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Stent insertion

The variety of medical applications for shape memory alloys is impressively hroad. These alloys are already used as stents inserted into blocked arteries, as vena-cava filters, as orthodontic devices, and in eyeglasses. [Pg.133]

The addition of ticlopidine to aspirin has been shown to have a synergistic effect on the inhibition of platelet aggregation after stent insertion (6), and this combination has also been found to be superior in terms of prevention of in-stent thrombosis to both aspirin alone and aspirin combined with warfarin (7). However, due to the rare but serious side effect of agranulocytosis associated with ticlopidine (8), and its slow onset of action, ticlopidine is no longer used in most countries. The combination of clopidogrel and aspirin has been proved to be as effective as aspirin and ticlopidine in the prevention of intrastent thrombosis (9). [Pg.525]

Taxane for ovarian cancer 8,271 Stent insertion and treatment 25,000... [Pg.917]

Technique for Stent Insertion Through Mesh of Occluded Stent... [Pg.13]

Stent insertion can be performed as an outpatient procedure, but we prefer to keep most patients in hospital overnight. At 4 h following stent insertion, patients are permitted to start free fluids. A barium esophagogram is performed either on the same day... [Pg.28]

The procedural mortality for metallic stent insertion is very low (0%-1.4%) (Acunas et al. 1996 Cwikiel et al. 1998 Song et al. 1994 Laasch et al. 1998 Saxon et al. 1995 Morgan et al. 1996). Procedural mortality is mainly due to comorbidity rather than trauma sustained as a result of the stent insertion procedure itself. It can be minimized by careful patient selection, optimization of patients before the procedure (e.g., by correction of electrolyte imbalances and treatment of chest infections with appropriate antibiotics and chest physiotherapy), and careful use of intravenous sedation. If possible, the use of sedation should be kept to a minimum. Stents can be inserted without... [Pg.32]

Esophageal hemorrhage occurs as both an immediate and a delayed procedural complication of esophageal stent insertion. Early hemorrhage may occur as a result of direct trauma to blood vessels in the esophageal wall or more usually damage to the friable vessels within the tumor itself. Late hemorrhage may be due to erosion of blood vessels by a direct pressure effect of the stent or may be due to local tumor invasion and completely unrelated to the presence of the stent. [Pg.32]

The procedure is generally straightforward and may be performed under local anesthesia and sedation, or under general anesthesia. Stent insertion is best per-... [Pg.43]

Finally, laboratory tests to check the coagulation status of the patient including INR, PTT, and platelets should be available prior to the procedure. In the case of severe coagulation disorders (INR >1.5, PTT >2 normal value, platelets <50,000) these should be corrected prior to stent insertion. [Pg.259]

In addition to stent insertion, a multitude of endobronchial endoscopy-assisted procedures can be carried out. In the case of complete bronchial occlusion, stent insertion immediately opens the postobstructed broncho-alveolar system. Often, postobstructive pneumonia, abscess formation or mucus retention can be treated with suction and lavage after stent insertion. In the case of mucosal tumors causing obstruction, endobronchial therapeutic measures such as laser ablation can be carried out to remove tumor burden prior to stent placement. [Pg.260]

After stent insertion, a final completion bronchoscopy with the use of the flexible endoscope should be done to check appropriate stent position, determine patency of bronchial ostia, rule out complications (e.g., bleeding, airway disruption, mucus impaction) and ascertain proper attachment of the proximal and distal stent ends to the tracheobronchial mucosa (see Fig. 12.If). [Pg.260]

The series from Brescia, Italy reported by Cavaliere et al. comprises 306 patients and placement of 393 silicone stents (Cavaliere et al. 1996). The vast majority of patients were treated with 363 Dumon stents in 27 cases a Y-shaped Hood stent was placed, and in another four cases a Y-shaped Dynamic stent. Stents were inserted into the trachea in 38.7%, right main stem bronchus and bronchus intermedius in 19.8%, left main stem bronchus in 15.5%, trachea and right or left main stem bronchus in 13.5%, and in other positions in 12.5%. Stent insertion resulted in improvement in pulmonary function tests and quality of life in all but six patients (98% success rate). The median survival of patients was 108 days. All patients had malignant tracheobronchial tumors. [Pg.261]

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. [Pg.261]

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. [Pg.262]

Tan et al. (1996) reported on seven patients with unresectable cancer comprising the large airways, where they placed Wallstents in the trachea ( =3) and bronchi (n=ll). Patients showed improvement of their dyspnea after stent insertion. One patient died immediately after the procedure from cardiac arrest. The remaining patients died after a survival of up to 10 months. [Pg.262]

Dasgupta and colleagues (1998) treated 20 patients with neoplastic tracheobronchial strictures with uncovered Wallstents. Stents were successfully deployed in all patients and airway patency was restored. Four patients were successfully weaned after stent insertion, five were receiving mechanical ventilatory assistance, while the remaining died from unrelated causes while receiving mechanical ventilatory assistance. No deaths occurred from stent failure or stent related complications. [Pg.262]

A small series of four patients with malignant tracheobronchial obstruction was presented by Col-REAVY et al. (2000). Stenting was successful in all four patients and led to dramatic relief of stridor. Mean survival was 6 months. One patient died some hours after stent insertion due to bleeding from a site where laser recanalization was carried out, but did not bleed from the stent insertion site. One patient required laser treatment 3 months after stent placement for tumor regrowth. [Pg.263]

A large series of 100 Ultraflex stent insertions in 96 patients comes from two experienced airway centers (Herth et al. 2001). In all, 79 stents were placed for malignant incurable central airway diseases, the remaining indications were benign conditions. Of the 96 patients, 90 had high-grade stenoses. Stents... [Pg.263]

Because of its smaller opening diameter, Palmaz stents have been used mainly in children (Filler et al. 1998 Furman et al. 1999) and only occasionally in the adult bronchial tree. Slonim et al. (1998) reported on Palmaz stent insertion in bronchial stenosis of three patients with malignant, inoperable obstructions (Slonim et al. 1998). Two patients had respiratory distress and one atelectasis. Immediately after stent placement, all patients had improvement of the respiratory distress or the atelectasis. The follow-up period ranged from 0.5 to 9.2 months. [Pg.263]


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See also in sourсe #XX -- [ Pg.695 ]

See also in sourсe #XX -- [ Pg.59 , Pg.260 ]




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