胆道内支架留置术

本文５例恶性肿瘤所致梗阻性黄疸患者，成功施行了胆道内架留置术，其中１例直接经Ｔ管留置；１例经Ｔ管内窥镜引导留置；１例Ｂ超下ＰＴＣＤ外引流术后留置；２例直接经ＰＴＣＤ后留置。所用支架４例为Ｚ型自胀式支架，１例为Ｗａｌｌｓｔｅｎｔ支架。支架直径８－１０ｍｍ，长度６－８ｃｍ，留置术后患者黄疸症状逐步减轻至消失，支架未出现再狭窄及移位。最长病例支架留置后存活一年，未出现再狭窄。我们认为，胆道内支架留置术是     

Significance of Stent Abutment in Gastroduodenal Stent Placement for Gastric Outlet Obstructions

Purpose

To evaluate the frequency, severity, and clinical significance of stent abutment (SA) after gastroduodenal stent placement in patients with gastric outlet obstruction caused by unresectable gastric cancer.

Coaxial Stent Graft inside a Constraining Stent for Transjugular Intrahepatic Portosystemic Shunt Reduction

A technique to create a coaxial, self-expanding stent graft inside a constraining, bare-metal, balloon-expandable stent for transjugular intrahepatic portosystemic shunt (TIPS) reduction is described. The key steps are performed on a back table rather than inside the patient, and the resulting construct is deployed using standard unsheathing maneuvers. The construct was used in 4 patients to make 6 TIPS diameter reductions (mean postreduction diameter, 6 mm; range, 0–8 mm), all resulting in increases in the portosystemic pressure gradient (mean increase, 6 mm Hg; range, 1–19 mm Hg). On average, hepatic encephalopathy improved 1 point on the West Haven scale (range, 0–2).     

Comparison of a New Polytetrafluoroethylene-Covered Metallic Stent to a Noncovered Stent in Canine Ureters

The aim of this study was to determine the feasibility of using a newly designed polytetrafluoroethylene (PTFE)-covered metallic stent in the ureter by comparing its effectiveness with that of the noncovered stent in a canine model. We placed 14 stents in the ureters of seven mongrel dogs that weighed 30–40 kg each. The covered and noncovered stents were deployed in the right and left ureters, respectively, of six dogs. In the seventh dog, a covered stent and a double-J catheter were inserted in the right ureter, and a covered stent only was inserted in the left ureter. The first six dogs were sacrificed at 5, 10, and 15 weeks after deployment of the stents (two for each follow-up period), and the seventh dog was sacrificed at 30 weeks. There was no migration or poor expansion of any of the stents observed on plain radiography. On intravenous pyelogram and retrograde pyelogram, all of the covered stents at each follow-up period had patent lumens at the stented segments without hydronephrosis, and the passage of contrast material through it was well preserved. The noncovered stents in the dogs sacrificed at 5 and 10 weeks and one of the two dogs sacrificed at 15 weeks showed near-complete occlusion of the stent lumen due to ingrowth of the soft tissue, and severe hydronephrosis was also noted. The noncovered stent in the other dog sacrificed at 15 weeks showed the passage of contrast material without hydronephrosis, but the lumen of the stent was still nearly occluded by the soft tissue. There was no evidence of hydronephrosis or passage disturbance of the contrast material in both ureters of the dog sacrificed at 30 weeks. We conclude that the newly designed PTFE-covered stent effectively prevented the luminal occlusion caused by urothelial hyperplasia compared to the near-total occlusion of the noncovered stents, and no migration of the covered stents was noted.     

Vascular Pathology and Impact of Stent Eccentricity for Stent Restenosis in Femoropopliteal Endovascular Therapy

PurposeTo explore the clinical features associated with stent eccentricity and reveal the impact of stent eccentricity on the risk of 1-year restenosis after femoropopliteal stent implantation for symptomatic atherosclerotic peripheral artery disease (PAD).Materials and MethodsThe clinical database of a multicenter prospective study was used. It registered 2,018 limbs of 1,766 patients in whom intravascular ultrasound (IVUS)-supported femoropopliteal endovascular therapy (EVT) for symptomatic atherosclerotic PAD was planned from November 2015 to June 2017. The study included 1,233 limbs of 1,088 patients implanted with a bare nitinol stent, drug-eluting stent (DES), or stent graft and administered ≥2 antithrombotic drugs. The stent eccentricity was evaluated using IVUS, calculated as [(maximum diameter) / (minimum diameter) ? 1] at the cross-sectional segment with the lowest lumen area after stent implantation.ResultsChronic total occlusion and bilateral arterial calcification (peripheral artery calcification scoring system Grades 3 and 4) were positively associated with stent eccentricity, whereas renal failure while receiving dialysis, DES use, and stent graft use were negatively associated with stent eccentricity (all P < .05). Stent eccentricity was associated with an increased risk of 1-year restenosis (odds ratio [OR], 1.18; 95% CI, 1.01–1.37; P = .034). However, after adjustment for lesion severity and implanted stent types, the association was no longer significant (OR, 1.07; 95% CI, 0.91–1.24; P = .43).ConclusionsStent eccentricity was not significantly associated with the risk of 1-year restenosis after femoropopliteal EVT.     

Palliation of Pyloric Stenosis Caused by Gastric Cancer Using an Endoscopically Placed Covered Ultraflex Stent: Covered Stent Inside an Occluded Uncovered Stent

A 71-year-old man developed pyloric stenosis caused by gastric cancer. Vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18-23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation showed a very narrow residual lumen. A covered Ultraflex stent (length 10 cm, inner diameter 18-23 mm) was inserted through the first stent and expanded to its maximum diameter over the next 2 days. The patient's vomiting and nausea improved rapidly. He died 6 months after the second stenting procedure, from metastatic tumor spread, having remained free of nausea and vomiting. In this case, a covered metallic stent prevented tumor ingrowth and maintained gastrointestinal patency.     

Stent placement for tracheobronchial disease

Early treatment for airway stenoses or occlusions involved open repair with the attendant risks of thoracotomy or sternotomy. With the advent of rigid and, more recently, flexible bronchoscopy, the placement of airway stents has come to the forefront in the treatment of benign and malignant tracheobronchial disease. This paper describes the history of surgical and endoluminal treatment of airway disease and discusses the indications and contraindications for airway stent placement. The advantages and limitations of such therapy are reviewed as well as the procedural details and the imaging evaluation and follow-up of patients undergoing endoluminal treatment. Although the placement of tracheobronchial stents is now primarily performed by interventional pulmonologists, imaging anatomically complex airway disease also requires the skills of an accomplished cross-sectional radiologist. Additionally, interventional radiologists using fluoroscopic guidance and alternative access routes to the airways can salvage failed bronchoscopic procedures and primarily treat selected cases. Due to the importance of pre- and post-procedural imaging in these patients, radiologists should be aware of airway anatomy suitable for stent placement and the appearance of various complications of this procedure.     

Hydrophilic Stent Coating Inhibits Platelet Adhesion on Stent Surfaces: Initial Results In Vitro

CardioVascular and Interventional Radiology - Endovascular stents and flow diverter stents (FDS) have revolutionized the treatment of intradural aneurysms; however, the need for dual anti-platelet...     

Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture

Objective  

This study was designed to compare the clinical effectiveness of intraluminal radioactive stent loaded with iodine-125 seeds implantation versus covered stent alone insertion in patients with malignant esophageal stricture.     

Primary and Secondary Percutaneous Ureteral Stent Placement: Comparison of Stent Patency and Clinical Outcome

CardioVascular and Interventional Radiology - To compare early double J ureteral stent (DJUS) dysfunction rate and long-term patency between two percutaneous ureteral stent placement methods:...     

Stent Diameter,Not Cephalic Arch Anatomy,Predicts Stent Graft Patency in Cephalic Arch Stenosis

PurposeTo investigate the relationship between anatomic factors and primary patency of brachiocephalic arteriovenous fistulae (AVFs) after stent graft (SG) placement for cephalic arch stenosis (CAS).Materials and MethodsThis retrospective study reviewed all cephalic arch SGs placed in brachiocephalic AVFs in a tertiary academic medical center between 2014 and 2017. Sixty-three patients were included in the study. The mean patient age at the time of SG placement was 62.6 years ± 19, and the mean patient follow-up was 1,994 days ± 353. A cohort of patients (n = 31) who underwent brachiocephalic fistulograms for CAS but only received percutaneous transluminal angioplasty (PTA) was the control group. Patient demographic characteristics, AVF anatomy, SG type, and clinical outcomes were reviewed. The duration of primary cephalic arch patency after SG placement was compared with that after previous PTA.ResultsThe median AVF age at the time of data retrieval was 345 days. The primary patency of CAS after SG placement at 6 months, 12 months, and 3 years was 64%, 49.9%, and 23.5%, respectively. Primary cephalic arch patency was significantly associated with the SG diameter (P = .007) but not with cephalic vein–axillary vein junction anatomy, size of feeding artery, or SG length (P > .05). The primary patency of CAS in patients treated with PTA only (n = 31) at 6 months, 12 months, and 3 years was 61%, 35%, and 0%, respectively, which was significantly lower than that in patients treated with SG placement (P = .01).ConclusionsThis study showed that the primary patency of CAS after SG placement was significantly higher than that of PTA-only treatment. Moreover, primary cephalic arch patency after SG placement was significantly associated with the SG diameter.     

Retrograde Transileal Conduit Stent Placement for Obstructed Uropathy—Success of Primary and Exchange Stent Placement

PurposeTo assess the safety, success, and complications associated with retrograde ureteric stent insertion via the ileal conduit.Materials and MethodsThe study population comprised 35 consecutive patients (17 men and 18 women; mean age, 55 y; age range, 40–75 y) requiring primary (20 stents) and exchange (70 stents) retrograde ureteric stent insertion via the ileal conduit over a 3-year period. Patient demographic data, procedural and technical data, and clinical follow-up data were collected.ResultsTechnical success was 90% (18 of 20) for primary stent placement and 100% (70 of 70) for stent exchange. There were two immediate complications (< 24 h) of sepsis and ureteric injury and one early complication (> 25 h but < 30 d) of sepsis requiring observation and medical management. Difficult procedures (defined as a fluoroscopy screening time > 31 min) and technical failures were found to be associated with encrusted stents visualized on prior computed tomography (P = .012), increased length of ileal conduit (> 20 cm) (P = .023), and ileal conduit kink (< 90 degrees) (P = .032). Only the occurrence of encrusted stents visualized on prior computed tomography (P = .022) was associated with complications.ConclusionsRetrograde placement of ureteric stents via the ileal conduit is safe and effective. Retrograde stent placement should be considered the treatment option of choice for a first-time occurrence of obstructive uropathy at the ureteroileal anastomosis.     

Stent, Ballon oder Clip?

Zusammenfassung Die Behandlung intrakranieller Aneurysmen ist in den letzten Jahren zunehmend durch die endovaskuläre Therapie übernommen worden. Eine technische Limitation stellen jedoch breitbasige Aneurysmen da, bei denen Coils aus dem Aneurysma in das Trägergefäß prolabieren können und dieses potentiell okkludieren. Heutzutage stehen allerdings Techniken zur Verfügung, um auch diese früher interventionell nicht therapierbaren Aneurysmen endovaskulär effektiv behandeln zu können. Es wurden verschiedene Techniken und Materialien entwickelt, um den breiten Hals eines Aneurysmas vorübergehend oder permanent bzw. komplett oder partiell zu verschließen und somit die Embolisation zu unterstützen oder überhaupt zu ermöglichen. Die „Remodeling-Technik“ verhindert durch temporären und kompletten Verschluss des Aneurysmahalses das Prolabieren der Coils in das Trägergefäß. Diese Technik wirkt aber auch modellierend auf das Coil-Paket, um die Coils in die meist unregelmäßige Form des Aneurysmas zu komprimieren und zu formen. Im Prinzip die identische Wirkungsweise, jedoch mit einem flüssigen Embolisat, hat die Behandlung mit Onyx. Eine permanente Kontrolle über den Aneurysmaeingang bieten ablösbare Systeme, wie TriSpan und vor allem Stents.Diese Übersichtsarbeit zeigt den heutigen Stand der Techniken und Systeme in der Behandlung von breitbasigen Aneurysmen, welche zunehmend einer endovaskulären Therapie zugänglich sind. Es besteht ein großes Potential für zukünftige Entwicklungen, um die interventionelle Behandlung weiter zu optimieren.     

Peripheral Stent Placement in Hemodialysis Grafts

The purpose of the present study was to evaluate the clinical outcome of peripheral stent placement after failed balloon angioplasty in patients with grafts who are on hemodialysis. We examined 30 Wallstents that were placed in 26 patients because balloon angioplasty failed or early restenosis (<3 months) occurred within 3 months. We retrospectively reviewed 267 consecutive balloon angioplasties performed in 71 patients with graft access between August 2000 and March 2007. Stent placements accounted for 30 (11.2%) of the 267 balloon angioplasties. The clinical success rate of stent placement was 93.3% (28 of 30 stent placements). The 3-, 6-, and 12-month primary patency rates were 73.3%, 39.3%, and 17.7%, respectively. The 1-, 2-, and 3-year secondary patency rates were 90.2%, 83.8%, and 83.8%, respectively. Primary patency was significantly prolonged by stent placement after early restenosis compared with previous balloon angioplasty alone (P = 0.0059). Primary patency after stent placement was significantly lower than after successful balloon angioplasty without indications for stent placement (P = 0.0279). Secondary patency rates did not significantly differ between stent placement and balloon angioplasty alone. The mean number of reinterventions required to maintain secondary patency after stent placement was significantly larger than that after balloon angioplasty alone (Mann–Whitney U test, P = 0.0419). We concluded that peripheral stent placement for graft access is effective for salvaging vascular access after failed balloon angioplasty and for prolonging patency in early restenosis after balloon angioplasty. However, reinterventions are required to maintain secondary patency after stent placement. Furthermore, peripheral stent placement for graft access cannot achieve the same primary patency as balloon angioplasty alone.     

Stent Placement on Fresh Venous Thrombosis

Purpose: To report on the efficacy of fixing fresh venous thrombus to the venous wall by stent placement. Methods: Seven patients underwent stenting to treat acute venous thrombosis. In two patients, the hemodialysis fistula was thrombosed with the thrombus extending into the brachial veins. In three patients, the hemodialysis fistula was patent but massive swelling of the ipsilateral arm was caused by proximal venous thrombosis. Two patients presented with iliac venous thrombosis within stented pelvic veins. Stent placement was preceded by other mechanical thrombectomy methods in all cases. Results: Attachment of thrombus to the venous wall was successful in all cases treated. Acute rethrombosis did not occur. Follow-up patency in dialysis patients was 7.2 ± 2.1 months. One patient had rethrombosis of the dialysis graft 3 months after primary treatment. Three patients developed restenosis within a mean period of 7.7 months. One shunt remained patent for 10 months with no event of reobstruction during follow-up. In both patients with iliac stent placement, the vein remained patent over a follow-up period of 8 and 12 months respectively. Conclusion: Stenting fresh venous thrombus can achieve immediate venous patency. It may be used as an alternative approach when all other percutaneous methods fail. Frequent restenosis within stented veins limits its use to very selected cases. Received: 0/00/00/Accepted: 0/00/00     

急性心肌梗塞冠状动脉支架植入术

目的探讨急性心肌梗塞(AMI)支架植入术的临床应用价值。材料和方法AMI冠状动脉高压球囊支架植入24例。男23例，女1例。年龄40～72岁，平均51.3岁。AMI前壁10例，前侧壁3例，前间壁2例，下壁和下后壁各4例，侧壁1例。结果26支与梗塞相关的血管植入支架28只。支架适应证Primary4例，Denovo5例，Suboptimal8例，Bial-out7例。术后血管残余狭窄3.8±6.9％，均无严重急性、亚急性血管和出血并发症。术后冠状动脉造影(CAG)随访3例，平均随访时间84.3天，无支架再狭窄。结论AMI确诊后尽早行支架植入术，可取得满意的疗效。     

食管内置放金属支架的选择

目的　严格掌握食管内支架置放适应证 ,提高金属支架的放置效果。方法　经胃镜在X线电视下植入 ,选用 2种材料支架 ,对 72例食管 (食管、胃连接部 )良恶性狭窄 ,共置放 83根金属支架。结果　置放支架均一次成功。以被覆镍钛合金支架效果较好。患者的生活质量均得到提高。结论　失去手术治疗机会 (包括放射治疗 )的晚期肿瘤或肿瘤手术后 (复发 ) ,而引起管腔狭窄的患者可首选食管内支架置放术 ,良性狭窄慎用此术 ,无被覆支架不宜采用。     

Budd-Chiari综合征血管内支架治疗

目的：研究完全闭塞型及合并肝静脉病变的Ｂｕｄｄ－Ｃｈｉａｒｉ综合征介入治疗方法和支架移位的防治。方法：１２例Ｂｕｄｄ－Ｃｈｉａｉｒ综合征，膜性狭窄７例，节段性病变５例，术前下腔静脉内径平均０．５６ｍｍ，平均静脉压３．２０±０．４６ｋＰａ。在球囊扩张的基础上置入了血管内支架。结果：技术操作全部成功，无严重并发症发生。临床症状及体征明显好转，治疗后下腔静脉直径平均达１９．８０ｍｍ，平均静脉压１．５０±０．４０ｋＰａ。经２－２３个月（平均１１．５个月）的随访，除１例因支架移位引起再狭窄外，其余下腔静脉血流均通畅，未出现再狭窄。结论：Ｂｕｄｄ－Ｃｈｉａｒｉ综合征血管内支架治疗，近期及中期疗效显著，是理想的治疗方法。