Stents

Chapter 6


Stents


Gregory J. Dubel and Timothy P. Murphy




Introduction


Stents and stent-grafts have a variety of applications for image-guided interventions, including both vascular and nonvascular uses. Many stents marketed in the United States are U.S. Food and Drug Administration (FDA) approved for treating biliary or tracheobronchial stenoses, although recently more have gained FDA approval for intravascular use (Tables e6-1, e6-2, and e6-3; also see discussions of individual stents).



TABLE e6-1


Balloon-Expandable (BX) Stents
























































































































































































































































Device Company Name FDA Indication Critical Features Metal Minimum Introducer (F) Maximum wire (in) Stent Diam. (mm) Stent Length (mm)
Assurant Cobalt Medtronic Inc. Iliac, Biliary High strength/radiopacity, minimal foreshortening, mod flexibility, fused module design, smaller cells CoCr 6 0.035 6-8 20, 30, 40, 60
9-10 30, 40, 60
Express Iliac LD Boston Scientific Iliac, Biliary Mod strength, min foreshortening, flexible, micro/macro modules assist conformability 316 L-SS 6 0.035 5-8 17, 27, 37
7 0.035 8 57
7 0.035 9, 10 25, 37, 57
Express Renal SD Boston Scientific Renal, biliary Low-profile version of Express with similar attributes 316 L-SS 5 0.018 4, 5 15, 19
5 0.018 6 14, 18
6 0.018 7 15, 19
Formula 414 RX/Formula 418 Cook Medical Biliary Mod strength/radiopacity, no foreshortening, low-profile on par w/Cobalt designs, min balloon overhang 316 L-SS 5,6 0.014 (414 RX) 0.018 (418) 3-8 12, 16, 20, 24, 30
IntraStent Double Strut LD ev3/Covidien Biliary Mod-high radial strength/radiopacity, mod-high flexibility, no foreshortening, open-cell 316 L-SS 8 Unmounted 9-12 16, 26, 36, 56, 76
IntraStent Mega LD ev3/Covidien Biliary Mod-high radial strength/radiopacity, mod flexibility, no foreshortening, open-cell 316 L-SS 9 Unmounted 9-12 16, 26, 36
IntraStent Max LD ev3/Covidien Biliary High radial strength/radiopacity, moderate flexibility, no foreshortening, open-cell 316 L-SS 11 Unmounted 12 16, 26, 36
Palmaz (M, L, or XL) Cordis Endovascular Iliac (L), Iliac/Renal (M), Biliary (XL) High strength/radiopacity, closed-cell design, variable foreshortening, can be overdilated, poor flexibility, unmounted stents require crimper from manufacturer 316 L-SS 6, 7 (M) Unmounted 4-8 10, 15, 20, 29, 39 (biliary ind)
8-12 (L) 8-12 30
10-12 (XL) Unmounted 10 (over dil 14-26) 30, 40, 50
Palmaz Blue Cordis Endovascular Biliary As per Palmaz Blue with monorail delivery CoCr alloy (L605) 5 0.014 5-6 15, 18
Increased strength/flexibility/radiopacity, decreased metal surface area, increased cell size compared with Genesis, improved MRA 5 0.018 4-7 12, 15, 18, 24
Palmaz Genesis Cordis Endovascular Biliary As per Genesis with monorail delivery 316 L-SS 4-6 0.014 4-7 12, 15, 18, 24
Strength near Palmaz, more flexible/conformable/trackable, less foreshortening, closed cell, proprietary nesting on balloon, final length dependent upon dilation diameter 5, 6 0.018 3-8 12, 15, 18, 24, 29, 39
6,7 0.035 4-10 12, 15, 18, 24, 29, 39, 59, 79
Palmaz Genesis (unmounted)   Biliary As per Genesis, unmounted, requires manufacturer crimper 316 L-SS 6
7-7.5
8
Unmounted 5-8
5-10
10-12
12, 15, 18, 24
29, 39, 59, 79
19, 25, 29, 39, 59
 
 
ParaMount Mini GPS ev3/Covidien Biliary Tantalum markers at end, low-profile, minimal foreshortening, open small cells, conformable, flexible, zero balloon overhang 316 L-SS 5
6
0.014, 0.018 5, 6
7
14, 18, 21
14, 18, 21
Visi-Pro ev3/Covidien Biliary Tantalum markers at end, no foreshortening, low-profile, open small cells, conformable, flexible, zero balloon overhang 316 L-SS 6 0.035 5-8 12 (ex 8 mm), 17, 27, 37, 57
7 0.035 9-10 17, 27, 37, 57
Racer Medtronic Inc. Biliary Mod-high strength, more flexible/conformable/trackable, min foreshortening, small cells, proprietary stent retention system, improved MRA Co alloy (MP35N) 5, 6 0.014, 0.018 4-7 12, 18
RX Herculink Elite Abbott Vascular Renal, biliary Mod-high strength/radiopacity, mod-high flexibility, open small cell, low foreshortening, stent retention system, monorail CoCr 5 0.018 4, 4.5, 5, 5.5, 6, 6.5, 7 12 (ex 7 mm), 15, 18
Omnilink Abbott Vascular Biliary Mod strength/radiopacity, mod-high flexibility, low foreshortening, small cells, can be overdilated 316 L SS 5, 6, 7, 8 0.018 4-10 18, 28, 38, 58
5, 6, 7, 8 0.035 5-10 12, 16, 18, 28, 38, 58
Valeo Bard Peripheral Vascular Biliary Mod radial strength and radiopacity, flexible, open cell 316 L SS 6
7
0.035
0.035
6,7,8
9,10
18, 26, 36, 56 (ex 8 × 56)
18, 26, 36, 56 (ex 8 × 56)


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TABLE e6-2


Self-Expandable (SX) Stents




























































































































































































































































































































































































































































































Device Manufacturer FDA Indication Critical Features Metal Min Introducer (OD) (F) Max wire (in) Stent Diameter (mm) Stent Length (mm) Delivery System Length (cm) Notes
Rx Acculink Abbott Vascular Carotid Monorail, small cells/good scaffolding, fixed handle deployment, for use with Accunet EPS Nitinol 6 0.014 5-10 straight 20, 30, 40 126  
6-8, 7-10 taper 30, 40  
Absolute Pro Abbott Vascular Biliary Injectable triaxial delivery catheter, platinum markers at ends Nitinol 6 0.035 5-10 20, 30, 40, 60, 80, 100 80, 135 Inject delivery catheter
Complete SE Medtronic Inc. Iliac Open small cells, tantalum markers at ends Nitinol 6 0.035 6-10 20, 40, 60, 80, 100 80, 120  
Iliac, biliary Nitinol 6 0.035 4-10 20-150 120 Gold markers
Supera Veritas IDEV Technologies Biliary Woven, highly flexible, conformable, closed cell Nitinol 6 0.035 4-8 40, 60, 80, 100, 120 120  
Dynalink Guidant Biliary Mod size open cells, highly conformable, fixed handle deployment Nitinol 6 0.018 5-10 28, 38, 56, 80, 100 80, 120 Can inject sheath w/stent in place, accurate deployment system
LifeStent Vascular
LifeStent XL
LifeStent Solo
Bard Peripheral Vascular SFA/prox pop Small open-cell design, platinum markers, rotating knob delivery catheter
As LifeStent but with ratchet handle delivery system
Nitinol 6 0.035
0.035
0.035
6-7
6-7
6-7
20, 30, 40, 60, 80,
100, 120, 150, 170
200
80, 130
80, 130
80, 130
 
E·Luminexx Bard Peripheral Vascular Iliac, biliary Small cell size, large welded Ta markers, enhanced electropolishing, ratchet delivery Nitinol 6 0.035 7-10 20, 30, 40, 50, 60, 80, 100 80, 135 Tantalum markers
Neuroform Boston Scientific HDE wide-neck intracranial aneurysms Designed for intracranial/small-vessel use, min foreshortening, highly conformable, Humanitarian Device Exemption (HDE) Nitinol 5 0.014 2.5, 3, 3.5, 4, 4.5 10, 15, 20, 30    
Precise Cordis Endovascular Biliary OTW, low-profile S.M.A.R.T., extremely flexible/conformable, segmented Nitinol 6 0.018 5-10 20, 30, 40 135  
Precise RX Cordis Endovascular Biliary Monorail version of Precise Nitinol 5 0.014 5-7 20, 30, 40 135  
6 0.014 8-10 20, 30, 40 135  
Precise Carotid Cordis Endovascular Carotid OTW, autotapering, use with Emboshield EPS Nitinol 5.5
6
0.018
0.018
5-8
9-10
20, 30, 40
20, 30, 40
135
135
 
 
Precise Pro RX Cordis Endovascular Carotid Monorail, autotapering, use with Emboshield EPS Nitinol 5 0.014 5-18 20, 30, 40 135 5 F 6-8, 6F 9-10
6 0.014 9-10 20, 30, 40 135  
Protege GPS ev3/Covidien Biliary Flexible, retention lock prevents stent jumping, tantalum markers at ends, zero foreshortening Nitinol 6 0.018 6-10 20, 30, 40, 60, 80 135  
6 0.035 9, 10, 12, 14 20, 30, 40, 60, 80 80, 120  
Protege EverFlex ev3/Covidien Biliary As per Protege GPS with added flexibility Nitinol 6 0.035 5-8 20, 30, 40, 60, 80, 100, 120, 150 (150 not avail in 5 mm) 80, 120  
Protege BIGGS ev3/Covidien Biliary Large-diameter version of Protege EverFlex Nitinol 6 0.035 9-14 20, 30, 40, 60, 80 80, 120  
Protege RX ev3/Covidien Carotid Carotid version of Protege, monorail, use w/SpiderFX EPS Nitinol 6 0.018 6-10 straight 20, 30, 40, 60 n/a  
6 0.018 6-8, 7-10 taper 30, 40 n/a  
Sentinol Boston Scientific Biliary Variable cell size, platinum markers, proprietary surface prep to decrease corrosion Nitinol 6 0.035 5-10 20, 40, 60, 80, 75, 135  
S.M.A.R.T. Cordis Endovascular Biliary Small cell size, highly conformable, segmented Nitinol 7 0.035 6-8 120, 150 120  
S.M.A.R.T. Control Cordis Endovascular Biliary As per S.M.A.R.T. plus coined tantalum markers, w/thumb screw delivery system Nitinol 6 0.035 9-10 30, 40, 60, 80 80, 120  
7 0.035 12-14 30, 40, 60, 80 80, 120  
Iliac 6 0.035 6, 7, 8 20, 30, 40, 60, 80, 100 80, 120  
6 0.035 9, 10 20, 30, 40, 60 80, 120  
Symphony Boston Scientific Biliary Hexagonal, large cells from shaped nitinol wire, less flexible, mod hoop strength, platinum markers Nitinol 7 0.035 5-8, 10, 12, 14 20, 22, 23, 40, 44, 60 75, 110  
Wallstent (various designs) Boston Scientific Carotid
Iliac
Venous
Biliary
Tracheobronchial
TIPS
Braided, foreshortens, use with FilterWire EPS Elgiloy 5-6 0.014 6, 8, 10 21, 22, 24, 29, 36, 37 135  
Braided, high flexible/scaffolding, closed-cell, 20%-50% foreshortening, reconstrainable, multiple designs (iliac, biliary, etc.) 6 0.035 6-10 18-69 various 100, 160  
6-10 0.035 10, 12, 14, 16 20, 40, 42, 60, 68, 90, 94 75  
6-9 0.035 8, 10, 12 20, 40, 42, 60, 68, 90, 94 75  
6-12 0.035 5-24 various 20-94 various 135  
7-9 0.035 10, 12 40, 42, 60, 68, 90, 94 75  
Xact Abbot Vascular Carotid Monorail, closed cell, straight and tapered styles, use w/Emboshield Nitinol 6 0.014 7-10 straight 20, 30 135  
0.014 6-8, 7-9, 8-10 taper 30, 40  
Xceed Abbott Vascular Biliary Small cell size, highly conformable, coined radiopaque markers Nitinol 6 0.035 5-8 20, 30, 40, 60, 80 80, 120  
Xpert Abbott Vascular Biliary Very low profile, highly open cell, low chronic outward force, small vessel applications Nitinol 4 0.018 3-6 20, 30, 40, 60 80, 120  
Nitinol 5 0.018 8 30, 40, 60 80, 120  
Zilver 518
Zilver 518 RX
Zilver 635
Zilver 635 Biliary
Cook Medical IliacBiliary Small, open cell design, gold markers, no foreshortening Nitinol 5 0.018 6-10 20, 30, 40, 60, 80 125  
Nitinol 5 0.018 6-10 125  
Nitinol 6 0.035 6-10 80, 125  
Nitinol 6 0.035 4, 5, 12, 14 80, 125  
Enterprise Codman Neurovascular Wide-neck intracranial aneurysms Closed-cell, one-time recapture, radiopaque markers at ends of stent Nitinol via microcath >0.021 ID n/a 4.5 14, 22, 28, 37 135  
Wingspan Boston Scientific HDE for intracranial atherosclerotic disease Open-cell, flexible, radiopaque markers at ends, HDE Nitinol 5 0.014 2.5, 3, 3.5, 4, 4.5 9, 15, 20 131  


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TABLE e6-3


Peripheral Stent-Grafts














































































































Device Company Name FDA Indication Critical Features Construction Introducer Size (F) Max wire (in) Device Diameter (mm) Device Length (mm)
aSpire Vascular Architects
Vascular Architects
Biliary Flexible, mod foreshortening, reconstrainable, tantalum markers, side-branch patency ePTFE-covered helically shaped nitinol ribbon 7
8
0.018
0.035
6 -9
6-10, 12
25, 50, 100, 150
25, 50, 100, 150
Fluency Plus Bard Peripheral Vascular Tracheobronchial Flexible, min foreshortening, low profile, tantalum markers Nitinol w/internal and external layer ePTFE 8-9 0.035 6-10 40, 60, 80
Flair Bard Peripheral Vascular AV hemodialysis Grafts Flared end, flexible, min foreshortening, low profile, tantalum markers Nitinol w/internal and external layer ePTFE 9 0.035 6-9 30, 40, 50
iCast/Advanta Atrium Medical Tracheobronchial Balloon-expandable, min foreshortening, small delivery sheath 316 L-SS balloon-expandable stent encapsulated w/ePTFE 6 0.035 5-9 16, 22, 38, 59
7 0.035 10,12 38, 59
Viabahn W.L. Gore & Associates SFA, iliac, tracheobronchial Min foreshortening, flexible/conformable, must be covered w/sheath, heparin coating ePTFE externally supported with nitinol wire 6 0.018 5-6 25, 50, 100, 150
7 0.018 7-8  
11-12 0.035 9-11, 13 25, 50, 100, 150
Viabil W.L. Gore & Associates Biliary Biliary use, proximal anchors, w or w/o drainage holes ePTFE externally supported with nitinol wire 10 0.035 8, 10 40, 60, 80, 100
Viatorr W.L. Gore & Associates TIPS A 2-cm uncovered portal end, markers at hepatic end, and junction uncovered/covered Dual-layer ePTFE externally supported with nitinol wire 10 0.038 8,10,12 60, 70, 80, 90, 100
Wallgraft Boston Scientific Tracheobronchial, biliary Reconstrainable, 20%-50% foreshortening, non-flared ends Braided Elgiloy filaments covered w/ PET 9-12 0.035 6-12 20, 30, 50, 70

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Dec 23, 2015 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on Stents

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