stent

摘要： BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.

摘要： BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI therapy,such as vessel perforation and dissection in the brachiocephalic,subclavian,internal mammary,and thyrocervical arteries,are rarely reported.Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction,hemothorax,respiratory failure,hemorrhagic shock,and death if not diagnosed early and treated promptly.CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation.During the procedure,the patient felt pharyngeal pain and tightness,which we mistook for myocardial ischemia.After PCI,swelling in the right neck and supraclavicular area was observed.The patient experienced dyspnea,emergency endotracheal intubation was performed,and then a sudden drop in blood pressure was observed.Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding.Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery.A covered stent was deployed to the right subclavian artery with successful sealing of the perforation,and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI.Early prevention,rapid recognition,and prompt treatment may improve the prognosis.

摘要： Stent deployments with residual stenosis(RS)were linked to increased risk of in-stent restenosis and thrombosis.The objective of the present work was to explore the underlying biomechanical mechanism(s)for adverse events with RS.The patient-specific carotid models with RS were constructed to investigate wall shear stress(WSS),velocity,relative residence time(RRT),and oscillating shear index(OSI)after stenting in the host artery.The results showed that stented artery accompanied by RS would result in evident vortex,stagnation and recirculation zone at the stenosis throat,where relatively more areas were at abnormal low level of TAWSS,high level of RRT and OSI.Moreover,effects of stenting with RS on velocity,WSS,RRT and OSI in host artery would be significantly enhanced by severe RS,long stent and common carotid artery(CCA)stenting.These results indicated that stenting with RS might aggravate adverse flow around the stent and the other region without stent,leading to increased adverse events in clinic.Therefore,to obtain better poststenting outcomes,stenting with RS requires caution and careful consideration,especially for the host artery with a severe RS,long stent and some locations of stenting.

摘要： BACKGROUND Experimental studies suggest that self-expanding metal stents(SEMSs)enhance the aggressive behavior of obstructive colorectal cancer.The influence of SEMS placement on pathological alterations remains to be elucidated.AIM To determine whether SEMS placement is associated with molecular or pathological features of colorectal carcinoma tissues.METHODS Using a nonbiased molecular pathological epidemiology database of patients with obstructive colorectal cancers,we examined the association of SEMS placement with molecular or pathological features,including tumor size,histological type,American Joint Committee on Cancer(AJCC)-pTNM stage,and mutation statuses in colorectal cancer tissues compared with the use of transanal tubes.A multivariable logistic regression model was used to adjust for potential confounders.RESULTS SEMS placement was significantly associated with venous invasion(P<0.01),but not with the other features examined,including tumor size,disease stage,mutation status,and lymphatic invasion.In both the univariable and multivariable models with adjustment for potential factors including tumor location,histological type,and AJCC-pT stage,SEMS placement was significantly associated with severe venous invasion(P<0.01).For the outcome category of severe venous invasion,the multivariable odds ratio for SEMS placement relative to transanal tube placement was 19.4(95%confidence interval:5.24–96.2).No significant differences of disease-free survival and overall survival were observed between SEMS and transanal tube groups.CONCLUSION SEMS placement might be associated with severe venous invasion in colorectal cancer tissue,providing an impetus for further investigations on the pathological alterations by SEMSs in colorectal cancer development.

摘要： To the Editor:Biliary drainage is essential for controlling cholangitis and/or jaundice in patients with malignant hilar biliary obstruction,and endoscopy is the first choice of approach due to its less invasiveness.For unresectable cases,placement of self-expandable metal stents(SEMSs)has been recommended over that of plastic stents due to their longer patency,and bilateral placement is also recommended to achieve higher clinical success and patency rates[1].

摘要： BACKGROUND Endoscopic approach could effectively manage postoperative anastomotic leakage.Various endoscopic methods have been developed for the treatment of anastomotic leakage.CASE SUMMARY A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy.Endoscopic clip closure failed due to strong wall tension;therefore,a fully covered self-expandable esophageal metal stent(fc-SEMS)was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl.However,fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS.Using the previous fluoroscopic image for guidance,a catheter was inserted at the leakage site.The radiocontrast dye was injected and was seen spreading along the sinus tract.Thereafter,histoacryl was injected.Seven days after the last procedure,upper gastrointestinal contrast studies showed no leaks.The patient was subsequently discharged 9 d after histoacryl injection without any complications.CONCLUSION To seal an anastomosis leak after stent application,salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.

摘要： Stent fracture represents a rare cause of stent failure especially in the era of new genera-tion coronary drug-eluting stents(DES).It is described as the interruption of stent continuity resulting in increased risk of in-stent restenosis and stent thrombosis and predisposes to repeat revascu-larization.[1]Although a growing number of octo-genarians benefit today from an invasive treatment of coronary artery disease(CAD),this benefit could be lost in frail patients with multiple comorbidities.[2]Octogenarians constitute a high-risk population in whom frailty and multiple comorbidities mandate for careful treatment planning.

摘要： Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract.We evaluated their role in this setting.Methods:We conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures.They were randomized into three groups.Group A(n=46)received CAP(nitrofurantoin 100 mg once daily[OD]).Group B(n=48)received cranberry extract 300 mg and d-mannose 600 mg twice daily(BD).Group C(n=40)received no prophylaxis.The stents were removed between 15 days and 45 days after surgery.Three groups were compared in terms of colonization of stent and urine,stent related symptoms and febrile urinary tract infections(UTIs)during the period of indwelling stent and until 1 week after removal.Results:In Group A,9(19.5%)patients had significant bacterial growth on the stents.This was 8(16.7%)in the Group B and 5(12.5%)in Group C(p-value:0.743).However,the culture positivity rate of urine specimens showed a significant difference(p-value:0.023)with Group B showing least colonization of urine compared to groups A and C.There was no statistically significant difference in the frequency of stent related symptoms(p-value:0.242)or febrile UTIs(p-value:0.399)among the groups.Conclusion:Prophylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent,stent related symptoms or febrile UTIs.Cranberry extract may reduce the colonization of urinary tract,but its clinical significance needs further evaluation.

摘要： Stent implantation has been proven to be safe and has become the first-line intervention for May-Thumer syndrome(MTS),with satisfactory mid-term patency rates and clinical outcomes.Recent research has demonstrated that catheter-directed thrombolysis is the preferred strategy when MTS is combined with deep vein thrombosis after self-expanding stent placement.However,the stent used for the venous system was developed based on the experience obtained in the treatment of arterial disease.Consequently,relatively common corresponding complications may come along later,which include stent displacement,deformation,and obstruction.Different measures such as adopting a stent with a larger diameter,improving stent flexibility,and increasing stent strength have been employed in order to prevent these complications.The ideal venous stent is presently being evaluated and will be introduced in detail in this review.

摘要： Objective:To investigate the advantages and effects of pipeline embolization device(PED)or Willis stent,in treating traumatic pseudoaneurysms.Traumatic pseudo intracranial aneurysms(TPIA)can be caused by either direct trauma or iatrogenic injuries,usually caused by direct arterial wall injury or shear due to acceleration.We describe a series of patients with TPIA who received a PED or Willis stent.Materials and methods:Retrospective analysis was performed on nine patients with TPIA admitted to the southern hospital of Southern Medical University from December 2017 to June 2019,of whom four were treated with PED and five were implanted with six Willis covered stents.The occlusive rate and complication in the two kinds of stents were compared by postoperative follow-up and modified rankin score(MRS).Results:After the implantation of PED,four patients showed an immediate stagnation of blood flow or a decreased filling in aneurysms,three out of four patients exhibited complete occlusion,and the remaining patient had nearly complete occlusion.Four out of five cases of Willis stent implantation were associated with immediate complete occlusion of aneurysms,and the modified rankin score of these patients ranged from 0 to 1.One patient died of unassociated complications.Conclusion:For different types of TPIA in the internal carotid artery(ICA),PED and Willis stents provide significant advantages in treatment,with fewer postoperative complications and prognosis well.

摘要： 一种可收缩医疗设备以及将其植入选定的器官和血管的相关方法，其中，该医疗设备由形状记忆纤维制成。该装置较佳地由连续管状纤维织物和终结于一为贯穿通道而设的一开口端的各端组成。各终端还包括一附着于端部外围的固定体，其中，基本平面由其周边与纵向轴相交而形成至少一钝角或一锐角而确定。纤维织物可在注塑模中进行热处理以基本形成装置所希望的形状。固定部分也可附着在引导线末端或传送管上，由此可布置并在医疗设备布置后将其收回。