Stent placement

Stent placement may also decrease the degree of vessel stenosis and may prevent extension of the dissection. Until randomized trials are performed, stenting for craniocervical dissection should be considered experimental and unproven. 

Lylyk R Cohen JE, Ceratto R, Eerrario A, Miranda C. Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol 2002 23 430 36. 

At least 2 weeks for bare metal stent placement. 

At least 2 to 3 months for sirolimus-eluting stent placement. 

At least 6 months following paclitaxel-eluting stent placement. 

Elevated homocysteine concentrations have been associated with an increased risk for cardiovascular disease in both epidemiologic and clinical studies.43 Several studies have evaluated the benefit of lowering homocysteine levels with folic acid supplementation. One study reported a reduction in major cardiac events with the combination of folic acid, vitamin B12, and vitamin B6 following PCI.44 However, a more recent study found an increased risk of instent restenosis and the need for target-vessel revascularization with folate supplementation following coronary stent placement.45 The role of folate in the management of IHD is currently unclear. 

Two-vessel coronary artery disease (60% right coronary artery [RCA] and 80% left anterior descending artery [LAD] occlusion) after intracoronary CYPHER stent placement to the mid-LAD artery lesion 10 months ago. 

LC is a 51 -year-old female with a history of CHD (stent placement in the left anterior descending coronary artery 3 years prior) and type 2 diabetes who is referred to you for follow-up of her cholesterol. She is taking simvastatin 20 mg once daily in the evening for her cholesterol, and metformin 2000 mg once daily in the evening and piogliti-zone 15 mg once daily for diabetes. Her diabetes is well controlled. Her laboratory test results are within normal limits, except for her fasting lipid profile total cholesterol 215 mg/dL (5.57 mmol/L), triglycerides 135 mg/dL (1.53 mmol/L), HDL cholesterol 51 mg/dL (1.32 mmol/L), and LDL cholesterol 137 mg/dL (3.55 mmol/L). 

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

The major measure of outcome of treatment of SVCS is the relief of symptoms, regardless of the therapy used. SVC stenting provides rapid relief of symptoms within 1 to 7 days of stent placement.15 Patients who receive chemotherapy and/or radiotherapy generally will experience symptom relief within 1 to 2 weeks. Monitor the patient for relief of symptoms by... 

Stenting Placement of a stent (a short metal or plastic tube) to allow blood flow through an artery. 

Cardiac catheterization and coronary angiography are used in patients with suspected CAD to document the presence and severity of disease as well as for prognostic purposes. Interventional catheterization is used for thrombolytic therapy in patients with acute MI and for managing patients with significant CAD to relieve obstruction through percutaneous transluminal coronary angioplasty, atherectomy, laser treatment, or stent placement. 

The AHA/ASA guidelines recommend that antiplatelet therapy as the cornerstone of antithrombotic therapy for the secondary prevention of ischemic stroke and should be used in noncardioembolic strokes. Aspirin, dopidogrel, and extended-release dipyridamole plus aspirin are all considered first-line antiplatelet agents (see Table 13-1). The combination of aspirin and clopido-grel can only be recommended in patients with ischemic stroke and a recent history of myocardial infarction or coronary stent placement and then only with ultra-low-dose aspirin to minimize bleeding risk. 

Rogers C, Tseng DY, Squire JC, Edelman ER. Ballon-artery interactions during stent placement a finite element analysis approach to pressure, compliance, and stent design as contributors to vascular injury. Circ Res 1999 84 378-383. 

In 2006, however, focus shifted to another rare but potentially catastrophic event known as late stent thrombosis, which, in contrast to subacute thrombosis, occurs months to years after stent placement. It usually occurs before endothelialization is complete. For bare metal stents, this takes a few weeks. However, in drug eluting stents, this process of endotheliazation is delayed [68]. This complication... 

Fischman DL, Leon MB, Bairn DS, et al., for the Stent Restenosis Study Investigators. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994 331 496-501. 

Hausleiter J, Kastrati A, Mehili J, et al. Predictive factors for early cardiovascular events and angiographic restenosis after coronary stent placement in small coronary arteries. J Am Coll Cardiol 2002 40 882-889. 

Vrolix M, Grollier G, Legrand V et al. Heparin-coated wire coil (Wiktor) for elective stent placement-The MENTOR trial (abstract), Eur Heart J 1997 18 155. 

Haude M, Konorza Tp Kalnins U, et al. Heparin-coated stent placement for the treatment of stenoses in small coronary arteries of symptomatic patients. Circulation 2003 ... 

Carter AJ, Farb A, Gould KE, Taylor AJ, Virmani R, The degree of neointimal formation after stent placement in atherosclerotic rabbit iliac arteries is dependent on the underlying plaque, Cardiovasc Pathol 1999 8(2) 73-80. 

Mukherjee M, Moliterno DJ. Brachytherapy for in-stent restenosis a distant second choice to drug-eluting stent placement. JAMA 2006 295 1307-1309. 

The majority of patients received either a 15 mm stent (71 patients, 41 %), a 18 mm stent (38 patients, 22%), or an I I mm stent (32 patients, 18%). Mean balloon diameter and length were 3.3 and 16.6mm, respectively. Mean maximum balloon inflation pressure was 13.3 atm. Delivery balloon rupture occurred in four patients (2%) during the stent placement. The... 

Percutaneous coronary intervention (PCI) inevitably causes extensive denudation of the vascular endothelium at the stenosis site, In animal models of stent placement, re-endothelialization begins to occur in the first two to seven days postplacement, Full re-endothelialization of the stent takes three or four weeks, This process has been called stent passivation, It is thought that a similar or longer time course occurs in humans, although this has been difficult to quantify from the rarity of available autopsy specimens from patients poststent insertion (3), In animals, endothelial dysfunction is seen up to three months poststenting (4),... 

Usui M, Miyagi M, Fukasawa S, et al, A first trial in the clinical application of photodynamic therapy for the prevention of restenosis after coronary-stent placement, Lasers Surg Med 2004 34(3)235-241. 

Vos JA, van den BergJC, Ernst SM, et al. Carotid angioplasty and stent placement comparison of transcranial Doppler US data and clinical outcome with and without filtering cerebral protection devices in 509 patients. Radiology 2005 234 493 -99,... 

Wholey MH, Wholey M, Mathias K, et al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 2000 50 160-167. 

Post balloon angioplasty and nitinol stent placement at distal end of graft. 

---