RESUMEN
The role of a low-profile visualized intraluminal support stent (LVIS) and Enterprise in the treatment of unruptured intracranial aneurysms is well established. Although previous studies have investigated one single type of stent for the treatment of ruptured intracranial aneurysms (RIA), the safety and efficacy between the two types of stents has not been fully explored. Herein we conducted a study to compare the outcomes of the two stents for treatment of RIA. This is a prospective registry database of aneurysmal subarachnoid hemorrhage (aSAH) patients admitted to a single institution between 2018 and 2021. We collected patient baseline information, secondary complications, follow-up angiographic data, long-term prognostic outcomes, and conducted propensity score matching (PSM) analysis with 1:1 ratio and a multivariable logistic regression to compare the outcomes of the two types of stents. A total of 231 patients with RIAs were included in this study, with 108 treated using the LVIS device and 123 treated using the Enterprise device. Before PSM analysis, only the incidence of poor prognosis after 12 months was higher in the Enterprise group comparing to the LVIS group (20% vs. 10%, P = 0.049). After PSM analysis, there was a higher occurrence of delayed cerebral ischemia (DCI) in the Enterprise group compared to the LVIS group (odds ratio [OR] 3.95, 95% confidence interval [CI] [1.20-13.01], P = 0.024). However, no significant difference in prognosis was observed after PSM adjustment. Furthermore, subgroup analysis revealed that patients with female (P = 0.019), hypertension (P = 0.048), and anterior circulation aneurysms (P = 0.019) receiving the Enterprise device had a higher risk of DCI. The overall efficacy of LVIS and Enterprise in the treatment of RIA is comparable, while the incidence of DCI in the LVIS group is lower than that in the Enterprise group after PSM analysis. Registration number: NCT05738083 ( https://clinicaltrials.gov/ ).
Asunto(s)
Aneurisma Roto , Embolización Terapéutica , Aneurisma Intracraneal , Puntaje de Propensión , Stents , Humanos , Aneurisma Intracraneal/terapia , Femenino , Masculino , Aneurisma Roto/terapia , Persona de Mediana Edad , Embolización Terapéutica/métodos , Embolización Terapéutica/instrumentación , Anciano , Adulto , Resultado del Tratamiento , Estudios de Cohortes , Procedimientos Endovasculares/métodos , Hemorragia Subaracnoidea/terapiaRESUMEN
OBJECTIVE: Currently, the factors influencing poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy are still unclear. Therefore, the aim of this study was to determine the risk factors for poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy and to provide evidence for the prevention of this complication. METHODS: This retrospective study included 86 patients who underwent periodic replacement of ureteral stents following radical cystectomy with cutaneous ureterostomy between October 2017 and March 2024. The general data and related indicators of the patients were collected, the risk factors were identified through univariate and multivariate logistic regression analyses, and corresponding interventions were proposed. RESULTS: Among the 86 patients, 26 had poor drainage of ureteral stents, with an incidence rate of 30.23%, and no serious consequences occurred after timely and effective treatment. Univariate and multivariate logistic regression analyses revealed that body mass index (BMI) (p = 0.003, odds ratio (OR) = 2.909, 95% CI: 1.435-5.898), diabetes mellitus (p = 0.012, OR = 14.073, 95% CI: 1.770-111.889), urinary tract infection (p = 0.004, OR = 16.792, 95% CI: 2.402-117.411), and foreign body blockage (p = 0.048, OR = 5.277, 95% CI: 1.012-27.512) were independent risk factors for poor drainage of ureteral stents. CONCLUSIONS: The incidence of poor drainage of ureteral stents after radical cystectomy with cutaneous ureterostomy is relatively high. Maintenance of a healthy weight, strict management of blood glucose levels, active prevention of urinary tract infections, and timely detection and removal of small foreign bodies that may be present are essential to prevent this complication.
Asunto(s)
Cistectomía , Drenaje , Complicaciones Posoperatorias , Stents , Ureterostomía , Humanos , Estudios Retrospectivos , Cistectomía/métodos , Cistectomía/efectos adversos , Masculino , Stents/efectos adversos , Femenino , Ureterostomía/métodos , Factores de Riesgo , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Persona de Mediana Edad , Uréter/cirugíaRESUMEN
To address the conflict between the "fitness" and "feasibility" of body-fitted stents, this paper investigates the impact of various smoothing design strategies on the mechanical behaviour and apposition performance of stent. Based on the three-dimensional projection method, the projection region was fitted with the least squares method (fitting orders 1-6 corresponded to models 1-6, respectively) to achieve the effect of smoothing the body-fitted stent. The simulation included the crimping and expansion process of six groups of stents in stenotic vessels with different degrees of plaque calcification. Various metrics were analyzed, including bending stiffness, stent ruggedness, area residual stenosis rate, contact area fraction, and contact volume fraction. The study findings showed that the bending stiffness, stent ruggedness, area residual stenosis rate, contact area fraction and contact volume fraction increased with the fitting order's increase. Model 1 had the smallest contact area fraction and contact volume fraction, 77.63% and 83.49% respectively, in the incompletely calcified plaque environment. In the completely calcified plaque environment, these values were 72.86% and 82.21%, respectively. Additionally, it had the worst "fitness". Models 5 and 6 had similar values for stent ruggedness, with 32.15% and 32.38%, respectively, which indicated the worst "feasibility" for fabrication and implantation. Models 2, 3, and 4 had similar area residual stenosis rates in both plaque environments. In conclusion, it is more reasonable to obtain the body-fitted stent by using 2nd to 4th order fitting with the least squares method to the projected region. Among them, the body-fitted stent obtained by the 2nd order fitting performs better in the completely calcified environment.
Asunto(s)
Stents , Humanos , Diseño de Prótesis , Simulación por Computador , Placa AteroscleróticaRESUMEN
BACKGROUND: Angina pectoris can occur in up to 40% of patients following percutaneous coronary intervention (PCI). There is limited data assessing whether the type of stent implanted during revascularization can predict post-PCI angina symptoms. METHODS: In this study, data regarding revascularization characteristics including the stent type in patients admitted for PCI was collected. Prospective data including occurrence of angina and the presenting class, new onset ST-segment elevation myocardial infarction (STEMI), and other clinical outcomes were collected at 1, 3, and 6-month follow-up intervals. Univariable and multivariable logistic regression models were used to assess the potential predictors of angina symptoms at 6-month follow-up. RESULTS: A total of 787 patients (64.5% males) undergoing PCI with three stent types (Orsiro, Promus, and Xience) were included in the study. The occurrence of post PCI angina pectoris and new STEMI was similar among the stent types (p > 0.05). A linear association was found between the development of new STEMI (p = 0.018) and stroke (p = 0.003) and the worsening of angina class. The stent type was not a predictor of angina during the follow-up period. Other variables including dyslipidemia (odds ratio (OR) (95% CI), 1.51 (1.08; 2.10)), prior coronary artery disease (CAD) (OR (95% CI), 1.63 (1.02; 2.61)), and previous hospitalization (OR (95% CI), 2.10 (1.22; 3.63)) were independent predictors of angina. CONCLUSIONS: Although the type of stent may not have an association with the post-PCI angina, other predictors such as dyslipidemia and previous CAD and hospitalization may predict recurrence of cardiac angina. The class of angina severity may have a linear association with new-onset STEMI and stroke.
Asunto(s)
Angina de Pecho , Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Diseño de Prótesis , Infarto del Miocardio con Elevación del ST , Stents , Humanos , Masculino , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Femenino , Persona de Mediana Edad , Angina de Pecho/terapia , Angina de Pecho/etiología , Angina de Pecho/diagnóstico , Factores de Riesgo , Anciano , Resultado del Tratamiento , Factores de Tiempo , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/diagnóstico , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Medición de Riesgo , Estudios ProspectivosRESUMEN
Thoracic endovascular aortic repair is commonly used in the surgical treatment of patients with aortic coarctation, but complications such as endoleaks can occur. This video tutorial presents a case study involving the exclusion of a stent graft from the bloodstream through total transection of the aortic arch and abdominal aorta, with off-pump aortic grafting and debranching of the left carotid and subclavian arteries.
Asunto(s)
Implantación de Prótesis Vascular , Endofuga , Procedimientos Endovasculares , Humanos , Endofuga/etiología , Endofuga/cirugía , Endofuga/diagnóstico , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/efectos adversos , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/efectos adversos , Masculino , Aorta Abdominal/cirugía , Stents , Aorta Torácica/cirugía , Prótesis Vascular/efectos adversos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnósticoRESUMEN
Congenital Quadricuspid Aortic Valve (QAV) malformation is a relatively rare cardiac valve malformation, especially with abnormal coronary opening and severe stenosis of Coronary Artery Disease (CAD). The patient underwent "one-stop" interventional treatment with transcatheter aortic valve replacement and percutaneous coronary stent implantation. Follow up for 12-month with good outcomes.
Asunto(s)
Válvula Aórtica , Enfermedad de la Arteria Coronaria , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Masculino , Stents , Intervención Coronaria Percutánea/métodos , Angiografía Coronaria , AncianoRESUMEN
We present two clinical cases of successful endovascular treatment of proximal deep vein thrombosis following May-Thurner syndrome. In the first case, 2-day regional catheter thrombolysis, percutaneous mechanical thrombectomy and venous stenting were required to restore hemodynamics in the left lower limb. In the second case, regional catheter thrombolysis continued for 3 days with subsequent thrombotic mass lysis. However, iliac vein was severely narrowed that required venous stenting. Long-term results were favorable in both cases. Venous outflow has become almost normal after endovascular treatment. The patients' ability to work has been restored.
Asunto(s)
Procedimientos Endovasculares , Vena Ilíaca , Síndrome de May-Thurner , Stents , Trombectomía , Trombosis de la Vena , Humanos , Síndrome de May-Thurner/complicaciones , Síndrome de May-Thurner/terapia , Síndrome de May-Thurner/diagnóstico , Síndrome de May-Thurner/cirugía , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia , Trombosis de la Vena/cirugía , Trombosis de la Vena/diagnóstico , Procedimientos Endovasculares/métodos , Resultado del Tratamiento , Vena Ilíaca/cirugía , Trombectomía/métodos , Femenino , Masculino , Terapia Trombolítica/métodos , Persona de Mediana Edad , Adulto , Extremidad Inferior/irrigación sanguíneaAsunto(s)
Broncoscopía , Stents , Humanos , Broncoscopía/métodos , Masculino , Persona de Mediana Edad , Femenino , Siliconas , Anciano , Resultado del Tratamiento , AdultoRESUMEN
BACKGROUND: Aorto-ostial (AO) coronary interventions may be associated with multiple problems, including the potential embolization of atherothrombotic debris into the aorta and systemic circulation. Such embolization could theoretically lead to stroke or silent brain injury (SBI). In this study, we aimed to investigate whether there is an increased risk of SBI in patients undergoing AO stent implantation. METHODS: Fifty-five consecutive patients undergoing AO stenting and 55 consecutive patients undergoing non-AO stenting were included. Venous blood samples were obtained before and 12 h after the procedure to measure neuron-specific enolase (NSE), which is a sensitive marker of brain injury. Newly developed NSE elevation after the procedure in an asymptomatic patient was defined as SBI. RESULTS: SBI was detected in 24 (43.6%) patients in the AO stenting group and 17 (30.9%) patients in the non-AO stenting group (p = .167). Although the SBI rates were statistically comparable between the groups, the presence of significant (≥50%) AO stenosis was found to be an independent predictor of SBI in multivariate logistic regression analysis [odds ratio (OR) 2.856; 95% confidence interval (CI) 1.057-7.716; p = .038]. A longer procedure time was another independent predictor for the development of SBI (OR 1.037; 95% CI 1.005-1.069; p = .023). CONCLUSION: This study suggests that AO stenting may be associated with an increased risk of SBI if the lesion in the ostium is significant.
Asunto(s)
Intervención Coronaria Percutánea , Fosfopiruvato Hidratasa , Stents , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Stents/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Fosfopiruvato Hidratasa/sangre , Lesiones Encefálicas/etiología , Factores de Riesgo , Biomarcadores/sangreAsunto(s)
Intervención Coronaria Percutánea , Stents , Humanos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/cirugía , Stents Liberadores de Fármacos , Diseño de PrótesisRESUMEN
BACKGROUND: Although femoropopliteal-specific stents have durable patency, stent thrombosis (ST) may occur, which can lead to acute limb ischaemia (ALI). AIMS: We aimed to investigate the clinical features and outcomes of ALI caused by femoropopliteal ST in patients with lower extremity artery disease. METHODS: This multicentre retrospective study included 499 patients with ALI - of whom 108 patients had ALI caused by femoropopliteal ST (ST-ALI) and 391 patients had ALI caused by other aetiologies (de novo ALI) - who underwent treatment between September 2011 and March 2023. Clinical features and outcomes were compared between the two groups. The primary outcome measure was 12-month amputation-free survival; factors associated with amputation or death were investigated using multivariate Cox proportional hazards regression analysis. RESULTS: Patients with ST-ALI were significantly more likely to exhibit conventional atherosclerotic risk factors, including diabetes mellitus (63% vs 26%) and haemodialysis (51% vs 10%) compared to patients with de novo ALI, whereas patients with de novo ALI were older (80 years vs 74 years) and more likely to have atrial fibrillation (49% vs 18%) than patients with ST-ALI. The 12-month amputation-free survival rate was significantly lower in the ST-ALI group than that in the de novo ALI group (51% vs 76%; p<0.001). Multivariate analysis revealed that ST-ALI, older age, haemodialysis, atrial fibrillation, the presence of a wound, peak C-reactive protein level, and non-ambulatory status all have an independent, positive association with death or major amputation. CONCLUSIONS: The current study revealed that patients with ST-ALI had worse clinical outcomes than those with de novo ALI, highlighting the need to maximise ST prevention.
Asunto(s)
Amputación Quirúrgica , Arteria Femoral , Isquemia , Enfermedad Arterial Periférica , Arteria Poplítea , Stents , Trombosis , Humanos , Masculino , Anciano , Femenino , Estudios Retrospectivos , Arteria Poplítea/cirugía , Isquemia/terapia , Isquemia/mortalidad , Isquemia/etiología , Isquemia/cirugía , Arteria Femoral/cirugía , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/mortalidad , Anciano de 80 o más Años , Persona de Mediana Edad , Trombosis/etiología , Trombosis/mortalidad , Resultado del Tratamiento , Factores de Riesgo , Recuperación del Miembro , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Extremidad Inferior/irrigación sanguínea , Enfermedad Aguda , Grado de Desobstrucción VascularRESUMEN
Ruptured vertebral artery dissecting aneurysms(VADA) carry a poor prognosis owing to the high rates of rebleeding, stroke, and mortality without appropriate treatment. Various endovascular techniques are employed to treat these aneurysms. Deconstructive techniques, involving internal trapping with coils, often achieve complete angiographic occlusion at higher rates; however, they carry a risk of medullary infarction. Reconstructive techniques using neck-bridge stents preserve the parent vessel and reduce perioperative morbidity. Nevertheless, these techniques are associated with a higher rate of aneurysmal rebleeding or recurrence. Optimal treatment modalities should be chosen based on the anatomical characteristics of the aneurysm and the trade-off between risks and benefits.
Asunto(s)
Aneurisma Roto , Procedimientos Endovasculares , Disección de la Arteria Vertebral , Humanos , Procedimientos Endovasculares/métodos , Disección de la Arteria Vertebral/cirugía , Disección de la Arteria Vertebral/diagnóstico por imagen , Aneurisma Roto/cirugía , Aneurisma Roto/diagnóstico por imagen , StentsRESUMEN
Healthcare is a major generator of greenhouse gases, so consideration of this contribution to climate change needs to be quantified in ways that can inform models of care. Given the availability of activity-based financial data, environmentally-extended input-output (EEIO) analysis can be employed to calculate systemic carbon footprints for healthcare activities, allowing comparison of different patient care pathways. We thus quantified and compared the carbon footprint of two common care pathways for patients with stable coronary artery disease, with similar clinical outcomes: coronary stenting and coronary artery bypass surgery (CABG). Healthcare cost data for these two pathways were disaggregated and the carbon footprint associated with this expenditure was calculated by connecting the flow of money within the economy to the greenhouse gases emitted to support the full range of associated activities. The systemic carbon footprint associated with an average stable patient CABG pathway, at a large tertiary referral hospital in Sydney, Australia in 2021-22, was 11.5 tonnes CO2-e, 4.9 times greater than the 2.4 tonnes CO2-e footprint of an average comparable stenting pathway. These data suggest that a stenting pathway for stable coronary disease should be preferred on environmental grounds and introduces EEIO analysis as a practical tool to assist in health-care related carbon footprinting.
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Huella de Carbono , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Stents , Humanos , Enfermedad de la Arteria Coronaria/cirugía , Australia , Costos de la Atención en SaludRESUMEN
To provide optimal care in pancreatic ductal adenocarcinoma, involvement of palliative medicine and nutritional support is recommended. Advances in endoscopy have resulted in robust options for biliary and gastrointestinal stenting for relief of obstruction. Notwithstanding, surgical hepaticojejunostomy and gastrojejunostomy remain incontrovertible considerations for biliary obstruction and gastric outlet obstruction, respectively. For PDAC-associated pain, opioid therapy continues to be the mainstay. However, refractory pain may be treated with interventional procedures such as celiac or splanchnic nerve blocks or neurolysis. In patients with PDAC, enteral nutrition can be further complicated by exocrine pancreatic insufficiency, which should be treated with oral pancreatic enzyme supplementation.
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Cuidados Paliativos , Neoplasias Pancreáticas , Humanos , Cuidados Paliativos/métodos , Neoplasias Pancreáticas/cirugía , Carcinoma Ductal Pancreático/cirugía , StentsAsunto(s)
Intervención Coronaria Percutánea , Stents , Humanos , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/instrumentación , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Angiografía Coronaria/métodosRESUMEN
BACKGROUND: Clopidogrel monotherapy improved clinical outcomes compared with aspirin monotherapy during a chronic maintenance period in patients who underwent coronary stenting in the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) trial. However, it is uncertain whether the beneficial effect of clopidogrel over aspirin is different according to the renal function. METHODS AND RESULTS: We conducted a post hoc analysis of the HOST-EXAM trial. Chronic kidney disease (CKD) was defined as baseline estimated glomerular filtration rate <60 mL/min per 1.73 m2. The primary end point was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium bleeding type ≥3, during the 2-year follow up. Among the 5438 patients enrolled in the HOST-EXAM trial, 4844 patients (mean age, 63.3±10.6 years; 74.9% men) with a baseline creatinine value were analyzed in this study. A total of 508 (10.5%) patients had CKD, who were at higher risk of the primary end point compared with those without CKD (hazard ratio [HR], 2.01 [95% CI, 1.51-2.67]). Clopidogrel monotherapy was associated with a lower rate of the primary end point in both patients with CKD (HR, 0.74 [95% CI, 0.44-1.25]) and patients without CKD (HR, 0.71 [95% CI, 0.56-0.91]). No significant interaction was observed between the treatment effect and CKD status (P for interaction=0.889). CONCLUSIONS: During the chronic maintenance period after coronary stenting, the risk of thrombotic and bleeding events was significantly higher in patients with CKD compared with those without CKD. There was no statistical difference in the treatment effect of clopidogrel monotherapy in those with versus without CKD.
Asunto(s)
Aspirina , Clopidogrel , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria , Insuficiencia Renal Crónica , Humanos , Clopidogrel/uso terapéutico , Clopidogrel/efectos adversos , Clopidogrel/administración & dosificación , Masculino , Femenino , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Inhibidores de Agregación Plaquetaria/administración & dosificación , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Aspirina/administración & dosificación , Aspirina/uso terapéutico , Aspirina/efectos adversos , Anciano , Hemorragia/inducido químicamente , Resultado del Tratamiento , Tasa de Filtración Glomerular , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Stents , Factores de TiempoRESUMEN
PURPOSE: Aim of this study is to summarize medical device reports (MDRs) between 2012 and 2022 relating to ureteral stents within the Manufacturer and User Facility Device Experience (MAUDE) database maintained by The Food and Drug Administration (FDA). METHODS: MAUDE was analyzed for all MDRs relating to each FDA-approved ureteral stent. Event descriptions were reviewed and characterized into specific event types. Outcome measures include specific ureteral stent and reported events as detailed by the MDRs. Data is presented as number of specific event/total events. Pooled Relative risk was used to compare data. RESULTS: 2652 reports were retrieved in 10 years and a progressive rise in reported events was recorded. 831/2652 (31%) were reported as injury while 1810/2652 (68%) as malfunction of the ureteral stent and 4 events of death. The most frequently reported adverse events (AEs) were stent break (627/2652: 23%); material problems (384/2652: 14%); calcification (222/2652: 8%); difficulty to insert, advance or remove the device (155/2652: 6%). Bard stents were associated with most material problems (19%), Resonance stents were associated with most difficulty to insert, advance or remove the device (9%) and calcification (15%) while filiform double pigtail stent set were associated with most breakage reports (56%) when compared to the other stents (PRR > 1, p < 0,05). CONCLUSIONS: According to MAUDE database the most frequent complications related to ureteral stents are breakage, material problems, calcification and difficulty to insert/advance/remove the device. As well Resonance ureteral stents seem to be associated with a higher risk of device problems.