Endovascular stenting

  Endoluminal metallic stent (EMS) includes endovascular stent and non-endovascular stent. Endoluminal stenting is the placement of an endoprosthesis in the lesioned segment based on balloon dilatation and shaping to support the stenosed and occluded segment, reduce elastic retraction and remodeling of the vessel, and maintain luminal flow. Some of the endoprostheses also have the effect of preventing restenosis.  The materials commonly used for stent fabrication include tantalum metal, medical stainless steel and nickel-titanium alloy. Metal stents have achieved remarkable efficacy after entering clinical treatment, but after more than a decade of application, some shortcomings and drawbacks of metal stents have been gradually exposed, such as easy thrombogenicity, high restenosis rate, causing damage to the vessel wall and permanent retention in vivo. In response to these shortcomings, overlapping stents and biomaterial stents have been developed.  The types of stents can be divided into two types: self-extending and balloon-expandable according to the way they are deployed in the blood vessels. The former, such as the Z-shaped stent (Gianturco stent) and the mesh-shaped Wallstent stent, can be self-expanded in the blood vessel. The latter, such as Palmaz stent and Strecker stent, are inelastic and rely on balloon expansion to a certain diameter value to adhere to the vessel. The stents can be divided into bare type, coated type and overcoated type according to the surface treatment. The surface of the bare type is only polished; the coated type is coated with heparin, titanium oxide and other substances on the metal surface; the coated type is coated with degradable or non-degradable polymer film on the exterior of the metal stent. Therapeutic stents include stents that are coated with drugs on the exterior of the stent or carry therapeutic substances by using the outer coating of the stent or radioactive stents.  After stent placement, elastic retraction and remodeling of the vessel are reduced, keeping the lumen open and smooth, and reducing the occurrence of restenosis. Two important features of stent placement are: no obstruction of the branch vessel opening and no stimulation of atheroma formation.  When endovascular stenting is performed, angiography must first be performed to clarify the nature, location and extent of the lesion and to select the appropriate indication, and then, most importantly, to select the appropriate stent according to the characteristics of the lesion, including the type, diameter and length of the stent. The diameter of the stent should be 10-15% larger than the diameter of the normal vessel in the adjacent segment of the lesion. The stent length should be longer than the lesion. If one or section is not enough, two stents can be overlapped or multi-section stents can be used. Special attention should be paid to the accurate positioning of the stent when it is placed. Successful stent placement should result in accurate placement of the stent in the stented segment and coverage of the upper and lower ends of the lesion. Postoperative anticoagulation therapy should be observed.  Stents have been widely used in the arterial and venous systems and in the non-vascular lumen system. The arterial system includes peripheral and visceral arteries, coronary arteries and cerebral arteries; the venous system includes the vena cava, portal vein and peripheral venous system, and others such as the establishment of TIPSS shunts. Any site where balloon angioplasty can be performed can be treated with stent placement. Stents are mainly used to treat stenosis-occlusive diseases, but in recent years they have also been used to treat dilated arterial diseases such as thoracic and abdominal aortic aneurysms and pseudoaneurysms and arteriovenous fistulas, which have a higher rate of vessel opening, fewer complications and better efficacy than balloon angioplasty alone.