Verification of small intestinal submucosa graft stent in vitro / 国际生物医学工程杂志

Objective To verify the feasibility of using small intestine submucosa for graft stents.Methods A Z-type Nitinol wire stent was used as the metal stent material,and porcine small intestine submucosa was used as the biofilm material to prepare the bio-coated stent.In vitro implantation,extracorporeal pulsation and extracorporeal flexion of the stents were designed based on the requirements for the small intestine submucosa graft stent implantation during the endovascular aneurysm repair and of the mechanical properties of the graft stent during human body activity.The feasibility of using small intestine submucosa for the graft stents was evaluated according to the patency of the stent lumen after the experiment,the presence or absence of cracks in the membrane,and the presence or absence of fracture of the metal stent.Results In the in vitro experiments,all the samples were able to maintain complete tunica and luminal patency except the 8th sample that showed suture rupture.Besides,all the samples showed good rebounding and adhering properties in both in vitro implantations and extracorporeal pulsation pressure experiments,and no dangerous problems were found such as film rupture,suture loss and stent fracture.Conclusion Small intestine submucosa can meet the durability requirements of graft stents,adapt to the conditions of graft stents such as implantation,bending and blood pulsation,and can be used as the covering material of graft stents.

Coronary Stent Infection Presented as Recurrent Stent Thrombosis

Percutaneous transluminal coronary angioplasty with metal stent placement has become a well-developed treatment modality for coronary stenotic lesions. Although infection involving implanted stents is rare, it can, however, occur with high morbidity and mortality. We describe herein a case of an inserted coronary stent that was infected and complicated with recurrent stent thrombosis, pseudoaneurysm formation and severe sepsis. Despite repeated intervention and bypass surgery, the patient died from severe sepsis.

Iatrogenic Subclavian Artery Perforation Rescued by Operator-Modified Graft Stent

Subclavian artery (SCA) perforation is a rare complication while performing SCA intervention. In our present report, a 73-year-old female, with stenosis of the left SCA and situs inversus, presented with exercise-induced left arm weakness. The SCA stenosis was treated with direct stenting with a balloon-expansible Express LD 10×25 mm stent. However, it caused iatrogenic SCA perforation and hemothorax. The perforation was sealed by endovascular repair with operator-modified Endurant II graft stent, which complicated with occlusion of left common carotid artery. And, the carotid artery was rescued by another stent. The graft stent, which was originally designed for abdominal aortic aneurysm, can be modified to suitable length and take as a rescue stent of large vessel with iatrogenic perforation. Due to strong radial force of graft stent, preservation of large side branches should been watched out.

Treatment of High-Flow Carotid Cavernous Fistula Using a Graft Stent: Case Report / 대한신경손상학회지

Currently, endovascular treatment of carotid cavernous fistula (CCF) is widely accepted and performed. However, a graft stent is rarely used for the treatment of high-flow CCF. Here we describe our experience using a graft stent to treat CCF and discuss the indications for its use.

Endovascular Treatment Using Graft-Stent for Pseudoaneurysm of the Cavernous Internal Carotid Artery

A 57-year-old man presented with a 2-day history of left oculomotor palsy. Digital subtraction angiography revealed a pseudoaneurysm of the left cavernous internal carotid artery (ICA) measuring 37x32 mm. The pseudoaneurysm was treated with a balloon expandable graft-stent to occlude the aneurysmal neck and preserve the parent artery. A post-procedure angiogram confirmed normal patency of the ICA and complete sealing of the aneurysmal neck with no opacification of the sac. After the procedure, the oculomotor palsy improved gradually, and had completely resolved 3 months after the procedure. A graft-stent can be an effective treatment for a pseudoaneurysm of the cavernous ICA with preservation of the parent artery.

Endovascular Graft-Stent Placement for Treatment of Traumatic Carotid Cavernous Fistulas

Detachable balloon-based endovascular fistula occlusion is a widely accepted treatment for traumatic carotid cavernous fistulas (CCF). However, more recently coils have been used to obliterate the lesion, especially in case detachable balloon is not available. We failed balloon-assisted coil embolization for CCF because of large fistulas and herniation of coil loops into the parent artery. The authors describe our experiences of balloonexpandable graft-stents to treat CCF, and place emphasis on arterial wall reconstruction. Three traumatic CCF patients were treated using a graft-stent with/without coils, and underwent angiographic follow-up to evaluate the patency of the internal carotid artery (ICA). In all cases, symptoms related to CCF regressed after stent deployment and did not recur during follow-up. Follow-up angiography revealed good patency of the ICA in all patients. Graft-stents should be considered as an alternative means of treating CCF and preserving the parent artery by arterial wall reconstruction especially in patients with a fistula that cannot be successfully occluded with detachable balloons or coils.

Giant Coronary Aneurysm with Stenosis and Thrombus Formation due to Kawasaki Disease: Treatment with Graft Stent

Kawasaki disease is an acute systemic vasculitis of unknown origin. Coronary aneurysm or ectasia is one of the most serious complications of Kawasaki disease. The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm. Percutaneous balloon angioplasty, rotational ablation, directional coronary artherectomy, stent insertion and coronary artery bypass graft can be used to treat coronary artery stenosis or occlusion. We describe a 6-year old boy who had an episode of Kawasaki disease with giant coronary artery aneurysm diagnosed at the age of 3 years. Surveillance echocardiogram showed giant coronary aneurysm with stenosis and large mural thrombus in the proximal portion of left main coronary artery. So we inserted two polytetrafluoroethylene(PTFE) covered graft stent without complication.