Self-expanding metal stents for palliative treatment of superior vena caval syndrome.
OBJECTIVE
Two stent types (a new Wallstent and a Z-stent) were investigated in 30 patients with recurrent malignant superior vena caval syndrome (SVCS).


METHODS
Eligibility requirements were that the patient had recurrent symptoms after appropriate radiation therapy, chemotherapy, or both; >/= 75% of the vessel was occluded; and there was collateral flow. Because of the limited availability of stents, it was not possible to perform a prospectively randomized study.


RESULTS
In the Z-stent group (17 patients), occlusion of the stent due to acute thrombosis occurred within 12 hr in 4 patients (24%), but in the other 13 patients (76%) symptoms disappeared completely. After 2 weeks the cavogram in these patients showed no signs of thrombosis, and 12 (61%) of the patients remained symptom-free. There was partial occlusion in 5 patients (29%), without relevant clinical symptoms. Of the 13 patients who received Wallstents, only 1 had an acute immediate thrombosis (8%). Symptoms disappeared completely in the other 12 patients and no signs of thrombosis were seen. However, after 2 weeks complete stent occlusion with SVCS was found in 3 patients (23%) and partial occlusion with minor clinical symptoms in 6 (46%). Only 3 patients (23%) had complete relief of the SVCS. The difference between the rates of occlusion of the two stents after 2 weeks was highly significant (p = 0.008).


CONCLUSIONS
The overall clinical success rate for long-term patency was 100% for the Z-stents and 69% for the new Wallstent. These results suggest that when used for this purpose, the new Wallstent is more thrombogenic at 2 weeks than the Z-stent.
Oudkerk
M
M
Department of Radiodiagnostics, Dr. Danile den Hoed Cancer Center/University Hospital Rotterdam, Rotterdam, The Netherlands
Kuijpers
T J
TJ
Schmitz
P I
PI
Loosveld
O
O
de Wit
R
R
D003131:Combined Modality Therapy; D000075202:Contraindications; D004867:Equipment Design; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome