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Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [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: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
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Wang Q, Huang S, Miao J, Chen Z, Li H, Zhao L, Yuan J. Impact of inverse unequal height strut structure on the functional performance of an additively manufactured cardiovascular stent. J Mech Behav Biomed Mater 2023; 146:106058. [PMID: 37549521 DOI: 10.1016/j.jmbbm.2023.106058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
Recently, additive manufacturing (AM) has been investigated as an innovative method to manufacture stents due to its capability in producing complex and customized structures. In this paper, the cardiovascular stents of M-type and N-type with inverse unequal height strut structure and N-type with equal height strut structure were designed and manufactured by Selective Laser Melting (SLM). Following surface polishing, balloon expansion, plane compression and three-point bending experiments were carried out to evaluate the mechanical performance of the stent. The stents designed with inverse unequal height strut structure showed higher radial support performance and lower radial recoil when compared to the stents with uniform design. This study proved the feasibility of SLM in rapid manufacturing of cardiovascular stents that can be used for performance evaluation in design stage.
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Affiliation(s)
- Qilong Wang
- School of Mechanical and Equipment Engineering, Hebei University of Engineering, Handan, 056038, China
| | - Suxia Huang
- School of Mechanical and Equipment Engineering, Hebei University of Engineering, Handan, 056038, China; School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Jingtao Miao
- School of Mechanical and Equipment Engineering, Hebei University of Engineering, Handan, 056038, China
| | - Zhiang Chen
- School of Mechanical and Equipment Engineering, Hebei University of Engineering, Handan, 056038, China
| | - Hezong Li
- School of Mechanical and Equipment Engineering, Hebei University of Engineering, Handan, 056038, China; Key Laboratory of Intelligent Industrial Equipment Technology of Hebei Province, Handan, 056038, China.
| | - Liguo Zhao
- School of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China.
| | - Jiangyong Yuan
- Affiliated Hospital of Hebei Engineering University, Handan, 056001, China
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Shi Q, Zhang B, Wang X, Fei J, Qin Q, Zheng B, Chen M. Safety and efficacy of a novel 3D-printed bioresorbable sirolimus-eluting scaffold in a porcine model. ASIAINTERVENTION 2023; 9:133-142. [PMID: 37736208 PMCID: PMC10507451 DOI: 10.4244/aij-d-22-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/19/2022] [Indexed: 09/23/2023]
Abstract
Background The effect of 3D-printed bioresorbable vascular scaffolds (BRS) in coronary heart disease has not been clarified. Aims We aimed to compare the safety and efficacy of 3D-printed BRS with that of metallic sirolimus-eluting stents (SES). Methods Thirty-two BRS and 32 SES were implanted into 64 porcine coronary arteries. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were performed at 14, 28, 97, and 189 days post-implantation. Scanning electron microscopy (SEM) and histopathological analyses were performed at each assessment. Results All stents/scaffolds were successfully implanted. All animals survived for the duration of the study. QCA showed the two devices had a similar stent/scaffold-to-artery ratio and acute percent recoil. OCT showed the lumen area (LA) and scaffold/stent area (SA) of the BRS were significantly smaller than those of the SES at 14 and 28 days post-implantation (14-day LA: BRS vs SES 4.52±0.41 mm2 vs 5.69±1.11 mm2; p=0.03; 14-day SA: BRS vs SES 4.99±0.45 mm2 vs 6.11±1.06 mm2; p=0.03; 28-day LA: BRS vs SES 2.93±1.03 mm2 vs 4.82±0.74 mm2; p=0.003; 28-day SA: BRS vs SES 3.86±0.98 mm2 vs 5.75±0.71 mm2; p=0.03). Both the LA and SA of the BRS increased over time and were similar to those of the SES at the 97-day and 189-day assessments. SEM and histomorphological analyses showed no significant between-group differences in endothelialisation at each assessment. Conclusions The novel 3D-printed BRS showed safety and efficacy similar to that of SES in a porcine model. The BRS also showed a long-term positive remodelling effect.
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Affiliation(s)
- Qiuping Shi
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bin Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Jintao Fei
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Qiao Qin
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People's Republic of China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China
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Gregory DA, Fricker ATR, Mitrev P, Ray M, Asare E, Sim D, Larpnimitchai S, Zhang Z, Ma J, Tetali SSV, Roy I. Additive Manufacturing of Polyhydroxyalkanoate-Based Blends Using Fused Deposition Modelling for the Development of Biomedical Devices. J Funct Biomater 2023; 14:jfb14010040. [PMID: 36662087 PMCID: PMC9865795 DOI: 10.3390/jfb14010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
In the last few decades Additive Manufacturing has advanced and is becoming important for biomedical applications. In this study we look at a variety of biomedical devices including, bone implants, tooth implants, osteochondral tissue repair patches, general tissue repair patches, nerve guidance conduits (NGCs) and coronary artery stents to which fused deposition modelling (FDM) can be applied. We have proposed CAD designs for these devices and employed a cost-effective 3D printer to fabricate proof-of-concept prototypes. We highlight issues with current CAD design and slicing and suggest optimisations of more complex designs targeted towards biomedical applications. We demonstrate the ability to print patient specific implants from real CT scans and reconstruct missing structures by means of mirroring and mesh mixing. A blend of Polyhydroxyalkanoates (PHAs), a family of biocompatible and bioresorbable natural polymers and Poly(L-lactic acid) (PLLA), a known bioresorbable medical polymer is used. Our characterisation of the PLA/PHA filament suggest that its tensile properties might be useful to applications such as stents, NGCs, and bone scaffolds. In addition to this, the proof-of-concept work for other applications shows that FDM is very useful for a large variety of other soft tissue applications, however other more elastomeric MCL-PHAs need to be used.
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Two-Step Geometry Design Method, Numerical Simulations and Experimental Studies of Bioresorbable Stents. MATERIALS 2022; 15:ma15072385. [PMID: 35407718 PMCID: PMC8999420 DOI: 10.3390/ma15072385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/16/2022]
Abstract
The stent-implantation process during angioplasty procedures usually involves clamping the stent onto a catheter to a size that allows delivery to the place inside the artery. Finding the right geometrical form of the stent to ensure good functionality in the open form and to enable the clamping process is one of the key elements in the stent-design process. In the first part of the work, an original two-step procedure for stent-geometry design was proposed. This was due to the necessary selection of a geometry that would provide adequate support to the blood-vessel wall without causing damage to the vessel. Numerical simulations of the crimping and deployment processes were performed to verify the method. At the end of this stage, the optimal stent was selected for further testing. In addition, numerical simulations of selected experimental tests (catheter-crimping process, compression process) were used to verify the obtained geometrical forms. The results of experimental tests on stents produced by the microinjection method are presented. The digital image correlation (DIC) method was used to compare the results of numerical simulation and experimental tests. The two-step modeling approach was found to help select the appropriate geometry of the expanded stent, which is an extremely important step in the design of the crimping process. In the part of the paper where the results obtained by numerical simulation were compared with those gained by experiment and using the DIC method, a good compatibility of the displacement results can be observed. For both longitudinal and transverse (pinch) stent compression, the results practically coincide. The paper presents also the application of the DIC method which significantly expands the research possibilities, allowing for a detailed inspection of the deformation state and, above all, verification of local dangerous areas. This approach significantly increases the possibility of assessing the quality of the stents.
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Wang L, Jiao L, Pang S, Yan P, Wang X, Qiu T. The Development of Design and Manufacture Techniques for Bioresorbable Coronary Artery Stents. MICROMACHINES 2021; 12:mi12080990. [PMID: 34442612 PMCID: PMC8398368 DOI: 10.3390/mi12080990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 02/02/2023]
Abstract
Coronary artery disease (CAD) is the leading killer of humans worldwide. Bioresorbable polymeric stents have attracted a great deal of interest because they can treat CAD without producing long-term complications. Bioresorbable polymeric stents (BMSs) have undergone a sustainable revolution in terms of material processing, mechanical performance, biodegradability and manufacture techniques. Biodegradable polymers and copolymers have been widely studied as potential material candidates for bioresorbable stents. It is a great challenge to find a reasonable balance between the mechanical properties and degradation behavior of bioresorbable polymeric stents. Surface modification and drug-coating methods are generally used to improve biocompatibility and drug loading performance, which are decisive factors for the safety and efficacy of bioresorbable stents. Traditional stent manufacture techniques include etching, micro-electro discharge machining, electroforming, die-casting and laser cutting. The rapid development of 3D printing has brought continuous innovation and the wide application of biodegradable materials, which provides a novel technique for the additive manufacture of bioresorbable stents. This review aims to describe the problems regarding and the achievements of biodegradable stents from their birth to the present and discuss potential difficulties and challenges in the future.
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Affiliation(s)
- Liang Wang
- School of Mechanical Engineering, Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.W.); (S.P.)
| | - Li Jiao
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
| | - Shuoshuo Pang
- School of Mechanical Engineering, Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.W.); (S.P.)
| | - Pei Yan
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
| | - Xibin Wang
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
| | - Tianyang Qiu
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
- Correspondence:
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Pan C, Han Y, Lu J. Structural Design of Vascular Stents: A Review. MICROMACHINES 2021; 12:mi12070770. [PMID: 34210099 PMCID: PMC8305143 DOI: 10.3390/mi12070770] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
Percutaneous Coronary Intervention (PCI) is currently the most conventional and effective method for clinically treating cardiovascular diseases such as atherosclerosis. Stent implantation, as one of the ways of PCI in the treatment of coronary artery diseases, has become a hot spot in scientific research with more and more patients suffering from cardiovascular diseases. However, vascular stent implanted into vessels of patients often causes complications such as In-Stent Restenosis (ISR). The vascular stent is one of the sophisticated medical devices, a reasonable structure of stent can effectively reduce the complications. In this paper, we introduce the evolution, performance evaluation standards, delivery and deployment, and manufacturing methods of vascular stents. Based on a large number of literature pieces, this paper focuses on designing structures of vascular stents in terms of “bridge (or link)” type, representative volume unit (RVE)/representative unit cell (RUC), and patient-specific stent. Finally, this paper gives an outlook on the future development of designing vascular stents.
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Affiliation(s)
- Chen Pan
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
- Institute of Engineering Medicine, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China
| | - Yafeng Han
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
- Correspondence:
| | - Jiping Lu
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
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Xiao J, Zhang Y, Fang T, Yuan T, Tian Q, Liu J, Cheng Y, Zhu Y, Cheng L, Cui W. Mineralized manganese dioxide channel as the stent coating for in situ precise tumor navigation. NANO RESEARCH 2020. [DOI: 10.1007/s12274-020-3114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 08/30/2023]
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Kawashima H, Ono M, Kogame N, Takahashi K, Chang CC, Hara H, Gao C, Wang R, Tomaniak M, Modolo R, Wykrzykowska JJ, De Winter RJ, Sharif F, Serruys PW, Onuma Y. Drug-eluting bioresorbable scaffolds in cardiovascular disease, peripheral artery and gastrointestinal fields: a clinical update. Expert Opin Drug Deliv 2020; 17:931-945. [DOI: 10.1080/17425247.2020.1764932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chun-Chin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Rutao Wang
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Joanna J. Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J. De Winter
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Miranda CS, Ribeiro ARM, Homem NC, Felgueiras HP. Spun Biotextiles in Tissue Engineering and Biomolecules Delivery Systems. Antibiotics (Basel) 2020; 9:E174. [PMID: 32290536 PMCID: PMC7235791 DOI: 10.3390/antibiotics9040174] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022] Open
Abstract
Nowadays, tissue engineering is described as an interdisciplinary field that combines engineering principles and life sciences to generate implantable devices to repair, restore and/or improve functions of injured tissues. Such devices are designed to induce the interaction and integration of tissue and cells within the implantable matrices and are manufactured to meet the appropriate physical, mechanical and physiological local demands. Biodegradable constructs based on polymeric fibers are desirable for tissue engineering due to their large surface area, interconnectivity, open pore structure, and controlled mechanical strength. Additionally, biodegradable constructs are also very sought-out for biomolecule delivery systems with a target-directed action. In the present review, we explore the properties of some of the most common biodegradable polymers used in tissue engineering applications and biomolecule delivery systems and highlight their most important uses.
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Affiliation(s)
| | | | | | - Helena P. Felgueiras
- Centre for Textile Science and Technology (2C2T), Department of Textile Engineering, University of Minho, Campus of Azurém, 4800-058 Guimarães, Portugal; (C.S.M.); (A.R.M.R.); (N.C.H.)
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Dinh Nguyen T, Feng G, Yi X, Lyu Y, Lan Z, Xia J, Wu T, Jiang X. Six-month evaluation of novel bioabsorbable scaffolds composed of poly-L-lactic acid and amorphous calcium phosphate nanoparticles in porcine coronary arteries. J Biomater Appl 2019; 33:227-233. [PMID: 30096995 DOI: 10.1177/0885328218790332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Using coronary angiography and intravascular ultrasound methods to evaluate the performance of the novel fully bioabsorbable scaffold (NFBS) composed of poly-L-lactic acid/amorphous calcium phosphate (PLLA/ACP) at six-month follow-up by comparing with PLLA scaffolds Methods Twelve PLLA/ACP scaffolds and 12 PLLA scaffolds were implanted into the coronary arteries of 12 miniature pigs. Quantitative coronary angiography (QCA) was used to measure the reference vessel diameter (RVD), mean lumen diameter (MLD) and late lumen loss (LLL). According to IVUS images, we calculated the strut malapposition rate (SMR) at post implantation, strut overlap rate (SOR), reference vessel area (RVA), mean stent area (MSA), mean lumen area (MLA) and luminal patency rate (LPR) at six-month follow-up. The radial strength of the scaffold was evaluated using a catheter tensile testing machine. Results QCA results indicated that, at six month, MLD of PLLA/ACP scaffolds was greater than those of PLLA scaffolds (2.47 ± 0.22 mm vs. 2.08 ± 0.25 mm, P < 0.05); LLL of PLLA/ACP scaffolds was less than those of PLLA scaffolds (0.42 ± 0.20 mm vs. 0.75 ± 0.22 mm, P < 0.05). IVUS results showed the SMR and SOR were all significantly less with the PLLA/ACP scaffolds than the PLLA scaffolds (5.84% ± 3.56% vs. 17.72% ± 4.86%, P < 0.05) (6.17% ± 4.63% vs. 17.65% ± 4.29%, P < 0.05). MSA, MLA and LPR of the PLLA/ACP scaffolds were all greater than those of PLLA scaffolds (6.35 ± 0.45 mm2 vs. 5.35 ± 0.51 mm2, P < 0.05) (4.76 ± 0.46 mm2 vs. 3.77 ± 0.46 mm2, P < 0.05) (78.01% ± 12.29% vs. 61.69% ± 9.76%, P < 0.05). Radial strength of PLLA/ACP scaffold at six month was greater than that of PLLA scaffold (76.33 ± 3.14 N vs. 67.67 ± 3.63 N). Conclusion The NFBS had less stent recoil, better lumen patency rate and greater radial strength than PLLA scaffolds. The results suggest the NFBS scaffolds can maintain the structural strength and functional performance, which are effective for up to six months when implanted in porcine coronary arteries.
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Affiliation(s)
- Thanh Dinh Nguyen
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaoke Feng
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Yi
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yongnan Lyu
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiyuan Lan
- 2 VasoTech Inc., Lowell, MA, USA.,3 Department of Plastic Engineering, University of Massachusetts Lowell, Lowell, MA, USA.,5 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Tim Wu
- 2 VasoTech Inc., Lowell, MA, USA.,3 Department of Plastic Engineering, University of Massachusetts Lowell, Lowell, MA, USA.,5 Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuejun Jiang
- 1 Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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Mollazadeh-Moghaddam K, Rezaei Nejad H, Chen AZ, Ju J, Tamayol A, Liu X, Zhang YS, Oklu R, Khademhosseini A. Fracture-Resistant and Bioresorbable Drug-Eluting Poly(glycerol Sebacate) Coils. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kamyar Mollazadeh-Moghaddam
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Hojatollah Rezaei Nejad
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Ai-Zheng Chen
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Institute of Biomaterials and Tissue Engineering; Huaqiao University; Xiamen Fujian 362021 P. R. China
| | - Jie Ju
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Ali Tamayol
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Department of Mechanical and Materials Engineering; University of Nebraska-Lincoln; Lincoln NE 68508 USA
| | - Xiao Liu
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Beijing Advanced Innovation Center for Biomedical Engineering; Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education; School of Biological Science and Medical Engineering; Beihang University; Beijing 100083 P. R. China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology; Minimally Invasive Therapeutics Laboratory; Mayo Clinic, 5777 E. Mayo Blvd Phoenix AZ 85054 USA
| | - Ali Khademhosseini
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Center for Minimally Invasive Therapeutics; University of California-Los Angeles; Los Angeles CA 90095 USA
- Department of Radiology, David Geffen School of Medicine; University of California-Los Angeles; Los Angeles CA 90095 USA
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences; University of California-Los Angeles; Los Angeles CA 90095 USA. California NanoSystems Institute; University of California-Los Angeles; Los Angeles 90095 CA USA. Department of Bioindustrial Technologies; Konkuk University; Seoul 143-701 Republic of Korea
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13
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Biodegradable stents for coronary artery disease treatment: Recent advances and future perspectives. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 91:163-178. [DOI: 10.1016/j.msec.2018.04.100] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 04/11/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
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Borhani S, Hassanajili S, Ahmadi Tafti SH, Rabbani S. Cardiovascular stents: overview, evolution, and next generation. Prog Biomater 2018; 7:175-205. [PMID: 30203125 PMCID: PMC6173682 DOI: 10.1007/s40204-018-0097-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/25/2018] [Indexed: 12/01/2022] Open
Abstract
Compared to bare-metal stents (BMSs), drug-eluting stents (DESs) have been regarded as a revolutionary change in coronary artery diseases (CADs). Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Despite supreme advantages over BMSs, in-stent restenosis (ISR) and long-term safety of DESs are still deemed ongoing concerns over clinically application of DESs. The failure of DESs for long-term clinical use is associated with following factors including permanent polymeric coating materials, metallic stent platforms, non-optimal drug releasing condition, and factors that have recently been supposed as contributory factors such as degradation products of polymers, metal ions due to erosion and degradation of metals and their alloys utilizing in some stents as metal frameworks. Discovering the direct relation between stent materials and associating adverse effects is a complicated process, and yet it has not been resolved. For clinical success it is of significant importance to optimize DES design and explore novel strategies to overcome all problems including inflammatory response, delay endothelialization, and sub-acute stent thrombosis (ST) simultaneously. In this work, scientific reports are reviewed particularly focusing on recent advancements in DES design which covers both potential improvements of existing and recently novel prototype stent fabrications. Covering a wide range of information from the BMSs to recent advancement, this study mostly sheds light on DES's concepts, namely stent composition, drug release mechanism, and coating techniques. This review further reports different forms of DES including fully biodegradable DESs, shape-memory ones, and polymer-free DESs.
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Affiliation(s)
- Setareh Borhani
- Department of Chemical Engineering, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran
| | - Shadi Hassanajili
- Department of Nanochemical Engineering, School of New Science and Technology, Shiraz University, Shiraz, Iran.
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar, Tehran, Iran
| | - Shahram Rabbani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar, Tehran, Iran
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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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Katagiri Y, Stone G, Onuma Y, Serruys P. State of the art: the inception, advent and future of fully bioresorbable scaffolds. EUROINTERVENTION 2017; 13:734-750. [DOI: 10.4244/eij-d-17-00499] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Vurugonda U, Rednam P, Sinha M. Development of biodegradable scaffold using polylactic acid and polycaprolactone for cardiovascular application. INT J POLYM MATER PO 2017. [DOI: 10.1080/00914037.2017.1297945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Upender Vurugonda
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Ahmedabad, Gandhinagar, Gujarat, India
| | - PoornaJyothi Rednam
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Ahmedabad, Gandhinagar, Gujarat, India
| | - Mukty Sinha
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Ahmedabad, Gandhinagar, Gujarat, India
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Sekimoto Y, Obara H, Matsubara K, Fujimura N, Harada H, Kitagawa Y. Comparison of early vascular morphological changes between bioresorbable poly-L-lactic acid scaffolds and metallic stents in porcine iliac arteries. Organogenesis 2017; 13:29-38. [PMID: 28102777 DOI: 10.1080/15476278.2017.1280211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Bioresorbable scaffolds have the potential to overcome several problems associated with metallic stents. Bioresorbable poly-L-lactic acid (PLLA) scaffold implantation for the treatment of peripheral artery disease has already been reported in animal models and clinical trials; however, no studies comparing PLLA scaffolds and bare metal stents (BMSs) with regard to early vascular morphological changes, identified using intravascular ultrasound (IVUS) analysis, have been reported. In this study, PLLA scaffolds and BMSs were implanted bilaterally in iliac arteries of five miniature pigs. Digital subtraction angiography and IVUS were performed before and immediately after stent implantation and at 6-week follow-up. All PLLA scaffolds and BMSs were patent at 6-week follow-up. Per IVUS analysis, the percent area stenosis did not significantly differ between PLLA scaffolds and BMSs (65.7% vs. 67.2%, P = .761). Furthermore, percent vessel lumen change also did not differ significantly. Neointima formation (the neointimal area plus medial area) was significantly less with PLLA scaffolds than with BMSs (15.65 mm2 vs. 25.69 mm2, P < .001). In conclusion, based on IVUS results, short-term results after stent implantation in porcine iliac arteries were comparable between PLLA scaffolds and BMSs. Therefore, PLLA scaffolds are safe and feasible for implantation in peripheral arteries.
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Affiliation(s)
- Yasuhito Sekimoto
- a Department of Surgery , Keio University School of Medicine , Tokyo , Japan.,b Department of Surgery , Tokyo Dental College Ichikawa General Hospital , Chiba , Japan
| | - Hideaki Obara
- a Department of Surgery , Keio University School of Medicine , Tokyo , Japan
| | - Kentaro Matsubara
- a Department of Surgery , Keio University School of Medicine , Tokyo , Japan
| | - Naoki Fujimura
- a Department of Surgery , Keio University School of Medicine , Tokyo , Japan
| | - Hirohisa Harada
- b Department of Surgery , Tokyo Dental College Ichikawa General Hospital , Chiba , Japan
| | - Yuko Kitagawa
- a Department of Surgery , Keio University School of Medicine , Tokyo , Japan
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Sabti Z, Jeger R. [Not Available]. PRAXIS 2017; 106:85-89. [PMID: 28103170 DOI: 10.1024/1661-8157/a002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Die perkutane Ballonangioplastie revolutionierte die Behandlung der koronaren Herzkrankheit. Der Einsatz von Gefässstützen (Stents) setzte diese Revolution fort. Nach den reinen Metallstents (Bare metal stents, BMS) und den Medikamenten-beschichteten Stents (drug-eluting stents, DES) folgen nun bioresorbierbare Stents (bioresorbable vascular scaffolds, BVS). Im Gegensatz zu den ersten zwei Stent-Generationen werden die BVS nach einer bestimmten Zeit vollständig abgebaut und versprechen eine Antwort für bisher ungelöste Probleme von BMS und DES.
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Affiliation(s)
- Zaid Sabti
- 1 Klinik für Kardiologie, Universitätsspital Basel
| | - Raban Jeger
- 1 Klinik für Kardiologie, Universitätsspital Basel
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Bontinck J, Goverde P, Schroë H, Hendriks J, Maene L, Vermassen F. Treatment of the femoropopliteal artery with the bioresorbable REMEDY stent. J Vasc Surg 2016; 64:1311-1319. [PMID: 27462002 DOI: 10.1016/j.jvs.2016.05.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Bioresorbable stents are an emerging technology in the endovascular treatment of femoropopliteal lesions. They address the issue of leaving permanent stents in the treated arterial segment that are only temporarily needed to treat dissection or recoil. The REMEDY stent (Kyoto Medical Planning Co, Kyoto, Japan) was the first commercially available biodegradable scaffold for peripheral use. We evaluated its performance and safety in the treatment of short femoropopliteal stenosis or occlusion. METHODS A prospective, multicenter, observational registry was set up of patients in Rutherford-Becker categories 2 to 5 with femoropopliteal lesions that could be treated with one REMEDY stent. Clinical examination and duplex ultrasound imaging were performed at 1, 6, and 12 months. The primary end point was absence of clinically driven target lesion revascularization at 12 months. Secondary end points were technical and clinical success, primary and secondary patency rate, clinically driven target vessel revascularization, major complications, and Rutherford-Becker classification at 6 and 12 months. RESULTS The registry enrolled 99 patients between January 2011 and July 2013 in 12 centers in Belgium. Most lesions were determined as TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) A (n = 80) and located in the superficial femoral artery (n = 91). There were 19 total occlusions (mean length, 41.3 mm) and 80 stenoses (mean length, 37.5 mm). Technical success was achieved in 96 patients, and clinical success was obtained in 95. Target lesion revascularization, which equalled target vessel revascularization, was 19% at 6 months and rose to 33% at 12 months. Primary patency was 68% at 6 months and 58% at 12 months. Secondary patency was 85% at 6 months and 86% at 12 months. After 12 months, two patients had undergone an amputation. CONCLUSIONS The 1-year follow-up results of the REMEDY stent do not meet current standards set by nitinol stents. Given the significant issues concerning bioresorbable stents in femoropopliteal arteries, their use outside clinical trials should be withheld until improvements are made and better data are available.
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Affiliation(s)
- Jan Bontinck
- Department of Vascular Surgery, ZNA Stuivenberg, Antwerp, Belgium.
| | - Peter Goverde
- Department of Vascular Surgery, ZNA Stuivenberg, Antwerp, Belgium
| | - Herman Schroë
- Department of Vascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jeroen Hendriks
- Department of Vascular Surgery, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Lieven Maene
- Department of Vascular Surgery, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Frank Vermassen
- Department of Vascular Surgery, Universitair Ziekenhuis Gent, Ghent, Belgium
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Bowen PK, Shearier ER, Zhao S, Guillory RJ, Zhao F, Goldman J, Drelich JW. Biodegradable Metals for Cardiovascular Stents: from Clinical Concerns to Recent Zn-Alloys. Adv Healthc Mater 2016; 5:1121-40. [PMID: 27094868 PMCID: PMC4904226 DOI: 10.1002/adhm.201501019] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/01/2016] [Indexed: 12/31/2022]
Abstract
Metallic stents are used to promote revascularization and maintain patency of plaqued or damaged arteries following balloon angioplasty. To mitigate the long-term side effects associated with corrosion-resistant stents (i.e., chronic inflammation and late stage thrombosis), a new generation of so-called "bioabsorbable" stents is currently being developed. The bioabsorbable coronary stents will corrode and be absorbed by the artery after completing their task as vascular scaffolding. Research spanning the last two decades has focused on biodegradable polymeric, iron-based, and magnesium-based stent materials. The inherent mechanical and surface properties of metals make them more attractive stent material candidates than their polymeric counterparts. A third class of metallic bioabsorbable materials that are based on zinc has been introduced in the last few years. This new zinc-based class of materials demonstrates the potential for an absorbable metallic stent with the mechanical and biodegradation characteristics required for optimal stent performance. This review compares bioabsorbable materials and summarizes progress towards bioabsorbable stents. It emphasizes the current understanding of physiological and biological benefits of zinc and its biocompatibility. Finally, the review provides an outlook on challenges in designing zinc-based stents of optimal mechanical properties and biodegradation rate.
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Affiliation(s)
- Patrick K Bowen
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Emily R Shearier
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Shan Zhao
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Feng Zhao
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, 49931
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Yang K, Ling C, Yuan T, Zhu Y, Cheng Y, Cui W. Polymeric Biodegradable Stent Insertion in the Esophagus. Polymers (Basel) 2016; 8:E158. [PMID: 30979258 PMCID: PMC6432023 DOI: 10.3390/polym8050158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
Esophageal stent insertion has been used as a well-accepted and effective alternative to manage and improve the quality of life for patients diagnosed with esophageal diseases and disorders. Current stents are either permanent or temporary and are fabricated from either metal or plastic. The partially covered self-expanding metal stent (SEMS) has a firm anchoring effect and prevent stent migration, however, the hyperplastic tissue reaction cause stent restenosis and make it difficult to remove. A fully covered SEMS and self-expanding plastic stent (SEPS) reduced reactive hyperplasia but has a high migration rate. The main advantage that polymeric biodegradable stents (BDSs) have over metal or plastic stents is that removal is not require and reduce the need for repeated stent insertion. But the slightly lower radial force of BDS may be its main shortcoming and a post-implant problem. Thus, strengthening support of BDS is a content of the research in the future. BDSs are often temporarily effective in esophageal stricture to relieve dysphagia. In the future, it can be expect that biodegradable drug-eluting stents (DES) will be available to treat benign esophageal stricture, perforations or leaks with additional use as palliative modalities for treating malignant esophageal stricture, as the bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.
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Affiliation(s)
- Kai Yang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Christopher Ling
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou 215006, China.
- Nanotechnology Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Tianwen Yuan
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Wenguo Cui
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou 215006, China.
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He D, Liu W, Zhang T. The development of carotid stent material. INTERVENTIONAL NEUROLOGY 2015; 3:67-77. [PMID: 26019710 PMCID: PMC4439791 DOI: 10.1159/000369480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endovascular angioplasty with stenting is a promising option for treating carotid artery stenosis. There exist a rapidly increasing number of different stent types with different materials. The bare-metal stent is the most commonly used stent with acceptable results, but it leaves us with the problems of thrombosis and restenosis. The drug-eluting stent is a breakthrough as it has the ability to reduce the restenosis rate, but the problem of late thrombosis still has to be addressed. The biodegradable stent disappears after having served its function. However, restenosis and degradation rates remain to be studied. In this article, we review every stent material with its characteristics, clinical results and complications and point out the standards of an ideal carotid stent.
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Affiliation(s)
- Dongsheng He
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wenhua Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Tao Zhang
- College of Engineering and Applied Science, Nanjing University, Nanjing, China
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Materials and manufacturing technologies available for production of a pediatric bioabsorbable stent. BIOMED RESEARCH INTERNATIONAL 2013; 2013:137985. [PMID: 24089660 PMCID: PMC3780513 DOI: 10.1155/2013/137985] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/06/2013] [Indexed: 11/18/2022]
Abstract
Transcatheter treatment of children with congenital heart disease such as coarctation of the aorta and pulmonary artery stenosis currently involves the use of metal stents. While these provide good short term results, there are long term complications with their use. Children outgrow metal stents, obligating them to future transcatheter dilations and eventual surgical removal. A bioabsorbable stent, or a stent that goes away with time, would solve this problem. Bioabsorbable stents are being developed for use in coronary arteries, however these are too small for use in pediatric congenital heart disease. A bioabsorbable stent for use in pediatric congenital heart disease needs to be low profile, expandable to a diameter 8 mm, provide sufficient radial strength, and absorb quickly enough to allow vessel growth. Development of absorbable coronary stents has led to a great understanding of the available production techniques and materials such as bioabsorbable polymers and biocorrodable metals. Children with congenital heart disease will hopefully soon benefit from the current generation of bioabsorbable and biocorrodable materials and devices.
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Seedial SM, Ghosh S, Saunders RS, Suwanabol PA, Shi X, Liu B, Kent KC. Local drug delivery to prevent restenosis. J Vasc Surg 2013; 57:1403-14. [PMID: 23601595 DOI: 10.1016/j.jvs.2012.12.069] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/20/2012] [Accepted: 12/22/2012] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Despite significant advances in vascular biology, bioengineering, and pharmacology, restenosis remains a limitation to the overall efficacy of vascular reconstructions, both percutaneous and open. Although the pathophysiology of intimal hyperplasia is complex, a number of drugs and molecular tools have been identified that can prevent restenosis. Moreover, the focal nature of this process lends itself to treatment with local drug administration. This article provides a broad overview of current and future techniques for local drug delivery that have been developed to prevent restenosis after vascular interventions. METHODS A systematic electronic literature search using PubMed was performed for all accessible published articles through September 2012. In an effort to remain current, additional searches were performed for abstracts presented at relevant societal meetings, filed patents, clinical trials, and funded National Institutes of Health awards. RESULTS The efficacy of local drug delivery has been demonstrated in the coronary circulation with the current clinical use of drug-eluting stents. Until recently, however, drug-eluting stents were not found to be efficacious in the peripheral circulation. Further pursuit of intraluminal devices has led to the development of balloon-based technologies, with a recent surge in trials involving drug-eluting balloons. Early data appear encouraging, particularly for treatment of superficial femoral artery lesions, and several devices have recently received the Conformité Européene mark in Europe. Investigators have also explored the periadventitial application of biomaterials containing antirestenotic drugs, an approach that could be particularly useful for surgical bypass or endarterectomy. In the past, systemic drug delivery has been unsuccessful; however, there has been recent exploration of intravenous delivery of drugs designed specifically to target injured or reconstructed arteries. Our review revealed a multitude of additional interesting strategies, including >65 new patents issued during the past 2 years for approaches to local drug delivery focused on preventing restenosis. CONCLUSIONS Restenosis after intraluminal or open vascular reconstruction remains an important clinical problem. Success in the coronary circulation has not translated into solutions for the peripheral arteries. However, our literature review reveals a number of promising approaches, including drug-eluting balloons, periadventitial drug delivery, and targeted systemic therapies. These and other innovations suggest that the future is bright and that a solution for preventing restenosis in peripheral vessels will soon be at hand.
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Zhang Y, Bourantas CV, Farooq V, Muramatsu T, Diletti R, Onuma Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds in the treatment of coronary artery disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:37-48. [PMID: 23662091 PMCID: PMC3647349 DOI: 10.2147/mder.s22547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Indexed: 12/23/2022] Open
Abstract
Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS) were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.
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Affiliation(s)
- Yaojun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; ; Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Hämäläinen M, Nieminen R, Uurto I, Salenius JP, Kellomäki M, Mikkonen J, Kotsar A, Isotalo T, Teuvo Tammela LJ, Talja M, Moilanen E. Dexamethasone-eluting vascular stents. Basic Clin Pharmacol Toxicol 2013; 112:296-301. [PMID: 23374962 DOI: 10.1111/bcpt.12056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Abstract
Percutaneous transluminal angioplasty (PTA) with stenting is widely used in the treatment of vascular disorders, but restenosis remains a significant problem. Drug-eluting stents (DES) have been developed as an attempt to reduce the intimal response leading to restenosis. Drugs used in DES include mainly immunosuppressive and anti-proliferative compounds. Glucocorticoids are also an interesting possibility for those purposes because they have anti-proliferative effects in vascular smooth muscle cells and down-regulate the production of cytokines and growth factors driving inflammation and fibrosis. In this MiniReview, feasibility and safety of drug-eluting metal and biodegradable vascular stents are discussed with special emphasis on dexamethasone-eluting stents.
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Affiliation(s)
- Mari Hämäläinen
- The Immunopharmacology Research Group, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
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Freeing the vessel from metallic cage: what can we achieve with bioresorbable vascular scaffolds? Cardiovasc Interv Ther 2013; 27:141-54. [PMID: 22569783 DOI: 10.1007/s12928-012-0101-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bosiers M, Scheinert D, Simonton CA, Schwartz LB. Coronary and endovascular applications of the Absorb™ bioresorbable vascular scaffold. Interv Cardiol 2012. [DOI: 10.2217/ica.12.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Comparison of acute recoil between bioabsorbable poly-L-lactic acid XINSORB stent and metallic stent in porcine model. J Biomed Biotechnol 2012; 2012:413956. [PMID: 23093843 PMCID: PMC3470892 DOI: 10.1155/2012/413956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/09/2012] [Indexed: 01/02/2023] Open
Abstract
Objective. To investigate acute recoil of bioabsorbable poly-L-lactic acid (PLLA) stent. Background. As newly developed coronary stent, bioabsorbable PLLA stent still encountered concern of acute stent recoil. Methods. Sixteen minipigs were enrolled in our study. Eight PLLA XINSORB stents (Weite Biotechnology Co., Ltd., China) and eight metallic stents (EXCEL, Jiwei Co., Ltd. China) were implanted into coronary arteries. Upon quantitative coronary angiography analysis, acute absolute recoil was defined as the difference between mean diameter of inflated balloon (X) and mean lumen diameter of stent immediately after deployment (Y), while acute percent recoil was defined as (X−Y)/X and expressed as a percentage. Intravascular ultrasound (IVUS) was performed immediately after implantation and 24 hours later to compare cross-sectional area (CSA) between two groups and detect stent malapposition or collapse. Results. Acute absolute recoil in XINSORB and EXCEL was 0.02 ± 0.13 mm and −0.08 ± 0.08 mm respectively (P = 0.19). Acute percent recoil in XINSORB and EXCEL was 0.66 ± 4.32% and −1.40 ± 3.83%, respectively (P = 0.45). CSA of XINSORB was similar to that of EXCEL immediately after implantation, so was CSA of XINSORB at 24-hours followup. Within XINSORB group, no difference existed between CSA after implantation and CSA at 24-hours followup. No sign of acute stent malapposition was detected by IVUS. Conclusions. The acute stent recoil of XINSORB is similar to that of EXCEL. No acute stent malapposition or collapse appeared in both kinds of stent. This preclinical study was designed to provide preliminary data for future studies of long-term efficacy and safety of XINSORB stent.
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Jabara R, Pendyala L, Geva S, Chen J, Chronos N, Robinson K. Novel fully bioabsorbable salicylate-based sirolimus-eluting stent. EUROINTERVENTION 2012; 5 Suppl F:F58-64. [PMID: 22100678 DOI: 10.4244/eijv5ifa10] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The concept of fully biodegradable stents has emerged as an attractive alternative to current permanent metallic stents, mainly as a potential solution to avoid late stent thrombotic events. We sought to evaluate a novel, fully bioabsorbable sirolimus-eluting stent (SES) synthesised entirely from a unique salicylic-acid polymer, in a clinically relevant animal model. METHODS AND RESULTS Fully biodegradable balloon-expandable stents (n=45) were implanted in a porcine coronary arteries using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) to optimise stent apposition. Dose density of sirolimus was 8.3 µg/mm of stent length with in vitro studies demonstrating elution over 30 days and complete stent degradation over 12 months. Animals were terminated at 7, 14, 30, 90, and 180 days for complete histological analysis. Optical coherence tomography (OCT) was also performed for the 90- and 180-days samples. All stents were deployed successfully without notable mechanical difficulties. Angiographic diameter stenosis (DS) was 20±16%, 24±4%, and 23±17%, at one, three, and six months, respectively. In parallel, IVUS showed good stent apposition with DS of 21±9%, 25±7%, and 18±3%; and area stenosis (AS) of 35±13%, 33±7%, and 32±4% at one, three, and six months,respectively. OCT further demonstrated good stent apposition with DS of 28±7% and 20±6%, and AS of 37±10% and 33±13% at three and six months, respectively. OCT showed reduction of stent thickness by 23% from three to six months. Histologic analysis confirmed these in vivo findings and revealed a favourable healing process of absorbable stent incorporation into the arterial wall, without excessive thrombotic or inflammatory reactions. CONCLUSIONS This study shows favourable vascular compatibility and efficacy for a novel fully bioabsorbable salicylate-based SES. This device has good mechanical performance during deployment and stays well-apposed to the vessel wall at long-term follow-up. These initial results are highly encouraging and support progress into more extensive preclinical studies as well as early clinical testing.
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Affiliation(s)
- Refat Jabara
- Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Ielasi A, Latib A, Colombo A. Current and future drug-eluting coronary stent technology. Expert Rev Cardiovasc Ther 2011; 9:485-503. [PMID: 21517732 DOI: 10.1586/erc.11.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite the impressive benefits obtained following the introduction of the drug-eluting stent, safety concerns have been raised over their long-term safety with particular regard to stent thrombosis. Various mechanisms such as delayed endothelialization, local hypersensitivity and endothelial dysfunction owing to the durable polymer coating and/or the drug itself have been suggested as possible causes of this phenomenon. Therefore, to address these concerns, a newer-generation of drug-eluting stents has been developed and they are currently undergoing preclinical and clinical evaluation in order to increase both the safety and biocompatibility by optimizing the three major components of drug-eluting stents: the stent platform, the polymer and the drug. This article critically reviews the key clinical trials and the current status of these new coronary devices as well as preventing future perspectives for their continued development.
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Affiliation(s)
- Alfonso Ielasi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, 20100, Milan, Italy
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Guo Q, Lu Z, Zhang Y, Li S, Yang J. In vivo study on the histocompatibility and degradation behavior of biodegradable poly(trimethylene carbonate-co-D,L-lactide). Acta Biochim Biophys Sin (Shanghai) 2011; 43:433-40. [PMID: 21571741 DOI: 10.1093/abbs/gmr034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to explore the in vivo behavior and histocompatibility of poly(trimethylene carbonate-co-D,L-lactide) (PDLLA/TMC) and its feasibility of manufacturing cardiovascular stents. Copolymers with 50/50 molar ratio were synthesized by ring-opening polymerization with TMC and D, L-LA, or TMC and L-LA. Poly(L-lactide) (PLLA) was synthesized as a control. The films of the three polymers were implanted into 144 Wistar rats. At different time points of implantation, polymer films were explanted for the evaluation of degradation characteristics and histocompatibility using size exclusion chromatography , nuclear magnetic resonance , environmental scanning electron microscope , and optical microscope. Results showed that there were differences in the percentage of mass loss, molecular weight, shape and appearance changes, and inflammation cell counts between different polymers. With the time extended, the film's superficial structure transformed variously, which was rather obvious in the polymer of PDLLA/TMC. In addition, there were relatively lower inflammation cell counts in the PDLLA/TMC and poly(trimethylene carbonate-co-L-lactide) (PLLA/TMC) groups at different time points in comparison with those in the PLLA group. The differences were of statistical significance (P< 0.05) in the group of PDLLA/TMC vs. PLLA, and the group of PLLA/TMC vs. PLLA, but not within the PDLLA/TMC and PLLA/TMC groups (P> 0.05). These results suggested that the polymer of PDLLA/TMC (50/50) with favorable degradation performance and histocompatibility is fully biodegradable and suitable for manufacturing implanted cardiovascular stents.
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Affiliation(s)
- Qingkui Guo
- Department of Cardio-thoracic Surgery, Shanghai Sixth People Hospital, Shanghai Jiao Tong University School of Medicine, China
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Lei L, Guo SR, Chen WL, Rong HJ, Lu F. Stents as a platform for drug delivery. Expert Opin Drug Deliv 2011; 8:813-31. [DOI: 10.1517/17425247.2011.572068] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Onuma Y, Serruys PW. Bioresorbable scaffold: the advent of a new era in percutaneous coronary and peripheral revascularization? Circulation 2011; 123:779-97. [PMID: 21343594 DOI: 10.1161/circulationaha.110.971606] [Citation(s) in RCA: 301] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yosinobu Onuma
- Thoraxcenter, Erasmus Medical Center, 's Gravendijkwal 230, Rotterdam, the Netherlands
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Garg S, Serruys PW. Coronary stents: looking forward. J Am Coll Cardiol 2010; 56:S43-78. [PMID: 20797503 DOI: 10.1016/j.jacc.2010.06.008] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 11/24/2022]
Abstract
Despite all the benefits of drug-eluting stents (DES), concerns have been raised over their long-term safety, with particular reference to stent thrombosis. In an effort to address these concerns, newer stents have been developed that include: DES with biodegradable polymers, DES that are polymer free, stents with novel coatings, and completely biodegradable stents. Many of these stents are currently undergoing pre-clinical and clinical trials; however, early results seem promising. This paper reviews the current status of this new technology, together with other new coronary devices such as bifurcation stents and drug-eluting balloons, as efforts continue to design the ideal coronary stent.
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Affiliation(s)
- Scot Garg
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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40
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Birkenhauer P, Yang Z, Gander B. Preventing restenosis in early drug-eluting stent era: recent developments and future perspectives. J Pharm Pharmacol 2010; 56:1339-56. [PMID: 15525440 DOI: 10.1211/0022357044797] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Restenosis is the major limitation of the successful therapy of percutaneous coronary intervention (PCI) for patients with coronary artery disease. The problem was appreciated in the late 1970s to early 1980s. Only in recent years, anti-restenotic therapy has achieved a breakthrough with the development of drug-eluting stents. Here, we provide an overview about pathological mechanisms of restenosis after PCI. Present therapeutic approaches to overcome restenosis and recent clinical results are revisited, and some major concerns in the post-drug-eluting stent era are discussed.
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Affiliation(s)
- Peter Birkenhauer
- Institute of Pharmaceutical Sciences, ETH Hönggerberg HCI, 8093 Zürich, Switzerland
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Di Mario C, Borgia F. Assimilating the current clinical data of fully bioabsorbable stents. EUROINTERVENTION 2009; 5 Suppl F:F103-8. [DOI: 10.4244/eijv5ifa18] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Doyle B, Holmes DR. Next generation drug-eluting stents: focus on bioabsorbable platforms and polymers. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2009; 2:47-55. [PMID: 22915914 PMCID: PMC3417859 DOI: 10.2147/mder.s5617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The success of drug-eluting stents in preventing restenosis has shifted the focus of new stent development toward enhancing long term safety and efficacy of these devices, while simultaneously eliminating the need for indefinite dual antiplatelet therapy. A technical advance fulfilling these aims would hold tremendous potential to reduce morbidity, mortality and economic costs associated with the percutaneous treatment of coronary artery disease. An attractive approach is the use of bioabsorbable stent designs. These may include stents with different bioabsorbable drugs, bioabsorbable polymers or even bioabsorbable metallic backbones. A device that could achieve excellent acute and long-term results, but disappear completely within months (thereby avoiding the need for prolonged dual antiplatelet therapy), would be a tremendous advance. Too good to be true? We explore here the scientific rationale and prospects for success with this exciting concept.
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Affiliation(s)
- Brendan Doyle
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Brown DA, Lee EW, Loh CT, Kee ST. A new wave in treatment of vascular occlusive disease: biodegradable stents--clinical experience and scientific principles. J Vasc Interv Radiol 2009; 20:315-24; quiz 325. [PMID: 19157901 DOI: 10.1016/j.jvir.2008.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 11/11/2008] [Accepted: 11/11/2008] [Indexed: 01/24/2023] Open
Abstract
Stent-based therapies in percutaneous vascular intervention are associated with significant long-term complications related to in-stent restenosis. A growing body of literature demonstrates the feasibility of biodegradable materials for endovascular stents, which may, in theory, circumvent many of the immunologic and inflammatory response issues seen with long-term metallic stent failure in coronary and peripheral applications. This review describes the history of endovascular stents and the challenges encountered with metallic, drug-eluting, and biodegradable stents. A review of the basic engineering principles of biodegradable stents is provided, along with a discussion of the cellular mechanisms of restenosis.
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Affiliation(s)
- David A Brown
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095-1721, USA
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Kraitzer A, Kloog Y, Zilberman M. Approaches for prevention of restenosis. J Biomed Mater Res B Appl Biomater 2008; 85:583-603. [PMID: 18098192 DOI: 10.1002/jbm.b.30974] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery disease is characterized by a narrowing (stenosis) of the arteries that supply blood to the tissue of the heart. Continued restriction of blood flow manifests itself as angina and ultimately myocardial infarction (heart attack) for the patient. Heart bypass was once the only treatment for this condition, but over the years percutaneous coronary intervention (PCI) has become an increasingly attractive alternative to medical therapy and surgical revascularization for the treatment of coronary artery disease. A vascular stent is a medical device designed to serve as a temporary or permanent internal scaffold, to maintain or increase the lumen of a blood vessel. Metallic coronary stents were first introduced to prevent arterial dissections and to eliminate vessel recoil and intimal hyperplasia associated with PCI. Further advancement in the treatment of coronary artery disease is the development of drug-eluting stents that dramatically reduce the incidence of in-stent restenosis to less than 5%. Local drug delivery offers the advantages of allowing a relatively high local concentration of drug at the treatment site while minimizing systemic toxic effect. This review describes approaches for prevention of restenosis. It focuses on drugs for prevention of restenosis, bare metal stents, and drug-eluting stents. It also describes recent advances in bioresorbable stents. One of the chapters is dedicated to our novel composite bioresorbable drug-eluting fibers, designed to be used as basic elements in drug-eluting stents.
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Affiliation(s)
- Amir Kraitzer
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv 69978, Israel
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Kraitzer A, Ofek L, Schreiber R, Zilberman M. Long-term in vitro study of paclitaxel-eluting bioresorbable core/shell fiber structures. J Control Release 2008; 126:139-48. [DOI: 10.1016/j.jconrel.2007.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 11/13/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
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Zilberman M, Kraitzer A. Paclitaxel-eluting composite fibers: drug release and tensile mechanical properties. J Biomed Mater Res A 2008; 84:313-23. [PMID: 17607755 DOI: 10.1002/jbm.a.31286] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
New core/shell fiber structures loaded with paclitaxel were developed and studied. These composite fibers are ideal for forming thin, delicate, biomedically important structures for various applications. Possible applications include fiber-based endovascular stents that mechanically support blood vessels while delivering drugs for preventing restenosis directly to the blood vesel wall, or drug delivery systems for treatment of cancer. The core/shell fiber structures were formed by "coating" dense core fibers with porous paclitaxel-containing poly(DL-lactic-co-glycolic acid) (PDLGA) structures. Shell preparation ("coating") was performed by freeze-drying water in oil emulsions. The present study focused on the effects of the emulsion's formulation (composition) and processing conditions on the paclitaxel release profile and on the fibers' tensile mechanical properties. In general, the porous PDLGA shell released approximately 40% of the paclitaxel, with most of the release occurring during the first 30 days. The main release mechanism during the tested period is diffusion, rather than polymer degradation. The release rate and quantity increased with increased drug content or decreased polymer content, whereas the organic:aqueous phase ratio had practically no effect on the release profile. These new composite fibers are strong and flexible enough to be used as basic elements for stents. We demonstrated that proper selection of processing conditions based on kinetic and thermodynamic considerations can yield polymer/drug systems with the desired drug release behavior and good mechanical properties.
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Affiliation(s)
- Meital Zilberman
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv 69978, Israel.
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Saito Y, Tanaka T, Andoh A, Minematsu H, Hata K, Tsujikawa T, Nitta N, Murata K, Fujiyama Y. Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci 2008; 53:330-3. [PMID: 17713855 DOI: 10.1007/s10620-007-9873-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 05/09/2007] [Indexed: 12/14/2022]
Abstract
The application of metallic stents for benign stenosis is limited due to long-term complications. We report here the results of the implantation of a novel biodegradable poly-L-lactic acid (PLLA) esophageal stent in two patients with benign esophageal stenosis after endoscopic submucosal dissection (ESD). Case 1 was a 64-year-old man who received ESD for an early squamous esophageal cancer in the middle esophagus. The mucosal defect was seven-eighths of the circumference, and the distal margin of the resection scar formed the stenosis. After balloon dilatation, the PLLA esophageal stent was endoscopically placed; for 6 months, he has not experienced any symptoms of re-stenosis. Case 2 consisted of a 62-year-old man who developed an early squamous esophageal cancer in the middle esophagus. The lesion was resected by ESD, and the mucosal defect was seven-eighths of the circumference. The resection scar formed the stenosis, and the PLLA esophageal stent was endoscopically placed. He also has not experienced any symptoms of re-stenosis for 6 months. In conclusion, the PLLA esophageal stent provides a new possibility for the management of benign esophageal strictures after ESD. Due to the biodegradable features of this stent, longer term studies are necessary to investigate the relationship between the expected disappearance of the stent and the patency of the stricture.
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Affiliation(s)
- Yasuharu Saito
- Department of Endoscopic Medicine, Shiga University of Medical Science, Seta Tukinowa, Otsu 520-2192, Japan.
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Bünger CM, Grabow N, Sternberg K, Goosmann M, Schmitz KP, Kreutzer HJ, Ince H, Kische S, Nienaber CA, Martin DP, Williams SF, Klar E, Schareck W. A biodegradable stent based on poly(L-lactide) and poly(4-hydroxybutyrate) for peripheral vascular application: preliminary experience in the pig. J Endovasc Ther 2008; 14:725-33. [PMID: 17924740 DOI: 10.1177/152660280701400518] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the technical feasibility and biocompatibility of a novel stent based on poly(L-lactide) (PLLA) and poly(4-hydroxybutyrate) (P4HB) for peripheral vascular applications. METHODS A polytetrafluoroethylene aortobi-iliac graft was implanted in 5 pigs through a midline abdominal incision. After transverse graft limb incision, 5 PLLA/P4HB stents and 5 metal stents (316L stainless steel) were randomly deployed at both iliac anastomotic sites with 6-mm balloon catheters. Angiography was performed to determine patency prior to sacrifice at 6 weeks. Stented segments were surgically explanted and processed for quantitative histomorphometry. Vascular injury and inflammation scores were assigned to the stented iliac segments. RESULTS No animals were lost during follow-up. All PLLA/P4HB stents were deployed within 2 minutes by balloon inflation to 8 bars without rupture of the stent struts or anastomotic suture. All stents were patent on postprocedural angiography. Histological analysis showed no signs of excessive recoiling or collapse. PLLA/P4HB stents demonstrated decreased residual lumen area and increased neointimal area after 6 weeks (12.27+/-0.62 and 8.40+/-1.03 mm(2), respectively) compared to 316L stents (13.54+/-0.84 and 6.90+/-1.11 mm(2), respectively) as the result of differences in stent areas (PLLA/P4HB: 4.31+/-0.15 mm(2); 316L: 2.73+/-0.29 mm(2)). Vascular injury scores showed only mild vascular trauma for all stents (PLLA/P4HB: 0.41+/-0.59; 316L: 0.32+/-0.47). Inflammatory reaction was slightly higher around PLLA/P4HB stent struts (1.39+/-0.52) compared to 316L (1.09+/-0.50). CONCLUSION Rapid balloon expansion of PLLA/P4HB stents is feasible without risk of strut rupture. PLLA/P4HB stents provide adequate mechanical stability after iliac anastomotic stenting in pigs. Smaller residual luminal areas in the PLLA/P4HB stents might have been caused by tissue ingrowth into the larger strut interspaces due to higher strut thickness (stent area) in this group. This limitation needs to be addressed in future work on the stent design.
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Abstract
The limitations of currently available metallic drug-eluting stents have renewed interest in biodegradable stents (BDS). Apart from removing the (offending) foreign material that may potentiate a thrombotic event, BDS have the advantage of avoiding 'full metal jackets,' and thus can preclude subsequent coronary surgery. In addition, they do not interfere with the diagnostic evaluation of non-invasive imaging such as cardiac magnetic resonance and CT. There are now several BDS in development or in clinical trials that incorporate a variety of biodegradable polymer technologies. Two broad categories of materials are generally used: those made from organic biopolymers and those made from corrodible metals. However, to date, none of the materials/stents tested have been able to establish a perfect balance between biocompatibility, the kinetics of degradation needed to maintain mechanical strength to limit recoil, and inflammation. However, studies, such as the ABSORB trial with the everolimus eluting poly-L-lactide stent, which demonstrated comparable restenotic rates with bare metallic stents and a low incidence of major adverse cardiac events (MACE) at 12 months of 3.3%, with only one patient having a non-Q-wave myocardial infarction and no target lesion revascularization, suggest that there has been significant progress with respect to the earlier prototypes. The acute recoil observed could potentially be addressed with the polytyrosine REVA stent currently being evaluated in the RESORB trial, which incorporates a novel locking mechanism within its design. Alternative BDS designs include the combination of an antiproliferative drug with endothelial progenitor cell capturing antibodies to facilitate epithelialization and/or dual eluting having, in addition to the antiproliferative drug, polymeric salicyclic acid to limit inflammation. Compared with biodegradable polymers, there are fewer metals used in the manufacture of BDS. The only metal BDS in trials is the Biotronik absorbable magnesium stent, which showed a MACE of 26.7% at 12 months without deaths, stent thrombosis, or acute myocardial infarction in the PROGRESS-AMS trial. Unlike magnesium stents, there has been little progress with iron stents, which remain in the pre-clinical phase, and this may be partly due to the longer degradation times needed and potential issues related with iron clearance.
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Affiliation(s)
- Steve Ramcharitar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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