Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending t...Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending thoracic aorta. We systematically reviewed about literatures of stented elephant trunk operation （SET） identified through searches of the electronic databasesEMBASE and Medline, and aimed to summarize studies of patients undergoing SET for extensive aneurysms. Since 1996, Kato Mintroduced a hybrid technique by using stented graft implantation to the descending aorta for treatment of thoracic aortic aneurysm or dissection. It has been describe a good option for extensive thoracic aortic aneurysms and in a fashion similar to the elephant trunk technique.展开更多
Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exp...Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive展开更多
BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease.Iliac stent patency is multifactorial,and current management is based on best clinical practices,varying by ...BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease.Iliac stent patency is multifactorial,and current management is based on best clinical practices,varying by institution.AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes.METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein(CIV)stenting between December 2013 and December 2019 at a large academic center.Search criteria included CIV stenting and iliac vein compression.Nonthrombotic lesions and iliocaval thrombosis and/or occlusions were excluded.A total of 65 patients were selected for final analysis.Demographic information,procedural data points,and post-procedural management and outcomes were collected.Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients.RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting.Of these patients,33(50.8%)underwent thrombophilia testing,with 16(48.5%)testing positive.Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo(92.3%vs 81.3%,P=0.6),6 mo(83.3%vs 80%,P>0.9),or 12 mo(77.8%vs 76.9%,P=0.8).Immediately after stent placement,thrombophilia patients were more likely to be placed on dual therapy(aspirin and anticoagulation)or triple therapy(aspirin,clopidogrel,and anticoagulation)(50%vs 41.2%,P>0.9),and remain on dual therapy at 6 mo(25%vs 12.5%,P=0.5)and 12 mo(25%vs 6.7%,P=0.6).There was no significant difference in re-intervention rates(25%vs 35.3%,P=0.7)or number of reinterventions(average 2.3 vs 1.3 per patient,P=0.4)between thrombophilia positive and negative patients.CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive.The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.展开更多
Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression...Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics（CFD） methods are performed to study how the shape and the aspect ratio（AR） of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress（WSS） in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.展开更多
Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study...Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study constructed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall; however, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely damaged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.展开更多
Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass graftin...Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups;those with (Group P, protected) and without (Group NP;non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.展开更多
Current therapeutic strategies for ischemic stroke fall short of the desired objective of neurological functional recovery.Therefore,there is an urgent need to develop new methods for the treatment of this condition.E...Current therapeutic strategies for ischemic stroke fall short of the desired objective of neurological functional recovery.Therefore,there is an urgent need to develop new methods for the treatment of this condition.Exosomes are natural cell-derived vesicles that mediate signal transduction between cells under physiological and pathological conditions.They have low immunogenicity,good stability,high delivery efficiency,and the ability to cross the blood–brain barrier.These physiological properties of exosomes have the potential to lead to new breakthroughs in the treatment of ischemic stroke.The rapid development of nanotechnology has advanced the application of engineered exosomes,which can effectively improve targeting ability,enhance therapeutic efficacy,and minimize the dosages needed.Advances in technology have also driven clinical translational research on exosomes.In this review,we describe the therapeutic effects of exosomes and their positive roles in current treatment strategies for ischemic stroke,including their antiinflammation,anti-apoptosis,autophagy-regulation,angiogenesis,neurogenesis,and glial scar formation reduction effects.However,it is worth noting that,despite their significant therapeutic potential,there remains a dearth of standardized characterization methods and efficient isolation techniques capable of producing highly purified exosomes.Future optimization strategies should prioritize the exploration of suitable isolation techniques and the establishment of unified workflows to effectively harness exosomes for diagnostic or therapeutic applications in ischemic stroke.Ultimately,our review aims to summarize our understanding of exosome-based treatment prospects in ischemic stroke and foster innovative ideas for the development of exosome-based therapies.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
BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who ex...BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.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 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 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
Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions.However,its use in complex biliary obstructions is limited.Over the past decades,th...Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions.However,its use in complex biliary obstructions is limited.Over the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical approaches.Studies show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate expertise.For malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different modalities.The treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic therapy.Due to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging stents.These novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.展开更多
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 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
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting ...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.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 Esophageal stricture is a prevalent condition affecting the digestive system,primarily marked by dysphagia and the obstruction of food passage through the esophagus.This narrowing of the esophageal lumen ca...BACKGROUND Esophageal stricture is a prevalent condition affecting the digestive system,primarily marked by dysphagia and the obstruction of food passage through the esophagus.This narrowing of the esophageal lumen can significantly impact a person’s ability to eat and drink comfortably,often leading to a decrease in nutritional intake and quality of life.AIM To explore the current research status and future trends of esophageal stricture through bibliometric analysis.METHODS Literature on esophageal stricture from 2004 to 2023 was retrieved from the Web of Science Core Collection.Statistical analysis was performed using Excel,VOSviewer,CiteSpace,and RStudio.This study provides data on annual production trends,countries/regions,influential authors,institutions,journals,references,and keywords.RESULTS The study included 1485 publications written by 7469 authors from 1692 institutions across 66 countries/regions,published in 417 journals.The United States,China,and Japan are the major contributors to this field,with many quality papers.Song Ho-young,Diseases of the Esophagus,Gastrointestinal Endoscopy,and Mayo Clinic are the top authors,journals,co-cited journals,and institutions,respectively.The most frequent keywords are stent,endoscopy,management,etiology,and prevention;regenerative medicine,endoscopic injection,and autologous tissue transplantation are the latest research frontiers.These keywords reflect continuous advancements in technical innovation,treatment strategies,preventive measures in the esophageal stricture research field,and a sustained focus on improving patient prognosis.In contrast,the basic sciences were underrepresented.CONCLUSION This study provides an insightful analysis of the developments in the field of esophageal stricture over the past twenty years,with stent placement is currently a hot research topic.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
文摘Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending thoracic aorta. We systematically reviewed about literatures of stented elephant trunk operation （SET） identified through searches of the electronic databasesEMBASE and Medline, and aimed to summarize studies of patients undergoing SET for extensive aneurysms. Since 1996, Kato Mintroduced a hybrid technique by using stented graft implantation to the descending aorta for treatment of thoracic aortic aneurysm or dissection. It has been describe a good option for extensive thoracic aortic aneurysms and in a fashion similar to the elephant trunk technique.
文摘Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive
文摘BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease.Iliac stent patency is multifactorial,and current management is based on best clinical practices,varying by institution.AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes.METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein(CIV)stenting between December 2013 and December 2019 at a large academic center.Search criteria included CIV stenting and iliac vein compression.Nonthrombotic lesions and iliocaval thrombosis and/or occlusions were excluded.A total of 65 patients were selected for final analysis.Demographic information,procedural data points,and post-procedural management and outcomes were collected.Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients.RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting.Of these patients,33(50.8%)underwent thrombophilia testing,with 16(48.5%)testing positive.Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo(92.3%vs 81.3%,P=0.6),6 mo(83.3%vs 80%,P>0.9),or 12 mo(77.8%vs 76.9%,P=0.8).Immediately after stent placement,thrombophilia patients were more likely to be placed on dual therapy(aspirin and anticoagulation)or triple therapy(aspirin,clopidogrel,and anticoagulation)(50%vs 41.2%,P>0.9),and remain on dual therapy at 6 mo(25%vs 12.5%,P=0.5)and 12 mo(25%vs 6.7%,P=0.6).There was no significant difference in re-intervention rates(25%vs 35.3%,P=0.7)or number of reinterventions(average 2.3 vs 1.3 per patient,P=0.4)between thrombophilia positive and negative patients.CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive.The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.
基金Supported by National Natural Science Foundation of China(Grant No.5775179)
文摘Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics（CFD） methods are performed to study how the shape and the aspect ratio（AR） of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress（WSS） in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.
基金supported by the National Natural Science Foundation of China (Grants 11332003, 11421202, 61190123, 31200703, 11472031)Special Fund for Excellent Doctoral Degree Dissertation of Beijing (Grant 20131000601)+1 种基金the 111 Project (Grant B13003)the Innovation Foundation of BUAA for Ph.D. graduates
文摘Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study constructed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall; however, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely damaged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.
文摘Background: After a successful primary percutaneous transluminal coronary angioplasty (PTCA)/stent placement, performing bypass surgery to an artery with a patent stent during semiurgent coronary artery bypass grafting (CABG) surgeries may protect the patient against ischemic complications due to acute stent occlusion. This issue, however, is controversial. Loss of bypass graft function may occur in the early stages due to the competition between native flow and graft flow. In the present study, the effects of bypass surgery to an artery with a patent stent on the outcomes were investigated. Methods: Fifty nine patients who had undergone isolated CABG surgery within 6 weeks after a successful primary PTCA/stent placement were included in the study. Patients who had undergone emergency operation due to suspicion of acute stent occlusion and the redo cases were excluded in the study. Patients were divided into two groups;those with (Group P, protected) and without (Group NP;non-protected) coronary bypass to an artery with a patent stent. Preoperative, operative and postoperative data were collected retrospectively from the patient files. The need for urgent revascularization was recorded postoperatively. Mann-Whitney U test was used for the analysis of continuous variables, whereas categorical variables were analyzed either using Pearson's chisquare test or Fisher's exact test. Results: Of 59 patients, 35 underwent bypass surgery to the artery with patent stent, whereas bypass was not performed on 24 patients. It was observed that dual antiplatelet therapy had been performed on 20% of the patients in Group P and 87.5% of those in Group NP (p = 0.001). No acute ischemic change due to stent occlusion was determined in Group P, whereas it was observed in one patient in Group NP (p = 0.4). The prevalence of hospital mortality was found to be 8.6% and 8.3% in Group P and Group NP, respectively (p = 1). Conclusions: Although it was not statistically significant, it was observed that bypass surgery might have a protective effect against stent occlusion in patients who underwent bypass surgery. However, postoperative dual antiplatelet therapy substantially prevented stent occlusion in those without bypass surgery. On the other hand, stent-supported coronary circulation may be unsafe in case of discontinuation of clopidogrel therapy. Therefore, it was suggested that performing bypass surgery to an artery with a patent stent would be more reasonable in patients who underwent semi-urgent CABG surgery.
基金supported by the National Natural Science Foundation of China,Nos.82071291(to YY),82301464(to HM)the Norman Bethune Health Science Center of Jilin University,No.2022JBGS03(to YY)+2 种基金a grant from Department of Science and Technology of Jilin Province,Nos.YDZJ202302CXJD061(to YY),20220303002SF(to YY)a grant from Jilin Provincial Key Laboratory,No.YDZJ202302CXJD017(to YY)Talent Reserve Program of First Hospital of Jilin University,No.JDYYCB-2023002(to ZNG)。
文摘Current therapeutic strategies for ischemic stroke fall short of the desired objective of neurological functional recovery.Therefore,there is an urgent need to develop new methods for the treatment of this condition.Exosomes are natural cell-derived vesicles that mediate signal transduction between cells under physiological and pathological conditions.They have low immunogenicity,good stability,high delivery efficiency,and the ability to cross the blood–brain barrier.These physiological properties of exosomes have the potential to lead to new breakthroughs in the treatment of ischemic stroke.The rapid development of nanotechnology has advanced the application of engineered exosomes,which can effectively improve targeting ability,enhance therapeutic efficacy,and minimize the dosages needed.Advances in technology have also driven clinical translational research on exosomes.In this review,we describe the therapeutic effects of exosomes and their positive roles in current treatment strategies for ischemic stroke,including their antiinflammation,anti-apoptosis,autophagy-regulation,angiogenesis,neurogenesis,and glial scar formation reduction effects.However,it is worth noting that,despite their significant therapeutic potential,there remains a dearth of standardized characterization methods and efficient isolation techniques capable of producing highly purified exosomes.Future optimization strategies should prioritize the exploration of suitable isolation techniques and the establishment of unified workflows to effectively harness exosomes for diagnostic or therapeutic applications in ischemic stroke.Ultimately,our review aims to summarize our understanding of exosome-based treatment prospects in ischemic stroke and foster innovative ideas for the development of exosome-based therapies.
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.
文摘BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
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 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 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Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions.However,its use in complex biliary obstructions is limited.Over the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical approaches.Studies show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate expertise.For malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different modalities.The treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic therapy.Due to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging stents.These novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.
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 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Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.
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.
基金Supported by Beijing Science and Technology Planning Project,No.Z221100007422061the Natural Science Foundation of Shaanxi Province,General Project,No.2018SF-159.
文摘BACKGROUND Esophageal stricture is a prevalent condition affecting the digestive system,primarily marked by dysphagia and the obstruction of food passage through the esophagus.This narrowing of the esophageal lumen can significantly impact a person’s ability to eat and drink comfortably,often leading to a decrease in nutritional intake and quality of life.AIM To explore the current research status and future trends of esophageal stricture through bibliometric analysis.METHODS Literature on esophageal stricture from 2004 to 2023 was retrieved from the Web of Science Core Collection.Statistical analysis was performed using Excel,VOSviewer,CiteSpace,and RStudio.This study provides data on annual production trends,countries/regions,influential authors,institutions,journals,references,and keywords.RESULTS The study included 1485 publications written by 7469 authors from 1692 institutions across 66 countries/regions,published in 417 journals.The United States,China,and Japan are the major contributors to this field,with many quality papers.Song Ho-young,Diseases of the Esophagus,Gastrointestinal Endoscopy,and Mayo Clinic are the top authors,journals,co-cited journals,and institutions,respectively.The most frequent keywords are stent,endoscopy,management,etiology,and prevention;regenerative medicine,endoscopic injection,and autologous tissue transplantation are the latest research frontiers.These keywords reflect continuous advancements in technical innovation,treatment strategies,preventive measures in the esophageal stricture research field,and a sustained focus on improving patient prognosis.In contrast,the basic sciences were underrepresented.CONCLUSION This study provides an insightful analysis of the developments in the field of esophageal stricture over the past twenty years,with stent placement is currently a hot research topic.
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.
