A novel animal model of gastrointestinal obstruction for the development of stent

Background

The need for newer gastrointestinal (GI) stents has been continuously raised. Newly developed stents are generally tested for physical properties in vitro and directly introduced to clinical practice because there is no reliable animal model of GI obstruction. The aim of this study was to establish an animal model both that can represent obstruction of the GI tract and be used to develop new stents.

Material and methods

Surgical obstruction of the descending colon by wrapping with a nonabsorbable synthetic mesh and rubber bands was made in 17 healthy mongrel dogs. Four days later, a covered self-expanding metallic stent was placed for the obstructed segment in each dog under fluoroscopic guidance. Patency and migration of the inserted stents were evaluated clinically on a daily basis and fluoroscopically on a weekly basis. After sacrifice of the dogs, the degree and extent of residual colonic obstruction were assessed fluoroscopically. The specimen of the colonic obstructed segment was examined microscopically.

Results

In all 17 mongrel dogs, segmental obstruction in the descending colon was successfully created and confirmed with fluoroscopic examination using a contrast medium. The percentage of luminal narrowing ranged from 99%–100%. Stent placement was technically successful in all 17 dogs. During the follow-up period, stent migration occurred in 12 dogs and indwelling time of a stent ranged from 0–95 d (mean 29.2 ± 38.8 d). On postmortem pathologic examination, it was found that fibrosis had newly formed outside the colonic longitudinal muscle layer in all dogs.

Conclusions

Our canine colonic obstruction model is the first animal model that can be feasible for developing a new design of stent and provide in vivo data on complications, particularly stent migration.     

Retrievable stent thrombectomy in the treatment of acute ischemic stroke: Analysis of a revolutionizing treatment technique

Acute ischemic stroke resulting from intracranial vessel occlusion is associated with high morbidity and mortality. The mainstays of therapy are fibrinolytics and mechanical thrombectomy in properly selected patients. A new Food and Drug Administration-approved technology to perform thrombectomy, retrievable stenting, may provide superior revascularization rates and improved patient outcomes. We analyzed the cumulative human experience reported for the Trevo Pro Retrieval System (Stryker, Kalamazoo, MI, USA) and the Solitaire FR Revascularization Device (ev3, Irvine, CA, USA) as the definitive treatment for acute ischemic stroke. A literature search was undertaken to identify studies using the retrievable stents published up to September 2012. Nineteen studies identified a total of 576 patients treated with either the Trevo (n = 221) or Solitaire (n = 355) devices. Pooled data analysis identified median baseline National Institutes of Health Stroke Scale scores of 18.5 ± 0.289 (standard error of the mean) and 17.9 ± 0.610, and time to recanalization of 53.9 ± 23.6 minutes and 59.0 ± 8.0 minutes for the Trevo and Solitaire groups, respectively. Recanalization was variably defined by individual studies, most commonly achieving at least a thrombolysis in cerebral infarction score of 2a–3 or a thrombolysis in myocardial infarction score of 2–3. Revascularization (83%, 82%), mortality (31%, 14%), hemorrhage (8%, 6%), device complications (5%, 6%), and good patient outcomes (51%, 47%) were found with the Trevo and Solitaire devices, respectively. Preliminary analysis reveals excellent clinical outcomes for retrievable stent technology. This may be attributable to both high rates of revascularization with a relatively short time to perfusion restoration.     

血管内带膜支架在颅底血管性病变中的应用

目的探讨Jostent冠脉带膜支架对于颅底动脉瘤和颈动脉海绵窦瘘的血管内治疗效果。方法于2005年6月-2006年5月应用Jostent冠脉带膜支架治疗14例患者,包括8例颅底动脉瘤和6例颈动脉海绵窦瘘,年龄14~62岁。结果在12例患者中带膜支架被成功释放于靶动脉,导致动脉瘤或瘘完全消除并保持载瘤(瘘)动脉畅通,临床效果满意。在另两例患者中,因血管纡曲带膜支架无法到达指定位置。无手术相关并发症发生。4例患者于带膜支架放置后6个月获造影随访,显示病变未再通,载瘤(瘘)动脉畅通。结论带膜支架对于某些颅底动脉瘤和颈动脉海绵窦瘘是有用的血管内治疗手段。带膜支架的制作工艺仍有待发展和优化,以使之适用于脑血管系统。     

国产支架在急性心肌梗死患者急诊冠状动脉介入治疗中的安全性和疗效

目的探讨急性心肌梗死患者中置入国产支架的安全性及疗效。方法共有36例急性心肌梗死患者人选。年龄(57±9．7)岁的36例患者均顺利完成急诊PCI及支架置人。其中前璧心肌梗死18例；下壁心肌梗死14例；高侧壁心肌梗死2例；后壁合并右室心肌梗死2例。合并糖尿病12例,高血压20例．吸烟18例。结果36例患者置入国产支架37枚,术中未出现并发症,血流均达到TIMI3级。7d时20例患者造影随访未见支架内血栓形成,血流维持TIMI3级。结论国产支架用于急性心肌梗死是安全有效的。     

后循环缺血的名称演变及治疗进展

【摘要】 后循环缺血（posterior circulation ischemia,PCI）的概念逐渐被临床医师接受,其治疗亦越来越受到重视,但目前仍缺乏专门针对后循环缺血的大样本随机对照研究,除常规的药物治疗外,溶栓治疗与介入治疗可使后循环缺血患者明显受益,但手术治疗方面未见有更多研究报道。我们结合国内外文献,概述了后循环缺血名称的演变,总结了后循环缺血治疗的最新研究成果并做一简要综述。     

肾动脉内支架置入治疗肾血管性高血压

目的探讨肾动脉内支架置入术(percutaneous translum inal renal artery stenting,PTRAS)治疗肾血管性高血压的疗效。方法对9例肾动脉狭窄(renal artery stenosis,RAS)患者进行了肾动脉支架置入术,并观察手术对患者血压的影响。结果9例患者均成功置入肾动脉支架。患者收缩压由术前的186.1±45.6 mmHg降至术后的139.4±15.4 mmHg(p<0.05),舒张压由术前的114.2±27.1 mmHg降至术后的89.4±17.9 mmHg(p<0.05),服用降压药物种类由术前的2.2±0.8种减少为术后的1.4±0.7种(p<0.05)。结论PTRAS技术成功率高,可有效降低肾血管性高血压患者血压。     

一站式腔内介入治疗髂静脉压迫综合征继发下肢深静脉血栓疗效观察

目的：探讨一站式腔内介入治疗髂静脉压迫综合征（IVCS）继发下肢深静脉血栓（DVT）临床效果及安全性。方法：回顾性分析2018年1月至2021年12月于河北省人民医院血管外科因左侧IVCS继发DVT入院治疗的26例患者的资料,均采用超声引导下膝下深静脉穿刺、Angiojet导管吸栓、髂静脉球囊扩张及支架植入、同期滤器取出的一站式腔内介入治疗,记录手术时间和导管吸栓时间;观察手术前后左下肢深静脉通畅度评分、健患肢膝上15?cm和膝下10?cm周径差,以及手术前后1?d血红蛋白量、肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、间接胆红素水平变化。通过随访,评价血栓后综合征发生率及髂静脉支架通畅情况。结果：26例患者均成功实施一站式腔内介入治疗,手术时间为（171±35）min,吸栓时间为（263±89）s。与手术治疗前相比,手术治疗后静脉通畅度评分、健患肢膝上及膝下周径差均减小（均P<0.01）;血红蛋白量减少,肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素及间接胆红素水平均上升（均P<0.01）。患者随访时间为1~12个月,其中1例患者7个月后出现支架内血栓形成,经保守治疗后症状改善;1例患者存在支架内附壁血栓形成,支架内血流无影响;其余患者均支架通畅。所有患者随访期间未见血栓后综合征。结论：一站式腔内介入治疗IVCS合并左下肢DVT安全可行,治疗过程中须关注导管吸栓所致的肝肾功能指标的变化,及时给予相应干预,避免相关并发症发生。     

中晚期食管癌支架置入术后支架内再狭窄风险Nomgram模型的建立与评估

  目的  通过分析中晚期食管癌患者支架置入术后支架内再狭窄(in-stent restenosis,ISR)发生的相关影响因素,建立并评估个体化预测中晚期食管癌患者支架置入术后ISR发生风险的列线图模型。  方法  选取2015年5月—2019年6月在瑞安市人民医院消化内科确诊并住院行支架置入术治疗的中晚期食管癌患者160例为研究对象,并根据中晚期食管癌患者支架置入术后ISR的发生与否将研究对象分为术后ISR组(26例)和非术后ISR组(134例)。采用logistic回归模型分析中晚期食管癌患者支架置入术后ISR的独立危险因素。应用列线图在线网站绘制预测中晚期食管癌患者支架置入术后ISR发生风险的列线图模型。采用ROC曲线、校准曲线及Hosmer-Lemeshow拟合优度检验评估列线图模型进行验证。  结果  Logistic回归模型显示,年龄大、合并食管瘘、临床分期为Ⅳ期是中晚期食管癌患者支架置入术后ISR发生的独立危险因素(均P＜0.05),支架置入术后接受放射治疗是中晚期食管癌患者支架置入术后ISR发生的保护因素(P＜0.05)。ROC曲线结果显示,预测中晚期食管癌患者支架置入术后ISR发生风险的AUC为0.869。校准曲线为斜率接近1的直线,Hosmer-Lemeshow拟合优度检验χ2=5.661,P=0.685。  结论  本研究基于年龄、支架置入术后接受放射治疗、合并食管瘘、临床分期这4项独立影响因素构建的预测中晚期食管癌支架置入术后ISR风险的列线图模型,具有良好的区分度与准确度。      

Surgical options for esophageal stenosis in children北大核心CSCD

Objective To explore the clinical efficacy of progressive individualized options for esophageal stenosis (ES) in children. Methods From January 2017 to December 2022, retrospective review was conducted for 106 ES children with regular follow-ups. There were 59 boys and 47 girls with an age range of (3.00 ± 0. 75) year and a body weight of (9.00 ± 1. 25) kg. The causes were anastomotic (n: 58), corrosive (n: 47) and congenital (n: 1). Sequential treatments of direct balloon dilation under gastroscope, submucosal injection of drugs into esophagus, esophageal stenting and surgical procedures were applied. After interventions, degree of ES was observed by esophagography and gastroscopy along with dysphagia grade for evaluating clinical efficacy. Differences were compared by I or yr test. Results All of them were discharged uneventfully. After balloon dilatation, the outcomes were excellent under direct gastroscopic view alone (n: 55). Among 35 children with balloon dilation plus esophageal submucosal drug injection, the outcomes were excellent (n: 25) and esophageal stenting (n: 10). Among 25 children with esophageal stenting, the outcomes were excellent (n:21) and additional surgery (n: 4). Surgical procedures were performed with excellent outcomes (n:5). Conclusions The clinical outcomes progressive individualized options of direct visualization balloon dilation under gastroscope, balloon dilation plus submucosal injection of drugs into esophagus, esophageal stenting and surgical procedure are precise, convenient and efficacious for ES in children. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All Rights Reserved.