A Dedicated Venous Self-expanding Oblique Hybrid Nitinol Stent (Sinus-Obliquus Stent)
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1 A Dedicated Venous Self-expanding Oblique Hybrid Nitinol Stent (Sinus-Obliquus Stent) Anna Stuck, Rolf P. Engelberger, Nils Kucher Division of Angiology Cantonal Hospital Fribourg & Bern University Hospital Switzerland
2 Patency of iliofemoral vein stents Primary patency Secondary patency Nonthrombotic Chronic postthrombotic Acute thrombosis Mahmood K. Razavi et al. Circ Cardiovasc Interv. 2015;8:e Copyright American Heart Association, Inc. All rights reserved.
3 Patency of iliofemoral vein stents Meissner Phlebology 2013;28: 91
4 Contralateral iliac vein thrombosis after May Thurner stenting using conventional stents placed into IVC is it an issue or not?
5 Contralateral iliac vein thrombosis The rate of contralateral iliac vein thrombosis after conventional May-Thurner stenting with proximal position in the IVC is unclear because almost no study looked at long term data in patients with stopped anticoagulation therapy post stenting After 5 years up to 10% with contralateral DVT with Wallstent Murphy et al, J Vasc Surg Venous Lymphat Disord 2017;5:8-17
6 Challenge for Stents: Strength and Flexibility 90 kinking CIV Iliac vein anatomy: Lateral view 90 hip flexion Baekgaard et al, Phlebology 2013 Courtesy of Prof N. Kucher
7 Dedicated May-Thurner Stent: sinus-obliquus stent Proximal closed cell design: Provides high radial force at compression site Oblique design (35 ) prevents jailing off the contralateral iliac vein 4 markers for correct rotational positioning Distal open cell design: Provides flexibility and less radial force for accomodating the curved anatomy of iliac veins during hip flexion
8 Dedicated May-Thurner Stent: sinus-obliquus stent Visualized from behind
9 sinus-obliquus stent implantation
10 Objective We investigated venous patency rates and clinical outcomes of patients with iliac vein compression treated with this novel venous self-expanding oblique hybrid nitinol stent (sinus-obliquus, Optimed, Germany) Stuck A, et al. J Endovasc Ther 2017;24:159
11 Bern Venous Stent Registry The Bern Venous Stent Registry is a prospective registry including all patients receiving venous stents at the University Clinic of Angiology in Bern, Switzerland For this analysis, patients treated with sinus- Obliquus Stent and minimal follow-up of 6 months were analyzed Stuck A, et al. J Endovasc Ther 2017;24:159
12 Results Study population 24 patients: 20 women, mean age 39 ± 18 years 10 with acute ilio-femoral DVT after catheter-directed thrombolysis 10 with post-thrombotic syndrome (PTS) 4 with non-thrombotic iliac vein compression Mean Follow up was 10 months (range 6-18 months) Mean time range between most recent DVT and intervention: 10.3 years in patients with PTS 7 days in patients with acute DVT Interventional details 23 (96%) patients with stent implantation in left common iliac vein 12 (50%) with distal stent extension in CFV (sinux-xl Flex) Stuck A, et al. J Endovasc Ther 2017;24:159
13 Results: patency rates Primary patency estimates by Kaplan-Meier analysis were 92% at 6 months [95% CI 71-98%] Secondary patency was 100%. Stuck A, et al. J Endovasc Ther 2017;24:159
14 Results: reinterventions Three symptomatic patients underwent reintervention for early and late stent thromboses and the third for in-stent restenosis. No stent fractures No contralateral DVTs Stuck A, et al. J Endovasc Ther 2017;24:159
15 Results: clinical outcomes In 10 patients with PTS: Villalta score decreased by 6 ± 6 points (P=0.02) Revised Venous Clinical Severity score (rvcss) decreased by 3 ± 1 points (P=.05) In 10 patients with acute DVT all patients were free from the PTS at the latest follow-up Stuck A, et al. J Endovasc Ther 2017;24:159
16 Conclusion Patency rates and clinical outcomes at 6 months in patients with common iliac vein compression treated with the sinus- Obliquus stents were excellent Further studies need to investigate the efficacy and safety of sinus-obliquus stenting in a long-term perspective.
17 A Dedicated Venous Self-expanding Oblique Hybrid Nitinol Stent (Sinus-Obliquus Stent) Anna Stuck, Rolf P. Engelberger, Nils Kucher Division of Angiology Cantonal Hospital Fribourg & Bern University Hospital Switzerland
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