Vascular stents play an important role in the minimally invasive treatment of vascular diseases,such as vascular stenosis,vascular aneurysm,vascular dissection and vascular atherosclerotic plaque disease.Bare metal st...Vascular stents play an important role in the minimally invasive treatment of vascular diseases,such as vascular stenosis,vascular aneurysm,vascular dissection and vascular atherosclerotic plaque disease.Bare metal stents were initially fabricated;however,the incidence of complications such as thrombosis,inflammation,restenosis,vascular injury,displacement and endoleakage is still high after implantation.To overcome these complications,several strategies for designing functional vascular stents have been carried out.Drug-eluting stents,biodegradable stents and bionic stents were manufactured and investigated.This review aims to comprehensively analyze the vascular diseases suitable for stent implantation treatment,tissue reactions after implantation,the materials and manufacturing techniques used to fabricate vascular stents,the various application scenarios in which they could be used to treat vascular lesions and the development process of vascular stents.Future development trends of vascular stents are expected to prioritize their performance,biocompatibility,and clinical accessibility.The design of vascular stents may be transformed or improved to better fulfill the rehabilitation requirements of vascular disease patients.Finally,various application scenarios may be used to treat vascular or even nonvascular diseases via endovascular access.展开更多
BACKGROUND Postoperative pancreatic fistula(POPF)is the most frequent cause of morbimortality after pancreaticoduodenectomy,but the best technique to use to prevent its development is unclear.The choice of drainage me...BACKGROUND Postoperative pancreatic fistula(POPF)is the most frequent cause of morbimortality after pancreaticoduodenectomy,but the best technique to use to prevent its development is unclear.The choice of drainage method external duct stent(EDS),internal duct stent(IDS),or non-ductal stent(NDS)is also controversial.AIM To compare the three groups(EDS,IDS and NDS),analyzing the patient characteristics,perioperative examinations and survival.METHODS Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020,were divided into the EDS,IDS and NDS groups.RESULTS Of the 244 patients included,129 were in the EDS group,71 in the IDS group,and 44 in the NDS group.Except for preoperative pancreatitis in the NDS patients,comorbidities were similar among the groups.Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas(P<0.001).A lower rate of grade C POPF was observed in the EDS(1.6%)compared to the NDS(9.1%)and IDS group(14.1%)(P=0.009).The groups showed similar findings for delayed gastric emptying,postoperative hemorrhage,reoperation,and 5-year survivals.Ninety-day mortality rate was significantly higher in the IDS group(5.6%)compared to the EDS(1.6%)and NDS(4.5%)groups(P=0.046).Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF(P=0.034),and 90-day mortality(P=0.018).Additionally,a Wirsung duct diameter<3 mm was the only risk factor for grade B/C POPF(P=0.001),and 90-day mortality(P=0.031).CONCLUSION The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality,and the Wirsung duct<3 mm was a risk factor for grade B/C POPF and 90-day mortality.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
BACKGROUND Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction(MHBO)but remains technically challenging.The emergence of self-expandable meta...BACKGROUND Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction(MHBO)but remains technically challenging.The emergence of self-expandable metallic stents carried by an ultrathin(6 Fr or smaller)delivery system now permits simultaneous bilateral stent placement.To date,only a few studies have compared this new method with conventional sequential bilateral stenting.AIM To evaluate a possible superiority of simultaneous“side by side”(SBS)biliary drainage in unresectable MHBO.METHODS We identified 135 patients who benefited from bilateral drainage using uncovered self-expandable metallic stents between 2010 and 2023.Among them,62 benefited from simultaneous SBS bilateral drainage between 2017 and 2023,and 73 benefited from sequential bilateral drainage[38 using“stent in stent”(SIS)technique and 35 using SBS technique between 2010 and 2017].RESULTS Technical success was significantly increased in simultaneous drainage compared with sequential drainage(94%vs 75%,P=0.008).However,simultaneous SBS drainage and sequential SIS drainage had a similar technical success(94%vs 95%).We observed no differences regarding clinical success,procedure duration and recurrent biliary obstruction rate.Stent patency was shorter in the SIS group compared with the simultaneous group(103 days vs 144 days).Early adverse events were more frequent in the sequential group(31%vs 21%,P=0.205),with no differences regarding SIS or SBS technique.Technical failure was associated with a higher rate of infectious fatal adverse events(9.5%vs 1.7%,P=0.02).Reintervention after recurrent biliary obstruction seems to be more successful after using SBS rather than SIS techniques(83%vs 75%,P=0.53).CONCLUSION Simultaneous SBS metallic stent placement using an ultra-thin delivery system was technically easier and as efficient as sequential bilateral stenting in unresectable MHBO to achieve bilateral drainage.The SIS procedure remains a good option in unresectable MHBO.展开更多
Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,...Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
Biliary system,which is responsible for transporting bile from the liver into the intestine,is commonly damaged by inflammation or tumors eventually causing liver failure or death.The implantation of biliary stents ca...Biliary system,which is responsible for transporting bile from the liver into the intestine,is commonly damaged by inflammation or tumors eventually causing liver failure or death.The implantation of biliary stents can effectively alleviate both benign and malignant biliary strictures,but the plastic and metal stents that are currently used cannot degrade and nearly has no beneficial biological effects,therefore their long-term service can result into inflammation,the formation of sludges and re-obstruction of bile duct.In recent years,magnesium(Mg)metal has been received increasing attention in the field of biomedical application due to its excellent biocompatibility,adequate mechanical properties,biodegradability and other advantages,such as anti-inflammatory and anti-tumor properties.The research on biliary stents made of magnesium metals(BSMM)has also made significant progress and a series of experiments in vitro and vivo has proved their possibility.However,there are still some problems holding back BSMM’s clinical use,including rapid corrosion rate and potential harmful reaction.In this review,we would summarize the current research of BSMM,evaluate their clinical benefits,find the choke points,and discuss the solving method.展开更多
BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement impro...BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.展开更多
BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older g...BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.展开更多
BACKGROUND Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery.However,acute stent ...BACKGROUND Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery.However,acute stent occlusion is a troublesome complication due to the need for open surgery or the risk of distal embolization.Herein,we reported a novel approach to treat the acute thrombotic occlusion of an aortoiliac stent using both hemolytic and conventional mechanical thrombectomy coupled with a large diameter sheath.CASE SUMMARY A 64-year-old male patient presented with severe claudication of the right leg.The patient's history included multiple prior interventions for aortoiliac lesions.The preoperative computed tomography(CT)imaging showed a thrombotic occlusion of right aortoiliac stenting.An Angiojet Omni thrombectomy catheter(Boston Scientific,Marlborough,MA,United States)was used to remove the thrombus in a retrograde fashion after the successful placement of the large-diameter sheath in the right common femoral artery for prevention of distal embolization.The remnant organized thrombus was removed with an over-the-wire Fogarty catheter(Edwards Lifesciences,Irvine,CA,United States).Completion angiogram and postoperative CT imaging demonstrated complete removal of thrombus and no evidence of distal embolization.CONCLUSION This novel approach provides successful management of acute thrombotic occlusion of aortoiliac stent without distal embolization.展开更多
Magnesium(Mg)-based bioresorbable stents represent a potentially groundbreaking advancement in cardiovascular therapy;offering tem-porary vessel support and complete biodegradability—addressing limitations of traditi...Magnesium(Mg)-based bioresorbable stents represent a potentially groundbreaking advancement in cardiovascular therapy;offering tem-porary vessel support and complete biodegradability—addressing limitations of traditional stents like in-stent restenosis and long-term com-plications.However,challenges such as rapid corrosion and suboptimal endothelialisation have hindered their clinical adoption.This review highlights the latest breakthroughs in surface modification,alloying,and coating strategies to enhance the mechanical integrity,corrosion resistance,and biocompatibility of Mg-based stents.Key surface engineering techniques,including polymer and bioactive coatings,are ex-amined for their role in promoting endothelial healing and minimising inflammatory responses.Future directions are proposed,focusing on personalised stent designs to optimize efficacy and long-term outcomes,positioning Mg-based stents as a transformative solution in interventional cardiology.展开更多
Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergen...Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.展开更多
Magnesium alloy,as a new material for vascular stents,possesses excellent mechanical properties,biocompatibility,and biodegradability.However,the mechanical properties of magnesium alloy stents exhibit relatively infe...Magnesium alloy,as a new material for vascular stents,possesses excellent mechanical properties,biocompatibility,and biodegradability.However,the mechanical properties of magnesium alloy stents exhibit relatively inferior performance compared to traditional metal stents with identical structural characteristics.Therefore,improving their mechanical properties is a key issue in the development of biodegradable magnesium alloy stents.In this study,three new stent structures(i.e.,stent A,stent B,and stent C)were designed based on the typical structure of biodegradable stents.The changes made included altering the angle and arrangement of the support rings to create a support ring structure with alternating large and small angles,as well as modifying the position and shape of the link.Using finite element analysis,the compressive performance,expansion performance,bending flexibility performance,damage to blood vessels,and hemodynamic changes of the stent were used as evaluation indexes.The results of these comprehensive evaluations were utilized as the primary criteria for selecting the most suitable stent design.The results demonstrated that compared to the traditional stent,stents A,B,and C exhibited improvements in radial stiffness of 16.9%,15.1%,and 37.8%,respectively;reductions in bending stiffness of 27.3%,7.6%,and 38.1%,respectively;decreases in dog-boning rate of 5.1%,93.9%,and 31.3%,respectively;as well as declines in the low wall shear stress region by 50.1%,43.8%,and 36.2%,respectively.In comparison to traditional stents,a reduction in radial recoiling was observed for stents A and C,with decreases of 9.3% and 7.4%,respectively.Although there was a slight increase in vessel damage for stents A,B,and C compared to traditional stents,this difference was not significant to have an impact.The changes in intravascular blood flow rate were essentially the same after implantation of the four stents.A comparison of the four stents revealed that stents A and C exhibited superior overall mechanical properties and they have greater potential for clinical application.This study provides a reference for designing clinical stent structures.展开更多
Tracheal collapse(TC),defined by excessive tracheal collapsibility,often results in severe respiratory distress in small-breed dogs.Surgical intervention,including the placement of extraluminal stents,has been employe...Tracheal collapse(TC),defined by excessive tracheal collapsibility,often results in severe respiratory distress in small-breed dogs.Surgical intervention,including the placement of extraluminal stents,has been employed as a treatment option.Owing to the anatomical and physiological similarities between rabbit and canine tracheas,a rabbit model was utilized to develop a novel extraluminal silicone tracheal stent and evaluate its feasibility in treating tracheomalacia.The stent was surgically implanted in eight New Zealand White rabbits after the induction of tracheomalacia.Postoperative evaluations,including clinical assessment,radiography,computed tomography(CT),and histological analysis,were performed at 1,2,and 6 months post-implantation.All rabbits in the stent group survived without exhibiting signs of respiratory distress,whereas all rabbits in the tracheomalacia group experienced respiratory distress,with one succumbing to respiratory failure.Radiographic and CT evaluations confirmed that the stent effectively maintained airway patency,with tracheal measurements not significantly different from the preoperative values,indicating successful restora-tion of tracheal diameter.Histological analysis demonstrated minimal inflammatory response,the absence of fibrosis,and preserved structural integrity of the tracheal cartilage.Therefore,the novel extraluminal silicone tracheal stent provides effective airway support while minimizing adverse tissue reactions.Further studies,including the use of this stent in a canine TC model and assessment of its long-term outcomes,are warranted to explore its potential clinical applications in veterinary medicine.展开更多
BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been est...BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.展开更多
BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stent...BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentia...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.展开更多
The case report by Elsayed et al presented a multidisciplinary approach to treating recurrent biliary strictures following proximal bile duct injury.Bioresorbable biliary stents,an innovative option for managing bilia...The case report by Elsayed et al presented a multidisciplinary approach to treating recurrent biliary strictures following proximal bile duct injury.Bioresorbable biliary stents,an innovative option for managing biliary strictures in recent years,are a key part of this approach.Unlike traditional metal/plastic stents,bioresorbable stents made from materials like polylactic acid(PLA)or polycaprolactone gradually degrade in the body.This eliminates the need for endoscopic removal,reducing patient trauma and costs.Nondegradable stents often lead to complications such as restenosis,migration,or infection.In contrast,bioresorbable stents can have their degradation rate tailored to the bile duct healing process(e.g.,PLA stents remained unobstructed for 25.7 weeks in a porcine model),minimizing long-term complications.We analyzed the advantages and disadvantages of bioresorbable stents,outlined future research directions,and aimed to offer valuable insights for clinical practice.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
BACKGROUND Self-expandable metallic stent(SEMS)placement is a common intervention for obstructive left-sided colon cancer.However,the long-term prognosis post-SEMS placement remains debated.Mechanical compression with...BACKGROUND Self-expandable metallic stent(SEMS)placement is a common intervention for obstructive left-sided colon cancer.However,the long-term prognosis post-SEMS placement remains debated.Mechanical compression within the tumor caused by SEMS may induce vascular compression,leading to tissue ischemia and hypoxia.These alterations in the tumor microenvironment could affect patient prognosis.AIM To assess the influence of glucose transporter-1(GLUT-1)and Ki-67 expression in obstructive colon cancer tissues pre and post SEMS placement on patient prognosis.METHODS A retrospective analysis was conducted on clinical and pathological data from 71 patients with obstructive colon cancer who underwent SEMS placement followed by surgery.Paired colon cancer tissue samples were collected from each patient pre and post SEMS placement.Immunohistochemical techniques were employed to evaluate GLUT-1 and Ki-67 expression in the specimens.RESULTS The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were 14.1%and 43.7%,respectively(P<0.001).GLUT-1 expression was associated with vascular invasion post-SEMS placement(P=0.03).Ki-67 expression showed no significant difference pre and post SEMS placement and was unrelated to clinical pathological characteristics(all P>0.05).The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were associated with worse recurrence-free interval(pre-SEMS:40.0%vs 72.3%,P=0.026;post-SEMS:45.5%vs 85.7%,P=0.001).Cox regression analysis revealed that both pre-SEMS placement(HR=3.490,95%CI:1.165-10.453,P=0.026)and post-SEMS placement(HR=4.335,95%CI:1.539-12.214,P=0.006)GLUT-1 expression were adverse prognostic factors for patients.CONCLUSION Though the precise impact of stent placement on the mechanical compression and biological behavior of tumors is not fully understood,our study found an increase in GLUT-1 expression in tumor tissues after SEMS placement.Tumor GLUT-1 serves as a prognostic biomarker for the survival of patients with obstructive colon cancer treated with SEMS placement.展开更多
基金supported by Natural Science Foundation of China(No.31930067)Natural Science Foundation of Sichuan Province(No.23NSFSC5880)+2 种基金Chengdu Medical Research Project(No.2022004)Natural Science Foundation of Clinical Medical College and Affiliated Hospital of Chengdu University(No.Y202206)Postdoctoral Research and Development Fund of West China Hospital,Sichuan University(No.2023HXBH052).
文摘Vascular stents play an important role in the minimally invasive treatment of vascular diseases,such as vascular stenosis,vascular aneurysm,vascular dissection and vascular atherosclerotic plaque disease.Bare metal stents were initially fabricated;however,the incidence of complications such as thrombosis,inflammation,restenosis,vascular injury,displacement and endoleakage is still high after implantation.To overcome these complications,several strategies for designing functional vascular stents have been carried out.Drug-eluting stents,biodegradable stents and bionic stents were manufactured and investigated.This review aims to comprehensively analyze the vascular diseases suitable for stent implantation treatment,tissue reactions after implantation,the materials and manufacturing techniques used to fabricate vascular stents,the various application scenarios in which they could be used to treat vascular lesions and the development process of vascular stents.Future development trends of vascular stents are expected to prioritize their performance,biocompatibility,and clinical accessibility.The design of vascular stents may be transformed or improved to better fulfill the rehabilitation requirements of vascular disease patients.Finally,various application scenarios may be used to treat vascular or even nonvascular diseases via endovascular access.
文摘BACKGROUND Postoperative pancreatic fistula(POPF)is the most frequent cause of morbimortality after pancreaticoduodenectomy,but the best technique to use to prevent its development is unclear.The choice of drainage method external duct stent(EDS),internal duct stent(IDS),or non-ductal stent(NDS)is also controversial.AIM To compare the three groups(EDS,IDS and NDS),analyzing the patient characteristics,perioperative examinations and survival.METHODS Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020,were divided into the EDS,IDS and NDS groups.RESULTS Of the 244 patients included,129 were in the EDS group,71 in the IDS group,and 44 in the NDS group.Except for preoperative pancreatitis in the NDS patients,comorbidities were similar among the groups.Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas(P<0.001).A lower rate of grade C POPF was observed in the EDS(1.6%)compared to the NDS(9.1%)and IDS group(14.1%)(P=0.009).The groups showed similar findings for delayed gastric emptying,postoperative hemorrhage,reoperation,and 5-year survivals.Ninety-day mortality rate was significantly higher in the IDS group(5.6%)compared to the EDS(1.6%)and NDS(4.5%)groups(P=0.046).Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF(P=0.034),and 90-day mortality(P=0.018).Additionally,a Wirsung duct diameter<3 mm was the only risk factor for grade B/C POPF(P=0.001),and 90-day mortality(P=0.031).CONCLUSION The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality,and the Wirsung duct<3 mm was a risk factor for grade B/C POPF and 90-day mortality.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
文摘BACKGROUND Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction(MHBO)but remains technically challenging.The emergence of self-expandable metallic stents carried by an ultrathin(6 Fr or smaller)delivery system now permits simultaneous bilateral stent placement.To date,only a few studies have compared this new method with conventional sequential bilateral stenting.AIM To evaluate a possible superiority of simultaneous“side by side”(SBS)biliary drainage in unresectable MHBO.METHODS We identified 135 patients who benefited from bilateral drainage using uncovered self-expandable metallic stents between 2010 and 2023.Among them,62 benefited from simultaneous SBS bilateral drainage between 2017 and 2023,and 73 benefited from sequential bilateral drainage[38 using“stent in stent”(SIS)technique and 35 using SBS technique between 2010 and 2017].RESULTS Technical success was significantly increased in simultaneous drainage compared with sequential drainage(94%vs 75%,P=0.008).However,simultaneous SBS drainage and sequential SIS drainage had a similar technical success(94%vs 95%).We observed no differences regarding clinical success,procedure duration and recurrent biliary obstruction rate.Stent patency was shorter in the SIS group compared with the simultaneous group(103 days vs 144 days).Early adverse events were more frequent in the sequential group(31%vs 21%,P=0.205),with no differences regarding SIS or SBS technique.Technical failure was associated with a higher rate of infectious fatal adverse events(9.5%vs 1.7%,P=0.02).Reintervention after recurrent biliary obstruction seems to be more successful after using SBS rather than SIS techniques(83%vs 75%,P=0.53).CONCLUSION Simultaneous SBS metallic stent placement using an ultra-thin delivery system was technically easier and as efficient as sequential bilateral stenting in unresectable MHBO to achieve bilateral drainage.The SIS procedure remains a good option in unresectable MHBO.
文摘Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
基金supported by Natural Science Foundation of Hunan Province(2021JJ31081,2024JJ5619)the Science Fund of State Key Laboratory of Advanced Design and Manufacturing Technology for Vehicle(No 32215004).
文摘Biliary system,which is responsible for transporting bile from the liver into the intestine,is commonly damaged by inflammation or tumors eventually causing liver failure or death.The implantation of biliary stents can effectively alleviate both benign and malignant biliary strictures,but the plastic and metal stents that are currently used cannot degrade and nearly has no beneficial biological effects,therefore their long-term service can result into inflammation,the formation of sludges and re-obstruction of bile duct.In recent years,magnesium(Mg)metal has been received increasing attention in the field of biomedical application due to its excellent biocompatibility,adequate mechanical properties,biodegradability and other advantages,such as anti-inflammatory and anti-tumor properties.The research on biliary stents made of magnesium metals(BSMM)has also made significant progress and a series of experiments in vitro and vivo has proved their possibility.However,there are still some problems holding back BSMM’s clinical use,including rapid corrosion rate and potential harmful reaction.In this review,we would summarize the current research of BSMM,evaluate their clinical benefits,find the choke points,and discuss the solving method.
文摘BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.
文摘BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.
文摘BACKGROUND Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery.However,acute stent occlusion is a troublesome complication due to the need for open surgery or the risk of distal embolization.Herein,we reported a novel approach to treat the acute thrombotic occlusion of an aortoiliac stent using both hemolytic and conventional mechanical thrombectomy coupled with a large diameter sheath.CASE SUMMARY A 64-year-old male patient presented with severe claudication of the right leg.The patient's history included multiple prior interventions for aortoiliac lesions.The preoperative computed tomography(CT)imaging showed a thrombotic occlusion of right aortoiliac stenting.An Angiojet Omni thrombectomy catheter(Boston Scientific,Marlborough,MA,United States)was used to remove the thrombus in a retrograde fashion after the successful placement of the large-diameter sheath in the right common femoral artery for prevention of distal embolization.The remnant organized thrombus was removed with an over-the-wire Fogarty catheter(Edwards Lifesciences,Irvine,CA,United States).Completion angiogram and postoperative CT imaging demonstrated complete removal of thrombus and no evidence of distal embolization.CONCLUSION This novel approach provides successful management of acute thrombotic occlusion of aortoiliac stent without distal embolization.
文摘Magnesium(Mg)-based bioresorbable stents represent a potentially groundbreaking advancement in cardiovascular therapy;offering tem-porary vessel support and complete biodegradability—addressing limitations of traditional stents like in-stent restenosis and long-term com-plications.However,challenges such as rapid corrosion and suboptimal endothelialisation have hindered their clinical adoption.This review highlights the latest breakthroughs in surface modification,alloying,and coating strategies to enhance the mechanical integrity,corrosion resistance,and biocompatibility of Mg-based stents.Key surface engineering techniques,including polymer and bioactive coatings,are ex-amined for their role in promoting endothelial healing and minimising inflammatory responses.Future directions are proposed,focusing on personalised stent designs to optimize efficacy and long-term outcomes,positioning Mg-based stents as a transformative solution in interventional cardiology.
文摘Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.
基金supported by the National Natural Science Foundation of China(Grant Nos.12272250 and 12372310)China Postdoctoral Science Foundation(Grant No.2020M680913)+1 种基金Shanxi Scholarship Council of China(Grant No.2022-081)Shanxi Postgraduate Innovation Project and Shanxi Huajin Orthopaedic Public Foundation.
文摘Magnesium alloy,as a new material for vascular stents,possesses excellent mechanical properties,biocompatibility,and biodegradability.However,the mechanical properties of magnesium alloy stents exhibit relatively inferior performance compared to traditional metal stents with identical structural characteristics.Therefore,improving their mechanical properties is a key issue in the development of biodegradable magnesium alloy stents.In this study,three new stent structures(i.e.,stent A,stent B,and stent C)were designed based on the typical structure of biodegradable stents.The changes made included altering the angle and arrangement of the support rings to create a support ring structure with alternating large and small angles,as well as modifying the position and shape of the link.Using finite element analysis,the compressive performance,expansion performance,bending flexibility performance,damage to blood vessels,and hemodynamic changes of the stent were used as evaluation indexes.The results of these comprehensive evaluations were utilized as the primary criteria for selecting the most suitable stent design.The results demonstrated that compared to the traditional stent,stents A,B,and C exhibited improvements in radial stiffness of 16.9%,15.1%,and 37.8%,respectively;reductions in bending stiffness of 27.3%,7.6%,and 38.1%,respectively;decreases in dog-boning rate of 5.1%,93.9%,and 31.3%,respectively;as well as declines in the low wall shear stress region by 50.1%,43.8%,and 36.2%,respectively.In comparison to traditional stents,a reduction in radial recoiling was observed for stents A and C,with decreases of 9.3% and 7.4%,respectively.Although there was a slight increase in vessel damage for stents A,B,and C compared to traditional stents,this difference was not significant to have an impact.The changes in intravascular blood flow rate were essentially the same after implantation of the four stents.A comparison of the four stents revealed that stents A and C exhibited superior overall mechanical properties and they have greater potential for clinical application.This study provides a reference for designing clinical stent structures.
文摘Tracheal collapse(TC),defined by excessive tracheal collapsibility,often results in severe respiratory distress in small-breed dogs.Surgical intervention,including the placement of extraluminal stents,has been employed as a treatment option.Owing to the anatomical and physiological similarities between rabbit and canine tracheas,a rabbit model was utilized to develop a novel extraluminal silicone tracheal stent and evaluate its feasibility in treating tracheomalacia.The stent was surgically implanted in eight New Zealand White rabbits after the induction of tracheomalacia.Postoperative evaluations,including clinical assessment,radiography,computed tomography(CT),and histological analysis,were performed at 1,2,and 6 months post-implantation.All rabbits in the stent group survived without exhibiting signs of respiratory distress,whereas all rabbits in the tracheomalacia group experienced respiratory distress,with one succumbing to respiratory failure.Radiographic and CT evaluations confirmed that the stent effectively maintained airway patency,with tracheal measurements not significantly different from the preoperative values,indicating successful restora-tion of tracheal diameter.Histological analysis demonstrated minimal inflammatory response,the absence of fibrosis,and preserved structural integrity of the tracheal cartilage.Therefore,the novel extraluminal silicone tracheal stent provides effective airway support while minimizing adverse tissue reactions.Further studies,including the use of this stent in a canine TC model and assessment of its long-term outcomes,are warranted to explore its potential clinical applications in veterinary medicine.
文摘BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.
文摘BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.
基金Supported by PhD Supervisor Training Program,No.22GSSYA-3Gansu Provincial Health Industry Research Project,No.GSWSKY2020-45Gansu Natural Science Foundation,No.20JR10RA378.
文摘The case report by Elsayed et al presented a multidisciplinary approach to treating recurrent biliary strictures following proximal bile duct injury.Bioresorbable biliary stents,an innovative option for managing biliary strictures in recent years,are a key part of this approach.Unlike traditional metal/plastic stents,bioresorbable stents made from materials like polylactic acid(PLA)or polycaprolactone gradually degrade in the body.This eliminates the need for endoscopic removal,reducing patient trauma and costs.Nondegradable stents often lead to complications such as restenosis,migration,or infection.In contrast,bioresorbable stents can have their degradation rate tailored to the bile duct healing process(e.g.,PLA stents remained unobstructed for 25.7 weeks in a porcine model),minimizing long-term complications.We analyzed the advantages and disadvantages of bioresorbable stents,outlined future research directions,and aimed to offer valuable insights for clinical practice.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
文摘BACKGROUND Self-expandable metallic stent(SEMS)placement is a common intervention for obstructive left-sided colon cancer.However,the long-term prognosis post-SEMS placement remains debated.Mechanical compression within the tumor caused by SEMS may induce vascular compression,leading to tissue ischemia and hypoxia.These alterations in the tumor microenvironment could affect patient prognosis.AIM To assess the influence of glucose transporter-1(GLUT-1)and Ki-67 expression in obstructive colon cancer tissues pre and post SEMS placement on patient prognosis.METHODS A retrospective analysis was conducted on clinical and pathological data from 71 patients with obstructive colon cancer who underwent SEMS placement followed by surgery.Paired colon cancer tissue samples were collected from each patient pre and post SEMS placement.Immunohistochemical techniques were employed to evaluate GLUT-1 and Ki-67 expression in the specimens.RESULTS The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were 14.1%and 43.7%,respectively(P<0.001).GLUT-1 expression was associated with vascular invasion post-SEMS placement(P=0.03).Ki-67 expression showed no significant difference pre and post SEMS placement and was unrelated to clinical pathological characteristics(all P>0.05).The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were associated with worse recurrence-free interval(pre-SEMS:40.0%vs 72.3%,P=0.026;post-SEMS:45.5%vs 85.7%,P=0.001).Cox regression analysis revealed that both pre-SEMS placement(HR=3.490,95%CI:1.165-10.453,P=0.026)and post-SEMS placement(HR=4.335,95%CI:1.539-12.214,P=0.006)GLUT-1 expression were adverse prognostic factors for patients.CONCLUSION Though the precise impact of stent placement on the mechanical compression and biological behavior of tumors is not fully understood,our study found an increase in GLUT-1 expression in tumor tissues after SEMS placement.Tumor GLUT-1 serves as a prognostic biomarker for the survival of patients with obstructive colon cancer treated with SEMS placement.
