Gianturco stent

The Gianturco stent is seldom used in the treatment of mahgnant biliary strictures because of the high rates of tumor ingrowth through the wide mesh. 

Fig. 2.7a-c. Treatment of malignant dysphagia with a covered Gianturco stent, a A 79-year-old patient with a distal malignant stricture, b A covered Gianturco stent has been advanced to the level of the stricture (as defined by surface marker). The stent is constrained by the delivery sheath, c The stent was deployed. This 24-h esophagogram shows good position and expansion... 

Pain following stenting is common but usually resolves after a few days. Persistent severe pain occurs in a small minority of patients, and maybe related to the placement of stents in the upper esophagus. Pain is probably more common with more rigid stents such as the Gianturco stent than with softer stents such as the Ultraflex stent. However, the incidence and severity of pain related to esophageal stenting has never been assessed accurately, and its relationship has not been systematically correlated with individual stents. 

Fig. 2.15. Total migration of a stent. This covered Gianturco stent was placed across a malignant stricture one day previously. This plain abdominal radiograph shows complete migration of the stent into the stomach. The stent produced no symptoms and was left in place. A new stent was inserted across the stricture, which did not migrate...

The results of the largest series of stenting for malignant fistulas and perforations are presented in Table 2.3 (Morgan et al. 1997 Saxon et al. 1995 Han et al. 1996 Mohammed and Moss 1996 Nicholson et al. 1995 Raijman et al. 1998). All types of covered stents have been found to be effective in the treatment of leaks and fistulas. Clinical success, defined as successful closure of the fistula or leak, occurs in 67%-100% of patients. The largest series involved 39 patients with 19 perforations and 20 fistulas, treated with covered Wallstent endoprostheses (36 patients) and covered Gianturco stents (three patients) at Guy s Hospital. The technical... 

Other types of stents such as the Strecker tantalum stent (SoLT and Papp 1993), the Strecker Nitinol stent (Strecker et al. 1995) or modified and covered Gianturco stents (Song et al. 1993) have been used only occasionally and not much experience exists with these stents. Recently, however, two series of 19 and 24 patients have been published advocating covered metallic expandable stents for prevention of tumour ingrowth after stenting for gastroduodenal obstruction (Jung et al. 2000 Park et al. 2001). 

Using a rather unconventional puncture site for catheterization of the axillary vein, at the junction between the axillary and subclavian vein, trauma to the brachial nervous plexus is avoided, particularly when large-diameter catheters, serving for Gianturco stents for instance, are introduced (Dondelinger et al. 1991). As a general rule, venous stents should be placed sequentially, first in a distal position, then more proximally, in relation to the puncture site. When the confluence of the innominate veins is treated, the technique used depends on the anatomy and the type of stents required. Usually, the develop-... 

There are no dedicated tracheobronchial covered balloon-expandable stents available yet. The Gianturco stent for tracheobronchial application is commercially only provided as an uncovered stent. 

The first report on the oldest metal stent used in the tracheobronchial system was pubUshed by Wallace et al. in 1986 (Wallace et al. 1986). Since then, several studies on the use of this stent type have been pub-hshed and the stent became one of the most frequently applied metal stents in tracheobronchial mahgnancy. Wallace and colleagues initially reported on two cancer patients. Gianturco stents were placed in one to dilate a postoperative bronchial stenosis that caused pneumonia, and in the second to support a tracheal graft that collapsed with respiration. Stents were successfully placed and the patients symptoms improved (Wallace et al. 1986). 

George and colleagues (1992) treated nine patients with malignant central airway obstruction due to tracheal (n=3) or main bronchial ( =6) stenosis with Gianturco stents. All patients suffered from severe dyspnea or asphyxia (four were emergency treatments). All patients had dramatic and rapid reUef of their symptoms after stent insertion. Two patients with intraluminal tumor growth required additional endobronchial measures to control local tumor progression. Patients survived between 3 weeks and 8 months after the intervention. Causes of death were cachexia or pneumonia. 

Wallace and coworkers presented updated results on 36 cancer patients treated with the Gianturco stent in 1994 (Carrasco et al. 1994). Stents were placed in the trachea and bronchi due to symptomatic incurable malignancies. Symptoms improved in 78% of the patients following stent insertion. The median survival was 1 month and 3 weeks. Patients who showed improvement after stenting had a median survival of 3 months compared with a median survival of 1 month for those who did not respond. 

The largest published series of Gianturco stents placed for mahgnant tracheobronchial lesions was published by Wilson and colleagues (1996). A total of 56 patients with incurable mahgnant tracheobronchial tumors (47 bronchial carcinomas and nine metastases) were treated with a total of 117 stents placed in the following locations trachea, 19 left main bronchus, 13 right main bronchus, 10 both main bronchi, 7 trachea and left main bronchus. 

Carrasco CH, Nesbitt JC, Charsangavej C, Ryan B, Walsh GL, Yasumori K, Lawrence DD, Wallace S (1994) Management of tracheal and bronchial stenoses with the Gianturco stent. Ann Thorac Surg 58 1012-1016 Cavaliere S, Venuta F, Foccoli P et al. (1996) Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest 110 1536-1542... 

Miyayama S, Matsui O, Kamimura R, Kakuta K, Takashima T (1997) Partially covered Gianturco stent for tracheobronchial stricture caused by intraluminal tumor. Cardiovasc Intervent Radiol 20 60-62 Miyazawa T, Yamakido M, Ikeda S, Furukawa K, Takiguchi Y, Tada H, Shirakusa T (2000) Implantation of Ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 118 959-965... 

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