nitinol and Carcinoma--Hepatocellular

To evaluate the technical success and clinical efficacy of percutaneously placed self-expandable metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma (HCC).. Fifteen men (mean age, 59.3 years) with obstructive jaundice resulting from HCC were treated with self-expandable metallic stents (28 stents in 19 sessions). The authors evaluated the technical success, clinical success (decrease of 30% of total serum bilirubin level or <2 mg/dL [34.2 micromol/L]), treatment efficacy according to lowest total serum bilirubin level, complications, and duration of stent patency.. Technical success was achieved in all patients. Clinical success was achieved in 11 of the 15 patients (73%). After stent placement, seven patients (47%) had a low bilirubin level (<2 mg/dL [34.2 micromol/L]), three (20%) had an intermediate bilirubin level (2-10 mg/dL [34.2-171 micromol/L]), and five (33%) had a high bilirubin level (>10 mg/dL [171 micromol/L]). A low bilirubin level was achieved in all patients with Child-Pugh A disease and stage T2 or T3 HCC. Major complications such as hemobilia necessitating transfusion (n=1) or abscess formation (n=1) occurred in two of the 19 sessions (10%). The overall mean stent patency was 149.8 days (range, 12-790 days). The mean stent patency in patients with Child-Pugh class A disease (257.8 days) was significantly longer than that of patients with Child-Pugh class B and C disease (123.2 and 63 days, respectively) (P<.05).. The percutaneous placement of a self-expandable metallic stent is a feasible and effective palliative treatment for patients with obstructive jaundice resulting from HCC, especially for those with Child-Pugh class A disease and stage T2 or T3 HCC.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Carcinoma, Hepatocellular; Catheterization; Doxorubicin; Female; Fluoroscopy; Humans; Iodized Oil; Jaundice, Obstructive; Liver Neoplasms; Male; Middle Aged; Radiography, Interventional; Retrospective Studies; Statistics, Nonparametric; Stents; Treatment Outcome; Ultrasonography, Interventional

Topics: Alloys; Blood Vessel Prosthesis Implantation; Carcinoma, Hepatocellular; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Phlebography; Prosthesis Design; Stents; Vena Cava, Inferior; Venous Thrombosis

To evaluate the treatment of malignant biliary stenoses and occlusions using a new stent.. In a prospective study, 25 patients with malignant obstructive jaundice were treated with SMART(R) stents. The handling and the quality of stent expansion were documented. Stent function was assessed 2 - 4 days after intervention by cholangiography and laboratory tests. A follow-up was performed three months, after stent placement.. All lesions were treated successfully, with a total of 35 stents implanted. In 14 patients a further balloon dilatation was performed after stent placement (8 - 10 mm diameter/ 40 - 80 mm length). The mean serum bilirubin level decreased significantly from 11.6 mg/dl to 4.6 mg/dl after intervention (p < 0.05). The follow-up showed a mean serum bilirubin level at 4.0 mg/dl. In 4 cases (16 %) a further intervention (PTCD or stent) was performed. Six patients died due to tumor progression. The stents proved to be patent in 79 % (n = 15) of patients alive at the time of follow-up.. Placement of the SMART stent for the therapy of malignant biliary lesions yields good technical and clinical results.

Topics: Aged; Aged, 80 and over; Alloys; Bilirubin; Breast Neoplasms; Carcinoma, Hepatocellular; Cholestasis; Colonic Neoplasms; Drainage; Female; Follow-Up Studies; Humans; Klatskin Tumor; Liver Neoplasms; Male; Middle Aged; Pancreatic Neoplasms; Prospective Studies; Radiography; Reoperation; Stents; Stomach Neoplasms; Time Factors