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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).

View larger version (197K): [in a new window]   Figure 1. Covered, retrievable, expandable nitinol stent (left) and lacrimal polyurethane stent (right).

View larger version (106K): [in a new window]   Figure 2a. Covered, retrievable, expandable nitinol stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Lateral fluoroscopic image obtained during retrograde stent insertion. Note the compressed stent (arrowheads) in a sheath and four radiopaque markers (two at each end [arrows] of the stent). (c) Posteroanterior fluoroscopic image obtained after sheath removal shows the stent (arrowheads) in the tract from the top of the lacrimal sac to the nasal floor. Note radiopaque markers (arrows) at ends of the stent. (d) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after placement. (e) Six months after stent placement, posteroanterior subtraction dacryocystogram shows complete obstruction of the stent with a large filling defect (arrowheads) in the lacrimal sac.

View larger version (125K): [in a new window]   Figure 2b. Covered, retrievable, expandable nitinol stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Lateral fluoroscopic image obtained during retrograde stent insertion. Note the compressed stent (arrowheads) in a sheath and four radiopaque markers (two at each end [arrows] of the stent). (c) Posteroanterior fluoroscopic image obtained after sheath removal shows the stent (arrowheads) in the tract from the top of the lacrimal sac to the nasal floor. Note radiopaque markers (arrows) at ends of the stent. (d) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after placement. (e) Six months after stent placement, posteroanterior subtraction dacryocystogram shows complete obstruction of the stent with a large filling defect (arrowheads) in the lacrimal sac.

View larger version (138K): [in a new window]   Figure 2c. Covered, retrievable, expandable nitinol stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Lateral fluoroscopic image obtained during retrograde stent insertion. Note the compressed stent (arrowheads) in a sheath and four radiopaque markers (two at each end [arrows] of the stent). (c) Posteroanterior fluoroscopic image obtained after sheath removal shows the stent (arrowheads) in the tract from the top of the lacrimal sac to the nasal floor. Note radiopaque markers (arrows) at ends of the stent. (d) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after placement. (e) Six months after stent placement, posteroanterior subtraction dacryocystogram shows complete obstruction of the stent with a large filling defect (arrowheads) in the lacrimal sac.

View larger version (99K): [in a new window]   Figure 2d. Covered, retrievable, expandable nitinol stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Lateral fluoroscopic image obtained during retrograde stent insertion. Note the compressed stent (arrowheads) in a sheath and four radiopaque markers (two at each end [arrows] of the stent). (c) Posteroanterior fluoroscopic image obtained after sheath removal shows the stent (arrowheads) in the tract from the top of the lacrimal sac to the nasal floor. Note radiopaque markers (arrows) at ends of the stent. (d) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after placement. (e) Six months after stent placement, posteroanterior subtraction dacryocystogram shows complete obstruction of the stent with a large filling defect (arrowheads) in the lacrimal sac.

View larger version (82K): [in a new window]   Figure 2e. Covered, retrievable, expandable nitinol stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Lateral fluoroscopic image obtained during retrograde stent insertion. Note the compressed stent (arrowheads) in a sheath and four radiopaque markers (two at each end [arrows] of the stent). (c) Posteroanterior fluoroscopic image obtained after sheath removal shows the stent (arrowheads) in the tract from the top of the lacrimal sac to the nasal floor. Note radiopaque markers (arrows) at ends of the stent. (d) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after placement. (e) Six months after stent placement, posteroanterior subtraction dacryocystogram shows complete obstruction of the stent with a large filling defect (arrowheads) in the lacrimal sac.

View larger version (117K): [in a new window]   Figure 3a. Polyurethane stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction of the lacrimal system at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after stent placement. (c) Eighteen months after stent placement, posteroanterior subtraction dacryocystogram shows near complete obstruction of the stent with a filling defect (arrowheads) at the "mushroom" portion of the stent.

View larger version (114K): [in a new window]   Figure 3b. Polyurethane stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction of the lacrimal system at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after stent placement. (c) Eighteen months after stent placement, posteroanterior subtraction dacryocystogram shows near complete obstruction of the stent with a filling defect (arrowheads) at the "mushroom" portion of the stent.

View larger version (123K): [in a new window]   Figure 3c. Polyurethane stent placement. (a) Posteroanterior subtraction dacryocystogram shows complete obstruction of the lacrimal system at the junction (arrow) between the lacrimal sac and the nasolacrimal duct. (b) Posteroanterior subtraction dacryocystogram shows good flow of contrast medium through the stent immediately after stent placement. (c) Eighteen months after stent placement, posteroanterior subtraction dacryocystogram shows near complete obstruction of the stent with a filling defect (arrowheads) at the "mushroom" portion of the stent.

View larger version (21K): [in a new window]   Figure 4. Graph of overall cumulative patency after stent placement. The curves show the difference in cumulative patency rates between the covered, retrievable, expandable nitinol stent and the lacrimal polyurethane stent.