Search Results (370)

Hydronephrosis caused by malignant ureteral obstruction or radiotherapy-induced ureteral stenosis is a frequent complication in patients with cervical cancer. Effective management requires continuous urinary drainage, which can be achieved either internally through ureteral stent placement or externally via percutaneous nephrostomy. Among available devices, the Allium^TM fully covered nitinol mesh ureteral stent is designed to treat ureteral or urethral strictures while allowing safe and easy removal. However, serious complications have been reported, including uretero-enteric, uretero-arterial, and uretero-vaginal fistulas, pseudoaneurysm, ureteral perforation and sepsis. We report the case of a 44-year-old woman diagnosed in 2020 with stage IIIC1 cervical cancer (FIGO classification) who underwent surgery followed by adjuvant radiotherapy. In 2021, a right metallic ureteral stent was placed to treat ureteral obstruction. Two years later, she presented with right lumbar pain, and abdominal ultrasonography revealed grade III right hydronephrosis. CT scan demonstrated migration of the metallic ureteral stent into the rectal wall. Endoscopic extraction of the migrated stent was successfully performed via colonoscopy. Retrograde pyelography and CT imaging confirmed the presence of a recto-ureteral fistula. A 6 Ch/26 cm double-J ureteral stent was subsequently placed with good positioning and drainage. At the six-month follow-up, replacement of the double-J stent was performed. Imaging studies showed only minor residual hydronephrosis. Although metallic ureteral stents are effective for managing malignant ureteral obstruction, particularly in complex oncologic cases, they are not free of severe complications. The risk appears increased in patients who have undergone radiotherapy, emphasizing the need for careful monitoring and long term follow-up. Full article

Background: Acute malignant colorectal obstruction requires urgent management, traditionally by emergency resection or stoma formation. Colonic stenting as a bridge to surgery (BTS) has emerged as an alternative, but concerns persist regarding oncologic safety. This systematic review evaluates short-term and long-term outcomes of BTS with self-expanding metal stents (BTS-stent) compared with acute resection (AR). Methods: A systematic review was conducted on multiple databases. PubMed, Cochrane Library, and Google Scholar were searched for studies published between 2015 and 2025 reporting surgical management of obstructive colon cancer. Outcomes included perioperative morbidity and mortality, laparoscopic conversion, stoma formation, stent-related complications, and long-term overall survival (OS) and disease-free survival (DFS). Data were synthesized descriptively with reference to reported comparative effects and prior meta-analyses. Results: Fifteen studies published between 2015 and 2025 were included, encompassing 6999 patients (AR: 4944; BTS-stent: 1739; other BTS: 311). BTS was associated with higher rates of laparoscopic surgery (57% vs. 14%) and primary anastomosis, and significantly reduced stoma formation (27% vs. 60%). Postoperative morbidity and 30-day mortality were lower or comparable in BTS cohorts (4.9% vs. 7.8%). SEMS technical success ranged from 78 to 97%, with perforation rates of 0–15%, representing the main adverse event. Long-term outcomes were comparable between groups. Five-year OS ranged from 46 to 75% (BTS) and 46 to 74% (AR), with similar DFS. Subgroup data suggested possible worse outcomes in T4 tumors and improved results in selected stage III patients. Delayed surgery (>4 weeks) may improve survival, but increases complication risk. Conclusions: BTS with SEMS improves short-term outcomes without compromising long-term survival. Careful selection and avoidance of perforation are essential. Full article

Background/Objectives: Laparoscopic cholecystectomy (LC) is the current gold standard in patients with acute cholecystitis. Percutaneous cholecystostomy (PC) remains an option for those who are not surgical candidates but is associated with adverse effects. We studied technical success and patient satisfaction for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) after initially receiving a PC drain. Methods: A multi-center study was conducted at 4 institutions involving patients who initially received a PC. These patients were given the option to transition to receive EUS-GBD. A 5-point Likert scale was used to assess patient satisfaction comparing PC vs. EUS-GBD. Demographic data, including age, sex, reason for PC, complications, and patient satisfaction scores, were collected. Result: All seven patients who underwent percutaneous cholecystostomy rated their experience as 1 (very dissatisfied), whereas the same patients rated EUS-guided gallbladder drainage with a mean satisfaction score of 4.7 (very satisfied). Conclusions: EUS-GBD is effective and offers higher satisfaction scores in patients who are not surgical candidates. Full article

Background/Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a minimally invasive alternative for managing acute cholecystitis in patients who are unsuitable for surgery. Although its short-term efficacy is well-established, its long-term outcomes, especially in patients with malignancy-associated cholecystitis, remain unclear. Methods: This multicenter, retrospective study included 139 patients who underwent EUS-GBD with a plastic stent for inoperable acute cholecystitis between January 2010 and October 2023. Patients were divided into two groups: a malignant group (n = 60) with cystic duct obstruction caused by cancer invasion or self-expandable metal stents, and a benign group (n = 79) with calculous or acalculous cholecystitis. The outcomes assessed included cholecystitis recurrence, time to recurrence, adverse events, and risk factors for recurrence. Results: Technical success was achieved in all patients, with an overall clinical success rate of 94.6%. Cholecystitis recurred significantly more frequently in the malignant group than in the benign group (13.3% vs. 2.5%; p = 0.015). Univariate analysis identified malignancy as a significant risk factor of recurrence (odds ratio, 5.92; p = 0.028). Conclusions: EUS-GBD is a safe and effective long-term treatment for cholecystitis in non-surgical candidates. However, malignancy-associated cholecystitis carries a high risk of recurrence, warranting careful follow-up and individualized management. Full article

Background/Objectives: Commercially available drug-eluting stents still suffer from poor blood compatibility, polymer coating delamination, polymer cracking and lack of stability during and after stent implantation that led to adverse events such as stent thrombosis and in-stent restenosis. This article highlights the advantages of using silicon nanofilament (SiNf) as an interface between stent surface and drug-in-polymer coating or bloodstream. Methods: Thin layer of SiNf was successfully formed on the surface of Co-Cr substrate via one-step simple method. For stent applications, sirolimus-in-poly(D,L-lactide) (PDLLA/SRL) matrix was coated on control and SiNf-modified Co-Cr substrates and the stability, cracking, and long-term degradation was compared. Blood compatibility studies were also compared between control and SiNf-modified Co-Cr substrates. Results: The morphology of the filaments showed nanosized structures with nano-gaps between the filaments which support mechanical interlocking of PDLLA/SRL coating and enhanced the coating stability with no coating delamination whereas, the control substrate presented 97% of coating delamination. The PDLLA/SRL coating on stent platform demonstrates smooth and uniform morphology without webbing between stent struts. After stent ballooning, the control stent presented cracking and peeling of the polymer coating from the surface whereas, the SiNf-modified stent did not show any signs of these unfavorable defects. Moreover, SiNf-modified surface showed reduced fibrinogen adsorption and lower number of platelet adhesion with round shape morphology. Conclusions: Overall, this suggests that modifying the metallic substrates with SiNf could act as a universal coating for reinforcing the polymer coating stability, prevent coating defects that accompany stent ballooning, and improve the blood compatibility of the material surfaces that could have various applications to medical implants and devices. Full article

Background/Objectives: Malignant distal biliary obstruction (MDBO) is a frequent complication of pancreatic cancer and often leads to obstructive jaundice, impaired liver function, and delayed oncologic treatment. Endoscopic biliary drainage using endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the standard minimally invasive approach for restoring biliary flow. However, clinical outcomes and complication rates vary across studies depending on stent design, placement technique, and patient characteristics. The aim of this systematic review was to evaluate the clinical outcomes and complications associated with endoscopic biliary stenting in pancreatic cancer-related MDBO. Methods: A systematic literature search was performed in PubMed/MEDLINE, ScienceDirect, Web of Science, and the Cochrane Library for studies published between January 2016 and January 2026. Studies evaluating ERCP-guided biliary stenting in adult patients with pancreatic cancer-related malignant distal biliary obstruction were included. Study selection followed PRISMA 2020 guidelines, and methodological quality was assessed using the Newcastle–Ottawa Scale. Clinical outcomes including technical success, clinical success, stent patency, recurrent biliary obstruction, and procedure-related complications were analyzed. Results: Eighteen studies involving a total of 3291 patients were included in the qualitative synthesis. Technical success rates were consistently high, reaching up to 100% in several studies, while clinical success rates generally exceeded 90%. Median time to recurrent biliary obstruction ranged from approximately 102 to 541 days depending on stent type and placement technique. Recurrent biliary obstruction was the most frequently reported complication, occurring in 30.7% of patients. Stent migration occurred in 14.9% of cases, while post-ERCP pancreatitis was reported in approximately 4.2% of patients. Several studies demonstrated longer patency with self-expandable metal stents compared with plastic stents. Conclusions: Endoscopic biliary stenting performed during ERCP is an effective and safe strategy for the management of malignant distal biliary obstruction in pancreatic cancer. Self-expandable metal stents provide more durable biliary drainage and reduce the need for repeat interventions. Nevertheless, recurrent biliary obstruction remains a common limitation, highlighting the need for further improvements in stent technology and optimized placement strategies. Full article

Background and Objectives: Percutaneous coronary intervention (PCI) has markedly improved outcomes in coronary artery disease through the implantation of bare-metal stents (BMS) or drug-eluting stents (DES). However, in-stent restenosis (ISR) remains a significant complication, often necessitating repeat interventions. This study aimed to identify risk factors associated with ISR in patients with ST-elevation myocardial infarction (STEMI) who underwent PCI. Materials and Methods: We conducted a retrospective, non-randomized observational study of 107 STEMI patients treated with PCI between January 2016 and December 2019 who subsequently underwent clinically indicated (predominantly symptom-driven) follow-up coronary angiography within 12 months. ISR was defined as ≥50% luminal narrowing at follow-up angiography. Time-to-event analysis was performed using Cox regression models, incorporating clinical, biochemical, and angiographic variables. Results: In this selected cohort of patients undergoing follow-up angiography, ISR of any degree was identified in 87% of patients, and 52% had restenosis >70%. Advanced age, prior cardiovascular events, diabetes mellitus, chronic kidney disease, and history of stroke significantly increased the hazard of ISR. Smoking, dyslipidemia, and hypertension were prevalent in patients with severe ISR. Women presented with more severe clinical profiles (higher Killip class and troponin levels). DES showed slightly better TIMI flow than BMS, but stent type, dimensions, and number did not significantly impact restenosis risk. Thrombolytic therapy was associated with a significantly reduced ISR hazard. Mortality was 6% in patients with severe ISR. The highest restenosis incidence occurred in the LAD and RCA territories. Conclusions: ISR is a multifactorial process influenced by demographic, clinical, and procedural factors. Despite technological advances, ISR remains a prevalent issue, particularly in high-risk groups undergoing clinically indicated follow-up angiography. Secondary prevention strategies, optimized stent deployment, and targeted therapies addressing inflammation and vascular remodeling are essential to improving long-term PCI outcomes. Full article

Background/Objectives: MRI-guided neurovascular interventions could benefit from lower-field systems due to reduced magnetic and radiofrequency hazards. However, safety and practical visibility of commonly used neurointerventional devices at 0.55 T remain insufficiently characterized. We evaluated magnetic field interactions, RF-induced heating, and qualitative device visibility in 11 commercially available and commonly used neurovascular devices on a 0.55 T MRI system. Methods: Eleven devices, including stent retrievers, guidewires, catheters, and one embolization implant, were tested at 0.55 T. Magnetostatic interactions were quantified using the American Society for Testing and Materials (ASTM)-guided deflection methods for translational force (ASTM-F2052) and a two-string suspension apparatus for torque (adapted from Stoianovici et al.). RF-induced heating was measured in an in vitro perfused cerebral vessel phantom using a 15 min high-specific absorption rate spin echo sequence under static and flow conditions. Qualitative device visibility was assessed using a turbo spin echo (TSE) and balanced steady-state free precession (bSSFP) imaging on each device individually. Results: Eight of eleven devices passed the translational force test, while three devices (D, E, and G), containing significant ferromagnetic components, failed with deflection angles > 45°. Eight devices passed torque testing, remaining below the critical threshold in all rotation positions; three devices (D, G, and J) failed by exceeding the 54° criterion, including one guidewire and two devices with braided/coiled metallic structures. Under static conditions, RF-induced heating ranged from negligible to 10.4 °C (maximum in device D) and generally decreased under flow; in the flow configuration, temperature rise remained below 2 °C for 6/11 devices. Qualitative imaging performance differed by sequence, with bSSFP enabling improved delineation of device structure (best for devices A, C, and H), whereas devices D, E, F, and J produced extensive signal voids that precluded reliable visualization in both sequences. Overall, three devices satisfied all safety criteria while remaining clearly visible under MRI. Conclusions: Devices that pass safety thresholds at 0.55 T can serve as candidates for further sequence optimization and preclinical workflow development, enabling the design of low-SAR, device-compatible imaging protocols tailored for neurointerventional workflows. These results provide key safety data supporting the feasibility of MR-guided neurovascular procedures at 0.55 T. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

After vessel preparation, using different strategies such as balloon angioplasty, specialty balloons, atherectomy or intravascular lithotripsy, definitive treatment has emerged as a key feature in endovascular treatment strategies. Based on current guidelines, endovascular treatment is the most common treatment option in patients with claudication. In patients with chronic limb-threatening ischemia (CLTI), on the other hand, the best treatment modality, including bypass surgery and endovascular revascularization, needs to be selected by an interdisciplinary team, focusing on individual anatomic and patient-specific characteristics, on the availability of a vein graft and on cardiovascular and other comorbidities of the patients. With endovascular therapy, currently, a plethora of options are available for the treatment of femoropopliteal lesions, which are increasingly gaining in complexity. Therefore, a practical systematic case-based approach, entailing contemporary treatment options, like drug-coated balloon (DCB) angioplasty tools, self-expanding bare-metal stents (BMSs), drug-eluting stents (DESs), interwoven stents and covered stents, is crucial. Generally, most endovascular operators adhere to the ‘leave nothing behind’ concept, meaning that, after proper lesion preparation, lesions can be treated with DCBs, avoiding the implantation of permanent metallic implants. However, in the case of severe dissections or significant recoil, stent implantation becomes necessary to achieve adequate limb perfusion. The selection between long versus spot stenting and the different stent options depends on the current scientific evidence, guidelines and expert opinion statements. An interdisciplinary expert consensus was recently compiled on how these modalities should be used in specific lesions and patients in the femoropopliteal segment. Herein we present a practical case-based approach, which is based on this algorithm and aims at harmonization of endovascular treatment strategies in daily practice and ultimately at further improvements in limb and patient outcomes. Full article

Endoscopic biliary drainage using self-expanding metal stents (SEMSs) is a standard palliative therapy for cholangitis and obstructive jaundice caused by malignant distal biliary obstruction (MDBO). Fully-covered SEMSs (FC-SEMSs) prevent tumor ingrowth and provide longer patency; however, recent advances in chemotherapy have increased stent migration due to tumor shrinkage, resulting in reduced functional patency compared with uncovered SEMSs. Partially covered SEMSs can reduce migration but are often difficult to remove after deployment. In addition, adverse events such as acute pancreatitis and cholecystitis remain a concern with FC-SEMSs. To address these limitations, Dr. Kobayashi introduced a novel porous SEMS with multiple side holes in the covering membrane (MH-SEMSs) in 2019. This design allows limited bile duct epithelial ingrowth through side holes, providing anchorage while maintaining removability. The side-hole structure may also reduce cholecystitis and pancreatitis by preserving flow through the pancreatic and cystic duct orifices. Over five years since their introduction, clinical evidence supporting MH-SEMSs has steadily increased. This review summarizes current data and explores future perspectives for MH-SEMS use in MDBO management. Full article

Background: Visceral artery aneurysms (VAAs) are rare but potentially life-threatening vascular lesions often clinically silent until rupture. The widespread use of advanced imaging has increased incidental detection, highlighting the need for accurate, noninvasive diagnostic strategies. Dual-Energy Computed Tomography Angiography (DECTA) offers potential advantages over conventional CT across diagnostic and post-treatment settings; however, its role in VAAs remains incompletely defined. This narrative review summarizes current evidence on DECTA applications in VAAs, focusing on diagnosis, emergency evaluation, and post-treatment follow-up. Methods: A non-systematic literature search of PubMed and Embase focusing on English-language articles up to June 2025 was performed. The search included peer-reviewed original research articles, systematic reviews, and meta-analyses addressing dual-energy CT and spectral CT in vascular and aneurysmal imaging. Case reports without technical data and non-English articles were excluded. Results: In the diagnostic phase, DECTA enhances tissue differentiation through virtual monoenergetic images, iodine maps, and material decomposition reconstructions. In the post-treatment setting, DECTA supports assessment after endovascular procedures, including coil embolization or stent graft placement. In VAAs, these techniques may improve aneurysm delineation, reduce metal artifacts after endovascular treatment, enable accurate detection of endoleaks or residual perfusion, and support volumetric follow-up. Virtual Non-Contrast images may reduce radiation exposure without compromising diagnostic confidence. Conclusions: DECTA represents a versatile imaging modality with potential benefits across the diagnostic, emergency, and post-treatment phases of VAA management. Although many applications are extrapolated from aortic and peripheral vascular disease, emerging evidence supports its growing clinical relevance. Further dedicated studies are needed to define its role in VAA-specific decision-making and follow-up. Full article

Interventional endoscopic ultrasound (EUS) has become a cornerstone in the management of malignant pancreatobiliary diseases, offering minimally invasive alternatives to traditional surgical approaches. More recently, accumulating evidence supports its expanding role in the treatment of benign pancreatobiliary conditions, including acute cholecystitis and pancreatitis, benign gastric outlet obstruction, and scenarios involving altered gastrointestinal anatomy. This narrative review provides an overview of key EUS-guided drainage techniques utilizing lumen-apposing metal stents (LAMSs) in benign settings. It focuses on procedures such as EUS-guided gallbladder drainage, drainage of abdominal collections, EUS-directed transgastric ERCP (EDGE), and EUS-gastroenterostomy. These interventions have demonstrated high technical and clinical success rates, favorable safety profiles, and expanding indications, particularly among patients who are poor surgical candidates. This review highlights evolving techniques, clinical outcomes, and the impact of device innovations on procedural efficacy and safety. Full article

In-stent restenosis (ISR) remains a clinically relevant cause of recurrent ischemia and repeat revascularization despite progressive refinements in stent design and implantation technique. Contemporary data indicate that restenosis-related target lesion revascularization (TLR) has declined from bare-metal stent (BMS) to early- and newer-generation drug-eluting stents (DESs), yet ISR continues to accumulate over long-term follow-up and is associated with worse outcomes than PCI for de novo lesions. Mechanistically, ISR is a time-dependent, heterogeneous process dominated early by neointimal hyperplasia—triggered by mechanical endothelial injury, delayed re-endothelialization, inflammation/oxidative stress, vascular smooth muscle cell phenotypic switching, and extracellular matrix deposition—and later by in-stent neoatherosclerosis, which may confer a higher-risk plaque substrate and overlap with thrombotic complications. Clinically, ISR frequently presents as an acute coronary syndrome (ACS) rather than stable symptoms, underscoring the prognostic relevance of prompt recognition and mechanism-informed management. Patient-level risk determinants repeatedly reported across cohorts include diabetes mellitus, chronic kidney disease, dyslipidemia, hypertension, and smoking, while lesion/procedural factors include small vessel caliber, long/complex or bifurcation lesions, multiple stent layers, and suboptimal stent expansion. Intravascular imaging (OCT/IVUS) is central to phenotyping ISR mechanisms (e.g., underexpansion, calcific neoatherosclerosis, stent fracture, homogeneous hyperplasia) and can guide targeted prevention and therapy. This review synthesizes current evidence on ISR biology and risk factors to support risk stratification, preventive strategies, and individualized management. Full article

To address the issues of displacement and insufficient positional stability observed in the clinical use of the PROPEL Mini stent, this study investigates the influence of different biodegradable materials on the mechanical properties of the stent under the constraint of a fixed monofilament braided closed-loop geometry. Finite element analyses are conducted using Abaqus/Explicit to quantitatively evaluate the nonlinear mapping between nominal diameter, axial length, and radial pressure throughout a loading–unloading cycle. The results reveal that while axial behavior is consistent during compression, material-specific plasticity causes irreversible geometric sets in Mg alloy and PLGA models, whereas the PCL stent achieves total elastic recovery to its initial dimensions. During unloading, the Mg alloy stent recovers to a nominal diameter of 28 mm with a reduced axial length of approximately 22 mm, whereas the PLGA stent exhibits a much smaller recovery diameter of 14 mm with an axial length of approximately 23 mm. These post-release configurations directly determine the functional expansion range of the biodegradable stents after implantation. During unloading, the Mg alloy stent provides the highest radial pressure (peak 6.8 kPa) with a functional recovery range up to 26.5 mm, ensuring superior scaffolding stability. In contrast, while PCL achieves the widest recovery (52 mm), its radial pressure is clinically negligible (the maximum value is still less than 165 Pa), and the PLGA model exhibits both insufficient support and a restricted functional recovery limit (13 mm). By using high-strength materials such as Mg alloys, the radial anchoring force of the stent can be effectively enhanced without changing the existing structure, providing a scientific basis for solving clinical displacement problems. Full article