Safety and Patency of Dedicated Venous Stents for Treatment of Thoracic Central Vein Stenosis Compared to Non-venous stents

Monday, March 6, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Christopher Gallo, MD (he/him/his)

Resident
Duke University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Brendan Cline, n/a

Assistant Professor of Radiology
Duke University Medical Center
NB

Nicholas T. Befera, MD

Assistant Professor
Duke University Medical Center
JR

James Ronald, MD, PhD

Assistant Professor of Radiology
Duke University Medical Center
Jon G. Martin, MD (he/him/his)

Assistant Professor of Radiology
Duke University Medical Center
Alan A. Sag, MD

Assistant Professor, Interventional Radiology and Orthopaedic Surgery
Duke University
WP

Waleska Pabon-Ramos, MD

Associate Professor of Radiology
Duke University Medical Center
Paul Suhocki, MD

Associate Professor of Radiology
Duke University Medical Center
TS

Tony P. Smith, MD

Professor of Radiology
Duke University Medical Center
Charles Y. Kim, MD, FSIR

Professor and Chief of Interventional Radiology
Duke University Medical Center

Disclosure(s):

Christopher Gallo, MD: No financial relationships to disclose

Nicholas T. Befera, MD: Scanslated, Inc: Management Position (Ongoing), Ownership Interest (Ongoing)

Jon G. Martin, MD: Inari medical: Speaking and Teaching (Ongoing); Neptune medical: Consultant (Ongoing)

Alan A. Sag, MD: No relevant disclosure to display

Waleska Pabon-Ramos, MD: NXT Biomedical: Consultant (Ongoing)

Charles Y. Kim, MD, FSIR: Becton Dickinson: Consultant (Ongoing); Boston Scientific: Advisory Committee or Review Panel Member (Ongoing); Humacyte/ACI: Advisory Committee or Review Panel Member (Ongoing)

Purpose:

Dedicated venous stents have recently emerged with properties of increased diameter, greater radial force, and increased flexibility compared to previous stents. While there is ample data on their safety and performance in the iliocaval veins, there is a marked lack of data for the thoracic central veins. The purpose of this study was to evaluate the safety and patency of contemporary, dedicated venous stents for the treatment of symptomatic thoracic central vein stenosis or occlusion.

Materials and Methods:

This retrospective study was comprised of 37 consecutive patients (18 men, mean age 59.7 years) who underwent stenting of the thoracic central veins with dedicated venous stents. Patients received the Abre (n = 15), Venovo (n = 19), or Vici (n = 3) stents. Primary patency was defined as the interval from stent placement until greater than or equal to 50% re-stenosis, recurrence of attributable symptoms, or reintervention. Patency data was compared to a cohort of patients treated with conventional non-venous self-expanding bare-metal stents for benign (n = 40) or malignant (n = 17) stenosis/occlusion. Stent patency was calculated using the Kaplan Meier method, and group comparisons were made with the log-rank test.

Results:

Improvement in symptoms within one month after stent placement occurred in 96% (26/27). In the benign stenosis group, dedicated venous stents had a higher primary patency rate compared to non-venous stents, with a 6- and 12-month patency rate of 73% and 63% compared to 66% and 38%, respectively (p = 0.04). However, in the malignant stenosis group, the primary patency rates were similar between groups (67% and 67% vs 77% and 56%, respectively). No major complications occurred in the benign stenosis group. Four major complications occurred in the malignant group. All four were SVC stents ranging from 16-20mm diameter.

Conclusion:

For benign thoracic central venous stenosis, dedicated venous stents were safe and with primary patency rates that were superior to conventional non-venous bare-metal stents. However, for malignant stenosis, the safety profile of using dedicated venous stents was modest and with similar patency rates compared to conventional bare-metal stents.