case_images: PMC3542310_01
case_images: New stant and its use for hepatic hilar malignant obstruction treatmeant.. A. Newly designed Y-shaped Covered Biliary Stent. Y-configured stent appearance can be achieved by connecting short limb covered stent of main piece and contra-lateral long limb covered stent. Diameter of Y-shaped branched covered stent is 10 mm at main bare trunk (T) and 7 mm at covered limb stents (L).. Insertion of Y-shaped covered biliary stent in 72-year old woman with type II cholangiocarcinoma. B-a. Initial cholangiogram showed patient's tumor as Bismuth type II cholangiocarcinoma (Arrows indicates cancerous proximal and distal margins). B-b. For insertion of newly designed Y-shaped covered stent, we made another percutaneous transhepatic biliary drainage (PTBD) tract through left IHD and inserted drainage catheters (arrows) bilaterally. C. After bilateral PTBD, we inserted and located main piece of stent into common bile duct through left PTBD tract, under guidance of 0.035-inch guide wire. Proximal end (thick arrows) of main piece stent (EGIS KEY-MB stent) was located in left intrahepatic bile duct (IHD) beyond boundary of hilar tumor. Short limb covered portion of main piece stent was directed toward left side in common bile duct (Thin arrows indicate lateral markers of short limb covered stent). D. Only short limb covered stent (thin arrows) of main piece was deployed, and long limb covered stent (thick arrows) of main piece (EGIS KEY-MB stent) was not deployed. E. After confirmation of its proximal end located in right IHD beyond boundary of hilar tumor and distal end located within lumen of short limb covered stent, we deployed contra-lateral long limb covered stent (arrows) (EGIS KEY-CL stent) (S&G Bio, Seoul, Korea). F. Post-stenting cholangiography showed good internal drainage into duodenum and bilateral IHD communication, after completely deploying long limb covered stent of main piece. Outer diameter of Y-shaped covered stent introducer is 7 Fr.
case_images: kjr-14-97-g001.jpg
case_images: PMC3542310_01_kjr-14-97-g001.jpg
case_images: F1
case_images: Percutaneous transhepatic biliary drainage (PTBD) through the right intrahepatic bile duct (Fig. 1B-a) resulted from a Bismuth type II cholangiocarcinoma. We planned on the newly designed Y-shaped covered stent insertion on the fourth day after the initial drainage procedure, and performed another PTBD through the left intrahepatic bile duct (S3 duct) (Fig. 1B-b). Tokyo, Japan) bilaterally. First, we inserted and located the main piece of stent into the common bile duct through left PTBD tract (Fig. 1C). The proximal end of the main piece stent (EGIS KEY-MB stent) (S&G Bio, Seoul, Korea) was located in the left intrahepatic bile duct (IHD) beyond the boundary of the hilar tumor (Fig. 1C, thick arrows). The short limb covered portion of the main piece stent was directed toward the left side of the common bile duct (Fig. 1C, thin arrows). To easily insert and deploy the contra-lateral long limb covered stent (EGIS KEY-CL stent) (S&G Bio, Seoul, Korea) without kinking its struts, the long limb covered stent of the main piece was not to be deployed (Fig. 1D, three thick arrows) until the contra-lateral long limb covered stent was completely deployed in an adequate position. After the confirmation that its proximal end was located in the right IHD beyond the boundary of the hilar tumor, we deployed the contra-lateral long limb covered (Fig. 1E). To confirm the correct stent expansion and function, post-stenting cholangiography was performed through the drainage catheter just after the stent insertion (Fig. 1F) and 7 days later.