Showing posts with label Stents. Show all posts
Showing posts with label Stents. Show all posts
Saturday, May 19, 2012
Tuesday, December 6, 2011
Diabolo Stent - Fontan Fenestration Creation, Creation of Dumbell shape
Catheter Cardiovasc Interv. 2010 Nov 15;76(6):860-4.
Novel technique to reduce the size of a Fontan Diabolo stent fenestration.
Anderson B, Bhole V, Desai T, Mehta C, Stumper O.
Source
The Birmingham Children's Hospital, Birmingham, United Kingdom.
Abstract
OBJECTIVES:
To develop an effective catheter technique to reduce the size of a Diabolo stent fenestration in the failing Fontan circulation.
OBJECTIVES:
To develop an effective catheter technique to reduce the size of a Diabolo stent fenestration in the failing Fontan circulation.
BACKGROUND:
Diabolo stent fenestration is employed by many centers in the treatment of the failing Fontan patient. With subsequent recovery, exercise tolerance may be impaired by significant desaturation secondary to the right to left shunt across the fenestration. Complete fenestration closure carries the risk of recurrence of the initial symptoms and, hence, reduction of the size of fenestration should be the preferred technique.
Diabolo stent fenestration is employed by many centers in the treatment of the failing Fontan patient. With subsequent recovery, exercise tolerance may be impaired by significant desaturation secondary to the right to left shunt across the fenestration. Complete fenestration closure carries the risk of recurrence of the initial symptoms and, hence, reduction of the size of fenestration should be the preferred technique.
METHODS:
Twenty-eight patients with failing Fontan circulations (16 early and 12 late) underwent Diabolo stent fenestration for relief of symptoms. Five of these patients remained very limited by severe desaturation even at rest, after complete recovery from symptoms. Further cardiac catheterization with crimping/reduction of the size of the waist of the stent was carried out using a technique whereby a snare catheter was placed over the waist of the stent aided by an arterio-venous guidewire loop and a balloon catheter placed within the stent.
Twenty-eight patients with failing Fontan circulations (16 early and 12 late) underwent Diabolo stent fenestration for relief of symptoms. Five of these patients remained very limited by severe desaturation even at rest, after complete recovery from symptoms. Further cardiac catheterization with crimping/reduction of the size of the waist of the stent was carried out using a technique whereby a snare catheter was placed over the waist of the stent aided by an arterio-venous guidewire loop and a balloon catheter placed within the stent.
RESULTS:
All 5 patients had successful stent reduction with improvement in saturations, whilst still maintaining a small residual fenestration. No complications were encountered.
All 5 patients had successful stent reduction with improvement in saturations, whilst still maintaining a small residual fenestration. No complications were encountered.
ONCLUSION:
This novel technique of reduction of a diabolo stent fenestration, in a failing Fontan circulation, offers the advantages of avoidance of implanting further devices in the circulation and the ability to redilate the stent should symptoms recur.
This novel technique of reduction of a diabolo stent fenestration, in a failing Fontan circulation, offers the advantages of avoidance of implanting further devices in the circulation and the ability to redilate the stent should symptoms recur.
Copyright © 2010 Wiley-Liss, Inc.
Bifurcation stenting - RVOT. Branch PA, Coarctation
Catheter Cardiovasc Interv. 2011 Sep 1;78(3):419-24. doi: 10.1002/ccd.23025. Epub 2011 Mar 30.
A novel technique for stenting pulmonary artery and conduit bifurcation stenosis.
Stumper O, Bhole V, Anderson B, Reinhardt Z, Noonan P, Mehta C.
SourceHeart Unit, Birmingham Children's Hospital, United Kingdom. oliver.stumper@bch.nhs.uk
Abstract
BACKGROUND: Distal conduit obstruction is a recognized complication after surgery for congenital heart disease requiring implantation of a conduit from the right ventricle to the pulmonary arteries. Endovascular stenting of distal conduit obstruction can be challenging due to the proximity to the pulmonary artery bifurcation.
OBJECTIVE: A technique is described, whereby a single stent is mounted onto two balloon angioplasty catheters in tandem. This ensemble was delivered to the distal conduit/pulmonary artery via a large Mullins sheath on two guidewires, one placed in each of the branch pulmonary arteries. The aim was to assess safety and efficacy of this novel technique.
MATERIALS AND RESULTS: Seven patients (mean age 13.4 (6.7-23.4) years, mean weight 44.2 (23-69) kg were treated with this method. The pressure gradient was reduced from 36 (26-52) mm Hg to 11 (8-15) mm Hg [P< 0.05]. RV/LV pressure ratio decreased from 0.85 (0.6-0.95) to 0.42 (0.35-0.5) [P < 0.05]. There were no significant complications. During follow-up over a median of 2.6 (0.3-6.7) years no patient required re-intervention or surgery.
CONCLUSION: This novel technique appears to be safe and effective for stenting stenoses just proximal to pulmonary artery bifurcation.
Copyright © 2011 Wiley-Liss, Inc.
Catheter Cardiovasc Interv. 2011 Sep 1;78(3):425-7.
Dual wire technique for aortic coarctation stent placement.
Lampropoulos K, Budts W, Gewillig M.
SourceCongenital, University Hospitals Leuven, Belgium.
Abstract
A young adult presented for percutaneous treatment of a narrow aortic coarctation. A very large left subclavian artery originated immediately proximal to the coarctation. In order not to exclude or jail the left subclavian artery with a stent, a double wire technique was used. From a femoral approach, two guide wires were positioned, one in the aortic arch and another in the subclavian artery. A stent crimped over a 16-mm balloon and a 4-Fr catheter was advanced over the two wires within a 14-Fr long introducer sheath. The stent was successfully deployed and molded within the bifurcation by a kissing balloon technique, relieving the obstruction and leaving a guaranteed passage to the subclavian artery. The double wire technique is an elegant way to deliver a stent safely across a narrowing with guaranteed access to important side branches.
Copyright © 2010 Wiley-Liss, Inc.
Tuesday, June 21, 2011
Cath: Hybrid Procedure - Aortic stent placement for recoarctation after Norwood Procedure
Catheterization and Cardiovascular Interventions
Volume 78, Issue 1, pages 93–100, 1 July 2011
Catheterization and Cardiovascular Interventions
Volume 78, Issue 1, pages 93–100, 1 July 2011Abstract
Objective:
We describe a hybrid approach to the treatment of aortic obstruction after stage 1 palliation (S1P) of hypoplastic left heart syndrome.
Background:
Recurrent aortic obstruction is a common problem after S1P of hypoplastic left heart syndrome. Even mild aortic obstruction is poorly tolerated so early and definitive therapy is desirable. Although stent implantation is an effective treatment for aortic obstruction in older children and adults, technical issues due to small vessels and concerns regarding future potential for expansion have generally precluded the use of stents in this setting.
Methods:
Six patients underwent hybrid aortic reconstruction (HAR) in the operating room or catheterization laboratory, with the interventional cardiologist and cardiac surgeon working in cooperation.
Results:
Patients had a mean weight of 5.8 kg (2.9–7.7) and a mean age of 5.6 months (0.5–12.9) at the time of HAR. Five patients had undergone prior balloon angioplasty at a mean age of 2.8 months (2.1–3.5), and five had moderately depressed single ventricular function prior to HAR. The balloons used had a diameter of 7–10 mm and introducer sheath size ranged from 6 to 10 F. There were no immediate or late procedure related complications. Stent redilation was performed in 5 patients for relief of recurrent obstruction or to keep pace with somatic growth. At a median follow up of 4.8 years (0.2–7.9), there were 3 patients progressing well after Fontan palliation and 3 deaths.
Conclusions:
HAR allows for placement of stents that can ultimately reach adult size in small infants who have recurrent aortic obstruction after balloon angioplasty following S1P. Advantages include freedom from delivery sheath constraints when determining stent type/size, facilitation of precise stent position, and avoidance of vascular damage or hemodynamic compromise during the procedure. Longer follow-up and larger experience are required to determine if this therapy will provide a long-term solution to this difficult problem. © 2011 Wiley-Liss, Inc
Wednesday, November 10, 2010
How much is too much?!
A Heart With 67 Stents
Rami N. Khouzam, MD, Rajvir Dahiya, MD and Richard Schwartz, MD
Winthrop University Hospital, Mineola, New York
JACC 2010;56:1605
A 56-year-old male with coronary artery disease presented with angina, nonspecific electrocardiographic changes, and elevated troponins. Coronary angiography revealed total occlusion of a stent in the circumflex artery, where another was deployed—his 67th stent. The patient had 28 catheterizations over 10 years, with stents placed in his native coronary arteries as well as in 3 bypass grafts. All stents were placed to relieve his angina, refractory to maximal medical treatment and transmyocardial laser revascularization. Stents can be a great tool to help revascularization and relieve symptoms; unfortunately, they are prone to thrombosis and restenosis. If they fail while medical management is maximized unsuccessfully, alternative tools are lacking. This case raises many questions: "How much is too much?" "Are there guidelines?" and "What else can be offered for symptom relief?" More studies are needed to evaluate impact on quality of life versus risks in this multistent population. LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; OM = obtuse marginal branch of the circumflex coronary artery; RCA = right coronary artery.
Rami N. Khouzam, MD, Rajvir Dahiya, MD and Richard Schwartz, MD
Winthrop University Hospital, Mineola, New York
JACC 2010;56:1605
A 56-year-old male with coronary artery disease presented with angina, nonspecific electrocardiographic changes, and elevated troponins. Coronary angiography revealed total occlusion of a stent in the circumflex artery, where another was deployed—his 67th stent. The patient had 28 catheterizations over 10 years, with stents placed in his native coronary arteries as well as in 3 bypass grafts. All stents were placed to relieve his angina, refractory to maximal medical treatment and transmyocardial laser revascularization. Stents can be a great tool to help revascularization and relieve symptoms; unfortunately, they are prone to thrombosis and restenosis. If they fail while medical management is maximized unsuccessfully, alternative tools are lacking. This case raises many questions: "How much is too much?" "Are there guidelines?" and "What else can be offered for symptom relief?" More studies are needed to evaluate impact on quality of life versus risks in this multistent population. LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; OM = obtuse marginal branch of the circumflex coronary artery; RCA = right coronary artery.
Tuesday, October 19, 2010
Stent Malposition - Predictors
J Am Coll Cardiol Intv, 2010; 3:1080-1086
Anatomic and Technical Predictors of Stent Malposition During Implantation for Vascular Obstruction in Patients With Congenital and Acquired Heart Disease
Jeffery Meadows, MD*, David Teitel, MD, Phillip Moore, MD
Objectives: We evaluated the anatomic and technical factors predicting stent malposition and embolization in patients undergoing endovascular stent implantation for relief of noncoronary vascular obstruction.
Background: Endovascular stent implantation provides a highly effective, minimally invasive solution to vascular obstruction in patients with structural heart disease. However, stent implantation is technically challenging and stent embolization occurs in up to 5.5% of cases.
Methods: We reviewed patient and procedural characteristics of all endovascular stent implantations performed for relieving noncoronary vascular obstruction from January 1, 1999, through December 31, 2009. Univariate and multivariate predictors of stent malposition or embolization were explored through logistic regression methods.
Results: During the 10-year study period, 429 stents were implanted. Of these, 399 were placed for relief of vascular obstruction in 267 patients during 322 procedures. Initial implantation failure occurred in 33 patients (8.3%), including stent malposition in 18 (4.5%) and stent embolization in 15 (3.8%). Patient size and vascular obstruction caused by external compression or a vascular fold were independent predictors of stent malposition or embolization. All malpositioned and embolized stents were successfully managed without surgery, and none resulted in death, sustained hemodynamic instability, or important vascular injury.
Conclusions: Endovascular stent implantation is a highly effective and safe means of relieving noncoronary vascular obstruction in patients with congenital and acquired structural heart disease. Stent embolization occurs in approximately 3.8% of implantation procedures but can be managed successfully without surgical intervention. Anatomic and technical factors predict stent malposition, and consideration of these factors may improve procedural results.
Editorial on this article: By Audrey Marshall & James Lock
JACC Interv 2010;3:1087-8
Additional referece:
Law MA, Shamzad P, Nugent AW, et al. Pulmonary artery stents: Long-term follow-up. Catheter Cardiovasc Interv 2010;75:757-64.
Anatomic and Technical Predictors of Stent Malposition During Implantation for Vascular Obstruction in Patients With Congenital and Acquired Heart Disease
Jeffery Meadows, MD*, David Teitel, MD, Phillip Moore, MD
Objectives: We evaluated the anatomic and technical factors predicting stent malposition and embolization in patients undergoing endovascular stent implantation for relief of noncoronary vascular obstruction.
Background: Endovascular stent implantation provides a highly effective, minimally invasive solution to vascular obstruction in patients with structural heart disease. However, stent implantation is technically challenging and stent embolization occurs in up to 5.5% of cases.
Methods: We reviewed patient and procedural characteristics of all endovascular stent implantations performed for relieving noncoronary vascular obstruction from January 1, 1999, through December 31, 2009. Univariate and multivariate predictors of stent malposition or embolization were explored through logistic regression methods.
Results: During the 10-year study period, 429 stents were implanted. Of these, 399 were placed for relief of vascular obstruction in 267 patients during 322 procedures. Initial implantation failure occurred in 33 patients (8.3%), including stent malposition in 18 (4.5%) and stent embolization in 15 (3.8%). Patient size and vascular obstruction caused by external compression or a vascular fold were independent predictors of stent malposition or embolization. All malpositioned and embolized stents were successfully managed without surgery, and none resulted in death, sustained hemodynamic instability, or important vascular injury.
Conclusions: Endovascular stent implantation is a highly effective and safe means of relieving noncoronary vascular obstruction in patients with congenital and acquired structural heart disease. Stent embolization occurs in approximately 3.8% of implantation procedures but can be managed successfully without surgical intervention. Anatomic and technical factors predict stent malposition, and consideration of these factors may improve procedural results.
Editorial on this article: By Audrey Marshall & James Lock
JACC Interv 2010;3:1087-8
Additional referece:
Law MA, Shamzad P, Nugent AW, et al. Pulmonary artery stents: Long-term follow-up. Catheter Cardiovasc Interv 2010;75:757-64.
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