Palliative treatment of superior vena cava syndrome with nitinol stents

Abstract

This study aims to retrospectively evaluate the outcomes following nitinol stent placement for malignant superior vena cava syndrome. A total of 25 patients with thoracic malignancies were treated with self-expanding nitinol stents for superior vena cava syndrome (E*Luminexx [Bard GmbH/Angiomed, Karlsruhe, Germany], Sinus-XL [OptiMed Medizinische Instrumente GmbH, Ettlingen, Germany], and Zilver Vena [Cook Medical Inc., Bloomington, IN]). It was seen that the procedural success rate was 76% with all stents deployed as intended and no procedure-related complications but in five patients with 50% residual stenosis and one patient with stent occlusion within 48 hours after stent deployment. Stent occlusion occurred in further two patients during follow-up: one patient developed infection, thrombosis, and occlusion in the stent seen at 2-month follow-up, and one patient had stent occlusion at 4-month follow-up. The clinical success rate was 96%. Stent compression leading to a greater than 50% reduction in stent diameter was observed in three patients at follow-up. Overall 22 patients died at a mean follow-up of 3.5 months for reasons related to their underlying malignancy. It was concluded that the stent treatment for superior vena cava syndrome is a safe treatment with good clinical effect in patients with superior vena cava syndrome in the terminal phase of malignant disease. In this small patient population, no trends were observed which would suggest that outcomes vary by stent type, though additional, large-scale studies are needed.

Keywords: interventional radiology; palliative; stent; superior vena cava syndrome; treatment.

Fig. 1

Patient No. 7: A 62-year-old woman with SCLC (T4N3M1b). (A) 90% SVC stenosis prestenting. One E*Luminexx 14 × 40 mm stent and one Sinus-XL 18 × 60 mm stent were implanted and postdilated with a 14 mm balloon. (B) No residual stenosis poststenting. (C) Very good clinical results and imaging results at > 120 days follow-up. SCLC, small cell lung cancer; SVC, superior vena cava. (E*Luminexx [Bard GmbH/Angiomed, Karlsruhe, Germany] and Sinus-XL [OptiMed Medizinische Instrumente GmbH, Ettlingen, Germany].)

Fig. 2

(A) Patient No. 18: A 50-year-old woman with disseminated SCLC (T4N2M1a). Contrast-enhanced CT shows occlusion of SVC and thrombi in cava and right brachiocephalic trunk. (B) Same patient as in (A). Venografia showing occluded SVC and thrombi in both brachiocephalic trunks. Two Sinus-XL stents of 16 × 60 mm were implanted, one into SVC from the right femoral vein, and the other one into left brachiocephalic trunk from the left jugular vein. Postdilatation with 14 mm balloon with good flow. Very good clinical effect. Reintervention 4 months later because of recurrent SVC syndrome (Patient No. 14) and stenosis of 75% with one E*Luminexx 14 × 60 mm stent in cava with very good clinical effect lasting until death 8 months later. CT, computed tomography; SCLC, small cell lung cancer; SVC, superior vena cava. (E*Luminexx [Bard GmbH/Angiomed, Karlsruhe, Germany].)

Fig. 3

Patient No. 19: A 58-year-old man with SCLC. (A) Approximately 66% stenosis on pretreatment venography (arrow) and (B) a slit-shaped stenosis of about 90% on pretreatment contrast-enhanced CT (arrow). CT, computed tomography; SCLC, small cell lung cancer.

Fig. 4

Patient No. 3: A 68-year-old woman with disseminated NSCLC. Approximately 99% stenosis of the SVC on pretreatment CT. After deployment of three Zilver Vena stents the stenosis was reduced to 25%. Good primary clinical effect, but at 2 months follow-up air and thrombus were seen inside and distal to the stents. CT, computed tomography; NSCLC, nonsmall cell lung cancer; SVC, superior vena cava. (Zilver Vena [Cook Medical Inc., Bloomington, IN])

Fig. 5

Patient No. 24: A 56-year-old man with neuroendocrine NSCLC. Approximately 90% stenosis of the SVC on pretreatment CT. One Sinus-XL 16 × 60 mm stent was implanted and postdilated with a 12 mm balloon. There was no residual stenosis and very good clinical result. At follow-up 2 months later the stent was patent, but compressed with a reduced diameter of 75%. The patient died a few weeks later without SVC syndrome. CT, computed tomography; NSCLC, nonsmall cell lung cancer; SVC, superior vena cava. (Sinus-XL [OptiMed Medizinische Instrumente GmbH, Ettlingen, Germany].)