Stent placement in ostial and nonostial atherosclerotic renal arterial stenoses: a prospective follow-up study

PURPOSE: To compare the results of balloon percutaneous transluminal renal angioplasty (PTRA) and stent placement in atherosclerotic ostial, proximal, and isolated truncal stenoses. MATERIALS AND METHODS: Between January 1994 and April 1998 the authors prospectively followed up 163 consecutive patients with 200 atherosclerotic renal arterial lesions after primary PTRA or primary stent placement. Duplex ultrasonography was performed 1 day and 3, 6, and 12 months later. RESULTS: The primary 12-month PTRA patency rates were 34% (21 of 33 atherosclerotic lesions) for ostial stenoses, 65% (20 of 60) for proximal stenoses, and 83% (five of 30) for truncal stenoses (chi(2) value, 15.63; P <.001). The corresponding stent patency rates were 80% (four of 21), 72% (nine of 34), and 66% (five of nine), respectively (chi(2) value, 4.11; not significant). Significant stent-related reduction in risk of restenosis was limited to the ostial stenoses (P =.002). CONCLUSION: Renal arterial stent placement considerably improves patency in ostial stenoses, but compared with the technically successful PTRA, it does not significantly improve primary patency in proximal and isolated truncal renal arterial stenoses.     

Renal Artery Stenting in Patients with a Solitary Functioning Kidney

Purpose: To retrospectively evaluate the results of renal artery stenting in patients with renovascular disease and a solitary functioning kidney. Methods: Palmaz stents were placed in 16 patients with a solitary functioning kidney, renal artery stenosis, hypertension and renal failure. Stenoses were evaluated with color Doppler ultrasound, MR angiography and digital subtraction angiography (DSA). Indications for stenting were: recoil after percutaneous transluminal renal angioplasty (PTRA) (63%), arterial dissection after PTRA (13%) and primary stenting (25%). Immediate results were evaluated by DSA. On follow-up (6-36 months), patients underwent periodical evaluation of clinical conditions (blood pressure and serum creatinine level) and stent patency, by means of color Doppler ultrasound. Results: Stent placement was successful in all patients (100%). Cumulative primary patency rate was: 100% at 1 day, 93.75% at 6 months, 81.25% at 12 months and 75% at 24 months. A significant reduction in diastolic blood pressure occurred (mean ± SD 104 ± 6 vs 92 ± 3; p < 0.05); renal function improved or stabilized in over 80% of patients. However, there was no significant difference in the creatinine values before and after treatment (mean ± SD 200 ± 142 mmol/l vs 197 ± 182 mmol/l; p > 0.05). Conclusion: Renal artery stenting, both after PTRA and as primary stenting, represents a safe procedure, able to preserve renal function in patients with a solitary functioning kidney.     

Complications during renal artery stent placement for atherosclerotic ostial stenosis

Purpose To describe short-term complications during stent placement for atherosclerotic renal artery ostial stenosis. Methods Sixty-one arteries in 50 patients were treated with Palmaz stents. Nineteen patients had a single functioning kidney, 23 had a bilateral stenosis, which was stented bilaterally in 11, and 8 had a unilateral stenosis. The complications were grouped as those related to the catheterization procedure, those related to stent placement, and those possibly related to either category. The complications were divided into those with severe clinical significance (SCS), those with minor clinical significance (MCS), and radiological-technical complications (RTC). The stent placement procedures were ordered chronologically according to examination date and the complications were tabulated per group of 10 patients. Results Five (10%) SCS, 5 (10%) MCS, and 8 (16%) RTC occurred in 50 patients. The catheterization procedure led to 2 SCS, 3 MCS, and 1 RTC. Stent placement gave rise to 7 RTC. Three SCS and 2 MCS could have been related to either catheterization or stent placement. More SCS occurred in the first group of 10 patients than in the following groups. Conclusion Renal artery stent placement for atherosclerotic ostial stenosis has a considerable complication rate and a learning curve is present. The complications related to the actual stent placement were without clinical consequences.     

Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths in antegrade and crossover procedures: midterm results

The aim of this study was to evaluate the technical performance of the implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths. Thirty-three lesions (24 stenoses, 9 occlusions) in 32 patients (mean age 67 years) were stented. Selective stent implantation was performed after unsatisfactory percutaneous transluminal angioplasty result with an antegrade access in 21 patients and through a crossover sheath in 11 patients. A total of 36 stents were implanted. Stent delivery was successful in all cases (stent diameter 5 or 6 mm, stent length 11–38 mm). In none of the cases was stent dislodgement from the balloon observed. Stent placement was optimal without residual stenosis in 30 cases. In 1 case the stent was chosen too short requiring implantation of a second stent. In 1 patient distal embolization was observed which was treated with catheter embolectomy. Nine-month primary and secondary patency rates were 79±8.7 and 86±7.7%, respectively. Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths is safe in antegrade and crossover procedures. Presented at ECR 2002.     

Percutaneous angioplasty for atherosclerotic renal artery disease: Effect on renal function in azotemic patients

Purpose We studied the effect of percutaneous transluminal renal angioplasty (PTRA) on renal function in azotemic patients with atherosclerotic renal artery stenosis.Methods The results of PTRA were analyzed retrospectively in 40 patients. There were 61 stenoses, 54 of which received balloon angioplasty; 7 had stent placement during the initial procedure, 6 for recurrent stenosis 6–18 months after PTRA.Results Technical success was achieved in 95% of cases. The complication rate was 15%, compared to 6% in nonazotemic patients. Mean creatinine rose from 1.9 ± 0.15 mg/dl (mean ± SEM) to 2.4 ± 0.17 mg/dl during the year before PTRA, stabilizing at 2.5 ± 0.57 mg/ dl for 1 year after PTRA. PTRA was clinically successful in 60% of patients; 40% showed further deterioration of renal function. Clinical failure was associated with residual renal artery stenosis and presence of intermittent claudication.Conclusion We conclude that PTRA helps salvage renal function in patients with azotemia and atherosclerotic renal artery stenosis.     

Feasibility of Angioplasty and Stenting for Abdominal Aortic Lesions Adjacent to Previously Stented Visceral Artery Lesions in Patients with Takayasu Arteritis

Two young female patients with Takayasu arteritis presented with symptomatic long-segment abdominal aortic stenosis in the vicinity of previously deployed celiac and renal artery stents that projected markedly into the narrowed aortic lumen. Crushing or distortion of the visceral artery stents during aortic angioplasty was avoided by performing simultaneous or alternating balloon dilatations in the aorta and in the visceral artery stents. Consequently, the visceral artery stents remained patent and shortened longitudinally, allowing unhindered deployment of Wallstents in the adjacent aorta and abolition of a pressure gradient across the aortic lesions. Access to side branches covered by the Wallstent was obtained without difficulty, enabling the performance of balloon dilatation in multiple side branches and ostial stent deployment in a renal artery. These techniques could increase the scope of endovascular therapy in the treatment of patients with Takayasu arteritis.     

肾动脉内支架置入术治疗肾性高血压

报告了肾动脉狭窄采用Ｐａｌｍａｚ支架留置的程序，并报告了典型病例和十三个半月的追踪结果。结合文献复习讨论了肾动脉内支架留置的适应证和禁忌证及作者的初步体会。肾动脉内支架留置后的长期开通需要进一步追踪观察。     

The erasme study: A multicenter study on the safety and technical results of the palmaz stent used for the treatment of atherosclerotic ostial renal artery stenosis

Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5–18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up.     

Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement

Purpose

To retrospectively evaluate and compare the long term patency and antihypertensive effect of angioplasty and stent insertion in renal artery stenosis caused by Takayasu arteritis, with CT angiography and clinical follow-up.

Materials and methods

We retrospectively analyzed and compared effects on hypertension and patency of renal artery in 16 patients (age ranging from 16 to 58 years, mean: 32.1 years) with renovascular hypertension caused by Takayasu arteritis who underwent endovascular treatment including angioplasty (n = 13) and stent placement (n = 9) for 22 stenotic renal arteries.

Results

Technical success was 95% (21/22) without major complications. In the last follow-up CT angiogram (mean 85 ± 41 months), restenosis was 8% (1/12) in angioplasty and 66% (6/9) in stent. Patency rates of angioplasty were 100%, 91.7%, 91.7% and primary unassisted and primary assisted patency rates of stent placement were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% at 1-, 3- and 5-years, respectively. In clinical follow-up (mean 120 ± 37.8 months, range 48–183 months), beneficial effects on hypertension were obtained in 87% of patients (13/15) and there was no significant difference between the patients who were treated by only angioplasty and the patients who received stent placement in at least one renal artery, regardless of whether or not angioplasty had been performed in the other renal artery.

Conclusion

Compared with stent placement, angioplasty demonstrated better long term patency and similar clinical benefit on renovascular hypertension in renal artery stenosis of Takayasu arteritis. We suggest that stent placement should be reserved for obvious angioplasty failure.     

Midterm results of renal artery stenting

Percutaneous transluminal angioplasty (PTA) has become the treatment of choice for major renal artery stenosis. Nonetheless, about 10% of renal artery stenoses cannot be properly dilated, and among the patients successfully dilated, 10%–15% had a recurrence. Renal artery stenting was used in 21 patients in cases of insufficient results after PTA: persisting significant stenosis after a primary or several PTAs (15 cases), recurrences (9 cases). Follow-up in all patients was from 12 months to 4 years. Implantation was performed without any problems but the low radioopacity of the stent makes placement difficult in obese patients, particularly for ostial lesions. There was no major complication except occlusion of a segmental branch of the renal artery in 1 case. Radiological controls have shown a preserved patency in all cases except 2, which present restenosis inside the stent by intimal hyperplasia. A significant clinical improvement was obtained in 90% of cases. These results suggest that the endovascular prosthesis represents an important adjunct to renal PTA.     

Low-profile stent placement with the monorail technique for treatment of renal artery stenosis: midterm results of a prospective trial

PURPOSE: To determine feasibility, safety, and midterm patency of a monorail balloon stent device for the treatment of renal artery stenosis (RAS). MATERIALS AND METHODS: During a period of 30 months, 47 patients (with severe hypertension, n=45; renal insufficiency, n=20) with 50 cases of RAS and indications for stent implantation (calcified ostial lesion, n=41; insufficient percutaneous transluminal angioplasty, n=6; dissection, n=3) were enrolled into the prospective evaluation. After predilation, 59 stents (Rx-Herculink 4 mm, n=2; 5 mm, n=19; 6 mm, n=35; 7 mm, n=3) were implanted under manometer control with use of the long-sheath technique (5 F; 6 F for 7-mm stents) via a femoral (n=44) or transbrachial approach (n=6). Parameters of hypertension and renal insufficiency were determined before and after the procedure and for a maximum of 18 months. Restenosis rate was determined with color duplex ultrasonography. RESULTS: Renal artery stent placement (mean diameter, 5.7 mm; mean length, 16 mm) was technically successful in all cases (100%). Mean blood pressure and serum creatinine level decreased from 177/93 mm Hg to 145/78 mm Hg and from 1.8 mg/dL to 1.5 mg/dL, respectively. Within 48 hours after the implantation, acute occlusions occurred in two patients, supposedly triggered by cholesterol embolization. Primary and primary assisted patency rates were 87% and 92% at 6 months and 75% and 84% at 18 months. CONCLUSIONS: Renal artery stent placement with the rapid-exchange monorail system is a safe procedure with promising patency rates. In combination with the long-sheath technique, adequate control of stent deployment is guaranteed during the entire intervention. The low profile of the device facilitates the use of small sheaths (5 F) to minimize access-site complications.     

Renal vein renin analysis: Limitations of its use in predicting benefit from percutaneous angioplasty

Two hundred forty-four consecutive patients (mean age 61 years), including 123 who had technically valid renal vein renin (RVR) analysis and 121 without RVR data, underwent technically successful percutaneous renal artery angioplasty (PTRA). They were retrospectively examined to evaluate the utility of RVR analysis in identifying renal hypertension (RVH), predicting benefit from PTRA, and determining if the lack of knowledge of renin levels significantly affected clinical outcome after PTRA. Abnormal RVR values were associated with clinical benefit after PTRA in 62 of 93 patients (67% sensitivity, 20% specificity, 72% positive predictive value). Clinical improvement following PTRA occurred in 31 of 37 patients with normal pre-PTRA RVR values (16% negative predictive value). RVR analysis correctly identified 86 of 117 patients with renovascular hypertension (74% sensitivity, 16% negative predictive value). Improved blood pressure (BP) control occurred in 72% with abnormal RVR analysis and 66% of the 121 patients without RVR data (p>0.1). We conclude that the very low negative predictive value significantly limited the use of RVR analysis in this elderly (mean age 60 years) patient population with a high incidence of mild renal functional impairment (mean serum creatinine 1.4 mg/dl) and bilateral renal artery stenosis (38%). The lack of pre-PTRA renin data did not significantly affect clinical outcome. If RVR data were relied upon as the exclusive selection criterion in patients of this type, many would be prevented from having the benefit of cure or improvement by PTRA.     

Popliteal Artery Stenting Using Flexible Tantalum Stents

Purpose: To evaluate the safety and efficacy of stent therapy for the treatment of residual stenoses after percutaneous transluminal angioplasty (PTA) of popliteal stenoses and occlusions. Methods: In a prospective single-center study, flexible tantalum stents were implanted in 32 popliteal arteries for the treatment of residual stenosis greater than 50% after PTA of stenoses (n = 17) or occlusions (n = 15) in the P1 (n = 16), the P2 (n = 13), or both P1 and P2 segment (n = 3). Follow-up patency was assessed by clinical examination, ankle-brachial index, and color Doppler sonography or angiography. Results: Early stent thrombosis (10 days): 1 of 32 arteries (3%). 1-year and 2-year primary patency rate (PPR): 81% ± 7.1% and 74% ± 9.1%, respectively. 1-year PPRs for subgroups: stented stenoses versus stented occlusions: 88% ± 7.8% vs 73% ± 12.0%, p = 0.12; good lower limb runoff versus poor: 84.0% ± 8.7% vs 76.0% ± 12.4; p = 0.09; P1 versus P2: 77.3% ± 9.8% vs 85.7% ± 9.4%, p = 0.38. Recurrent PTA lesions treated with stents showed higher restenosis rate than de novo lesions. Conclusion: The results of stent therapy of residual popliteal stenosis after PTA are encouraging and warrant further investigation.     

The role of interventional radiology in management of patients with end-stage renal disease

The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40%. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89-90%. Primary patency rate is 8-26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. Renal and perirenal fluid collection are usually treated successfully with percutaneous drainage. Doppler US, magnetic resonance angiography and digital subtraction angiography have a principle role in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Stenosis, the most common vascular complication, occurs in 1-12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82-92% of the cases, and graft salvage rate has ranged from 80 to 100%. Restenosis occurs in up to 20% of cases, but are usually amenable to repeated PTRA. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon, predominantly they consist of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections.     

Renal artery stenosis: preliminary results of treatment with the Strecker stent.

Use of the Strecker flexible balloon-expandable tantalum stent for treatment of renal artery stenosis after failed angioplasty or transaortic thromboendarterectomy was evaluated in 10 patients (nine hypertensive, one normotensive). Left (n = 3) and right (n = 5) renal arteries were involved; renal artery stenosis in two patients had developed after kidney transplantation. Indications for stent placement were inadequate immediate postangioplasty response (n = 7), development of considerable restenosis after angioplasty (n = 1), and obstructing intimal flaps following transaortic endarterectomy (n = 2). Stent placement was technically successful (less than 20% residual stenosis) and patency was preserved in eight patients. Of the seven hypertensive patients with successful implantation, two were cured, three had improvement, and two had no change at latest follow-up evaluation (mean, 10.6 months; range, 6-12 months). The Strecker stent may be helpful in treating restenosis after failed revascularization procedures, although the precise indication, true safety, and long-term efficacy of stent placement in renal arteries will not be known until trials with more subjects and longer follow-up periods are completed.     

Repeated intervention for in-stent restenosis of the renal arteries

PURPOSE: To assess the long-term technical success of repeated endovascular intervention in stenosed renal artery stents. MATERIALS AND METHODS: Fifteen patients with stenoses >or=50% in a renal stent placed because of an ostial atherosclerotic renal artery stenosis were included in this study. In the presence of increased blood pressure or decreased renal function, the in-stent restenosis was treated with percutaneous transluminal angioplasty (PTA) in the stent or placement of a second stent if the stenosis was located too distally in the stent. The results of these repeat interventions were evaluated by angiography. RESULTS: The 15 patients had a total of 20 stenosed stents. Eighteen of these in-stent stenoses were treated with PTA and two were treated with placement of a second stent. Angiographic follow-up was available in 16 arteries, showing in-stent restenosis in four (25%; mean follow-up, 11 mo). The cumulative patency rates after repeat endoluminal intervention were 93% (95% CI: 80%-106%) and 76% (95% CI: 52%-101%) after 6 and 12 months, respectively. Renal function remained stable or improved in most patients (80%) after repeated intervention in the stent, and hypertension was classified as improved or cured in 47% of patients after 1 year. CONCLUSION: Patients with stenosed renal artery stents can be treated successfully with PTA in a majority of cases, with a long-term success rate of 75% and stable renal function 1 year after repeated intervention.     

Long-term results of angioplasty in 110 patients with renal artery stenosis.

Percutaneous transluminal renal angioplasty (PTRA) is generally considered of little benefit in the treatment of ostial renal artery stenosis. This report contains long-term follow-up (> 12 months in all patients; mean follow-up, 38 months) for 110 patients who underwent PTRA for treatment of ostial renal artery stenosis. There was no significant difference in patient benefit related to bilaterality or multiplicity of lesions treated or to renal function before angioplasty (P > .1). Although there was no statistically significant difference in benefit among groups of patients who received treatment, certain trends were apparent. The least benefit occurred in patients with insulin-dependent diabetes and those with symptoms or history of vascular disease in another organ system. Treatment of lesions with proportionately larger balloons did not result in greater benefit. Restenoses were redilated in 16 patients for whom initial treatment failed. Eleven of these were ostial restenoses. The ostial stenosis in one patient was redilated a second time. At the end of follow-up, primary, secondary, and tertiary clinical benefits were 48%, 57%, and 58%, respectively. This was not statistically different (P = .14) from a control group of 94 patients with nonostial stenoses who had 68% long-term benefit. The authors conclude that ostial renal artery stenosis is not a contraindication to PTRA, and balloon angioplasty can play an important role in blood pressure control in this patient population.     

Iliac and femoropopliteal vascular occlusive disease treated with flexible tantalum stents

Two hundred patients were treated with tantalum stents, 2 in the aortoiliac bifurcation, 114 in the iliac, and 84 in the femoropopliteal arteries. The indications for stenting were technically unsuccessful percutaneous transluminal angioplasty (PTA) due to arterial recoil, dissection (156 patients), or acute occlusions (15 patients). Long iliac artery occlusions (29 patients) were indications for primary stenting. Life-table analysis revealed a 3-year patency rate of 95% for stented iliac arteries, and a 1-year patency rate of 80% for stented femoropopliteal arteries. Restenosis of the stented femoropopliteal lumen was particularly frequent in stents placed for restenosis following prior PTA (7 of 12 patients), in stents placed into the distal superficial femoral and popliteal arteries (14 of 24 patients), and in stents positioned over a longer than 4-cm artery segment (9 of 16 patients). For the aortic bifurcation and iliac arteries, arterial stenting has proved to be a valuable adjunct to PTA; for femoropopliteal arteries, stenting should be restricted to acute arterial occlusions or severe residual stenosis following PTA.     

Metallic stent placement for iliac artery occlusive disease

Since 1991, we have performed stent placement for 35 iliac artery lesions in 31 patients. The etiologic diseases were atherosclerotic in 34 patients and traumatic dissection in one. The indications of placement were total occlusion in 3, late restenosis after angioplasty in 5, dissection in 5, and residual stenosis due to inadequate angioplasty in 21. We also performed direct stent placement for one traumatic dissection. The stents used were Wallstents in 10, Palmaz stents in 14, Strecker stents in 9, and Memotherm stents in 2 lesions. Follow-up was performed clinically or angiographically with measurement of the ankle/arm pressure index. Stent placement was successful in all cases, and relief or improvement of symptoms was achieved. The follow-up period ranged from 6-85 months (mean, 37.3 months). Late stent stenosis or occlusion occurred in 6 cases, among which 4 occluded lesions were successfully recanalized by thrombolytic therapy with angioplasty or second stent placement. In total, the primary patency rates were 88% and 77% at two and four years, respectively, while the secondary patency rates were 94% and 94%. In conclusion, metallic stent placement may offer extended application of intravascular treatment for iliac artery occlusive disease, and good long-term patency rates can be expected.     

Budd-Chiari syndrome due to prothrombotic disorder: mid-term patency and efficacy of endovascular stents

Our objective was to evaluate efficacy and patency of metallic stent placement for symptomatic Budd-Chiari syndrome (BCS) due to prothrombotic disorders. Eleven patients with proved BCS due to prothrombotic disorders were referred for endovascular treatment because of refractory ascites (n=9), abdominal pain (n=8), jaundice (n=6), and/or gastrointestinal bleeding (n=4). Stents were inserted for stenosed hepatic vein (n=7), inferior vena cava (n=2), or mesenterico-caval shunt (n=2). Clinical efficacy and stent patency was evaluated by clinical and Doppler follow-up. After a mean follow-up of 21 months, 6 patients had fully patent stents without reintervention (primary stent patency: 55%). Two patients with hepatic vein stenosis had stent thrombosis and died 4 months after procedure. Restenosis occurred in 3 cases (2 hepatic vein and 1 mesenterico-caval shunt stenosis) and were successfully treated by balloon angioplasty (n=2) and addition of new stents (n=1) leading to a 82% secondary stent patency. Of 9 patients with patent stent, 7 were asymptomatic (77%) at the end of the study. Stent placement is a safe and effective procedure to control of symptomatic BCS. Prothrombotic disorder does not seem to jeopardize patency in anticoagulated patients. Electronic Publication