共查询到20条相似文献,搜索用时 31 毫秒
1.
I. Kaare Tesdal Werner Jaschke Mathias Bühler Ralf Adamus Thomas Filser Eggert Holm Max Georgi 《Cardiovascular and interventional radiology》1997,20(1):29-37
Purpose To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic
stents.
Methods Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35–72 years, mean 54 years) underwent the TIPS
procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies,
wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n=48) and self-expanding (n=45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range
3–24 months) were obtained in 39 of these patients.
Results Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy,
the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n=1) and late shortening (n=4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its
lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up
(mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant
complications related to the TIPS insertions.
Conclusion An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding
stent. 相似文献
2.
Metallic stents for treatment of benign biliary obstruction: a long-term study comparing different stents 总被引:4,自引:0,他引:4
Tesdal IK Roeren T Weiss C Jaschke W Dueber C 《Journal of vascular and interventional radiology : JVIR》2005,16(11):1479-1487
PURPOSE: To investigate the role of metallic stents in the treatment of benign biliary strictures and analyze the differences in primary patency associated with the various types of stents deployed. MATERIALS AND METHODS: Between 1990 and 1997, 21 patients with benign obstructive jaundice were treated with transhepatic placement of metallic stents (11 Wallstents in 10 patients, nine Palmaz stents in seven patients, and four tantalum Strecker stents in four patients). Nineteen patients presented with strictures not responding to balloon angioplasty (postsurgical, n = 13; cholangitis, n = 5; unknown, n = 1). Estimates for cumulative patency, patency rate in the different stent groups, and survival were calculated with use of life-table analysis; the log-rank test was used to compare the different stent groups. The prognostic relevance of the selected variables-stent type, stent length, etiology, and location-were modeled with respect to patency according to Weibull distribution. RESULTS: The median follow-up time was 80.5 months (range, 2-116 months). The median survival time was 91 months. One patient was lost to follow-up after 3 months. Repeat intervention for recurrent obstructive jaundice was necessary in 11 patients (55%), and the median patency rate was 26 months (range, 2-96 months). The Palmaz stent was the most effective in achieving long-term patency, with a median patency duration of 36 months (range, 22-96 months), versus 9 months (range, 3-67 months) for the Wallstent and 6 months (range, 2-15 months) for the tantalum Strecker stent. The cumulative patency rate with the Palmaz stent was significantly higher than for the tantalum Strecker stent (log-rank test, P = .017) and nonsignificantly higher compared with the Wallstent (log-rank test, P = .07). Multivariate analysis showed that the type of stent (Wald test, P = .003) and stent length (Wald test, P < .0001) influenced the patency rate. CONCLUSIONS: These results suggest that the type of stent and the stent length have a significant influence on the patency rate. In this series, the Palmaz stent was most effective in achieving long-term patency in benign biliary strictures. 相似文献
3.
Miltiadis Krokidis Fabrizio Fanelli Gianluigi Orgera Mario Bezzi Roberto Passariello Adam Hatzidakis 《Cardiovascular and interventional radiology》2010,33(1):97-106
To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant
jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half
of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death.
Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in
9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent
group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior
to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication
rates. Appropriate patient selection should be performed prior to stent placement. 相似文献
4.
Karl Schürmann M.D. Dierk Vorwerk Arthur Kulisch Eva Stroehmer-Kulisch Stefan Biesterfeld Tadeusz Stopinski Rolf W. Günther 《Cardiovascular and interventional radiology》1996,19(4):248-254
Purpose To compare neointima formation following insertion of low-profile Nitinol stents, Palmaz stents, and Wallstents.
Methods Nitinol stents, Palmaz stents, and Wallstents similar in size were transfemorally inserted into the iliac arteries of 12 sheep.
Four stents per sheep were deployed; the position of the stents was varied so that each type of stent was placed in each position
(right or left, proximal or distal) with equal frequency. Stent patency was followed by angiography. Six sheep were euthanized
after 1 month, and the remaining six after 6 months. Iliac arteries were removed en bloc and prepared for histological examination.
Neointimal and medial thickness were measured by light microscopy, and measurements were analyzed statistically.
Results Mean neointimal thickness both over (NO) and between (NB) the stent struts was greater in Wallstents (NO=0.341 mm, NB=0.368
mm) than in the Nitinol (NO=0.260 mm, NB=0.220 mm) and Palmaz stents (NO=0.199 mm, NB=0.204 mm), but differences were not
significant (p>0.05). Medial atrophy in the area between the stent struts was greater in Wallstents compared with Nitinol and Palmaz stents
(p<0.007 andp<0.02, respectively); in the area under the stent struts there was a significant difference only between Palmaz stents and
Wallstents (p<0.02).
Conclusion Under defined experimental conditions, none of the three types of stent appears to be preferable to the others regarding neointima
formation in the short-to mid-term follow-up period. 相似文献
5.
Venous recanalization by metallic stents after failure of balloon angioplasty or surgery: Four-year experience 总被引:2,自引:0,他引:2
Gwen K. Nazarian M.D. William R. Austin Scott A. Wegryn Haraldur Bjarnason Daniel J. Stackhouse Wilfrido R. Castañeda-Zúñiga David W. Hunter 《Cardiovascular and interventional radiology》1996,19(4):227-233
Purpose: This retrospective study describes our updated experience in treating venous stenoses and occlusions with metallic endovascular
stents.
Methods: Gianturco, Palmaz, and Wallstent stents were placed in 55 patients over a 4-year period. Stent sites included the subclavian
veins (9), innominate veins (3), superior vena cava (4), inferior vena cava (3), iliac veins (29), femoral veins (5), and
portal veins (6). The most common indications for stent placement were malignant stenoses and chronic pelvic venous occlusions.
Venoplasty and/or urokinase were used as ancillary therapy. Patients were anticoagulated for 3–6 months. Follow-up included
clinical assessment and duplex ultrasound.
Results: Lifetable analysis shows 59%, 63%, and 72% primary, primary assisted, and secondary 1-year patency rates, respectively. The
4-year primary patency rates were the same. Duration of patency depended on the venous site. Death was a complication of stent
placement in 2 patients and 12 patients died within 6 months after stent placement from primary disease progression. Although
early failures were more common in stents placed across occlusions than stenoses, 1-year secondary patency rates were comparable.
Primary patency rates were only slightly lower in patients with malignant obstruction than in patients with benign disease.
Conclusion: Endovascular stent placement provides a nonsurgical alternative for reestablishment of venous flow and symptomatic relief
in patients with benign as well as malignant venous obstruction.
Received: 0/00/00/Accepted: 0/00/00 相似文献
6.
Kuhlman CG Patel NH Johnson MS Shah H Namyslowski J Stecker MS Johnson CS Trerotola SO 《Journal of vascular and interventional radiology : JVIR》2002,13(4):405-408
Thirteen patients underwent placement of a balloon-expandable stent either at initial transjugular intrahepatic portosystemic shunt (TIPS) creation (n = 3) because of immediate technical failure of the Wallstent or at shunt revision because of failure of the Wallstent to reduce the portosystemic gradient 相似文献
7.
de Gregorio Ariza MA Gamboa P Gimeno MJ Alfonso E Mainar A Medrano J López-Marin P Tobio R Herrera M 《European radiology》2003,13(4):853-862
The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with
benign and malignant disease using expandable metallic stent. From January 1995 to April 2000, 87 expandable stents were implanted
in 82 patients (59 men, 23 women; mean age 57.8 years, age range 39–79 years) for the treatment of SVCS. The SVCS was defined
as symptomatic bilateral obstruction of venous drainage from head, neck and upper extremities. In 68 patients SVCS was due
to malignant neoplasia, and in 14 cases it was due to benign aetiology. All patients were treated with expandable stent. We
implanted 81 Wallstent prostheses and 6 Palmaz stents. Adjuvant thrombolysis was applied in 12 patients who required fibrinolysis.
After recanalization, the stent was implanted in all cases in SVC (infra- or supra-azygos vein). All patients were treated
with heparin of low molecular weight (HBPM) during 6 months. Patency was analyzed according to clinical symptoms and Doppler
US or venograms exploration. Technical success was observed in all cases. Clinical success was reached in 78 of 82 patients
(95.1%) (absence of symptoms in 2 or 3 days). Four patients suffered immediate thrombosis which required fibrinolitic treatment
with a new prosthesis placement in 1 case. The follow-up for the malignant process was of 7.1 months (range 1–39 months) and
in benign cases was 31.2 months (range 11–61 months). Sixty-two (91.1%) patients with malignancy died without SVCS symptomatology.
All the patients with benign pathology are alive. Clinical primary patency in malignant cases was 87% with assisted patency
of 96.2%. Endovascular therapy using metallic stent and thrombolysis is a successful method to treat SVCS due to benign or
malignant aetiology.
Electronic Publication 相似文献
8.
K A Hausegger J Lammer B Hagen F Flückiger M Lafer G E Klein E Pilger 《Acta radiologica (Stockholm, Sweden : 1987)》1992,33(4):292-296
A total of 82 iliac artery lesions (62 stenoses and 20 occlusions) were treated with 3 different types of endovascular metallic stents (12 lesions with the Palmaz stent, 36 with the Wallstent, and 34 with the Strecker stent). The complication rate was 12%. Occlusion of 2 Wallstents occurred 4 and 12 weeks after stent placement, respectively. Both stents were recanalized by local fibrinolysis. One Strecker stent occluded after 8 months. The observation period was 3 to 26 months (mean 9.7 months). The patency rate with secondary intervention (fibrinolysis) was 100% after 3 and 6 months, and 98% after 9 months. All 3 stent designs turned out to be effective in the treatment of complicated iliac artery occlusive disease. 相似文献
9.
Purpose: To retrospectively evaluate the
patency of Wallstents placed at the venous anastomosis of
polytetraflouroethylene (PTFE) hemodialysis grafts to preserve function
following angioplasty-induced rupture.
Methods: The
charts of all patients who underwent percutaneous angioplasty of
functioning hemodialysis PTFE grafts between September 1997 and
September 2001 were retrospectively reviewed. A total of 414
angioplasties were performed. Nine cases of rupture at the venous
anastomosis managed with stent placement were identified (7 women, 2
men). Two grafts were loop grafts, seven grafts were straight grafts.
All stents placed were Wallstents; six stents were 8 × 40 mm, the
remaining three were 8 × 20 mm, 8 × 60 mm and 10 × 42
mm. Average follow-up was 13 months.
Results: Technical
and clinical success of stent placement was 100%. The primary patency
rates (±SE) of stents placed at the venous anastomosis were 88%
(12%) at 30 days, 63% (17%) at 90 days, 33% (18%) at 180 days and
17% (15%) at 360 days. The secondary patency rates (±SE) were 89%
(11%) at 90 days, 76% (15%) at 180 days and 69% (23%) (6 stents
patent) at 360 days. During follow-up, one graft was removed because of
infection, one patient died and another was lost to follow-up. A single
minor complication of a puncture site hematoma occurred (11%) with no
major complications.
Conclusions: This small
retrospective series suggests that Wallstent placement following
angioplasty-induced venous anastomotic rupture is effective for
preserving dialyzable flow in hemodialysis grafts. Patency is
comparable to that of stents placed for reasons other than rupture. 相似文献
10.
Karl Schürmann Dierk Vorwerk Arthur Kulisch Christoph Rosenbaum Stefan Biesterfeld Rolf W. Günther 《Cardiovascular and interventional radiology》1995,18(6):383-390
Purpose Puncture of venous Wallstents and nitinol stents with dialysis needles was tested in an animal study.Methods In 15 sheep, divided into a group with prior surgical unilateral carotid-jugular shunt creation (9 sheep) and a second group without shunt creation (6 sheep), a self-expanding nitinol stent and/or a Wallstent were bilaterally placed into the jugular veins. After 1 month, 10 nitinol stents and 9 Wallstents were punctured weekly with a 15-gauge cannula over a period of 15 weeks. Stent patency was followed up by colorcoded duplex ultrasound and angiography. After sacrifice, high resolution X-rays of the removed vessels were taken to assess stent deformation. From histological slices, neointimal thickness inside the stents was measured and analyzed statistically.Results Puncturing of both the nitinol stent and the Wallstent was technically feasible. Stent deformations were not found. One stent stenosis, probably related to puncture, was observed. The pattern of intimal hyperplasia differed between the nitinol stent and the Wallstent. Outward bulge of the vascular layers over the stent struts was greater in nitinol stents. In the relevant area in between the stent struts there was no significant difference in intimal thickness between the two types of stents. Intimal thickness was more pronounced in shunted than in nonshunted animals only in the Wallstent subgroup (p = 0.025) and more pronounced in punctured than in nonpunctured stents only in the nitinol stent subgroup (p = 0.018).Conclusion Puncturing of stents was feasible without major short-term complications. Therefore, stent implantation into the punctured segment of a hemodialysis fistula may be indicated if there is no alternative treatment. 相似文献
11.
Expandable Metal Stents for the Palliation of Malignant Gastroduodenal Obstruction 总被引:11,自引:0,他引:11
Razzaq R Laasch HU England R Marriott A Martin D 《Cardiovascular and interventional radiology》2001,24(5):313-318
Purpose: Gastric outlet obstruction is a debilitating complication of upper gastrointestinal malignancy. We present our experience
with insertion of self-expanding metal stents (SEMS).
Methods: Twenty-eight patients were referred, stenting being attempted in 23. Two patients had esophageal Wallstents inserted through
a gastrostomy; 21 had an endoscopic approach with enteral Wallstents.
Results: One stent insertion failed, ten patients (45%) returned to a normal diet, ten patients (45%) managed semi-solid food and
two patients (9%) had no significant improvement. No immediate complications were seen. One patient subsequently developed
pancreatitis. Reintervention (4 stents, 1 jejunostomy, 1 gastrojejunostomy) was required in six of 22 patients (27%) for inadequate
stent expansion (1), second stricture (2), stent migration (1), and tumor ingrowth (2). The mean survival was 95.4 days (SD
78.8 days, range 3–230 days). The mean follow-up time was 98.9 days (SD 86.7 days, range 3–309 days).
Conclusions: SEMS are effective in palliating malignant gastric outlet obstruction. A combined endoscopic/fluoroscopic approach allows
the most complete assessment of the stricture and removes the need for gastrostomy insertion. Careful assessment of the gastrointestinal
tract distal to the lesion is important. 相似文献
12.
Percutaneous cholangioscopy in obstructed biliary metal stents 总被引:2,自引:0,他引:2
Klaus A. Hausegger Hans J. Mischinger Radenko Karaic Guenther E. Klein Cristian Kugler Robert Kern Martin Uggowitzer Dieter Szolar 《Cardiovascular and interventional radiology》1997,20(3):191-196
Purpose To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings.
Methods Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason
for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered
stents had been inserted in 12 patients; in 3 cases a polyurethane-covered prototype Wallstent had been used. Stent occlusions
occurred after 1–55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the
working channel of the endoscope.
Results In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven
granulation tissue). Stent incorporation varied from absent (n=1) to subtotal (n=8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in
2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents,
the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth
in one of them.
Conclusion PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion
are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important,
although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and
the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients
with such a stent was 3 months. 相似文献
13.
Majid Maybody Karen T. Brown Lynn A. Brody Anne M. Covey Constantinos T. Sofocleous Raymond H. Thornton George I. Getrajdman 《Cardiovascular and interventional radiology》2009,32(4):707-713
The purpose of this study was to determine the primary patency of two or more noncoaxial self-expanding metallic Wallstents
(Boston Scientific, Natick, MA) and to compare this with the primary patency of a single stent in malignant bile duct obstruction.
From August 2002 to August 2004, 127 patients had stents placed for malignant bile duct obstruction. Forty-five patients were
treated with more than one noncoaxial self-expanding metallic stents and 82 patients had a single stent placed. Two patients
in the multiple-stent group were lost to follow-up. The primary patency period was calculated from the date of stenting until
the first poststenting intervention for stent occlusion, death, or the time of last documented follow-up. The patency of a
single stent was significantly different from that of multiple stents (P = 0.0004). In the subset of patients with high bile duct obstruction, the patency of a single stent remained significantly
different from that of multiple stents (P = 0.02). In the single-stent group, there was no difference in patency between patients with high vs. those with low bile
duct obstruction (P = 0.43). The overall median patency for the multistent group and the single-stent group was 201 and 261 days, respectively.
In conclusion, the patency of a single stent placed for malignant low or high bile duct obstruction is similar, and significantly
longer than, that of multiple stents placed for malignant high bile duct obstruction. Given the median patency of 201 days,
when indicated, percutaneous stenting of multiple bile ducts is an effective palliative measure for patients with malignant
high bile duct obstruction. 相似文献
14.
Magnetic resonance angiography of intravascular endoprostheses: Investigation of three devices 总被引:2,自引:0,他引:2
Jean-Pierre Laissy Céline Grand Celso Matos Julien Struyven Jean-François Berger Elisabeth Schouman-Claeys 《Cardiovascular and interventional radiology》1995,18(6):360-366
Purpose To assess the value of magnetic resonance angiography (MRA) in the evaluation of vascular patency after intravascular endoprosthesis placement.Methods Three different metallic stents (Wallstent, Strecker, Palmaz) were studied in vitro, and in vivo in six patients with spin-echo (SE) and gradient-echo (GRE) MR imaging. Time-of-flight, two-dimensional (2D) gadolinium-enhanced MRA was performed with GRE and flow-compensation technique, and reconstructed with a maximum-intensity projection (MIP) algorithm. MRA was compared to digital angiograms.Results In vitro studies demonstrated that the signal intensity (SI) within the stent differed according to the device employed, the lowest SI being observed within the Palmaz stent (p = .001). There was no difference in SI or apparent diameter of the stent according to the sequence (SE vs GRE) or length of echo time (TE). In patients, the endoprostheses recorded as a well-defined area of signal void or drop-out (p = 0.004), whereas vessels above and below the stent displayed high signal intensities.Conclusion MRA does not seem as yet to be well suited for evaluating vascular patency after endoprosthesis placement, even if the Strecker and Wallstent endoprostheses provide fewer artifacts than the Palmaz stent. 相似文献
15.
Roger Philip Davies M.D. Guy Richard James Sissons Neil Adair McIntosh 《Cardiovascular and interventional radiology》1993,16(2):105-108
A percutaneous transjugular intrahepatic portocaval shunt (TIPS) was successfully performed using Wallstents in a 53-year-old
man with neoplastic disease causing portal hypertension and life-threatening variceal hemorrhage. Shortly after-wards, recurrent
hemorrhage was investigated by shunt venography which showed that extrinsic narrowing of the hepatic vein and hepatic vena
cava was causing shunt thrombosis. Shunt thrombosis was cleared by balloon occlusion of the shunt and forceful retrograde
flushing of thrombus into the portal circulation. The compressed hepatic vein and vena cava were then dilated and stented
using Gianturco “Z” stents. Bleeding recurred 3 months later due to focal narrowing within the shunt which possibly was due
to intimal proliferation. Repeat dilatation and placement of a coaxial Palmaz stent again relieved portal hypertension. Creation
of a TIPS for portal hypertension secondary to neoplasm can produce valuable palliation. Complete assessment of hepatic vein
and vena cava patency is required to ensure shunt function. 相似文献
16.
Christoph A. Binkert Eric Schoch Gerd Stuckmann Jon Largiader Pius Wigger Wolfdietrich Schoepke Christoph L. Zollikofer 《Cardiovascular and interventional radiology》1998,21(1):22-26
Purpose: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative
to surgery.
Methods: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients
(seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic
leg swelling). Four patients had surgical thrombectomy prior to stent placement.
Results: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency
rate of 100% was observed during an average follow-up of 3 years (range 10–121 months). There were no procedural or stent-related
complications.
Conclusion: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative
to surgery in the treatment of symptomatic pelvic venous spur.
Received: 0/00/00/Accepted: 0/00/00 相似文献
17.
Treatment of common bile duct obstruction by pancreatic cancer using various stents: single-center experience 总被引:4,自引:2,他引:2
Nakamura T Hirai R Kitagawa M Takehira Y Yamada M Tamakoshi K Kobayashi Y Nakamura H Kanamori M 《Cardiovascular and interventional radiology》2002,25(5):373-380
PURPOSE: To compare the effectiveness of various means of stenting in patients with biliary obstruction caused by pancreatic cancer in a retrospective analysis. METHODS: Sixty-two patients with biliary obstruction due to unresectable pancreatic cancer underwent biliary stenting. On the basis of the findings obtained by percutaneous transhepatic cholangiography (10 patients) and endoscopic retrograde cholangiography (52 patients), the site of obstruction was distal to the hilar confluence, predominantly especially in the middle to lower third of the common bile duct. Polyurethane-covered Wallstents (9 mm in diameter) were inserted in 13 patients, while uncovered Wallstents (10 mm in diameter) were used in 10 patients and plastic stents (10 Fr and 12 Fr) were used in 39 patients. RESULTS: Stenting was successful in 34 patients (87.2%) treated with plastic stents and in 22 patients (95.7%) treated with Wallstents. Effective biliary drainage was achieved in 32 out of 34 patients (94.1%) treated with plastic stents and in 21 out of 22 patients (95.5%) treated with Wallstents. The cumulative patency rate was significantly higher for the uncovered and covered Wallstents compared to plastic stents, but was not significantly higher for covered than for uncovered Wallstents. Stent occlusion occurred in 23 patients (70%; all by clogging) from the plastic stent group, in two patients (22%; by tumor ingrowth) from the uncovered Wallstent group, and in one patient (9%; by clogging) from the covered Wallstent group. The survival rate showed no significant difference among the three stent groups. CONCLUSION: The Wallstent is effective for long-term palliation in patients with obstruction caused by pancreatic cancer invading the middle to lower part of the common bile duct. The covered Wallstent can prevent tumor ingrowth, a problem with the uncovered Wallstent. However, it may be necessary to take measures to prevent the migration or clogging of covered Wallstents. 相似文献
18.
Siegfried A. Thurnher M.D. Johannes Lammer Majda M. Thurnher Friedrich Winkelbauer Oswald Graf Reinhard Wildling 《Cardiovascular and interventional radiology》1996,19(1):10-14
Purpose: We report our preliminary results with a new type of self-expanding covered stent for treatment of malignant biliary obstruction.
Methods: Wallstents, fully covered with high elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of
69 mm, were placed transhepatically under fluoroscopic guidance in five patients. The length of the biliary obstruction varied
between 30<+>–<+>50 mm. At 1 and 3 months (82<+>–<+>98 days) clinical assessment, serum bilirubin measurement, and ultrasound
examination of the biliary tree were performed.
Results: Initial uncomplicated deployment of the stents and internal drainage was possible in all patients. Distal stent migration
resulted in early biliary reobstruction in one patient. At 3-month follow-up, partial reobstruction, most probably due to
sludge formation, was found in another patient.
Conclusion: Our initial results indicate that the covered, self-expanding Wallstent endoprosthesis can be reliably and safely deployed
transhepatically for malignant biliary obstruction. 相似文献
19.
Miltiadis Krokidis Fabrizio Fanelli Gianluigi Orgera Dimitrios Tsetis Ioannis Mouzas Mario Bezzi Elias Kouroumalis Roberto Pasariello Adam Hatzidakis 《Cardiovascular and interventional radiology》2011,34(2):352-361
The purpose of this study was to compare the clinical effectiveness of expanded polytetrafluoroethylene/fluorinated-ethylene-propylene
(ePTFE/FEP)–covered stents with that of uncovered nitinol stents for the palliation of malignant jaundice caused by inoperable
pancreatic head cancer. Eighty patients were enrolled in a prospective randomized study. Bare nitinol stents were used in
half of the patients, and ePTFE/FEP–covered stents were used in the remaining patients. Patency, survival, complications,
and mean cost were calculated in both groups. Mean patency was 166.0 ± 13.11 days for the bare-stent group and 234.0 ± 20.87 days
for the covered-stent group (p = 0.007). Primary patency rates at 3, 6, and 12 months were 77.5, 69.8, and 69.8% for the bare-stent group and 97.5, 92.2,
and 87.6% for the covered-stent group, respectively. Mean secondary patency was 123.7 ± 22.5 days for the bare-stent group
and 130.3 ± 21.4 days for the covered-stent group. Tumour ingrowth occurred exclusively in the bare-stent group in 27.5% of
cases (p = 0.002). Median survival was 203.2 ± 11.8 days for the bare-stent group and 247.0 ± 20 days for the covered-stent group
(p = 0.06). Complications and mean cost were similar in both groups. Regarding primary patency and ingrowth rate, ePTFE/FEP–covered
stents have shown to be significantly superior to bare nitinol stents for the palliation of malignant jaundice caused by inoperable
pancreatic head cancer and pose comparable cost and complications. Use of a covered stent does not significantly influence
overall survival rate; nevertheless, the covered endoprosthesis seems to offer result in fewer reinterventions and better
quality of patient life. 相似文献
20.
C. Gazzera D. Righi F. Valle A. Ottobrelli M. Grosso G. Gandini 《La Radiologia medica》2009,114(1):83-94