Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis:A case report and literature review

BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal bleeding.While clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat bleeding.Splenic vein stenting has been shown to be a safe option.CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding.She was anemic with a hemoglobin of 8.0 g/dL.As a source of bleeding,CV were identified.Computed tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years prior.In a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed.The hepatic venous pressure gradient was within normal range.In an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully performed.Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV.However,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.

Commentary on a case report and literature review of acute carotid stent thrombosis

In this commentary on the article entitled“Acute carotid stent thrombosis:A case report and literature review”,the key points of the article are discussed.Acute carotid stent thrombosis(ACST)in the setting of carotid artery stenting(CAS)represents a rare but potentially catastrophic event.There is a wide range of treatment options available,including carotid endarterectomy,which is generally recommended for cases of refractory ACST.While there is no standard treatment regimen,dual antiplatelet therapy is typically recommended both before and after CAS to reduce risk of ACST.

Double-vessel verylate stent thrombosis following Resolute Onyx zotarolimus eluting stents implantation in an octogenarian

Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However,early- generation DES produced late thrombotic events,more than l-year,by delaying arterial healing of stented vessels,[2-5] New-generation DES have been developed'with thinner stent struts,more biocompatible polymer coatings for drug release,and a variety of antiproliferative agents with similar or superior anti-restenotic efficacy.[6]This development has led to a significant improvement in the efficacy and safety of new-generation DES,and consistently lower rates of very late stent thrombosis (VLST).[7,8]In fact,use of new-ge- neration DES is the standard treatment in contemporary PCI practice.[9]

Analysis of risk factors for early stent thrombosis in the Chinese population:A multicenter restrospective study

BACKGROUND:The predictive scoring systems for early stent thrombosis(EST)remains blank in China.The study aims to evaluate the risk factors and conduct a prediction model of EST in the Chinese population.METHODS:EST was defined as thrombosis that occurs within the first 30 days after primary percutaneous coronary intervention(PCI).Patients from ten Chinese hospitals diagnosed as stent thrombosis(ST)from January 2010 to December 2016 were retrospectively included as the study group.A control group(1 case:2 controls)was created by including patients without ST,major adverse cardiovascular events,or cerebrovascular events during follow-up.The present study evaluated 426 patients with single-vessel lesions and ultimately included 40 patients with EST and 80 control patients,who were included to identify factors that predicted EST and to develop a prediction scoring system.The other 171 patients without integrated 1:2 pair were used for external validation.RESULTS:EST was independently associated with a low hemoglobin concentration(adjusted odds ratio[OR]0.946,95%confi dence interval[95%CI]0.901-0.993,P=0.026),a high pre-PCI Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score(OR 1.166,95%CI 1.049-1.297,P=0.004),and a DAPT(DAPT)duration of<30 days(OR 28.033,95%CI 5.302-272.834,P<0.001).The simple EST prediction score provided an area under the curve(AUC)of 0.854(95%CI 0.777-0.932,P<0.001)with 70.0%sensitivity and 90.0%specifi city,and 0.742(95%CI 0.649-0.835,P<0.001)with 54.5%sensitivity and 81.0%specifi city for external validation dataset.CONCLUSIONS:EST may be independently associated with DAPT discontinuation within 30 days,a low hemoglobin concentration,and a high SYNTAX score.The scoring system also has a good ability to predict the risk of EST and may be useful in the clinical setting.

Acute carotid stent thrombosis:A case report and literature review

BACKGROUND Acute carotid stent thrombosis(ACST)is a rare but devastating complication in the carotid artery stenting(CAS)procedure.The aim of this article is to report a case and review cases of ACST reported in the literature,and investigate risk factors and management strategies for ACST.CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS.Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020.The demographic data,risk factors,treatment strategies,and prognosis were extracted and analyzed.CONCLUSION The reason for ACST is multifactorial.Proper patient selection,normative antiplatelet treatment,and perfect technical detail may decrease the incidence of ACST.Several treatment strategies such as thrombolysis,mechanical thrombectomy,and open surgery may be options for the treatment of ACST.Limited data have shown that carotid endarterectomy is effective with favorable results.

Acute coronary artery stent thrombosis caused by a spasm:A case report

BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.

Early stent thrombosis secondary to food allergic reaction:Kounis syndrome following rice pudding ingestion

Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.

A case of very late stent thrombosis after sirolimus-eluting stent implantation in a patient with provoked severe coronary spasm

A 73-year-old male patient suffered from very late stent thrombosis occurred 6 years after sirolimuseluting stent (SES) implantation in the ostial and proximal left anterior descending coronary artery (LAD). He presented emergently with cardiogenic shock and emergent coronary angiography showed thombus in the ostial stent and in the ostial left circumflex artery. Optical coherence tomography found delayed healing on the ostial stent. Acetylcholine provocation test had also shown severe provoked coronary spasm in all coronary arteries 28 months after SES implantation which suggested the association of severe coronary endothelial dysfunction as a potential mechanism of very late stent thrombosis.

Sirolimus-eluting stent fractures associated with aneurysm and very late stent thrombosis in the right coronary artery

Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……

Should antiplatelet therapy be interrupted in drug eluting stent recipients throughout the periendoscopic period？ A very late stent thrombosis case re-port and review of the literature

在在有 drug-eluting stents (DES ) 的病人的 antiplatelet 药的停止以后的 In-stent 血栓是在诊所的一个重要问题，特别地在 perioperative 时期。我们与高血压，冠的动脉疾病和长期的衰退胃炎的病历报导一个 87 岁的人的一个案例。sirolimus-eluting stent 的很迟了的血栓发生了在培植，在 clopidogrel 的中止以后的七个月，和在一个选任的内视镜的胃肠的过程的准备的阿司匹林 13 天的打断以后的 1207 天与尖锐心肌的梗塞介绍了。病人与 thrombectomy 并且成功地被对待有二 sirolimus-eluting stents 的重迭的 revascularized。在 catheterization 实验室管理的药包括了低分子的重量肝磷脂和硝化甘油。流动在心肌的梗塞规模被定义为根据 thrombolysis 的等级 2。在揭示的过程以后的心电图坚持，但是减少，处于在前面偏一边的领先的圣片断举起。病人无止境地在阿司匹林和 clopidogrel 上恢复了并且被解除。在二个年后续时期期间没有心脏的事件。这个盒子加重维持血栓的平衡并且与低流血风险在病人之中在 periendoscopic 过程期间在为阿司匹林治疗的继续的非心脏的过程和可能的需要的 perioperation 期间流血的重要性收到了 DES。

Acute Stent Thrombosis Following Concomitant Balloon Aortic Valvuloplasty and Percutaneous Coronary Intervention

Balloon aortic valvuloplasty is often used as a palliative measure or as a bridge to transcatheter aortic valve replacement in the management of aortic stenosis in high risk or inoperable patients. Severe aortic stenosis coexisting with coronary artery dis-ease is not uncommon. In these circumstances, adjuvant percutaneous coronary intervention may be warranted. The safety and efficacy of combined valve and coronary intervention strategies has been recently studied. An increased incidence of complications when both procedures are performed in the same setting may throw new challenges. We report a case of fatal acute stent thrombosis following balloon aortic valvuloplasty and percutaneous coronary intervention.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P<0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Advantages and disadvantages of biodegradable platforms in drug eluting stents

Coronary angioplasty with drug-eluting stent(DES)implantation is currently the most common stent procedure worldwide.Since the introduction of DES,coronary restenosis as well as the incidence of target vessel and target lesion revascularization have been significantly reduced.However,the incidence of very late stent thrombosis beyond the first year after stent deployment has more commonly been linked to DES than to baremetal stent(BMS)implantation.Several factors have been associated with very late stent thrombosis after DES implantation,such as delayed healing,inflammation,stent mal-apposition and endothelial dysfunction. Some of these adverse events were associated with the presence of durable polymers,which were essential to allow the elution of the immunosuppressive drug in the first DES designs.The introduction of erodable polymers in DES technology has provided the potential to complete the degradation of the polymer simultaneously or immediately after the release of the immunosuppressive drug,after which a BMS remains in place.Several DES designs with biodegradable(BIO)polymers have been introduced in preclinical and clinical studies, including randomized trials.In this review,we analyze the clinical results from 6 observational and randomized studies with BIO polymers and discuss advantages and disadvantages of this new technology.

Acute portal vein thrombosis after liver transplant presenting with subtle ultrasound abnormalities:A case report and literature review

BACKGROUND Portal vein thrombosis(PVT) after liver transplantation(LT) is an uncommon complication with potential for significant morbidity and mortality that transplant providers should be cognizant of.Recognizing subtle changes in postoperative ultrasounds that could herald but do not definitively diagnose PVT is paramount.CASE SUMMARY A 30-year-old female with a history of alcohol-related cirrhosis presented with painless jaundice and received a deceased donor orthotopic liver transplant.On the first two days post-operatively,her liver Doppler ultrasounds showed a patent portal vein,increased hepatic arterial diastolic flows,and reduced hepatic arterial resistive indices.She was asymptomatic with improving labs.On postoperative day three,her resistive indices declined further,and computed tomography of the abdomen revealed a large extra-hepatic PVT.The patient then underwent emergent percutaneous venography with tissue plasminogen activator administration,angioplasty,and stent placement.Aspirin was started to prevent stent thrombosis.Follow-up ultrasounds showed a patent portal vein and improved hepatic arterial resistive indices.Her graft function improved to normal by discharge.Although decreased hepatic artery resistive indices and increased diastolic flows on ultrasound are often associated with hepatic arterial stenosis post-LT,PVT can also cause these findings.CONCLUSION Reduced hepatic arterial resistive indices on ultrasound can signify PVT post-LT,and thrombolysis,angioplasty,and stent placement are efficacious treatments.

Portal vein thrombosis in cirrhosis: Controversies and latest developments

Portal vein thrombosis(PVT) is encountered in livercirrhosis, particularly in advanced disease. It has been a feared complication of cirrhosis, attributed to significant worsening of liver disease, poorer clinical outcomes and potential inoperability at liver transplantation; also catastrophic events such as acute intestinal ischaemia. Optimal management of PVT has not yet been addressed in any consensus publication.We review current literature on PVT in cirrhosis; its prevalence, pathophysiology, diagnosis, impact on the natural history of cirrhosis and liver transplantation,and management. Studies were identified by a search strategy using MEDLINE and Google Scholar. The incidence of PVT increases with increasing severity of liver disease: less than 1% in well-compensated cirrhosis, 7.4%-16% in advanced cirrhosis. Prevalence in patients undergoing liver transplantation is 5%-16%.PVT frequently regresses instead of uniform thrombus progression. PVT is not associated with increased risk of mortality. Optimal management has not been addressed in any consensus publication. We propose areas for future research to address unresolved clinical questions.

A Novel High Nitrogen Nickel-free Coronary Stents System: Evaluation in a Porcine Model

Objective To study the safety of the novel high nitrogen nickel-free austenitic stainless steel bare metal stents （BMS） in a recognized porcine coronary model and to select a better grid structure of it. Methods Three types of stents were randomly implanted in different coronary arteries of the same pig： 316L stainless steel BMS （316L-BMS） （n=12）, novel high nitrogen nickel-free stents Grid A （NF-A-BMS） （n=12） and novel high nitrogen nickel-free stents Grid B （NF-B-BMS） （n=12）. In total, eighteen animals underwent successful random placement of 36 oversized stents in the coronary arteries. Coronary angiography was performed after 36 d of stents implantation. Nine animals were respectively sacrificed after 14 d and 36 d for histomorphologic analysis. 〈br〉 Results Quantitative coronary angiography （QCA） showed similar luminal loss （LL） in the three groups：（0.21±0.17） mm for 316L-BMS, （0.16±0.12） mm for NF-A-BMS, （0.24±0.15） mm for NF-B-BMS （P=0.05）. Histomorphomeric analysis after 15 d and 36 d revealed that there was also no significant difference among the three groups in neointimal area （NA） with similar injury scores respectively. High magnification histomorphologic examination showed similar inflammation scores in the three groups, but NF-A-BMS group had poorer endothelialization scores compared with NF-B-BMS group, 2.00±0.63 vs. 2.83±0.41 （P=0.015） at 15 d, which also could be proved by the scanning electron microscope. However, the difference could not been observed at 36 d. Conclusion The novel NF-BMS showed similar safety as 316L-BMS during the short-term study. NF-B-BMS had better endothelialization than NF-A-BMS and this may owe to the specific strut units.

Current Status and Prospect of Stent Placement for May-Thurner Syndrome

Stent implantation has been proven to be safe and has become the first-line intervention for May-Thumer syndrome(MTS),with satisfactory mid-term patency rates and clinical outcomes.Recent research has demonstrated that catheter-directed thrombolysis is the preferred strategy when MTS is combined with deep vein thrombosis after self-expanding stent placement.However,the stent used for the venous system was developed based on the experience obtained in the treatment of arterial disease.Consequently,relatively common corresponding complications may come along later,which include stent displacement,deformation,and obstruction.Different measures such as adopting a stent with a larger diameter,improving stent flexibility,and increasing stent strength have been employed in order to prevent these complications.The ideal venous stent is presently being evaluated and will be introduced in detail in this review.

Combination of thrombolytic therapy and angioplastic stent insertion in a patient with Budd-Chiari syndrome

A 31-year-old female who had well-established polycythemia vera one year before, presented with the sudden onset. She had severe ascites and hepatic encephalopathy 12 d prior to admission. Real-time ultrasonography revealed a supra hepatic thrombosis extending toward the inferior vena cava (lVC). Thrombolytic therapy with systemic streptokinase (250 000 IU loading + 100 000 IU/h infusion) was started. At the end of 72 h infusion, the patient's general condition improved. A color Doppler ultrasonography then showed complete and partial resolution of the thrombosis in the supra hepatic vein and IVC, respectively. Despite this good response, 12 d later, the symptoms recurred. Venography detected complete obstruction of the lVC. Percutanous balloon angioplasty with stent insertion was performed successfully and the patient was discharged without any evidence of liver disease. A combination of systemic streptokinase and radiological intervention was effective in our patient.

Recent advances in cardiovascular stent for treatment of in-stent restenosis:Mechanisms and strategies

Treatments of atherogenesis,one of the most common cardiovascular diseases(CVD),are continuously being made thanks to innovation and an increasingly in-depth knowledge of percutaneous transluminal coronary angioplasty(PTCA),the most revolutionary medical procedure used for vascular restoration.Combined with an expanding balloon,vascular stents used at stricture sites enable the long-time restoration of vascular permeability.However,complication after stenting,in-stent restenosis(ISR),hinders the advancement of vascular stents and are associated with high medical costs for patients for decades years.Thus,the development of a high biocompatibility stent with improved safety and efficiency is urgently needed.This review provides an overview of current advances and potential technologies for the modification of stents for better treatment and prevention of ISR.In particular,the mechanisms of in-stent restenosis are investigated and summarized with the aim to comprehensively understanding the pathogenesis of stent complications.Then,according to different therapeutic functions,the current stent modification strategies are reviewed,including polymeric drug eluting stents,biological friendly stents,prohealing stents,and gene stents.Finally,the review provides an outlook of the challenges in the design of stents with optimal properties.Therefore,this review is a valuable and practical guideline for the development of cardiovascular stents.

Safety and Performance of Sirolimus-Eluting Coronary Stent System with Biodegradable Polymer: A Retrospective Analysis in Real-World Patient Population

Background and Aim: Newer generation coronary stent systems with low profile metallic frame, biodegradable polymer coating and potent but safe anti-restenosis drug from “limus family” are emerging as safe and effective stents. To evaluate the safety and performance of Metafor SES (Meril life Sciences Pvt. Ltd., Vapi, India) in consecutive patients in a real-world population. Methods: The study was a retrospective, non-randomized, single-center study which evaluated the data of 127 patients who underwent percutaneous coronary intervention (PCI) treated with Metafor SES from February 2012 to February 2015 and mean follow-up period of those patients was 3.6 ± 0.6 years. The primary endpoint was a major adverse cardiac event (MACE) including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). In addition, Stent thrombosis (ST) was analyzed at respective follow-up period. Results: A total of 127 patients (mean age: 53.70 ± 8.41 years and 99 males) were included. Among those 80 (63%) patients had hypertension and 58 (45.7%) patients with diabetes mellitus.At follow-up, MACE in form of TLR was observed in 2 (1.6%) patients only. No cardiac death or stent thrombosis was reported in any patient. A total of 169 lesions were treated with the Metafor SES (1.3 stents per lesion). The 38.4% of patients treated with the Metafor SES with lesion length ≥24 mm, and the procedural success was 100%. Conclusions: The lower incidence of MACE in uncontrolled and real world population at long term follow-up clearly depicts the prolonged safety and performance of the Metafor SES.