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Obstruction of the Lacrimal System: Treatment with a Covered, Retrievable, Expandable Nitinol Stent versus a Lacrimal Polyurethane Stent¹

¹ From the Departments of Radiology (G.Y.K., H.Y.S., T.S.S., K.B.S., H.K.Y.) and Biomedical Engineering (T.H.K.), Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, Korea. Received October 12, 2001; revision requested January 8, 2002; final revision received July 1; accepted August 19. Supported by grant HMP-98-G-2-043 from the Highly Advanced National (HAN) Project, Ministry of Health and Welfare, Republic of Korea. Address correspondence to H.Y.S. (e-mail: hysong@amc.seoul.kr).

PURPOSE: To compare the clinical effectiveness of a covered nitinol stent with that of a polyurethane stent for treatment of lacrimal system obstructions.

MATERIALS AND METHODS: A nitinol stent was knit from a single thread of 0.1-mm nitinol wire in a tubular configuration and was covered by dipping the stent into a polyurethane solution. The stent was 4 mm in diameter and 30 or 35 mm long. With fluoroscopic guidance, a covered nitinol stent (n = 33, group A) or a polyurethane stent (n = 35, group B) was placed in 68 patients. The following items were evaluated retrospectively: technical success, procedure time, cumulative patency rate, and complications. An unpaired Student t test was used to analyze the difference between the procedure times. Kaplan-Meier survival curves and a log-rank test were used to compare the cumulative patency rates.

RESULTS: Stent placement was technically successful in 31 (94%) of 33 patients in group A and in all 35 (100%) patients in group B. After stent placement, all patients showed resolution of epiphora. Average procedure time was 400 seconds (range, 270–900 seconds) in group A and 260 seconds (range, 150–900 seconds) in group B. The difference between the procedure times was statistically significant (P = .0003). During the mean follow-up period of 40 months, there was recurrence of epiphora in 30 of 31 patients in group A and 26 of 35 patients in group B. The difference of the cumulative patency rates was statistically insignificant (P = .2).

CONCLUSION: Although the polyurethane stent used for treatment seemed to be more effective than the nitinol stent, selection of these stents for placement should be made with caution, because the long-term patency rates are not encouraging.

© RSNA, 2003

Index terms: Lacrimal gland and duct, 223.24 • Lacrimal gland and duct, interventional procedures, 223.126 • Stents and prostheses

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