Usefulness of Double Esophageal Stent for Malignant Esophageal Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic self expandable metallic stent (SEMS) has become the palliative treatment of choice for inoperable malignant esophageal stricture. However, covered and uncovered stents carry limitations such as stent migration and tumor ingrowth, respectively. A double esophageal stent has been developed to overcome these problems. The aim of this study was to evaluate the usefulness of double esophageal stent (outer uncovered stent and inner covered stent) for palliation of malignant esophageal stricture. METHODS: Between February 2001 and November 2006, 32 patients with malignant esophageal stricture were treated with double esophageal stents. The patients were retrospectively assessed for the technical outcome, the clinical outcome and the complications of the process. RESULTS: Stent implantation was successful in all 32 patients (100%). The dysphasia score significantly improved from a mean of 3.22 to 1.63 (p<0.001) for all 32 patients. Eight patients had recurrent dysphagia due to stent overgrowth (6/32, 18%), stent migration (1/32, 3%) and tumor ingrowth (1/32, 3%). Symptomatic gastroesophageal reflux occurred in six patients (18%). Aspiration pneumonia occurred in two patients (6%). CONCLUSIONS: Double esophageal stent is effective for symptomatic relief of malignant esophageal stricture. It seems to reduce tumor ingrowth and stent migration, but it has limitations such as tumor overgrowth and GERD.

The Feasibility and Safety of Transradial Coronary Stenting Using 6 French Guiding Catheter / 대한내과학회지

OBJECTIVES: Powerful anticoagulant and antiplatelet therapies after coronary stenting may carry the risk of increased bleeding complications if large-bore guiding catheters are introduced via the femoral artery. Recently smaller radial artery is introduced as an entry site for coronary interventions owing to miniaturization of equipments, easy hemostasis and lower access site complications, and little hand ischemia. The purpose of this study is to evaluate the feasibility and safety of coronary stent implantation via the radial artery. METHODS: After a learning curve for transradial diagnostic coronary angiography, stent implantation was attempted in 131 consecutive patients, 135 lesions. Immediately after procedure, the introducer sheath was withdrawn and mobilization was initiated. Clinical follow-up was done for punctured radial arteries. RESULTS: Procedural success and uncomplicated clinical course was achieved in 129(98%) patients, 133(99%) lesions. No stent embolization or migration within the coronary artery, and no procedure-related death, Q wave myocardial infarction or emergent bypass surgery were happened. No stroke or severe arm vessel complications were happened except 4(3%) cases of moderate hematoma. Failed 2 cases were in early period and stents did not pass the lesions due to inappropriate selection and poor backup of guiding catheters. During follow-up of 124+/-36 days, punctured radial arteries showed weak or absent radial pulse in 10(7%) patients, but no claudication or ischemia of hand was observed. CONCLUSION: Transradial coronary stenting was performed safely with high success rate and low complication rate. This study supports that transradial approach is a promising primary route for coronary stenting.

Transradial Stenting of an Anomalous Right Coronary Artery Originating from the Left Sinus of Valsalva

Anomalous right coronary artery arising from the left sinus of Valsalva is rare, but not protected from ather-osclerotic disease. Major factor determining successful angioplasty is the selection of the appropriate guiding catheter to provide optimal coaxial backup support. We report the first case of successful transradial stenting of an anomalous right coronary artery originating from the left sinus of Valsalva.