Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke

Purpose: Retrievable stents are widely used in acute ischemic stroke(AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS. Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia(TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale(NIHSS) and the modified Rankin Scale(mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed. Results: The 73 patients enrolled included 39 males and 34 females(median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42%(39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04%(65/73). Perioperative embolization events and symptomatic intracranial hemorrhage(sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients(42.47%), NIHSS score decreased by >8. Good functional independence(mRS score≤2) was achieved in 39 patients(53.42%) at 90 days; 12 patients(16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages. Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS.

Analysis of Factors Influencing the Complications of Solitaire AB Stent Mechanical Thrombectomy in Patients with Acute Intracranial Artery Occlusion

To investigate the influence factors of hemorrhage and stroke with retriever with Solitaire AB stent in patients with acute intracranial artery occlusion.Methods:A retrospective of 43 cases of patients with acute intracranial artery occlusion for endovascular treatment with Solitaire AB stent enrolled from March 2016 to June 2018 in our hospital,combining the characteristics of the patients of our city,through the clinical baseline data statistical analysis,complications screening of risk factors of complications.Results:There were 81.4%of patients who were dredged totally.The incidences of cerebral hemorrhage and infarction were 18.6%and 16.3%,cerebral hemorrhage group compared with control group,diabetes,blood pressure,revascularized time,NIHSS score,ASPECTS score had statistically significant differences,when infarction group compared with control group,age,opening time,ASITN_SIR score and grade of mTICI had statistically significant differences.Conclusion:Mechanical thrombectomy with Solitaire AB stent in patients with acute intracranial artery occlusion,the occurred of complications associated with various clinical factors,and the occurrence of complications seriously affect the prognosis of patients,therefore,selecting the indications strictly,and adopt individualized treatment to reduce complications.

支架辅助栓塞治疗颅内破裂宽颈动脉瘤的安全性和有效性:Solitaire支架和Neuroform支架的比较

目的比较Solitaire支架和Neuroform支架辅助弹簧圈栓塞治疗颅内破裂宽颈动脉瘤的安全性和有效性。方法回顾性分析2017年9月至2022年10月支架辅助栓塞治疗的118例颅内破裂宽颈动脉瘤的临床资料,其中采用Solitaire支架45例,Neuroform支架73例。结果术中所有支架均成功展开,无支架打开不良或移位,无弹簧圈突入载瘤动脉瘤。术后即刻造影显示,Solitaire支架组动脉瘤完全闭塞率(84.4%,38/48)与Neuroform支架组(86.3%,65/73)无统计学差异(P=0.683)。Solitaire支架组1例术中出现动脉瘤破裂出血,Neuroform支架组1例术后出现局部脑缺血;两例病人出院时均无明显神经功能受损。出院时,Solitaire支架组预后良好率(86.7%,39/45)与Neuroform支架组(87.7%,64/73)无统计学差异(P=0.874)。107例(90.7%,107/118)获得临床随访(102~458 d;平均145 d),Solitaire支架组末次随访预后良好率(86.0%,37/43)与Neuroform支架组(85.9%,55/64)无统计学差异(P=0.323)。88例(74.8%,88/118)接受影像学随访(213~817 d;平均264 d),Solitaire支架组末次随访动脉瘤完全闭塞率(92.1%,35/38)与Neuroform支架组(90.0%,45/50)无统计学差异(P=0.670)。随访期间未发生出血或缺血事件。结论对于颅内破裂宽颈动脉瘤,采用Solitaire支架和Neuroform支架辅助栓塞治疗是安全的、有效的,二者的安全性和有效性相当。

Efficacy of Solitaire AB stent-release angioplasty in acute middle cerebral artery atherosclerosis obliterative cerebral infarction

BACKGROUND In both national and international studies,the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good,and the disability rate was significantly reduced.However,there are currently only a few reports on the differences in endovascular treatment for different etiological classifications,especially in the anterior cranial circulation,aorta atherosclerotic stenosis,and acute thrombosis.AIM To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.METHODS Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019.The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis[modified thrombolysis in cerebral infarction(mTICI)]at the 2b/3 level or above,the stent was then unfolded and released.RESULTS All 25 patients underwent successful surgery,with an average recanalization time of 23 min.One patient died of cerebral hemorrhage and cerebral herniation after the operation.The National Institutes of Health Stroke Scale(NIHSS)scores immediately after surgery(7.5±5.6),at 24 h(5.5±5.6)and at 1 wk(3.6±6.7)compared with the preoperative NIHSS score(15.9±4.4),were significantly different(P<0.01).One case of restenosis was observed 3 mo after surgery(the stenosis rate was 50%without clinical symptoms),the modified Rankin scale scores were 0 points in 14 cases(56%),1 point in 4 cases(16%),2 points in 2 cases(8%),3 points in 3 cases(12%),4 points in 1 case(4%),and 6 points in 1 case(4%).CONCLUSION In acute middle cerebral artery atherosclerosis obliterative cerebral infarction,when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher,stent release may be a safe and effective treatment method;however,long-term observation and a larger sample size are required to verify these findings.

Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中疗效观察

目的:探讨Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中的疗效。方法:选取急性缺血性脑卒中患者108例,随机分为对照组(54例,单独应用动脉溶栓治疗)和联合组(54例,采用Solitaire AB支架机械取栓联合动脉溶栓治疗)。比较两组血管总再通率、血液流变学指标(纤维蛋白原、全血比黏度、红细胞沉降率、血小板聚集率)、炎症因子[肿瘤坏死因子(TNF-α)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]、神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]、疗效及并发症发生情况。结果:治疗后,联合组血管总再通率和治疗总有效率较对照组更高(均P<0.05);血液流变学指标水平、炎症因子水平、NIHSS评分较对照组更低(均P<0.05);两组并发症发生率比较无统计学差异(P>0.05)。结论:相较于单纯动脉溶栓治疗,Solitaire AB支架机械取栓联合动脉溶栓更能改善急性缺血性脑卒中患者血液流变学,降低炎症因子水平,提高血管总再通率和疗效,且安全性好。

Revolutionizing palliative care:Electrocautery-enhanced lumenapposing metal stents in endoscopic-ultrasound-guided biliary drainage for malignant obstructions

Patients with malignant biliary obstruction,following endoscopic retrograde cholangiopancreatography(ERCP)failure could be referred for endoscopicultrasound-guided biliary drainage through electrocautery-enhanced(ECE)lumen-apposing metal stent(LAMS)placement.However,the efficacy and safety of ECE-LAMS in this scenario have remained debatable due to minimal scientific evidence.The current confirmed 91.0%clinical success,96.7%technical success,7.3%reintervention rate,and 17.5%adverse events,following the treatment of malignant biliary obstruction with ECE-LAMS delivery.Finally,ECE-LAMS proved to be a generalizable strategy for managing biliary obstruction for patients who were excluded from ERCP.

Solitaire支架机械取栓结合双重抗血小板治疗对急性脑梗死患者肢体功能和血管再闭塞的影响

目的探讨Solitaire支架机械取栓结合双重抗血小板治疗对急性脑梗死患者肢体功能和血管再闭塞的影响。方法研究选择2020年2月至2023年8月接受治疗的急性脑梗死患者为样本,共134例。根据患者术前1周是否每天规律服用阿司匹林和氯吡格雷,分为观察组(服用)和对照组(未服用),各67例。比较治疗1周后的血管再通情况,根据国立卫生研究院卒中量表(NIHSS)和简易Fugl-meyer运动功能量表(FMA)对两组患者治疗前、治疗后1 d、1周、1个月的神经损伤和肢体功能进行评估,比较两组治疗前和治疗后1个月的脑血流动力学指标[脑血管外周阻力(CVR)、平均血流量(Qmean)和平均血流速度(Vmean)]和血栓形成相关因子[血栓素B2(TXB2)、正血小板α-颗粒膜糖蛋白(CD62P)、外周血6酮前列腺素F1α(6-keto-PGF1α)],记录患者治疗3个月后血管再闭塞情况,通过logistic回归分析探讨患者血管再闭和血流动力学、血栓形成因子的关系。结果治疗后观察组患者的血管再通率、FMA评分、Qmean、Vmean、6-keto-PGF1α高于对照组,NIHSS评分、CVR、TXB2、CD62P比对照组降低,均差异有统计学意义(P<0.05)。且观察组患者的血管再闭塞率低于对照组。Logistic分析显示,患者的脑血流动力学指标和血栓形成相关因子水平均会影响其血管再闭的发生(P<0.05)。结论Solitaire支架机械取栓结合双重抗血小板治疗有助于急性脑梗死患者的肢体功能恢复,并降低血管再闭塞的风险。

静脉溶栓联合Solitaire FR型支架取栓术对急性大动脉闭塞性脑梗死患者的疗效分析

目的探究静脉溶栓联合Solitaire FR型支架取栓术对急性大动脉闭塞性脑梗死患者血管再通、神经功能的影响及预后分析。方法回顾性选取2020年10月至2023年3月南京市溧水区人民医院收治的急性大动脉闭塞性脑梗死患者172例,根据治疗方法分为对照组和研究组,每组86例,对照组采用阿替普酶静脉溶栓治疗,研究组采用阿替普酶静脉溶栓联合Solitaire FR型支架取栓术治疗。比较2组血管再通、神经功能、脑血流灌注和不良事件情况,随访90 d采用改良Rankin量表评价预后。结果2组成功再通率比较,差异无统计学意义(P>0.05),研究组完全再通率高于对照组(68.60%vs 50.00%,P<0.05)。治疗后7 d、14 d,研究组美国国立卫生研究院卒中量表评分低于对照组,差异有统计学意义(P<0.01)。治疗后,研究组脑血容量、脑血流量高于对照组,平均通过时间低于对照组,差异有统计学意义(P<0.05,P<0.01);2组治疗期间不良事件总发生率比较,差异无统计学意义(P>0.05)。随访90 d,研究组良好预后比例高于对照组(80.23%vs 63.95%,P<0.05)。结论静脉溶栓联合Solitaire FR型支架取栓术在急性大动脉闭塞性脑梗死中效果较好,血管再通效果理想,可明显改善患者神经功能和预后。

Unloading and successful treatment with bioresorbable stents during percutaneous coronary intervention:A case report

BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually.Metal drug-eluting stent unloading is one of the most common clinical complications.Comparatively,BRS detachment is more concealed and harmful,but has yet to be reported in clinical research.In this study,we report a case of BRS unloading and successful rescue.This is a case of a 59-year-old male with the following medical history:“Type 2 diabetes mellitus”for 2 years,maintained with metformin extended-release tablets,1 g PO BID;“hypertension”for 20 years,with long-term use of metoprolol sustained-release tablets,47.5 mg PO QD;“hyperlipidemia”for 20 years,without regular medication.He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours,on February 20,2022 at 15:35.Electrocardiogram results showed sinus rhythm,ST-segment elevation in leads I and avL,and poor R-wave progression in leads V1–3.High-sensitivity troponin I level was 4.59 ng/mL,indicating an acute high lateral wall myocardial infarction.The patient’s family requested treatment with BRS,without implanta-tion.During PCI,the BRS became unloaded but was successfully rescued.The patient was followed up for 2 years;he had no episodes of angina pectoris and was in generally good condition.CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue.By analyzing images,the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations.We discuss preventive measures for BRS unloading.

Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction:Updated meta-analysis

BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography(ERCP)failure.However,most of the studies that have assessed its efficacy and safety were small and hetero-geneous.Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence.AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary ob-struction after ERCP failure.METHODS We searched PubMed,EMBASE,and Scopus databases from the inception of the ECE technique to May 13,2022.Primary outcome measure was pooled technical success rate,and secondary outcomes were pooled rates of clinical success,re-intervention,and adverse events.Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R soft-ware(version 4.1.3).RESULTS Fourteen eligible studies involving 620 participants were ultimately included.The pooled rate of technical success was 96.7%,and clinical success was 91.0%.Adverse events were reported in 17.5%of patients.Overall reinter-vention rate was 7.3%.Subgroup analyses showed results were generally consistent.CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible.The consistency of results across most subgroups suggested that this is a generalizable approach.

Solitaire AB支架机械介入取栓术联合阿替普酶溶栓治疗急性缺血性脑卒中的效果及对脑部血流速度、神经因子水平的影响

目的探讨Solitaire AB支架机械介入取栓术联合阿替普酶溶栓治疗急性缺血性脑卒中的效果及对脑部血流速度、神经因子水平的影响。方法选取2020年1月至2022年12月收治的100例急性缺血性脑卒中患者为研究对象,根据入院时间将其分为对照组和观察组,各50例。对照组接受阿替普酶溶栓治疗,观察组在对照组基础上加Solitaire AB支架机械介入取栓术。比较两组的治疗效果。结果观察组的治疗总有效率为96.00%,明显高于对照组的82.00%(P<0.05)。治疗后,观察组的大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)血流速度均大于对照组(P<0.05)。治疗后,观察组的神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)水平低于对照组,神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平高于对照组(P<0.05)。结论Solitaire AB支架机械介入取栓术联合阿替普酶溶栓治疗急性缺血性脑卒中的效果显著,可改善脑部血流速度,调节神经因子水平,值得推广。

EmboTrapⅡ支架和Solitaire FR支架取栓术治疗大血管闭塞性急性缺血性脑卒中的疗效对比

目的对比EmboTrapⅡ支架与Solitaire FR支架在颅内动脉取栓中的差别。方法回顾性分析同济大学附属东方医院胶州医院66例急性脑栓塞患者,根据术中使用支架分为EmboTrapⅡ支架组及Solitaire FR支架组,对两组患者手术时间及一次性再通率和预后进行对比。结果EmboTrapⅡ支架组在手术操作难度、预后上与Solitaire FR支架组无统计学差异,但是可以大大提高一次取栓再通率并缩短手术时间。结论EmboTrapⅡ支架在颅内动脉取栓中可以大大缩短手术时间,提高一次取栓再通率。

急性缺血性脑卒中患者支架取栓术失败的影响因素及补救性Solitaire AB支架置入的可行性分析

目的 探究急性缺血性脑卒中(AIS)患者支架取栓术失败的影响因素及补救性Solitaire AB支架置入的可行性。方法 以2018-10—2020-03沧州市人民医院160例AIS患者为研究对象,均给予支架取栓术治疗,根据手术疗效分为成功组及失败组,分析AIS患者支架取栓术失败的影响因素;根据术后是否置入Solitaire AB支架将失败组分为支架置入组及对照组,比较2组疗效、脑血管血流状况、神经营养因子水平及预后。结果 160例AIS患者中支架取栓术失败率为26.25%(42/160),失败组中年龄≥60岁、合并高脂血症、既往有脑卒中史、闭塞部位为颈内动脉的比例及入院时NIHSS评分高于成功组,发病至股动脉穿刺时间、穿刺至再通时间、发病至再通时间长于成功组,血栓切除次数多于成功组(P<0.05)。颈内动脉闭塞(OR=2.143,95%CI:1.411~3.253)、入院时NIHSS评分升高(OR=1.677,95%CI:1.138~2.472)、发病至再通时间延长(OR=2.063,95%CI:1.041~4.088)、血栓切除次数增加(OR=1.902,95%CI:1.412~2.562)是影响AIS患者支架取栓术失败的危险因素(P<0.05)。支架置入组及对照组总有效率对比差异无统计学意义(90.48%比61.90%,P>0.05)。支架置入组治疗后缺血面积小于对照组(P<0.05),CBV、CBF大于对照组(P<0.05),NSE、S-100β水平低于对照组(P<0.05),2组mRS评分对比差异无统计学意义(P>0.05)。结论 颈内动脉闭塞、入院时NIHSS评分升高、发病至再通时间延长是AIS患者支架取栓术失败的危险因素,对支架取栓术失败患者给予补救性Solitaire AB支架置入治疗,可改善脑组织血流灌注,促进神经功能恢复。

Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery.It is believed that lesser stent material within the bladder mitigates stent-related symptoms.This study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention.Methods:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were analysed.Parameters compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal.Results:Both groups had similar median age,distribution in male to female ratio,and stone size.The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at voiding.Both groups had similar ease in insertion with no hospital readmissions.Conclusion:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues.It showed a good safety profile with easy deployment and removal.It promises a new standard in stenting.

球囊扩张联合Solitaire支架对伴动脉粥样硬化急性颅内大血管闭塞患者血管开通与病情转归影响

目的 探讨伴动脉粥样硬化急性颅内大血管闭塞患者采用球囊扩张联合Solitaire支架治疗对血管开通与病情转归的影响。方法 回顾性纳入2020年6月—2022年6月河北中石油中心医院105例伴动脉粥样硬化急性颅内大血管闭塞患者,依据治疗方案不同分为对照组(52例)与研究组(53例),对照组采用Solitaire支架治疗,研究组采用球囊扩张联合Solitaire支架治疗,比较两组基线资料、治疗后血管开通情况、并发症,对患者进行为期3个月的随访,嘱咐患者入院复查,对比两组治疗前、治疗3个月时mRS评分、GCS评分、NIHSS评分,并统计两组再狭窄情况。结果 治疗后,与对照组相比,研究组mTICI分级更高(P<0.05)。两组并发症比较差异不显著(P>0.05)。治疗后3个月,两组mRS、NIHSS评分均低于治疗前,GCS评分均高于治疗前;且与对照组相比,研究组mRS、NIHSS评分更低,GCS评分更高(P<0.05)。随访3个月,与对照组相比,研究组再狭窄发生率更低(P<0.05)。结论 球囊扩张联合Solitaire支架治疗可促进伴动脉粥样硬化急性颅内大血管闭塞患者血管开通及病情转归,降低再狭窄发生率,且不会增加并发症。

Solitaire支架介入取栓术治疗急性脑梗死的临床效果分析

目的:探讨Solitaire支架介入取栓术治疗急性脑梗死的临床效果。方法:选取2022年2月—2023年2月郴州市第一人民医院收治的74例急性脑梗死患者作为研究对象,以随机数字表法分为对照组、支架组,各37例。对照组行常规溶栓治疗,支架组行Solitaire支架介入取栓术治疗。比较两组凝血指标、恢复情况、治疗效果、并发症发生情况。结果:治疗前,两组凝血酶原时间(PT)、D-二聚体(D-D)、活化部分凝血活酶时间(APTT)比较,差异无统计学意义(P>0.05)。治疗后,两组PT、APTT长于治疗前,且支架组长于对照组,两组D-D水平低于治疗前,且支架组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)评分比较,差异无统计学意义(P>0.05);治疗后,两组NIHSS、mRS评分低于治疗前,且支架组低于对照组,差异有统计学意义(P<0.05)。支架组治疗总有效率高于对照组,差异有统计学意义(P=0.047)。支架组并发症总发生率低于对照组,差异有统计学意义(P=0.022)。结论:Solitaire支架介入取栓术治疗急性脑梗死的临床效果较好,能改善患者凝血功能,促进患者恢复,减少并发症。

Acute Stent Thrombosis: A Case at the Montlucon Hospital Center

Background and objective: Coronary angioplasty is one of the techniques introduced in 1976 by Andreas Grüntzig in Zurich. It is a revolutionary procedure that allows coronary circulation to be restored by inserting a stent. This new technique has considerably evolved over time, but sometimes has limitations, such as the development of neo-pathologies like stent thrombosis. The aim of our case report is to highlight one of the limitations of coronary angioplasty, although rare, and to encourage greater clinical and electrical monitoring after each procedure. Case report: We report the case of a patient who presented with early stent thrombosis barely an hour after placement of a pharmacoactive stent. Chest pain reported by the patient after the procedure and electrical changes prompted an urgent repeat procedure. Aetiologies of stent thrombosis are multifactorial, including patient-, procedure- and stent-dependent factors. Conclusion: Although rare, there is a risk of stent thrombosis after coronary angioplasty. Careful monitoring and rigorous follow-up of patients after coronary angioplasty are therefore required, as the prognosis for stent thrombosis is fairly poor.

Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?

Objective:Ureteral stents are customarily inserted to facilitate urinary drainage,but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences.The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade(Clavien-Dindo Grade 4A or above)complications.Methods:The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed.The parameters recorded included patient demographics,indwelling time,need for percutaneous nephrostomy,hemodialysis,urine culture,blood culture,total blood counts,serum creatinine,radiologic findings,management techniques,number of surgical interventions,modified Clavien-Dindo complications,follow-up,and mortality,if any.Results:Forty patients were included in the study.The median age was 52(range 6-85)years.Of the total,25(62.5%)patients had a“significant”stent load;31(77.5%)had renal failure or acute kidney injury on presentation;19(47.5%)patients had sepsis at presentation.Among the patients presented with sepsis,11(57.9%)patients demonstrated a positive urine culture;and 7/11(63.6%)patients exhibited pan-resistant organisms.Twelve out of 40(30.0%)patients in our series developed high-grade Clavien-Dindo complications.On univariate analysis,sepsis at presentation(p=0.007),stent load(p=0.031),diabetes(p=0.023),positive urine culture(p=0.007),and stent indwelling time of more than 1 year(p=0.031)were found to be significant.On multivariate logistic regression analysis,sepsis at presentation(p=0.017)and positive urine culture(p=0.016)were significant predictors for high-grade complications.Conclusion:It is prudent to identify specific risk factors,namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.

Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series

AIM:To report the outcome of Baerveldt glaucoma implant(BGI)with Supramid©ripcord use in neovascular glaucoma(NVG).METHODS:We retrospectively evaluated the surgical outcome of the BGI with Supramid©3/0 ripcord stent in patients with NVG.No tube ligation or venting slits were performed.Supramid was removed after 3mo if the target intraocular pressure(IOP)was not achieved.Surgical success was defined as IOP≤21 mm Hg with(qualified success)or without IOP-lowering medications(complete success).RESULTS:Twenty-six eyes from 24 patients were included in the study.The median duration of follow-up was 4[interquartile range(IQR)=1-5]y,ranging from 0.5 to 5y.IOP decreased by a mean of 24.2 mm Hg(59.7%);from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg,P≤0.001.The number of glaucoma medications reduced from a median of 5(IQR=5-6)to 1(IQR=0-2,P≤0.001)at the final follow-up.Overall success rates were 88.0%at 1y,34.8%at 3y,66.7%at 4y,and 50%at 5y.Hypertensive phase(HP)in the first 3mo occurred in 15/26 eyes(57.7%)with a mean IOP of 31.1 mm Hg.CONCLUSION:BGI with Supramid©ripcord stent gives close to 90%of the overall survival rate at the final follow-up without significant early hypotony.However,early HP is still a challenge.

Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis:A systematic review and meta-analysis

Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.Methods: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.Results: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.Conclusion: PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.