Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

AbstractThere is limited evidence supporting the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. We conducted a retrospective analysis of 10 benign sPJS patients. A forward-viewing endoscope was used in all sessions. Following items were evaluated: technical success, adverse events, and clinical outcome of ERPD. The technical success rate was 100% (10/10) in initial ERPD; 9 patients had a pancreatic stent (no-internal-flap: n = 4, internal-flap: n = 5). The median follow-up was 920 days. Four patients developed recurrence. Among them, 3 had a stent with no-internal-flap in initial ERPD, the stent migrated in 3 at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up interventions were performed. No recurrence was observed in 6 patients. None of the stents migrated (no-internal-flap: n = 1, internal-flap: n = 5) and no stents were replaced due to stent failure. Stenting with no-internal-flap was associated with recurrence (p = 0.042). Mild adverse events developed in 14.3% (2/14). In conclusions, ERPD was performed safely with high technical success. Recurrence was common after stenting with no-internal-flap. Long-term stenting did not result in stent failure.Clinical trial register and their clinical registration number: Nos. 58-115 and R2-9.

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Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

10.21203/rs.3.rs-119255/v1 ◽

2020 ◽

Author(s):

Akihiko Kida ◽

Taro Kawane ◽

Hitoshi Omura ◽

Tatsuo Kumai ◽

Masaaki Yano ◽

...

Keyword(s):

Adverse Events ◽

Stent Placement ◽

Stent Migration ◽

Anastomotic Stenosis ◽

Technical Success ◽

Long Term Outcomes ◽

Endoscopic Retrograde ◽

Technical Success Rate

Abstract 【Background】 There is limited evidence demonstrating the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. 【Methods】 We conducted a retrospective analysis of 10 benign sPJS patients. Following items were evaluated: technical success, adverse events and clinical outcome of ERPD. 【Results】 Technical success rate was 100% (10/10); 9 patients had a pancreatic stent (no-internal-flap: n=4, internal-flap: n=5). Median follow-up was 920 days. Four patients developed recurrence. Among them, 3 patients had a stent with no-internal-flap in initial ERPD and the stent migrated in 3 patients at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up ERPD were performed. No recurrence was observed in 6 patients. Among them, none of the stents migrated (no-internal-flap: n=1, internal-flap: n=5), and none were replaced stents due to stent failure. A stent placement with no-internal-flap was associated with recurrence (p=0.042). Mild adverse events developed in 14.3% (2/14). 【Conclusions】 ERPD was performed safely with high technical success. Recurrence was common in a stent placement with no-internal-flap, which was associated with stent migration. Long-term stent placement didn’t result in stent failure.

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Simultaneous Stenting for Symptomatic Tandem Extracranial and Intracranial Posterior Circulation Stenoses: Long-Term Outcomes and Procedural Experience

Frontiers in Neurology ◽

10.3389/fneur.2021.724985 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zichang Jia ◽

Yanqing Zhao ◽

Peng Wang ◽

Jintao Han ◽

Shilu Zhao ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Posterior Circulation ◽

Technical Success ◽

Long Term Outcomes ◽

Technical Success Rate ◽

Stent Restenosis

Few studies have reported on simultaneous endovascular stenting for tandem posterior circulation (PC) stenoses and its long-term outcomes. Thus, our aim was to investigate the safety and efficacy of simultaneous stenting in patients with symptomatic tandem extra- and intracranial PC stenoses. From September 2014 to June 2018, 16 such patients with symptomatic stenoses who underwent simultaneous stent placement were analyzed. The primary outcome was occurrence of any stroke, TIA, or death within 30 days after the procedure. The secondary outcomes were technical success, clinical success, and the occurrence of in-stent restenosis ≥50% during follow-up. Technical success was defined as stent coverage of all tandem lesions and residual stenosis <30%. Clinical success was determined based on any occurrence of neurological events or death within 3 months after the procedure. All stents (19 intracranial and 14 extracranial) were placed with a technical success rate of 100%. One patient experienced a pontine ischemic stroke 2 days after the procedure and had recovered well at discharge. One patient experienced a minor complication of groin hematoma. The clinical success rate was 93.75% (15/16). During a median follow-up of 36.0 ± 11.0 months, two patients developed ISR ≥50% at the 1-year follow-up. None of the patients experienced stroke, TIA, or death after discharge during follow-up. Simultaneous stenting for symptomatic tandem extra- and intracranial PC stenoses is safe and feasible. Its impact on long-term stroke prevention is promising, and further study of a larger patient population is needed.

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The long-term outcomes of radiosurgery for arteriovenous malformations in pediatric and adolescent populations

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.1.peds14407 ◽

2015 ◽

Vol 16 (2) ◽

pp. 222-231 ◽

Cited By ~ 29

Author(s):

Shunya Hanakita ◽

Tomoyuki Koga ◽

Masahiro Shin ◽

Hiroshi Igaki ◽

Nobuhito Saito

Keyword(s):

Adverse Events ◽

Arteriovenous Malformations ◽

Therapeutic Option ◽

Long Term Outcomes ◽

Bleeding Rate ◽

Study Institute ◽

Delayed Complications ◽

Risk Of Hemorrhage

OBJECT Although stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, substantial data are still lacking regarding the outcomes of SRS for AVMs in this age group, especially long-term complications. This study aimed to clarify the long-term outcomes of SRS for the treatment of AVM in pediatric patients aged ≤ 18 years. METHODS Outcomes of 116 patients who were aged 4–18 years when they underwent SRS between 1990 and 2009 at the study institute were analyzed retrospectively. RESULTS The median follow-up period after SRS was 100 months, with 6 patients followed up for more than 20 years. Actuarial obliteration rates at 3 and 5 years after SRS were 68% and 88%, respectively. Five hemorrhages occurred in 851 patient-years of follow-up. The annual bleeding rate after SRS before obliteration was calculated as 1.3%, which decreased to 0.2% after obliteration. Shorter maximum nidus diameter (p = 0.02) and higher margin dose (p = 0.03) were associated with a higher obliteration rate. Ten patients experienced adverse events after SRS. Of them, 4 patients presented with delayed complications years after SRS (range 9–20 years after SRS). CONCLUSIONS SRS can reduce the risk of hemorrhage in pediatric and adolescent AVMs, with an acceptable risk of complications in the long term. However, adverse events such as expanding hematoma and radiation necrosis that can occur after substantial follow-up should be taken into account at the time that treatment decisions are made and informed consent is obtained.

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Treatment of intracranial aneurysms using the pipeline flex embolization device with shield technology: angiographic and safety outcomes at 1-year follow-up

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014204 ◽

2018 ◽

Vol 11 (4) ◽

pp. 396-399 ◽

Cited By ~ 16

Author(s):

Mario Martínez-Galdámez ◽

Saleh M Lamin ◽

Konstantinos G Lagios ◽

Thomas Liebig ◽

Elisa F Ciceri ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Technical Success ◽

First Line ◽

Post Procedure ◽

Safety Outcomes ◽

Registration Number ◽

Aneurysm Diameter ◽

Major Stroke

PurposeThe Pipeline Embolization Device (PED) is a routine first-line treatment option for intracranial aneurysms (IAs). The Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield) is an updated version of the PED which has been modified to include a surface phosphorylcholine biocompatible polymer. Its early technical success and safety have been reported previously. Here, we assessed the long-term safety and efficacy of the Pipeline Shield for the treatment of IAs.Materials and methodsThe Pipeline Flex Embolization Device with Shield Technology (PFLEX) study was a prospective, single-arm, multicenter study for the treatment of unruptured IAs using the Pipeline Shield. The primary endpoint was a major stroke in the territory supplied by the treated artery or neurologic death at 1-year post-procedure. Angiographic outcomes were also assessed by an independent radiology laboratory at 6 months and 1 year.ResultsFifty patients (mean age, 53 years; 82% female) with 50 unruptured IAs were treated. Mean aneurysm diameter was 8.82±6.15 mm. Of the target aneurysms, 38/50 (76%) were small (<10 mm), 11/50 (22%) were large (≥10 and<25 mm), and 1/50 (2%) was giant (≥25 mm). Forty-seven (94%) were located in the internal carotid artery and three (6%) in the vertebral artery. At 1-year post-procedure, no major strokes or neurologic deaths were reported, and complete occlusion was achieved in 27/33 (81.8%). There were no instances of aneurysm recurrence or retreatment.ConclusionsOur 1-year follow-up concerning angiographic and safety outcomes corroborate previous evidence that the Pipeline Shield is a safe and effective treatment for IAs.Trial registration numberNCT02390037

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Management of aortoiliac aneurysms by retrograde endovascular hypogastric artery preservation

Vascular ◽

10.1177/1708538112474256 ◽

2013 ◽

Vol 22 (2) ◽

pp. 116-120 ◽

Cited By ~ 6

Author(s):

Bernardo Massière ◽

Arno von Ristow ◽

Alberto Vescovi ◽

Cleoni Pedron ◽

Lea M B Fonseca

Keyword(s):

Computed Tomography ◽

Spinal Cord ◽

Spinal Cord Ischemia ◽

Hybrid Procedure ◽

Hypogastric Artery ◽

Technical Success ◽

Long Term Outcomes ◽

Buttock Claudication

We evaluated the outcome of the retrograde endovascular hypogastric artery preservation (REHAP) technique for the treatment of complex aortoiliac aneurysms (AIAs). Perioperative and long-term outcomes were assessed for 12 patients (mean age 77 years, range 64–86 years) who underwent elective endovascular AIA repair via aortouniiliac endografting and REHAP between January 2004 and January 2011. Preoperative images obtained by computed tomography were used for planning. Postoperative images were obtained one and six months after surgery, and once a year thereafter. Technical success was achieved in all cases. No patients exhibited endoleak related to the endoprosthesis, occlusion of implanted components, hip and/or buttock claudication, or colon or spinal cord ischemia during follow-up. This hybrid procedure illustrates the potential of REHAP in the treatment of AIA cases.

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Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms

Journal of Neurosurgery ◽

10.3171/2014.7.jns132237 ◽

2014 ◽

Vol 121 (5) ◽

pp. 1093-1101 ◽

Cited By ~ 9

Author(s):

Christopher R. Durst ◽

Robert M. Starke ◽

John R. Gaughen ◽

Scott Geraghty ◽

K. Derek Kreitel ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Technical Success ◽

Parent Vessel ◽

Technical Success Rate ◽

Single Center Experience ◽

Long Term Follow Up ◽

Coil Migration

Object The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique. Methods The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported. Results The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0–2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%. Conclusions The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.

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Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis

10.21203/rs.2.24504/v2 ◽

2020 ◽

Author(s):

Yonghua Bi ◽

Jindong Li ◽

Liangliang Bai ◽

Xinwei Han ◽

Jianzhuang Ren

Keyword(s):

Success Rate ◽

Tracheal Stenosis ◽

Survival Rates ◽

Technical Success ◽

Technical Success Rate ◽

Stent Removal ◽

Total Incidence ◽

Significant Difference

Abstract Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.

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Long-term Outcomes in Peripartum Cardiomyopathy

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401913010013 ◽

2019 ◽

Vol 13 (1) ◽

pp. 13-23 ◽

Cited By ~ 2

Author(s):

Madeline K Mahowald ◽

Nivedita Basu ◽

Latha Subramaniam ◽

Ryan Scott ◽

Melinda B. Davis

Keyword(s):

Adverse Events ◽

Left Ventricular ◽

Subsequent Pregnancy ◽

Peripartum Cardiomyopathy ◽

Left Ventricular Ejection ◽

Long Term Outcomes ◽

Ventricular Assist ◽

Ventricular Ejection Fraction

Background: Prior studies of Peripartum Cardiomyopathy (PPCM) are limited by short-term follow-up. Contemporary long-term outcomes and change in myocardial function over time are poorly characterized. Methods and Results: This retrospective cohort study included women with PPCM at the University of Michigan (2000-2011), with follow-up on March 31, 2017. Subsequent pregnancies were excluded. Recovery was sustained left ventricular Ejection Fraction (EF) ≥55%. Major Adverse Events (MAE) included death, cardiac transplantation, left ventricular assist device, or inotrope-dependence. A total of 59 women were included (mean [SD] age at diagnosis, 29.5 [6.8]; 28.8% Black), with a mean follow-up of 6.3 years. Recovery occurred in 22 women (37%); of these, 8 women (36%) had delayed recovery (>12 months). All cause mortality was 20% (12/59) with median survival 4.2 years; of these, 9 women (75%) died after the first year (range 2 - 10 years). MAE occurred in 19 women (32%); of these, 11 women (42%) had MAE >12 months from time of diagnosis (range 2-20 years). Deterioration in EF by >10% from the time of diagnosis occurred in 16 women (27%). This group had worse long-term outcomes, including lower final EF (mean 25 vs 42%, p=0.010), less recovery (12 vs 46%, p=0.016), and higher rates of death (38 vs 14%, p=0.046) and MAE (56 vs 23%, p=0.016). Conclusion: Women with PPCM have long-term risks of mortality, MAE, and subsequent decline in EF, even in the absence of a subsequent pregnancy. Deterioration in EF is associated with adverse events; thus, long-term management is important.

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Medium- and Long-Term Effects of Endovascular Treatments for Severely Stenotic Basilar Arteries Supported by Multimodal Imaging

10.21203/rs.3.rs-24994/v1 ◽

2020 ◽

Author(s):

Yuanzhi Li ◽

Weimin Xie ◽

Xianghao Gong ◽

Dongliang He ◽

Xin Zhang ◽

...

Keyword(s):

Basilar Artery ◽

Neurological Dysfunction ◽

Long Term Effects ◽

Technical Success ◽

Technical Success Rate ◽

Atherosclerotic Stenosis ◽

Stenosis Rate ◽

Basilar Artery Stenosis

Abstract Background: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging.Method: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70%- 99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were followed up.Results: The mean age of 67 patients(67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of active treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of microlead wire being clamped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36–66 months. 55 cases were regularly reviewed with images. Intrastenting stenosis occurred in 4 cases, and 12 cases were followed up by phone or WeChat.The average follow-up period was 56 ± 21 months (36–66 months). No TIA or stroke occurred during follow-up.Conclusions: In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.

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Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000407 ◽

2020 ◽

pp. svn-2020-000407

Author(s):

Yu Chen ◽

Ruinan Li ◽

Li Ma ◽

Xiangyu Meng ◽

Debin Yan ◽

...

Keyword(s):

Conservative Management ◽

Subgroup Analysis ◽

Arteriovenous Malformations ◽

Rupture Risk ◽

Long Term Outcomes ◽

Single Centre Experience ◽

Registration Number ◽

Positive Effect

ObjectiveThe aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations (AVMs) after different management modalities.MethodsThe authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017. The rupture risk was represented by annualised haemorrhagic rate. Patients were divided into five groups: conservation, microsurgery, embolisation, stereotactic radiosurgery (SRS) and embolisation+SRS. Neurofunctional outcomes were evaluated by the modified Rankin Scale (mRS). Subgroup analysis was conducted between different management modalities to compare the long-term outcomes in rupture or unruptured cohorts.ResultsAll of 61 brainstem AVMs (12 unruptured and 49 ruptured) were followed up for an average of 4.5 years. The natural annualised rupture risk was 7.3%, and the natural annualised reruptured risk in the ruptured cohort was 8.9%. 13 cases were conservative managed and 48 cases underwent intervention (including 6 microsurgery, 12 embolisation, 21 SRS and 9 embolisation+SRS). In the selection of interventional indication, diffuse nidus were often suggested conservative management (p=0.004) and nidus involving the midbrain were more likely to be recommended for intervention (p=0.034). The risk of subsequent haemorrhage was significantly increased in partial occlusion compared with complete occlusion and conservative management (p<0.001, p=0.036, respectively). In the subgroup analysis, the follow-up mRS scores of different management modalities were similar whether in the rupture cohort (p=0.064) or the unruptured cohort (p=0.391), as well as the haemorrhage-free survival (p=0.145). In the adjusted Bonferroni correction analysis of the ruptured cohort, microsurgery and SRS could significantly improve the obliteration rate compared with conservation (p<0.001, p=0.001, respectively) and SRS may have positive effect on avoiding new-onset neurofunctional deficit compared with microsurgery and embolisation (p=0.003, p=0.003, respectively).ConclusionsIntervention has similar neurofunctional outcomes as conservation in these brainstem AVM cohorts. If intervention is adopted, partial obliteration should be avoided because of the high subsequent rupture risk.Trial registration numberNCT04136860.

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