• Title/Summary/Keyword: Stent implantation

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The effects of labeling gap and susceptibility artifacts in pCASL perfusion MRI (pCASL 관류 영상에서 표지 간격과 자화감수성 인공물이 영상에 미치는 영향)

  • Kim, Seong-Hu
    • Journal of the Korean Society of Radiology
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    • v.9 no.4
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    • pp.213-217
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    • 2015
  • To report problems found in a patient who has implemented stent implantation and then conducted a perfusion MRI using ASL(Arterial Spin Labeling), in order to suggest a solution to them. The perfusion MRI was conducted, using pCASL among ASL methods. Data from pCASL(Pseudo Continuous Arterial Spin Labeling) was acquired together with the structural image simply by changing position(labeling gap 15 mm, 170 mm) of the labeling pulse to avoid stent. Data was processed through the ASLtbx. When perfusion MRI was acquired using pCASL, it showed that the position of the conventional labeling pulse (labeling gap 24 mm) was overlapped with that of stent, which made signal intensity in right brain tissue appear as if it were void. When the labeling pulse was positioned (labeling gap 15 mm) to avoid stent, high signal intensity images were acquired. In labeling pulse (labeling gap 170 mm), the signal intensity was more reduced due to relaxation before labeled blood arrived at the imaging slice. pCASL can be stably repeated measurements because it does not use a contrast agent. And it should be selected with the appropriate image acquisition parameters for the high quality image.

Assessment of the Intracranial Stents Patency and Re-Stenosis by 16-Slice CT Angiography with Optimized Sharp Kernel : Preliminary Study

  • Choo, Ki-Seok;Lee, Tae-Hong;Choi, Chang-Hwa;Park, Kyung-Pil;Kim, Chang-Won;Kim, Suk
    • Journal of Korean Neurosurgical Society
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    • v.45 no.5
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    • pp.284-288
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    • 2009
  • Objective : Our retrospective study aimed to determine whether 16-slice computerized tomography (CT) angiography optimized sharp kernel is suitable for the evaluation of visibility, luminal patency and re-stenosis of intracranial stents in comparison with conventional angiography. Methods : Fifteen patients with symptomatic intracranial stenotic lesions underwent balloon expandable stent deployment of these lesions (10 middle cerebral arteries, 2 intracranial vertebral arteries, and 3 intracranial internal carotid arteries). CT angiography follow-up ranged from 6 to 15 months (mean follow-up, 8 months) after implantation of intracranial stents and conventional angiography was confirmed within 2 days. Curved multiplanar reformations with maximal intensity projection (MIP) with optimal window settings for assessment of lumen of intracranial stents were evaluated for visible lumen diameter, stent patency (contrast distal to the stent as an indirect sign), and re-stenosis by two experienced radiologists who blinded to the reports from the conventional angiography. Results : All of stents deployed into symptomatic stenotic lesions. All stents were classified as patent and no re-stenosis, which was correlated with results of conventional angiography. Parts of the stent lumen could be visualized in all cases. On average, 57% of the stent lumen diameter was visible using optimized sharp kernel. Significant improvement of lumen visualization (22%, p<0.01) was observed using the optimized sharp kernel compared with the standard sharp kernel. Inter-observer agreements on the measurement of lumen diameter and density were judged as good, respectively (p<0.05). Conclusion : Sixteen-slice CT using the optimized sharp kernel may provide a useful information for evaluation of lumen diameter patency, and re-stenosis of intracranial stents.

Surgical outcomes in dogs with tracheal collapse treated with a novel cross-and-hook braided endoluminal stent

  • Uemura, Akiko;Ozai, Yusuke;Hamabe, Lina;Yoshida, Tomohiko;Tanaka, Ryou
    • Journal of Veterinary Science
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    • v.23 no.3
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    • pp.46.1-46.8
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    • 2022
  • Background: Stenting is an effective treatment option for tracheal collapse in dogs. Cross-braided tracheal stents are currently the norm in veterinary medicine, but cross-and-hook braided stents have recently been adopted in human medicine. We examined whether stents manufactured using this novel braiding technique provided additional advantages for the treatment of tracheal collapse in dogs. Objectives: To evaluate the outcomes of cross-and-hook braided stent implantation in the treatment of tracheal collapse in dogs. Methods: The medical records of 22 client-owned dogs that underwent luminal placement of cross-and-hook braided Fauna Stents for the treatment of tracheal collapse between January 2018 and July 2021 were examined and data on canine signalment, clinical signs, diagnostic test results, surgical outcomes, and postoperative complications were retrieved and analyzed statistically. Results: Twenty-six stents were surgically implanted, with 20 dogs (90.9%) receiving one stent and the remaining two (9.1%) receiving two or more stents. All dogs survived the procedure. The median survival time at a median follow-up of 990 days was 879 days. At the final follow-up examination, loss or mild improvement of cough was observed in all dogs. Conclusions: Compared with conventional lumen stents, the cross-and-hook braided Fauna Stent offered a higher survival rate and improved clinical symptoms in all patients. The results of this study suggest that the Fauna Stent may be a promising treatment option for dogs with tracheal collapse.

Prognostic Analysis of Drug-Eluting Balloon Catheter and Drug-Eluting Stent for In-Stent Restenosis of Drug-Eluting Stent (스텐트 재협착 병변에서 약물코팅 풍선카테터과 약물용출 스텐트의 예후 분석)

  • Lee, Doo Hwan;Song, Jong Nam;Park, Sin eui;Choi, Nam Gil;Han, Jae Bok;Kim, In Soo
    • Journal of the Korean Society of Radiology
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    • v.13 no.3
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    • pp.381-389
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    • 2019
  • Although the development of Drug-eluting stent (DES) improved the ISR significantly more than the Bare metal stent (BMS), the coronary stent restenosis (ISR) treatment still has a high recurrence rate. This study is compared the efficacy of DEB with that of DES implantation in patients with ISR. Among 4,316 patients who underwent coronary stent implantation at the Chonnam National University Hospital between November 2012 and December 2016, 187 patients developed ISR on follow-up coronary angiography ($66.3{\pm}11.0years$, 123 males) were enrolled and divided into two groups according to revascularization method as group I (DEB group; n=127) and group II (DES group; n=60). Primary end point was defined as major adverse cardiac events (MACEs), composite of cardiac death (CD), myocardial infaction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) during two-year follow-up between the two groups. There were no differences in the baseline characteristics and angiographic findings except that prevalence of device length was shorter ($21.1{\pm}5.3$ vs. $25.3{\pm}9.6 mm$, p<0.002) in group I.Two-year MACE were not different in the two groups (8.7%vs.10.0%, p=0.789). The incidences of cardiac death (0%vs.0%, p=1.000), MI (1.6%vs.6.7%, p=0.085), TLR(8.7% vs. 10.0%, p=0.789) and ST (0% vs. 0%, p=1000). DEB demonstrated comparable risk reduction for MACEs compared with DES in patients with ISR during two-year follow-up. DEB might be good alternative for the treatment of ISR in patients with ISR.

Clinical Outcomes and Prognosis of Patients with Stent Fracture after Successful Drug-Eluting Stent Implantation (관상동맥 약물 방출 스텐트 삽입 후 스텐트 골절에 대한 임상결과 및 예후)

  • Kim, In-Soo;Han, Jae-Bok;Jang, Seong-Joo
    • Journal of radiological science and technology
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    • v.37 no.2
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    • pp.109-116
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    • 2014
  • Many studies have suggested that in the era of Drug-Eluting Stents(DES) are one of the causes of In-Stent Restenosis(ISR) of Stent Fracture(SF). The present study sought to evaluate clinical characteristics of patients with stent fracture after successful DES implantation. The 4,701 patients were selected for analysis who underwent a follow-up coronary angiography irrespective of ischemic symptoms. The overall incidence of SF was 32 patients(male:female=19:13, Av. age $62.44{\pm}9.8$year, 0.68%). Fractures of Sirolimus-Eluting Stents(SES), Paclitaxel-Eluting Stents(PES), Biolimus A9-Eluting Stents(BES), Everolimus-Eluting Etents(EES), Endothelial Progenitor Cell Capture Stent(EPC) and Zotarolimus-Eluting Stents(ZES) are accounted for 19(59.4%), 9(28.1%), 2(6.3%), 1(3.1%), 1(3.1%) and 0(0%) respectively. SF developed in the left Anterior Dscending(LAD) artery in 16 patients(50%) and in complex(type B2, C) lesions in 25 patients(69.4%). Ten patients were treated with heterogenous DES, the rest being treated with either homogenous DES(3 patients), plain old balloon angioplasty(3 patients), or conservative medical treatment(17 patients). None of the patients with SF suffered from cardiac death during a follow-up period of $32.9{\pm}12.4$ months. The overall rate of DES fracture over up to 3.7 years of follow-up was 0.68% with higher incidence in SES than in PES. SF frequently occurred in the LAD artery and in complex lesions. Of the patients with SF, coronary intervention was performed only when the binary restenosis lesion was significant. During the follow-up, patients with SF have continued on combination antiplatelet therapy. There is a very low rate of major adverse cardiac events(post-detection of SF), especially cardiac death associated with SF.

Improving Smoothness of Hydrophilic Natural Polymer Coating Layer by Optimizing Composition of Coating Solution and Modifying Chemical Properties of Cobalt-Chrome Stent Surface (코팅 용액의 조성 최적화 및 코발트-크롬 금속스텐트의 화학적 표면개질을 통한 친수성 천연 고분자 코팅층의 표면 거칠기 개선)

  • Kim, Dae Hwan;Kum, Chang Hun
    • Journal of Chitin and Chitosan
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    • v.23 no.4
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    • pp.256-261
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    • 2018
  • Recently, the number of cardiovascular disease-related deaths worldwide has increased. Therefore, the importance of percutaneous cardiovascular intervention and drug-eluting stents (DES) has been highlighted. Despite the great clinical success of DES, the re-endothelialization at the site of stent implantation is retarded owing to the anti-proliferative effect from the coated drug, resulting in late thrombosis or very late restenosis. In order to solve this problem, studies have been actively carried out to excavate new drugs that promote rapid re-endothelialization. In this study, we introduced hydrophilic drug, tauroursodeoxycholate (TUDCA), that improves the proliferation of endothelial progenitor cells and promotes apoptosis of vascular smooth muscle cells. In addition, we utilized shellac, which is a natural resin from lac bug to coat TUDCA on the surface of the metal. When using conventional coating method including biodegradable polymers and organic solvents, phase separation between polymer and drug occurred in the coating layer that caused incomplete incorporation of drug into the polymer layer. However, when using shellac as a coating polymer, no phase separation was observed and drug was fully covered with the polymer matrix. In addition, by adjusting the composition of coating solution and modifying the hydrophilicity of the metal surface using oxygen plasma, the surface roughness decreased due to the increased affinity between coating solution and metal surface. This result provides a method of depositing a hydrophilic drug layer on the stent.

Hemodynamic Consideration for Endoleak and Aneurysm Size Change after the Stent-Graft Application of Aortic Aneurysm

  • Park, Jea-Hyung;Jae, Hwan-Joon;Lee, Whal;Chung, Jin-Wook
    • International Journal of Vascular Biomedical Engineering
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    • v.2 no.2
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    • pp.10-15
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    • 2004
  • Purpose: In the treatment of aortic aneurysm, endovascular stent-graft application has become an established method of treatment. To observe the outcomes of the procedure as the size change of aneurysm in relation with endoleak, a retrospective analysis was done for the consecutive cases who undertook the procedure. Materials & Method: Stent-graft was applied to the aortic aneurysm in 33 patients. The location of the aneurysm was thoracic in 11 patients and abdominal in 22 patients. CT angiographic was done for the follow-up evaluation to analyze the aneurysm size and the presence of endoleak. Results: Technical success rate was 97% (32/33). The primary success rate without endoleak was 84% (28/33). The secondary success was 90% (30/33). During the follow-up period of 3 months to 7years and 6months in 26 patients, a secondary endoleak developed in 5 cases. Post-implantation syndrome developed in 17 cases (51%). Among the 14 cases with follow-up imaging data for size, endoleak was negative in 10 cases. The aneurysm decreased in 5 cases, stable in size in 4 cases and enlarged in one case (10%).Among the 4 cases with endoleak positive, the aneurysm enlarged in two cases (50%). Conclusion: In the stent-graft application for aortic aneurysm, there is high chance of decrease of aneurysm size in those cases with endoleak negative. However, the aneurysm may increase and eventually rupture in the cases with en do leak positive. Close observation with CT angiography is necessary for the evaluation for the presence of endoleak and size change.

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Deflation Treatment for Subcutaneous Emphysema in a Goffin Cockatoo(Cacatua goffini) (피하 기종에 이환된 고핀 앵무새(Goffin Cockatoo, Cacatua Goffini)에서의 디플레이션 처치)

  • Lee, So-Young;Kim, Ha-Jung;Kim, Ju-Won
    • Journal of Veterinary Clinics
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    • v.28 no.5
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    • pp.519-521
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    • 2011
  • A 1-year-old Goffin cockatoo (Cacatua goffini) presented a soft non-painful and balloon-like mass around the cervical area. Subcutaneous emphysema due to cervicocephalic air sac trauma was diagnosed based on history and physical examination, and was confirmed by radiographic examination. Because the cutaneous tab was unsuccessful, a modified syringe stent was carried out. The bird showed no adverse signs for two weeks after implantation. After surgical removal of the stent, the bird did not reveal subcutaneous emphysema.

Ex vivo Morphometric Analysis of Coronary Stent using Micro-Computed Tomography (미세단층촬영기법을 이용한 관상동맥 스텐트의 동물 모델 분석)

  • Bae, In-Ho;Koh, Jeong-Tae;Lim, Kyung-Seob;Park, Dae-Sung;Kim, Jong-Min;Jeong, Myung-Ho
    • Journal of the Korean Society of Radiology
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    • v.6 no.2
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    • pp.93-98
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    • 2012
  • Micro-computed tomography (microCT) is an important tool for preclinical vascular imaging, with micron-level resolution. This non-destructive means of imaging allows for rapid collection of 2D and 3D reconstructions to visualize specimens prior to destructive analysis such as pathological analysis. Objectives. The aim of this study was to suggest a method for ex vivo, postmortem examination of stented arterial segments with microCT. And ex vivo evaluation of stents such as bare metal or drug eluting stents on in-stent restenosis (ISR) in rabbit model was performed. The bare metal stent (BMS) and drug eluting stent (DES, paclitaxel) were implanted in the left or right iliac arteries alternatively in eight New Zealand white rabbits. After 4 weeks of post-implantation, the part of iliac arteries surrounding the stent were removed carefully and processed for microCT. Prior to microCT analysis, a contrast medium was loaded to lumen of stents. All samples were subjected to an X-ray source operating at 50 kV and 200 ${\mu}A$ by using a 3D isotropic resolution. The region of interest was traced and measured by CTAN analytical software. Objects being exposed to radiation had different Hounsfield unit each other with values of approximately 1.2 at stent area, 0.12 ~ 0.17 at a contrast medium and 0 ~ 0.06 at outer area of stent. Based on above, further analyses were performed. As a result, the difference of lengths and volumes between expanded stents, which may relate to injury score in pathological analysis, was not different significantly. Moreover, ISR area of BMS was 1.6 times higher than that of DES, indicating that paclitaxel has inhibitory effect on cell proliferation and prevent infiltration of restenosis into lumen of stent. And ISR area of BMS was higher ($1.52{\pm}0.48mm^2$) than that of DES ($0.94{\pm}0.42mm^2$), indicating that paclitaxel has inhibitory effect on cell proliferation and prevent infiltration of restenosis into lumen of stent. Though it was not statistically significant, it showed that the extent of neointema of mid-region of stents was relatively higher than that of anterior and posterior region in parts of BMS as showing cross-sectional 2-D image. suggest that microCT can be utilized as an accessorial tool for pathological analysis.

Anti-Proliferative Effect of Tetraphenylporphine (TPP) as an Iron Chelator on Vascular Smooth Muscle Cells and its Release Profiles from Polymer Coating Layer (철 킬레이터로서의 tetraphenylporphine의 혈관평활근세포의 성장억제효과와 고분자 코팅막으로부터의 방출 특성)

  • Park, Min-Hee;Kang, Soo-Yong;Park, Hyun-Jeong;Seo, Jin-Seon;Park, Young-A;Kim, Ji-Eun;Kim, Yang-Geun;Whang, Bae-Geon;Munkhjargal, Odonchimeg;Shim, Young-Key;Kho, Weon-Gyu;Lee, Woo-Kyoung
    • Journal of Pharmaceutical Investigation
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    • v.38 no.2
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    • pp.93-98
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    • 2008
  • The drug-eluting stent (DES) implantation is a widely acceptable treatment for coronary heart disease. It was reported that iron chelator had anti-proliferative effect on human vascular smooth muscle cells (HA-VSMCs). In this study, tetraphenylporphine (TPP) was selected as an iron chelator and drug for DES. MTT assay showed that TPP had antiproliferative effect on HA-VSMCs. TPP and polycaprolactone (PCL) were coated onto stainless steel plate using a spraycoating method. From the surface morphology examination of the coated plate by SEM, smooth polymer coating layer could be observed. The thickness of coating layer could be controlled by changing repeating time of coating. From in vitro release test, sustained release of TPP was observed from plate during two weeks. Thus, TPP as iron chelator can be used as drug for stent coating because of its antiproliferative effect and sustain release profile.