Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: safety and efficacy evaluation

ObjectivesTo evaluate the feasibility, safety, and efficacy of Solitaire stent placement after balloon angioplasty for the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS).MethodsWe retrospectively reviewed the clinical data from 44 patients who underwent Solitaire stent placement for complex symptomatic ICAS at our department between November 2010 and March 2014, with focus on the clinical factors, lesion characteristics, treatment results, and periprocedural complications. We also summarized the early outcomes and imaging findings during the follow-up period.ResultsOverall, the technical success rate was 100% (44/44). Post-stenting residual stenosis ranged from 0% to 40% (mean 15.00±12.94%). The overall 30-day rate of procedure-related complications was 9.09% (4/44). The incidence of recurrent ischemic events related to the territory artery was 4.55% during a mean clinical follow-up period of 25.5 months. Five patients (11.36%) developed in-stent restenosis during a mean angiographic follow-up period of 9.3 months.ConclusionsThis is the first case series study of ICAS treated by Solitaire stent placement. Deployment of a Solitaire stent with balloon angioplasty in the treatment of complex severe intracranial stenosis appears safe and effective, with a high technical success rate, relatively low periprocedural complication rate, and favorable outcome during follow-up.

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Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise

Interventional Neuroradiology ◽

10.1177/1591019919832244 ◽

2019 ◽

Vol 25 (5) ◽

pp. 484-490 ◽

Cited By ~ 1

Author(s):

Aysun Erbahceci Salik ◽

Hatem H Selcuk ◽

Hasanagha Zalov ◽

Fatih Kilinc ◽

Musa Cirak ◽

...

Keyword(s):

Success Rate ◽

Balloon Angioplasty ◽

High Grade ◽

Intracranial Artery ◽

Technical Success ◽

Medium Term ◽

Stent Deployment ◽

Technical Success Rate ◽

Angioplasty And Stenting

Purpose The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70–99%) stenosis of a major intracranial artery with Enterprise stent. Methods This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70–99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. Results A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6–72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. Conclusion In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

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Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/3983707 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Hideki Kamada ◽

Hideki Kobara ◽

Naohito Uchida ◽

Kiyohito Kato ◽

Takayuki Fujimori ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

High Risk Patients ◽

Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

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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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The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

Journal of Ophthalmology ◽

10.1155/2020/3638410 ◽

2020 ◽

Vol 2020 ◽

pp. 1-16 ◽

Cited By ~ 3

Author(s):

Aleksandra Pekacka

Keyword(s):

Success Rate ◽

Retention Rate ◽

Intraarterial Chemotherapy ◽

Treatment Modalities ◽

Technical Success ◽

Secondary Neoplasms ◽

Systemic Complications ◽

Technical Success Rate

Introduction. Retinoblastoma is the most common primary intraocular neoplasm in children. With the advances in medicine, the armamentarium of available treatment modalities has grown. Intraarterial chemotherapy is a relatively new treatment method with promising outcomes. The purpose of this literature review is to evaluate its role in the management of retinoblastoma. Methods. A systematic online search was conducted using Ovid Embase and Ovid Medline. The final results included 23 studies. The studies were published between 2011 and 2019. The studies evaluated the technical success rate of IAC, globe salvage rate, and ocular and systemic complications, as well as the occurrence of deaths, metastasis, and secondary neoplasms. In total, 1827 eyes with retinoblastoma were analysed. The follow-up was between 0 and 252 months. Results. Overall globe retention rate ranged from 30% to 100%. Sixteen out of 23 studies reported ocular salvage between 60 and 80%. Eyelid oedema and erythema were the most commonly reported ocular complications following IAC. The most common systemic complications included nausea, vomiting, and neutropenia. Metastases and deaths were reported in 6 out of 23 studies. Three studies reported the development of secondary neoplasms. The technical success rate of IAC procedure ranged from 91% to 100%. Discussion. The studies have shown that IAC is a safe and effective treatment for advanced retinoblastoma, especially group D. It allows to save the globe without compromising patients’ survival. Local and systemic complications are acceptable. The role of IAC in less advanced tumours is yet to be established. Future work should focus on conducting larger prospective studies with longer follow-up. Multiple novel therapies for the management of retinoblastoma are currently being tested, including angiogenic inhibitors and targeted agents. The results seem to be promising. Future advances require a further in-depth understanding of unique genetics of retinoblastoma and complex interactions between tumour cells and their microenvironment.

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Usefulness of a long sheath in ureteral catheterization after failure of antegrade ureteral stent placement using a short sheath

Acta Radiologica ◽

10.1177/0284185120969952 ◽

2020 ◽

pp. 028418512096995

Author(s):

Cheng Shi Chen ◽

Jong Woo Kim ◽

Ji Hoon Shin ◽

Hai-Liang Li ◽

Hyung Jin Lee ◽

...

Keyword(s):

Success Rate ◽

Stent Placement ◽

Balloon Catheter ◽

Ureteral Stent ◽

Ureteral Stricture ◽

Technical Success ◽

Exact Test ◽

Technical Success Rate ◽

Ureteral Catheterization ◽

A Minor

Background When antegrade ureteral intervention fails due to severe ureteral stricture or tortuosity, a longer sheath can be used to facilitate ureteral catheterization. Purpose To evaluate the feasibility and effectiveness of the use of a long sheath in antegrade ureteral stent placement after failure of antegrade ureteral stent placement using a short sheath. Material and Methods Among 1284 procedures in 934 patients who received ureteral stent placement, a long sheath was used after stricture negotiation failure using a short sheath in 57 (4.4%) procedures in 53 patients. The data of these 53 patients were retrospectively reviewed. Results The most common reasons for long sheath use were failure of balloon catheter (59.6%) or guidewire (29.8%) advancement across the stricture. Technical success, successful stricture negotiation after using a long sheath, was achieved in 50/57 (87.7%) procedures. In two of seven failed procedures, an additional TIPS sheath was used and the technical success rate improved to 91.2% (52/57). The technical success rate was significantly higher in the patients who have failed balloon catheter advancement (97.1%, 33/34) than the patients who have failed guidewire advancement (64.7%, 11/17) (Fisher’s exact test, P = 0.004). Self-limiting hematoma occurred in one patient after use of the long sheath and was considered a minor complication. Conclusion Ureteral catheterization using a long sheath is feasible and effective when antegrade ureteral intervention using a short sheath fails. When using a long sheath, the technical success rate was higher when advancing the balloon catheter over the guidewire than when advancing the guidewire through tight stricture.

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Endoscopic transcecal appendectomy: a new endotherapy for appendiceal orifice lesions

Endoscopy ◽

10.1055/a-1675-2625 ◽

2021 ◽

Author(s):

Linjie Guo ◽

Liansong Ye ◽

Yilong Feng ◽

Johannes Bethge ◽

Juliana Yang ◽

...

Keyword(s):

Hospital Stay ◽

Postoperative Bleeding ◽

Case Series ◽

Length Of Hospital Stay ◽

Lesion Size ◽

Complete Resection ◽

Technical Success ◽

Case Series Study ◽

Submucosal Lesions

Background Endoscopic transcecal appendectomy (ETA) has been reported as a minimally invasive alternative procedure for lesions involving the appendiceal orifice. The aim of this case series study was to evaluate the feasibility, safety, and effectiveness of ETA for lesions at the appendiceal orifice. Methods This retrospective study included consecutive patients with appendiceal orifice lesions who underwent ETA between December 2018 and March 2021. The primary outcome was technical success. The secondary outcomes included postoperative adverse events, postoperative hospital stay, and recurrence. Results 13 patients with appendiceal orifice lesions underwent ETA during the study period. The median lesion size was 20 mm (range 8–50). Lesions morphologies were polypoid lesions (n = 5), laterally spreading tumors (n = 4), and submucosal lesions (n = 4). Technical success with complete resection was achieved in all 13 cases. There were no postoperative bleeding, perforation, or intra-abdominal abscess. The median length of hospital stay after ETA was 8 days (range 6–18). There was no tumor recurrence during a median follow-up of 17 months (range 1–28). Conclusions ETA is feasible, safe, and effective for complete resection of appendiceal orifice lesions. Larger, multicenter, prospective studies are needed to further assess this technique.

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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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Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Case Reports in Gastroenterology ◽

10.1159/000502835 ◽

2019 ◽

Vol 13 (3) ◽

pp. 385-397 ◽

Cited By ~ 1

Author(s):

C. Rinaldi A. Lesmana ◽

Rino A. Gani ◽

Irsan Hasan ◽

Andri Sanityoso Sulaiman ◽

Khek Yu Ho ◽

...

Keyword(s):

Success Rate ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Clinical Success ◽

Case Series ◽

Clinical Success Rate ◽

Malignant Biliary Obstruction ◽

Technical Success Rate ◽

Case Series Study

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

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Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i3.5896 ◽

2021 ◽

Author(s):

Javad Salimi ◽

Ehsan Rahimpour ◽

Hossein Zabihi Mahmoudabadi ◽

Pezhman Farshidmehr

Keyword(s):

Success Rate ◽

Treatment Success ◽

Case Series ◽

Pulmonary Hemorrhage ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Technical Success Rate ◽

Catheter Directed Thrombolysis ◽

One Year

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the oneyear study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.

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