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Background Biliary plastic stent (PS) mandates timely removal or replacement. The coronavirus disease 2019 (COVID-19) pandemic had affected the accessibility to medical therapy resulting in delay. We evaluated the burden of retained biliary PS, clinical profile, and impact of COVID-19 pandemic on stent retention.

Background Biliary plastic stent (PS) mandates timely removal or replacement. The coronavirus disease 2019 (COVID-19) pandemic had affected the accessibility to medical therapy resulting in delay. We evaluated the burden of retained biliary PS, clinical profile, and impact of COVID-19 pandemic on stent retention. Material and Method Endoscopy database records between November 2019 and April 2022 were reviewed retrospectively to identify patients who had undergone stent exchange or removal > 3 months, that is, retained stents. Demography, comorbidity, indication and outcomes of index endoscopic retrograde cholangiopancreatography, size and duration of indwelling biliary PS, clinical presentation, imaging findings, cholangiography findings, stent-related complications, and stone formation and endotherapy details were noted. Results A total of 252 patients (100 [39.68%] males; median age 47 years [interquartile range [IQR] 32–56 years]) had common bile duct (CBD) stent retention. Median duration of retained CBD stent was 5 months (IQR = 4–6 months). Seventy (27.8%) were symptomatic with cholangitis (22, 8.7%), only jaundice (16, 6.3%), and only biliary abdominal pain (32, 12.7%). Sixty-one of 70 (87.1%) had abnormal imaging; 59/70 (84.3%) had new onset biliary stone or sludge (p ≤ 0.005). Stent retention > 6 months was significantly associated with stent fragmentation (0 vs. 20, p < 0.005) and choledocholithiasis (9 vs. 58, p < 0.005). Small caliber stent retention was more symptomatic (7 vs. 10 French [12/28 [42.85%] vs. 58/224 [25%], p = 0.049]). Univariate logistic regression analysis showed serum aspartate aminotransferase (AST), alkaline phosphatase levels, and CBD stent retention > 6 months were significantly associated with complications. On multivariate logistic regression analysis, serum AST > 2× upper limit normal (odds ratio [OR] = 5.487, 95% confidence interval [CI] = 3.1–9.9, p ≤ 0.005) and CBD stent retention > 6 months (OR = 8.6, CI = 3.1–23.92, p ≤ 0.005) were associated with complications. Out of 101 COVID-19 pandemic-attributed delay, 56/101 (55.44%) had symptomatic stent dysfunction. Endoscopic technical success rate was 97%, unsuccessful ones were due to large stones and impacted stents; with no mortality. Conclusion CBD PS stent retention, although mostly asymptomatic, can result in significant morbidity like jaundice, cholangitis, stent migration, fragmentation, or impaction in one-fourth of patients. Use of 7 Fr stent, retention duration > 6 months, abnormal imaging findings, and AST > twice the upper limit were significantly associated with complications. Endoscopic management was successful in 97% of patients. [ABSTRACT FROM AUTHOR]

Following renal transplant, ureteral stents aim to minimise ureteroneocystostomy anastomotic complications. Although there is no specified timing for stent removal after transplantation, these are ideally removed at between 2 and 4 weeks. However, forgotten stents can adversely affect renal allograft function and contribute to obstructive uropathy. We present a 59-year-old man with a retained ureteral stent for more than 19 years with an absence of encrustations, fragmentation, migration and stone formation. To our knowledge, this is the longest retained ureteral stent in a renal transplant patient and the first forgotten stent removed via flexible cystoscopy under local anaesthetic.

Objective: The objective of this study was to evaluate the feasibility of a computer based stent registry with patient directed automated information system to prevent retained double J stents. Materials and Methods: A stent registry system was developed in collaboration with our Computerized Hospital Information Processing Service Department. This computer based stent registry with patient directed automated information system was integrated with the existing clinical work station. We reviewed the records retrospectively and assessed the feasibility of the system in reminding clinicians and patients regarding the stent and its date of removal. Results: In a short run at our department, this new system appeared feasible, with patients promptly responding to the short message service and letter alerts. Conclusions: Computer based stent registry with patient directed automated information system is feasible in a clinical setting. A prospective study is needed for evaluation of its efficacy in preventing retained stents.

A 75-year-old woman who had undergone pancreatoduodenectomy 19 years earlier was referred to us for investigation of progressive abdominal pain without conclusive preliminary complementary tests. Computed tomography enabled us to identify that the transanastomotic pancreatic stent had migrated distally, resulting in bowel perforation. She underwent surgery and the foreign body was removed. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the feasibility of a computer based stent registry with patient directed automated information system to prevent retained double J stents. Materials and Methods: A stent registry system was developed in collaboration with our Computerized Hospital Information Processing Service Department. This computer based stent registry with patient directed automated information system was integrated with the existing clinical work station. We reviewed the records retrospectively and assessed the feasibility of the system in reminding clinicians and patients regarding the stent and its date of removal. Results: In a short run at our department, this new system appeared feasible, with patients promptly responding to the short message service and letter alerts. Conclusions: Computer based stent registry with patient directed automated information system is feasible in a clinical setting. A prospective study is needed for evaluation of its efficacy in preventing retained stents. [ABSTRACT FROM AUTHOR]

Background: Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important.Case Report: A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot. On withdrawal, the tines of the Solitaire stent lodged inside the Precise carotid stent. The patient was started on aspirin, Plavix, and heparin infusion, and underwent a carotid endarterectomy (CEA) with safe removal of the stents and primary vessel repair.Conclusion: This is the first case reported to date of a Solitaire stent becoming lodged inside a Precise carotid stent, salvaged by CEA with safe removal of the stents and primary vessel repair. We discuss the timing, indication, alternatives, and technical nuances of a CEA in this setting. [ABSTRACT FROM AUTHOR]