Very delayed coronary stent fracture: A case report

A stent fracture is an emerging complication of the coronary stents. There are numerous risk factors for stent fractures; which include forceful exaggerated motion in the atrioventricular groove seen in right coronary artery, long stent, an ostial lesion at the point of maximum curvature in a tortuous vessel, stent over-expansion, stent overlapping with different size stents, complex lesion after stenting of a totally occluded vessel, Cypher stent and a highly mobile segment causing high mechanical stress. Furthermore, chronic stretch at specific vessel sites as bends may lead to late occurrence of fracture.Here we report a case of 40-year-old male who had two overlapping Cypher stents (3.0 × 13 mm and 2.75 × 18 mm) deployed at mid left anterior descending artery 2 years earlier presented with progressive chest pain.     

IVUS-guided rotational atherectomy for unexpandable paclitaxel-eluting stent: A case report and review of literature

We describe a patient suffering from late stent thrombosis in a paclitaxel-eluting stent which had an underexpanded ring due to the three-hundred-sixty-degree circumferential calcified plaque. Intravas...     

Small bowel perforation from a migrated biliary stent:A case report and review of literature

BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention.CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.     

Esophageal lichen planus:A case report and review of the literature

Esophageal involvement by lichen planus(ELP),previously thought to be quite rare,is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus(LP).Considering that the symptoms of ELP do not present in a predictable manner,ELP is perhaps more under-recognized than rare.To date,four cases of squamous cell carcinoma in association with ELP have been reported,suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up.In this case report,a 69-year-old female presented with dysphagia and odynophagia.She reported a history of oral LP but had no active oral or skin lesions.Endoscopic examination revealed severe strictures and web-like areas in the esophagus.Histologic examination demonstratedextensive denudation of the squamous epithelium,scattered intraepithelial lymphocytes,rare eosinophils and dyskeratotic cells.Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders.By using clinical,endoscopic,and histologic data,a broad list of differential diagnoses can be narrowed,and the accurate diagnosis of ELP can be made,which is essential for proper treatment and subsequent follow-up.     

Successful stent-in-stent dilatation of the common bile duct through a duodenal prosthesis,a novel technique for malignant obstruction:A case report and review of literature

For patients suffering from both biliary and duodenal obstruction,endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the treatment of choice.ERCP through an already existing duodenal prosthesis is an uncommon procedure and furthermore no studies have reported installing a covered metal stent onto an already existing bare metal stent in the common bile duct(CBD).We describe a rare case of a stent-in-stent dilatation of the CBD through an already existing self-expanding metal stent in the second part of duodenum for the patient presenting with jaundice in setting of biliary and duodenal obstruction from pancreatic adenocarcinoma.The biliary obstruction was relieved with a decrease in bilirubin levels post-stenting.     

Sirolimus-eluting stent displaced fracture: case report and review of the literature

Drug-eluting stents have greatly reduced the risk of in-stent restenosis compared to bare metal stents by inhibiting neointimal growth. However, they may carry some long-term risks, especially the risk of late stent thrombosis. Recently, several cases of drug-eluting stent fracture have been also reported. The mechanisms, the diagnosis, the clinical implications and the management of this new complication are not well-known. We report the observation of a new case of displaced, sirolimus drug-eluting stent fracture. To our knowledge, this is the first reported case in France.     

硅酮支架与覆膜金属支架并发症的对比观察

目的对照观察硅酮支架与Z型不锈钢覆膜金属支架置入后的并发症,为临床支架的选择提供参考。方法 2014年4月至2015年2月因气道狭窄或气道瘘65例患者置入硅酮支架,77例患者置入覆膜金属支架,术后定期支气管镜检查,观察2个月内两组病例的主要并发症。结果硅酮支架组置入分叉型支架45例、沙漏状支架7例、直筒型支架13例;覆膜支架组置入分叉型支架70例、直筒型支架7例。两组并发症比较:痰液潴留硅酮支架50例(76.9%)、覆膜支架61例(79.2%),相差不显著(P0.05);肉芽增生硅酮支架39例(60.0%)、覆膜支架69例(89.6%),相差显著(P0.01);支架移位:分叉型及沙漏状支架均无移位,直筒型支架移位硅酮支架2例(15.3%)、覆膜支架6例(85.7%),相差显著(P0.01);顽固性咳嗽硅酮支架4例(6.1%)、覆膜支架7例(9.0%),相差不显著(P0.05)。因肉芽增生明显经处理效果差,9例覆膜支架取出支架,硅酮支架未因肉芽增生取出支架。结论硅酮支架与覆膜支架比较,硅酮致肉芽增生较轻,其直筒型移位较少,建议对需长期放置支架的患者,优先考虑硅酮支架。     

A case of popliteal stent fracture with pseudoaneurysm formation.

We describe a case of angiographically documented stent fracture and pseudoaneurysm formation in a patient with femoropopliteal disease, which was successfully treated with deployment of an endovascular stent graft. Technical aspects of the procedure are discussed and the experience with stent fractures previously reported in the literature is reviewed.     

Longitudinal stent compression of everolimus-eluting stent: A report of 2 cases

Second generation drug eluting stents(DES) have shown better safety and efficacy in comparison to first generation DES,because of thinner struts,nondurable polymers and coating with better anti-proliferative drugs.The newer DES with cobalt alloy base have demonstrated a greater trackability,deliverability,conformability,flexibility and radio-opacity.However,these thin strut stents have a downside of poor longitudinal axial strength,and therefore get easily deformed/ compressed at their end with a slight trauma during exchange of various catheters.We hereby report two cases of "longitudinal stent compression(LSC)" of everolimus-eluting stent,which happened during percutaneous coronary intervention of right coronary artery.Both the cases were successfully managed with non-compliant balloon dilatation.Various reasons for LSC and its management are discussed in the article.     

Clinical outcomes of secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction

Background

Although a substantial number of patients require secondary stents insertion due to primary stent malfunction in malignant gastric outlet obstruction, data on the outcomes of secondary self-expanding metal stents are sparse.

Aim

To investigate clinical outcomes and factors related with secondary stent malfunction in patients with malignant gastric outlet obstruction given secondary stent-in-stent self-expanding metal stent insertion.

Methods

For this retrospective study, a total 77 patients who underwent secondary stent-in-stent self-expanding metal stent placement for primary stent malfunction in malignant gastric outlet obstruction were enrolled. We compared the effectiveness and complications of secondary covered and uncovered stents and explored the predictive factors for stent malfunction.

Results

Stent-in-stent self-expanding metal stent placements were technically successful in all patients. Both groups also had comparable clinical success rates (covered stent, 87.2% and uncovered stent, 90.0%, P = 1.000). Stent malfunction rates (31.9% and 36.7% respectively, P = 0.805) and median patency time of stent (165 [95% confidence interval: 112–218] and 165 [95% confidence interval: 126–204] days, respectively, P = 0.358) were similar between secondary covered and uncovered stents. Longer patients’ survival time (≥100 days) was associated with increased risk of stent malfunction (odds ratio: 4.598; 95% confidence interval: 1.473–14.355; P = 0.009).

Conclusions

Secondary stent-in-stent self-expanding metal stent placement is feasible and effective treatment for primary stent malfunctions in malignant gastric outlet obstruction. Covered and uncovered stent are equally acceptable in terms of stent-related complications and stent patency, regardless of primary stent type.     

Stent placement for benign colonic stenosis: case report,review of the literature,and animal pilot data

BACKGROUND: Permanent metal stent placement for malignant intestinal obstruction has been proven to be efficient. Temporary stents for benign conditions of the colon and rectum are less studied. This is a case study, review of the literature, and observation from an animal model on placement of stents in the colorectum for benign disease. MATERIALS AND METHODS: A 55-year-old man presented with recurrent obstructions from a benign stricture of the distal sigmoid colon. After failed balloon dilations, a polyester coated stent was placed. The purpose of the stent was to improve symptoms and avoid surgery. The stent was expelled after 5 days. We conducted a literature review of stents placed for benign colorectal strictures and an animal study to evaluate stent migration. RESULTS: In the literature, there were 53 reports of uncovered metal stents, four covered metal stents, and six polyester stents. Patency rates were 71%, and migration rate was 43%. Migration occurred earlier with polyester stents (mean = 8 days) versus covered (32 days) or uncovered metal stents (112 days). Severe complications were seen in 23% of patients. Four 45-kg pigs underwent rectosigmoid transection with a 21-mm anastomosis and endoscopic placement of a Polyflex stent. Two stents were secured with suture. Stents without fixation were expelled within 24 h of surgery. Stents with fixation were expelled between postoperative days 2 and 14. CONCLUSION: Stents for the treatment of benign colorectal strictures are safe, with comparable patency rates between stent types. Metal stents can cause severe complications. In a pig model, covered polyester stents tend to migrate early even with fixation. Further investigation needs to focus on new stent designs and/or better fixation.     

Esophageal tuberculosis: case report and review of the literature

The esophageal tuberculosis is the rarest form of this infection in the gastrointestinal tract, corresponding to 0.15% of the cases. This pathology is unusual even in countries with high prevalence of tuberculosis. Its clinical presentation could be easily confused with the one of esophageal carcinoma. The diagnosis is reached by demonstrating in a sample of the mucosa the presence of caseating granulomas or by finding the Mycobacterium tuberculosis in a sample of tissue. In the present case report 73-year-old male with dysphagia, weight loss and fever is presented. At the endoscopy an ulcerated lesion of 5 centimeters in the lower third of the esophagus that compromises 50% of the circumference is observed. In the chest x-ray there are bilateral lung infiltrates confirmed by the CT scan. A baciloscopy is done and the result is positive. At the histological analysis giant cells are found and there is evidence of tuberculous bacillus. The patient develops an intestinal obstruction secondary to chagasic megacolon. He presents a massive hemoptisis and die. The aim of this presentation is to comment a pathology rarely reported in the literature and enhance the importance of considering it according to the clinical context.     

支架置入术联合自体肾移植术治疗双侧肾动脉狭窄1例并文献复习

目的:评估支架置入术联合自体肾移植术治疗肾血管性高血压的疗效。方法:顽固性高血压患者1例,经血管造影证实为双侧肾动脉显著狭窄,左肾动脉起始部70%~80%狭窄,行肾动脉支架置入术(PTRAS),右肾动脉起始部90%狭窄,因狭窄部紧靠右肾动脉起始部,而且伴有显著的狭窄后扩张,故未行PTRAS,而采用自体肾移植术。结果:经左肾动脉行支架置入术后,血压控制仍不满意,继而行右侧自体肾移植术,术后停服所有降压药物,血压能维持在正常水平。结论:在双侧肾动脉显著狭窄时,采用支架置入术联合自体肾移植术是合理及有效的治疗手段。     

Colonic diverticular perforation by a migrated biliary stent: A case report with literature review

Rationale:Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature.Patients concerns:A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago.Diagnoses:Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis.Interventions:Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed.Outcomes:On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications.Lessons:Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.     

Removal of an embedded "covered" biliary stent by the "stent-in-stent" technique

A 46-year-old man was admitted with obstructive jaundice and cross-sectional imaging with computed tomography suggested distal biliary obstruction.A distal common bile duct stricture was found at endoscopic retrograde cholangiopancreatography(ERCP)and cytology was benign.A 6 cm fully covered self-expanding metal stent(SEMS)was inserted across the stricture to optimize biliary drainage.However,the SEMS could not be removed at repeat ERCP a few months later.A further fully covered SEMS was inserted within the existing stent to enable extraction and both stents were retrieved successfully a few weeks later.Fully covered biliary(SEMS)are used to treat benign biliary strictures.This is the first reported case of inability to remove a fully-covered biliary SEMS.Possible reasons for this include tissue hyperplasia and consequent overgrowth into the stent proximally,or chemical or mechanical damage to the polymer covering of the stent.Application of the stent-in-stent technique allowed successful retrieval of the initial stent.     

Intentional removal of erroneously deployed coronary stents: A case series and review of the literature

Most reports of stent retrieval involve undeployed, embolized stents. While the retrieval of fully deployed stents has been sporadically reported, most of these were not intentional. The feasibility and safety of intentional retrieval of fully deployed, but erroneously placed stents have not been well described. We report four cases of successful, intentional stent retrieval for stents placed erroneously in an aorto-ostial position. The stents were retrieved at varying times after deployment, ranging from immediately to up to 5 years. In all cases, stents were retrieved successfully with no complication. We conclude that the intentional retrieval of fully deployed, but erroneously placed stents is feasible and safe when stenting involved an aorto-ostial location.     

Occurrence of longitudinal stent compression before stent deployment: Two case studies

Several recent reports have described the occurrence of longitudinal stent deformation(LSD, defined as the distortion or shortening of a stent along the longitudinal axis), following its successful deployment. However, few reports have described LSD prior to any stent deployment. This previously unrecognized complication is the result of modifications to stent design. It has been noted that the new-generation stent platforms have a reduced number of connectors, which in turn causes a reduction in longitudinal stent strength. To corroborate previous findings by our lab and others(Vijayvergiya et al, 2013), we describe here two cases of LSD prior to stent deployment that occurred due to crushing of the proximal stent edge by the guide catheter while attempting to withdraw the crimped stent. In addition, we discuss the associated risk factors, such as the length of the stent, and specific management strategies, including technical guidelines and use of fluoroscopic guidance for maneuvering the stent during the procedure.     

Occurrence of longitudinal stent compression before stent deployment: Twocase studies简

Several recent reports have described the occurrence of longitudinal stent deformation (LSD, defined as the distortion or shortening of a stent along the longitudinal axis), following its successful deployment. However, few reports have described LSD prior to any stent deployment. This previously unrecognized complication is the result of modifications to stent design. It has been noted that the new-generation stent platforms have a reduced number of connectors, which in turn causes a reduction in longitudinal stent strength. To corroborate previous findings by our lab and others (Vijayvergiya et al, 2013), we describe here two cases of LSD prior to stent deployment that occurred due to crushing of the proximal stent edge by the guide catheter while attempting to withdraw the crimped stent. In addition, we discuss the associated risk factors, such as the length of the stent, and specific management strategies, including technical guidelines and use of fluoroscopic guidance for maneuvering the stent during the procedure.     

Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantation.

BACKGROUND: Stent fracture is one of the possible causes of restenosis after sirolimus-eluting stents (SES) implantation. The aim of our study was to evaluate the prevalence and clinical impact of coronary stent fracture after SES implantation. METHODS: From our prospective institutional database, 280 patients were treated solely with SES from August 2004 to June 2005. Among the 280 patients, 256 patients with a total of 307 lesions underwent follow-up angiography on an average of 240 days after the procedure. RESULTS: Stent fractures were observed in eight (2.6%) lesions. Of the eight lesions with stent fracture, five were located in the right coronary artery (RCA), two in the saphenous vein (SV) graft, and one in the left anterior descending coronary artery. The stent fractures were all in the locations that served as hinges during vessel movement in the cardiac contraction cycle. Seven of the eight stent fractures were adjacent to the edge of previously implanted or overlapped stent. Significant multivariate predictors of stent fracture were SV graft location (Odds ratio 35.88; 95% confidence interval 2.73-471.6, P = 0.006), implanted stent length (Odds ratio 1.04; 95% confidence interval 1.01-1.07, P = 0.02), and RCA location (Odds ratio 10.00; 95% confidence interval 1.11-89.67, P = 0.04). In-stent binary restenosis rate was 37.5% and target lesion repeat revascularization rate was 50.0% in patients with stent fracture. CONCLUSIONS: Stent fracture was likely to be affected by mechanical stress provoked by rigid structures and hinge points. Stent fracture might be associated with the high incidence of target lesion revascularization.