Advantages And Disadvantages Of Stents – A stent is a small metal tube that keeps your artery open so blood can flow better. After an angioplasty, your health care provider may place a stent to move plaque away from the inside of your artery. Stents are permanent and can prevent your artery from narrowing again.

A stent is a very small tube that your healthcare provider can place in your artery to keep it open after the plaque (cholesterol and fat) is removed. It helps blood flow more easily through your blood vessels.

Advantages And Disadvantages Of Stents

Advantages And Disadvantages Of Stents

Stents are tube-shaped devices that stay permanently in your artery. They resemble small fishing nets made of metal, not organic or synthetic fibers.

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Health care providers use stents to prevent an artery from becoming too narrow or blocked, which prevents blood from flowing easily. You may need it if you have had a heart attack or have atherosclerosis (plaque build-up in your arteries).

Stents help your blood vessels work better after your provider removes the plaque that has built up inside them. This plaque can form if you have:

Stents also help if you have deep vein thrombosis (a blood clot in the legs, arms, or abdomen) or an abdominal aortic aneurysm or other type of aneurysm. The use of stents is not limited to blood vessels. They can help with blockages in the airways, bile ducts, or urinary tract.

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Your healthcare provider will ask you not to eat or drink for six to eight hours before receiving the stent. They want to know what medications you are taking and what allergies you have. Before the procedure, they will give you blood thinners—such as aspirin and clopidogrel (Plavix®).

Your provider will give you intravenous (IV) medications to relax you, but you’ll still be alert enough to answer questions. Your IV blood thinners will help you avoid blood clots during the stent procedure.

While you sleep, your provider places a thin tube called a catheter through your skin and into one of the arteries in your thigh or arm. They use X-rays as a guide to find an artery with too much plaque. Adding dye to the catheter makes it easier to see your arteries on an X-ray.

Advantages And Disadvantages Of Stents

Your provider will place another catheter with a balloon at the end into your blocked or narrowed artery. They inflate a balloon that acts as a garbage bag for the plaque and pushes it against your artery walls. This creates space for a stent that can be inserted while deflating the balloon stud.

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If the artery is open after angioplasty, your provider may place a wire mesh stent. They inflate the balloon catheter, which simultaneously opens the inserted stent. Your provider deflates the balloon catheter and removes it, leaving the stent in place.

You will recover in the hospital for a few hours or overnight before going home. You may be given medication to lower your cholesterol. You may need to take medications such as aspirin and clopidogrel (Plavix®) that can prevent your blood from clotting. Your doctor will discuss this with you before you go home.

It takes about a week to heal from stent placement. Ask your service provider how many days you are allowed to be active in the following days. Instructions may vary depending on whether it’s in your hand or on your lap.

Your provider will prescribe antiplatelet medications to prevent blood clots from forming in the stent. You are taking aspirin and/or clopidogrel, ticagrelor or prasugrel. Depending on your risk of bleeding, you may take these medications for a month, several months, or a year or longer. It is very important that you take these medicines to prevent blood clots.

The Newest Generation Of Drug Eluting Stents And Beyond

You can return to work or drive after a week. If your job involves heavy lifting, you may need three or four weeks to recover before returning to work.

While your angioplasty and stent will help your circulation improve, you still need to do your part and live a healthy lifestyle. This means eating a healthy diet, exercising and avoiding tobacco products. You should also feel better if you take the medications prescribed by your provider and go to your follow-up appointments. Trial to increase metal stent patency: focus on drug eluting stents 2019. 03. 28. R4 강승 경 / Pf. 이 상 혁.

Presentation on theme: “Metal Stent Patency Prolongation Trial: Focus on Drug Eluting Stents 2019. 03. 28. R4 강승 경 / Pf. 이 상 혁.”— Presentation transcript:

Advantages And Disadvantages Of Stents

“The perfect stent does not exist yet” SEMS (Self-Expanding Metal Stents) have lower recurrent biliary obstruction (RBO) than plastic stents. Stainless Steel  Nitinol: Standard metal components for SEMS uncoated, partially or fully coated, but no difference in improving patient quality of life until patient death.

Contemporary Stent Treatment Of Coronary Bifurcations

Disadvantages Exposed SEMS Easy deployment (low shortening rate) Hilar segment available Finer introducer stent Inhibition of tumor growth Tumor overgrowth Partially covered SEMS Avoiding tumor growth Potential removal complications Migration/observation Pancreatitis Cholangitis Completely possible SEMS for tuberculosis.

Radial force (RF): Expansion force to expand SEMS against tumor compression structures. Maintain luminal patency of obstructed bile duct Short distance -> long SEMS showed less AF

Achilles heel of coated SEMS Coated SEMS removal ability increases risk of migration Migration risk factors: low RF, chemotherapy anti-migration system. Covered SEMS Valve Flared Tip Partially Covered Metal Stent External Exposed Area RF Variation

6 Introduction Photosensitizer-embedded self-expanding metal stents (PDT stents) Polymeric photosensitizers (polyacetate-conjugated pheophorbide A; PPA) Endoscopic PDT potential recurrence after stent placement

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Laser exposure of stent layer on tumor cell lines HCT-116 tumor xenograft mouse models (subcutaneous transplantation in mice) Endoscopic intervention of PDT stent in common bile duct of minipigs Feasibility of combined treatment of cholangiocarcinoma (stent + PDT).

8 Introduction Drug-eluting stents (DES); Antitumor agent: Inhibits tumor growth MSCPM-I: Membrane-covered metallic stent containing paclitaxel. Comparative prospective clinical trial No statistical difference in stent patency or survival Patient characteristics: short survival time (50% expire before stent closure) Stent membrane: membrane biodegradation  short-term release of paclitaxel from MSCPM-I. A new generation stent MSCPM-II was developed and improved: a metal stent covered with a membrane containing paclitaxel using a pluronic composite. Patience, safety and patient survival

9 사다의 한국이 (부논문) 바아 아 어사 아이스 한국어 한 Pluronic mixture pm-ii 를 cms 프국앜 와 한

Advantages And Disadvantages Of Stents

Number required: Total 150 (75 in each group) (2.5% type I error, 80% statistical power, throughput effective range 20%, dropout rate 10% Enrollment of 72 pts with inoperable remote malignant biliary obstruction Inclusion criteria Exclusion criteria Age : 19- 90 years Inoperable pancreatic or bile duct cancer not treated with metal stent placement Expected survival > 3 months Not pregnant Previous surgery biliary drainage Severe bleeding diathesis Malignant hilar and/or intrahepatic duct structures Endoscopic intervention impossible

Coronary Angioplasty Pci Stent Balloon

Gemcitabine Based Chemotherapy Gemcitabine / Gemcitabine + Erlotinib / Gemcitabine + Capecitabine 5-FU + Oxaliplatin Stents MSCPM-II Membrane (Niti-S Stent with ComVi Type Paclitaxel Eluting Membrane) External in Bilayer-20PT20-7-. Polyurethane (PTX-Plu-PU) 10 mm diameter, 5-8 cm long F/U Clinical SX, Labs (AST/ALT, ALP, GGT, Bilirubin): 0, 3, 7 Monthly CT: before stent placement, stent placement After 6 months

Technical Success: Successful deployment of SEMS at desired locations. Functional success: 50% reduction or normalization of bilirubin within 14 days after stent placement. Composite indicator: Recurrent biliary obstruction Tumor growth: Direct growth of tumor through the stent mesh Tumor overgrowth: Tumor growth at the proximal and/or distal end of the stent Statistical analysis Quantitative data: Student’s t-test Categorical parameters: Chi-test, Fisher’s exact test Stent patency, patient survival Time: Kaplan-Meier Life Table with 95% Confidence Interval and Cox Proportional Hazard Ratio

16 Discussion There was no statistical difference in stent patency between the MSCPM-II group and the CMS group. Early closure, not enrolling target number of patients  food debris d/t ComVi stent features high drop-out rate in first 6 months due to timing of stent closure (16% vs conventional CMS 4%) Sediments: Limited Evaluation Efficacy Subgroup Analysis , MSCPM- There was no statistical difference in stent patency between the II and CMS groups, in patients who had early occlusion of the cemented stent.

MSCPM: 2.5%(1/40), CMS: 3.1%(1/32) Previous MSCPM-I study: 22.4%(13/58) Inhibition of membrane biodegradation by PTFE or local antitumor effect Difficult to assess size of systemic cancer changes ChemoTx heterogeneous , malignant biliary obstruction disease, f/u CT bile duct time

Drug Eluting Coronary Stents: Insights From Preclinical And Pathology Studies

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