Wingspan stent for symptomatic M1 stenosis of middle cerebral artery

Objective

Stent placement for intracranial atherosclerotic stenosis has become an alternative treatment technique; however, stent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis, and its initial effect on prevention of ischemic events.

Methods

Fifty-three cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively (average 58 ± 18.5 years old, 19 women). All patients underwent angioplasty and stenting with the Gateway balloon–Wingspan stent system, and advised follow-up with DSA or TCD at 6th month.

Results

Patients had an average stenosis ratio of 76.5 ± 15.4% prior to the treatment. Of the 53 patients, the technical success rate was 98.1% as a whole (52/53). The mean degree of stenosis reduced from (76.5 ± 15.4)% to (18.2 ± 11.3)%. Complications associated with the procedure include subarachnoid hemorrhage (1.89%) and occlusion (3.78%) occurred. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 52 cases with successful stenting. Cerebral hemodynamics of MCA using transcranial Doppler monitoring were at normal level (<120 cm/s) in 41 follow-up patients. The follow up angiography at 6 month post-procedure was conducted in 32 patients and showed good patency in stented vessels.

Conclusions

Wingspan stent for symptomatic stenosis of middle cerebral artery is a safe and feasible procedure. It improves clinical outcome in the intermediate follow up, but its long-term effect remains to be further evaluated.     

Endovascular Treatment of Ruptured Abdominal Aneurysm into the Inferior Vena Cava in Patient After Stent Graft Placement

We report the case of a patient who underwent endovascular repair and then reintervention as a result of the presence of a persistent endoleak complicated by an aortocaval fistula. A 76-year-old patient with a history of endovascular treatment for abdominal aortic aneurysm 2 years earlier had a palpable abdominal mass, high-output cardiac failure, and renal failure. A computed tomographic scan and angiography revealed bending of the right iliac limb, a type I endoleak, and rupture of the aneurysm into the inferior vena cava with aortocaval fistula formation. An iliac extension was positioned in the right external iliac artery. The procedure was finished successfully. Control angiography showed normal flow within the endoprosthesis, and both iliac arteries were without signs of endoleakage and aortocaval fistula. Ectatic common iliac artery may lead to a late distal attachment site endoleak. The application of a stent graft in cases of secondary aortocaval fistula after stent graft repair is a good option, particularly in emergency cases.     

Peripheral endografts for the treatment of traumatic arterial injuries

Catheter-based endovascular techniques for vascular trauma management are being increasingly reported. Covered stents may be inserted and deployed through a remote site of percutaneous access under local anesthesia and are ideal for treating arterial ruptures and pseudoaneurysms and to seal off arteriovenous communications. Advantages of endovascular stent-graft repair of peripheral traumatic arterial injuries include less blood loss and tissue damage, reduced operative time and morbidity, shortened hospital stay and recovery periods, and reduced healthcare costs. The present report provides an overview of the role of balloon-expandable and self-expandable covered stents in the minimally invasive treatment of various types of traumatic arterial injuries.     

Treatment of a malignant esophageal fistula with a Gore-Tex-covered flexible nitinol stent

In order to treat fistulated esophageal cancer using a flexible stent, a covered flexible stent was constructed by wrapping a nitinol stent with a thin sheet of Gore-Tex, preserving the stents original advantages of flexibility and a low-profile introducer system. This stent was used to perform standard radiotherapy in a case of fistulated esophageal cancer.     

Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: Technical and clinical aspects after 3 1/2 years’ experience

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.     

自膨式支架治疗恶性食管狭窄

目的：评价置入自膨式食管支架缓解因恶性食管狭窄引起的咽下困难的安全性和效果。方法：３６例恶性食管狭窄患者放置了自膨式金属支架，所有患者均表现为明显的咽下困难，支架置入前后行食管造影对比观察。全部操作均在Ｘ线监视下进行。结果：所有患者支架位置放置正常，无操作失误和与操作有关的并发症发生，支架置入后咽下困难立即得到明显缓解。３６例中３５例可以进正常饮食，１例进半流食。结论：自膨式支架治疗恶性食管狭窄安全，操作简单，疗效确实。食管肿瘤的生长可能引起食管再狭窄。     

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。     

金属内支架治疗恶性梗阻性黄疸的临床研究：附33例分析

目的：总结胆管金属内支架放置术的临床经验和疗效分析。材料与方法：恶性梗阻性黄疸患者３３例，男２３例，女１０例。胆管癌１６例，胰头癌２例，原发性肝癌２例，肝转移瘤３例，肝门淋巴结转移瘤压迫胆管１０例。本组共采用金属内支架行内引流３３例，共使用６种３８枚金属内支架。１２例支架放置术后加局部放射治疗和化学治疗（简称放、化疗）。结果：３３例采用经皮经肝穿刺置入胆管支架均获得成功，其中２９例一次性植入支架，４例先行胆汁引流术（ＰＴＢＤ）后再放置金属内支架；９例因胆管梗阻复杂，金属支架置入后仍保留引流导管，其中３例在置管１５～２００天后拔除引流管。２８例（８４．８５％）黄疸消退满意。本组中位生存期７个月，支架植入后加局部放、化疗组中位生存期１０个月。结论：胆管内金属支架治疗恶性梗阻性黄疸，可用于不能手术治疗的高位胆管梗阻，支架植入后加局部放、化疗可望提高远期疗效。     

经皮胆道内支架置放术治疗胆道狭窄

目的：采用经皮肝穿胆道支架置入术治疗阻塞性黄疸并探讨其疗效、技术要点及并发症。材料与方法：２５例胆道狭窄接受经皮经肝胆道内支架置入术，其中胆管癌１６例，胰头癌４例，肝门区转移癌３例和胆道术后狭窄２例。结果：技术成功率为９６．０％。２例患者分别行右、左肝管双支架置入。恶性梗阻者６个月生存率为７３．３％，１２个月为４６．６％。６个月胆道再狭窄率为４０．０％。主要并发症为轻度胆道出血（４４．０％）和逆行感染（８．０％），经保守治疗痊愈。结论：结果显示本术治疗胆管狭窄安全有效，技术成功率较经ＥＲＣＰ途径高。配合动脉内化疗灌注可提高恶性阻塞患者的生存率。     

Multi-detector row CT angiography in the assessment of coronary in-stent restenosis: a systematic review

Purpose

The aim of this study was to perform a systematic review of the diagnostic accuracy of multi-detector row computed tomography angiography (MDCT) for detection of coronary in-stent restenosis in patients treated with coronary stenting when compared to invasive catheter angiography.

Materials and methods

A search of PUBMED and MEDLINE databases for English literature was performed. Only studies with at least 10 patients comparing 16- or more detector rows MDCT angiography with invasive catheter angiography in the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model.

Results

15 studies met selection criteria for inclusion in the analysis. There were eight studies performed with 16-detector row CT scanners, and five studies with 64-detector row scanners and one study with a 40-detector scanner. The remaining study was performed with a mixture of 16-and 64-detector row scanners. Prevalence of in-stent restenosis following coronary stenting was 18% (95% CI: 13, 24%). Pooled estimates of the sensitivity and specificity of overall MDCT angiography for the detection of coronary in-stent restenosis was 85% (95% CI: 78, 90%) and 97% (95% CI: 95, 98%), respectively. No significant difference was found between 16- and 64-detector row scanners regarding the sensitivity and specificity of MDCT for assessment of in-stent restenosis (p > 0.05).

Conclusion

The results showed that MDCT angiography (with 16 or more detector rows) has moderate sensitivity and high specificity for the detection of coronary in-stent restenosis when compared to invasive catheter angiography. A high specificity value of MDCT may be most valuable as a non-invasive technique of excluding coronary stent restenosis or occlusion. The main factors affecting visualization are stent diameters and stent materials.