담도 내에 장기간 플라스틱스텐트 거치 후 발생한 Stent-stone Complex

김현수 ( Hyun Soo Kim ),김민욱 ( Min Wook Kim ),박서화 ( Seo Hwa Park ),강은규 ( Eun Gyu Kang ),김시호 ( Si Ho Kim ),김근 ( Keun Kim ),김정권 ( Jeong Kwon Kim ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1

Plastic biliary stents are commonly used during endoscopic retrograde cholangio-pancreatography. Main indication for biliary stenting is benign or malignant obstruction. Plastic stents can be used as an escape route in patients with large common bile duct stones to provide drainage until definitive treatment. But, stent occlusion is the main disadvantage, limiting their patency to around 3 months, after which replacement is recommended. A biliary stent can act as a nidus for the biliary stone formation leading to stent-stone complex after long-term stent placement. This report was a case of a large stent-stone complex after plastic stent placement for 4 years. The stent-stone complex was successfully removed by mechanical lithotripsy and ballon catheter. In all other cases where plastic stents are placed into the common bile duct we should keep in mind that stents can act as nidus for stone formation, as all foreign bodies do.

Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis

조훈,김진우,홍유선,임상현,원제환 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.4

This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency. Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23–87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed. All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction). Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.

CASE REPORT : Two dislodged and crushed coronary stents: treatment of two simultaneously dislodged stents using crushing techniques

( Dong Hyeok Yang ),( Seong Ill Woo ),( Dae Hyeok Kim ),( Sang Don Park ),( Ji Hun Jang ),( Jun Kwan ),( Sung Hee Shin ) 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.6

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex ar-tery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, be-cause the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.

The Control of Drug Release and Vascular Endothelialization after Hyaluronic Acid-Coated Paclitaxel Multi-Layer Coating Stent Implantation in Porcine Coronary Restenosis Model

배인호,정명호,김주한,박용환,임경섭,박대성,심재원,김정하,안영근,홍영준,심두선 대한심장학회 2017 Korean Circulation Journal Vol.47 No.1

Background and Objectives: Hyaluronic acid (HA) is highly biocompatible with cells and the extracellular matrix. In contrast to degradation products of a synthetic polymer, degradation products of HA do not acidify the local environment. The aim of this study was to fabricate an HA-coated paclitaxel (PTX)-eluting stent via simple ionic interactions and to evaluate its effects in vitro and in vivo. Materials and Methods: HA and catechol were conjugated by means of an activation agent, and then the stent was immersed in this solution (resulting in a HA-coated stent). After that, PTX was immobilized on the HA-coated stent (resulting in a hyaluronic acid-coated paclitaxel-eluting stent [H-PTX stent]). Study groups were divided into 4 groups: bare metal stent (BMS), HA, H-PTX, and poly (L-lactide)- coated paclitaxel-eluting stent (P-PTX). Stents were randomly implanted in a porcine coronary artery. After 4 weeks, vessels surrounding the stents were isolated and subjected to various analyses. Results: Smoothness of the surface was maintained after expansion of the stent. In contrast to a previous study on a PTX-eluting stent, in this study, the PTX was effectively released up to 14 days (a half amount of PTX in 4 days). The proliferation of smooth muscle cells was successfully inhibited (by 80.5±12.11% at 7 days of culture as compared to the control) by PTX released from the stent. Animal experiments showed that the H-PTX stent does not induce an obvious inflammatory response. Nevertheless, restenosis was clearly decreased in the H-PTX stent group (9.8±3.25%) compared to the bare-metal stent group (29.7±8.11%). Conclusion: A stent was stably coated with PTX via simple ionic interactions with HA. Restenosis was decreased in the H-PTX group. These results suggest that HA, a natural polymer, is suitable for fabrication of drug-eluting stents (without inflammation) as an alternative to a synthetic polymer.

관상동맥 스텐트 시술 후의 재협착에 관한 연구

김윤철,이정우,김보영,강정아,임대승,이민수,김정희,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

Coronary stent implacement is known as an effective treatment in the intimal dissection after percutaneous transluminal coronary angioplasty and the prevention of restenosis. However, In-stent restenosis still remains a major concern in clinical stenting. The stents were placed in 103 patients from July 1996 to March 1999 and performed follow-up coronary angiograms in 59(57.3%) patients. To identify the clinical, angiographic and procedurerelated variables 'which predict late restenosis within the stented artery, 59 patients(58.3±9.9, M:F= 41:18) were studied. The clinical characteristics of the patients were stable angina in 23(39.0%), unstable angina in 14(23.7%), acute myocardial infarction in 21(35.6%) and old myocardial infarction in 1(1.7%). Coronary stenting was performed in 1 patient(1.7%) for primary lesion, 50 patients(84.7%) for suboptimal results after PTCA, 6 patients(10.2%) for bail-out procedure, and 2 patients(3.4%) for restenotic lesions. All patients were treated with aspirin and ticlopidinc. The follow-up angiograms were obtained at 7±4 months. The overall in-stent restenosis rate was 27.1%. The coronary angiographic findings were 32 single vessel(54.2%), 19 two vessel(32.2%) and 8 three vessel disease(13.6%). The angiographic morphological characteristics were type A in 33(55.9%), type B in 14(23.7%), type C in 12(20. 3%) cases. Variables of 16 patients with restenosis were compared with those of 43 patients without restenosis. Previously known predictors for in-stent restenosis were multiple stenting, stenting for restenotic lesions, residual stenosis after stenting, stenting for total occlusion lesions, reference diameter, balloon to vessel ratio, acute gain and minimal luminal diameter after procedure, design and characteristics of stents, ostial lesion of aorta, high pressure method for stenting, lesion length, diabetes mellitus, size of artheroma, saphenous vein grafts, ulcerlating lesions and calcified lesions. In this study, Reference diameter before stenting(2.43±0.54mm vs. 2.88±0.65mm, p=0.016) and balloon-to-artery ratio(1.28±0.26 vs. 1.11±0.18, p=0.006) were predictors for in-stent restenosis. 1) The overall in-stent restenosis rate was 27.1%. 2) In the analysis of predictors for in-stent restenosis, there was no significant differences in clinical, angiographic factors between group with restenosis and without restenosis. But, Only reference diameter before stenting and balloon-toartery ratio were predictors of late in-stent restenosis. In conclusion, stenting is effective revascularisation method for selected patients with ischemic heart disease, and to minimize in-stent restenosis rate, stent implanting is achieved in a large vessel on the basis of an artery-to-stnet ration of 1:1, if possible.

Relationship between Successful Cervical Carotid Stent Expansion and Low Levels of Serum Vitamin D

Han Jun Kim,Jung Hoon Han,Kyungmi Oh,Chi Kyung Kim 대한신경초음파학회 2022 대한신경초음파학회지 (JNN) Vol.14 No.1

Background: Serum vitamin D levels affect atherosclerosis development via diverse molecular mechanisms. The lesion characteristics of carotid stenosis affect the success of stent expansion. By comparing the pre-and post-stenting stenosis degrees, our study evaluated whether serum vitamin D levels are associated with the expansion rate of carotid stenting. Methods: Forty-six cases who underwent elective cervical carotid artery stenting were analyzed. Patients were classified into two groups according to serum total 25-hydroxy vitamin D (25[OH]D) levels; <15.1 and ≥15.1 ng/mL. The degree of stenosis before and after stent insertion was calculated using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. The stent expansion rate was calculated as follows: (1-[post-stent stenosis degree/pre-stent stenosis degree])×100 (%). To identify the independent factors for successful stent expansion, multivariable logistic regression analysis was conducted. Results: Among the 46 patients, 25 (54.3%) had low serum 25(OH)D levels. The successful stent expansion rate was significantly higher in the low 25(OH)D level group (48.0% vs. 19.0%, respectively; p=0.04). In multivariable analysis, after adjusting for possible covariates, a low serum 25(OH)D level was independently associated with successful stent expansion (adjusted odds ratio, 6.47; 95% confidence interval, 1.11-37.80). Conclusion: Low serum vitamin D levels were independently associated with successful carotid stent expansion. This study presents a new perception of biomarkers that should be considered for satisfactory carotid artery stenting.

Effect of a Dual Drug-Coated Stent With Abciximab and Alpha-Lipoic Acid in a Porcine Coronary Restenosis Model

임경섭,홍영준,정명호,김정하,심두선,이민구,박근호,김주한,안영근,조정관,박종춘,송선정,정경운,조동련,강정채,Daisuke Hachinohe,Khurshid Ahmed,송선주 대한심장학회 2011 Korean Circulation Journal Vol.41 No.5

stent coated with abciximab and alpha-lipoic acid (ALA) in a porcine coronary overstretch restenosis model. Materials and Methods: A total of 10 pigs were randomized into two groups (10 pigs, 10 coronaries in each group) in which the coronary arteries were stented with a dual-coated stent and a bare metal stent (control) by randomization. Stents were deployed with oversizing (stent/artery ratio 1.3 : 1) in the porcine coronary arteries, and histopathology was assessed 28 days after stenting. Results: There was no significant difference in the injury score between the two groups. In the neointima, the lymphohistiocyte count was significantly lower in dual-coat stent group compared with the control stent group (120±85 cells vs. 159±80 cells, p=0.048). There was no significant difference in the fibrin score between the two groups (0.16±0.34 in the dual-coated stent group vs. 0.25±0.48 in the control stent group, p=0.446). The neointima area was not significantly different between both groups (1.55±0.8 mm2 in dual-coated stent group vs. 1.40±0.86 mm2 in the control stent group, p=0.447). Conclusion: Although the dual-coated stent with abciximab and ALA showed no significant difference in inhibition of neointimal hyperplasia when compared with the bare metal stent, it was associated with a reduced inflammatory reaction when compared with the control stent in a porcine coronary restenosis model

담관 협착 치료를 위한 스텐트 삽입술

조영권,박상수,권동일,강성권 한국생체재료학회 2012 생체재료학회지 Vol.16 No.3

Stenting is the most common palliative treatment for patients suffering from either benign or malignant biliary strictures. First introduced in late 1970s, polymeric tube stent has been the most common stent but has had a problem of stent obstruction with sludge within 3-4 months. Self-expandable metallic stent (SEMS), with much larger diameter, considerably prolonged the stent patency period in biliary stenting. SEMS, however, has its own problem of tissue ingrowth through the stent wire mesh and difficulty in repositioning or removal when it is necessary. Polymer-covered selfexpandable metallic stent (PC-SEMS) is widening its application scope, as it has both large lumen and protection from tissue ingrowth through the stent wire mesh. PC-SEMS, however, has yet to solve its own problem of dislocation. Various aspects of the three biliary stent types are discussed in this paper.

Successful Management of a Rare Case of Stent Fracture and Subsequent Migration of the Fractured Stent Segment Into the Ascending Aorta in In-Stent Restenotic Lesions of a Saphenous Vein Graft

원호연,오재원,양영준,김미현,김충기,박준범,김병극,최동훈,홍명기 대한심장학회 2012 Korean Circulation Journal Vol.42 No.1

Stent fracture is a complication following implantation of drug eluting stents and is recognized as one of the risk factors for in-stent restenosis. We present the first case of successfully managing a stent fracture and subsequent migration of the fractured stent into the ascending aorta that occurred during repeat revascularization for in-stent restenosis of an ostium of saphenous vein graft after implantation of a zotarolimus-eluting stent. Although the fractured stent segment had migrated into the ascending aorta with a pulled balloon catheter, it was successfully repositioned in the saphenous vein graft using an inflated balloon catheter. Then, the fractured stent segment was successfully connected to the residual segment of the zotarolimus-eluting stent by covering it with an additional sirolimuseluting stent.

경요골동맥중재술시 발생한 스텐트탈락의 제거 : 8 Fr 유도초와 Forcep을 이용한 새로운 방법

박진곤,김무현,배영진,이수훈,차광수,양창호,김영대,김종성 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.10