Stent surgical procedure
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Stent Surgical Procedures: A Comprehensive Overview
Coronary Stent Placement vs. Balloon Angioplasty
Procedural Success and Restenosis Rates
Coronary stent placement, involving the implantation of a balloon-expandable, stainless-steel tube at the site of coronary stenosis, has shown significant advantages over standard balloon angioplasty. In a study comparing these two methods, stent placement demonstrated 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). Six months post-procedure, patients with stents had a larger luminal diameter and a lower rate of restenosis (31.6% vs. 42.1%) compared to those who underwent balloon angioplasty.
Clinical Outcomes
Despite the procedural advantages, the rate of clinical events such as death, myocardial infarction, and the need for coronary-artery bypass surgery was similar between the two groups. However, the need for revascularization due to recurrent myocardial ischemia was less frequent in the stent group (10.2% vs. 15.4%).
Intraoperative Stent Placement for Pulmonary Vessels
Pulmonary Artery and Vein Stenosis
Intraoperative stent placement under direct surgical vision has been utilized to address severe branch pulmonary artery stenosis (PAS) and pulmonary vein ostial stenosis (PVS). This method is particularly beneficial for patients requiring concomitant cardiac surgery or those with limited vascular access for catheterization. The procedure has shown significant clinical improvement, with a reduction in mean pulmonary gradient from 66 mm Hg preoperatively to 28 mm Hg postoperatively.
Long-term Outcomes
While the procedure has been effective in maintaining vessel patency and facilitating future surgical interventions, outcomes have been better for PAS compared to PVS. Only one out of five patients with PVS had a successful outcome, whereas all patients with PAS showed significant improvement.
Colonic Stents as a Bridge to Surgery
Comparison with Emergency Surgery
The use of self-expanding metallic stents as a bridge to surgery for obstructive colorectal cancer has been compared to emergency surgery. Meta-analyses indicate that stent placement reduces the need for intensive care and stoma creation, increases the primary anastomosis rate, and lowers overall complications, including anastomotic leakage . Stent insertion before elective surgery does not adversely affect mortality and long-term survival .
Surgical and Oncological Outcomes
Stenting has been associated with less blood loss, shorter ICU and hospital stays, and a higher number of lymph nodes harvested during surgery. However, long-term oncological outcomes, including 3- and 5-year survival rates, are similar between stent and emergency surgery groups.
Urethral Stents for Prostatic Obstruction
High-Risk Patients
For patients with prostatic outflow obstruction who are at high risk for conventional surgery, the use of permanently implanted urethral stents offers a quick, safe, and effective alternative. The procedure, performed under local anesthesia, has shown high patient satisfaction and successful outcomes in the majority of cases.
Hybrid and Intraoperative Stent Placement in Congenital Heart Disease
Complex Anatomies
Hybrid procedures, combining surgical and percutaneous techniques, have been employed to manage complex congenital heart disease cases with branch pulmonary artery stenosis. These procedures are particularly useful for patients with challenging anatomies or complications from previous percutaneous interventions . Hybrid stenting has proven to be safe and effective, although precise stent positioning is critical to avoid the need for future reinterventions .
Surgical Manipulation of Stents
In cases where patients with previously implanted pulmonary artery stents undergo subsequent cardiac surgery, surgical manipulation of the stents (removal, trimming, or patching) does not significantly alter the need for future reinterventions. However, stents that are transected longitudinally and patched may require more frequent catheter reinterventions.
Endovascular Stent-Grafting for Thoracic Aortic Aneurysms
Safety and Feasibility
Endovascular stent-grafting has emerged as a less invasive alternative for treating descending thoracic aortic aneurysms. This technique has shown promising results, with successful deployment in all patients and a relatively low postoperative mortality rate (9.5%). The procedure is particularly beneficial for patients unsuitable for conventional surgery, offering a viable option to exclude aneurysms from blood flow.
Long-term Outcomes
The long-term survival rates following endovascular stent-grafting are favorable, with actuarial survival rates of 79% at one year and 55% at five years. The procedure's success underscores the importance of adequate training in endovascular techniques for cardiothoracic surgeons.
Conclusion
Stent surgical procedures have revolutionized the treatment of various vascular and obstructive conditions, offering significant advantages in terms of procedural success, clinical outcomes, and long-term benefits. From coronary artery disease to obstructive colorectal cancer and congenital heart disease, stent placement continues to provide effective and less invasive alternatives to traditional surgical methods.
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