nickel-titanium (Nitinol) meant to automatically expand when inserted in a stricture in order to restore and preserve a larger caliber. Furthermore, the stent is coated with a biochemical co-polymer which prevents tissue ingrowth and incrustations. For this study 71 consecutive patients were enrolled. All of them had iatrogenic ureteral injury in the upper, mid and distal ureter after undergoing abdominal surgery. From these 71 patients, 21 underwent gynecologic surgery. The other 50 patients underwent abdominal surgery due to: ureteral stenosis caused by retroperitoneal lymph node metastasis (3pts 4,22%), uretero-cysto-anastomosis (4pts 5,63%), pyeloureteral junction stenosis (5pts 7,04%), colectomy (6pts 8,45%), ureteral obstruction due to bladder cancer (6pts 8,45%), bladder cuff excision (8pts 11,27%), ureteral stones (18 pts 25,36%). All of them were selected for positioning the allium prosthesis between January 2017 and December 2020. Ureteral leakage and stricture were diagnosed using intravenous pyelography. During the procedure the stent was inserted anterogradely or retrogradely with intraoperative x-ray guidance after dilation of the stricture. RESULTS: No major complications occurred during the stenting procedure. During the follow up (mean 36 months) 6 obstructions (8,45%) have been reported after 8 months caused by ureteral stones all successfully treated endoscopically with holmium laser. In addition, stent migration occurred in 10 patients (14,08%) within 3 months after its insertion, of which 5 were easily replaced and the other 5 were removed with the subsequent need of a robotic re-anastomosis. Among the 5 patients affected by pyeloureteral junction stenosis, 4 needed laparoscopic pyeloplasty due to stent migration. In 20 patients the stents were removed as planned after one year of indwelling time and remained asymptomatic in a follow-up period of up to 24 months. The removal of the left 31 stents is planned during the next 12 months. CONCLUSIONS: Due to its unique structure, the Allium stent resulted superior to the standard pigtail stents in the treatment of ureteral strictures. Stent migration was seen in 19.7% (14pts) of the patients, and mainly reported in patients with stricture of the upper ureter. The results of our study show that the use of Allium URS for the treatment of ureteral strictures is feasible, safe and effective. The relative ease of its insertion could encourage its use in a wide range of other indications. However, evaluating the results we do not recommend the use of Allium stent to treat pyeloureteral junction strictures because of its high risk of migration. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e593-e593 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Massimiliano Di Marco More articles by this author Antonio Luigi Pastore More articles by this author Yazan Al Salhi More articles by this author Andrea Fuschi More articles by this author Raniero Parascani More articles by this author Matteo Sampalmieri More articles by this author Alessia Fraioli More articles by this author Cristina Avitabile More articles by this author Saleh Abuorouq More articles by this author Fabio Maria Valenzi More articles by this author Antonio Carbone More articles by this author Expand All Advertisement Loading ...

Single Osteopathic Manipulative Treatment Session Eliminates Percutaneous Coronary Intervention-Induced Upper Thoracic Pain in Elderly Male

Abstract Restoration of blood flow is critical to a blocked coronary blood vessel. With respect to the heart, two main procedures, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) revascularize the area to prevent future blockages. Post-procedurally, bed rest iatrogenically produces non-life-threatening back pain.1,2 No exact guideline for the duration of post-procedural bed rest exists but recommendations range from 2 to 24 hours.1 However, research has shown that bed rest beyond 4 hours significantly increased the presence of post-procedural back pain.1,2 Osteopathic manipulative treatment (OMT) is the term ascribed to a number of categories of manual techniques used by osteopathic physicians to treat somatic dysfunctions, to complement conventional management in patient care. In this case report, we discuss a patient with post-procedural upper thoracic pain that resolves with OMT, demonstrating that OMT may play a useful post-PCI role in the care of patients who undergo stent procedures.

Transcervical Versus Transfemoral Approach in Carotid Stenting Real World Experience in a Community Hospital

Peri-procedural embolic events are the Achilles' heel of carotid stenting. To overcome this complication, transcervical access to the carotid artery was introduced. In this study we describe our "our life" experience with the transcervical approach in a community hospital. All carotid stent procedures between January 2010 and December 2020 were included in this retrospective analysis. The transcervical approach was compared to the transfemoral approach. In both procedures open-cell, closed-cell design and hybrid stents were used. In-hospital stroke was the primary outcome measure. A total of 340 procedures were performed, in 184 patients the transfemoral approach was used and in 156 patients the transcervical approach was used. In 12 patients (3.5%) an in-hospital stroke was diagnosed, 4 in the transfemoral group (2.2%) and 8 in the transcervical group (5.1%) (P=0.14). In the multivariate analyses a symptomatic lesion was associated with in-hospital stroke. Neither type of access nor cell design was associated with increased risk of in-hospital stroke. In contrast to previous studies, we could not confirm the advantages of the transcervical approach. However, conclusions should be carefully drawn, since this study is retrospective and was performed with multiple surgeon and different kind of stents.

Unilateral versus bilateral Y-type stent-in-stent metal stent insertions in inoperable malignant hilar biliary strictures: A multicenter retrospective study

BackgroundTo date, there is controversy regarding unilateral versus bilateral stent placement in patients with malignant hilar biliary strictures (MHBSs). The aim of this study was to compare the clinical outcomes and complications of unilateral and bilateral (stent-in-stent method) stent placements for these patients. MethodsWe conducted a multicenter retrospective analysis of patients with inoperable MHBS who underwent endoscopic self-expandable metal stent (SEMS) placement from January 2009 to December 2019. Two groups classified according to the stent procedure method were compared for demographic, procedural, and postprocedure factors. Survival analysis for patency loss and overall survival was also conducted. ResultsA total of 236 subjects were included. A superior technical success rate was found in the unilateral stent group (98.8% vs. 82.5%, P < 0.001), whereas the clinical success rate was higher in the bilateral group (85.7% vs. 70.5%, P = 0.028). There was no significant difference with respect to complications or patency loss, and the bilateral group had better overall survival (P < 0.01). In the Cox proportional hazard model, MHBSs from lymph node compression were associated with a higher risk of death (HR = 9.803, P = 0.003). In contrast, bilateral SEMS insertion showed reduced postprocedural mortality (HR = 0.316, P = 0.001). ConclusionsY-type stent-in-stent bilateral SEMSs are technically difficult but demonstrated more favorable overall survival for palliative bile drainage of inoperable MHBS patients compared to unilateral insertions.

10-Year Experience with Reinforced Ureteral Stents for Malignant Ureteral Obstruction.

IntroductionMalignant ureteral obstruction (MUO) hinders the management of malignant diseases. Indwelling stent is a common method to release renal obstruction, but stent failure with obstruction is frequent. The studies conclude that stent obstruction divides survival by 2 or even 4. We carried out the present study in order to evaluate drainage efficiency and overall survival by using stents with distinctive degrees of stiffness.Materials and MethodsWe performed an analysis of 156 patients with MUO drainage at a single institution from June 2009 to June 2019.ResultsOf the 156 patients, 128 (82.1%) died with a mean survival time of 15.3 ± 14.4 months after the first ureteral stent procedure (USP). In order to study stent failure and overall survival, the patients were divided into 3 groups. Group 1 with patients died soon after only one USP (n=37). Group 2 with patients had more than one USP and no obstruction (n=41). Patients in Group 3 had more than one USP and at least one stent obstruction (n=62). During the study period, 556 USPs were analysed separately. The stent failure with obstruction occurred in 23.0% (128/556) of USP at a mean of 4.4 ± 3.6 months. In case of stent failure, a progressive choice of stents was shaped to overcome each failure by focusing on the criterion of increasingly stiff stents. Patients in Group 1 died soon at mean of 4.9 ± 4.8 months. The mean survival time of patients in Groups 2 and 3 were, respectively, 19.4 ± 11.2 and 21.5 ± 16.3 months (P = 0.19).ConclusionMUO is a serious disease but this study is the first to prevent survival rate from falling by choosing the stent stiffness suitable for the patient. The active detection of stent failure has been shown to be essential for preserving survival.

Preliminary Experience With a Novel Metallic Segmented Transcordal Stent Modified With Three-Dimensional Printing for Inoperable Malignant Laryngotracheal Stenosis.

BackgroundThis study aims to assess the feasibility of a novel metallic segmented transcordal stent modified with three-dimensional (3D) printing for treating inoperable malignant laryngotracheal stenosis and the tolerability of the stent.MethodsThis was a retrospective study. The stents were individually customized with the aid of 3D printing model based on the anatomic features of each patient’s airway. The stent was composed of two separate segments that corresponded to the larynx and the upper trachea. The stents were barrel-shaped at the proximal end to prevent migration. The proximal end of the stent was located slightly above the vocal cord. The technical and clinical success of stenting procedure, patient tolerability, and stent-related complications of patients were evaluated.ResultsTen patients with dyspnea caused by malignant laryngotracheal stenosis underwent implantation of such stents. Technical and clinical success of the stenting procedure were achieved in all patients. For all patients, basic communication in life could be maintained by speaking softly. During follow-up, one patient showed intolerance to the stent, and the stent was retrieved 2 weeks after stenting. Stent migration was found in one patient, and the position of the stent was readjusted. Granulation tissue proliferation was found in two patients and was treated with cryotherapy by bronchoscopy. There were no deaths associated with stenting.ConclusionsThe individually customized metallic segmented transcordal stent is feasible and tolerable for patients with inoperable malignant laryngotracheal stenosis. The implantation of this stent may serve as a novel alternative treatment for patients who are not suitable for surgery or tracheotomy.

Efficacy of dural venous sinus stenting in treating idiopathic intracranial hypertension with acute vision loss.

Dural venous sinus stenting (VSS) is an effective, durable treatment for patients with idiopathic intracranial hypertension (IIH) due to underlying venous sinus stenosis. However, the use of venous sinus stenting to treat IIH with acute vision loss has rarely been described. A retrospective chart analysis identified patients who received VSS for fulminant IIH, defined as acute (< 8 weeks) visual field loss to within the central 5° and/or a decrease in visual acuity to less than or equal to 20/50 in either eye in the presence of papilledema. Ten patients were identified with average patient age of 31.0 years, and all except one were female. Mean body mass index was 41.2 kg/m2. All patients presented with vision loss and some with headache and tinnitus. The average trans-stenotic gradient pre-stenting was 28.7 mmHg (range 9-62 mmHg). All patients had diminished or resolved venous gradients immediately following the procedure. At mean follow-up of 60.5 weeks, 100% had improvements in papilledema, 80.0% had subjective vision improvement, 55.6% had headache improvement and 87.5% had tinnitus improvement. 90.0% had stable or improved visual acuity in both eyes with a mean post-stenting Snellen acuity of 20/30 and an average gain of 3 lines Snellen acuity post-stenting (95% confidence intervals 0.1185-0.4286, p = 0.0018). Two patients (20.0%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure. This series suggests that VSS is feasible in patients presenting with IIH and acute vision loss with a fairly low complication rate and satisfactory clinical outcomes.

Superior Ophthalmic Vein Flow Patterns as a Marker of Venous Sinus Stenosis and Hypertension in Idiopathic Intracranial Hypertension: A Case of Emergent Transverse Sinus Stenting as Treatment of Fulminant Idiopathic Intracranial Hypertension

Fulminant idiopathic intracranial hypertension (IIH) can cause rapid vision loss. Transverse sinus stenosis is a finding commonly associated with IIH, and transverse sinus stenting has been used to rapidly reduce intracranial pressure and improve visual symptoms. Our objective was to describe a case of immediate alteration in reversed superior ophthalmic vein (SOV) flow in a fulminant IIH patient who underwent venous sinus stenting. All charts, imaging, and notes spanning from the initial presentation to the post-intervention follow-up were reviewed and summarized for inclusion. A 24-year-old woman presented with several weeks of severe headaches and progressive vision loss. She was found to have severe papilledema and the opening pressure on lumbar puncture (LP) was 70 mm Hg. Computed tomography (CT) and magnetic resonance imaging demonstrated findings consistent with elevated intracranial pressure, and CT venography revealed stenosis of the right transverse sinus. She underwent an uncomplicated diagnostic cerebral angiogram, right venous sinus manometry, and right transverse to sigmoid sinus stenting procedure. Prior to deployment of the stent, a trans-stenotic pressure gradient of 12 mm Hg was observed within the right transverse-sigmoid junction, and flow through the bilateral SOVs was retrograde. Following stent placement, the pressure gradient normalized, and SOV flow was bidirectional. She subjectively reported improved vision, and there was improving papilledema. Repeat LP yielded an opening pressure of 21.6 mm Hg. This case demonstrates reversed SOV flow should be considered an indicator of severe venous sinus stenosis, and restoration to normal or near normal state following stenting for IIH is likely indicative of procedural success.

Usage and Efficiency of Drug Eluting Stents in Vertebral Ostial Stenosis

Objectives: Extracranial vertebral artery atherosclerosis is an insidious and hazardous disease. With technological development and accumulating experience, antiproliferative drug eluting stents became a viable option for reducing the instent restenosis of the origin of the vertebral artery. Here, we evaluated the technical success rates, efficiency, clinical and angiographic results of the usage of drug eluting stents in vertebral ostial stenosis. Patients and Methods: 28 stents were implanted in 24 patients with vertebral artery origin stenosis. Digital substraction angiographic or CT angiographic follow-up was made at 6, 12 and 24 months. Results: Paclitaxel eluting stents were placed with high technical success for the treatment of vertebral artery origin stenosis. There was no procedure related mortality. However one patient scummed to death due to aspiration pneumonia for a basiller artery stroke with successful stenting and thrombolysis procedure. There was only one limited subclavian artery dissection in a patient (%4.1) during the procedure which was managed conservatively. One stent (%3.7) had instent restenosis on early period (6th month) and one patient (%4.1) had recurrent neurological symptoms on follow-up (9th month). In a median follow-up of 13 months (6-25 months) none of the patients had late stent thrombosis. Conclusion: Vertebral artery ostial stenosis can be treated effectively and safely with high technical success and low instent restenosis rates with paclitaxel drug eluting stents. With low restenosis rates the antiproliferative drug eluting stents are an option for reducing the vertebral artery instent restenosis.

Treatment of aerodigestive fistulas with a novel covered metallic Y-shaped segmented airway stent customized with the assistance of 3D printing.

BackgroundThe management of aerodigestive fistula remains challenging. An airway stent that matches well with the individual geometry of the airway is needed for the treatment of the aerodigestive fistula. This study aimed to evaluate the feasibility of a novel covered metallic segmented Y-shaped airway stent customized with the assistance of 3D printing in aerodigestive fistulas involving the carina and distal bronchi and to compare the flexibility of the novel stent with the conventional wholly knitted stent.MethodsIn the flexibility study, we measured the longitudinal bending force and spring-back force of the segmented stent and wholly knitted stent. Patient-specific stents that were individually customized with the assistance of 3D printing technology were implanted in 26 patients with aerodigestive fistulas. The technical success, clinical success, Karnofsky performance status (KPS), and stent-related complications were recorded.ResultsThe bending force and spring-back force of the segmented stent were significantly lower than those of the wholly knitted stent. Stent deployment was technically successful in all patients. Clinical success was obtained in 21 patients. The KPS of patients after the stenting procedure improved significantly compared with that before stenting (P<0.001). During follow-up, granulation tissue proliferation, sputum retention, stent migration, and intolerance of the stent were found in 2, 5, 1, and 1 patient, respectively.ConclusionsThe segmented metallic Y-shaped airway stent had greater flexibility than the wholly knitted stent in an ex vivo setting. Implantation of the segmented stent individually customized with the aid of 3D printing is feasible in treating aerodigestive fistulas involving the carina and bronchi distal to the carina.

Predictive Factors for Requirement of Ureteral J Stenting in Ureteroscopic Treatment of Distal Ureteral Stones.

We aimed to investigate the factors predicting the need for ureteral J stent placement in the treatment of distal ureteral stones by ureteroscopy (URS). Between January 2007 and June 2018, 550 consecutive patients who underwent URS with the diagnosis of distal ureteral stone disease were evaluated in a single center. The patients were divided into two groups as; group 1 who received a ureteral J stent, and group 2 without ureteral J stent. The two groups were compared in terms of possible preoperative, perioperative and postoperative risk factors. History of systemic disease, stone disease and extracorporeal shock wave lithotripsy (SWL) were significantly higher in group 1 (P<0.001, P=0.009, P=0.016). The operation time was longer in group 1 (P<0.001). The rate of impacted stones was higher in group 1 (61.7% vs 15.6%; P<0.001). In multivariate analysis, co-morbidities, previous SWL history, presence of impacted ureteral stone and prolongation of the operation time were found to be statistically significant in predicting ureteral J stent placement. In the treatment of distal ureteral stones by URS, not only perioperative complications, prolongation of the operation time, and the presence of residual stones but also preoperative factors, such as systemic disease, and impacted ureteral stones should be considered as predictive factors in assessing the need for a ureteral J stent and to avoid unnecessary stent procedures.

Stent interventions guided by three-dimensional rotational angiography to treat total cavopulmonary connection stenosis

BackgroundStenosis of the total cavopulmonary connection (TCPC), in particular the pulmonary arteries, is common in children with single ventricle physiology. Stenting is an efficient interventional strategy to treat stenosis and optimize TCPC hemodynamics. MethodsA retrospective single center study was performed to investigate the prevalence, causes and outcome of TCPC stenosis in children treated with stent implantation guided by three-dimensional rotational angiography (3DRA). ResultsFrom September 2011 to February 15th 2021 48 patients received 73 stents at 67 locations in 59 3DRA stent procedures. Median age and weight were 3.6 years (0.0–17.2) and 14.1 ​kg (3.4–70.0), respectively. Left pulmonary artery (LPA) stenosis accounted for 75% of the stenosis and is often caused by retroaortic compression. Adverse events occurred in 6 catheterizations (10.2%). Twenty-one patients (43.8%) underwent 27 reinterventions including planned serial redilation (N ​= ​17), extra stent placement (N ​= ​6), surgery (N ​= ​2), unplanned balloon dilation (N ​= ​1) and stent placement (N ​= ​1) for restenosis by intima proliferation. ConclusionTCPC stenoses, especially of the LPA, are common in children with single ventricle physiology and external compression is one of the main causes. 3DRA safely guides stent interventions as intraprocedural knowledge of possible interactions with surrounding structures are evaluated. Besides it is effective in both short and long term and can be performed in small children. Restenosis by intima proliferation is rare, though repeated redilations are necessary to match stent diameter with patient size.

Non-protected carotid artery stenting for symptomatic carotid stenosis in low resource settings

BackgroundThe use of a distal cerebral protection device during extracranial carotid artery stenting is still a matter of debate. The aim of this work was to evaluate the safety of performing carotid artery stenting procedure without the use of cerebral protection device in patients with symptomatic carotid stenosis. A retrospective study was performed during the period from September 2015 till March 2020 including 91 patients with symptomatic carotid artery stenosis. All patients were treated with a single stent type (Wall stent® - Boston scientific) without the use of cerebral protection device. Pre- and post-procedural clinical assessment with the national institute of health stroke scale (NIHSS). Post procedure brain diffusion-weighted magnetic resonance imaging (DW-MRI) if clinically indicated within 24 h was used to determine periprocedural cerebral embolization.ResultsA low complication rate was found as only one case (1%) showed mild deterioration in NIHSS and new acute cerebral emboli were detected with brain DW-MRI.ConclusionCarotid artery stenting can be performed safely without the use of cerebral protection device.

Validation of the computational model of a coronary stent: a fundamental step towards in silico trials

The proof of the reliability of a numerical model is becoming of paramount importance in the era of in silico clinical trials. When dealing with a coronary stenting procedure, the virtual scenario should be able to replicate the real device, passing through the different stages of the procedure, which has to maintain the atherosclerotic vessel opened.Nevertheless, most of the published studies adopted commercially resembling geometries and generic material parameters, without a specific validation of the employed numerical models.In this work, a workflow for the generation and validation of the computational model of a coronary stent was proposed. Possible sources of variability in the results, such as the inter-batches variability in the material properties and the choice of proper simulation strategies, were accounted for and discussed. Then, a group of in vitro tests, representative of the device intended use was used as a comparator to validate the model.The free expansion simulation, which is the most used simulation in the literature, was shown to be only partially useful for stent model validation purposes. On the other hand, the choice of proper additional experiments, as the suggested uniaxial tensile tests on the stent and deployment tests into a deformable tube, could provide further suitable information to prove the efficacy of the numerical approach.

Endovascular Dural Venous Sinus Stenting for the Treatment of Papilledema in Idiopathic Intracranial Hypertension

Abstract Introduction: Recently a subset of patients with Benign Intracranial hypertension has been identified that have cerebral dural venous stenosis. Recent studies have demonstrated that venous sinus stenting can result in normalization of these pressures and resultant resolution of ophthalmologic findings. Methods: Twenty-six patients were referred to a single institution for optic nerve swelling due to Benign Intracranial hypertension and found to have cerebral dural venous sinus stenosis. These patients subsequently underwent cerebral venous sinus stenting. Ophthalmic manifestations were evaluated pre and post procedure as well as intravascular pressure measurements and pressure gradients before and after the stenting procedure. The pre and postoperative ophthalmologic findings were tabulated as well as the pre and post procedure pressure measurements before and after stenting. Results: The average preprocedural pressure gradient measured 13.8 mmHg and was reduced to 1.3 mmHg after the stenting procedure. 25 of 26 patients had improvement in their papilledema after the stenting procedure. No complications occurred during or after the procedure. Conclusion: Endovascular Dural Venous sinus stenting is a safe and effective treatment modality for the ophthalmic manifestations of Benign Intracranial Hypertension in those patients found to have cerebral venous sinus stenosis.

Lacrimal stenting versus three-snip punctoplasty for treatment of punctal stenosis or occlusion: An open-label, randomized clinical trial

Background: To compare the short-term anatomical and functional outcomes of, as well as patient satisfaction with, lacrimal stenting and three-snip punctoplasty for the treatment of punctal stenosis or occlusion.&#x0D; Methods: In this open-label, randomized clinical trial, we included 50 eyes of 30 patients diagnosed with punctal stenosis or occlusion. They were randomly allocated to two groups of 25 eyes each, using central telephone randomization. Group A underwent a lacrimal stenting procedure and was subdivided into two subgroups: Group A1 (13 eyes) received polyvinylpyrrolidone-coated perforated punctal plugs, and Group A2 (12 eyes) received closed intubation using a bicanalicular silicon tube. Group B included 25 eyes that underwent three-snip punctoplasty. All eyes were examined after 1 day, 1 week, 1 month, 3 months, and 6 months. Postoperative anatomical success assessing the punctum size, functional success using the fluorescein disappearance test, and patient satisfaction based on epiphora scoring were recorded.&#x0D; Results: Both study groups were comparable in terms of sex and age distribution. Compared to Group B, Group A had a significantly larger punctum size at one, three, and 6-month postoperatively (P = 0.009, 0.01, and 0.02, respectively). The difference in FDT results was significant between the two groups at all follow-up visits (P = 0.008, 0.0001, 0.003, and 0.002, at postoperative one week, one-months, three-month, and six-month, respectively). Likewise, patient satisfaction was significantly different between both groups at all follow-up visits (P = 0.007, 0.001, 0.005, and 0.002, at postoperative one week, one-months, three-month, and six-month, respectively).&#x0D; Conclusions: Lacrimal stenting is an effective method for the treatment of punctal stenosis or occlusion. Overall, the FDT results and patient satisfaction outcomes were significantly better.&#x0D; Keywords: punctal occlusion, punctal stenosis, epiphora, lacrimal stenting, closed intubation, bicanalicular silicon tube, perforated punctal plugs, three-snip punctoplasty, 3-snip punctoplasty

Mechanical performances of balloon post-dilation for improving stent expansion in calcified coronary artery: Computational and experimental investigations

Stent deployment in a calcified coronary artery is often associated with suboptimal outcomes such as stent underexpansion and malapposition. Post-dilation after stent deployment is commonly used for optimal stent implantation. There is no guideline for choosing the post-dilation balloon diameter and inflation pressure. In this work, ex-vivo/in-silico experiments were performed to investigate the efficacy of post-dilation balloon diameter and inflation pressure in improving the stent expansion in a calcified lesion. Post-dilations with three balloon diameters (3 mm, 3.5 mm, and 4 mm) were performed. For each balloon diameter, three inflation pressures (10 atm, 20 atm, and 30 atm) were sequentially applied. In ex-vivo experiments, optical coherence tomography images were acquired during the stenting procedure, i.e., pre- and post-deployment of 3 mm diameter stent, as well as after each post-dilation. The results from in-silico experiments were compared with ex-vivo experiments in terms of lumen area. In addition, stretch ratio analysis was developed to predict the stent-induced lumen area, along with the strain analysis and the in-silico experiments. Results have shown that target lumen area could be achieved with an oversized nominal balloon diameter of +0.5 mm (i.e., 0.5 mm greater than reference lumen diameter) at an inflation pressure of 20 atm. After each post-dilation, fibrotic tissue demonstrated a larger strain, contributing to improved lumen gain. However, minimal changes were observed in calcification. Moreover, a strong correlation (R2 = 0.95) between the stretch ratio of fibrotic tissue and lumen area after each post-dilation was observed. This indicated that the morphology of the fibrotic tissue could be a potential marker to predict the lumen gain. The detailed mechanistic quantifications of a single lesion cannot be generalized to all clinical cases. However, this work could be used to provide a fundamental understanding of the post-dilations, to develop experimental protocols for producing generalized guidelines, and to exploit their potential for optimal pre- and post-stent strategies.

A micro-costing analysis of outpatient flexible cystoscopy: implications for adoption of single-use flexible cystoscopes.

To evaluate the total cost of outpatient flexible cystoscopy associated with reusable device purchase, maintenance, and reprocessing, and to assess potential cost benefits of single-use flexible cystoscopes. Cost data regarding the purchasing, maintaining, and reprocessing of reusable flexible cystoscopes were collected using a micro-costing approach at a high-volume outpatient urology clinic. We estimated the costs to facilities with a range of annual procedure volumes (1000-3000) performed with a fleet of cystoscopes ranging from 10 to 25. We also compared the total cost per double-J ureteral stent removal procedure performed using single-use flexible cystoscopes versus reusable devices. The cost associated with reusable flexible cystoscopes ranged from $105 to $224 per procedure depending on the annual procedure volume and cystoscopes available. As a practice became more efficient by increasing the ratio of procedures performed to cystoscopes in the fleet, the proportion of the total cost due to cystoscope reprocessing increased from 22 to 46%. For ureteral stent removal procedures, the total cost per procedure using reusable cystoscopes (range $165-$1469) was higher than that using single-use devices ($244-$420), unless the annual procedure volume was sufficiently high relative to the number of reusable cystoscopes in the fleet (≥ 350 for a practice with ten reusable cystoscopes, ≥ 700 for one with 20 devices). The cost of reprocessing reusable cystoscopes represents a large fraction of the total cost per procedure, especially for high-volume facilities. It may be economical to adopt single-use cystoscopes specifically for stent removal procedures, especially for lower-volume facilities.