Efficient inhibition of in-stent restenosis by controlled stent-based inhibition of elastase: a pilot study

Microfabrication and nanotechnology in stent design

Intravascular stents were first introduced in the 1980s as an adjunct to primary angioplasty for management of early complications, including arterial dissection, or treatment of an inadequate technical outcome due to early elastic recoil of the atherosclerotic lesion. Despite the beneficial effects of stenting, persistent high rates of restenosis motivated the design of drug-eluting stents for delivery of agents to limit the proliferative and other inflammatory responses within the vascular wall that contribute to the development of a restenotic lesion. These strategies have yielded a significant reduction in the incidence of restenosis, but challenges remain, including incomplete repair of the endothelium at the site of vascular wall injury that may be associated with a late risk of thrombosis. A failure of vessel wall healing has been attributed primarily to the use of polymeric stent coatings, but the effects of the eluted drug and other material properties or design features of the stent cannot be excluded. Improvements in stent microfabrication, as well as the introduction of alternative materials may help to address those limitations that inhibit stent performance. This review describes the application of novel microfabrication processes and the evolution of new nanotechnologies that hold significant promise in eliminating existing shortcomings of current stent platforms.

Automated measurement and statistical modelling of elastic laminae in arteries

Structural features of elastic laminae within arteries can provide vital information for both the mechanobiology and the biomechanics of the wall. In this paper, we propose, test and illustrate a new computer-based scheme for automated analysis of regional distributions of elastic laminae thickness, inter-lamellar distances and fragmentation furcation points (FPs) from standard histological images. Our scheme eliminates potential artefacts produced by tissue cutting, automatically aligns tissue according to physiologic orientations and performs cross-sectional measurements along radial directions. A statistical randomised complete block design and F test were used to assess the potential (non)-uniformity of lamellar thicknesses and separations along both radial and circumferential directions. Illustrative results for both normotensive and hypertensive thoracic porcine aorta revealed marked heterogeneity along the radial direction in nearly stress-free samples. Clearly, regional measurements can provide more detailed information about morphologic changes that cannot be gained by globally averaged evaluations alone. We also found that quantifying FP densities offers new information about potential elastin fragmentation, particularly in response to increased loading due to hypertension.