Long-term tolerance of a fractured self-expanding metal stent in a patient with adenoid cystic carcinoma.

Self-expanding metals stent are used for recanalization of malignant CAO. Fracture of such a stent has been described. This prompts its removal. However removal of a metal stent is difficult and can be hazardous. Due to this US FDA advisory was released against their insertion in benign diseases where long life expectancy can expose the patients to the complications of prolonged indwelling time of these stents. We describe a case of adenoid cystic carcinoma who required SEMS placement for tracheal obstruction. However, stent fracture developed soon after its insertion causing patient to cough out stent pieces multiple times. In view of the challenge associated with removal of metal stent fixed to the tracheal walls at its proximal and distal ends, the stent was left in-situ. Patient has tolerated the fractured stent for 1-year and remains on follow-up without any complication or adverse event. This illustrates the long-term tolerance and safety of a fractured stent and helps to allay anxiety associated with this complication.

Can patients with significant renal artery stenosis who underwent renal angioplasty be monitored postprocedure in the general ward instead of the high dependency unit?

INTRODUCTION: Renal angioplasty has been increasingly used to treat significant renal artery stenosis (RAS). At the Tan Tock Seng Hospital (Singapore), renal angioplasty patients are routinely admitted to the high dependency unit (HDU) postprocedure for monitoring. METHODS: The complications of the RAS patients were reviewed postangioplasty, and it was determined whether the patients could be monitored in the general ward (GW) instead of the HDU. Cases of patients with RAS of more than 50% who underwent angioplasty between January 1999 and September 2006 were reviewed retrospectively. RESULTS: There were 35 patients with significant RAS who underwent angioplasty. Thirty were monitored in the HDU. Five were monitored in the GW because there were no HDU beds available. Patients in the GW were monitored every 30 min for 6 h, then every hour for 24 h. No immediate complications or deaths were recorded in the present series. CONCLUSION: It may be safe and cost-effective to monitor patients with significant RAS postangioplasty in the GW.

Outcome of blood pressure and renal function in patients with renal artery stenosis after stenting.

OBJECTIVE: To study the response of systolic and diastolic blood pressure (BP) and renal function after renal artery stenting at three months, six months, one year and last follow-up. METHODS: Patients with significant renal artery stenosis who underwent angioplasty with stenting from January 1999 to September 2006 were analyzed. The BP and serum creatinine levels were recorded at baseline, three months, six months, one year and at last follow-up. Generalized estimating equations were applied to analyze the changes in blood pressure and serum creatinine over time. RESULTS: There were 32 patients - 21 Chinese, six Malay and five Indian. The male to female ratio was 1.3:1. The mean age (± SD) was 69.4±8.8 years. The mean follow-up time was 1.8±1.6 years (range 0.5 to six years). When compared with the baseline BP, there was significant improvement at three months, six months, one year and at last follow-up. In the diabetes mellitus (DM) group, there was deterioration in serum creatinine. In the non-DM group, there was stabilization of serum creatinine with improvement at one year. CONCLUSION: Significant improvement in BP occurs in renal artery stenosis patients after stenting. In patients without DM, renal function remains stable or improves. However, in DM patients, especially those with proteinuria, there is deterioration in renal function.