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Ribaudo JG, He K, Madira S, Young ER, Martin C, Lu T, Sacks JM, Li X. Sutureless vascular anastomotic approaches and their potential impacts. Bioact Mater 2024; 38:73-94. [PMID: 38699240 PMCID: PMC11061647 DOI: 10.1016/j.bioactmat.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Sutureless anastomotic devices present several advantages over traditional suture anastomosis, including expanded global access to microvascular surgery, shorter operation and ischemic times, and reduced costs. However, their adaptation for arterial use remains a challenge. This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation. These approaches include extraluminal couplers, intraluminal devices, and methods assisted by lasers or vacuums, with a particular emphasis on tissue adhesives. We analyze these devices for artery compatibility, material composition, potential for intimal damage, risks of thrombosis and restenosis, and complications arising from their deployment and maintenance. Additionally, we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques. Ideally, a sutureless anastomotic device or technique should eliminate the need for vessel eversion, mitigate thrombosis through either biodegradation or the release of antithrombotic drugs, and be easily deployable for broad use. The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits.
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Affiliation(s)
- Joseph G. Ribaudo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Kevin He
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Sarah Madira
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Emma R. Young
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Cameron Martin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Tingying Lu
- Department of Plastic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | - Justin M. Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
| | - Xiaowei Li
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, MO, 63110, USA
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Huang X, Zheng C, Ding K, Zhang S, Lei Y, Wei Q, Yang L, Wang Y. Dual-crosslinked bioprosthetic heart valves prepared by glutaraldehyde crosslinked pericardium and poly-2-hydroxyethyl methacrylate exhibited improved antithrombogenicity and anticalcification properties. Acta Biomater 2022; 154:244-258. [PMID: 36306983 DOI: 10.1016/j.actbio.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023]
Abstract
Bioprosthetic heart valves (BHVs) have been widely used due to the revolutionary transcatheter aortic valve replacement (TAVR) techniques but suffer from a limited lifespan. Previous modification methods of BHVs mainly rely on glutaraldehyde precrosslinking and subsequent modification. In this study, we have engineered a Poly-2-Hydroxyethyl methacrylate (pHEMA) coated BHV based on co-crosslinking and co-polymerization strategies. Our BHV overcomes previous limitations of glutaraldehyde prefixation by introducing free molecules before crosslinking to achieve the crosslinking and allyl moiety immobilization simultaneously. Decellularized porcine pericardium and 2-Amino-4-pentenoic acid (APA) are firstly co-crosslinked by glutaraldehyde to obtain alkenylated porcine pericardium (APA-PP), then APA-PP is copolymerized with hydrophilic monomer 2-Hydroxyethyl methacrylate (HEMA) to prepare pHEMA grafted porcine pericardium (HEMA-PP). Compared with traditional glutaraldehyde crosslinked pericardium (GA), HEMA-PP exhibits decreased cytotoxicity and significantly increased endothelialial cells proliferation (7-folds higher than GA after 3-day incubation). In vitro and ex vivo hemocompatibility studies demonstrate the superiority of HEMA-PP in anti-thrombogenicity, where the platelet adhesion decreased by levels of approximately 89% compared to GA. Moreover, HEMA-PP maintains structurally stable with a low level of calcification in the subcutaneous model. The hydrodynamic performance and durability are proven to meet the requirements of ISO 5840-3. Altogether, HEMA-PP may have the potential for future clinical application. STATEMENT OF SIGNIFICANCE: Currently, bioprosthetic heart valves (BHVs) have drawbacks including cytotoxicity, calcification and thrombosis, which would accelerate structural valvular degeneration and limit the service life of BHVs. We developed a new modification strategy that could simultaneously improve the biocompatibility, anti-calcification and anti-thrombotic properties of BHVs. Moreover, the appropriate durability and hydrodynamic property demonstrated the potential of our strategy for clinical application. This work will potentially prolong the service life of BHVs and provide new insight for the modification of BHVs.
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Affiliation(s)
- Xueyu Huang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Cheng Zheng
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Kailei Ding
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Shumang Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Qingrong Wei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, PR China.
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Antibacterial Activity of Antibiotic-Releasing Polydopamine-Coated Nephrite Composites for Application in Drug-Eluting Contact Lens. MATERIALS 2022; 15:ma15144823. [PMID: 35888290 PMCID: PMC9315558 DOI: 10.3390/ma15144823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study is to prepare ciprofloxacin (CIP) or levofloxacin (LEVO)-incorporated and polydopamine (PDA)-coated nephrite composites for application in drug-eluting contact lenses. PDA was coated onto the surface of nephrite to improve antibacterial activity and to payload antibiotics. CIP or LEVO was incorporated into the PDA layer on the surface of nephrite. Furthermore, CIP-incorporated/PDA-coated nephrite composites were embedded into the contact lenses. PDA-coated nephrite composites showed dull and smooth surfaces according to the dopamine concentration while nephrite itself has sharp surface morphology. CIP- or LEVO-loaded/PDA-coated nephrite composites also have dull and smooth surface properties. Nano and/or sub-micron clusters were observed in field emission-scanning electron microscopy (FE-SEM) observation, indicating that PDA nanoparticles were accumulated and coated onto the surface of nephrite. Furthermore, CIP- or LEVO-incorporated/PDA-coated nephrite composites showed the sustained release of CIP or LEVO in vitro and these properties contributed to the enhanced antibacterial activity of composites compared to nephrite or PDA-coated nephrite composites. CIP-incorporated/PDA-coated nephrite composites were embedded in the contact lenses and then, in an antibacterial study, they showed higher bactericidal effect against Staphylococcus aureus (S. aureus) compared to nephrite itself or PDA-coated nephrite composites. We suggest that CIP- or LEVO-loaded/PDA-coated nephrite composite-embedded contact lenses are a promising candidate for therapeutic application.
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Nakayama Y, Nishi S, Ishibashi-Ueda H, Okamoto Y, Nemoto Y. Development of Microporous Covered Stents: Geometrical Design of the Luminal Surface. Int J Artif Organs 2018; 28:600-8. [PMID: 16015570 DOI: 10.1177/039139880502800609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To reduce in-stent restenosis rates we have developed newly designed covered stents, in which a stent strut is buried into a microporous elastomeric cover film to provide a physical barrier against tissue ingrowth and a pharmacological reservoir for drug-eluting. The covered stents were prepared by dip-coating balloon expandable stents mounted on a stainless steel rod in a segmented polyurethane (SPU) solution, and were subsequently subjected to laser-processed microporing (pore diameter, 100 μm; interpore distance, 200 μm). The covered stents, which possessed flat luminal surfaces and micropores that were homogeneously arranged on the whole surface of the covering film, were deployed into the bilateral common carotid arteries of normal New Zealand white rabbits. Angiography after one month of implantation showed all stents were patent with little thrombus formation. The mean thickness of the formed neointimal layers was 292 ± 177 μm (n=8), which was close to the size in non-covered bare stent (231 ± 58 μm, n=7), but markedly decreased (about 2/3) from that in the previously developed wrapping-type covered stents (415 ± 173 μm, P<0.01, n=8).
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Affiliation(s)
- Y Nakayama
- Department of Bioengineering, National Cardiovascular Center Research Institute, Suita, Osaka, Japan.
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Van De Walle E, Van Nieuwenhove I, De Vos W, Declercq H, Dubruel P, Van Vlierberghe S. Cell response of flexible PMMA-derivatives: supremacy of surface chemistry over substrate stiffness. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:183. [PMID: 29027051 DOI: 10.1007/s10856-017-5994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
The present work reports on the development of a range of poly(methyl methacrylate)/poly(ethylene glycol) (PMMAPEG)-based materials, characterized by different elasticity moduli in order to study the influence of the substrate's mechanical properties on the response of human umbilical vein endothelial cells (HUVECs). To render the selected materials cell-interactive, a polydopamine (PDA)/gelatin type B (Gel B) coating was applied. Prior to the in vitro assay, the success of the PDA and Gel B immobilization onto the materials was confirmed using X-ray photoelectron spectroscopy (XPS) as reflected by the nitrogen percentages measured for the materials after PDA and Gel B deposition. Tensile tests showed that materials with E-moduli ranging from 37 to 1542 MPa could be obtained by varying the ratio between PMMA and PEG as well as the PEG molecular weight and its functionality (i.e. mono-methacrylate vs. di-methacrylate). The results after 1 day of cell contact suggested a preferred HUVECs cell growth onto more rigid materials. After 1 week, the material with the lowest E-modulus of 37 MPa showed lower cell densities compared to the other materials. No clear correlation could be observed between the number of focal adhesion points and the substrate stiffness. Although minor differences were found, these were not statistically significant. This last conclusion again highlights the universal character of the PDA/Gel B modification. The present work could thus be valuable for the development of a range of cell substrates requiring different mechanical properties in line with the envisaged application while the cell response should ideally remain unaffected.
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Affiliation(s)
- Elke Van De Walle
- Polymer Chemistry & Biomaterials Group, Centre of Macromolecular Chemistry (CMaC), Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000, Ghent, Belgium
| | - Ine Van Nieuwenhove
- Polymer Chemistry & Biomaterials Group, Centre of Macromolecular Chemistry (CMaC), Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000, Ghent, Belgium
| | - Winnok De Vos
- Department of Chemistry, University of Antwerp, Universiteitsplein 1, BE-2610, Wilrijk-Antwerp, Belgium
- Department of Molecular Biotechnology, Ghent University, Coupure links 653, 9000, Ghent, Belgium
| | - Heidi Declercq
- Tissue Engineering Group, Department of Basic Medical Sciences, Ghent University, De Pintelaan 185 6B3, Ghent, B-9000, Belgium
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Group, Centre of Macromolecular Chemistry (CMaC), Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000, Ghent, Belgium.
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Group, Centre of Macromolecular Chemistry (CMaC), Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000, Ghent, Belgium.
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Van De Walle E, Van Nieuwenhove I, Vanderleyden E, Declercq H, Gellynck K, Schaubroeck D, Ottevaere H, Thienpont H, De Vos WH, Cornelissen M, Van Vlierberghe S, Dubruel P. Polydopamine-Gelatin as Universal Cell-Interactive Coating for Methacrylate-Based Medical Device Packaging Materials: When Surface Chemistry Overrules Substrate Bulk Properties. Biomacromolecules 2015; 17:56-68. [PMID: 26568299 DOI: 10.1021/acs.biomac.5b01094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite its widespread application in the fields of ophthalmology, orthopedics, and dentistry and the stringent need for polymer packagings that induce in vivo tissue integration, the full potential of poly(methyl methacrylate) (PMMA) and its derivatives as medical device packaging material has not been explored yet. We therefore elaborated on the development of a universal coating for methacrylate-based materials that ideally should reveal cell-interactivity irrespective of the polymer substrate bulk properties. Within this perspective, the present work reports on the UV-induced synthesis of PMMA and its more flexible poly(ethylene glycol) (PEG)-based derivative (PMMAPEG) and its subsequent surface decoration using polydopamine (PDA) as well as PDA combined with gelatin B (Gel B). Successful application of both layers was confirmed by multiple surface characterization techniques. The cell interactivity of the materials was studied by performing live-dead assays and immunostainings of the cytoskeletal components of fibroblasts. It can be concluded that only the combination of PDA and Gel B yields materials possessing similar cell interactivities, irrespective of the physicochemical properties of the underlying substrate. The proposed coating outperforms both the PDA functionalized and the pristine polymer surfaces. A universal cell-interactive coating for methacrylate-based medical device packaging materials has thus been realized.
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Affiliation(s)
- Elke Van De Walle
- Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University , Krijgslaan 281 S4Bis, Ghent B-9000, Belgium
| | - Ine Van Nieuwenhove
- Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University , Krijgslaan 281 S4Bis, Ghent B-9000, Belgium
| | - Els Vanderleyden
- Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University , Krijgslaan 281 S4Bis, Ghent B-9000, Belgium
| | - Heidi Declercq
- Tissue Engineering Group, Department of Basic Medical Sciences, Ghent University , De Pintelaan 185 6B3, Ghent B-9000, Belgium
| | - Karolien Gellynck
- Tissue Engineering Group, Department of Basic Medical Sciences, Ghent University , De Pintelaan 185 6B3, Ghent B-9000, Belgium
| | - David Schaubroeck
- Center for Microsystems Technology (CMST), Imec and Ghent University , Technologiepark 914A, B-9052 Ghent, Belgium
| | - Heidi Ottevaere
- B-PHOT Brussels Photonics Team, Department of Applied Physics and Photonics, Vrije Universiteit Brussels , Pleinlaan 2, 1050 Brussels, Belgium
| | - Hugo Thienpont
- B-PHOT Brussels Photonics Team, Department of Applied Physics and Photonics, Vrije Universiteit Brussels , Pleinlaan 2, 1050 Brussels, Belgium
| | - Winnok H De Vos
- Department of Molecular Biotechnology, Ghent University , Coupure links 653, 9000 Ghent, Belgium.,Department of Veterinary Sciences, Antwerp University , Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Maria Cornelissen
- Tissue Engineering Group, Department of Basic Medical Sciences, Ghent University , De Pintelaan 185 6B3, Ghent B-9000, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University , Krijgslaan 281 S4Bis, Ghent B-9000, Belgium.,B-PHOT Brussels Photonics Team, Department of Applied Physics and Photonics, Vrije Universiteit Brussels , Pleinlaan 2, 1050 Brussels, Belgium.,Department of Chemistry, University of Antwerp , Universiteitsplein 1, BE-2610 Wilrijk-Antwerp, Belgium
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Ghent University , Krijgslaan 281 S4Bis, Ghent B-9000, Belgium
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Functional polymeric nanoparticles for dexamethasone loading and release. Colloids Surf B Biointerfaces 2012; 93:59-66. [DOI: 10.1016/j.colsurfb.2011.12.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 11/20/2022]
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Vargün E, Sankir M, Aran B, Sankir ND, Usanmaz A. Synthesis and Characterization of 2-Hydroxyethyl Methacrylate (HEMA) and Methyl Methacrylate (MMA) Copolymer Used as Biomaterial. JOURNAL OF MACROMOLECULAR SCIENCE PART A-PURE AND APPLIED CHEMISTRY 2010. [DOI: 10.1080/10601320903526998] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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BAILEY STEVENR. DES Design: Theoretical Advantages and Disadvantages of Stent Strut Materials, Design, Thickness, and Surface Characteristics. J Interv Cardiol 2009. [DOI: 10.1111/j.1540-8183.2009.00449.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Okner R, Oron M, Tal N, Nyska A, Kumar N, Mandler D, Domb AJ. Electrocoating of stainless steel coronary stents for extended release of paclitaxel. J Biomed Mater Res A 2009; 88:427-36. [PMID: 18306316 DOI: 10.1002/jbm.a.31896] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- R Okner
- Department of Medicinal Chemistry and Natural Products, Faculty of Medicine, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Silvestri D, Cristallini C, Gagliardi M, Barbani N, D'Acunto M, Ciardelli G, Giusti P. Acrylic Copolymers as Candidates for Drug-Eluting Coating of Vascular Stents. J Biomater Appl 2008; 24:353-83. [DOI: 10.1177/0885328208095198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present work is the synthesis and characterization of polymer materials showing good adhesion, drug loading, and delivery properties, for potential cardiovascular application. In particular, poly(methylmethacrylate-co-acrylic acid) copolymers are prepared in different compositions by a radical polymerization and investigated as potential materials to coat metallic stents and to carry out a local drug release. Films obtained by dissolving the copolymer in an appropriate organic solvent (also loaded with an anti-restenosis drug, such as tacrolimus) are investigated: physicochemical properties, adhesiveness to metallic stent material, and kinetics of drug release in physiological environment are studied.
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Affiliation(s)
- D. Silvestri
- Department of Chemical Engineering, Industrial Chemistry and Materials Science, University of Pisa, Italy, , Interdepartmental Centre for the study and evaluation of Biomaterials and Endo-prosthesis'Nicolino Marchetti' (C.I.B.E.), Pisa, Italy
| | - C. Cristallini
- CNR Institute for Composite and Biomedical Materials IMCB Pisa, c/o Department of Chemical Engineering, Italy
| | - M. Gagliardi
- Department of Chemical Engineering, Industrial Chemistry and Materials Science, University of Pisa, Italy
| | - N. Barbani
- Department of Chemical Engineering, Industrial Chemistry and Materials Science, University of Pisa, Italy
| | - M. D'Acunto
- Department of Chemical Engineering, Industrial Chemistry and Materials Science, University of Pisa, Italy
| | - G. Ciardelli
- Department of Mechanics, Politecnico in Turin, Italy
| | - P. Giusti
- Department of Chemical Engineering, Industrial Chemistry and Materials Science, University of Pisa, Italy, CNR Institute for Composite and Biomedical Materials IMCB Pisa, c/o Department of Chemical Engineering, Italy, Interdepartmental Centre for the study and evaluation of Biomaterials and Endo-prosthesis
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Khan IA, Patravale VB. The Intra-Vascular Stent as a Site-Specific Local Drug Delivery System. Drug Dev Ind Pharm 2008; 31:59-78. [PMID: 15704858 DOI: 10.1081/ddc-44002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The current review focuses on utilization of a tubular structure (coated or uncoated, balloon expandable or self expanding) known as a "stent" for localized intravascular drug delivery. Emphasis of the review is on technologies currently employed for immobilization and coating for drug onto the stent prior to its placement in various lumen of the body. A brief discussion on stent design, comparison of angioplasty and coronary stenting, and market status complements the review for researchers new to this area.
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Affiliation(s)
- Imran Ahmad Khan
- Department of Pharmaceutical Sciences and Technology, University Institute of Chemical Technology, Matunga, Mumbai, India
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Huang LY, Yang MC. Surface immobilization of chondroitin 6-sulfate/heparin multilayer on stainless steel for developing drug-eluting coronary stents. Colloids Surf B Biointerfaces 2008; 61:43-52. [PMID: 17720460 DOI: 10.1016/j.colsurfb.2007.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 07/03/2007] [Accepted: 07/08/2007] [Indexed: 10/23/2022]
Abstract
A thin layer of gold was sputtered onto SUS316L stainless steel (SS) sheet. After thiolizing the Au layer with dimercaptosuccinic acid (DMSA), layers of chondroitin 6-sulfate (ChS) and heparin (HEP) were alternatively immobilized on the Au-treated SS. The resulting stent would be both anti-atherogenic and anti-thrombogenic. After repeating one to five cycles, one to five layers of polyelectrolyte complex (PEC) of ChS/HEP were successfully fabricated. A model drug, sirolimus, was loaded in the ChS/HEP layers. The SS-ChS-HEP surface was examined by X-ray photoelectron spectroscopy (XPS), contact angle, and atomic force microscopy (AFM) measurement. Biological tests including hemocompatibility, drug release pattern, and the inhibition of smooth muscle cell proliferation were also performed. The results show that the multilayer of ChS/HEP exhibits longer blood clotting time than pure SS substrates. Therefore, this biopolymer multilayer can avoid thrombosis on the stainless. The releasing rate of sirolimus can be controlled through the number of ChS/HEP PEC layers. With a five-layer coating, sirolimus can be released continuously for more than 20 days. Furthermore, the multilayer ChS/HEP loaded with sirolimus can suppress specifically to the growth of smooth muscle cells to avoid restenosis. This suggests that the PEC multilayer of ChS/HEP modified-SS could be applied in making drug-eluting stents.
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Affiliation(s)
- Li-Ying Huang
- Department of Polymer Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan, ROC
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Voudoukis T, Liatsikos EN, Kagadis GC, Christeas N, Flaris N, Katsanos K, Costantinides C, Perimenis P, Scopa CD, Filos KS, Nikiforidis GC, Alexopoulos D, Siablis D. Application of paclitaxel-eluting metal stents in renal artery of pig model. J Endourol 2007; 21:1571-6. [PMID: 18044994 DOI: 10.1089/end.2006.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent reports concerning coronary, carotid, and femoral vasculature have proposed the use of drug-eluting metal stents (MS) to improve clinical and angiographic outcomes. Based on these reports, we used paclitaxel-eluting MS within an animal renal artery lumen and compared the results with those using a bare-metal stent. MATERIALS AND METHODS The experimental model in this study was the female pig renal artery. Ten pigs with weights ranging from 25 to 30 kg were used. Twenty stents were placed, two in each animal. The MS placement was randomly performed in either the right or left renal artery of each animal. In 10 arteries, a 3.5 x 18 mm R-stent (group A) was placed; in the remaining 10 arteries, a 3 x 32 mm paclitaxel-eluting coronary stent (T-stent, group B) was inserted. Patency was estimated with the use of digital subtraction angiography, CT angiography, and virtual endoscopy at 24 hours and 1 month poststent placement. RESULTS The positioning of the MS was successful in all cases. The initial angiographic result was maintained 24 hours after the intervention. No stent migration was seen, except for one paclitaxel stent that was acutely occluded. The one-month patency rate, as demonstrated by angiography, CT angiography, and virtual endoscopy, was 70% (8 arteries) in group A and 90% (9 arteries) in group B. The thickness of the endothelium and of the muscular coat was statistically significantly less in group B compared with group A (P = 0.0352 and P = 0.0046, respectively). CONCLUSION These preliminary experimental study results suggest that the paclitaxel-eluting MS is more efficient than the bare-metal stent when used within the pig renal artery. Further experimental and clinical studies are necessary to validate our preliminary encouraging results.
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Affiliation(s)
- Theodore Voudoukis
- Department of Urology, University of Patras, School of Medicine, Patras, Greece
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Release profiles in drug-eluting stents: issues and uncertainties. J Control Release 2007; 120:149-60. [PMID: 17582635 DOI: 10.1016/j.jconrel.2007.04.022] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 04/19/2007] [Indexed: 11/23/2022]
Abstract
This review presents the current data on drug release from drug-eluting stents and the effects of the release profiles on animal and human data for coronary stenosis. Data for the two most important drugs, sirolimus (rapamycin) and paclitaxel, are presented, the polymers used are described and the observed release profiles are discussed for various polymer carriers. The current literature on the tissue compatibility of the polymers commonly used in drug-eluting stents is also discussed. The range of release rates from stents studied to date is limited for sirolimus, but somewhat broader for paclitaxel. Animal and human data comparing the different release profiles are limited to about 6 months for animals and 2-4 years for humans. From the data available, it appears that for both sirolimus and paclitaxel, a slow-releasing drug-eluting stent leads to slightly more favorable angiographic outcomes than more rapid release. Most of the complications arising from the use of drug-eluting stents are attributed to incomplete healing; one possible clinical consequence of this delay in healing is that anti-platelet therapy needs to be maintained over a much longer period than is the case for bare metal stents.
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Electrocoating of stainless steel coronary stents for extended release of Paclitaxel. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2007. [DOI: 10.1016/j.msec.2006.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mani G, Feldman MD, Patel D, Agrawal CM. Coronary stents: a materials perspective. Biomaterials 2006; 28:1689-710. [PMID: 17188349 DOI: 10.1016/j.biomaterials.2006.11.042] [Citation(s) in RCA: 407] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 11/29/2006] [Indexed: 12/21/2022]
Abstract
The objective of this review is to describe the suitability of different biomaterials as coronary stents. This review focuses on the following topics: (1) different materials used for stents, (2) surface characteristics that influence stent-biology interactions, (3) the use of polymers in stents, and (4) drug-eluting stents, especially those that are commercially available.
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Affiliation(s)
- Gopinath Mani
- Department of Biomedical Engineering, College of Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 0619, USA
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Asplund B, Sperens J, Mathisen T, Hilborn J. Effects of hydrolysis on a new biodegradable co-polymer. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2006; 17:615-30. [PMID: 16892724 DOI: 10.1163/156856206777346331] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to examine the feasibility of using a new low-modulus biodegradable thermoplastic elastomer for in vivo application as a stent cover. The new polymer, a thermoplastic elastomer, consists of a three-armed co-polymer of poly(lactide)acid (PLLA), poly(trimethylene carbonate) (PTMC) and poly(caprolactone) (PCL). A degradation study was performed in a buffer solution at 37 degrees C for 4 and 6 weeks. The effect of degradation on mechanical properties was studied by stress-strain measurements and explained by using modulated DSC, GPC and mass measurements. A tapered block of PLLA and trimethylene carbonate connecting the crystalline outer part and the inner elastic part was highly susceptible to hydrolysis and caused rapid degradation and subsequent loss of mechanical properties. Random chain scission and homogenous hydrolysis resulted in a loss in mass and molecular weight. After 6 weeks of in vitro hydrolysis the molecular weight had decreased 54% and the elongation-at-break dropped from more than 300% to 90%. A medium free cell seeding study showed that endothelial cells adhered well to the polymeric material. An indicative animal study with the polymer acting as a stent cover showed very low levels of inflammation; however, pronounced neointima thickening was observed which was probably due to the premature failure of the material.
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Affiliation(s)
- Basse Asplund
- The Angström laboratory, Uppsala University, Department of Material Chemistry, Box 538, S-752 21 Uppsala, Sweden.
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Ball M, O'Brien A, Dolan F, Abbas G, McLaughlin JA. Macrophage responses to vascular stent coatings. ACTA ACUST UNITED AC 2004; 70:380-90. [PMID: 15293311 DOI: 10.1002/jbm.a.30066] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diamond-like carbon (DLC) films have been proposed as potential coatings for blood-contacting devices. In this study, tetrahedral amorphous carbon (ta-C) films deposited by filtered cathodic vacuum arc system (FCVA) were compared with commercially deposited polyurethane coatings (PU) and uncoated stainless steel samples. X-ray reflectivity (XRR) measurements were performed to check density and thickness of the ta-C coatings, and contact angles measurements were used to assess surface wettability. J774 macrophages were used to assess the cell responses to the materials. Cell number, metabolic activity, and hydrogen peroxide production were measured by using biochemical assays, and the cell attachment and morphology were determined by using scanning electron microscopy and confocal laser scanning microscopy. Wettability measurements showed that of the materials, the stainless steel was the most hydrophilic, and the ta-C coatings were the most hydrophobic. Although the initial attachment and morphology did not appear to be dependent on the wettability, the cell numbers did increase with increasing wettability. Macrophages on the stainless steel samples were the most active in producing hydrogen peroxide. These data show that ta-C samples performed as well as commercial PU-coated samples in blocking cell reactions to the substrate and may prove to be effective coatings for blood-contacting materials.
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Affiliation(s)
- M Ball
- National Centre for Biomedical Engineering Science, NUI Galway, Ireland.
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Schwartz RS. Beauty's only skin deep: surface technologies emerge in stenting. Catheter Cardiovasc Interv 2003; 60:408-9. [PMID: 14571495 DOI: 10.1002/ccd.10678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Semiz E, Ermiş C, Yalçinkaya S, Sancaktar O, Değer N. Comparison of Initial Efficacy and Long-term Follow-up of Heparin-coated Jostent With Conventional NIR Stent. ACTA ACUST UNITED AC 2003; 44:889-98. [PMID: 14711184 DOI: 10.1536/jhj.44.889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The implantation of heparin-coated stents was reported to be well tolerated, but there are conflicting results about acute in-hospital complications. (sub)acute thrombosis rates, and long-term follow-up compared to uncoated stents. We compared the angiographic and clinical results after coronary placement of two stent models: the heparin-coated premounted Jostent and the uncoated premounted NIR stent. Of 710 patients revascularized, a total of 426 patients received Jostent (n = 230) or NIR stent (n = 196) implantation. The primary end points were acute or subacute thrombosis, urgent CABG, AMI or death, while the secondary end points were the comparison of the restenosis rates of the stents at the 6th month and of the functional angina classification of the stent groups at the 1st, 6th and 12th months. There were no significant differences between the Jostent and NIR stent groups regarding angiographic and procedural success. Acute thrombosis rates in the Jostent and NIR stent groups were similar while no subacute thrombosis was observed in either group. The major adverse cardiac event rates of the groups also did not differ. Angiographic restenosis occurred in 17% of the Jostent group and 16% of the NIR stent group (NS). The combined clinical and angiographic restenosis rate was also similar between the Jo and NIR groups (19% and 18%, respectively). Comparison of functional angina classes at the 1st, 6th and 12th months revealed no significant difference between the study groups. In conclusion, when compared with implantation of an uncoated premounted NIR stent, implantation of a heparin-coated premounted Jostent does not provide any more benefit with respect to initial efficacy, sub(acute) thrombosis and 6-month restenosis rates and 12-month clinical outcomes.
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Affiliation(s)
- Ender Semiz
- Department of Cardiology, Pamukkale University Medical School, Denizli, Turkey
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Tozzi P, Solem JO, Boumzebra D, Mucciolo A, Genton CY, Chaubert P, von Segesser LK. Is the GraftConnector a valid alternative to running suture in end-to-side coronary arteries anastomoses? Ann Thorac Surg 2001; 72:S999-1003. [PMID: 11565736 DOI: 10.1016/s0003-4975(01)02953-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND An animal study was carried out to compare long-term patency rates of coronary anastomoses performed with the GraftConnector versus running suture technique. METHODS 10 sheep, 45 to 55 kg, underwent off-pump coronary artery bypass grafting (right internal mammary artery to left anterior descending artery). In 5 animals, the anastomosis was performed with a GraftConnector and in 5 animals with 7-0 running suture. Intraoperative fluoroscopy and a fluoroscopic control at 6 months were performed. After 6 months, the animals were sacrificed and the anastomoses were examined histologically. RESULTS All animals survived at 6 months with 100% anastomosis patency rates in both groups. In the GraftConnector group, the anastomosis diameter at 6 months fluoroscopy was 118% of native left anterior descending artery versus 97% of the control group. Luminal anastomotic width at histology was 1.7 +/- 0.2 mm in the device group versus 1.6 +/- 0.1 mm in the control group. Mean intimal hyperplasia thickness was 0.21 +/- 0.1 mm in the device group versus 0.01 mm in the control group. CONCLUSIONS The GraftConnector provides a consistent and reproducible coronary artery anastomosis and reduces technical demand and manual dexterity in coronary operations. Long-term results demonstrate that off-pump coronary artery bypass grafting performed with the GraftConnector had the same patency rate and luminal width as those performed with running suture.
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Affiliation(s)
- P Tozzi
- Department of Cardiovascular Surgery, University of Lausanne, Switzerland.
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