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Deutsches Arzteblatt International Sep 2021Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in... (Review)
Review
BACKGROUND
Despite the use of modern drug-eluting stents (DES), in-stent restenosis (ISR) may still occur in as many as 2-10% of percutaneous coronary interventions (PCI) in certain lesion/patient subsets. ISR causes increased morbidity after stent implantation; acute myocardial infarction is a frequent correlate to a clinical ISR, arising in 5-10% of cases. Compared to de novo stenosis, patients with ISR also present more frequently with symptoms of unstable angina pectoris (45% versus 61%). In this article, we discuss the risk factors for ISR and the corresponding diagnostic measures and effective treatment strategies.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to current international guidelines and specialist society recommendations.
RESULTS
The type of implanted stent, the presence of diabetes mellitus, previous bypass surgery, and small vessel caliber are predictors for ISR. In their guidelines, the European specialist societies (ESC/EACTS) recommend repeated PCI with DES implantation or drug-coated balloon (DCB) angioplasty as the methods of choice for the treatment of ISR. This approach is supported by evidence from meta-analyses. The RIBS-IV trial showed that revascularization treatment of the target lesion is needed less often after everolimus-eluting stent (EES) implantation than after DCB dilatation (11 [7.1%] versus 24 [15.6%]; p = 0.015; hazard ratio: 0.43; 95% confidence interval: [0.21; 0.87]).
CONCLUSION
Because the pathogenesis of ISR is multifactorial, differentiated risk stratification is necessary. The identification of patient-, stent-, and lesion-related predictors is particularly important, as the most effective way to combat ISR is to prevent it.
Topics: Constriction, Pathologic; Coronary Angiography; Coronary Restenosis; Drug-Eluting Stents; Humans; Percutaneous Coronary Intervention; Prosthesis Design; Risk Factors; Stents; Treatment Outcome
PubMed: 34379053
DOI: 10.3238/arztebl.m2021.0254 -
Journal of Medicine and Life 2021Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed...
Double J stent is an essential tool in urology, being a basic part of many urological procedures. However, some issues related to their use still occur. Our study aimed to evaluate an important number of procedures, the complications of ureteral stents, and their prevention and treatment retrospectively. We evaluate 50,000 procedures performed between 1996 and 2021 on 36,688 patients. According to the stenting duration, the cases were divided into short-term (less than 6 weeks - 34,213 procedures), respectively long-term stenting (more than 6 weeks - 15,757 procedures). The indications of stenting for both groups were noted. The total number of complications was 41,369. We encountered 153 cases (0.3%) of JJ stent malposition, of which 3 cases were into the retroperitoneum, one case with parenchymal perforation and hematoma. Considering the double J migrations, we found proximal migration in 427 cases (0.9%) and distal double J migrations in 352 (0.7%) cases. The obstruction of the ureteral stent, causing inefficient drainage, was encountered in 925 cases, while irritative bladder symptoms occurred in 16,326 cases (32.7%). Hematuria was observed in 5,213 cases, in 7 cases blood transfusion being necessary. Urinary tract infection was diagnosed in 7,436 cases (14.8%). Stent encrustation and calcification occurred in 832 cases, while stent fragmentation was noted in 52 cases. Double J stent complications should be promptly evaluated and treated. Encrustation and stone formation in forgotten stents often lead to serious complications and should be managed with stent removal and combined endourological techniques.
Topics: Device Removal; Humans; Retrospective Studies; Stents; Ureter
PubMed: 35126746
DOI: 10.25122/jml-2021-0352 -
Endoscopy May 2020The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 : ESGE...
The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 : ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 : ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 : ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 : ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 : ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 : ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 : ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.
Topics: Colonic Neoplasms; Colonoscopy; Endoscopy, Gastrointestinal; Humans; Intestinal Obstruction; Self Expandable Metallic Stents; Stents
PubMed: 32259849
DOI: 10.1055/a-1140-3017 -
Endoscopy Jul 20211: ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic...
MALIGNANT DISEASE
1: ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 : ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3: ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 : ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence.
BENIGN DISEASE
5: ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6: ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7: ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8: ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9: ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 : ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.
Topics: Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Self Expandable Metallic Stents; Stents
PubMed: 33930932
DOI: 10.1055/a-1475-0063 -
Deutsches Arzteblatt International May 2020Stent thrombosis (ST) is a dreaded complication after stent implantation and is associated with a mortality between 5% and 45%. The mechanisms by which ST arises are... (Review)
Review
BACKGROUND
Stent thrombosis (ST) is a dreaded complication after stent implantation and is associated with a mortality between 5% and 45%. The mechanisms by which ST arises are complex. Because of the seriousness of this situation, all phy - sicians should have at least basic knowledge of it. In this article, we present the risk factors for ST and discuss some innovative approaches to its treatment.
METHODS
This review is based on pertinent articles retrieved by a selective search in PubMed, and on current international guidelines and expert recommendations.
RESULTS
The frequency of ST has been markedly lowered by technical advances in coronary stenting and by the implementation of modern implantation techniques, including the introduction of coverage with dual antiplatelet therapy (DAPT). Both patient-related risk factors and procedural aspects can elevate the risk of ST. The independent risk factors for ST include premature termination of DAPT (hazard ratio [HR] 26.8; 95% confidence interval [8.4; 85.4]; p <0.0001), malignant disease (odds ratio [OR]: 17.45; [4.67; 65.26]; p <0.0001), and diabetes mellitus (OR: 3.14; [1.33; 7.45]; p = 0.0093). In comparison to angiographically guided procedures, the use of intracoronary imaging techniques in patients with acute coronary syndrome lowers the frequency of ST (0.6% versus 1.2%; p = 0.005). These techniques enable the detection of many findings in the coronary arteries that are associated with the development of ST. In such cases, countermeasures such as secondary stent dilatation or prolongation of DAPT can help prevent ST.
CONCLUSION
As the pathophysiology of ST is multifactorial, research in this area presents a special challenge. Prospective clinical trials will be needed to determine whether the systematic use of imaging techniques can lower the frequency of ST.
Topics: Coronary Thrombosis; Humans; Risk Factors; Stents
PubMed: 32605709
DOI: 10.3238/arztebl.2020.0320 -
JACC. Cardiovascular Interventions Dec 2020
Topics: Drug-Eluting Stents; Everolimus; Humans; Network Meta-Analysis; Technology; Treatment Outcome
PubMed: 33357525
DOI: 10.1016/j.jcin.2020.10.004 -
International Journal of Medical... 2024Atherosclerosis, a chronic inflammation of blood vessel walls, is a progressive pathophysiological process characterized by lipid deposition and innate adaptive immune... (Review)
Review
Atherosclerosis, a chronic inflammation of blood vessel walls, is a progressive pathophysiological process characterized by lipid deposition and innate adaptive immune responses. Arteriosclerosis often leads to narrowing of blood vessels. At present, interventional stent therapy is the main treatment method for vascular stenosis, which has the advantages of less trauma, less risk and faster recovery. However, atherosclerosis occurs in a complex pathophysiological environment. Stenting inevitably causes local tissue damage, leading to complications such as inflammation, intimal hyperplasia, late thrombosis, stent restenosis and other complications. It is urgent to optimize interventional therapy program. This article summarizes the advantages and disadvantages of absorbable metal scaffolds and the research progress of absorbable polymer scaffolds. The optimization strategy of stent is proposed. The status quo of drug coating was summarized. The prospect of new stent. To improve the therapeutic effect of arteriosclerosis.
Topics: Humans; Absorbable Implants; Stents; Thrombosis; Atherosclerosis; Inflammation
PubMed: 38169581
DOI: 10.7150/ijms.90012 -
World Journal of Gastroenterology Oct 2021Fully covered self-expandable metal stents (FCSEMS) represent the latest advancement of metal biliary stents used to endoscopically treat a variety of obstructive... (Review)
Review
Fully covered self-expandable metal stents (FCSEMS) represent the latest advancement of metal biliary stents used to endoscopically treat a variety of obstructive biliary pathology. A large stent diameter and synthetic covering over the tubular mesh prolong stent patency and reduce risk for tissue hyperplasia and tumor ingrowth. Additionally, FCSEMS can be easily removed. All these features address issues faced by plastic and uncovered metal stents. The purpose of this paper is to comprehensively review the application of FCSEMS in benign and malignant biliary strictures, biliary leak, and post-sphincterotomy bleeding.
Topics: Biliary Tract Surgical Procedures; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Humans; Metals; Self Expandable Metallic Stents; Stents; Treatment Outcome
PubMed: 34720527
DOI: 10.3748/wjg.v27.i38.6357 -
JACC. Cardiovascular Interventions Jul 2022
Topics: Absorbable Implants; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Humans; Percutaneous Coronary Intervention; Prosthesis Design; Treatment Outcome
PubMed: 35798476
DOI: 10.1016/j.jcin.2022.06.003 -
JACC. Cardiovascular Interventions Jul 2020
Topics: Angioplasty; Carotid Arteries; Carotid Artery, Common; Humans; Stents; Treatment Outcome
PubMed: 32703596
DOI: 10.1016/j.jcin.2020.04.047