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Minimally Invasive Therapy 2006, 1–11, PrEview article


Mechanical comparative analysis of stents for colorectal obstruction


Materials Science and Technology Department, Centro Polite ´ cnico Superior de Ingenieros-ICMA-I3A, Universidad de ´ cnico Superior de Ingenieros-I3A, Zaragoza, Zaragoza, Spain, and 2Mechanical Engineering Department, Centro Polite Universidad de Zaragoza, Zaragoza, Spain

Abstract The goal of this work is the mechanical comparison of different types of stents for colorectal obstructions. We consider selfexpanding and balloon-expanding stents made of two different materials such as stainless steel and shape memory NiTi alloy. The mechanical parameters are expansion rate, shortening, radial compression resistance, longitudinal and perimetral adaptability, and buckling resistance. This analysis results in a better understanding of global mechanical behavior and also allows better design and device selection for colonic lesions.

Key words: Stent, colon, NiTi, Nitinol, mechanical behavior, stenosis, colorectal

Introduction Acute malignant colonic obstruction is a surgical emergency in 25% of colorectal cancer cases. The standard of care for these patients involves surgical decompression via colostomy and resection of the primary tumour. Several endoscopic alternatives to colostomy that do not involve surgery have been described for these cases, including bougienage, balloon dilatation, photodynamic therapy with Nd: YAG laser, photocoagulation, electrocoagulation and stenting. Most of these methods are applicable only to distal rectal tumours, each of them may need to be repeated to maintain luminal patency, and their efficacy rates are low. Colorectal stenting, particularly with self-expanding metal stents (SEMS), presents higher rates of safety and effectiveness (85– 90% respectively) in performing immediate bowel decompression and allowing adequate bowel preparation for elective surgery. Currently, decision analysis has been used to evaluate the cost-effectiveness of endoscopic colorectal stent insertion, which also results in an increased quality of life and less psychological repercussions for the patient (1,2). In 2002, the approximately five hundred cases treated by colorectal stenting for pre-surgery or

palliation described in the literature (3) asses the idea that stenting should be considered as a first-line treatment for malignant strictures and even be considered as a potential therapy for related benign strictures as opposed to balloon dilatation. However, intestinal stenting in benign disease is a potentially controversial area because the stent may not be easily removed after its placement in patients with benign colorectal strictures; further clinical trials are needed for this extension of the stenting technique (4,5). Since the first case of colorectal stent placement reported by Dohmoto in 1991, different stents have been widely used to relieve various forms of malignant gastrointestinal obstructions. All these configurations strive to fulfill the criteria of the ideal stent for colonic obstructions:



mechanical properties such as flexibility, high expansion rate, mechanical stability, and radial compression resistance, properties related to the stent delivery system, such as tractability, crossability and pushability needed to advance the stent to the point of the obstruction, and clinical features such as the prevention of the migration of propulsive forces of colonic mobility,

Correspondence: J. A. Pue ´ rtolas, Dept. Material Science and Technology, Centro Polite ´ cnico Superior, Universidad de Zaragoza, Marı ´a de Luna 3, E-50018 Zaragoza, Spain. Fax: +34 976 76 19 57. E-mail: japr@unizar.es ISSN 1364-5706 print/ISSN 1365-2931 online # 2006 Taylor & Francis DOI: 10.1080/13645700600929102

This stent always operates in elastic mode since the deformation from its work shape arises by pulling each wire from the helicoidal mode to an almost straight line. The high number of wires in the Wallstent provides a small cell size. The stent presents a bell-shape at the extremes of the stents. Song and Choo-Z modified Gianturco stents (Figures 2c and 2d) New versions of the Gianturco type have been developed. the version for colon. Gianturco Stent (Figure 2b) Rings of zigzag wire segments. etc) and materials (stainless steel. shortening. and tumorrelated ingrowth or overgrowth. joined by fine nylon or stainless steel wires. and biliary metallic stents (12) These comparison are sometimes applied to different configurations of a specific design like the Zstent (13). A lower value is better. An analytical model based on the theory of slender rods was used in order to obtain qualitative mechanical behaviour for mechanical parameters such as expansion rate. the first colonic stent was primarily designed for vascular or esophageal use. A higher value is better. Despite these differences. few studies have made a comparison of the mechanical properties to help correlate the efficacy and safety.8. Buckling resistance (Figure 1d): Stent resistance to inelastic collapse when compressed by pressure above a critical value. Auto-expandable stainless steel stents Wallstent (Figure 2a) This stent is based on braided wires in a tubular configuration. Nowadays. A lower value is better. Perimetral adaptability (Figure 1f): Ability to tightly adapt to the shape of the conduit cross section whose patency the device is maintaining. which is covered by a double layer of polyethylene. Expansion rate (Figure 1a): Ratio between the unexpanded and expanded diameter of the stent. the mechanical behavior of stents plays a central role in the clinical outcome. They are listed below. different configurations (braided mesh. including a qualitative evaluation for colorectal applications. does not present any covering.7. A higher value is better. set up the structure of this stent. A higher value is better. There is no connection between the wires in the helicoidal shape. Domingo et al. A higher value (lower stiffness) is better. kitted. longitudinal and perimetral adaptability. radial compression resistance. However. which results in the formation of sliding knots. perforation. A lower value is better.S. A higher value is better. In fact. Radial compression resistance (Figure 1c): Stiffness of the stent when compressed by uniformly distributed radial pressure. the colonic Z-stent. . Mesh opening: Total amount of conduit tissue area not covered by metal on each of the deformed cells of the expanded stent. a good radiopacity. A higher value is better. cell wire. The purpose of this work is to obtain a proper understanding of how stent mechanical properties could contribute to a better selection of the appropriate device for a given colonic lesion. Stent shortening (Figure 1b): Reduction of the overall length of the device during expansion (commonly expressed in percentage).3). This configuration introduces a right-angle Mechanical parameters Different mechanical parameters are considered in order to evaluate the performance of the different models of stents. due to the high length of the wire segments. Longitudinal adaptability (Figure 1g): Ability to tightly adapt to the shape of the conduit longitudinal section whose patency the device is maintaining. and buckling resistance. In contrast to the version for esophagus. nitinol) have been developed with clear differences between them in their clinical performance. Longitudinal flexibility (Figure 1e): Flexibility of the stent when globally bent as a tubular beam. The cells in the stent are extremely open. which is related to the high expansion rates in these types of stent. such as those observed in comparative studies of clinical trials (6. Migration tendency: Probability of stent displacement after correct implantation due to peristaltic movement in combination with poor mechanical performance.10). the use of stents as an alternative to colostomy came prior to the development of a stent specifically designed for placement in the colon and rectum. In this work we focus on the mechanical properties of different stainless steel and nitinol stents for colonic obstructions. balloon-expandable peripheral stents (11). Most of these studies are related to coronary stents (9. In the model of Song (Figure 2c) the end rings present a greater diameter than the rest of the rings.

this stent belongs to the sliding knots design. joined by polyurethane (Figure 3b). like in the basic Gianturco stent. NiTi wires were braided basically like a Wallstent configuration. Auto-expandable Nitinol stents Braided stents (Figures 3a and 3b) The first reference to these colonic stents is the prototype described by Longa ´ s et al. Ultraflex stent (Figure 3c) The prototype for colon is a braided and fabric Nitinol wire structure following the typical pattern used in cardiovascular applications. Another change is the non-uniform longitudinal helix pitch and cell . The Choo-Z stent (Figure 2d) introduces some modifications in this design: the number of rings in the central region increases and the length of the wires decreases. In a rigorous classification. The deployed structure presents an approximately hyperbolic profile instead of a cylindrical shape. Mechanical parameters for any type of stent: (a) Expansion rate. In the transition zone the segments are embeded in polyurethane. (d) buckling resistance. (e) longitudinal flexibility. which cannot be supported by fine wires. Song’s braided Nitinol stent is basically a combination of the braided embedded stent and the ChooZ configuration. A bell-shape is introduced in half of the stent by means of a thermal treatment for fixing this expanded form. known as the Strecker stent. (f) perimetral adaptability. (c) radial compression resistance. (14). both being higher in the extremes than in the central region (Figure 3a). (b) stent shortening. discontinuity. but with new improvements. size. which is a balloon-expandable operating mode stent. (g) longitudinal adaptability.Mechanical comparative analysis of stents for colorectal obstruction Figure 1. The final structure is the joint of three consecutive Nitinol Wallstents with the highest diameters at the extremes.

and a further expansion. succesive thermomechanical steps cause the expansion of the slotted tube. The combination of the laser technique and the appropriate surface treatments allows a good finish and blunt end. while in the Palmaz-Schatz the expansion happens in one process. the stent must present fixed knots. Choo stent (Figures 3e and 3f) To take advantage of all the Nitinol power. which is denoted as the CPS stent in this work. the work structure is obtained by cutting longitudinal and parallel grooves on the surface of a tube. The diffference between these stents and the Palmaz-Schatz is the material. On the other hand. Domingo et al. Basically. (a) (c) (b) (d) Figure 2. Auto-expandable stainless steel stents: (a) Wallstent. (15). The first prototype stent based on a Nitinol slotted tube design was referenced by S. which causes a set of joined romboidal cells. Nitinol versus AISI 316L. So. (b) Gianturco Z-stent. Its particular braiding provides flexible longitudinal bands alternating with narrow rigid bands. This stent was made by laser cutting from a tube of 5 mm diameter and incorporates some Esophacoil stent (Figure 3d) The stent presents a spiral configuration and originally was applied to the esophagus. respectively. CPS and Memotherm slotted tube stents (Figures 3g and 3h) The cutting laser technique has opened new possibilities for the stenting industry. In general. Domingo et al. the knots are crossed . Modified Gianturco stents: (c) Song Z-stent and (d) Choo Z-sent. This structure reduces the space between the turns in the central region and can be considered a stent with a practically closed cell. except the section.S. The Choo colorectal stent introduces an alternative fixation of the knots. In a perimetral ring. the loss of flexibility is compensated by the superelasticity. self-expanding versus balloon-expandable. the manufacturing process is simple and the design process does not admit any modification. This idea is carried out in cardiovascular stents like the Cook (Figure 3e) and Symphony (Figure 3f) stents by braided knots or laser. and in the next ring the knots are free. by torsion of the wires. and the operating mode. The helix is manufactured from a ribbon with a square transversal section and the minimum helix pitch to put the turns of the spiral in contact. in particular in the manufacture of superelastic stents with rigid knots.

(d) Esophacoil stent. (c) Ultraflex stent. (h) Memotherm stent. Nitinol auto-expandable stents: (a) Braided stent. (f) Symphony stent. (g) CPS stent. (b) Song stent. (e) Cook ZA stent.Mechanical comparative analysis of stents for colorectal obstruction (a) (b) (d) (c) (f) (e) (g) (h) Figure 3. .

(h) according to the constraint pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi L~ h2 zp2 D2 ð1Þ Considering the free-body diagram of one-half of one wire in the stent (Figure 4b). while the others present two layers of helicoidal springs turned in reverse sense with sliding knots between wires. which was first applied for esophagus and more recently was adapted for colonic applications. respectively. The first mechanism corresponds to a helicoidal spring (Figure 4a). then changes in the diameter (D) must be accommodated by changes in the pitch where E and G are the elasticity and shear moduli. the geometry is modified in the extremes in an asymmetric bell-shape. Again a Figure 4. In this case. Dx and Dq are the changes in principal curvature and twist of the spring induced by the pressure. The second mechanism is a radial spring with different shapes: Z-shape (Figure 5a) or Z modifiedshape (Figure 5b).S. a non-linear inverse problem must be solved to determine the stiffness of the stent corresponding to every expanded configuration. The manufacturing process based on the cryogenic deformation in the martensite state of the tube is another characteristic of the stent (15). taking into account that the stent is unloaded along its axis. and the diameter of the stent is p~ 4 cos2 a ½EI Dx sina{GJ Dq cosaŠ D2 sina ð2Þ Mechanical behaviour Resistance mechanisms The mechanical behaviour of the different types of stents analysed is based upon several distinct resistance mechanisms that are characterized below. Domingo et al. First. the relationship between the effective pressure. 22 in the opposite region and 18 mm in the central region (Figure 3g). The Memotherm stent is a commercial stent based on a Nitinol slotted tube design. diameter (D). a is the angle os the spring. The design parameters in this case are: pitch (h). tana5h/ pD. with a light symmetric bell-shape. geometric modifications with respect to a Palmaz ballon-expandable AISI 316L stent. braided. Wallstent. Due to the change of stiffness with expansion. diameter (D). By assuming that under small loads the total length of the wire (L) remains unchanged. wire diameter (d) or section dimensions if not circular. and moments. bending Mb and twisting Mt derived from the Bernoulli-Euler and Coulomb theories for slender beams (along the directions of the tangent and normal to the helix). axial Fa and shear Fs. In the free deployment state the diameter in the cranial extreme was 33 mm. equilibrium of forces. p. Its commercial dimensions are about 25–30 mm in diameter and 6–10 cm in length (Figure 3h). and number of wires (n). the number of wires per layer is another design parameter. Helicoidal spring. The Esophacoil stent is in fact a simple helicoidal spring. Song and Esophacoil stents are based on this mechanism. number of circumference divisions (n). . I and J are the inertial constants for bending and twist. wire diameter (d). whose design parameters are: helix pitch (h).

However. the relationship between the pressure and the diameter of the stent is 12EI pDD cosa p~ nL3 D ð4Þ p~ 2EI Dh r 2 g ð hÞ h ð6 Þ (d). Radial springs. Choo. Thus. the theory of slender arcs can be used to obtain a simplified model. Symphony and CPS stents correspond to this mechanism. radial Z-springs are more rigid than helicoidal or multiple arcs springs of similar dimensions. According to Figure 6b. with the following design parameters: pitch (h). arc angle with respect to the stent axis (a). the knots in the different modules of the stents can be corresponding (Symphony and CPS) or not corresponding (Gianturco. number of arcs along the circumference (n). concerning radial effects. The behaviour of this mechanism is much more complex. So. and arc semi-angle (h0). . The resistance mechanism of the rigid or sliding knots determines the global behaviour of the stent. with some variants. Finally. and taking into account that the stent is unloaded along its axis. Choo and Cook). By assuming that under small loads the total length of the arm between knots (L) remains unchanged. Gianturco. On the other hand. on the other hand. Song and Choo) while others present rigid knots (Cook. Cook. arc radius (r). some of them present sliding knots among modules (Gianturco. The Ultraflex stent is based on this mechanism. depending on the bending deformations of the least arcs which are the most significant. Symphony and CPS). Figure 5. The third mechanism corresponds to a radial spring with multiple arcs and sliding knots between wires (Figure 6a). then changes in the diameter (D) must be accommodated by changes in the pitch (h) according to the constraint rffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi p 2 D2 ð3Þ L~ h2 z 4n2 Considering the free-body diagram of one-half of one wire in the stent (Figure 5c). considering the bending deformations for an arc induced by the pressure a relationship between the pressure and the deformed shape of the stent (changes in D and h) can be obtained p~ pEI nr 2 hf ðhÞ DD D ð5 Þ where tan a5pD/2nh. on the one hand. Song. All these equations must be considered as a simplified approach to the actual mechanical behaviour of the stents. the use of rigid knots makes the stent more rigid longitudinally and decreases its deformability. which presents complex effects not included in this approach. such as plastic deformations and residual stresses appearing in some conformations processes. frictional resistance in sliding configurations. Gianturco. diameter (D). Song and Cook stents have straight arms while Choo. wire diameter where f(h) and g(h) are geometric functions. etc. Song. including multiple deformations at different levels.Mechanical comparative analysis of stents for colorectal obstruction non-linear inverse problem must be solved to determine the stiffness of the stent corresponding to each expanded configuration. Symphony and CPS stents have curved arms.

Songs braided Nitinol design. However. the stent becomes stiffer. when the pitch is increased. In this case. due to the rigid knots among segments. Mechanically. v10%. The compressed shape also requires catheters with large diameters and it has a low expansion rate. introduces negative aspects such as a strong reduction of the flexibility and the expansion rate. . and it needs at least 31 Fr catheters for its implantation. The Wallstent presents a high expansion rate and longitudinal flexibility. Figure 6. Radial multiple arcs spring. which provide maximum shortening after the deployment in the Wallstent and a minimal amount in the other two NiTi stents. Since this stent operates in elastic mode. which is an intrinsic property of the Wallstent configurations. the lack of connection between the wires in the Wallstent allows strong radius changes without each wire surpassing its yield stress. which is very suitable for winding vessels like the colon sigma. The total diameter in the compressed shape is high. the configuration of the Choo-Z stent provides more longitudinal flexibility. This aspect precludes its use in the majority of sigma colon stenosis. diameters and helix pitch. but less so than a stent in which all the NiTi segments are fixed by two rigid knots. which is higher than normal due to the prior cold work. Deployment and chronical mechanical parameters The highest expansion rates arise in the stainless steel Wallstent and in the CPS and Memotherm NiTi stents. the smaller the shortening. These behaviours are due to the different materials and geometries involved. This structure allows an increase in the opening capability of the stenosis without loss of flexibility. A flexible stent with a high expansion rate can be obtained with a thin diameter and few wires. The main characteristic of the Gianturco stent is its high radial stiffness. The shortening of the stent between its compressed shape in the catheter and its working shape. The only way to increase the radial expansive force is with higher wire thickness. In general. For a determined length of the wires and expansion rate. however. the pressure applied on the small contact area between the segments and the tissue can cause tissue necrosis. The flexible longitudinal bands alternating with narrow rigid bands in the Ultraflex stent produce a high radial compression resistance. each segment works like a double cantilever and this configuration reduces the deformation in the knots of the segments and avoids plastic deformation. These disadvantages are partially compensated by its performance in other dimensions. and can only be enhanced by increasing the diameter of wires or integrating the wires in polyurethane. This film eliminates the tendency to pull thread out of wires. its radial compression resistance and its capability to open stenosis are low. The shortening and the radial compression are not good. The modified Gianturco stents try to enhance their stiffness with a loss of global flexibility.S. this configuration presents low radial compression and crash resistance. The braided NiTi stent combines the geometry of the Wallstent with the superleasticity of the NiTi. However. contradictory performances are obtained when varying geometric parameters such as the number of wires. is a negative aspect during the interventional act. with lumens around 5 mm. In general. which can reach up to 50%. expansion rate and resistance to collapse. Domingo et al. although increasing the radial compression resistance and clearly decreasing its shorteness. as well as a low radiopacity. the higher the pitch. as carried out in Kangs stent version. This effect is inherent to the high helix pitch. Therefore. One of the main advantages of this configuration is the practically negligible shortening. and also limits its application to the rectum colon. there is less torsion and the stent needs more moment to obtain a global flexibility.

Mechanical comparative analysis of stents for colorectal obstruction The structure of the Esophacoil. This global flexibility is enhanced by the superelasticity of the Nitinol. This configuration increases the opening capability of the stenosis without affecting the elastic features of the structure. On the other hand. . Since its wire is part of the longitudinal structure. In addition to expansion rates of almost 7. with the short pitch and the high transversal section of the ribbon also provides a radial compression resistance. the operating mode is closer to torsion than to bending. The result is a stent with an expansion rate similar to the Wallstent and the high radial compression resistance and low shortening associated with the Gianturco Z-stent. or the pressure of adjacent organs is low because this applied local force is distributed in the pulled wires of the pressure plane. the sliding configuration of the Wallstent the vessel. The perimetral and longitudinal adaptability is low due to the small number of wires in each ring and the stiffness of the stainless steel. All these aspects are depicted in Figure 7. which increases since not all the knots are fixed. like in the esophagus. due to its configuration. the stent presents a longitudinal gradient of deployment pressure as a consequence of the different length of the grooves. which could require a pre-expansion. The configuration of the slotted tube stent provides a high perimetral adaptability like that present in the Ultraflex. presents higher resistance to collapse by curvature and crash pressure. Another deficiency is the lack of adaptation to the surface of Clinical behavior Restenosis is made more difficult by the small cell size in the Wallstent. On the contrary. Another positive aspect is the lower shortening compared to a Wallstent type stent. The mechanical stability is high whenever fracture does not occur. The transversal section is polygonal and not all the wires share the crash pressure. where the environment is less aggressive than in the colon. In the Ultraflex stent the fabric mesh presents a lack of crash resistance. with high flexibility. This configuration provides a high expansion rate in spite of the braided knots increasing the perimeter of the stent to more than that of the intrinsic wire. The fact that each turn works like an independent ring in bending allows an almost total adaptability to the surface of the vessel in response to symmetric or local pressure. which is a consequence of the polygonal articulated perimeter. The Song stent. provides a strong crash resistance. the superelastic structure of the romboidal cells allows a combination of the properties associated with a small segment working in flexion. The global flexibility is high since each turn works like an independent ring. which limits its application in winding or very localized stenosis. Other types of knot connections like in the Symphony stent. since the material admits elastic strain up to 8%. The behaviour of the Choo stent configuration against local forces provides the deformation of the romboidal cells and. due to its pitch and its section dimension. The global flexibility of this stent is low. the Esophacoil stent. the pressure in the stenosis causes a deformation in the wire independent of the vessel shape outside of the stenosis zone. In applications where the covering of the stent is necessary. and the global flexibility. a tumor growth. This negative aspect is compensated by other significant advantages. as has been recently referenced in the esophagus version. or a smaller diameter of the wires could minimize this effect. as a consequence. although the last case results in a loss of radiopacity. Finally. due to the partial fixation of the knots In the slotted tube stents (CPS and Memotherm). The negative features correspond to a low expansion rate. This structure establishes a good compromise between the radial forces that decrease with increasing segment length. All these aspects are depicted in Figure 7. the lack of adaptability is currently resolved by a bell-shape at the extremes of the stent. which reach up to 35 mm diameter in the extremes and 25 mm in the center. Even less likely is fracture by interstitial corrosion. as a double cantilever. On the other hand. its crash resistance is low. Buckling resistance and adaptability The response to a localized pressure in the Wallstent. In the Gianturco stent. In the Choo-Z stent the perimetral distribution of forces is more homogeneous and allows for greater adaptability. such as good adaptability to the vessel. the fracture resistance is high and can only happen by fatigue in the fine wire that joins the rings. it introduces high crash resistance in addition to good perimetral adaptability. in addition to a high crash resistance due to the absence of sliding knots. although this stent presents a high resistance against a symmetric radial compression. The Choo stent tries to compensate for the stiffness resulting from a structure with fixed knots with the compliance introduced by the superelasticity of the NiTi. and a high degree of shortening with the associated difficulty in implantation. such as a peristaltic movement.

In the slotted tube stent. More flexible stents lower the radiopacity. Other advantages are related to the finished surface of the ribbon. In the braided NiTi stent. since in some patients the fixation arises by the ends of the wires. Figure 7. in the Choo-Z and when the ended rings are not recovered. one of the advantages of the Gianturco configuration with the rigid knots within segments is that it provides precision in its implantation. type requires a more complex manufactured structure. and the bell-shape of the spiral in the extreme of the stent. Comparative mechanical analysis among stainless steel (grey background) and NiTi stents (white background). eliminates the risk of perforation. this effect is low in clinical trials. its configuration reduces the risk of migration. since the fabric mesh structure. and the risk of perforation is negligible. the bell-shape results in good adaptability to the vessel and prevents the formation of bags at the onset as well as the end of the prosthesis. which reduces perforation. the manufacturing process is easier than that of the Wallstent. since the knot does not slide and the segments can be embeded in the plastic. together with the high radiopacity of the high wire thickness. In the Song stent. On the other hand. On the contrary. the cutting laser and the surface treatments allow blunt ends with a very low perforation probability. The behaviour of the Choo stent with regard to perforation is good. a polymer film is sited in the middle of two stent configurations. Domingo et al. The configuration of the Esophacoil avoids tumoural growth without recovering the stent. which reduces migration. Regrettably. the stent provides better integration into the tissue and consequently a reduced risk of migration. since its surface does not present sharp wire ends. which is manufactured from one wire. However.S. On the other hand. different configurations may present optimum behaviours . Conclusions According to the former discussion. as well as at the end of the prosthesis. The lack of adaptability to the total surface of the vessel and the weak crash resistance cause it to exhibit a tendency to migrate. this behaviour is related in other cases to the perforation of the vessel. In that case. In the Ultraflex stent the mesh size is smaller than the Wallstent. its configuration prevents the formation of bag at the onset. In applications requiring recovered stents. The radiopacity of the Wallstent depends on the diameter of the wires.

Schmitz KP. Jour of Vascular and Interventional Radiology. Andresen R. Terada H. Mechanische Eigenshaften peripherer ballonexpandierbarer Stentsysteme. Projects: PI-031287 and PI-040364. Washiyama N. Current status of the expandable stent for the treatment of colorectal obstruction. Tsamakidis K. and includes a good longitudinal adaptability. Schmidt W. Finally. so the Esophacoil stent presents the best performance in this aspect. 2003. et al. 3. but in a general way the stents based on NiTi. Assesment of the trackability. Biomed Tech. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. References 1. Behrens P. Instituto de la Salud Carlos III.63:201–9. 2003. 13. Spain.47: 124–6. flexibility. Sweden. the wire diameter is very significant. Design characteristics and mechanical properties of a new NiTi stent. 2. 2004. Domingo S. Int J Colorectal Dis. Thus. Rı ´os R. et al. 2001. Suzki N. 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