Stent procedure
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Stent Procedures: Efficacy, Safety, and Clinical Outcomes
Renal Artery Stenting in Atherosclerotic Renal Artery Stenosis
Efficacy and Safety of Renal Artery Stenting
Renal artery stenting in patients with atherosclerotic renal artery stenosis (ARAS) and impaired renal function has been evaluated for its efficacy and safety. A randomized clinical trial involving 140 patients compared stent placement combined with medical treatment to medical treatment alone. The primary endpoint was a 20% or greater decrease in creatinine clearance. Results indicated no significant difference between the stent group and the medication group in reaching the primary endpoint (hazard ratio, 0.73 [95% CI, 0.33 to 1.61]). However, the stent group experienced serious complications, including procedure-related deaths and dialysis requirements due to cholesterol embolism. These findings suggest a conservative approach focusing on cardiovascular risk management may be preferable for patients with ARAS.
Coronary Artery Stenting vs. Balloon Angioplasty
Procedural Success and Restenosis Rates
Coronary artery stenting has shown higher procedural success rates and lower restenosis rates compared to balloon angioplasty. In a study with 410 patients, those who underwent stenting had a higher procedural success rate (96.1% vs. 89.6%) and a larger immediate increase in luminal diameter (1.72 mm vs. 1.23 mm). At six months, stented lesions maintained a larger luminal diameter and exhibited a lower rate of restenosis (31.6% vs. 42.1%). These results highlight the advantages of stenting over balloon angioplasty in terms of procedural success and reduced restenosis.
Clinical Outcomes and Revascularization
Despite the procedural benefits, the rate of clinical events such as death, myocardial infarction, and the need for revascularization did not differ significantly between the stent and angioplasty groups. However, revascularization of the original target lesion due to recurrent myocardial ischemia was less frequent in the stent group (10.2% vs. 15.4%). This suggests that while stenting offers procedural advantages, the long-term clinical outcomes may be similar to those of balloon angioplasty.
Stenting in Ischaemic Heart Disease
Effectiveness in Subacute and Acute Manifestations
Coronary artery stents are widely used in the treatment of ischaemic heart disease (IHD), including stable and unstable angina, and myocardial infarction (MI). A systematic review indicated that stents are effective in improving blood flow and reducing symptoms in IHD patients. The review also highlighted the increasing use of stents in percutaneous coronary interventions (PCIs), with stents being used in about 70% of PCIs in the UK.
Cost-Effectiveness and Clinical Benefits
The review also addressed the cost-effectiveness of stents compared to other treatments like percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). Stents were found to be cost-effective, particularly in reducing the need for repeat procedures and hospitalizations. This underscores the clinical and economic benefits of stenting in managing IHD.
Stenting in Congenital Heart Disease
Pediatric Applications and Challenges
Stenting has become an accepted procedure in pediatric cardiology for treating congenital heart disease (CHD). Despite the severity of CHD, the limited number of cases has resulted in a lack of dedicated devices, leading to the off-label use of adult stents in newborns. The review emphasized the need for stents optimized for pediatric use to improve clinical outcomes and reduce complications.
Covered Stents in Coarctation of the Aorta
Safety and Efficacy
Covered stents have been evaluated for their safety and efficacy in treating coarctation of the aorta in adults. A study involving 22 patients demonstrated successful device deployment in all cases, with significant reductions in peak systolic gradient and improvements in blood pressure and medication requirements. The study concluded that covered stents are a safe and effective option for managing coarctation of the aorta, with durable results and minimal complications.
Conclusion
Stent procedures have shown significant benefits in various clinical settings, including renal artery stenosis, coronary artery disease, ischaemic heart disease, congenital heart disease, and coarctation of the aorta. While stenting offers procedural advantages and improved outcomes in many cases, it is essential to consider the potential complications and long-term clinical benefits. A conservative approach focusing on risk management may be preferable in certain conditions, such as ARAS. Overall, stenting remains a valuable tool in modern medical practice, with ongoing research needed to optimize its use and improve patient outcomes.
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