Stents, covered stents, stent–grafts

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.

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“Paving and Cracking”: An Endovascular Technique to Facilitate the Introduction of Aortic Stent-Grafts through Stenosed Iliac Arteries

Journal of Endovascular Therapy ◽

10.1177/152660280701400505 ◽

2007 ◽

Vol 14 (5) ◽

pp. 630-633 ◽

Cited By ~ 46

Author(s):

Robert J. Hinchliffe ◽

Krassi Ivancev ◽

Björn Sonesson ◽

Martin Malina

Keyword(s):

Stent Graft ◽

Covered Stents ◽

Stent Grafts ◽

Endovascular Technique ◽

Iliac Arteries ◽

Aortic Stent Graft

Purpose: To describe a technique that facilitates the safe introduction of aortic stent-grafts through diseased iliac arteries. Technique: The technique involves relining and dilating (“paving and cracking”) stenosed iliac arteries with covered stents prior to the introduction of the main aortic stent-graft. It has been successfully used to introduce aortic stent-grafts in patients where other transfemoral endovascular measures have failed. Conclusion: This technique increases the applicability of transfemoral EVAR and prevents serious complications as a result of access-related damage to the iliac arteries.

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Intravascular Covered Stents and Stent Grafts (32)

Journal of Vascular and Interventional Radiology ◽

10.1016/s1051-0443(01)70194-7 ◽

2001 ◽

Vol 12 (1) ◽

pp. P329

Keyword(s):

Covered Stents ◽

Stent Grafts

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Covered stents in transjugular portosystemic shunt: healing response to non-porous ePTFE covered stent grafts with and without intraluminal irradiation

European Radiology ◽

10.1007/s00330-002-1690-x ◽

2002 ◽

Vol 13 (7) ◽

pp. 1549-1558 ◽

Cited By ~ 3

Author(s):

Klaus A. Hausegger ◽

Horst Portugaller ◽

Nicolas P. Macri ◽

Josef Tauss ◽

Peter Schedlbauer ◽

...

Keyword(s):

Covered Stent ◽

Portosystemic Shunt ◽

Covered Stents ◽

Stent Grafts ◽

Healing Response ◽

Transjugular Portosystemic Shunt

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Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

Journal of Endovascular Therapy ◽

10.1177/1526602819866435 ◽

2019 ◽

Vol 26 (6) ◽

pp. 787-794 ◽

Cited By ~ 5

Author(s):

Giovanni Federico Torsello ◽

Monika Herten ◽

André Frank ◽

Markus Müller ◽

Susanne Jung ◽

...

Keyword(s):

Shear Stress ◽

Stent Graft ◽

Stress Test ◽

Endovascular Aneurysm Repair ◽

Covered Stents ◽

Cobalt Chromium ◽

Stent Grafts ◽

Stent Geometry ◽

Stent Diameter

Purpose: To investigate 2 generations of balloon-expandable covered stents as potential bridging devices using an in vitro model of stent-graft fenestrations. Materials and Methods: Twenty BeGraft and 20 BeGraft+ cobalt-chromium stents covered in expanded polytetrafluoroethylene (ePTFE) in 6- and 8-mm diameters were tested in sheets mimicking stent-graft fenestrations. Microscopy and radiography were employed to evaluate stent morphology after flaring. In vitro bench tests measured maximum pullout (perpendicular displacement) and the shear stress (axial displacement) forces needed to dislocate the stents. Results: No alteration of ePTFE coverage was detected in the flared stents. Digital radiography and computed tomography showed marked alteration of the stent geometry, which was more pronounced in the BeGraft group. No fractures were detected. Median (minimum–maximum) pullout forces for the 6-mm stent-grafts were 17.1 N (15.8–19.6) for the BeGraft device and 30.4 N (20.2–31.9) for the BeGraft+ device (p=0.006). Median (minimum–maximum) pullout forces for the 8-mm stent-grafts were 11.3 N (11–12.1) for the BeGraft device and 21.8 N (18.2–25.5) for the BeGraft+ device (p<0.001). The shear stress test showed median forces of 10.5 vs 15.28 N at 150% of the stent diameter for the 6-mm BeGraft and BeGraft+ stent-grafts, respectively, and 15.23 vs 20.72 N at 150% stent diameter for the 8-mm models (p=0.016 and 0.017, respectively). Conclusion: Flaring changed the stent geometry but did not provoke stent fractures. The BeGraft+ is superior to the BeGraft in terms of pullout and shear stress forces, demonstrating greater resilience.

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Endovascular Covered Stent Repair of an Intercostal Artery Patch Dehiscence from a Descending Thoracic Aortic Aneurysm Graft

Journal of Endovascular Therapy ◽

10.1177/152660289600300310 ◽

1996 ◽

Vol 3 (3) ◽

pp. 299-305 ◽

Cited By ~ 1

Author(s):

Gerald Dorros ◽

Surendra Avula ◽

Paul Fox ◽

Bernard Rhomberg ◽

Paul Werner

Keyword(s):

Stent Graft ◽

Surgical Complication ◽

Balloon Catheter ◽

Suture Line ◽

Covered Stents ◽

Stent Grafts ◽

Initial Attempt ◽

Aortic Pseudoaneurysm ◽

Descending Thoracic Aortic Aneurysm ◽

Ultrasound Monitoring

Purpose: To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence. Methods and Results: A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm. Conclusions: This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.

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Use of coronary stent grafts for the treatment of high-flow carotid cavernous fistula

BMJ Case Reports ◽

10.1136/bcr-2021-245922 ◽

2021 ◽

Vol 14 (11) ◽

pp. e245922

Author(s):

Ivo Petrov ◽

Zoran Stankov ◽

Damyan Boychev ◽

Marko Klissurski

Keyword(s):

Carotid Artery ◽

Cavernous Sinus ◽

High Flow ◽

Coronary Stent ◽

Parent Artery ◽

Covered Stents ◽

Stent Grafts ◽

Carotid Cavernous Fistula ◽

Cavernous Fistula ◽

Carotid Cavernous Fistulas

Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.

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Elective placement of covered stents in native coronary arteries

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00059.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 294-301 ◽

Cited By ~ 4

Author(s):

E. Søvik ◽

N-E. Kløw ◽

M. Brekke ◽

S. Stavnes

Keyword(s):

Stent Graft ◽

Coronary Arteries ◽

Nyha Class ◽

Covered Stent ◽

Covered Stents ◽

Restenosis Rate ◽

Stent Grafts ◽

Target Vessel Revascularization ◽

Q Wave

Purpose: To study the feasibility of placing a polytetrafluoroethylene (PTFE)-covered stent graft into native coronary arteries and assess the complications and the restenosis rate. Material and Methods: Fifty consecutive patients with stable angina pectoris were included and the stent graft was placed into native coronary arteries. Clinical and angiographic follow-up were performed after 6 months. Results: The stent grafts were successfully placed in all patients. The mean reference diameter was 3.3 ± 0.6 mm. During follow-up the stent grafts occluded in patients after 1, 2 and 2.5 months and one more was occluded at 6 months. Three patients experienced myocardial infarction, 2 Q wave and one non-Q wave. After 6 months 42 (84%) patients had angina NYHA class 0 or 1. Target vessel revascularization was done in 11 cases for restenosis in the graft (n = 4), outside the graft (n = 3) and both (n = 4), giving a restenosis rate of 24%. The total major adverse coronary events at 6 months was 24%. Conclusion: The stent graft was deployed with a high success rate. The restenosis rate was not higher than expected for bare stents. However, this study showed that subacute occlusion may occur more frequently and we therefore recommend that ticlopidine or clopidogrel treatment should be prolonged to at least 3 months.

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