Nasolacrimal Duct Coronary Stent Recanalization (NCR): First Cadaver Experience and Its Potential as an Alternative to DCR

Abstract

Purpose: To investigate the feasibility of implanting a drug-eluting cobalt-chromium alloy coronary stent in the nasolacrimal ducts (NLDs) of human cadavers. Methods: The pilot study was carried out in 5 NLDs of 4 adult human cadavers. Sirolimus-eluting coronary stents of 2 mm in width and lengths of 8 and 12 mm, which were mounted on balloon catheters, were used. Following dilatation of the NLDs, the balloon catheters were introduced into the NLDs under direct endoscopy guidance. The stents were delivered following dilatation of the balloon to 12 ATMs and secured in a locked (spring out) position. The balloon is then deflated and securely extubated. The dacryoendoscopy confirmed the stent position. The lacrimal system was then dissected to assess several key parameters like the uniformity of the NLD expansion, anatomical interactions of the NLD mucosa with the stent rings and struts, integrity of the soft and bony NLD, stent movement on mechanical push and pull, and ease of manual removal. Results: The cobalt-chromium alloy coronary stents could be delivered with ease and secured in the cadaveric NLDs. Its position was confirmed by a dacryoendoscopy and later by the direct NLD dissection. The NLD was uniformly dilated 360° with a wide and uniform lumen. NLD mucosa was noted to be uniformly distributed in spaces between the stent rings without influencing the expanded lumen. Following the lacrimal sac’s dissection, the NLD stent showed significant resistance to downward movement but could be easily retrieved with forceps. The 12-mm stents could reach the near total length of the NLD with good luminal expansion. The integrity of the bony and soft-tissue NLD was maintained. The learning curve is shallow if the surgeon is adept with the techniques of balloon dacryoplasty. Conclusion: Drug-eluting cobalt-chromium alloy coronary stents can be precisely deployed and secured within the human NLDs. The study is the first of its kind to demonstrate the technique of NLD coronary stent recanalization in human cadavers. It is a step forward in the journey to evaluate their use in patients with primary acquired NLD obstructions and other NLD disorders.

Morphometric and morphological evaluation of the nasolacrimal groove in 150 dry bones in the Anatolian population

“…Because of the high interventional success rate, external or endoscopic dacryocystorhinostomy techniques are favored for nasolacrimal duct obstruction [2,11,14]. It is critical to understand the variations of the nasolacrimal groove reported in our study when designing devices or materials to be used during these interventions, both for endoscopic approaches and when planning new interventions using coronary angioplasty balloons in congenital nasolacrimal duct obstructions [3]. This may boost the success rate of surgical operation planning and may also be bene cial in the creation of new inventive technologies.…”

“…The use of coronary angioplasty balloons in the treatment of congenital nasolacrimal duct obstructions, punctocanaliculoplasty, and revision dacryocystorhinostomy has the potential to greatly alter the health economics of lacrimal drainage diseases in impoverished nations [1,3,6]. Therefore, the anatomical features of the NG should be well known in order to determine new interventional techniques or to increase the success rate of existing interventions.…”

Two-electron oxidized polyphenol chemistry-inspired superhydrophilic drug-carrying coatings for the construction of multifunctional nasolacrimal duct stents

“…8 Damaged columnar epithelial cells, persistent inflammatory responses, and severe bacterial infections result in fibroblast transition from the resting state to an active state; the fibroblasts continuously proliferate, migrate, and secrete various extracellular matrix proteins, leading to a high re-obstruction rate of approximately 70-80% after nasolacrimal duct stent implantation. [9][10][11][12][13][14] After a postoperative blockage occurs, another surgery is the only recourse, thus burdening the patients' physical and mental well-being and their financial resources. 7 However, the nasolacrimal ducts in current clinical practice primarily include bare stents composed of silicone, without anti-inflammatory, antibacterial, or anti-fibroblast proliferative properties.…”