ScholarWorks@중앙대학교

초록

OBJECTIVE: To investigate the safety and efficacy of large-bore uncovered stents for treating malignant superior vena cava syndrome. METHODS: This retrospective study included 115 patients (89 men, 26 women; mean age 63.2&#xa0;years; range 21-83&#xa0;years) who underwent endovascular large-bore (&#x2265;18&#xa0;mm in diameter) uncovered stent placement between August 2015 and July 2022. One patient was lost to follow-up. Therefore, 114 patients were available for follow-up. RESULTS: Stent placement was technically successful in all 115 patients. Minor procedure-related complications occurred in nine (7.8&#xa0;%) patients. One hundred eight (93.9&#xa0;%) patients experienced complete or marked symptomatic relief (Kishi score&#xa0;&#x2264;&#xa0;2) at a mean of 3&#xa0;days after procedure. The cumulative stent patency rates were 98.2&#xa0;%, 95&#xa0;%, 93.7&#xa0;%, 91.5&#xa0;%, 83.5&#xa0;%, and 83.5&#xa0;% at 1, 3, 6, 12, 18, and 24&#xa0;months, respectively. Stent occlusion occurred in ten (8.8&#xa0;%) of 114 patients at a mean of 215&#xa0;days (range 1-732&#xa0;days) due to thrombosis (n&#xa0;=&#xa0;7) and tumor ingrowth (n&#xa0;=&#xa0;3). Stent occlusion did not occur in 21 patients who underwent subsequent central venous catheter insertion. The median patient survival time was 159&#xa0;days (95&#xa0;% confidence interval 102-216&#xa0;days). Univariate and multivariate Cox regression analysis revealed adjuvant anticancer treatment (p&#xa0;=&#xa0;0.001) and tumor response (p&#xa0;<&#xa0;0.001) as independent predictors of patient survival. CONCLUSIONS: Endovascular placement of large-bore uncovered stents was a safe and effective treatment for malignant superior vena cava syndrome. Large-bore stent placement can effectively prevent stent occlusion by tumor ingrowth in most cases, and it can provide a sufficient diameter for subsequent insertion of central venous catheters. Copyright © 2024 Elsevier B.V. All rights reserved.

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