simvastatin + triflusal (IRIST stent)

Delayed glucocorticoid initiation is associated with lower stent removal rates in IgG4-related retroperitoneal fibrosis: a retrospective study.

Nagahata Ken K, Kanda Masatoshi M, Hamakawa Yuki Y, Nakamura Koki K et al.

IgG4-related retroperitoneal fibrosis (IgG4-related RPF) often causes hydronephrosis requiring ureteral stenting. While glucocorticoid (GC) therapy is generally effective, predictors of successful stent removal remain unestablished. This retrospective study investigated whether the interval from radiological diagnosis to GC initiation predicts stent-free outcomes. Twenty-one patients with IgG4-related RPF requiring ureteral stenting between April 2010 and December 2024 were categorized into stent-free (n = 12) and stent-dependent (n = 9) groups. Baseline serological markers (IgG, IgG4, and C-reactive protein) and renal function did not differ significantly between groups. However, the interval from radiological diagnosis to GC initiation was significantly shorter in the stent-free group compared to the stent-dependent group (median 110.5 vs. 264.0 days; p = 0.028). In the primary analysis, patients were dichotomized at the pre-specified cohort median of the diagnosis-to-GC interval (160 days), and Kaplan-Meier analysis showed that early initiation (≤ 160 days) was associated with a significantly higher stent removal rate (p = 0.031). An exploratory ROC analysis yielded a convergent optimal cutoff of 195 days (AUC 0.79; sensitivity 83%, specificity 78%). Delayed GC initiation may be associated with an increased risk of long-term stent dependence, suggesting the existence of a potential therapeutic window of approximately six months for achieving stent-free status.

EUS-guided gastroenterostomy versus enteral stent placement for malignant gastric outlet obstruction: A reconstructed individual patient data meta-analysis with meta-regression.

Al Hayek Mohammad M, Spadaccini Marco M, Fahaid Ammar A, Khashab Mouen M et al.

Malignant gastric outlet obstruction is a frequent complication of advanced pancreatic and gastric antral malignancies requiring palliative intervention. EUS-guided gastroenterostomy (EUS-GE) has emerged as an alternative to enteral stent placement (ESP), but comparative evidence remains limited. We conducted a pairwise and reconstructed individual patient data meta-analysis of randomized controlled trials and cohort studies comparing EUS-GE with duodenal stent placement in adults with malignant gastric outlet obstruction. Systematic searches of PubMed, Web of Science, Scopus, and the Cochrane Library were performed from inception through November 15, 2025. Stent-related failure was the primary outcome and was analyzed as a time-to-event endpoint using reconstructed individual patient data from published Kaplan-Meier curves. Secondary outcomes included technical success, clinical success, overall survival, length of hospital stay, and adverse events. Random-effects models were applied using hazard ratios and risk ratios (RRs) with 95% confidence intervals (CIs). Ten studies comprising 1359 patients were included. EUS-GE was associated with a significantly lower rate of stent-related failure compared with duodenal stenting (hazard ratio, 0.57; 95% CI, 0.45-0.73; P < 0.001). Technical success was slightly lower with EUS-GE (RR, 0.98; 95% CI, 0.97-1.00; P = 0.028), whereas clinical success was significantly higher than ESP (RR, 1.13; 95% CI, 1.08-1.19; P < 0.001). Overall survival, length of hospital stay, and rates of adverse events were comparable between groups. EUS-GE was associated with lower stent-related failure rates and higher clinical success compared with enteral stenting, with similar survival and safety outcomes. Despite slightly lower technical success rates, EUS-GE remains a durable palliative option in experienced centers, while ESP remains appropriate for short-term palliation.

Acute limb ischaemia five years after iliac covered stent placement due to protruding calcification.

Tanaka Atsuya A, Tokuda Takahiro T, Oba Yasuhiro Y

Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Critical Appraisal of Evidence and Clinical Practice : Short title:Intravascular Imaging-Guided Percutaneous Coronary Intervention.

Rostamzadeh Mohammad M, Jafari Negar N, Ranjbar Abdolmohammad A, Biglary Hamid H et al.

Intravascular imaging has emerged as a critical adjunct to percutaneous coronary intervention (PCI), providing detailed insights into coronary anatomy, plaque morphology, and stent optimization beyond conventional angiography. Despite advances in PCI, adverse outcomes such as stent thrombosis and restenosis persist, often related to suboptimal lesion assessment and stent deployment. This review critically evaluates contemporary evidence from randomized controlled trials, large registries, and meta-analyses comparing intravascular imaging-guided and angiography-guided PCI. Current data consistently demonstrate that imaging guidance, particularly with intravascular ultrasound (IVUS), improves procedural optimization and reduces adverse cardiovascular events, with the greatest benefit observed in complex coronary lesions. Optical coherence tomography (OCT) provides superior spatial resolution and enhances detection of stent-related complications, although its impact on clinical outcomes appears more context-dependent. While recent guidelines strongly endorse intravascular imaging in complex PCI, real-world adoption remains limited due to economic, procedural, and training-related barriers. Variation in study design and variability in imaging protocols further complicate interpretation of existing evidence. Intravascular imaging-guided PCI represents a transition toward precision-guided coronary revascularization. Future research should focus on standardized imaging strategies, long-term outcomes, and integration with emerging technologies to optimize patient selection and procedural outcomes.