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Zoppo CT, Epshtein M, Gounis MJ, Anagnostakou V, King RM. Longitudinal healing flow diverting stents with phosphorylcholine surface modification. J Neurointerv Surg 2024; 16:582-586. [PMID: 37402572 DOI: 10.1136/jnis-2023-020500] [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: 04/26/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Flow diversion has become a standard treatment for cerebral aneurysms. However, major drawbacks include the need for dual antiplatelet therapy after implant and delayed complete occlusion of the aneurysm, which occurs when new tissue growth excludes the aneurysm from the parent artery. Biomimetic surface modifications such as the phosphorylcholine polymer (Shield surface modification) represent major advances in reducing thrombogenicity of these devices. However, in vitro studies have raised concerns that this modification may also delay endothelialization of flow diverters. METHODS Bare metal Pipeline, Pipeline Shield, and Vantage with Shield devices were implanted in the common carotid arteries (CCAs) of 10 rabbits (two in the left CCA, one in the right CCA). Following implant and at 5, 10, 15, and 30 days, the devices were imaged with high-frequency optical coherence tomography and conventional angiography to evaluate tissue growth. At 30 days the devices were explanted and their endothelial growth was assessed with scanning electron microscopy (SEM) at five locations along their length using a semi-quantitative score. RESULTS The average tissue growth thickness (ATGT) was not different between the three devices. Neointima was apparent at 5 days and all devices demonstrated similar ATGT at each time point. On SEM, no difference was found in the endothelium scores between the device types. CONCLUSION In vivo, neither the Shield surface modification nor the device design (Vantage) altered the longitudinal healing of the flow diverter.
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Affiliation(s)
- Christopher T Zoppo
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mark Epshtein
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Luu CH, Nguyen NT, Ta HT. Unravelling Surface Modification Strategies for Preventing Medical Device-Induced Thrombosis. Adv Healthc Mater 2024; 13:e2301039. [PMID: 37725037 DOI: 10.1002/adhm.202301039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/29/2023] [Indexed: 09/21/2023]
Abstract
The use of biomaterials in implanted medical devices remains hampered by platelet adhesion and blood coagulation. Thrombus formation is a prevalent cause of failure of these blood-contacting devices. Although systemic anticoagulant can be used to support materials and devices with poor blood compatibility, its negative effects such as an increased chance of bleeding, make materials with superior hemocompatibility extremely attractive, especially for long-term applications. This review examines blood-surface interactions, the pathogenesis of clotting on blood-contacting medical devices, popular surface modification techniques, mechanisms of action of anticoagulant coatings, and discusses future directions in biomaterial research for preventing thrombosis. In addition, this paper comprehensively reviews several novel methods that either entirely prevent interaction between material surfaces and blood components or regulate the reaction of the coagulation cascade, thrombocytes, and leukocytes.
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Affiliation(s)
- Cuong Hung Luu
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan, Queensland, 4111, Australia
| | - Nam-Trung Nguyen
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan, Queensland, 4111, Australia
| | - Hang Thu Ta
- School of Environment and Science, Griffith University, Nathan, Queensland, 4111, Australia
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan, Queensland, 4111, Australia
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White TG, Santhumayor BA, Turpin J, Shah K, Toscano D, Teron I, Link T, Patsalides A, Woo HH. Flow diverter surface modifications for aneurysm treatment: A review of the mechanisms and data behind existing technologies. Interv Neuroradiol 2023:15910199231207550. [PMID: 37899636 DOI: 10.1177/15910199231207550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Flow diversion (FD) has become a mainstay treatment for large wide-necked aneurysms. Despite excellent safety and efficacy, the risk of thromboembolic complications necessitates the use of dual antiplatelet therapy (DAPT). The use of DAPT makes hemorrhagic complications of stenting carry high morbidity and mortality. Additionally, DAPT usage carries a risk of "nuisance" complications that do not directly impact intracranial circulation but need to be managed nonetheless. To circumvent this issue, the most recent generation of flow diverters have undergone surface modification with various compounds to confer blood compatibility to limit clotting and thrombosis. While these newer generation flow diverters are marketed to enhance ease of deployment, the goal is to eventually facilitate single antiplatelet use with flow diverter treatment. This generation of FDs have potential to expand indications beyond unruptured wide-necked aneurysms to include ruptured intracranial aneurysms without the necessity of DAPT. Currently, no comprehensive review details the molecular mechanisms and pre-clinical and clinical data on these modifications. We seek to fill this gap in the literature by consolidating information on the coating technology for four major FDs currently in clinical use-PipelineTM Flex and Vantage Shield TechnologyTM, FREDTMX, p48/64 hydrophilic coating, and Acandis Dervio® 2heal-to serve as a reference guide in neurointerventional aneurysm treatment. Although the Balt silkTM was one of the first FDs, it is uncoated, thus we will not cover this device in our review. A literature review was performed to obtain information on each coating technology for the major flow diverters currently on the market using international databases (PUBMED, Embase, Medline, Google Scholar). The search criteria used the keywords for each coating technology of interest "phosphorylcholine," "poly 2-methoxyethyl acrylate," "hydrophilic polymer coating," and "fibrin-heparin" Keywords related to the device names "Pipeline Shield," "Pipeline Shield with Flex Technology," "FRED," "FREDX," "p64," "p64-HPC," "Derivo 2heal" were also used. Studies that detailed the mechanism of action of the coating, any pre-clinical studies with surface-modified intravascular devices, and any clinical retrospective series, prospective series, or randomized clinical trials with surface-modified devices for aneurysm treatment were included.
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Affiliation(s)
- Timothy G White
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Brandon A Santhumayor
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Kevin Shah
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Daniel Toscano
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Ina Teron
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Thomas Link
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Manhasset, NY, USA
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Li Q, Wen C, Yang J, Zhou X, Zhu Y, Zheng J, Cheng G, Bai J, Xu T, Ji J, Jiang S, Zhang L, Zhang P. Zwitterionic Biomaterials. Chem Rev 2022; 122:17073-17154. [PMID: 36201481 DOI: 10.1021/acs.chemrev.2c00344] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The term "zwitterionic polymers" refers to polymers that bear a pair of oppositely charged groups in their repeating units. When these oppositely charged groups are equally distributed at the molecular level, the molecules exhibit an overall neutral charge with a strong hydration effect via ionic solvation. The strong hydration effect constitutes the foundation of a series of exceptional properties of zwitterionic materials, including resistance to protein adsorption, lubrication at interfaces, promotion of protein stabilities, antifreezing in solutions, etc. As a result, zwitterionic materials have drawn great attention in biomedical and engineering applications in recent years. In this review, we give a comprehensive and panoramic overview of zwitterionic materials, covering the fundamentals of hydration and nonfouling behaviors, different types of zwitterionic surfaces and polymers, and their biomedical applications.
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Affiliation(s)
- Qingsi Li
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Chiyu Wen
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Jing Yang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Xianchi Zhou
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yingnan Zhu
- Institute of Drug Discovery and Development, School of Pharmaceutical Sciences, Center for Drug Safety Evaluation and Research, Zhengzhou University, Zhengzhou 450001, China
| | - Jie Zheng
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron, Akron, Ohio 44325, United States
| | - Gang Cheng
- Department of Chemical Engineering, The University of Illinois at Chicago, Chicago, Illinois 60607, United States
| | - Jie Bai
- College of Chemical Engineering, Inner Mongolia University of Technology, Hohhot, Inner Mongolia 010051, China
| | - Tong Xu
- College of Chemical Engineering, Inner Mongolia University of Technology, Hohhot, Inner Mongolia 010051, China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Shaoyi Jiang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Lei Zhang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Peng Zhang
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
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Ishihara K. Biomimetic materials based on zwitterionic polymers toward human-friendly medical devices. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2022; 23:498-524. [PMID: 36117516 PMCID: PMC9481090 DOI: 10.1080/14686996.2022.2119883] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/01/2023]
Abstract
This review summarizes recent research on the design of polymer material systems based on biomimetic concepts and reports on the medical devices that implement these systems. Biomolecules such as proteins, nucleic acids, and phospholipids, present in living organisms, play important roles in biological activities. These molecules are characterized by heterogenic nature with hydrophilicity and hydrophobicity, and a balance of positive and negative charges, which provide unique reaction fields, interfaces, and functionality. Incorporating these molecules into artificial systems is expected to advance material science considerably. This approach to material design is exceptionally practical for medical devices that are in contact with living organisms. Here, it is focused on zwitterionic polymers with intramolecularly balanced charges and introduce examples of their applications in medical devices. Their unique properties make these polymers potential surface modification materials to enhance the performance and safety of conventional medical devices. This review discusses these devices; moreover, new surface technologies have been summarized for developing human-friendly medical devices using zwitterionic polymers in the cardiovascular, cerebrovascular, orthopedic, and ophthalmology fields.
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Affiliation(s)
- Kazuhiko Ishihara
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Osaka, Japan
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Li L, Liu S, Tan J, Wei L, Wu D, Gao S, Weng Y, Chen J. Recent advance in treatment of atherosclerosis: Key targets and plaque-positioned delivery strategies. J Tissue Eng 2022; 13:20417314221088509. [PMID: 35356091 PMCID: PMC8958685 DOI: 10.1177/20417314221088509] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atherosclerosis, a chronic inflammatory disease of vascular wall, is a progressive pathophysiological process with lipids oxidation/depositing initiation and innate/adaptive immune responses. The coordination of multi systems covering oxidative stress, dysfunctional endothelium, diseased lipid uptake, cell apoptosis, thrombotic and pro-inflammatory responding as well as switched SMCs contributes to plaque growth. In this circumstance, inevitably, targeting these processes is considered to be effective for treating atherosclerosis. Arriving, retention and working of payload candidates mediated by targets in lesion direct ultimate therapeutic outcomes. Accumulating a series of scientific studies and clinical practice in the past decades, lesion homing delivery strategies including stent/balloon/nanoparticle-based transportation worked as the potent promotor to ensure a therapeutic effect. The objective of this review is to achieve a very brief summary about the effective therapeutic methods cooperating specifical targets and positioning-delivery strategies in atherosclerosis for better outcomes.
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Affiliation(s)
- Li Li
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Sainan Liu
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Jianying Tan
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Lai Wei
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Dimeng Wu
- Chengdu Daxan Innovative Medical Tech. Co., Ltd., Chengdu, PR China
| | - Shuai Gao
- Chengdu Daxan Innovative Medical Tech. Co., Ltd., Chengdu, PR China
| | - Yajun Weng
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
| | - Junying Chen
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu, PR China
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Capuani S, Malgir G, Chua CYX, Grattoni A. Advanced Strategies to Thwart Foreign Body Response to Implantable Devices. Bioeng Transl Med 2022; 7:e10300. [PMID: 36176611 PMCID: PMC9472022 DOI: 10.1002/btm2.10300] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Mitigating the foreign body response (FBR) to implantable medical devices (IMDs) is critical for successful long‐term clinical deployment. The FBR is an inevitable immunological reaction to IMDs, resulting in inflammation and subsequent fibrotic encapsulation. Excessive fibrosis may impair IMDs function, eventually necessitating retrieval or replacement for continued therapy. Therefore, understanding the implant design parameters and their degree of influence on FBR is pivotal to effective and long lasting IMDs. This review gives an overview of FBR as well as anti‐FBR strategies. Furthermore, we highlight recent advances in biomimetic approaches to resist FBR, focusing on their characteristics and potential biomedical applications.
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Affiliation(s)
- Simone Capuani
- Department of Nanomedicine Houston Methodist Research Institute Houston TX USA
- University of Chinese Academy of Science (UCAS) 19 Yuquan Road Beijing China
| | - Gulsah Malgir
- Department of Nanomedicine Houston Methodist Research Institute Houston TX USA
- Department of Biomedical Engineering University of Houston Houston TX USA
| | | | - Alessandro Grattoni
- Department of Nanomedicine Houston Methodist Research Institute Houston TX USA
- Department of Surgery Houston Methodist Hospital Houston TX USA
- Department of Radiation Oncology Houston Methodist Hospital Houston TX USA
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8
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Fang H, Qi X, Zhou S, Yang S, Hang C, Tian Y, Wang C. High-Efficient Vacuum Ultraviolet-Ozone Assist-Deposited Polydopamine for Poly(lactic- co-glycolic acid)-Coated Pure Zn toward Biodegradable Cardiovascular Stent Applications. ACS APPLIED MATERIALS & INTERFACES 2022; 14:3536-3550. [PMID: 34941257 DOI: 10.1021/acsami.1c21567] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Zinc is a prospective metal for biodegradable cardiovascular stent applications, but the excessively released Zn2+ during degradation remains a huge challenge in biocompatibility. Considerable efforts have been made to develop a high-efficient surface modification method, while maintaining adhesion strength, mechanical support, and vascular compatibility. Biomimetic polydopamine (PDA) can adhere to Zn tightly, subsequently achieving robust chemical bonds with poly(lactic-co-glycolic acid) (PLGA) coating. However, the deposition of PDA on Zn depends on the controlled conditions such as a sensitive pH and a long period of time. Herein, we introduce vacuum ultraviolet-ozone (VUV/O3) assist-deposition technology to accelerate the polymerization of PDA on pure Zn, which shortens the process to 40 min at a moderate pH of 8.5 and improves the deposition rate by 1-2 orders of magnitude under sufficient active oxygen species (ROS). Additionally, PLGA/PDA coating enhances the corrosion resistance, and their effective protection maintains the mechanical properties after long-term corrosion. Moreover, the controlled Zn2+ release contributes to the superior in vitro biocompatibility, which inhibits the hemolysis rate and smooth muscle cell (SMC) proliferation. The enhanced endothelial cell (EC) proliferation is promising to promote the re-endothelialization, avoiding in-stent restenosis and neointimal hyperplasia. Such modified Zn might be a viable candidate for the treatment of cardiovascular diseases.
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Affiliation(s)
- Hui Fang
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
| | - Xiaoyun Qi
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
| | - Shicheng Zhou
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
| | - Shuhan Yang
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
| | - Chunjin Hang
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
| | - Yanhong Tian
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
| | - Chenxi Wang
- State Key Laboratory of Advanced Welding and Joining, Harbin Institute of Technology, Harbin 150001, China
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Comparison of biodegradable and newer generation durable polymer drug-eluting stents with short-term dual antiplatelet therapy: a systematic review and Bayesian network meta-analysis of randomized trials comprising of 43,875 patients. J Thromb Thrombolysis 2022; 53:671-682. [PMID: 34981305 DOI: 10.1007/s11239-021-02628-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
Newer generation durable polymer drug-eluting stents (DP-DES) and biodegradable polymer DES (BP-DES) have similar efficacy with dual-antiplatelet therapy (DAPT) duration of > 6 months. However, this difference in outcomes have not been well studied in shorter DAPT regime. This study compares the safety and efficacy profiles of DP-DES and BP-DES based on short-term (1-3 months), intermediate-term (4-6 months) and standard DAPT (6-12 months) durations. A search was conducted on Embase and Medline for Randomized Controlled Trials (RCTs) comparing stent types, and DAPT durations. Primary endpoints include cardiac death, myocardial infarction (MI), definite stent thrombosis, stroke, target vessel revascularization (TVR) and major bleeding. Network analysis was conducted to summarize the evidence. A total of 15 RCTs involving 43,875 patients were included. DP-DES was associated with significantly lower major bleeding rates compared to BP-DES (RR 0.44, Crl 0.22-0.83) in short-term DAPT. Among DP-DES patients, short-term DAPT was associated with lower major bleeding risk compared to standard DAPT (RR 0.47, CrI 0.32-0.69). This favorable bleeding profile with short DAPT was not found in BP-DES patients. Cardiac death, MI, definite stent thrombosis, stroke and TVR rates were similar across the various DAPT durations and stent types. Our preliminary findings demonstrated comparable efficacy and safety outcomes between BP-DES and newer generation BP-DES across various DAPT durations. In patients requiring short DAPT, DP-DES had more favourable major bleeding profile compared to BP-DES, without compromising anti-thrombotic efficacy.
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Mühl-Benninghaus R, Fries F, Kießling M, Tomori T, Krajewski S, Simgen A, Bauer S, Hey N, Brynda E, Taborska J, Riedel T, Reith W, Cattaneo G, Brochhausen C. Vascular Response on a Novel Fibrin-Based Coated Flow Diverter. Cardiovasc Intervent Radiol 2021; 45:236-243. [PMID: 34913987 PMCID: PMC8807434 DOI: 10.1007/s00270-021-03007-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
Purpose Due to thromboembolic complications and in-stent-stenosis after flow diverter (FD) treatment, the long-term use of dual antiplatelet treatment (DAPT) is mandatory. The tested nano-coating has been shown to reduce material thrombogenicity and promote endothelial cell proliferation in vitro. We compared the biocompatibility of coated (Derivo Heal) and non-coated (Derivo bare) FDs with DAPT in an animal model. Methods Derivo® bare (n = 10) and Derivo® Heal (n = 10) FD were implanted in the common carotid arteries (CCAs) of New Zealand white rabbits. One additional FD, alternately a Derivo bare (n = 5) or Derivo Heal (n = 5), was implanted in the abdominal aorta (AA) for assessment of the patency of branch arteries. Histopathological examinations were performed after 28 days. Angiography was performed before and after FD implantation and at follow-up. Results Statistical analysis of the included specimens showed complete endothelialization of all FDs with no significant differences in neointima thickness between Derivo® bare and Derivo® Heal (CCA: p = 0.91; AA: p = 0.59). A significantly reduced number of macrophages in the vessel wall of the Derivo Heal was observed for the CCA (p = 0.02), and significantly reduced fibrin and platelet deposition on the surface of the Derivo Heal was observed for the AA. All branch arteries of the stented aorta remained patent. Conclusion In this animal model, the novel fibrin-based coated FD showed a similar blood and tissue compatibility as the non-coated FD.
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Affiliation(s)
- Ruben Mühl-Benninghaus
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany.
| | - Frederik Fries
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | - Mara Kießling
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | - Stefanie Krajewski
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tübingen, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | | | | | - Eduard Brynda
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Johanka Taborska
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Riedel
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Kirrberger Strasse, 66424, Homburg, Germany
| | - Giorgio Cattaneo
- Institute for Biomedical Engineering, University of Stuttgart, Stuttgart, Germany
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11
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Tateishi K, Saito Y, Kitahara H, Kobayashi Y. Impact of glycemic variability on coronary and peripheral endothelial dysfunction in patients with coronary artery disease. J Cardiol 2021; 79:65-70. [PMID: 34456069 DOI: 10.1016/j.jjcc.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies have reported that glucose variability leads to endothelial dysfunction and progression of coronary atherosclerosis. However, few studies have directly evaluated the relation between glucose variability and coronary endothelial function in patients with coronary artery disease (CAD). METHODS A total of 38 patients with chronic CAD and a history of coronary drug-eluting stent implantation were enroled. Coronary endothelial function was evaluated by measuring the coronary vasoreactivity using quantitative coronary angiography in the segment distal to implanted stent in response to intracoronary acetylcholine (ACh) infusion (10-7 mol/l). Peripheral endothelial function was also assessed with reactive hyperemia index (RHI). The mean amplitude of glycemic excursion (MAGE) was calculated as a primary metric of glucose variability using a flash glucose monitoring system. RESULTS Of 38 patients, 17 (45%) had diabetes mellitus. The mean levels of glycated hemoglobin, MAGE, and RHI were 6.3 ± 0.8%, 71.4 ± 29.8 mg/dl, and 1.85 ± 0.63. In the distal segment to coronary stent, lumen diameter was constricted by 0.6 ± 7.3% in response to intracoronary ACh infusion compared to that at baseline. While peripheral endothelial function assessed with RHI was not significantly associated with MAGE (r = -0.16, p = 0.35), coronary endothelial function was correlated with MAGE (r = -0.38, p = 0.02). CONCLUSION Greater glucose variability was significantly associated with coronary rather than peripheral endothelial dysfunction in patients with CAD, suggesting an impact of glucose variability on coronary atherosclerosis.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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12
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Sheng Y, Yang J, Zhao X, Liu H, Cui S, Chen L, Zeng R, Wang X, Huang CH, Li W. Development and In Vitro Biodegradation of Biomimetic Zwitterionic Phosphorylcholine Chitosan Coating on Zn1Mg Alloy. ACS APPLIED MATERIALS & INTERFACES 2020; 12:54445-54458. [PMID: 33231070 DOI: 10.1021/acsami.0c16662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Zinc (Zn) alloys are promising alternatives to magnesium (Mg)- and iron (Fe)-based alloys because of their moderate corrosion rate and superior biocompatibility. To reduce the mass release of Zn2+ and improve the biocompatibility of Zn implants, the biomimetic zwitterionic polymer layer (phosphorylcholine chitosan-PCCs) was immobilized on the plasma-treated Zn1Mg surface. It is the chemical bonds between the -NH2 groups of the PCCs chain and O-C═O (C═O) groups on the plasma-treated Zn1Mg (Zn1Mg-PP) that contributes to the strong bonding strength between the film and the substrate, by which the PCCs (approx. 200 nm thick) layer can bear a 5.93 N normal load. The electrochemical impedance spectroscopy (EIS) results showed that the PCCs layer remarkably increased the resistance against corrosion attack, protecting substrates from over-quick degradation, and the protective effect of the layer with a thickness of 200 nm lasts for about 24 h. The corrosion products of Zn1Mg-PP-PCC in NaCl solution were determined as Zn5(OH)8Cl2·H2O and Zn3(PO4)2. Besides, the bulk Zn1Mg can trigger more aggressive macrophage activity, while the surface of Zn1Mg-PP and Zn1Mg-PP-PCC and their corrosion products (Zn3(PO4)2) tend to promote the differentiation of macrophages into the M2 phenotype, which is beneficial for implant applications.
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Affiliation(s)
- Yinying Sheng
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
| | - Junjie Yang
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
| | - Xueyang Zhao
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
| | - Hui Liu
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
| | - Shaogang Cui
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
| | - Lianxi Chen
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
| | - Rong Zeng
- Department of Materials Science and Engineering, College of Chemistry and Materials, Jinan University, Guangzhou 510632, China
| | - Xiaojian Wang
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
- National Joint Engineering Center of High-performance Wear-resistant Metallic Materials, Guangzhou 510632, China
| | - Chi-Hsien Huang
- Department of Material Engineering, Ming Chi University of Technology, New Taipei City 24301, Taiwan
| | - Wei Li
- Institute of Advanced Wear & Corrosion Resistant and Functional Materials, Jinan University, Guangzhou 510632, China
- National Joint Engineering Center of High-performance Wear-resistant Metallic Materials, Guangzhou 510632, China
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Abstract
Regenerative therapies aim to develop novel treatments to restore tissue function. Several strategies have been investigated including the use of biomedical implants as three-dimensional artificial matrices to fill the defect side, to replace damaged tissues or for drug delivery. Bioactive implants are used to provide growth environments for tissue formation for a variety of applications including nerve, lung, skin and orthopaedic tissues. Implants can either be biodegradable or non-degradable, should be nontoxic and biocompatible, and should not trigger an immunological response. Implants can be designed to provide suitable surface area-to-volume ratios, ranges of porosities, pore interconnectivities and adequate mechanical strengths. Due to their broad range of properties, numerous biomaterials have been used for implant manufacture. To enhance an implant’s bioactivity, materials can be functionalised in several ways, including surface modification using proteins, incorporation of bioactive drugs, growth factors and/or cells. These strategies have been employed to create local bioactive microenvironments to direct cellular responses and to promote tissue regeneration and controlled drug release. This chapter provides an overview of current bioactive biomedical implants, their fabrication and applications, as well as implant materials used in drug delivery and tissue regeneration. Additionally, cell- and drug-based bioactivity, manufacturing considerations and future trends will be discussed.
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14
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Ishihara K, Yanokuchi S, Teramura Y, Fukazawa K. Combination of two antithrombogenic methodologies for preventing thrombus formation on a poly(ether ether ketone) substrate. Colloids Surf B Biointerfaces 2020; 192:111021. [PMID: 32380403 DOI: 10.1016/j.colsurfb.2020.111021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 04/05/2020] [Indexed: 11/20/2022]
Abstract
To enhance the total antithrombogenicity of poly(ether ether ketone) (PEEK), we examined a combination of two methodologies for the suppression of activation in both the platelet and coagulation systems. A random copolymer (PMT) composed of a zwitterionic 2-methacryloyloxyethyl phosphorylcholine (MPC) unit and a cationic 2-methacryloyloxyethyl trimethylammonium chloride (TMAEMA) unit was grafted onto the PEEK surface by photoinduced self-initiated graft polymerization of the PEEK substrate (PMTx-g-PEEK). Then, negatively charged heparin was immobilized by ionic binding with TMAEMA units (Hep/PMTx-g-PEEK). The TMAEMA unit composition on grafted PMT altered the surface ζ-potentials of the PEEK substrates. Amounts of immobilized heparin depended on the ζ-potential. The concentration of heparin became constant on the sample surface where the TMAEMA unit composition was 30% or more, and was approximately 2.0 μg/cm2. The Hep/PMTx-g-PEEK with a TMAEMA unit composition of 50% showed not only decreased platelet adhesion, but also a 4-fold extension of the blood coagulation time of the poly(MPC)-g-PEEK substrate. The poly(MPC) layer could inhibit platelet adhesion and activation, resulting in surface antithrombogenic properties. Additionally, heparin released from the Hep/PMTx-g-PEEK prevented activation of the coagulation system in whole blood. Therefore, the combination of these antithrombogenic methodologies was promising for prolonging the blood coagulation period of the materials.
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Affiliation(s)
- Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; Department of Bioengineering School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
| | - Satoshi Yanokuchi
- Department of Bioengineering School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Yuji Teramura
- Department of Bioengineering School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
| | - Kyoko Fukazawa
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
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15
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Beshchasna N, Saqib M, Kraskiewicz H, Wasyluk Ł, Kuzmin O, Duta OC, Ficai D, Ghizdavet Z, Marin A, Ficai A, Sun Z, Pichugin VF, Opitz J, Andronescu E. Recent Advances in Manufacturing Innovative Stents. Pharmaceutics 2020; 12:E349. [PMID: 32294908 PMCID: PMC7238261 DOI: 10.3390/pharmaceutics12040349] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases are the most distributed cause of death worldwide. Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis. As coating materials (i) organic polymers: polyurethanes, poly(ε-caprolactone), styrene-b-isobutylene-b-styrene, polyhydroxybutyrates, poly(lactide-co-glycolide), and phosphoryl choline; (ii) biological components: vascular endothelial growth factor (VEGF) and anti-CD34 antibody and (iii) inorganic coatings: noble metals, wide class of oxides, nitrides, silicide and carbide, hydroxyapatite, diamond-like carbon, and others are used. DES were developed to reduce the tissue hyperplasia and in-stent restenosis utilizing antiproliferative substances like paclitaxel, limus (siro-, zotaro-, evero-, bio-, amphi-, tacro-limus), ABT-578, tyrphostin AGL-2043, genes, etc. The innovative solutions aim at overcoming the main limitations of the stent technology, such as in-stent restenosis and stent thrombosis, while maintaining the prime requirements on biocompatibility, biodegradability, and mechanical behavior. This paper provides an overview of the existing stent types, their functionality, materials, and manufacturing conditions demonstrating the still huge potential for the development of promising stent solutions.
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Affiliation(s)
- Natalia Beshchasna
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | - Muhammad Saqib
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | | | - Łukasz Wasyluk
- Balton Sp. z o.o. Modlińska 294, 03-152 Warsaw, Poland; (H.K.); (Ł.W.)
| | - Oleg Kuzmin
- VIP Technologies, Prospect Academicheskiy 8/2, 634055 Tomsk, Russia;
| | - Oana Cristina Duta
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Denisa Ficai
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Zeno Ghizdavet
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
| | - Alexandru Marin
- Department of Hydraulics, Hydraulic Machinery and Environmental Engineering, Faculty of Power Engineering, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania;
| | - Anton Ficai
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
- Academy of Romanian Scientists, Spl. Independentei 54, 050094 Bucharest, Romania
| | - Zhilei Sun
- Research School of High-Energy Physics, Tomsk Polytechnic University, Lenin Avenue 30, 634050 Tomsk, Russia;
| | - Vladimir F. Pichugin
- Research School of High-Energy Physics, Tomsk Polytechnic University, Lenin Avenue 30, 634050 Tomsk, Russia;
| | - Joerg Opitz
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany; (M.S.); (J.O.)
| | - Ecaterina Andronescu
- Department of Science and Engineering of Oxide Materials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania; (O.C.D.); (D.F.); (Z.G.); (E.A.)
- Academy of Romanian Scientists, Spl. Independentei 54, 050094 Bucharest, Romania
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16
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Skinner M, Johnston BM, Liu Y, Hammer B, Selhorst R, Xenidou I, Perry SL, Emrick T. Synthesis of Zwitterionic Pluronic Analogs. Biomacromolecules 2018; 19:3377-3389. [PMID: 30024744 DOI: 10.1021/acs.biomac.8b00676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Novel polymer amphiphiles with chemical structures designed as zwitterionic analogs of Pluronic block copolymers were prepared by controlled free radical polymerization of phosphorylcholine (PC) or choline phosphate (CP) methacrylate monomers from a difunctional poly(propylene oxide) (PPO) macroinitiator. Well-defined, water-dispersible zwitterionic triblock copolymers, or "zwitteronics", were prepared with PC content ranging from 5 to 47 mol percent and composition-independent surfactant characteristics in water, which deviate from the properties of conventional Pluronic amphiphiles. These PC-zwitteronics assembled into nanoparticles in water, with tunable sizes and critical aggregation concentrations (CACs) based on their hydrophilic-lipophilic balance (HLB). Owing to the lower critical solution temperature (LCST) miscibility of the hydrophobic PPO block in water, PC-zwitteronics exhibited thermoreversible aqueous solubility tuned by block copolymer composition. The chemical versatility of this approach was demonstrated by embedding functionality, in the form of alkyne groups, directly into the zwitterion moieties. These alkynes proved ideal for cross-linking the zwitteronic nanoparticles and for generating nanoparticle-cross-linked hydrogels using UV-initiated thiol-yne "click" chemistry.
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17
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Matsuda Y, Jang DK, Chung J, Wainwright JM, Lopes D. Preliminary outcomes of single antiplatelet therapy for surface-modified flow diverters in an animal model: analysis of neointimal development and thrombus formation using OCT. J Neurointerv Surg 2018; 11:74-79. [PMID: 29804090 PMCID: PMC6327918 DOI: 10.1136/neurintsurg-2018-013935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/09/2022]
Abstract
Objective To evaluate the rate of neointimal development and thrombus formation of surface-modified flow diverters in single antiplatelet therapy (SAPT) using optical coherence tomography (OCT) in a porcine model. Methods We divided 10 experimental pigs into two groups. One group (n=6) received dual antiplatelet therapy (DAPT) and the other group (n=4) received SAPT. Four stents (two per carotid artery) were implanted in both groups. The stents used were the Pipeline Flex embolization device (PED Flex), Pipeline Flex with Shield technology (PED Shield), and the Solitaire AB stent. All animals underwent weekly angiography and OCT. The OCT data were analyzed using the following measurements: neointimal ratio ((stent – lumen area)/stent area), stent-coverage ratio (number of stent struts covered by neointima/total stent struts), and the presence or absence of thrombus formation per 1 mm cross-section. Results PED Flex and Shield in the SAPT group had higher neointimal ratios than in the DAPT group (P<0.001, respectively). In the DAPT group, the speed of endothelial growth on day 7 in the PED Shield group was higher than that in the PED Flex group (P<0.001). In the SAPT group, PED Flex demonstrated significantly more thrombus formation on day 7 than PED Shield (P<0.001). Conclusions The PED Shield stent showed faster endothelial growth than the other devices and comparable neointimal volume. There was significantly less thrombus formation on PED Shield than PED Flex when using SAPT in a porcine model.
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Affiliation(s)
- Yoshikazu Matsuda
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Wakayama Medical University, Wakayama City, Japan
| | - Dong-Kyu Jang
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Joonho Chung
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Demetrius Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
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18
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Walcott BP, Koch MJ, Stapleton CJ, Patel AB. Blood Flow Diversion as a Primary Treatment Method for Ruptured Brain Aneurysms-Concerns, Controversy, and Future Directions. Neurocrit Care 2018; 26:465-473. [PMID: 27844465 DOI: 10.1007/s12028-016-0318-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Flow diversion is a novel treatment for brain aneurysms that works by redirecting blood flow away from the aneurysm. Immediately after placement of the stent, blood flow stagnates within the aneurysm dome and it undergoes thrombosis. Over time, a new endothelium develops across the neck, thereby reconstructing the parent vessel and curing the aneurysm. The use of this treatment method for ruptured aneurysms has two specific concerns: 1) risk of hemorrhage from the aneurysm after treatment because of potential delayed aneurysm occlusion; and 2) hemorrhagic complications from antiplatelet use, which is required to prevent thromboembolic complications from the device. In this review, we explore these two concerns based on the emerging published literature. Optimal peri-procedural management of these issues in the neurocritical care setting is vital to improving outcomes. We also identify ongoing clinical trials of flow diversion for the treatment of ruptured aneurysms. Flow diversion is an alternative to clipping or coiling for many ruptured aneurysms and may be potentially more efficacious in certain aneurysm subtypes.
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Affiliation(s)
- Brian P Walcott
- Department of Neurological Surgery, University of Southern California, USC Healthcare Center II, 1520 San Pablo St #3800, Los Angeles, CA, 90033, USA.
| | - Matthew J Koch
- Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Aman B Patel
- Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
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19
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Rizas KD, Mehilli J. Stent Polymers: Do They Make a Difference? Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.002943. [PMID: 27193905 DOI: 10.1161/circinterventions.115.002943] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/15/2016] [Indexed: 01/03/2023]
Abstract
The necessity of polymers on drug-eluting stent (DES) platforms is dictated by the need of an adequate amount and optimal release kinetic of the antiproliferative drugs for achieving ideal DES performance. However, the chronic vessel wall inflammation related to permanent polymer persistence after the drug has been eluted might trigger late restenosis and stent thrombosis. Biodegradable polymers have the potential to avoid these adverse events. A variety of biodegradable polymer DES platforms have been clinically tested, showing equal outcomes with the standard-bearer permanent polymer DES within the first year of implantation. At longer-term follow-up, promising lower rates of stent thrombosis have been observed with the early generation biodegradable polymer DES platforms compared to first-generation DES. Whether this safety benefit still persists with newer biodegradable polymer DES generations against second-generation permanent polymer DES needs to be explored.
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Affiliation(s)
- Konstantinos D Rizas
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany (K.D.R., J.M.); and Munich Heart Alliance at DZHK, Munich, Germany (J.M.)
| | - Julinda Mehilli
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany (K.D.R., J.M.); and Munich Heart Alliance at DZHK, Munich, Germany (J.M.).
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20
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Lawton JM, Habib M, Ma B, Brooks RA, Best SM, Lewis AL, Rushton N, Bonfield W. The effect of cationically-modified phosphorylcholine polymers on human osteoblasts in vitro and their effect on bone formation in vivo. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:144. [PMID: 28819908 PMCID: PMC5561156 DOI: 10.1007/s10856-017-5958-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
The effect of introducing cationic charge into phosphorylcholine (PC)-based polymers has been investigated in this study with a view to using these materials as coatings to improve bone formation and osseointegration at the bone-implant interface. PC-based polymers, which have been used in a variety of medical devices to improve biocompatibility, are associated with low protein adsorption resulting in reduced complement activation, inflammatory response and cell adhesion. However, in some applications, such as orthopaedics, good integration between the implant and bone is needed to allow the distribution of loading stresses and a bioactive response is required. It has previously been shown that the incorporation of cationic charge into PC-based polymers may increase protein adsorption that stimulates subsequent cell adhesion. In this paper, the effect of cationic charge in PC-based polymers on human osteoblasts (HObs) in vitro and the effect of these polymers on bone formation in the rat tibia was assessed. Increasing PC positive surface charge increased HOb cell adhesion and stimulated increased cell differentiation and the production of calcium phosphate deposits. However, when implanted in bone these materials were at best biotolerant, stimulating the production of fibrous tissue and areas of loosely associated matrix (LAM) around the implant. Their development, as formulated in this study, as bone interfacing implant coatings is therefore not warranted.
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Affiliation(s)
- Jonathan M Lawton
- Department of Materials Science and Metallurgy, Cambridge Centre for Medical Materials, University of Cambridge, New Museum Site, Cambridge, CB2 3QZ, UK
| | - Mariam Habib
- Department of Materials Science and Metallurgy, Cambridge Centre for Medical Materials, University of Cambridge, New Museum Site, Cambridge, CB2 3QZ, UK
| | - Bingkui Ma
- Orthopaedic Research Unit, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Roger A Brooks
- Orthopaedic Research Unit, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - Serena M Best
- Department of Materials Science and Metallurgy, Cambridge Centre for Medical Materials, University of Cambridge, New Museum Site, Cambridge, CB2 3QZ, UK
| | - Andrew L Lewis
- Biocompatibles UK Ltd, Chapman House, Farnham Business Park, Weydon Lane, Farnham, Surrey, GU9 8QL, UK.
| | - Neil Rushton
- Orthopaedic Research Unit, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2QQ, UK
| | - William Bonfield
- Department of Materials Science and Metallurgy, Cambridge Centre for Medical Materials, University of Cambridge, New Museum Site, Cambridge, CB2 3QZ, UK
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21
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Matsuda Y, Chung J, Lopes DK. Analysis of neointima development in flow diverters using optical coherence tomography imaging. J Neurointerv Surg 2017; 10:162-167. [PMID: 28592484 PMCID: PMC5800337 DOI: 10.1136/neurintsurg-2016-012969] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverters are used for the treatment of intracranial aneurysms. Surface modification may decrease the thrombogenicity of flow diverters but the details are unknown. Optical coherence tomography (OCT) is an intravascular imaging test with high resolution which identifies neointimal growth over stents. We compared the development of neointima in a flow diverter and stents with and without surface modification in a swine model. METHODS In this study we implanted four devices (two in each carotid artery) in four pigs. The devices used were the Pipeline Flex embolization device (PED Flex, n=6), PED with Shield technology (PED Shield, n=6), and Solitaire AB (n=4). Serial carotid angiographic and OCT images were obtained on days 0, 7, 14, and 21. The data analyzed included: neointimal area (lumen area - stent area), neointimal ratio ([lumen area - stent area]/stent area), and the neointimal thickness ratio (minimum neointimal thickness/maximum neointimal thickness). RESULTS There was no significant difference in where neointima formation was initiated in relation to the implanted device (distal vs middle vs proximal). The PED Shield had a trend towards earlier endothelial formation at day 7. By day 21 the neointimal ratio was significantly higher for the PED Flex and PED Shield devices than for Solitaire (p<0.05 and p<0.01, respectively). The neointimal thickness ratio was significantly higher with PED Shield than with PED Flex and Solitaire (p<0.05 and p<0.01, respectively). CONCLUSIONS OCT enabled us to follow and compare in vivo the development of neointima over implants. PED Shield showed a similar neointimal volume to PED Flex and more concentric neointima.
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Affiliation(s)
- Yoshikazu Matsuda
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Wakayama Medical University, Wakayama City, Japan
| | - Joonho Chung
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Demetrius K Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
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22
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Jin YJ, Kang S, Park P, Choi D, Kim DW, Jung D, Koh J, Jeon J, Lee M, Ham J, Seo JH, Jin HR, Lee Y. Anti-inflammatory and Antibacterial Effects of Covalently Attached Biomembrane-Mimic Polymer Grafts on Gore-Tex Implants. ACS APPLIED MATERIALS & INTERFACES 2017; 9:19161-19175. [PMID: 28557438 DOI: 10.1021/acsami.7b02696] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Expanded polytetrafluoroethylene (ePTFE), also known as Gore-Tex, is widely used as an implantable biomaterial in biomedical applications because of its favorable mechanical properties and biochemical inertness. However, infection and inflammation are two major complications with ePTFE implantations, because pathogenic bacteria can inhabit the microsized pores, without clearance by host immune cells, and the limited biocompatibility can induce foreign body reactions. To minimize these complications, we covalently grafted a biomembrane-mimic polymer, poly(2-methacryloyloxylethyl phosphorylcholine) (PMPC), by partial defluorination followed by UV-induced polymerization with cross-linkers on the ePTFE surface. PMPC grafting greatly reduced serum protein adsorption as well as fibroblast adhesion on the ePTFE surface. Moreover, the PMPC-grafted ePTFE surface exhibited a dramatic inhibition of the adhesion and growth of Staphylococcus aureus, a typical pathogenic bacterium in ePTFE implants, in the porous network. On the basis of an analysis of immune cells and inflammation-related factors, i.e., transforming growth factor-β (TGF-β) and myeloperoxidase (MPO), we confirmed that inflammation was efficiently alleviated in tissues around PMPC-grafted ePTFE plates implanted in the backs of rats. Covalent PMPC may be an effective strategy for promoting anti-inflammatory and antibacterial functions in ePTFE implants and to reduce side effects in biomedical applications of ePTFE.
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Affiliation(s)
- Young Ju Jin
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center , 5 Gil 20, Boramae-ro, Dongjak-Gu, Seoul 156-707, Republic of Korea
| | - Sunah Kang
- Department of Chemistry, College of Natural Sciences, Seoul National University , 1 Gwanak-ro, Gwanak-gu, Seoul 151-747, Republic of Korea
| | - Pona Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center , 5 Gil 20, Boramae-ro, Dongjak-Gu, Seoul 156-707, Republic of Korea
| | - Dongkil Choi
- Department of Chemistry, College of Natural Sciences, Seoul National University , 1 Gwanak-ro, Gwanak-gu, Seoul 151-747, Republic of Korea
| | - Dae Woo Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center , 5 Gil 20, Boramae-ro, Dongjak-Gu, Seoul 156-707, Republic of Korea
| | - Dongwook Jung
- Department of Chemistry, College of Natural Sciences, Seoul National University , 1 Gwanak-ro, Gwanak-gu, Seoul 151-747, Republic of Korea
| | - Jaemoon Koh
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine , 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Joohee Jeon
- Department of Chemistry, College of Natural Sciences, Seoul National University , 1 Gwanak-ro, Gwanak-gu, Seoul 151-747, Republic of Korea
| | - Myoungjin Lee
- Department of Materials Science and Engineering, Korea University , 145 Anam-ro, Seongbuk-gu, Seoul 136-701, Republic of Korea
| | - Jiyeon Ham
- Department of Chemistry, College of Natural Sciences, Seoul National University , 1 Gwanak-ro, Gwanak-gu, Seoul 151-747, Republic of Korea
| | - Ji-Hun Seo
- Department of Materials Science and Engineering, Korea University , 145 Anam-ro, Seongbuk-gu, Seoul 136-701, Republic of Korea
| | - Hong-Ryul Jin
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center , 5 Gil 20, Boramae-ro, Dongjak-Gu, Seoul 156-707, Republic of Korea
| | - Yan Lee
- Department of Chemistry, College of Natural Sciences, Seoul National University , 1 Gwanak-ro, Gwanak-gu, Seoul 151-747, Republic of Korea
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Abstract
Restenosis is a pathologic response to vascular injury, characterized by neointimal hyperplasia and progressive narrowing of a stented vessel segment. Although advances in stent design have led to a dramatic reduction in the incidence of restenosis, it continues to represent the most common cause of target lesion failure following percutaneous coronary intervention. Efforts to maximize restenosis prevention, through careful consideration of modifiable risk factors and an individualized approach, are critical, as restenosis, once established, can be particularly difficult to treat. Novel approaches are on the horizon that have the potential to alter the natural history of this stubborn disease.
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In Vitro Endothelialization Test of Biomaterials Using Immortalized Endothelial Cells. PLoS One 2016; 11:e0158289. [PMID: 27348615 PMCID: PMC4922589 DOI: 10.1371/journal.pone.0158289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/13/2016] [Indexed: 11/19/2022] Open
Abstract
Functionalizing biomaterials with peptides or polymers that enhance recruitment of endothelial cells (ECs) can reduce blood coagulation and thrombosis. To assess endothelialization of materials in vitro, primary ECs are generally used, although the characteristics of these cells vary among the donors and change with time in culture. Recently, primary cell lines immortalized by transduction of simian vacuolating virus 40 large T antigen or human telomerase reverse transcriptase have been developed. To determine whether immortalized ECs can substitute for primary ECs in material testing, we investigated endothelialization on biocompatible polymers using three lots of primary human umbilical vein endothelial cells (HUVEC) and immortalized microvascular ECs, TIME-GFP. Attachment to and growth on polymer surfaces were comparable between cell types, but results were more consistent with TIME-GFP. Our findings indicate that TIME-GFP is more suitable for in vitro endothelialization testing of biomaterials.
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Grinding and polishing instead of sectioning for the tissue samples with a graft: Implications for light and electron microscopy. Micron 2016; 85:1-7. [DOI: 10.1016/j.micron.2016.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/22/2022]
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Van den Branden BJL, Teeuwen K, Koolen JJ, van der Schaaf RJ, Henriques JPS, Tijssen JGP, Kelder JC, Vermeersch PHMJ, Rensing BJWM, Suttorp MJ. Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III): a randomised comparison of sirolimus-eluting stent implantation with zotarolimus-eluting stent implantation for the treatment of total coronary occlusions. EUROINTERVENTION 2016; 9:841-53. [PMID: 23628457 DOI: 10.4244/eijv9i7a138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We investigated whether sirolimus-eluting stents (SES) are superior to next-generation zotarolimus-eluting stents (ZES) in treating patients with total coronary occlusions (TCO). METHODS AND RESULTS In a prospective, randomised trial we compared the SES with the zotarolimus-eluting stent (ZES; Endeavor or Resolute) after successful recanalisation of TCO. During the first phase of the trial, 51 patients were assigned to receive the SES and 46 patients to receive the Endeavor ZES. In the second phase we randomised 103 patients to the SES group and 104 patients to the Resolute ZES group. The primary endpoint was in-segment late lumen loss at eight-month follow-up. At eight months, patients in the SES group had less in-segment and in-stent late loss as compared to the Endeavor group: -0.13±0.3 mm vs. 0.27±0.6 mm (p=0.0002) and -0.13±0.5 mm vs. 0.54±0.5 mm (p<0.0001), respectively. In contrast, the SES and the Resolute ZES showed comparable amounts of in-segment (-0.03±0.7 mm vs. -0.10±0.7 mm, p=0.6) and in-stent (0.03±0.8 mm vs. 0.05±0.8 mm, p=0.9) late loss. CONCLUSIONS In the treatment of TCOs, the SES was associated with superior angiographic outcomes compared to the Endeavor ZES. On the other hand, the SES and the Resolute ZES showed comparable angiographic outcomes.
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Sanz-Vicente I, Lapieza MP, Cebolla VL, Galbán J. Rapid enzymatic method for the determination of phosphoryl choline using the fluorescence of the enzyme choline oxidase. Sequential determination of choline and phosphorylcholine in milk powder for children. Microchem J 2015. [DOI: 10.1016/j.microc.2015.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rusinaru D, Vrolix M, Verheye S, Chowdhary S, Schoors D, Di Mario C, Desmet W, Donohoe DJ, Ormiston JA, Knape C, Bezerra H, Lansky A, Wijns W. Bioabsorbable polymer-coated sirolimus-eluting stent implantation preserves coronary vasomotion: A DESSOLVE II trial sub-study. Catheter Cardiovasc Interv 2015; 86:1141-50. [DOI: 10.1002/ccd.25610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/15/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Dan Rusinaru
- Cardiovascular Research Center Aalst, OLV Clinic; Aalst Belgium
| | | | | | - Saqib Chowdhary
- South Manchester University Hospital; Manchester United Kingdom
| | | | - Carlo Di Mario
- NIHR Cardiovascular Research Unit; Royal Brompton Hospital & Imperial College; London United Kingdom
| | - Walter Desmet
- Department of Cardiovascular Diseases; UZ Leuven Belgium
| | | | | | | | | | | | - William Wijns
- Cardiovascular Research Center Aalst, OLV Clinic; Aalst Belgium
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Skinner M, Selhorst R, Emrick T. Synthesis of water-soluble zwitterionic polysiloxanes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/pola.27773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Skinner
- Department of Polymer Science and Engineering; University of Massachusetts; 120 Governors Drive Amherst MA 01003
| | - Ryan Selhorst
- Department of Polymer Science and Engineering; University of Massachusetts; 120 Governors Drive Amherst MA 01003
| | - Todd Emrick
- Department of Polymer Science and Engineering; University of Massachusetts; 120 Governors Drive Amherst MA 01003
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Abstract
BACKGROUND Orthopaedic biomaterials are susceptible to biofilm formation. A novel lipid-based material has been developed that may be loaded with antibiotics and applied as an implant coating at point of care. However, this material has not been evaluated for antibiotic elution, biofilm inhibition, or in vivo efficacy. QUESTIONS/PURPOSES (1) Do antibiotic-loaded coatings inhibit biofilm formation? (2) Is the coating effective in preventing biofilm in vivo? METHODS Purified phosphatidylcholine was mixed with 25% amikacin or vancomycin or a combination of 12.5% of both. A 7-day elution study for coated titanium and stainless steel coupons was followed by turbidity and zone of inhibition assays against Staphylococcus aureus and Pseudomonas aeruginosa. Coupons were inoculated with bacteria and incubated 24 hours (N = 4 for each test group). Microscopic images of biofilm were obtained. After washing and vortexing, attached bacteria were counted. A mouse biofilm model was modified to include coated and uncoated stainless steel wires inserted into the lumens of catheters inoculated with a mixture of S aureus or P aeruginosa. Colony-forming unit counts (N = 10) and scanning electron microscopy imaging of implants were used to determine antimicrobial activity. RESULTS Active antibiotics with colony inhibition effects were eluted for up to 6 days. Antibiotic-loaded coatings inhibited biofilm formation on in vitro coupons (log-fold reductions of 4.3 ± 0.4 in S aureus and 3.1 ± 0 for P aeruginosa in phosphatidylcholine-only coatings, 5.6 ± 0 for S aureus and 3.1 ± 0 for P aeruginosa for combination-loaded coatings, 5.5 ± 0.3 for S aureus in vancomycin-loaded coatings, and 3.1 ± 0 for P aeruginosa for amikacin-loaded coatings (p < 0.001 for all comparisons of antibiotic-loaded coatings against uncoated controls for both bacterial strains, p < 0.001 for comparison of antibiotic-loaded coatings against phosphatidylcholine only for S aureus, p = 0.54 for comparison of vancomycin versus combination coating in S aureus, P = 0.99 for comparison of antibiotic- and unloaded phosphatidylcholine coatings in P aeruginosa). Similarly, antibiotic-loaded coatings reduced attachment of bacteria to wires in vivo (log-fold reduction of 2.54 ± 0; p < 0.001 for S aureus and 0.83 ± 0.3; p = 0.112 for P aeruginosa). CONCLUSIONS Coatings deliver active antibiotics locally to inhibit biofilm formation and bacterial growth in vivo. Future evaluations will include orthopaedic preclinical models to confirm therapeutic efficacy. CLINICAL RELEVANCE Clinical applications of local drug delivery coating could reduce the rate of implant-associated infections.
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Murase S, Suzuki Y, Yamaguchi T, Matsuda O, Murata A, Ito T. The relationship between re-endothelialization and endothelial function after DES implantation: comparison between paclitaxcel eluting stent and zotarolims eluting stent. Catheter Cardiovasc Interv 2014; 83:412-7. [PMID: 23901005 PMCID: PMC4262071 DOI: 10.1002/ccd.25140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/21/2013] [Indexed: 01/22/2023]
Abstract
Background Several studies have reported re-endothelialization and endothelial function after drug-eluting stent (DES) implantation; however, the relationship between re-endothelialization and endothelial function after DES implantation has not been investigated yet. Methods A total of 14 patients underwent evaluation of re-endothelialization by optical coherence tomography (OCT) and endothelial function by incremental Ach infusion at 9 months after DES implantation (ZES: N = 7, PES: N = 7). The neointimal thickness (NIT) inside each strut, strut coverage, and malapposition at every 1 mm cross-section were evaluated by OCT and the endothelial function was estimated by measuring the coronary vaso-reactivity in response to acetylcholine (Ach) infusion into coronary arteries. Results Zotarolims eluting stent (ZES), compared with paclitaxcel eluting stent (PES), showed more homogeneous neointimal coverage of stent struts and low rate of malapposition. Vasoconstriction in response to Ach in the peri-stent region was also less pronounced in ZES than PES. In particular, vasoconstriction was more often observed in cases with inhomogeneous neointimal coverage of stent struts in the PES group. Conclusions Our findings suggest that endothelial function seems to be better preserved with ZES than PES, and homogeneous neointimal coverage of stent struts seem to be associated with the preserved endothelial function. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Suguru Murase
- Division of Cardiovascular Medicine, Nagoya Heart CenterNagoya-shi, Aichi, Japan, 461-0045
| | - Yoriyasu Suzuki
- * Correspondence to: Yoriyasu Suzuki, MD, 1-1-14 Sunadabashi, Higashi-ku, Nagoya-shi, Aichi, Japan 461-0045. E-mail:
| | - Toshikazu Yamaguchi
- Division of Cardiovascular Medicine, Nagoya Heart CenterNagoya-shi, Aichi, Japan, 461-0045
| | - Osamu Matsuda
- Division of Cardiovascular Medicine, Nagoya Heart CenterNagoya-shi, Aichi, Japan, 461-0045
| | - Akira Murata
- Division of Cardiovascular Medicine, Nagoya Heart CenterNagoya-shi, Aichi, Japan, 461-0045
| | - Tatsuya Ito
- Division of Cardiovascular Medicine, Nagoya Heart CenterNagoya-shi, Aichi, Japan, 461-0045
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Goodfriend AC, Welch TR, Barker G, Ginther R, Riegel MS, Reddy SV, Wang J, Nugent A, Forbess J. Novel bioresorbable stent coating for drug release in congenital heart disease applications. J Biomed Mater Res A 2014; 103:1761-70. [PMID: 25196819 DOI: 10.1002/jbm.a.35313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/06/2014] [Accepted: 08/14/2014] [Indexed: 11/09/2022]
Abstract
A novel double opposed helical poly-l-lactic acid (PLLA) bioresorbable stent has been designed for use in pediatrics. The aim was to test the PLLA stent biocompatibility. The PLLA stent was immersed into whole pig's blood in a closed loop circuit then fibrin and platelet association was assessed via enzyme-linked immunosorbent assay. D-Dimer was valued at 0.2 ± 0.002 ng/mL and P-selectin 0.43 ± 00.01 ng/mL indicating limited association of fibrin and platelets on the stent. To improve biocompatibility by targeting inflammatory cells, dexamethasone was incorporated on PLLA fibers with two coating methods. Both coatings were poly(l-lactide-co-glycolide) acid (PLGA) but one was made porous with sucrose while the other remained nonporous. There was no change in mechanical properties of the fiber with either coating of PLGA polymer. The total amount of dexamethasone released was then determined for each coating. The cumulative drug release for the porous fiber was significantly higher (∼100%) over 8 weeks than the nonporous fiber (40%). Surface examination of the fiber with scanning electron microscopy showed more surface microfracturing in coatings that contain pores. The biocompatibility of this novel stent was demonstrated. Mechanical properties of the fiber were not altered by coating with PLGA polymer. Anti-inflammatory drug release was optimized using a porous PLGA polymer.
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Affiliation(s)
- Amy C Goodfriend
- Department of Pediatric Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, 75390
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Biocompatibility of Coronary Stents. MATERIALS 2014; 7:769-786. [PMID: 28788487 PMCID: PMC5453068 DOI: 10.3390/ma7020769] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 01/28/2023]
Abstract
Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD) a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES). Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.
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Chevalier B, DiMario C, Neumann FJ, Cutlip DE, Williams DO, Ormiston J, Grube E, Whitbourn R, Coe J, Schwartz LB. A randomized, controlled, multicenter trial to evaluate the safety and efficacy of Zotarolimus- vs. Paclitaxel-eluting stents in de novo occlusive lesions in coronary arteries: Five-year results from the ZOMAXX I trial. Catheter Cardiovasc Interv 2013; 82:1039-47. [DOI: 10.1002/ccd.24958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 02/06/2013] [Accepted: 04/07/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | - Carlo DiMario
- Department of Cardiology; Royal Brompton Hospital; London England
| | | | | | - David O. Williams
- Cardiovascular Institute; Rhode Island Hospital, Providence; Rhode Island
| | - John Ormiston
- Department of Cardiology; Auckland City Hospital; Auckland New Zealand
| | | | - Robert Whitbourn
- Cardiac Investigation Unit; St. Vincent's Hospital; Melbourne Australia
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Ye SH, Jang YS, Yun YH, Shankarraman V, Woolley JR, Hong Y, Gamble LJ, Ishihara K, Wagner WR. Surface modification of a biodegradable magnesium alloy with phosphorylcholine (PC) and sulfobetaine (SB) functional macromolecules for reduced thrombogenicity and acute corrosion resistance. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2013; 29:8320-7. [PMID: 23705967 PMCID: PMC3716277 DOI: 10.1021/la401341y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Siloxane functionalized phosphorylcholine (PC) or sulfobetaine (SB) macromolecules (PCSSi or SBSSi) were synthesized to act as surface modifying agents for degradable metallic surfaces to improve acute blood compatibility and slow initial corrosion rates. The macromolecules were synthesized using a thiol-ene radical photopolymerization technique and then utilized to modify magnesium (Mg) alloy (AZ31) surfaces via an anhydrous phase deposition of the silane functional groups. X-ray photoelectron spectroscopy surface analysis results indicated successful surface modification based on increased nitrogen and phosphorus or sulfur composition on the modified surfaces relative to unmodified AZ31. In vitro acute thrombogenicity assessment after ovine blood contact with the PCSSi and SBSSi modified surfaces showed a significant decrease in platelet deposition and bulk phase platelet activation compared with the control alloy surfaces. Potentiodynamic polarization and electrochemical impedance spectroscopy data obtained from electrochemical corrosion testing demonstrated increased corrosion resistance for PCSSi- and SBSSi-modified AZ31 versus unmodified surfaces. The developed coating technique using PCSSi or SBSSi showed promise in acutely reducing both the corrosion and thrombotic processes, which would be attractive for application to blood contacting devices, such as vascular stents, made from degradable Mg alloys.
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Affiliation(s)
- Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Yong-Seok Jang
- Department of Bioengineering, North Carolina Agricultural & Technical State University, Greensboro, NC, 27411
| | - Yeo-Heung Yun
- Department of Bioengineering, North Carolina Agricultural & Technical State University, Greensboro, NC, 27411
| | - Venkat Shankarraman
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Joshua R. Woolley
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Yi Hong
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Lara J. Gamble
- Department of Bioengineering and NESAC/BIO, University of Washington, Seattle, WA 98195, USA
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Minami Y, Kaneda H, Inoue M, Ikutomi M, Morita T, Nakajima T. Endothelial dysfunction following drug-eluting stent implantation: A systematic review of the literature. Int J Cardiol 2013; 165:222-8. [DOI: 10.1016/j.ijcard.2012.03.084] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/01/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
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Marcoux JE, Mycyk TR. Are any biocompatible coatings capable of attenuating the deleterious effects of cardiopulmonary bypass? Perfusion 2013; 28:433-9. [DOI: 10.1177/0267659113483802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Biocompatible circuits (BCC) are intended to decrease the activation of blood to the artificial cardiopulmonary bypass (CPB) surface. Typically, the coatings are made of various inert substances or molecules physiologically similar to endothelium. Thromboelastography (TEG) graphically represents clot formation, strength of clotting and fibrinolysis. TEG analysis was undertaken to determine if coagulation could be preserved by the BCC. Methods: Five different BCC were studied in clinical applications. These five coated circuits were then compared to an identical circuit where only the oxygenator was coated. A pre- and post-bypass TEG was done for comparison. Six well-studied parameters of TEG analysis were compared: R time, Angle, K, Maximum Amplitude (MA), LY30% and Clot Index (CI). Postoperative bleeding and transfusion requirements were compared to TEG results for comparison. Results: All postoperative TEG results were significantly different from preoperative parameters except LY30%. No BCC circuit was able to prevent the significant disruption of the observed TEG coagulation parameters R, K, angle, MA and CI. Of note, the postoperative TEG parameters resulting from the Control and Trillium™ groups – which had the same type of oxygenator – were practically identical. The oxygenator, which represents the largest surface area in the CPB circuit, is the single most important factor influencing coagulation. Conclusion: While not harmful, BCC are ineffective in preserving TEG coagulation parameters post CPB. Clinical findings support laboratory TEG results in that there were no differences in bleeding or transfusion requirements between groups.
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Affiliation(s)
- JE Marcoux
- Royal University Hospital, Saskatoon, Canada
| | - TR Mycyk
- Royal University Hospital, Saskatoon, Canada
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Dual antiplatelet therapy can be discontinued at three months after implantation of zotarolimus-eluting stent in patients with coronary artery disease. ISRN CARDIOLOGY 2013; 2013:518968. [PMID: 23762606 PMCID: PMC3649238 DOI: 10.1155/2013/518968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022]
Abstract
Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention increases the risk of bleeding. We studied the safety and clinical outcomes of switching from DAPT to aspirin monotherapy at 3 months after ZES implantation. We retrospectively evaluated 168 consecutive patients with coronary artery disease who had been implanted with a ZES from June 2009 through March 2010. After excluding 40 patients according to exclusion criteria such as myocardial infarction, 128 patients were divided into a 3-month DAPT group (67 patients, 88 lesions) and a 12-month conventional DAPT group (61 patients, 81 lesions). Coronary angiographic followup and clinical followup were conducted at more than 8 months and at 12 months after ZES implantation, respectively. Minor and major bleeding events, stent thrombosis (ST), and major adverse cardiac events (MACE) (death, myocardial infarction, cerebrovascular accident, target lesion revascularization, and target vessel revascularization) were evaluated. There were no statistically significant differences in the incidences of ST and MACE between the two groups. The incidence of bleeding events was significantly lower in the 3-month group than in the 12-month group (1.5% versus 11.5%, P < 0.05). DAPT can be safely discontinued at 3 months after ZES implantation, which reduces bleeding risk.
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The “Final” 5-Year Follow-Up From the ENDEAVOR IV Trial Comparing a Zotarolimus-Eluting Stent With a Paclitaxel-Eluting Stent. JACC Cardiovasc Interv 2013; 6:325-33. [DOI: 10.1016/j.jcin.2012.12.123] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/11/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
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Goh D, Tan A, Farhatnia Y, Rajadas J, Alavijeh MS, Seifalian AM. Nanotechnology-Based Gene-Eluting Stents. Mol Pharm 2013; 10:1279-98. [DOI: 10.1021/mp3006616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Debbie Goh
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom
- UCL Medical School, University
College London, London WC1E 6BT, United Kingdom
| | - Aaron Tan
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom
- UCL Medical School, University
College London, London WC1E 6BT, United Kingdom
| | - Yasmin Farhatnia
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - Jayakumar Rajadas
- Biomaterials & Advanced Drug Delivery Laboratory, School of Medicine, Stanford University, California 94305, United States
| | | | - Alexander M. Seifalian
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom
- Royal Free London NHS Foundation
Trust, London NW3 2QG, United Kingdom
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Wise SG, Waterhouse A, Kondyurin A, Bilek MM, Weiss AS. Plasma-based biofunctionalization of vascular implants. Nanomedicine (Lond) 2012; 7:1907-16. [DOI: 10.2217/nnm.12.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Polymeric and metallic materials are used extensively in permanently implanted cardiovascular devices and devices that make temporary but often prolonged contact with body fluids and tissues. Foreign body responses are typically triggered by host interactions at the implant surface, making surface modifications to increase biointegration desirable. Plasma-based treatments are extensively used to modify diverse substrates; modulating surface chemistry, wettability and surface roughness, as well as facilitating covalent biomolecule binding. Each aspect impacts on facets of vascular compatibility including endothelialization and blood contact. These modifications can be readily applied to polymers such as Dacron® and expanded polytetrafluoroethylene, which are widely used in bypass grafting and the metallic substrates of stents, valves and pacemaker components. Plasma modification of metals is more challenging given the need for coating deposition in addition to surface activation, adding the necessity for robust interface adhesion. This review examines the evolving plasma treatment technology facilitating the biofunctionalization of polymeric and metallic implantable cardiovascular materials.
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Affiliation(s)
- Steven G Wise
- School of Molecular Bioscience, University of Sydney, NSW 2006, Australia; School of Molecular Bioscience G08, University of Sydney, NSW 2006, Australia
- The Heart Research Institute, Sydney, NSW 2042, Australia
| | - Anna Waterhouse
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | | | - Marcela M Bilek
- School of Physics, University of Sydney, NSW 2006, Australia
| | - Anthony S Weiss
- Bosch Institute, University of Sydney, Sydney, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, 2006, Australia
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Feres F, Costa RA, Bhatt DL, Leon MB, Botelho RV, King SB, de Paula JET, Mangione JA, Salvadori D, Gusmão MO, Castello H, Nicolela E, Perin MA, Devito FS, Marin-Neto JA, Abizaid A. Optimized duration of clopidogrel therapy following treatment with the Endeavor zotarolimus-eluting stent in real-world clinical practice (OPTIMIZE) trial: rationale and design of a large-scale, randomized, multicenter study. Am Heart J 2012. [PMID: 23194480 DOI: 10.1016/j.ahj.2012.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Current recommendations for antithrombotic therapy after drug-eluting stent (DES) implantation include prolonged dual antiplatelet therapy (DAPT) with aspirin and clopidogrel ≥12 months. However, the impact of such a regimen for all patients receiving any DES system remains unclear based on scientific evidence available to date. Also, several other shortcomings have been identified with prolonged DAPT, including bleeding complications, compliance, and cost. The second-generation Endeavor zotarolimus-eluting stent (E-ZES) has demonstrated efficacy and safety, despite short duration DAPT (3 months) in the majority of studies. Still, the safety and clinical impact of short-term DAPT with E-ZES in the real world is yet to be determined. METHODS The OPTIMIZE trial is a large, prospective, multicenter, randomized (1:1) non-inferiority clinical evaluation of short-term (3 months) vs long-term (12-months) DAPT in patients undergoing E-ZES implantation in daily clinical practice. Overall, 3,120 patients were enrolled at 33 clinical sites in Brazil. The primary composite endpoint is death (any cause), myocardial infarction, cerebral vascular accident, and major bleeding at 12-month clinical follow-up post-index procedure. CONCLUSIONS The OPTIMIZE clinical trial will determine the clinical implications of DAPT duration with the second generation E-ZES in real-world patients undergoing percutaneous coronary intervention.
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Affiliation(s)
- Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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Abstract
Stenting in acute myocardial infarction (AMI) has the benefits of achieving acute optimal angiographic results and correcting residual dissection to decrease the incidence of restenosis and reocclusion. Studies have shown that percutaneous transluminal coronary angioplasty for primary treatment after AMI is superior to thrombolytic therapy regarding the restoration of normal coronary blood flow. Coronary stenting improves initial success rates, decreases the incidence of abrupt closure, and is associated with a reduced rate of restenosis. In the presence of thrombus-containing lesions, coronary stenting constitutes an effective therapeutic strategy, either after failure of initial angioplasty or electively as the primary procedure.
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Affiliation(s)
- Ahmed Magdy
- Cardiology Department, National Heart Institute, 44 Alsharifa Dina, Maadi, Cairo 11431, Egypt.
| | - Hisham Selim
- Cardiology Department, National Heart Institute, 44 Alsharifa Dina, Maadi, Cairo 11431, Egypt
| | - Mona Youssef
- Cardiology Department, National Heart Institute, 44 Alsharifa Dina, Maadi, Cairo 11431, Egypt
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46
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Wise SG, Waterhouse A, Michael P, Ng MKC. Extracellular matrix molecules facilitating vascular biointegration. J Funct Biomater 2012; 3:569-87. [PMID: 24955633 PMCID: PMC4031001 DOI: 10.3390/jfb3030569] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/01/2012] [Accepted: 08/06/2012] [Indexed: 12/16/2022] Open
Abstract
All vascular implants, including stents, heart valves and graft materials exhibit suboptimal biocompatibility that significantly reduces their clinical efficacy. A range of biomolecules in the subendothelial space have been shown to play critical roles in local regulation of thrombosis, endothelial growth and smooth muscle cell proliferation, making these attractive candidates for modulation of vascular device biointegration. However, classically used biomaterial coatings, such as fibronectin and laminin, modulate only one of these components; enhancing endothelial cell attachment, but also activating platelets and triggering thrombosis. This review examines a subset of extracellular matrix molecules that have demonstrated multi-faceted vascular compatibility and accordingly are promising candidates to improve the biointegration of vascular biomaterials.
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Affiliation(s)
- Steven G Wise
- The Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia.
| | - Anna Waterhouse
- Wyss Institute for Biologically Inspired Engineering at Harvard, Boston, MA 02115, USA.
| | - Praveesuda Michael
- The Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia.
| | - Martin K C Ng
- The Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia.
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47
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Haemocompatibility improvement of metallic surfaces by covalent immobilization of heparin–liposomes. Int J Pharm 2012; 432:91-8. [DOI: 10.1016/j.ijpharm.2012.04.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/19/2012] [Accepted: 04/21/2012] [Indexed: 01/24/2023]
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48
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Gray WA, Yeung AC, Cutlip DE, Popma JJ, Fitzgerald PJ, Williams DO, Heuer H, O'Shaughnessy CD, Overlie PA, Mann JT, Cannon LA, Hermiller JB, Henry TD, Whitbourn R, Stuckey TD, Midei MG, Coe J, Schwartz LB. A randomized, controlled, multi-center trial comparing the safety and efficacy of zotarolimus-eluting and paclitaxel-eluting stents in de novo lesions in coronary arteries: Final results of the ZoMaxx II trial. Int J Cardiol 2012; 157:96-101. [DOI: 10.1016/j.ijcard.2011.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 04/07/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
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49
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Yoneda S, Abe S, Taguchi I, Masawa N, Inoue K, Inoue T. Inflammation and impaired wound healing after zotarolimus-eluting stent implantation. Cardiovasc Pathol 2012; 21:511-4. [PMID: 22356902 DOI: 10.1016/j.carpath.2012.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 11/28/2011] [Accepted: 01/27/2012] [Indexed: 11/17/2022] Open
Abstract
An 86-year-old man died suddenly 5 months after implantation of a zotarolimus-eluting stent. Two zotarolimus-eluting stents were placed to treat a highly calcified diffuse lesion in the proximal-to-mid right coronary artery. The lesion was fully covered by the two stents, and intravascular ultrasound showed complete stent apposition. However, an X-ray at autopsy showed that the proximal stent was fractured. Although we thought that thrombotic occlusion at the fracture site might have caused his sudden death, no thrombus was present. In addition, in the other sites where the stents were optimally dilated, there was stent malapposition and peri-strut inflammation including macrophage infiltration, giant cells, polymer phagocytosis, and neovascularization in the neointima. Even with a second-generation drug-eluting stent, such as the zotarolimus-eluting stent, wound healing may be impaired at the stent-injured vessel site.
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Affiliation(s)
- Shuichi Yoneda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
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50
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Park HJ, Kim HY, Lee JM, Choi YS, Park CS, Kim DB, Her SH, Koh YS, Park MW, Kwon BJ, Kim PJ, Chang K, Chung WS, Seung KB. Randomized Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stents vs. Sirolimus-Eluting Stents for Percutaneous Coronary Intervention in Chronic Total Occlusion. Circ J 2012; 76:868-75. [DOI: 10.1253/circj.cj-11-1021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hun-Jun Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Hee-Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yoon Seok Choi
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Sung Ho Her
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yoon Seok Koh
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Mahn Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Beom-June Kwon
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Pum Joon Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Wook Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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