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Background: Malignant biliary obstruction is usually attributed to the enlargement of tumors within or adjacent to the biliary tract, leading to blockage or compression of the bile ducts. Common causes include pancreatic head cancer, bile duct cancer, gallbladder cancer, liver cancer, and metastatic diseases. Most cases have an insidious onset, lack effective early screening methods, and 70% of patients cannot undergo surgical resection, with a 5-year survival rate of about 30%. Therefore, relieving biliary tree obstruction is crucial. Biliary stents often mitigate the obstruction but can be hindered by tumor progression, endothelial hyperplasia, and bile sludge. As a result, new treatment approaches are constantly being explored to improve outcomes for patients with malignant biliary obstruction. Current situation: One promising technique that has emerged in recent years is radiofrequency ablation (RFA). This innovative method utilizes high-frequency radio waves to generate heat and selectively target tumor cells through localized heating while preserving surrounding healthy tissue. RFA aims to slow tumor growth and enhance biliary stent durability. Studies on endoscopic RFA for malignant biliary obstruction are encouraging. Integrating it with palliative care may better manage symptoms and extend patient quality of life. Conclusion: In conclusion, while malignant biliary obstruction remains a complex medical challenge with limited treatment options available for some patients, ongoing research into innovative techniques like radiofrequency ablation offers hope for better outcomes in the future. It is crucial for healthcare professionals to stay informed about these advancements and continue exploring new ways to enhance patient care in this difficult clinical scenario. [ABSTRACT FROM AUTHOR]

Stent invagination (SIV) sometimes occurs during interwoven nitinol stent (IWS) placement due to its complex deployment system. It may cause stent malapposition and reduce the minimum stent area. However, the clinical implications of SIV remain unclear. This retrospective single-center study sought to assess the clinical implications of IWS invagination in the femoropopliteal lesions in patients with peripheral arterial diseases. Thirty-two consecutive patients (23 men, mean age of 74 years, 34 limbs) with symptomatic femoropopliteal lesions who had received IWS implantation from January to July 2019 were enrolled. The study was approved by the ethics committee of our institution. The 12-month primary patency rate after the initial IWS placement was evaluated as the primary outcome, which was compared between lesions with SIV (SIV cohort) and without SIV (non-SIV cohort). All IWSs were deployed successfully, but nine cases (26.4%) of SIV occurred during placement. The mean lesion length was 22.3 cm, and critical limb threatening ischemia was observed in 40.6% of the limbs. The overall 12-month primary patency rate was 78.2%. The non-SIV cohort (25 cases) showed a significantly higher primary patency rate than the SIV cohort (9 cases, 91.7% vs. 41.7%, P = 0.0149). IWS implantation showed acceptable durability in Japanese patients in a real-world setting, however, SIV during IWS placement possibly led to a lower 12-month primary patency rate. [ABSTRACT FROM AUTHOR]

Background: Although percutaneous coronary intervention (PCI) had become widely employed therapeutic procedure for coronary artery disease, stent restenosis limited the benefits of this revascularization and the question how to prevent such events remained unresolved. While numerous empirical observations suggested Tongguan Capsules (通冠胶囊), a patented Chinese Medicine, could decrease frequency and duration of angina pectoris attacks, evidence supporting its efficacy on restenosis remained inadequate. Objective: This trial was designed to determine whether Tongguan Capsules would reduce restenosis rate in patients after successful stent implantation. Methods: Approximately 400 patients undergoing percutaneous coronary stent deployment were enrolled and randomized to control group or Tongguan Capsules (4.5 g/d) for 3 months. All patients received standard anti-platelet, anti-coagulation and lipid-decreasing treatments, concurrently. The primary clinical endpoint was the 12-month incidence of the major adverse cardiovascular events (defined as cardiac death, myocardial infarction, and recurrence of symptoms requiring additional revascularization). The angiographic end point was restenosis rate at 6 months. Conclusion: This study would provide important evidence for the use of Tongguan Capsules in patients after stent implantation in combination with routine therapies, which may significantly reduce incidence of the restenosis so as to potentially improve the clinical outcomes. (registration number: ChiCTR-TRC- ChiCTR-IIR-17011407) [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We sought to describe the use and outcomes of small, medium and large premounted stents in patients with congenital heart disease, including incidence of and risk factors for re-intervention and development of in-stent stenosis. Premounted stents offer several advantages over traditional manually crimped bare-metal stents, especially in small patients. There are no data describing the medium-term effectiveness and outcomes of premounted stents in congenital heart disease. We performed a single-center retrospective review of all small, medium and large premounted stents implanted over an 8-year period. Premounted stents were implanted in 71 vessels within 59 patients with a 97 % success rate. Regardless of implantation site, premounted stent implantation resulted in significant improvements in vessel size and pressure gradient ( p < 0.0001). Over a median follow-up duration of 3.1 years [interquartile range (IQR) 1.3-5.2], 25 patients (43 %) required re-intervention (18 catheter based, 3 surgical and 4 hybrid) at a median time of 1.4 years (IQR 0.9-3.0) from implant. Factors associated with re-intervention included age ≤1.9 years [hazard ratio (HR) 2.4, p = 0.03], weight ≤11.5 kg (HR 2.5, p = 0.03) and bare-metal premounted stents compared to covered premounted stents (HR 4.2, p = 0.001). In-stent stenosis was diagnosed in 42 % of premounted stents which underwent follow-up angiography. No identified characteristics were associated with in-stent stenosis, including 'oversizing' the premounted stent. Small, medium and large premounted stents are effective in treating vascular stenosis in congenital heart disease. Frequent follow-up is required, especially in smaller patients with expected somatic growth, and to evaluate for in-stent stenosis which occurs in nearly half of premounted stents. [ABSTRACT FROM AUTHOR]

A 61-year-old man with in-stent occlusion of the superficial femoral artery (SFA) underwent the endovascular therapy using a subintimal technique. The wire was intentionally advanced into the subintimal space next to the occluded stent in the SFA, and a stent was implanted in a double barrel fashion outside of the in-stent occlusion site. The procedure was performed without any complications and with the successful angiographic and intravascular ultrasound imaging results. At 1-year follow-up, the patient still had no leg complaints and the stent was still shown as patent. The procedure might be a useful technique when the recanalization was proved impossible after several attempts to recanalize the primary occluded stent in the SFA. [ABSTRACT FROM AUTHOR]

Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

P-selectin and P-selectin glycoprotein ligand-1 (PSGL-1) regulate the initial interactions between leukocytes, activated platelets and endothelial cells. Recently, a variable number of tandem repeats (VNTR) polymorphism in PSGL-1 gene affecting the length of the extracellular domain of PSGL-1 and the distance of the P-selectin binding site to the cell surface has been described. There are limited numbers of studies reporting PSGL-1 polymorphism might affect the inflammatory response and thrombosis. We explored the association between PSGL-1 VNTR polymorphisms (especially AB genotype that has the most deformed configuration of the binding site) and the development of coronary stent restenosis and stent thrombosis in patients with coronary artery disease (CAD). Eighty-seven patients with in-stent restenosis and 93 patients with patent coronary stents were included into the study. The distributions of age, gender, hypertension, diabetes, smoking, total cholesterol and triglyceride levels were similar between the groups. Genomic DNAs were obtained by standard methods from whole blood samples. Specific primers were used to amplify PSGL-1 gene by polymerase chain reaction (PCR). Three alleles and 5 different genotypes were detected. In the in-stent restenosis group; allele frequencies were 79.5% for A allele, 18.1% for B allele and 2.4% for C allele and in the patent stent group; allele frequencies were 79.3% for A allele, 20.1% for B allele and 0.6% for C allele. The allele frequencies were similar between the in-stent restenosis group and patent stent group ( P = 0.97 for A allele, P = 0.73 for B allele and P = 0.19 for C allele). Genotype distributions were also similar between the groups. There were not any significant associations between PSGL-1 AB genotype and stent restenosis (31.3% vs. 27.2%, P = 0.54), repetitive stent restenosis (33.3% vs. 28.8%, P = 0.82) or in-stent thrombosis (44.4% vs. 28.2%, P = 0.37). In neither male patients nor female patients, there was any significant association between AB genotype and restenosis (32.2% vs. 24.3% P = 0.31 and 29.2% vs. 38.9% P = 0.51, respectively). However, among patients with a family history of early CAD, significantly higher percentage of AB genotype was found in those with stent restenosis (41.4% vs. 18.8%, P = 0.03). No significant association was found between PSGL-1 VNTR polymorphisms and in-stent restenosis. However, in patients with a family history of early CAD presence of PSGL-1 AB genotype might increase the risk of in-stent restenosis. [ABSTRACT FROM AUTHOR]

To clarify the role of vascular endothelial growth factor (VEGF) in the process of restenosis, a Palmaz-Schatz stent was implanted in the left anterior descending coronary artery of male pigs at 2 weeks after balloon injury (balloon/artery ratio 1.2:1). The animals were euthanized at 1, 2, and 4 weeks after stenting, and western blot and immunohistochemical analysis were performed using VEGF, fms-like tyrosine kinase (flt)-1, and platelet-derived growth factor (PDGF) antibodies. The expressions of VEGF and flt-1 protein in the neointima were observed as early as 1 week after stenting and remained for up to 4 weeks, while re-endothelialization was complete at 2 weeks. These protein expressions were demonstrated in proliferated smooth muscle cells throughout the entire period after stenting and, in addition, they were observed in the macrophages and endothelial cells of microvessels around stent struts at 4 weeks. The expression pattern of VEGF corresponded with that of PDGF, a growth factor well-known to induce neointimal proliferation. The cell proliferative activity, measured by the proliferating cell nuclear antigen index, around the struts remained high until 4 weeks after stenting, while that in the other areas declined at 4 weeks. These results suggest that VEGF is involved in the process of restenosis not only through its angiogenic properties and induction of monocyte chemotaxis, but also by a synergistic effect with PDGF. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)