121 - Clinical Efficacy, Patency, and Safety of Dedicated Venous Stents for Treatment of Thoracic Central Vein Obstruction Compared to Conventional Bare-metal Self-expanding Stents

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Christopher Gallo, MD (he/him/his)

Resident Physician
Duke University, United States

Author/Co-author(s)

AM

Alexis Medema, MD

Resident Physician
Duke University, United States
Brendan Cline, MD

Assistant Professor of Radiology
Duke University Health System, United States
Nicholas T. Befera, MD

Assistant Professor of Radiology
Duke University, United States
JR

James Spencer Clayton Ronald, MD, PhD, FSIR

Associate Professor of Radiology
Duke University Health System, United States
Jonathan G. Martin, MD (he/him/his)

Associate Professor of Radiology
Duke University Health System, United States
WP

Waleska Pabon-Ramos, MD, MPH (she/her/hers)

Associate Professor of Radiology
Duke Health, United States
Paul Suhocki, MD

Associate Professor of Radiology
Duke University Medical Center, United States
TS

Tony P. Smith, MD

Professor of Radiology
Duke University Medical Center, United States
Charles Y. Kim, MD, FSIR

Professor and Chief of Interventional Radiology
Duke University, United States

Purpose:

Dedicated venous bare-metal stents have properties hypothesized to improve stent performance in the iliocaval system; however, their performance in the thoracic central veins is not well established. The purpose of this study was to evaluate the clinical efficacy, patency, and safety of contemporary dedicated venous stents for the treatment of thoracic central vein obstruction with comparison to conventional bare-metal self-expanding stents.

Materials and Methods:

This single-center retrospective study consisted of 126 consecutive patients (66 females, mean age 58.2 years) who underwent stent placement in the thoracic central veins using either contemporary dedicated venous stents [Abre (n=22), Venovo (n=17), or Vici (n=2)] or conventional bare-metal self-expanding stents. Patients were divided into benign (n=84) and malignant (n=42) obstruction groups. Stent patency was estimated using the Kaplan Meier method, and comparisons were made with the log-rank test.

Results:

For benign obstruction, symptoms improved in 92% of patients. Primary patency was significantly longer with dedicated venous stents than conventional stents, with 6-month primary patency rates of 89% versus 69% and 78% versus 46% at 12 months (p=0.013). In patients with malignant obstruction, 100% had symptom improvement after stenting. No difference in primary patency was observed in patients who received dedicated venous versus conventional stents, with 6-month patency rates of 65% versus 85% (p=0.39). In the benign obstruction group, no major complications occurred. In the malignant obstruction group, five had a major complication, all of which were with dedicated venous stents. Subanalysis of venous stents deployed in the SVC demonstrated that large stent diameters (18 or 20mm) had a significantly higher chance of a major complication when compared to smaller diameter stents (56% versus 6%, p< 0.01).

Conclusion:

Dedicated venous stents demonstrated superior primary patency rates than conventional stents for the treatment of benign thoracic central venous obstruction, but without difference in malignant obstruction. Large 18mm+ venous stents in the SVC were associated with higher rates of major complications in patients with malignant obstruction.