Five-year clinical outcomes using the bioresorbable vascular scaffold: Insights from the FRANCE ABSORB registry

Central illustration: cumulative major adverse cardiac events (MACE) and bioresorbable vascular scaffold (BVS) thrombosis rates after 1, 2, 3, 4 and 5 years.

     

Intracranial Angioplasty and Stenting in the Awake Patient

BACKGROUND AND PURPOSE: Endovascular treatment for intracranial atherosclerosis is evolving, but complications remain an issue. Most interventions are performed under general anesthesia, preventing intraprocedural clinical evaluations. We describe our approach to intracranial angioplasty and stenting, using local rather than general anesthesia, and intraprocedural neurological assessment. METHODS: We prospectively collected procedural and outcome information on all patients undergoing intracranial angioplasty and stenting. Patients underwent interventions under local anesthesia with mild intravenous sedation or analgesia only if needed. Intraoperative neurological evaluations were performed, and symptomatology was used to guide the interventional technique. RESULTS: Forty-eight arteries in 40 patients with a mean age of 65.2 years were treated. Thirty-two anterior and 16 posterior circulation segments were treated. Technical success was achieved in 100% of patients with reduction of the mean pretreatment stenosis from 85 +/- 8.6% to 7 +/- 10.1%. Stents were deployed in 40 segments; five patients were treated with drug-eluting stents. The cobalt-chromium coronary stents were the easiest to deliver. Thirty-seven patients were treated under local anesthesia and, of those, 61.4% experienced intraprocedural symptoms that led to some alteration of the interventional technique. Headache was the most common symptom, and, when persistent, it heralded the occurrence of subarachnoid hemorrhage. There were seven total neurological complications, but only five (10.5%) led to permanent morbidity (4 strokes) or mortality (1 death). CONCLUSIONS: Intracranial angioplasty and stenting can be successfully performed using coronary techniques and equipment including drug-eluting stents. Local anesthesia permits neurological evaluations and often leads to the adjustment of the interventional technique, potentially making the procedure safer.     

Covered metal stent for tumor obstruction of efferent loop recurrence after gastrectomy

Reports the case of a 60-year-old woman who underwent R2 total gastrectomy, and subsequent palliation of painful symptom recurrence via a membrane-covered metal stent. Received: 13 June 1996/Accepted: 31 July 1996     

Is it possible to prevent bacterial adhesion onto ureteric stents?

The aim of this study was to determine whether the use of bactericidal coatings or immersion in antibiotic solution reduces or prevents bacterial adhesion onto ureteric stents. Precut segments of full silicone, silver-coated and hydrogel-coated ureteric stents were incubated with two uropathogenic bacterial strains with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI). Microbiological analysis showed that immersion of ureteric stents in ceftriaxone and ciprofloxacin yielded a significant reduction of bacterial adhesion, whereas immersion in tobramycin did not. The surface material of the stents had no direct influence on bacterial adhesion. In this experimental study, neither the silver nor the hydrogel coat reduced bacterial adhesion onto ureteric stents whereas immersion in a suitable antibiotic solution significantly reduced and even prevented this phenomenon, probably due to the adhesion of the antibiotic onto the stent surface. Prevention of bacterial adhesion onto ureteric stents is essential to reduce the risk of UTI in connection with these devices.     

组织工程支架在犬急性脊髓损伤修复中应用的初步研究

目的探讨携带神经干细胞的聚碳酸亚丙酯[poly（propylene carbonate），PPC]可降解支架移植在犬脊髓急性损伤后修复中的作用。方法制作犬T13脊髓左侧半切损伤模型。将实验动物随机分为3组：细胞支架组在损伤后1周时将填充神经干细胞的PPC可降解支架植入损伤区．支架组只植入支架，对照组不作移植。8周后观察支架的组织反应、降解情况及神经干细胞的迁移分化和脊髓轴突再生情况。结果支架部分降解，管腔内未见瘢痕侵入。神经干细胞向支架邻近部位广泛迁移、扩散，并分化为3种神经细胞表型。神经丝蛋白（NF）及髓鞘碱性磷酯蛋白（MBP）免疫组化显示细胞支架组脊髓损伤区邻近部位的继发损害较其他组轻。结论携带神经干细胞的PPC可降解支架在犬脊髓组织中无明显组织反应．能够抵御瘢痕侵入：其携带的神经干细胞能够整合入邻近脊髓组织并起到一定保护作用。     

Postlaminectomy arteriovenous fistula masked by stenosis of the inferior vena cava

Discovery of a postlumbosacral discectomy fistula between the right iliac artery and vein was obscured by an associated severe stricture of the infrarenal inferior vena cava in a 49-year-old man. During venous stenting for treatment of peripheral edema, the fistula was suspected because of faint pulsatile right iliac vein flow and increased O₂ saturation of the venous blood. The suspicion was confirmed on subsequent iliac arteriography. Surgical closure of the fistula with arterial interposition grafting was then performed. The patient improved substantially.