Promoting endothelialization of flow-diverting stents: a review

2020 ◽  
Vol 13 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Kapilan Panchendrabose ◽  
Sandeep Muram ◽  
Alim P Mitha
Keyword(s):  
Intracranial Aneurysms ◽  
Surface Modifications ◽  
Biological Agents ◽  
Stent Insertion ◽  
Stent Design ◽  
Short And Long Term ◽  
Wall Apposition

Intracranial flow-diverting (FD) stents have revolutionized the treatment of intracranial aneurysms in recent years, but complications resulting from failed endothelialization can still occur. Approaches to promote endothelialization are understudied, but hold promise in mitigating both short- and long-term complications associated with FD stent insertion. The aim of this review is to highlight the various features of and modifications that have been made to FD stents in order to expedite endothelialization. More specifically, we focus on how endothelialization can be influenced by the stent design, wall apposition, surface modifications, and the inclusion of biological agents.

scholarly journals Filament inadequate wall apposition of the different ends of flow diverters in the abdominal aorta of rabbits

2019 ◽  
Vol 33 (1) ◽  
pp. 32-38
Author(s):  
Kuizhong Wang ◽  
Peng Jin ◽  
Peigang Lu ◽  
Qiang Liu ◽  
Bo Li ◽  
...  
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Stent Insertion ◽  
Digital Subtraction ◽  
Arterial Diameter ◽  
Significant Difference ◽  
Pathological Evaluation ◽  
Wall Apposition ◽  
Flow Diverters

Background Flow diverters (FDs) with flared ends (FEs) or straight ends (SEs) are used either alone or when overlapped to treat complex intracranial aneurysms. We evaluated filament inadequate wall apposition (IWA) of the FEs and SEs of FDs in vivo. Methods A total of 24 FDs with FEs and SEs were placed in an overlapping manner in the abdominal aortae of six rabbits (two sets per rabbit). Digital subtraction angiography was performed immediately after stent insertion and three months later. The anatomical and histopathological aortic features at FEs and SEs were evaluated. Results Angiography revealed no significant difference in terms of changes in arterial diameter between the FE and SE groups ( p = 0.877). Gross anatomical evaluation revealed IWA of the different ends of FDs but no thrombi or bleeding, showing that the metallic filaments were not in touch with the vessel wall and nor had they penetrated the vessel wall. The filaments’ IWA rates of FEs and SEs were 8.33% and 8.85%, respectively. The IWA rate at overlapping ends was lower than that at non-overlapping ends. The maximum neo-intimal thickness at FEs was greater than that at SEs (149.4 ± 48.9 and 98.6 ± 26.6 µm, respectively; p < 0.001). Conclusions Both the FEs and SEs of FDs can exhibit IMA. IWA events are reduced at the overlapped regions. On pathological evaluation, FEs increased neo-intimal thicknesses more than SEs did, but hyperplasia was minimal on angiography.

In-Stent Thrombosis and Stenosis After Neck-Remodeling Device-Assisted Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1523-1533 ◽  
Author(s):  
Hilal Kanaan ◽  
Brian Jankowitz ◽  
Aitziber Aleu ◽  
Dean Kostov ◽  
Ridwan Lin ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Complication Rates ◽  
Stent Patency ◽  
Unruptured Aneurysms ◽  
Short And Long Term ◽  
Stent Complications

Abstract BACKGROUND: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms. OBJECTIVE: To examine the technical and anatomic factors that predict short- and long-term stent patency. METHODS: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device. One hundred twenty-seven patients had catheter-based angiographic follow-up to evaluate 133 stent-coil constructs (mean, 15.4 months; median, 12.7 months). The technique of microcatheter jailing was used in a majority of patients; nonstandard stent configurations were also used. RESULTS: Clinical follow-up for all patients who had catheter-based angiograms demonstrated that among 133 stent constructs, a total of 9 (6.8%) had an in-stent event: 6 acute or subacute thrombosis (4.5%) and 3 delayed stenosis or occlusion (2.3%). Seven of these constructs were associated with a symptomatic event (5.3%). A significantly higher rate of in-stent events was seen with the use of constructs to treat anterior communicating artery aneurysms. When all patients are considered, including those who did not receive catheter-based follow-up imaging, 2 of 168 procedures (1.2%) resulted in the death of a patient, and procedural morbidity was 14.9%. CONCLUSION: From these results and those in the published literature, in-stent complication rates are low in carefully selected patients. The use of dual antiplatelet therapy, sensitivity assays, and glycoprotein IIb/IIIa inhibitors may decrease the rate of acute and chronic in-stent complications.

scholarly journals Retrograde Ureteric Stents via an Ileal Conduit

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Andrew Jack ◽  
Brent E. Burbridge
Keyword(s):  
Urinary Diversion ◽  
Pelvic Exenteration ◽  
Ileal Conduit ◽  
Late Complication ◽  
Stent Insertion ◽  
Tube Insertion ◽  
Radiation Induced ◽  
Short And Long Term ◽  
Fluid Collections

Patients having undergone pelvic exenteration with urinary diversion can present with short- and long-term complications such as ureteral strictures, anastomotic leakage, calculi, or fluid collections (abscess, urinoma, lymphocele, or hematoma). A dehiscence resulting in a perineal urinary fistula is an uncommon late complication of urinary diversion surgery; surgical treatment for this complication is less desirable because of postsurgical or radiation-induced pelvic changes that can occur. As a result, nephrostomy or antegrade stenting of the kidneys is more viable. Retrograde ureteric stent insertion is discussed in relation to a patient suffering from ileal conduit dehiscence. The presence of these stents probably helped diminish the potential for complications during subsequent nephrostomy tube insertion.

Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽  
2001 ◽  
Vol 7 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Robert ◽  
Mariéthoz ◽  
Pache ◽  
Bertin ◽  
Caulfield ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Long Term Results ◽  
Graves Disease ◽  
Laryngeal Nerve Palsy ◽  
Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

Short- and long-term memory tasks predict working memory performance, and vice versa.

2019 ◽  
Vol 73 (2) ◽  
pp. 79-93 ◽  
Author(s):  
Ian Neath ◽  
Jean Saint-Aubin ◽  
Tamra J. Bireta ◽  
Andrew J. Gabel ◽  
Chelsea G. Hudson ◽  
...  
Keyword(s):  
Working Memory ◽  
Memory Performance ◽  
Long Term Memory ◽  
Term Memory ◽  
Short And Long Term
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