scholarly journals New tracheal stainless steel stent pilot study: twelve month follow-up in a rabbit model

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7797 ◽  
Author(s):  
Sandra Lopez-Minguez ◽  
Carolina Serrano-Casorran ◽  
Jose A. Guirola ◽  
Sergio Rodriguez-Zapater ◽  
Cristina Bonastre ◽  
...  
Keyword(s):  
Pilot Study ◽  
Stent Placement ◽  
Clinical Success ◽  
Rabbit Model ◽  
Absorbable Suture ◽  
Safe Procedure ◽  
Tracheal Stent ◽  
Airway Pathology ◽  
Tracheal Collapse

Background Canine tracheal collapse is a complex airway pathology without promising treatment results. Currently nitinol stents are the best surgical option; however, some professionals are doubting if stent placement is the best option due to the associated complications. Objective Determine the technical feasibility, safety, and long-term follow-up after the implantation of a new tracheal stent designed for canine tracheal collapse. Methods Thirteen healthy, adult female New Zealander rabbits were involved in this pilot study.A new intra-tracheal device (Reference number 902711 patent registered as CasMin-Twine) was implanted in ten animals. Deployment was performed under general anesthesia, making a puncture incision via a 21 Gauge needle in the intra-tracheal space where the stent was introduced with a screwing process. The device was fixed to the tracheal wall with a non-absorbable suture. Computerized Tomography (CT) and an endoscopy to study structural abnormalities were performed after 30, 90 and 365 days after stent placement. Results Technical and clinical success was 100%. There was no significant change in behavior or respiratory disorders. CT studies showed no significant alterations. After the 30 days, 60% of the animals showed partial endothelization in the endoscopy study, and only one animal still presented partial endothelization after 12 months. Mucus accumulation was only present in 40% of cases and classified as low, without respiratory consequences. Only one animal presented a single granuloma at caudal stent tip. Conclusions This new tracheal stent (CasMin-Twine) is an effective and safe procedure with promising results, and also shows the possibility of removing the device after endothelization has been produced. New studies should be carried out to evaluate the effectiveness in patients with tracheomalacia. Clinical Significance/Impact This new product can give veterinarians a new option of treatment for this complicated pathology. Minimizing specific equipment for its deployment, CasMin-Twine will be more accessible for all professionals.

Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samir N Patel ◽  
J. Stephen Jenkins ◽  
Christopher J White ◽  
Paul McMullan ◽  
J.P. Reilly ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Clinical Success ◽  
High Morbidity ◽  
Symptom Resolution ◽  
Non Invasive ◽  
Procedural Success ◽  
Repeat Angiography ◽  
One Year

Background : Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients. Methods : One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR). Results : Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free. Conclusion : Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.

scholarly journals The Effects of Mycophenolate on the Formation of Granulation Tissue Post-operatively in Canine Tracheal Stent Patients (2014–2020)

2021 ◽  
Vol 8 ◽  
Author(s):  
Kevin F. Barber ◽  
Catherine A. Loughin ◽  
Dominic J. Marino ◽  
Martin Lesser
Keyword(s):  
Mycophenolate Mofetil ◽  
Granulation Tissue ◽  
Control Group ◽  
Tracheal Lumen ◽  
Loss To Follow Up ◽  
Treatment Groups ◽  
Tracheal Stent ◽  
Significant Difference ◽  
Tracheal Collapse

Objectives: To determine if mycophenolate mofetil reduces the incidence and severity of granulation tissue in-growth in canine tracheal stent patients.Study design: Randomized clinical trial.Animals: 111 dogs from the hospital population.Methods: Client-owned dogs that received an endoluminal self-expanding tracheal stent for canine tracheal collapse between 2014 and 2020 were randomly assigned into one of two treatment groups. Control group medication protocol consisted of prednisone 0.5 mg/kg PO BID/SID/EOD × 30 days, hydrocodone 0.25 mg/kg PO TID × 30 days, and cefovecin 8 mg/kg SQ post-placement. Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID × 30 days, SID for life. Recheck tracheoscopy was performed at 1, 3, and 6 months post-stent placement. Presence and severity of granulation tissue were determined by tracheoscopy and were recorded as a percentage of tracheal lumen obstruction by blinded evaluators (none present, <25%, >25–50%, and >50%).Results: At none of the three time points was there a statistically significant difference in grade between controls and those receiving mycophenolate (p = 0.467, p = 0.330, and p = 0.410).Conclusions and Clinical Significance: Our results suggest that mycophenolate can be safely given to these patients but do not support that its administration will reduce the incidence and severity of granulation tissue. Although a difference was observed in the severity of granulation tissue between the two groups, loss to follow-up may have influenced conclusions. A larger study would be warranted to further evaluate the effect of mycophenolate on the development of granulation tissue.

scholarly journals Self-Expanding Metal Stenting for Palliation of Patients with Malignant Colonic Obstruction: Effectiveness and Efficacy on 255 Patients with 12-Month's Follow-up

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Søren Meisner ◽  
Ferran González-Huix ◽  
Jo G. Vandervoort ◽  
Alessandro Repici ◽  
Dimitrios Xinopoulos ◽  
...  
Keyword(s):  
Stent Placement ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Metal Stents ◽  
Control Group ◽  
Metal Stent ◽  
Multicenter Studies ◽  
Malignant Colonic Obstruction ◽  
Procedural Success

Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery.Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures.Design. Two prospective, one Spanish and one global, multicenter studies.Settings. 39 centers (22 academic, 17 community hospitals) from 13 countries.Patients. A total of 257 patients were enrolled, and 255 patients were treated with a WallFlex uncovered enteral colonic stent. Follow-up was up to 12 months or until death or retreatment.Interventions(s). Self-expanding metal stent placement.Main Outcome Measures. Procedural success, clinical success, and safety.Results. Procedural success was 98.4% (251). Clinical success rates were 87.8% at 30 days, 89.7% at 3 months, 92.8% at 6 months, and 96% at 12 months. Overall perforation rate was 5.1%. Overall migration rate was 5.5%. Overall death rate during follow-up was 48.6% (124), with 67.7% of deaths related to the patient’s colorectal cancer, unrelated in 32.3%. Only 2 deaths were related to the stent or procedure.Limitations. No control group.Conclusions. The primary palliative option for patients with malignant colonic obstruction should be self-expanding metal stent placement due to high rates of technical success and efficacy in symptom palliation and few complications.

scholarly journals Endoscopic ultrasound-based transluminal cholecystolithotomy: the retrievable anchor assisted procedure

2019 ◽  
Author(s):  
Nan Ge ◽  
Jinlong Hu ◽  
Fei Yang ◽  
Fan Yang ◽  
Kai Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Outcome Measures ◽  
Clinical Success ◽  
Safe Procedure ◽  
Drainage Procedure ◽  
Indwelling Time ◽  
Per Oral

Abstract Background EUS guided gallbladder drainage has gradually emerging as an option among patients with cholecystitis. Stent bridged endoscope intervention in the gallbladder was further introduced. The aim of this study was to assess the effectiveness and safety of the ECE-LAMS and this newly designed retrievable puncture anchor applied in the transmural Cholecystolithotomy. Method We retrospectively reviewed consecutive patients undergoing EUS-guided transmural cholecystoscopic therapy. The main outcome measures for the EUS-GBD procedure were techniques success and adverse events, which were also compared between guided assisted group and retrievable anchor assisted group. The main outcome measures for the transmural cholecystoscopy after EUS-GBD were the stent indwelling time, clinical success and adverse events. Results A total of 24 (15 female) patients with gallstones were received the transluminal Cholecystolithotomy. Mean age is 36.08±13.69 years old. The successful rate of the anchor assisted group was high than the guidewire assisted group (92.9% Vs 70%, P=0.07). On the average of 12.25±2.77 (range 8-17) days after the initial BD drainage procedure, 20 patients received the per-oral cholecystoscopy via the fistula. Fistula broken was found in 2 patients in which the per-oral cholecystoscopy was applied on the ninth day after the EUS-GBD. During the follow-up period (mean 314.2± 213.7 days) no GB stones recurrence or other long term complications reported. Conclusion In conclusion, we have demonstrated that EUS-assisted per-oral cholecystoscopy technique with ECE-LMAS is an efficient and safe procedure. For the EUS-GBD procedure, retrievable anchor could significantly increase the success rate compared with the guidewire.

scholarly journals Standardized Duplex Ultrasound-Based Protocol for Early Diagnosis of Transplant Renal Artery Stenosis: Results of a Single-Institution Retrospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Vincenzo Li Marzi ◽  
Riccardo Campi ◽  
Francesco Sessa ◽  
Alessandro Pili ◽  
Graziano Vignolini ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Duplex Ultrasound ◽  
Artery Stenosis ◽  
Refractory Hypertension ◽  
Transplant Renal Artery Stenosis

Transplant renal artery stenosis (TRAS) is the most frequent vascular complication after kidney transplantation (KT) and has been associated with potentially reversible refractory hypertension, graft dysfunction, and reduced patient survival. The aim of the study is to describe the outcomes of a standardized Duplex Ultrasound- (DU-) based screening protocol for early diagnosis of TRAS and for selection of patients potentially requiring endovascular intervention. We retrospectively reviewed our prospectively collected database of KT from January 1998 to select patients diagnosed with TRAS. The follow-up protocol was based on a risk-adapted, dynamic subdivision of eligible KT patients in different risk categories (RC) with different protocol strategies (PS). Of 598 patients included in the study, 52 (9%) patients had hemodynamically significant TRAS and underwent percutaneous angioplasty (PTA) and stent placement. Technical and clinical success rates were 97% and 90%, respectively. 7 cases of restenosis were recorded at follow-up and treated with re-PTA plus stenting. Both DU imaging and clinical parameters improved after stent placement. Prospective high-quality studies are needed to test the efficacy and safety of our protocol in larger series. Accurate trial design and standardized reporting of patient outcomes will be key to address the current clinical needs.

Stenting Treatment for Intra- and Extra-Cranial Atherosclerotic Diseases

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 51-53 ◽  
Author(s):  
T. Mori ◽  
K. Kazita ◽  
K. Chokyu ◽  
K. Mori
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
Stent Placement ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Morbidity Rate ◽  
Biliary Stents ◽  
Stent Deformation ◽  
Cranial Arteries

The purpose of this study was to investigate the effect, safety and short-term outcome of stenting treatment for extra- and intra-cranial atherosclerotic diseases. Forty-one patients underwent stenting treatment using coronary and biliary stents. Eleven patients had tubular or diffuse high-grade stenoses not amenable to standard balloon angioplasty involving intra-cranial arteries, while in thirty, extra-cranial arteries were involved. Stents were successfully implanted in 36 out of 41 lesions (88%) with 2% (1/41) of overall procedural morbidity rate. Procedural and clinical success rate of intra-cranial stent placement was 64% (7/11) and no complications occurred during or after intra-cranial stent placement: the morbidity rate was 0%. Hyperperfusion injury occurred in two patients after successful implantation of stents in subtotal occlusion of the internal carotid artery, and consequently the overall clinical success rate was 80% (33/41). Restenosis occurred in four (12%) out of 33 patients who underwent six month follow-up arteriography. No ischemic attacks or stent-deformation occurred during follow-up after stenting treatment. For lesions not amenable to standard balloon angioplasty, endovascular stent placement seems to be a safe and effective treatment of modality.

Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery

2016 ◽  
Vol 58 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Dong Jae Shim ◽  
Ji Hoon Shin ◽  
Gi-Young Ko ◽  
Yook Kim ◽  
Kichang Han ◽  
...  
Keyword(s):  
Portal Vein ◽  
Stent Placement ◽  
Variceal Bleeding ◽  
Clinical Success ◽  
Recurrent Bleeding ◽  
Technical Success ◽  
Stent Patency ◽  
Stent Occlusion ◽  
Before And After

Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7–1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.

scholarly journals Endoscopic ultrasound-based transluminal cholecystolithotomy: the retrievable anchor assisted procedure

2019 ◽  
Author(s):  
Nan Ge ◽  
Jinlong Hu ◽  
Fei Yang ◽  
Fan Yang ◽  
Kai Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Outcome Measures ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Safe Procedure ◽  
Indwelling Time ◽  
Per Oral

Abstract Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is gradually emerging as an option among patients with cholecystitis. A stent-bridged endoscopic intervention in the gallbladder (GB) was further introduced. The aim of this study was to assess the effectiveness and safety of the electrocautery-enhanced delivery of a lumen apposing metal stent (ECE-LAMS) and this newly designed retrievable anchor (RA) applied in the transmural cholecystolithotomy. Method We retrospectively reviewed consecutive patients undergoing EUS-guided transmural cholecystoscopic therapy. The main outcome measures for the EUS-GBD procedure were technical success and adverse events, which were also compared between the guided assisted group and the RA-assisted group. The main outcome measures for transmural cholecystoscopy after EUS-GBD were the stent indwelling time, clinical success, and adverse events. Results A total of 24 (15 female) patients with gallstones received transluminal cholecystolithotomy. The mean age of the patients was 36.08±13.69 years. The success rate of the anchor-assisted group was higher than that of the guidewire-assisted group (92.9% vs. 70%, P=0.07). On an average of 12.25±2.77 (range 8-17) days after the initial GB drainage procedure, 20 patients received per-oral cholecystoscopy via the fistula. A ruptured fistula was found in 2 patients in whom the per-oral cholecystoscopy was applied on the ninth day after EUS-GBD. During the follow-up period (mean 314.2± 213.7 days), no GB stone recurrence or other long-term complications were reported. Conclusion We demonstrated that the EUS-assisted per-oral cholecystoscopy technique with ECE-LMAS is an efficient and safe procedure. For the EUS-GBD procedure, a RA could significantly increase the success rate compared with the guidewire.

scholarly journals Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study

2017 ◽  
Vol 127 (5) ◽  
pp. 1126-1133 ◽  
Author(s):  
Kenneth C. Liu ◽  
Robert M. Starke ◽  
Christopher R. Durst ◽  
Tony R. Wang ◽  
Dale Ding ◽  
...  
Keyword(s):  
Pilot Study ◽  
Intracranial Pressure ◽  
Pressure Gradient ◽  
Stent Placement ◽  
Venous Pressure ◽  
Visual Fields ◽  
Elevated Pressure ◽  
Venous Sinus ◽  
Sinus Stenosis

OBJECTIVEIdiopathic intracranial hypertension (IIH) may cause blindness due to elevated intracranial pressure (ICP). Venous sinus stenosis has been identified in select patients, leading to stenting as a potential treatment, but its effects on global ICP have not been completely defined. The purpose of this pilot study was to assess the effects of venous sinus stenting on ICP in a small group of patients with IIH.METHODSTen patients for whom medical therapy had failed were prospectively followed. Ophthalmological examinations were assessed, and patients with venous sinus stenosis on MR angiography proceeded to catheter angiography, venography with assessment of pressure gradient, and ICP monitoring. Patients with elevated ICP measurements and an elevated pressure gradient across the stenosis were treated with stent placement.RESULTSAll patients had elevated venous pressure (mean 39.5 ± 14.9 mm Hg), an elevated gradient across the venous sinus stenosis (30.0 ± 13.2 mm Hg), and elevated ICP (42.2 ± 15.9 mm Hg). Following stent placement, all patients had resolution of the stenosis and gradient (1 ± 1 mm Hg). The ICP values showed an immediate decrease (to a mean of 17.0 ± 8.3 mm Hg), and further decreased overnight (to a mean of 8 ± 4.2 mm Hg). All patients had subjective and objective improvement, and all but one improved during follow-up (median 23.4 months; range 15.7–31.6 months). Two patients developed stent-adjacent stenosis; retreatment abolished the stenosis and gradient in both cases. Patients presenting with papilledema had resolution on follow-up funduscopic imaging and optical coherence tomography (OCT) and improvement on visual field testing. Patients presenting with optic atrophy had optic nerve thinning on follow-up OCT, but improved visual fields.CONCLUSIONSFor selected patients with IIH and venous sinus stenosis with an elevated pressure gradient and elevated ICP, venous sinus stenting results in resolution of the venous pressure gradient, reduction in ICP, and functional, neurological, and ophthalmological improvement. As patients are at risk for stent-adjacent stenosis, further follow-up is necessary to determine long-term outcomes and gain an understanding of venous sinus stenosis as a primary or secondary pathological process behind elevated ICP.

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