Stent placement
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Stent Placement: Efficacy, Safety, and Clinical Outcomes
Coronary Stent Placement vs. Balloon Angioplasty
Procedural Success and Restenosis Rates
Coronary stent placement has shown significant advantages over balloon angioplasty in treating coronary artery disease. Studies indicate that stent placement results in higher procedural success rates (96.1% vs. 89.6%) and larger immediate increases in luminal diameter (1.72 mm vs. 1.23 mm) compared to balloon angioplasty. Additionally, patients with stents exhibit lower restenosis rates at six months (31.6% vs. 42.1%).
Clinical Outcomes
Despite the procedural benefits, the rate of coronary events (death, myocardial infarction, etc.) was similar between the stent and angioplasty groups (80.5% vs. 76.2%). However, the need for revascularization due to recurrent myocardial ischemia was less frequent in the stent group (10.2% vs. 15.4%).
Renal Artery Stenting in Atherosclerotic Renal Artery Stenosis (ARAS)
Efficacy and Safety
In patients with ARAS and impaired renal function, stent placement combined with medical treatment did not significantly affect the progression of renal impairment compared to medical treatment alone. However, stent placement was associated with serious complications, including procedure-related deaths and the need for dialysis due to cholesterol embolism. These findings suggest a conservative approach focusing on cardiovascular risk management may be preferable.
Meta-Analysis Insights
A meta-analysis comparing renal arterial stent placement with percutaneous transluminal angioplasty (PTA) found that stenting had higher technical success (98% vs. 77%) and lower restenosis rates (17% vs. 26%). However, the complication rates were similar between the two treatments.
Stent Placement for Coarctation of the Aorta (CoA)
Lack of Comparative Evidence
There is insufficient evidence to determine whether stent placement or open surgery is the superior treatment for CoA. A review of available studies found no direct comparisons between the two methods, highlighting the need for randomized controlled trials to establish the best approach.
Stent Placement in Saphenous Vein Grafts
Procedural and Clinical Outcomes
For patients with obstructive disease in saphenous-vein grafts post-coronary bypass surgery, stent placement showed higher procedural efficacy (92% vs. 69%) and better clinical outcomes in terms of freedom from major cardiac events (73% vs. 58%) compared to balloon angioplasty. However, the rate of angiographic restenosis did not significantly differ between the two groups.
Ureteral Stent Placement
Symptom Relief and Safety
Intraureteral stent placement has been found to significantly reduce ureteral stent-related symptoms compared to conventional stent placement. Patients reported lower pain scores and reduced use of analgesics, with no significant difference in complication rates between the two methods.
Long-Term Outcomes in Iliac and Femoropopliteal Arteries
Patency and Complications
Long-term studies on stent placement in iliac and femoropopliteal arteries show high primary patency rates, particularly in iliac arteries (86% at four years). The procedure is associated with low acute thrombosis rates and manageable restenosis, often treated successfully with repeat angioplasty.
Conclusion
Stent placement offers significant procedural and some clinical advantages over traditional methods like balloon angioplasty and surgery in various vascular conditions. However, the benefits must be weighed against potential complications, and in some cases, conservative management may be preferable. Further research, particularly randomized controlled trials, is needed to establish the best practices for stent placement in specific conditions.
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