nitinol and Carcinoma

Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect.. Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival.. Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death.. m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.

Topics: Aged; Aged, 80 and over; Alloys; Carcinoma; Cholestasis; Digestive System Neoplasms; Drainage; Equipment Design; Feasibility Studies; Female; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Prosthesis Failure; Recurrence; Reoperation; Stents; Time Factors

A high incidence of migration with covered metal stents has been reported in malignant gastric outlet obstruction (GOO). A newly modified, partially covered, triple-layer nitinol stent was developed that has a longer uncovered portion (5-15 mm) to prevent stent migration.. To estimate the efficacy and safety of the modified covered, triple-layer metal stent.. Multicenter, prospective cohort study.. Three tertiary referral centers.. Fifty consecutive patients (26 with pancreatic carcinoma, 14 with gastric carcinoma, 9 with cholangiocarcinoma, 1 with a metastatic node) who presented with symptomatic unresectable malignant GOO between April 2007 and March 2010.. Endoscopic placement of the modified covered, triple-layer metal stent.. The primary endpoint was to improve the GOO scoring system (GOOSS) score. Secondary endpoints were success rate, patency, and complications.. The median GOOSS score improved significantly (P < .0001) after stenting (from 0 to 3). The technical and clinical success rates were 100% and 90%, respectively. Stent occlusion by tumor overgrowth or ingrowth at the uncovered portion developed in 5 patients (10%). Asymptomatic stent migration occurred in 3 patients (6%) receiving chemotherapy at 95, 230, and 553 days after stent placement, but these patients tolerated solid food 68, 260, and 142 days after stent migration, respectively. Other complications occurred in 1 patient with insufficient expansion, cholangitis, and pancreatitis. No procedure-related deaths occurred.. A single-arm study in tertiary-care centers.. The modified covered, triple-layer metal stent was effective and safe for managing malignant GOO and can prevent tumor ingrowth and stent migration. (. UMIN000004566.).

Topics: Aged; Alloys; Bile Duct Neoplasms; Carcinoma; Cholangiocarcinoma; Female; Gastric Outlet Obstruction; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pancreatic Neoplasms; Prosthesis Failure; Stents; Stomach Neoplasms

Self-expandable metallic stents (SEMS) of varying designs and materials have been developed to reduce complications, but few comparative data are available with regard to the type of stent and the stent manufacturer. We analyzed the success rates and complication rates, according to stent type (uncovered vs. covered stent) and individual stent manufacturer, in malignant colorectal obstruction.. From November 2001 to August 2008, 103 patients were retrospectively included in this study: four types of uncovered stents in 73 patients and two types of covered stents in 30 patients. The SEMS was inserted into the obstructive site by using the through-the-scope method.. Technical and clinical success rates were not different between stent type or among stent manufacturers: 100 and 100% (p = ns) and 100 and 96.6% (p > 0.05), respectively, in uncovered and covered stents. Stent occlusion and migration rates were 12.3 and 3.3% (p = 0.274) and 13.7 and 16.7% (p = 0.761), respectively, in uncovered and covered stents, and 11.1, 5, and 9% (p = 0.761) and 25.9, 15, and 0% (p = 0.037) in Wallstent, Niti-S, and Bonastent uncovered stents, respectively.. The placement of SEMS is an effective and safe treatment for patients with malignant colorectal obstruction. Although minor differences in outcome were detected according to the type and the manufacturer of the stents, no statistically significant difference was observed, except in stent migration among the stent manufacturer.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Alloys; Carcinoma; Chromium Alloys; Coated Materials, Biocompatible; Cobalt; Colonic Diseases; Colonic Neoplasms; Colonoscopy; Equipment Design; Female; Fluoroscopy; Foreign-Body Migration; Humans; Intestinal Obstruction; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Radiography, Interventional; Rectal Diseases; Stents; Stomach Neoplasms; Treatment Outcome; Uterine Cervical Neoplasms

Despite being commercially available for a few years now, the literature regarding the outcome of Ultraflex stent insertion in complex malignant airway stenoses is sparse.. To assess long-term complications and survival in patients with complex malignant airway stenoses treated with insertion of nitinol stents.. 60 consecutive patients with Ultraflex stent insertion for malignant airway stenoses were included. Follow-up was obtained in all patients.. 62 Ultraflex stents (covered = 51, uncovered = 11) were implanted in 60 patients. Diagnoses were bronchial carcinoma (n = 50), esophageal carcinoma (n = 3) and metastases (n = 7). Stents were inserted in the trachea (n = 5), main bronchi/intermediate bronchus (n = 22), from main bronchi/intermediate bronchus to lobar bronchi (n = 28) or in the lobar bronchi themselves (n = 7). Successful reopening of the stenoses and relief were achieved in all patients. There was no procedure-related mortality. Complications included mucous plugging in 8%, stenosing granulation tissue in 5%, tumor ingrowth in 5% and stent migration in 5% of patients. Using Kaplan-Meier estimates, the overall mean survival was 160 days (standard error: 30). Median survival was 91 days. The overall 3- and 6-month survival were 52 and 20%, respectively. Death (n = 59, 98%) was attributed mainly to disease progression with cachexia and metastases, pneumonia (n = 5, 10%), and hemoptysis (n = 1, 2%).. Ultraflex stents have a low complication rate and can be effectively used in complex malignant airway stenoses with marked asymmetry or irregularity, angulation or changing diameters.

Topics: Adult; Aged; Airway Obstruction; Alloys; Bronchial Neoplasms; Carcinoma; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Retrospective Studies; Stents; Survival Analysis

Hemorrhage caused by tumor invasion of the axillary artery is a rare, but serious complication. A 70-year-old female with a history of inflammatory breast cancer was diagnosed with hypovolemic shock caused by arterial bleeding into the left axilla. After successful reanimation an emergency arteriography was performed. The bleeding site was localized in the proximal part of the axillary artery. A self-expanding endoluminal graft was positioned across the lesion. The final angiography showed a correct placement of the stent with excellent distal flow, and no signs of bleeding. On the seventh day, the patient was discharged with ambulatory follow up.

Topics: Aged; Alloys; Angioplasty, Balloon; Axilla; Axillary Artery; Blood Vessel Prosthesis Implantation; Breast Neoplasms; Carcinoma; Female; Hemorrhage; Humans; Neoplasm Invasiveness; Radiography; Shock; Stents

A flexible nitinol stent was inserted to treat malignant stricture of the esophagus in 28 patients. Stenting was successful in all 28 patients, leading to an improved oral intake that was maintained for >80% of the survival period in 26 patients. Patients with tumors arising in the esophagus (n=24) were divided into two groups to compare complications and prognosis: patients who underwent stenting only (n=10); and patients who underwent stenting after radiochemotherapy (n=14). Fatal complications associated with stenting were seen in four patients (28.6%) who underwent stenting after radiochemotherapy and in one patient (10.0%) who underwent stenting only. Although survival was significantly longer for patients who underwent prior radiochemotherapy than for patients who did not, the incidence of fatal complications tended to be higher. No significant differences in background factors other than radiochemotherapy before stenting were observed between patients with fatal and non-fatal complications. Stenting was shown to represent a useful treatment for malignant stricture of the esophagus, as oral intake improved and was maintained for a long period of time in most patients. However, incidence of fatal complications was high among patients who underwent radiochemotherapy, and caution must be exercised due to the difficulty in predicting fatal complications.

Topics: Adult; Aged; Aged, 80 and over; Alloys; Carcinoma; Deglutition Disorders; Esophageal Neoplasms; Esophagoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Stents; Survival Rate; Treatment Outcome

Thirty patients with incurable malignant obstruction of the oesophagus and cardia were treated with self expanding oesophageal memory metal stents (Ultraflex) in a prospective study. The endoprostheses were successfully placed in all patients. Within one week after implantation dysphagia had improved in 25 of 30 patients (83%). Stent expansion was incomplete within one week after implantation in 12 of 30 patients (40%). After an average of two dilatation sessions eight of 12 stents had expanded completely. Five patients complained of retrosternal pain and three of them suffered from heartburn over several days despite acid inhibition. Major problems in the follow up period occurred in 10 of 30 patients (30%) and included late perforation (one) and tumour ingrowth/overgrowth (nine). All of these complications were treated endoscopically. Improvement of the dysphagia of the patients with tumour ingrowth/overgrowth lasted for about eight weeks (median; range: 2-38 weeks). Until November 1994 six of 30 patients were still alive with a survival time of 309 days (median; range: 103-368 days). It is concluded that oesophageal memory metal stents are easy to implant, prove effective in the palliation of malignant oesophageal obstructions, and have a low risk of severe complications. The only disadvantages are that incomplete initial stent expansion as well as tumour ingrowth/overgrowth occurred in nearly one third of the patients.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Alloys; Carcinoma; Carcinoma, Squamous Cell; Cardia; Esophageal Neoplasms; Esophageal Stenosis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Palliative Care; Prospective Studies; Stents; Stomach Neoplasms