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
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
Drug-eluting magnesium(Mg)alloy stents have a slower degradation rate and lower restenosis rate compared with uncoated stents,demonstrating good clinical efficacy.However,the release of anti-hyperplasia drugs from coa...Drug-eluting magnesium(Mg)alloy stents have a slower degradation rate and lower restenosis rate compared with uncoated stents,demonstrating good clinical efficacy.However,the release of anti-hyperplasia drugs from coatings delays endothelial tissue repair,thus leading to late stent thrombosis.To address these issues,a dual self-healed coating with various biological properties was fabricated on magnesium fluoride/polydopamine(MgF_(2)/PDA)-treated Mg alloys by spraying-assisted layer-by-layer(LBL)self-assembly of chitosan(CS),gallic acid(GA),and 3-aminobenzeneboronic acid-modified hyaluronic acid(HA-ABBA).The LBL coating,approximately 1.50μm thick,exhibited a uniform morphology with good adhesion strength(~1065 mN).The annual corrosion rate(Pi)of LBL samples was~1400 times slower than that of the Mg substrate,due to the physical barrier function provided by MgF_(2)/PDA layers and the dual self-healed ability of LBL layers.The rapid self-healing ability(with a healing period of~4 h under dynamic/static conditions)resulted from the synergistic interplay between the recombination of diverse chemical bonds within the LBL coating and the coordination of LBL-released GA with Mg2+,as corroborated by computer simulations.Compared with the drug-eluting coatings,the LBL sample demonstrated substantial advantages in anti-oxidation,anti-denaturation of fibrinogen,anti-platelet adhesion,anti-inflammation,anti-hyperplasia,and promoted-endothelialization.These benefits effectively address the limitations associated with drug-eluting coatings.展开更多
Acute colonic obstruction,a life-threatening condition often caused by malignant or benign strictures,necessitates rapid and effective intervention to avoid severe complications such as bowel perforation or sepsis.Sel...Acute colonic obstruction,a life-threatening condition often caused by malignant or benign strictures,necessitates rapid and effective intervention to avoid severe complications such as bowel perforation or sepsis.Self-expandable metal stents(SEMS)have emerged as a minimally invasive,effective treatment alternative,either as a bridge to surgery or for palliation in malignant cases.This editorial focuses on the current mechanisms and techniques for SEMS placement in acute colonic obstruction,discussing the various endoscopic approaches,stent design considerations,technical success rates,complications,and long-term outcomes.We explore cutting-edge techniques such as fluoroscopy-free endoscopic placement,two-person colonoscopy,and the use of advanced endoscopic equipment like slim gastroscopes and ultrathin endoscopes.Additionally,the editorial delves into complications associated with SEMS placement,such as stent migration,perforation,and occlusion,and discusses strategies to mitigate these risks.Finally,future directions in SEMS technology,including advancements in stent design and optimal timing for surgery,are presented.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
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
Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction(STEMI). First generation drug-eluting stents(DES),(sirolimus dru...Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction(STEMI). First generation drug-eluting stents(DES),(sirolimus drug-eluting stents and paclitaxel drug-eluting stents), reduce the risk of restenosis and target vessel revascularization compared to bare metal stents. However, stent thrombosis emerged as a major safety concern with first generation DES. In response to these safety issues, second generation DES were developed with different drugs, improved stent platforms and more biocompatible durable or bioabsorbable polymeric coating. This article presents an overview of safety and efficacy of the first and second generation DES in STEMI.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
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 Endoscopic ultrasound(EUS)-guided biliary drainage(BD)is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography.In a recent study,EUS-BD rep...BACKGROUND Endoscopic ultrasound(EUS)-guided biliary drainage(BD)is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography.In a recent study,EUS-BD reportedly demonstrated similar safety between elderly patients and all other patients.However,the appropriate stent for placement in elderly patients is unknown.AIM To clarify whether a metallic stent(MS)or a plastic stent(PS)is suitable when performing EUS-BD in elderly patients.METHODS This was a multicenter retrospective study of patients who underwent EUS-BD between March 2005 and February 2025.The data of patients aged 70 years or older who underwent successful EUS-BD were analyzed,and the longterm outcomes of patients treated with an MS(MS group)and those treated with a PS(PS group)were compared.RESULTS Ninety-four patients underwent successful EUS-BD,of whom 64 were aged 70 years or older.The PS group included 51 patients,and the MS group included 13 patients.The time to recurrent biliary obstruction(TRBO)was not significantly different between the PS group and the MS group(6-month recurrent biliary obstruction rate 50.8%vs 26.8%,P=0.18).When patients were limited to those with malignancies without antegrade stenting,the TRBO was significantly longer in the MS group than in the PS group(6-month recurrent biliary obstruction rate 63.3%vs 20.7%,P=0.036).CONCLUSION A PS might be sufficient for performing EUS-BD in elderly patients aged 70 years or older with benign biliary disease because it is easily replaced.However,an MS might be more effective for elderly individuals with malignant biliary obstruction because of the expectation of a longer TRBO and a reduced need for stent replacement.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
Guided by the clinical concept of“intervention without implantation”,Mg alloys show promise as next-generation cardiovascular stent materials due to their complete degradability and excellent biocompatibility.Althou...Guided by the clinical concept of“intervention without implantation”,Mg alloys show promise as next-generation cardiovascular stent materials due to their complete degradability and excellent biocompatibility.Although existing drug-eluting coatings can delay Mg stent degradation and inhibit restenosis,the persistent drug release-induced delayed endothelial healing and increased thrombotic risks present a critical paradox that has severely hindered clinical translation.To address this challenge,researchers are focused on developing multifunctional coating systems that exhibit simultaneous anticoagulation and hyperplasia suppression,while promoting endothelial repair.This review systematically examines the following key research frontiers:natural bioactive molecular coatings,NO release coatings,and biofunctional molecular coatings,along with their various combinations,referred to collectively as“drug-like coatings”.The fabrication strategies,functional performance,and challenges associated with drug-like coatings are discussed,and suggestions and ideas are presented to guide future prioritization of development directions.This comprehensive analysis provides both a theoretical foundation and technological roadmaps for developing next-generation degradable Mg alloy stents with superior service performance and clinical safety.展开更多
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 c...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.展开更多
As an emerging treatment,esophageal anti-reflux stent has gradually become the palliative treatment of choice for many digestive diseases due to its features of low trauma,high safety,and conformity to the physiologic...As an emerging treatment,esophageal anti-reflux stent has gradually become the palliative treatment of choice for many digestive diseases due to its features of low trauma,high safety,and conformity to the physiological and anatomical structure of the esophagus.This study presents a review of the latest clinical progress of esophageal anti-reflux stents to provide theoretical references for subsequent studies.展开更多
Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during sec...Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.AIM To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS,and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.METHODS We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024.Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group(DBBSG).Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.RESULTS The median age of the patients included was 62 years(interquartile range:51-70),with 53.11%being female.During stent removal,DBBSG showed higher rates of chyme reflux(23.27%vs 9.65%,P<0.001)and CBDS(42.77%vs 21.05%,P<0.001)compared to the single pigtail biliary stent group.No significant differences were found in the incidence of adverse reactions between the two groups(P>0.05),and no serious events or deaths occurred.DBBSG patients had increased risks of chyme reflux(hazard ratio=2.793;95%confidence interval:1.695-4.603;P<0.001)and CBDS(hazard ratio:2.475;95%confidence interval:1.732-3.536;P<0.001).CONCLUSION Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS.The safety of intra-biliary cleaning during stent removal has been validated,and as a result,it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.展开更多
We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterol...We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterology Practice Guideline on the Role of Esophageal Stents in Benign and Malignant Diseases concludes that SEMSs cannot be routinely recommended in conjunction with chemo-radiation. The comparison of ultraflex and choostent in the Italian study found no difference in the palliation of dysphagia, rate of complications and survival rate.展开更多
Stent-grafts were commercialized rapidly and gained a broad clinical acceptance over the past two decades. However,relatively more recent recognition of particular stent-graft design shortcomings have been identified ...Stent-grafts were commercialized rapidly and gained a broad clinical acceptance over the past two decades. However,relatively more recent recognition of particular stent-graft design shortcomings have been identified which need to be addressed. It appears that various stent-graft designs may be more or less resistant to metal fatigue and /or fabric abrasions which can lead to type III and type IV endoleaks over the long term. Therefore,it is necessary to investigate the fatigue performance of the most common stentgraft designs: Z-stents and ringed stents,in a long-term in vitro fatigue simulation environment. This paper aimed to analyze nondestructively( gross observations) and destructively( fabric characteristics,mechanical and chemical properties) in order to put forward suggestions to improve the fabric and stent characteristics that may prevent type III and IV endoleaks. The fabric supported with ringed stent-grafts remained nearly completely intact after 168h. However, the fabric supported with Z-stents demonstrated significant damage. Fabric characteristics and tensile strength of the fibers did not present a significant difference between the control and fatigue simulated specimens. The crystallinity declined for both specimens. The fatigue performance of fabrics supported with ringed stents appears to be superior to that supported with Z-stents. The potential for a dynamic and destructive interaction between the apices of Z-stents which can lead to fraying and /or tearing of the graft fabric must be addressed in future designs.展开更多
In the past, the esophagus diseases causing the patient to unable to intake oral diet such as esophageal strictures, leaks, tracheoesophageal fistulas, etc. were managed by surgical interventions and parenteral nutrit...In the past, the esophagus diseases causing the patient to unable to intake oral diet such as esophageal strictures, leaks, tracheoesophageal fistulas, etc. were managed by surgical interventions and parenteral nutrition to meet the demand of the body. After the development of technique of stent placement in esopahgus, there was revolutionary change in the management of such conditions promoting patients to take diet orally and improve their nutritional status as well as quality of life. Different types of commercial stents are available in the market with their own pros and cons. Our aim of this study was to review the different stents being used currently in the clinical practice, comparing the stents on their therapeutic outcome and complications, optimal timing of removal of stents for benign conditions and the methods studied by different clinicians to lower the rate of complications and reinterventions.展开更多
A new type of vascular stent is designed for treating stenotic vessels. Aiming at overcoming the shortcomings of existing equipment and technology for preparing a bioabsorbable vascular stent （BVS）, a new method whi...A new type of vascular stent is designed for treating stenotic vessels. Aiming at overcoming the shortcomings of existing equipment and technology for preparing a bioabsorbable vascular stent （BVS）, a new method which combines 3D bio-printing and electrospinning to prepare the composite bioabsorbable vascular stent （CBVS） is proposed. The inner layer of the CBVS can be obtained through 3D bio- printing using poly-p-dioxanone （PPDO）. The thin nanofiber film that serves as the outer layer can be built through electrospinning using mixtures of chitosan-PVA （poly （vinyl alcohol））. Tests of mechanical properties show that the stent prepared through 3D bio-printing combined with electrospinning is better than that prepared through 3D bio- printing alone. Cells cultivated on the CBVS adhere and proliferate better due to the natural, biological chitosan in the outer layer. The proposed complex process and method can provide a good basis for preparing a controllable drug-carrying vascular stent. Overall, the CBVS can be a good candidate for treating stenotic vessels.展开更多
AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to s...AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to spleen flex) carcinoma patients (47 males and 34 females,aged 18-94 years,mean = 66.2 years) treated between September 2004 and June 2010 for acute colon obstruction were enrolled to this study,and their clinical and radiological features were reviewed.After a cleaning enema was administered,urgent colonoscopy was performed.Subsequently,endoscopic decompression using SEMS placement was attempted.RESULTS: Endoscopic decompression using SEMS placement was technically successful in 78 (96.3%) of 81 patients.Three patients’ symptoms could not be relieved after SEMS placement and emergent operation was performed 1 d later.The site of obstruction was transverse colon in 18 patients,the hepatic flex in 42,and the ascending colon in 21.Following adequate cleansing of the colon,patients’ abdominal girth was decreased from 88 ± 3 cm before drainage to 72 ± 6 cm 7 d later,and one-stage surgery after 8 ± 1 d (range,7-10 d) was performed.No anastomotic leakage or postoperative stenosis occurred after operation.CONCLUSION: SEMS placement is effective and safe in the management of acute proximal colon obstruction due to colon carcinoma,and is considered as a bridged method before curative surgery.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.
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.
基金supported by the National Key Research and Development Program of China(No.2021YFC2400703)the Key Scientific and Technological Research Projects in Henan Province(Nos.232102311155 and 232102230106)Zhengzhou University Major Project Cultivation Special Project(No.125-32214076).
文摘Drug-eluting magnesium(Mg)alloy stents have a slower degradation rate and lower restenosis rate compared with uncoated stents,demonstrating good clinical efficacy.However,the release of anti-hyperplasia drugs from coatings delays endothelial tissue repair,thus leading to late stent thrombosis.To address these issues,a dual self-healed coating with various biological properties was fabricated on magnesium fluoride/polydopamine(MgF_(2)/PDA)-treated Mg alloys by spraying-assisted layer-by-layer(LBL)self-assembly of chitosan(CS),gallic acid(GA),and 3-aminobenzeneboronic acid-modified hyaluronic acid(HA-ABBA).The LBL coating,approximately 1.50μm thick,exhibited a uniform morphology with good adhesion strength(~1065 mN).The annual corrosion rate(Pi)of LBL samples was~1400 times slower than that of the Mg substrate,due to the physical barrier function provided by MgF_(2)/PDA layers and the dual self-healed ability of LBL layers.The rapid self-healing ability(with a healing period of~4 h under dynamic/static conditions)resulted from the synergistic interplay between the recombination of diverse chemical bonds within the LBL coating and the coordination of LBL-released GA with Mg2+,as corroborated by computer simulations.Compared with the drug-eluting coatings,the LBL sample demonstrated substantial advantages in anti-oxidation,anti-denaturation of fibrinogen,anti-platelet adhesion,anti-inflammation,anti-hyperplasia,and promoted-endothelialization.These benefits effectively address the limitations associated with drug-eluting coatings.
文摘Acute colonic obstruction,a life-threatening condition often caused by malignant or benign strictures,necessitates rapid and effective intervention to avoid severe complications such as bowel perforation or sepsis.Self-expandable metal stents(SEMS)have emerged as a minimally invasive,effective treatment alternative,either as a bridge to surgery or for palliation in malignant cases.This editorial focuses on the current mechanisms and techniques for SEMS placement in acute colonic obstruction,discussing the various endoscopic approaches,stent design considerations,technical success rates,complications,and long-term outcomes.We explore cutting-edge techniques such as fluoroscopy-free endoscopic placement,two-person colonoscopy,and the use of advanced endoscopic equipment like slim gastroscopes and ultrathin endoscopes.Additionally,the editorial delves into complications associated with SEMS placement,such as stent migration,perforation,and occlusion,and discusses strategies to mitigate these risks.Finally,future directions in SEMS technology,including advancements in stent design and optimal timing for surgery,are presented.
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Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction(STEMI). First generation drug-eluting stents(DES),(sirolimus drug-eluting stents and paclitaxel drug-eluting stents), reduce the risk of restenosis and target vessel revascularization compared to bare metal stents. However, stent thrombosis emerged as a major safety concern with first generation DES. In response to these safety issues, second generation DES were developed with different drugs, improved stent platforms and more biocompatible durable or bioabsorbable polymeric coating. This article presents an overview of safety and efficacy of the first and second generation DES in STEMI.
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 Endoscopic ultrasound(EUS)-guided biliary drainage(BD)is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography.In a recent study,EUS-BD reportedly demonstrated similar safety between elderly patients and all other patients.However,the appropriate stent for placement in elderly patients is unknown.AIM To clarify whether a metallic stent(MS)or a plastic stent(PS)is suitable when performing EUS-BD in elderly patients.METHODS This was a multicenter retrospective study of patients who underwent EUS-BD between March 2005 and February 2025.The data of patients aged 70 years or older who underwent successful EUS-BD were analyzed,and the longterm outcomes of patients treated with an MS(MS group)and those treated with a PS(PS group)were compared.RESULTS Ninety-four patients underwent successful EUS-BD,of whom 64 were aged 70 years or older.The PS group included 51 patients,and the MS group included 13 patients.The time to recurrent biliary obstruction(TRBO)was not significantly different between the PS group and the MS group(6-month recurrent biliary obstruction rate 50.8%vs 26.8%,P=0.18).When patients were limited to those with malignancies without antegrade stenting,the TRBO was significantly longer in the MS group than in the PS group(6-month recurrent biliary obstruction rate 63.3%vs 20.7%,P=0.036).CONCLUSION A PS might be sufficient for performing EUS-BD in elderly patients aged 70 years or older with benign biliary disease because it is easily replaced.However,an MS might be more effective for elderly individuals with malignant biliary obstruction because of the expectation of a longer TRBO and a reduced need for stent replacement.
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.
基金the High-level Talent Research Start-up Project Funding of Henan Academy of Sciences(Project NO.241817243)the Fundamental Research Fund of Henan Academy of Sciences(Project NO.20250617002)+1 种基金the Scientific and Technological Research Project of Henan Province(Project NO.252102230110)the National Key Research and Development Program of China(NO.2021YFC2400703).
文摘Guided by the clinical concept of“intervention without implantation”,Mg alloys show promise as next-generation cardiovascular stent materials due to their complete degradability and excellent biocompatibility.Although existing drug-eluting coatings can delay Mg stent degradation and inhibit restenosis,the persistent drug release-induced delayed endothelial healing and increased thrombotic risks present a critical paradox that has severely hindered clinical translation.To address this challenge,researchers are focused on developing multifunctional coating systems that exhibit simultaneous anticoagulation and hyperplasia suppression,while promoting endothelial repair.This review systematically examines the following key research frontiers:natural bioactive molecular coatings,NO release coatings,and biofunctional molecular coatings,along with their various combinations,referred to collectively as“drug-like coatings”.The fabrication strategies,functional performance,and challenges associated with drug-like coatings are discussed,and suggestions and ideas are presented to guide future prioritization of development directions.This comprehensive analysis provides both a theoretical foundation and technological roadmaps for developing next-generation degradable Mg alloy stents with superior service performance and clinical safety.
文摘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.
基金National College Students’Innovative Entrepreneurial Training Plan Program Funded Project(Project No.:2024118400010)。
文摘As an emerging treatment,esophageal anti-reflux stent has gradually become the palliative treatment of choice for many digestive diseases due to its features of low trauma,high safety,and conformity to the physiological and anatomical structure of the esophagus.This study presents a review of the latest clinical progress of esophageal anti-reflux stents to provide theoretical references for subsequent studies.
基金Supported by the Key Specialty Construction Project of Shanghai Pudong New Area Health Commission,No.PWZzk2022-17the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2021-06+1 种基金Clinical Research Project of Shanghai East Hospital,No.DFLC2022019Shanghai Dongfang Hospital Key Discipline Department of Gallstone Disease,No.2024-DFZD-005DS.
文摘Biliary stent placement and removal are common medical procedures,but they carry risks of chyme regurgitation and residual common bile duct stones(CBDS),highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.AIM To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS,and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.METHODS We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024.Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group(DBBSG).Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.RESULTS The median age of the patients included was 62 years(interquartile range:51-70),with 53.11%being female.During stent removal,DBBSG showed higher rates of chyme reflux(23.27%vs 9.65%,P<0.001)and CBDS(42.77%vs 21.05%,P<0.001)compared to the single pigtail biliary stent group.No significant differences were found in the incidence of adverse reactions between the two groups(P>0.05),and no serious events or deaths occurred.DBBSG patients had increased risks of chyme reflux(hazard ratio=2.793;95%confidence interval:1.695-4.603;P<0.001)and CBDS(hazard ratio:2.475;95%confidence interval:1.732-3.536;P<0.001).CONCLUSION Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS.The safety of intra-biliary cleaning during stent removal has been validated,and as a result,it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.
文摘We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterology Practice Guideline on the Role of Esophageal Stents in Benign and Malignant Diseases concludes that SEMSs cannot be routinely recommended in conjunction with chemo-radiation. The comparison of ultraflex and choostent in the Italian study found no difference in the palliation of dysphagia, rate of complications and survival rate.
基金"111 Project"Biomedical Textile Materials Science and Technology of China(No.B07024)Fundamental Research Funds for the Central Universities of China(No.12D10112)+2 种基金National Students Innovation Plans of China(No.X120711287,No.12T1010601)National Natural Science Foundation of China(No.81371648)Research Fund for the Doctoral Program of Higher Education of China(No.20100075110001)
文摘Stent-grafts were commercialized rapidly and gained a broad clinical acceptance over the past two decades. However,relatively more recent recognition of particular stent-graft design shortcomings have been identified which need to be addressed. It appears that various stent-graft designs may be more or less resistant to metal fatigue and /or fabric abrasions which can lead to type III and type IV endoleaks over the long term. Therefore,it is necessary to investigate the fatigue performance of the most common stentgraft designs: Z-stents and ringed stents,in a long-term in vitro fatigue simulation environment. This paper aimed to analyze nondestructively( gross observations) and destructively( fabric characteristics,mechanical and chemical properties) in order to put forward suggestions to improve the fabric and stent characteristics that may prevent type III and IV endoleaks. The fabric supported with ringed stent-grafts remained nearly completely intact after 168h. However, the fabric supported with Z-stents demonstrated significant damage. Fabric characteristics and tensile strength of the fibers did not present a significant difference between the control and fatigue simulated specimens. The crystallinity declined for both specimens. The fatigue performance of fabrics supported with ringed stents appears to be superior to that supported with Z-stents. The potential for a dynamic and destructive interaction between the apices of Z-stents which can lead to fraying and /or tearing of the graft fabric must be addressed in future designs.
文摘In the past, the esophagus diseases causing the patient to unable to intake oral diet such as esophageal strictures, leaks, tracheoesophageal fistulas, etc. were managed by surgical interventions and parenteral nutrition to meet the demand of the body. After the development of technique of stent placement in esopahgus, there was revolutionary change in the management of such conditions promoting patients to take diet orally and improve their nutritional status as well as quality of life. Different types of commercial stents are available in the market with their own pros and cons. Our aim of this study was to review the different stents being used currently in the clinical practice, comparing the stents on their therapeutic outcome and complications, optimal timing of removal of stents for benign conditions and the methods studied by different clinicians to lower the rate of complications and reinterventions.
基金The National Natural Science Foundation of China(No.51475281,51375292)the National Natural Science Foundation for Young Scholar of China(No.51105239)
文摘A new type of vascular stent is designed for treating stenotic vessels. Aiming at overcoming the shortcomings of existing equipment and technology for preparing a bioabsorbable vascular stent （BVS）, a new method which combines 3D bio-printing and electrospinning to prepare the composite bioabsorbable vascular stent （CBVS） is proposed. The inner layer of the CBVS can be obtained through 3D bio- printing using poly-p-dioxanone （PPDO）. The thin nanofiber film that serves as the outer layer can be built through electrospinning using mixtures of chitosan-PVA （poly （vinyl alcohol））. Tests of mechanical properties show that the stent prepared through 3D bio-printing combined with electrospinning is better than that prepared through 3D bio- printing alone. Cells cultivated on the CBVS adhere and proliferate better due to the natural, biological chitosan in the outer layer. The proposed complex process and method can provide a good basis for preparing a controllable drug-carrying vascular stent. Overall, the CBVS can be a good candidate for treating stenotic vessels.
基金Supported by Shanghai Science and Technology Committee,No.09411967100Shanghai Municipal Health Bureau,No.2007Y38
文摘AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to spleen flex) carcinoma patients (47 males and 34 females,aged 18-94 years,mean = 66.2 years) treated between September 2004 and June 2010 for acute colon obstruction were enrolled to this study,and their clinical and radiological features were reviewed.After a cleaning enema was administered,urgent colonoscopy was performed.Subsequently,endoscopic decompression using SEMS placement was attempted.RESULTS: Endoscopic decompression using SEMS placement was technically successful in 78 (96.3%) of 81 patients.Three patients’ symptoms could not be relieved after SEMS placement and emergent operation was performed 1 d later.The site of obstruction was transverse colon in 18 patients,the hepatic flex in 42,and the ascending colon in 21.Following adequate cleansing of the colon,patients’ abdominal girth was decreased from 88 ± 3 cm before drainage to 72 ± 6 cm 7 d later,and one-stage surgery after 8 ± 1 d (range,7-10 d) was performed.No anastomotic leakage or postoperative stenosis occurred after operation.CONCLUSION: SEMS placement is effective and safe in the management of acute proximal colon obstruction due to colon carcinoma,and is considered as a bridged method before curative surgery.
