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Vascular Access
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
Stent grafting? Why not consider a bare metal stent?“No. Bare metal stents have not demonstrated an advantage in long term patency over balloon angioplasty.”
Perioperative issues
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Gordon A. G. McKenzie, David J. H. Shipway
The deployment of stents in the coronary vasculature requires antiplatelet cover to reduce the risk of stent thrombosis and myocardial infarction (MI) until the stent has undergone successful endothelialisation. The type of previous percutaneous coronary intervention (PCI) and stenting determines the minimum recommended duration of dual antiplatelet therapy (DAPT), and therefore may affect the timing of elective surgery. Cessation of DAPT prior to these timeframes represents an increased risk of perioperative in-stent thrombosis and acute MI, which is associated with greatly increased cardiovascular mortality: Bare metal stent (30 days)Drug-eluting stent (3–6 months, depending on product used; upper limit preferred)Balloon angioplasty (2 weeks or more) [11]
Stents, covered stents, stent–grafts
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
There is typically a larger sheath required for covered stents than for bare metal stents. In order to make more room for delivery through the sheath, many covered stents are delivered over smaller diameter guidewires, such as 0.018-inch diameter wires. The deliverability is partly diminished with covered stents due to the larger amount of material that usually fits very tightly within the sheath. After the constrained covered stent has passed through the sheath, the outside surface of the covered stent is typically irregular, and the device itself on the catheter is usually slightly bulkier than a bare metal stent. All these aspects affect the ability to deliver the covered stent to its desired location. If the covered stent is being delivered into a tortuous area, such as when being used as a renal or visceral snorkel, it will likely not pass bareback. In this case, the sheath is placed where the covered stent is desired, the stent is advanced into location, and then the sheath is withdrawn.
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
Due to poor angioplasty outcomes, in part due to the need for recurrent interventions and poor primary patency, alternative management options for CAS are being investigated. Stent graft placement improves angioplasty outcomes and is becoming more employed in the primary management of CAS (Figure 4). Bare metal stents (BMS) are falling out of favor due to high in-stent restenosis and low patency rates making stent grafts a better alternative. Bare metal stents appear relatively superior to angioplasty alone [39]. Dukkipati et al. compared outcomes following angioplasty alone to BMS in their study of 45 patients. The authors reported a median patency of 152 days among BMSs patients versus 91.5 days in those who underwent only angioplasty [40]. Shemesh et al. conducted a randomized control trial comparing the patency rates of bare metal stents and stent graft among 25 patients undergoing management for failed angioplasty for the management of recurrent CAS. They reported primary patency at 6 months for BMS at 39% compared to stent grafts at 82%. Primary patency at 1 year was 32% in the stent graft group versus 0% in the bare stent group. Rate of restenosis was 70% (10) in the BMS group and 18% (11) in the stent graft group [41]. Jones et al. described a group of 39 patients who underwent stent graft placement for management of CAS. They reported primary patency of 85%, 67%, and 4%, at 3, 6, and 12 months respectively. Primary assisted patency was 95% at 12 months [42].
Interventions in Congenital Heart Disease:A Review of Recent Developments: Part I
Published in Structural Heart, 2021
Despite important advances in the understanding of this disease, management of PVS remains challenging, with neither surgical nor transcatheter interventions yielding satisfactory long-term results. The introduction of “sutureless” surgical techniques has been useful in treating proximal disease, but results remain disappointing in cases of distal disease.70 In this regard, transcatheter intervention has become a component of various treatment strategies. Conventional balloon angioplasty and cutting balloon angioplasty (BA) are of comparable efficacy in providing acute hemodynamic and angiographic relief. However, restenosis is the norm with no difference in reintervention rates (freedom from reintervention at 1 year 4% for cutting balloon and 23% for conventional BA).71 There are no data comparing outcomes of stent versus balloon angioplasty. The largest published experience of bare metal stents (BMS) in primary pediatric and postoperative PVS reported freedom from reintervention of only 42 ± 7% at 1 year, despite excellent acute gradient relief. A stent implant with larger diameter, ≥7 mm, was associated with longer freedom to reintervention.72 Hybrid pulmonary vein stenting has been proposed as a useful adjunct at the time of surgical intervention for recurrent and malignant PVS.73
Bioresorbable polymer and durable polymer metallic stents in coronary artery disease: a meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2021
Tanveer Mir, Layla Shanah, Usman Ahmad, Yasar Sattar, Bhavin Chokshi, Ankita Aggarwal, Preeya Prakash, Hassan Bin Attique, Khalid Hamid Changal, Kartik Kumar, Chadi Alraies, Waqas T Qureshi, Luis Afonso
We searched Medline, PubMed, and Google Scholar for randomized controlled trial (RCT) studies that compared DPS and BPS outcomes. The combinations of medical terms ‘Durable polymer stents,’ ‘bioresorbable polymer stents,’ ‘percutaneous coronary intervention,’ ‘outcome,’ ‘CAD’ was employed to conduct a comprehensive search in the above-mentioned databases. All searches were restricted to studies conducted on human subjects published through May 2020 considering the evolving trend in techniques. We included every study that was subjected to coronary artery disease without restriction to a particular population, like diabetics. We excluded studies that were duplicate, studies with unclear data, and did not directly compare BPS and DPS. Studies comparing BPS with the first-generation DPS were excluded. Studies in languages other than English were excluded. Observational studies were excluded to determine better cause and effect analysis. Articles were excluded if data on outcome in terms of complications were missing. Studies comparing bare-metal stents with DPS or BPS were excluded.