NHE wrote:Dr. Sclafani,
I recently ran across the following pdf PowerPoint presentation that discusses the incidence of stent fracture in the superficial femoral artery (SFA).
Stent Fractures in the SFA - Scheinert.pdf
I know that you are personally against the use of stents in the jugular veins of MS patients. I also know that several doctors are currently using stents and that many patients that have been treated for CCSVI have received stents. Some of these patients have had complications with in-stent stenosis either due to intimal hyperplasia or due to thrombosis. However, one thing that I haven't seen addressed is the expected lifetime of such stents in the jugular vein. The presentation discusses several types of stresses which could lead to fracture and some of these stresses might be found in the jugular vein. For example, axial compression of the stent might occur when one raises or lowers their head in a nodding motion and torsional strain on the stent might occur when one turns their head to look to the side. I realize that many of the stents that have been used in the jugular veins are shorter than the ones discussed for the SFA, however, the presentation still reports a fracture rate of 13.2% for stents shorter than 8 cm. My question is should patients be concerned about stent fracture in stents used for jugular veins? It is still very early in the history of stent use in jugular veins, but could such failures become more common in the not too distant future? Is the possiblity of stent fracture a reason to avoid stents in the jugular veins? The patency rate of Nitinol Smart stents reported in the presentation at only 60% after just 1 year is not very encouraging. Moreover, the patency rate of fractured stents after 20 months is also disturbingly low (around 10%).
Thanks in advance for your response, NHE
sorry i missed this question and thanks for bringing my failure to answer to my attention.
yes, stent fracture is one of the reasons i am against stenting. Not only is there stress with nodding and with neck rotation, there is also stress from shoulder motion and a stent that is used against the valvular problems at the confluens, just under the clavicle, which also moves.
In addition, some proceduralists have used balloon expandable stents and these risk being crushed by powerful forces in the neck or by external compression as well.
There are other reasons I do not want to use stents as well