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1.
Medicine (Baltimore) ; 99(33): e21621, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872019

RESUMO

Upper gastrointestinal stenting is a palliative treatment for relieving symptoms such as nausea, vomiting, and dietary intake in patients with obstruction due to inoperable advanced stomach cancer. Self-expandable metal stent (SEMS) implantation for malignant obstruction has recently become more effective, safer, and less expensive than operative modality. It also has better short-term outcomes, particularly a shorter hospital stay and a more rapid return to oral intake, than surgical treatment. However, there is no comparative analysis regarding the efficacy, side effects, and survival rate of stenting between the esophagogastric junction (EGJ) and pyloric obstructions.To compare the prognoses and complications after SEMS implantation between EGJ and pyloric obstructions in advanced gastric cancer.Among advanced gastric cancer patients with gastrointestinal obstruction diagnosed from January 2008 to December 2017 at the Gastroenterology Department of Chungnam National University Hospital, 42 and 76 patients presented with EGJ (EGJ obstruction group) and gastric pyloric obstructions (pyloric obstruction group), respectively. We retrospectively reviewed the survival period, changes in food intake, and complications of these patients before and after SEMS placement.The prevalences of aspiration pneumonia were 11.9% (5/42) and 2.6% (2/76) in the EGJ and pyloric obstruction groups, respectively, before SEMS placement (P value: .041). Other symptoms associated with gastric malignant obstruction were not statistically different between the groups. Success rate and adverse events did not significantly differ between the EGJ and pyloric obstruction groups. There was no difference in frequency of stent reinsertion procedures performed owing to reobstruction, but the reprocedure average period was statistically significantly longer in the EGJ obstruction group [EGJ obstruction: 158.3 days (±42.4); pyloric obstruction: 86.0 days (±29.1)] (P value: .022). As an index of improved dietary status, the Gastric Outlet Obstruction Scoring System score was not significantly different between the groups before and after SEMS placement.The EGJ and pyloric obstruction groups did not significantly differ in prognosis or complication rates. However, EGJ stent was more stable than pyloric stent when reobstruction was considered.


Assuntos
Junção Esofagogástrica/patologia , Piloro/patologia , Stents Metálicos Autoexpansíveis/efeitos adversos , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dieta , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Pneumonia Aspirativa/etiologia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia
2.
Medicine (Baltimore) ; 99(33): e21724, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872053

RESUMO

BACKGROUND/AIMS: Intraductal radiofrequency ablation (ID-RFA) is a novel therapy for unresectable malignant biliary obstructions. ID-RFA for perihilar lesions is associated with a high risk of adverse events. We aimed to evaluate the feasibility and efficacy of temperature-controlled ID-RFA for perihilar malignant biliary obstruction. METHODS: Sixteen patients with pathologically proven perihilar cholangiocarcinoma were prospectively enrolled to evaluate the feasibility of hilar ID-RFA. Clinical efficacy and outcomes were subsequently evaluated in a multicenter retrospective cohort. RESULTS: Nine of the 16 patients in the prospective cohort had Bismuth type IV and 7 had type IIIA perihilar cholangiocarcinoma. The median length of stricture was 34.5 mm. The median number of ID-RFA sessions was three, and all sessions were technically and functionally successful without severe adverse events. Clinical outcomes were assessed using a multicenter hilar ID-RFA cohort of 21 patients; the median stent patency and overall survival were 90 days (range: 35-483 days) and 147 days (range: 92-487 days), respectively. An approximate 16-month patency of the bile duct was maintained in one patient who had an intraductal growth pattern. In a comparison of the self-expandable metallic stent (SEMS) and plastic stent (PS) after hilar ID-RFA, no differences in stent patency (89 vs 90.5 days, respectively; P = .912) and adverse events (20.0% vs 10%, respectively; P = .739) were observed. CONCLUSIONS: ID-RFA at 7 W for 120 seconds is safe and feasible in patients with advanced perihilar cholangiocarcinoma. After ID-RFA, SEMS and PS placement showed comparable patency and survival rates. TRIAL REGISTRATION NUMBER: KCT0003223.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colangiocarcinoma/complicações , Ablação por Radiofrequência , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/etiologia , Constrição Patológica/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Cochrane Database Syst Rev ; 8: CD013267, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32789891

RESUMO

BACKGROUND: Intracranial atherosclerotic stenosis (ICAS) is an arterial narrowing in the brain that can cause stroke. Endovascular therapy and medical management may be used to prevent recurrent ischaemic stroke caused by ICAS. However, there is no consensus on the best treatment for people with ICAS. OBJECTIVES: To compare the safety and efficacy of endovascular therapy (ET) plus conventional medical treatment (CMT) with CMT alone for the management of symptomatic ICAS. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (30 August 2019), Cochrane Central Register of Controlled Trials (CENTRAL: to 30 August 2019), MEDLINE Ovid (1946 to 30 August 2019), Embase Ovid (1974 to 30 August 2019), Scopus (1960 to 30 August 2019), Science Citation Index Web of Science (1900 to 30 July 2019), Academic Source Complete EBSCO (ASC: 1982 to 30 July 2019), and China Biological Medicine Database (CBM: 1978 to 30 July 2019). We also searched the following trial registers: ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Stroke Trials Registry. We also contacted trialists and researchers where additional information was required. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing ET plus CMT with CMT alone for the treatment of symptomatic ICAS. ET modalities included angioplasty alone, balloon-mounted stent, and angioplasty followed by placement of a self-expanding stent. CMT included antiplatelet therapy in addition to control of risk factors such as hypertension, hyperlipidaemia, and diabetes. DATA COLLECTION AND ANALYSIS: Two review authors independently screened trials to select potentially eligible RCTs and extracted data. Any disagreements were resolved by discussing and reaching consensus decisions with the full team. We assessed risk of bias and applied the GRADE approach to assess the quality of the evidence. The primary outcome was death of any cause or non-fatal stroke of any type within three months of randomisation. Secondary outcomes included any-cause death or non-fatal stroke of any type more than three months of randomisation, ipsilateral stroke, type of recurrent event, death, restenosis, dependency, and health-related quality of life. MAIN RESULTS: We included three RCTs with 632 participants who had symptomatic ICAS with an age range of 18 to 85 years. The included trials had high risks of performance bias and other potential sources of bias due to the impossibility of blinding of the endovascular intervention and early termination of the trials. Moreover, one trial had a high risk of attrition bias because of the high rate of loss of one-year follow-up and the high proportion of participants transferred from endovascular therapy to medical management. The quality of evidence ranged from low to moderate, downgraded for imprecision. Compared to CMT, ET probably results in a higher rate of 30-day death or stroke (risk ratio (RR) 3.07, 95% confidence interval (CI) 1.80 to 5.24; 3 RCTs, 632 participants, moderate-quality evidence), 30-day ipsilateral stroke (RR 3.54, 95% CI 1.98 to 6.33; 3 RCTs, 632 participants, moderate-quality evidence), 30-day ischaemic stroke (RR 2.52, 95% CI 1.37 to 4.62; 3 RCTs, 632 participants, moderate-quality evidence), and 30-day haemorrhagic stroke (RR 15.53, 95% CI 2.10 to 115.16; 3 RCTs, 632 participants, low-quality evidence). ET was also likely associated with a worse outcome in one-year death or stroke (RR 1.69, 95% CI 1.21 to 2.36; 3 RCTs, 632 participants, moderate-quality evidence), one-year ipsilateral stroke (RR 2.28, 95% CI 1.52 to 3.42; 3 RCTs, 632 participants, moderate-quality evidence), one-year ischaemic stroke (RR 2.07, 95% CI 1.37 to 3.13; 3 RCTs, 632 participants, moderate-quality evidence), and one-year haemorrhagic stroke (RR 10.13, 95% CI 1.31 to 78.51; 2 RCTs, 521 participants, low-quality evidence). There were no significant differences between ET and CMT in 30-day transient ischaemic attacks (TIA) (RR 0.52, 95% CI 0.11 to 2.35, P = 0.39; 2 RCTs, 181 participants, moderate-quality evidence), 30-day death (RR 5.53, 95% CI 0.98 to 31.17, P = 0.05; 3 RCTs, 632 participants, low-quality evidence), one-year TIA (RR 0.82, 95% CI 0.32 to 2.12; 2 RCTs, 181 participants, moderate-quality evidence), one-year death (RR 1.20, 95% CI 0.50 to 2.86, P = 0.68; 3 RCTs, 632 participants, moderate-quality evidence), and one-year dependency (RR 1.90, 95% CI 0.91 to 3.97, P = 0.09; 3 RCTs, 613 participants, moderate-quality evidence). No data on restenosis and health-related quality of life for meta-analysis were available from the included trials. Two RCTs are ongoing. AUTHORS' CONCLUSIONS: This systematic review provides moderate-quality evidence showing that ET, compared with CMT, in people with recent symptomatic severe intracranial atherosclerotic stenosis probably does not prevent recurrent stroke and appears to carry an increased hazard. The impact of delayed ET intervention (more than three weeks after a qualifying event) is unclear and may warrant further study.


Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares/métodos , Arteriosclerose Intracraniana/complicações , Inibidores da Agregação de Plaquetas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Angioplastia/métodos , Viés , Isquemia Encefálica/etiologia , Isquemia Encefálica/mortalidade , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/etiologia , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Stents Metálicos Autoexpansíveis , Stents , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
4.
Medicine (Baltimore) ; 99(22): e20498, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481466

RESUMO

To explore the outcome of placing a single Y-shaped tracheal self-expandable metallic stent (SEMS) to treat emergent carinal stenosis combined with stenosis of the right main and intermediate bronchi.The clinical and imaging data of 10 patients (8 males, 2 females) with carinal stenosis combined with stenosis of the right main and intermediate bronchi were retrospectively analyzed. There were 4 patients with esophageal cancer and 6 patients with lung cancer. All patients underwent treatment with a single Y-shaped tracheal SEMS. The long branch was inserted into the right main and intermediate bronchi, while the short branch was inserted into the left main bronchus. A modified Borg scale score was used as the criterion for assessing dyspnea in patients before and after stenting.A total of 10 Y-shaped tracheal SEMSs were successfully placed in 10 patients without any procedure-related complications. Compared with the score before stent placement, the mean Borg score for dyspnea after stent placement decreased from 7.6 to 0.8 (P = .04). Chest computed tomography showed that the stenosis disappeared 3 to 5 days poststenting. During the follow-up period, the most common complications were tumor ingrowth (n = 5) and granulation tissue hyperplasia (n = 7). The mean survival time after tracheal stent placement was 103 ±â€Š50 (23-172) days.The application of a single Y-shaped tracheal SEMS for emergent carinal stenosis combined with stenosis of the right main and intermediate bronchi can effectively relieve dyspnea through a simple operation.


Assuntos
Broncopatias/terapia , Stents Metálicos Autoexpansíveis , Estenose Traqueal/terapia , Idoso , Idoso de 80 Anos ou mais , Broncopatias/diagnóstico por imagem , Constrição Patológica , Neoplasias Esofágicas/complicações , Feminino , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Estenose Traqueal/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(21): e19432, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481247

RESUMO

Self-expandable metallic stent (SEMS) placement is widely used for relieving symptoms in malignant gastric outlet obstruction (MGOO). This study aimed to evaluate the efficacy and safety of multiple gastroduodenal stent placement using the stent-in-stent technique and to identify factors predictive of stent patency.We retrospectively analyzed data from 170 patients with GOO receiving SEMS using the stent-in-stent technique between July 2006 and July 2018. Of these, 90 had been treated with SEMS placement for MGOO. Technical and clinical success rates were evaluated. Clinical outcomes and predictors of stent patency were also analyzed.Second SEMS placement was used in 34.4% of cases and 9.7% were treated with third SEMS placement because of prior stent dysfunction. Median stent patency time was 15.7 weeks for the first SEMS, 10.4 weeks for the second, and 11.3 weeks for the third. The technical and clinical success rates were 100% and 97.8% for the first SEMS, 100% and 90.3% for the second, respectively, and both 100% for the third. Multivariable analysis showed that use of covered SEMS and chemotherapy after first and second SEMS placement was significant predictors of stent patency. Serious complications such as bleeding or perforation did not occur in any patient.Second and third gastroduodenal SEMS placement using the stent-in-stent technique is safe and effective for management of first stent dysfunction in MGOO. Stent patency is significantly associated with the use of covered SEMS and chemotherapy after SEMS placement.


Assuntos
Obstrução da Saída Gástrica/cirurgia , Implantação de Prótese/métodos , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Colangiocarcinoma/complicações , Feminino , Obstrução da Saída Gástrica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Neoplasias Gástricas/complicações , Resultado do Tratamento
6.
Expert Rev Med Devices ; 17(6): 519-532, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32500761

RESUMO

INTRODUCTION: Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. AREAS COVERED: The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. EXPERT OPINION: technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.


Assuntos
Aneurisma Intracraniano/terapia , Stents/tendências , Embolização Terapêutica , Humanos , Desenho de Prótese , Stents Metálicos Autoexpansíveis , Resultado do Tratamento
7.
Khirurgiia (Mosk) ; (4): 61-64, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352670

RESUMO

A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Further study of this method and its clinical introduction in case of favorable results can significantly reduce the incidence of complications and mortality in patients with perforated gastroduodenal ulcers.


Assuntos
Úlcera Duodenal/cirurgia , Úlcera Péptica Perfurada/cirurgia , Idoso de 80 Anos ou mais , Ligas , Materiais Revestidos Biocompatíveis , Duodenoscopia , Gastroscopia , Humanos , Laparoscopia/efeitos adversos , Poliuretanos , Implantação de Prótese , Reoperação , Stents Metálicos Autoexpansíveis , Técnicas de Sutura/efeitos adversos
8.
Gan To Kagaku Ryoho ; 47(1): 111-113, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-32381875

RESUMO

A 67-year-old woman was diagnosed with borderline resectable pancreatic cancer and obstructive jaundice. A covered self-expandable metallic stent(SEMS)was placed endoscopically. Neoadjuvant chemotherapy with gemcitabine plus nabpaclitaxel was provided. Forty-seven days after the SEMS placement, she presented with hematemesis. Computed tomography revealed migration of SEMS into the small bowel. No pseudoaneurysms were detected. Upper digestive endoscopy demonstrated hemobilia without obvious causes of bleeding in the stomach or duodenum. As hemorrhage recurrence was confirmed in the bile duct, we performed pancreaticoduodenectomy. Thus, bile duct hemorrhage can occur in patients with pancreatic cancer after SEMS placement.


Assuntos
Sistema Biliar , Hemobilia , Neoplasias Pancreáticas , Stents Metálicos Autoexpansíveis , Idoso , Feminino , Hemobilia/complicações , Humanos , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia
9.
J Vasc Interv Radiol ; 31(6): 978-985, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32414572

RESUMO

PURPOSE: This study evaluated the long-term outcomes of the Misago peripheral stent trial (Terumo) for atherosclerotic lesions in the superficial femoral artery (SFA) in patients with claudication. MATERIALS AND METHODS: This was a prospective multicenter, single-arm, clinical trial of primary stent placement for de novo cases of SFA disease conducted in the United States and Asia. The primary endpoint was freedom from clinically driven target lesion revascularization (CD-TLR) at 36 months. Secondary outcomes were ankle-brachial index (ABI), Rutherford score, Walking Impairment Questionnaire (WIQ), a quality of life survey, and rate of device fracture. RESULTS: A total of 276 patients (64.4% male; mean age, 69.3 ± 10.1 years) were enrolled. Freedom from CD-TLR was 78.5% (95% confidence interval [CI], 73.0%-83.0%) at 24 months and 75.4% (95% CI, 69.6%-80.2%) at 36 months. Baseline ABI was 0.7 ± 0.1 and 0.98 ± 0.20 (P < .001) at 30 days after the procedure. Baseline Rutherford score was 3.6 ± 0.6 and 1.6 ± 1.0 30 at 30 days after the procedure (P < .001). Mean (and changed) ABI and Rutherford score at 36 months compared to day 30 after the procedure were, respectively, 0.91 (-0.1 ± 0.2) and 1.5 (-0.2 ± 1.1). WIQ score at baseline was 21.49 ± 26.30 and 50.51 ± 38.49 at 30 days after the procedure ( P < .001). The mean WIQ score at 2 years was 46.65 ± 37.31 (P = .12). Stent fracture rate at 36 months was 2.0% (4 of 202 patients). CONCLUSIONS: OSPREY (Occlusive-Stenotic Peripheral Artery Revascularization Study) 36-month data demonstrated persistent freedom from CD-TLR and sustained improvement in ABI and Rutherford score with primary stent placement for SFA lesions.


Assuntos
Procedimentos Endovasculares/instrumentação , Artéria Femoral , Claudicação Intermitente/terapia , Doença Arterial Periférica/terapia , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Ásia , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Grau de Desobstrução Vascular
10.
Medicine (Baltimore) ; 99(14): e19557, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243372

RESUMO

The self-expanding metallic stent (SEMS) has been comprehensively investigated as a bridge to surgery. SEMS enables the control of acute colonic obstruction. However, comparison between SEMS and diverting colostomy as another bridge procedure was still challenging issue. Thus, the aim of this study was to compare these 2 procedures.In this retrospective cohort study, patients who received diverting colostomy and SEMS for acute left colonic obstruction between February 2016 and August 2018 were included. They were classified into the colostomy group (n = 27), including 5 patients who had SEMS failure previously, and the SEMS group (n = 23). The clinicopathologic parameters, pathologic results, and short-term outcomes were compared.No significant differences were found in clinicopathologic characteristics and complication rates between the 2 groups. After the bridge procedures, the SEMS group showed a higher rate of laparoscopic colonic resection than the colostomy group (100% vs 76%, P = .023). The colostomy group showed a higher rate of rectal cancer (24.0% vs 9.1%, P = .019) and later recovery of flatus (3 vs 2 days, P = .011) than the SEMS group. Additionally, the length of resected colon was longer in the colostomy group than in the SEMS group (33.9 vs 23.4 cm, P = .007).Although SEMS might permit higher laparoscopic resection rates and faster recovery of bowel habits than diverting colostomy, SEMS showed meaningful failure rate including migration and perforation. In addition, diverting colostomy showed acceptable complication rates and feasible performance. An individualized approach is necessary considering the advantages and disadvantages of both procedures.


Assuntos
Neoplasias Colorretais/complicações , Colostomia/métodos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Adulto , Idoso , Colectomia/métodos , Colectomia/estatística & dados numéricos , Colostomia/efeitos adversos , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos
11.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(2): 334-339, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32329287

RESUMO

In order to evaluate the safety performance of self-expandable NiTi alloy stents systematically, the dynamic safety factor drawn up by International Organization for Standardization, was used to quantitatively reflect the safety performance of stents. Based on the constitutive model of super-elastic memory alloy material in Abaqus and uniaxial tensile test data of NiTi alloy tube, finite element method and experiments on accelerated fatigue life were carried out to simulate the self-expansion process and the shape change process under the action of high and low blood pressure for three L-type stents of Φ8×30 mm, Φ10×30 mm, Φ12×30 mm. By analyzing the changes of stress and strain of self-expanding NiTi alloy stent, the maximum stress and strain, stress concentration position, fatigue strength and possible failure modes were studied, thus the dynamic safety factor of stent was calculated. The results showed that the maximum stress and plastic strain of the stent increased with the increase of grip pressure, but the maximum stress and strain distribution area of the stent had no significant change, which were all concentrated in the inner arc between the support and the connector. The dynamic safety factors of the three stents were 1.31, 1.23 and 1.14, respectively, which indicates that the three stents have better safety and reliability, and can meet the fatigue life requirements of more than 10 years, and safety performance of the three stents decreases with the increase of stent's original diameter.


Assuntos
Ligas , Stents Metálicos Autoexpansíveis , Análise de Elementos Finitos , Níquel , Reprodutibilidade dos Testes , Estresse Mecânico , Titânio
12.
Ann R Coll Surg Engl ; 102(6): 451-456, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32347738

RESUMO

INTRODUCTION: UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. METHODS: All colorectal surgery department leads in England were contacted in 2018 and invited to complete an objective multiple choice questionnaire pertaining to service provision of colorectal stenting (including referrals, time, location and specialty). RESULTS: Of 182 hospitals contacted, 79 responded (24 teaching hospitals, 55 district general hospitals). All hospitals considered stenting, with 92% performing stenting and the remainder referring. The majority (93%) performed fewer than four stenting procedures per month. Most (96%) stented during normal weekday hours, with only 25% stenting out of hours and 23% at weekends. Compared with district general hospitals, a higher proportion of teaching hospitals stented out of hours and at weekends. Stenting was performed in the radiology department (64%), the endoscopy department (44%) and operating theatres (15%), by surgeons (63%), radiologists (60%) and gastroenterologists (48%). A radiologist was present in 66% of cases. Of 14 hospitals that received referrals, 3 had a protocol, 3 returned patients the same day and 4 returned patients for management in the event of failure. CONCLUSIONS: All responding hospitals in England consider the use of SEMS in colonic obstruction. Nevertheless, there is great variation in stenting practices, and challenges in terms of access and expertise. Centralisation and regional referral networks may help maximise availability and expertise but more work is needed to support this.


Assuntos
Colonoscopia/instrumentação , Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Plantão Médico/estatística & dados numéricos , Protocolos Clínicos/normas , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/cirurgia , Estudos Transversais , Inglaterra , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/normas , Hospitais de Distrito/estatística & dados numéricos , Hospitais Gerais/normas , Hospitais Gerais/estatística & dados numéricos , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Obstrução Intestinal/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Stents Metálicos Autoexpansíveis/normas , Inquéritos e Questionários/estatística & dados numéricos
13.
Radiol Med ; 125(10): 999-1007, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32319004

RESUMO

PURPOSE: To investigate the technical success, efficacy, and safety of a newly designed partially covered bilateral self-expanding metallic stent (SEMS) in patients with malignant biliary obstruction. MATERIAL AND METHODS: From May 2016 to November 2017, ten patients with malignant hilar biliary stenosis (bismuth type II-IV) underwent stent placement with the newly designed partially covered T/Y-configured SEMS. Technical success, drainage catheter removal, jaundice remission, early and late complications, stent patency, and overall survival were analyzed. RESULTS: The stent was successfully deployed in all patients. The total bilirubin level significantly decreased one month after stent placement (P < 0.05). Drainage catheter removal rate was 90%. Two cases (20%) experienced early complications (bile duct hemorrhage and cholangitis) and two cases (20%) experienced late complications (hepatic abscess and cholangitis). During the follow-up (mean 276 days; range 57-503 days) stent occlusion occurred in three patients (30%), and two patents died of hepatic failure. The median stent patency and overall survival were 275 days (95% CI 223.8-326.3 days) and 428.9 days (95% CI 347.9-509.8 days), respectively. CONCLUSION: The newly designed partially covered T/Y-configured SEMS is technically feasible and clinically effective for biliary trifurcation obstruction.


Assuntos
Colestase/terapia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Neoplasias dos Ductos Biliares/complicações , Bilirrubina/sangue , Colangiocarcinoma/complicações , Colangiografia , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/mortalidade , Feminino , Neoplasias da Vesícula Biliar/complicações , Humanos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Stents Metálicos Autoexpansíveis/efeitos adversos , Análise de Sobrevida , Fatores de Tempo
14.
J Clin Neurosci ; 75: 210-212, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32209274

RESUMO

BACKGROUND: Giant partially thrombosed aneurysms are challenging lesions for which treatment can be difficult due to their unfavourable anatomical configuration and abnormal flow conditions. CASE DESCRIPTION: The patient presented in this report suffered from a symptomatic giant partially thrombosed donut-shaped aneurysm of the left-sided supraophthalmic internal carotid artery. Due to the location and the size of the aneurysm, endovascular treatment was performed. Navigation of the microcatheter-microwire-system distal to the aneurysm for stent deployment was technically not possible due to limited support, caused by the large aneurysm. Therefore, a WEB device was placed in the distal leg of the donut-shaped aneurysm. Additionally to the occlusion of this part of the aneurysm, the WEB device enabled enough support to navigate the microcatheter-microwire-system distal to the aneurysm. After deployment of a flow-diverting stent, coiling of the aneurysm was performed. Follow-up angiography showed complete occlusion of the aneurysm. The patient suffered from severe headaches which were no longer present 6 months after treatment. CONCLUSIONS: The WEB intraaneurysmal flow diverter can be effectively used as combined support and embolization device for the treatment of complex aneurysms in selective cases where other catheterization and embolization strategies have failed.


Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Stents Metálicos Autoexpansíveis , Trombose/diagnóstico por imagem , Trombose/terapia , Anticoagulantes/administração & dosagem , Terapia Combinada/métodos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Cardiovasc Surg (Torino) ; 61(1): 84-92, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32079379

RESUMO

BACKGROUND: The aim of this study was to evaluate the safety and performance of the sinus-SuperFlex-635 self-expandable nitinol stent (Optimed GmbH) for the treatment of steno-occlusive lesions in the superficial femoral artery (SFA) and proximal popliteal artery (PPA). METHODS: The prospective, multicenter, observational HERO study recruited 117 eligible patients (83 men; mean age 69.4±9.7y) from 7 centers in Belgium. RESULTS: A total of 129 stents were successfully deployed in 121 lesions in 117 patients (100%). The patients presented with symptomatic ≥50% stenosis or chronic total occlusion (CTO) (30.6%). Mean lesion length was 71.4±56.3 mm. Moderate to severe calcification was present in 82.6% of the lesions. Acute lesion success (<30% residual stenosis) was achieved in 96.0%. There were no in-hospital serious adverse events. Duplex ultrasound-driven primary patency at 12 months was recorded in 84 of 107 (78.5%) lesions. The overall target lesion revascularization (TLR) rate was 8.4% at 12 months; the target extremity revascularization (TER) rate was 4.7%. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford class, without the need for TLR (i.e. primary sustained clinical improvement) in 83.9% of patients and with the need for TLR in 90.6% of patients (i.e. secondary sustained clinical improvement). CONCLUSIONS: Based on the high primary patency, low stent fracture rate and significant clinical improvement, combined with refined stent design and long stent availability, the sinus-SuperFlex-635 self-expandable nitinol stent proves its value in the treatment of complex femoropopliteal lesions.


Assuntos
Procedimentos Endovasculares/instrumentação , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents Metálicos Autoexpansíveis , Calcificação Vascular/terapia , Idoso , Idoso de 80 Anos ou mais , Ligas , Bélgica , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Grau de Desobstrução Vascular
16.
Endoscopy ; 52(3): 233, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097966
17.
Medicine (Baltimore) ; 99(3): e18718, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011448

RESUMO

BACKGROUND AND AIM: Biliary obstruction can impair the effectiveness of neo-adjuvant chemotherapy. This study was designed to compare biliary stenting with covered self-expandable metal stents (FCSEMS) and plastic stents (PS) in patients with biliary obstruction caused by borderline resectable pancreatic cancer (BRPC) who were undergoing neo-adjuvant chemotherapy during preoperative biliary drainage. METHODS: This single-center, comparative, randomized, superiority study was designed to compare FCSEMS with PS for drainage of biliary obstruction of BRPC. Twenty two eligible patients providing informed consent will be randomized 1:1 by computer to either FCSEMS or PS for endoscopic retrograde biliary drainage (ERBD). All subsequent clinical interventions, including crossover to alternative procedures, will be at the discretion of the treating physician based on standard clinical care. The primary outcomes will be the rates and causes of stent dysfunction during preoperative biliary drainage. Other outcomes include time required for ERBD, adverse events related to ERBD, period from ERBD to surgery, percentage of patients able to undergo surgery, operation time, intraoperative bleeding volume, postoperative adverse events, and postoperative hospitalization. Subjects, treating clinicians, and outcome assessors will not be blinded to assignment. DISCUSSION: This study is intended to determine whether FCSEMS or PS is the better biliary stent for ERBD for management of patients with biliary obstruction of BRPC, a common clinical dilemma that has not yet been investigated in randomized trials. TRIALS REGISTRATION: UMIN-CTR, Identifier: UMIN000030473. Registered July 10, 2017, Wakayama Medical University Hospital.


Assuntos
Colestase/etiologia , Colestase/cirurgia , Neoplasias Pancreáticas/complicações , Stents , Procedimentos Cirúrgicos do Sistema Biliar , Quimioterapia Adjuvante , Humanos , Neoplasias Pancreáticas/terapia , Plásticos , Cuidados Pré-Operatórios , Estudos Prospectivos , Projetos de Pesquisa , Stents Metálicos Autoexpansíveis , Método Simples-Cego
18.
Medicine (Baltimore) ; 99(3): e18806, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011485

RESUMO

RATIONALE: Esophagopleural fistula (EPF) is a rare critical life-threatening condition that features high misdiagnosis rate. Although various surgical and conservative techniques have been developed for the treatment of EPF, the mortality rate of EPF remains high. PATIENT CONCERNS: An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding. DIAGNOSES: Upper endoscopy revealed bleeding large esophageal varices, and endoscopic injection sclerotherapy (EIS) was performed. Two weeks after the EIS was performed, the patient developed pyrexia, left-sided pleuritic chest pain. Air and pleural effusion were showed in the left pleural cavity by high-resolution computed tomography (HRCT), and a linear fistulous communication was noticed from the distal esophagus. These findings were consistent with hepatic cirrhosis, esophageal varices, upper gastrointestinal bleeding, and esophagopleural fistula. INTERVENTIONS: The patient was intensively treated with endoscopic self-expandable metallic stent (covered-SEMS) implantation and comprehensive treatments (including thoracic closed drainage, antibiotics, nasojejunal nutrition, and antacids). OUTCOMES: The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments. LESSONS: This case indicates that pleural effusion with food residue is a specific finding in EPF. Thorax CT exhibited high sensitivity for the diagnosis of EPF. Endoscopic self-expandable metallic stent implantation and comprehensive conservative treatments may be preferable for the severe liver disease with EPF.


Assuntos
Endoscopia Gastrointestinal , Fístula Esofágica/etiologia , Varizes Esofágicas e Gástricas/terapia , Escleroterapia , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/terapia , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Masculino , Esquistossomose mansoni/complicações , Esquistossomose mansoni/terapia , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Stents Metálicos Autoexpansíveis
20.
J Neurointerv Surg ; 12(5): 536, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32051321

RESUMO

Endovascular treatment of wide-necked bifurcation intracranial aneurysms is technically challenging, often requiring adjunctive devices such as stents or balloons to maintain coil mass within the aneurysm sac. Comaneci is a radiopaque embolization-assist device that can be temporarily deployed in the parent artery across the aneurysm neck without arresting blood flow for remodeling of coil mass. It is removed once coiling without luminal coil protrusion is achieved. In this video, we demonstrate use of the device for coiling of a wide-necked right middle cerebral artery (MCA) aneurysm in a 54-year-old woman. This patient presented with an unruptured MCA bifurcation aneurysm that showed growth on serial imaging. She wanted to avoid dual antiplatelet therapy, precluding the use of stent-assisted coiling. After detailed discussion with the patient, we proceeded with Comaneci-assisted coiling. Satisfactory aneurysm coiling was achieved without periprocedural complication. In the video, we further discuss potential indications and advantages of the device.


Assuntos
Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents Metálicos Autoexpansíveis , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
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