title: In situ cooling with ice water for the easier removal of self-expanding nitinol stents.
abstract: BACKGROUND
  It is yet to be determined what effects temperature has on the properties of nitinol in order to simplify the process of removing nitinol self-expanding metal stents (SEMS).
  
  
  METHODS
  We describe the procedure for removal of SEMS in a total of 11 cases with 9 patients. A study involving cooling of nitinol stents in situ with ice water just before their removal was attempted.
  
  
  RESULTS
  All stents were removed successfully. In partially covered and in fully covered stents, the stent rigidity was noticeably reduced following cooling. Stent removal was performed by inversion, which was achieved by pulling on the stent from its distal end. No adverse events were observed during this trial.
  
  
  CONCLUSIONS
  The higher pliability of the stents after ice-water cooling facilitates stent removal. With this method, a mobilization of all stents by the invagination technique was achieved. The separation of the uncoated stent ends from the intestinal wall by the invagination technique, as well as the mucosal vasoconstriction resulting from the cooling, lead to an easier SEMS removal and may serve to prevent severe bleeding of the mucosal wall during this process.
authors.affiliation: Clinic for Internal Medicine, St. Hedwig-Krankenhaus, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Merkel
authors.affiliation: Department of Gastroenterology, St. Josefs-Hospital, Cloppenburg, Germany.
authors.forename: Eckhard
authors.initials: E
authors.lastname: Brinkmann
authors.affiliation: Clinic for Internal Medicine, St. Hedwig-Krankenhaus, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiens
authors.affiliation: Clinic for Internal Medicine, St. Hedwig-Krankenhaus, Berlin, Germany.
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Derwahl