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Can intracranial stents help prevent strokes?

Strokes can be caused by narrowed or blocked blood vessels in the brain. The most common way to prevent further strokes in people who have already had a stroke for this reason is to use medication. Stents can also be used to keep the blood vessel open, but research shows that they often trigger intracranial hemorrhages when they are put in, which can in turn also cause a stroke.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 11, 2015

Drug‐eluting stents versus bare metal stents for angina or acute coronary syndromes

Coronary artery disease generally results from the build‐up of fatty material and other substances on the internal surface of the blood vessels which supply the heart, gradually reducing its supply of oxygen. There may or may not be associated pain (angina). The disease may cause sudden death and limit normal daily activity. One strategy used to control symptoms or restore blood supply is Percutaneous Transluminal Coronary Angioplasty (PTCA) in which a small elongated balloon is inflated at the site of the plaque, compacting the deposited material against the vessel wall. This review explores the effects of one category of interventional device used with PTCA: coronary artery stents. These are expandable devices resembling a tubular wire mesh used to 'scaffold' vessels open during PTCA procedures to relieve coronary obstructions in patients. The success rates associated with these devices are high, complication rates low and most patients experience improvement in symptoms. Nonetheless, rates of restenosis (re‐narrowing of the treated vessel) which may require a repeat intervention, are a significant limitation of the use of stents. An adaption of stent technology involves stents which release (elute) drugs over time in order to reduce restenosis; however these stents are expensive in comparison to their bare metal equivalent. Our review includes results from 47 studies (including more than 14,500 patients) and contains data up to five years following treatment. No statistically significant differences in death, myocardial infarction or vessel blockage were reported between drug‐eluting stents (DES) and bare metal stents (BMS). Use of DES did result in decrease in the number of times patients had to be re‐treated due to blockage of the blood vessel and/or stent. Thus, DES are effective in reducing rates of restenosis but are not superior to standard BMS in terms of decreasing death, myocardial infarction or thrombosis. The increased cost of DES and lack of evidence of their cost‐effectiveness means that various health funding agencies are either limiting their use or attempting to regulate use in relation to their price.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Endovascular stents for intermittent claudication

Intermittent claudication is a cramping leg pain that develops when walking and is relieved with rest. It is caused by inadequate blood flow to the leg muscles because of atherosclerosis (fatty deposits on the walls of the arteries blocking blood flow). People with mild‐to‐moderate claudication are advised to keep walking, stop smoking and reduce cardiovascular risk factors. Possible treatments include exercise, drugs, bypass surgery or angioplasty. Angioplasty involves expanding the narrowed artery. This can be done by inflating a 'balloon' inside the artery. Sometimes stents (thin metal sleeves) are inserted to keep the artery open.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy

The use of stents following pancreaticoduodenectomy was studied in 656 patients from five randomised controlled trials. Overall, the use of stents did not improve clinically meaningful outcomes. However, a subgroup analysis demonstrated a significant reduction in the incidence of pancreatic fistula, major complications and length of hospital stay with the use of external stents when compared with no stents. Further adequately‐powered randomized controlled trials are warranted to confirm the effectiveness of external stents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

People who undergo bypass surgery for narrowed coronary vessels may be less likely to need re‐intervention than those treated using angioplasty with stents

Narrowing of coronary arteries can be alleviated by complete replacement using bypass surgery or, alternatively, unblocking and supporting the vessels open using angioplasty and stents. Analysis of RCTs to 2004 indicates re‐intervention (to alleviate subsequent narrowing) is needed less commonly after surgery than after stenting. Risk of death or heart attack following either treatment appeared the same, but this may be because too few trial participants were collected together in the review and variation between trials (heterogeneity) may be masking true differences. Further trials of new techniques in a greater variety of patients with subsequent systematic review are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

In people who have had a heart attack because of blocked heart arteries insertion of thin metal tubes (stents) were better than using small balloons to open the arteries up again

Arteries can become clogged and narrowed with deposits of fat, cholesterol and other substances. This is called atherosclerosis and can cause heart attack. Two methods to open narrowed or clogged arteries in people who have had a recent heart attack are inserting a deflated small balloon in the artery and expand it to open the vessel (balloon angioplasty) or to insert a thin metal tube or sleeve (stent) into the artery to scaffold the artery open. This review compared these treatments and found both were equally effective at preventing death but using stents was better than balloon angioplasty because fewer arteries needed to be re‐cleared and stents prevented more heart attacks than balloon angioplasty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Palliative biliary stents for obstructing pancreatic cancer

The majority of patients with cancer of the pancreas are diagnosed only after blockage of the bile ducts has occurred. Surgical by‐pass (SBP) or endoscopic stenting (ES) of the blockage are the treatment options available for these patients. This review compares 29 randomised controlled trials that used surgical by‐pass, endoscopic metal stents or endoscopic plastic stents in patients with malignant bile duct obstruction. All included studies contained groups where cancer of the pancreas was the most common cause of bile duct obstruction. This review shows that endoscopic stents are preferable to surgery in palliation of malignant distal bile duct obstruction due to pancreatic cancer. The choice of metal or plastic stents depends on the expected survival of the patient; metal stents only differ from plastic stents in the risk of recurrent bile duct obstruction. Polyethylene stents and stainless‐steel alloy stents (Wallstent) are the most studied stents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Different stent graft types to repair thoracic aortic aneurysms

An aneurysm is a localised widening of an artery. The thoracic aorta is the largest artery in the body, delivering blood from the heart to the arms and head. If an aneurysm occurs in the thoracic aorta it can expand and may rupture, resulting in death. Open surgery can treat these aneurysms, which involves opening the chest and placing an artificial graft over the widening. A new alternative treatment involves an artificial stent graft, delivered through an arterial blood vessel in the groin, fixed over the widening. This technique is called endovascular repair. There are many different types of stent grafts available. They differ in how they are inserted into/access the blood vessel, how they attach to the walls of the artery and the design and materials they are made from. We searched for evidence directly comparing the different types of stent grafts in aneurysm repair. This review found no evidence from randomised controlled trials to determine if any specific stent graft performs better than another type of stent graft. More research is required to help surgeons decide which specific type of stent graft to use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Different stent grafts for repair of abdominal aortic aneurysms

An aneurysm is a localised widening of an artery. The abdominal aorta is the largest artery in the body, delivering blood from the heart to the organs in the abdomen and the legs. If an aneurysm occurs in the abdominal aorta it can expand and may rupture, resulting in death. Open surgery can treat these aneurysms; this involves opening the abdomen and placing an artificial graft over the widening. A new alternative treatment involves an artifical stent graft, delivered through an arterial blood vessel in the groin, fixed over the widening. This technique is called endovascular repair. There are many different types of stent graft available. They differ in how they are inserted in/access the blood vessel, how they attach to the walls of the artery and the design and materials they are made from. We searched for evidence directly comparing the different types of stent grafts in aneurysm repair. This review found no randomised controlled trial evidence investigating if any specific stent graft performs better than another type of stent graft. More research is required to help surgeons decide which specific type of stent graft to use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Still awaiting evidence for effect of ursodeoxycholic acid and/or antibiotics in the prevention of biliary stent occlusion

Malignant occlusion of the biliary tract can be relieved by insertion of a stent, which allows passage of the biliary fluid. However, stents often clog. This Review examines if ursodeoxycholic acid (a bile acid) and/or antibiotics may prevent clogging of biliary stents. At present there is not sufficient evidence to recommend ursodeoxycholic acid and/or antibiotics for biliary stented patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Thoracic endoscopic stent graft versus open surgery for thoracic aneurysm

An aneurysm is a localised dilation or widening of an artery. Thoracic aneurysm is a relatively infrequent disease that affects both older men and women. The cause of thoracic aneurysm is unknown but the aneurysms generally do not cause symptoms. They are, however, likely to increase in size. Patients who do not receive surgical treatment at the time of diagnosis have a greater chance of dying from rupture of the aneurysm. Aneurysms greater than 5 cm carry a higher risk of bursting. Surgical repair of aneurysms requires general anaesthesia and opening of the chest wall to place an artificial graft in the area of the diseased vessel. This is associated with procedure‐related deaths and complications such as paraplegia, stroke, and renal failure and excludes some patients because of age and accompanying illnesses. Endovascular repair is a recently introduced, minimally invasive technique in which a stent is delivered through a blood vessel and fixed to the aneurysm. A seal forms between the stent and the vessel wall so that blood does not flow between the two. We searched for evidence of the effectiveness of endovascular repair compared with open surgical repair for thoracic aneurysms. No randomised controlled trials were found in the medical literature. Reports from non‐randomised studies suggest that endovascular repair is technically feasible and may reduce early negative outcomes including death and paraplegia. However, stent devices have late complications that are uncommon to open surgery (for example, development of leaks, graft migration, need for re‐intervention) and patients receiving stents may require frequent surveillance with computed tomography (CT) scans.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Patients with refractory ascites may temporarily benefit from transjugular intrahepatic portosystemic stent‐shunts

Refractory ascites causes substantial morbidity in patients with cirrhosis. Randomised trials have compared transjugular intrahepatic portosystemic stent‐shunts with paracentesis. Mortality, gastrointestinal bleeding, renal failure, or infection did not differ significantly between the two intervention groups. Transjugular intrahepatic portosystemic stent‐shunts effectively decreased the risk of ascites fluid re‐accumulation, but was associated with an increased risk of hepatic encephalopathy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Early invasive versus conservative strategies for unstable angina and non‐ST elevation myocardial infarction in the stent era

Patients with prolonged or recurrent chest pain may have a condition called unstable angina or suffer a certain type of heart attack called non‐ST elevation myocardial infarction. These conditions can be managed with two main treatment strategies. Several studies have been done to determine which strategy is superior. In one strategy, the routine invasive strategy, all patients have a catheter inserted to image their coronary arteries and look for atherosclerotic narrowing. If a significant narrowing or complicated plaque is found then the artery may be dilated by means of a balloon catheter that is inserted and inflated across the narrowing. The patency of the vessel is maintained by insertion of a metallic stent. In some cases, the narrowing will not be amenable to this approach and surgery to bypass the narrowing is required. In the other conservative strategy, patients are initially treated with drugs and only those who suffer more chest pain while receiving the drugs or who demonstrate evidence of atherosclerotic narrowing as suggested by other non‐invasive tests, such as stress testing or imaging, undergo coronary angiography and revascularization if indicated.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Intravascular brachytherapy (radiation treatment), inside arteries or bypass grafts, after angioplasty or stent surgery

Intravascular brachytherapy (radiation treatment) inside arteries after angioplasty, stent insertion, or bypass grafts may prevent narrowing of the arteries or grafts. Narrowed and blocked arteries can be treated by bypassing the blockage using a graft, angioplasty (widening the artery by inserting a balloon), or inserting a stent (thin metal sleeve) to hold the artery open. However, restenosis (return of the narrowing or obstruction) often occurs within a year. Intravascular brachytherapy (IVBT) aims to prevent restenosis by the application of radiation to the affected part of the artery after the angioplasty or stent insertion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Renal Artery Stenosis Treatments: A Guide for Consumers

This guide can help you talk with your doctor or nurse about treatments for renal artery stenosis (pronounced “steh-NO-sis”). The information in this guide comes from a government-funded review of research about the treatment of RAS. It talks about: Health problems caused by RAS, like high blood pressure and kidney damage. Two kinds of treatment for RAS.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 26, 2007

Colonic stenting has no decisive advantages to Emergency surgery.

Emergency surgical decompression has been the traditional treatment of choice for the malignant colorectal tumours presenting as an acute obstruction. This is associated with higher morbidity and mortality due to the emergency nature of the procedure along with other existing co morbidities. This systematic review of five randomised trial shows higher rates of clinical relief of obstruction in emergency surgery. Colonic stent has not been shown to be as effective as emergency surgery in malignant colorectal obstructions. However, use of colonic stent is associated with comparable mortality and morbidity with advantage of shorter hospital stay and procedure time and less blood loss. Further randomised controlled trials with larger sample size and robust trial design are required on this topic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for reducing difficulty in swallowing in people with oesophageal cancer

For most patients with unresectable or inoperable oesophageal cancer, providing clinical benefit with palliative treatment is highly desirable. However, the optimal palliative technique for dysphagia improvement and better quality of life is not established.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Angioplasty versus angioplasty plus stenting for lesions of the superficial femoral artery

Intermittent claudication is pain in the leg that is brought on by walking and which is relieved by rest. The pain is a result of insufficient blood flow to the muscles of the leg due to narrowing of the arteries by atherosclerosis. People who have narrowing of the main artery in the thigh, the superficial femoral artery, and intermittent claudication which severely restricts their quality of life or causes dangerous tissue changes in the leg may undergo a procedure known as angioplasty to widen this narrowing. This procedure involves passing a balloon into the narrowed segment and inflating the balloon to push the artery open. In addition to this, a cylindrical piece of metal mesh called a stent may be inserted at the site where the artery has been pushed open with the aim of holding the narrowing open in the future. While stents work well in the arteries of the heart and in other arteries, it is not clear whether adding stents following angioplasty to narrowings of the superficial femoral artery gives any benefit to the patient.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treatments for coarctation of the thoracic aorta

Coarctation of the aorta (CoA) is a congenital narrowing of the lumen in a section of the aorta. The narrowing is most commonly in the upper thoracic aorta but can occur in the abdominal aorta. It is present at birth and males are more often affected than females. Clinical symptoms are variable and depend on the position, degree and extent of the narrowed segment of the aorta. Other congenital heart abnormalities may also be present. In general, the diagnosis is made by finding a difference in pulsations and blood pressure between the upper body and arms and the lower body and legs. If left unrepaired, average survival is 31 years. The treatment of CoA is intended to improve life expectancy and quality of life by reducing the incidence of aortic and cardiac disabling conditions such as aneurysm (dilation) of the ascending aorta, coronary artery disease, high blood pressure, and aortic and mitral valvular disease. The treatment of CoA consists of enlarging of the narrowed segment. Traditionally this required open heart surgery. Balloon angioplasty became available as an alternative treatment in the 1980s but recurrence, aneurysm and aortic dissection (a tear in the inner wall of the aorta causing blood to flow between the layers of the blood vessel wall) remained disadvantages of both treatments. In the early 1990s, endovascular stents were introduced and have become an alternative approach to surgical repair. The present review looked at the available evidence for the effectiveness of open surgery compared with placing a stent in the coarctation of the thoracic aorta. The review authors searched the medical literature but they did not found any studies that compared open surgery and stent placement for the treatment of coarctation of the thoracic aorta. The treatment of CoA is a challenging procedure and the centers that perform this treatment have a well‐established strategy for patients with CoA; the strategy is in accordance with the experience of involved professionals and local resources. In both situations experience and resources have improved the results of the treatment. However a more concrete and long‐term analysis of these strategies is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Routine prophylactic stenting reduces the incidence of major urological complications in kidney transplant recipients

Kidney transplantation is the treatment of choice for end‐stage kidney disease, improving quality of life and extending the recipient's life expectancy. Interventions aimed at reducing the burden of post‐transplant complications are a major area of research amongst the transplant community. Major urological complications (MUCs) (e.g. urine leak, obstruction) can occur in the immediate post‐transplant period. This review aimed to determine the benefit and harms of the use of routine stenting in kidney transplant recipients in the prevention of urological complications. Seven studies (1154 patients) were identified. The incidence of MUCs were significantly reduced by the use of prophylactic stenting. Urinary tract infections (UTIs) were more common in stented patients however the addition of antibiotic prophylaxis resulted in no difference in the incidence of UTIs between the two groups. More studies are needed to investigate the use of selective versus universal prophylactic stenting for the unresolved issues of quality of life and cost.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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