Shape Memory Polymer-Based Endovascular Devices: Design Criteria and Future Perspective

CFD investigations of a shape-memory polymer foam-based endovascular embolization device for the treatment of intracranial aneurysms

The hemodynamic and convective heat transfer effects of a patient-specific endovascular therapeutic agent based on shape-memory polymer foam (SMPf) are evaluated using computational fluid dynamics studies for six patient-specific aneurysm geometries. The SMPf device is modeled as a continuous porous medium with full expansion for the flow studies and with various degrees of expansion for the heat transfer studies. The flow simulation parameters were qualitatively validated based on the existing literature. Further, a mesh independence study was conducted to verify an optimal cell size and reduce the computational costs. For convective heat transfer, a worst-case scenario is evaluated where the minimum volumetric flow rate is applied alongside the zero-flux boundary conditions. In the flow simulations, we found a reduction of the average intra-aneurysmal flow of > 85% and a reduction of the maximum intra-aneurysmal flow of > 45% for all presented geometries. These findings were compared with the literature on numerical simulations of hemodynamic and heat transfer of SMPf devices. The results obtained from this study provide a novel and practical framework for optimizing the design of patient-specific SMPf devices, integrating advanced computational models of hemodynamics and heat transfer. This framework could guide the future development of personalized endovascular embolization solutions for intracranial aneurysms with improved therapeutic outcome.

Design of thermally programmable 3D shape memory polymer-based devices tailored for endovascular treatment of intracranial aneurysms

Despite recent technological advancements in endovascular embolization devices for treating intracranial aneurysms (ICAs), incomplete occlusion and aneurysm recanalization remain critical challenges. Shape memory polymer (SMP)-based devices, which can be manufactured and tailored to patient-specific aneurysm geometries, possess the potential to overcome the suboptimal treatment outcome of the gold standard: endovascular coiling. In this work, we propose a highly porous patient-specific SMP embolic device fabricated via 3D printing to optimize aneurysm occlusion, and thus, improve the long-term efficacy of endovascular treatment. To facilitate device deployment at the aneurysm via Joule-heating, we introduce a stable, homogeneous coating of poly-pyrrole (PPy) to enhance the electrical conductivity in the SMP material. Using an in-house pulse width modulation circuit, we induced Joule-heating and characterized the shape recovery of the PPy-coated SMP embolic devices. We found that the employed PPy coating enables enhanced electrical and thermal conductivity while only slightly altering the glass transition temperature of the SMP material. Additionally, from a series of parametric studies, we identified the combination of catalyst concentration and pyrrole polymerization time that yielded the shape recovery properties ideal for ICA endovascular therapy. Collectively, these findings highlight a promising material coating for a future coil-free, personalized shape memory polymer (SMP) embolic device, designed to achieve long-lasting, complete occlusion of aneurysms.

CFD investigations of a shape-memory polymer foam-based endovascular embolization device for the treatment of intracranial aneurysms

The hemodynamic and convective heat transfer effects of a patient-specific endovascular therapeutic agent based on shape memory polymer foam (SMPf) are evaluated using computational fluid dynamics studies for six patient-specific aneurysm geometries. The SMPf device is modeled as a continuous porous medium with full expansion for the flow studies and with various degrees of expansion for the heat transfer studies. The flow simulation parameters were qualitatively validated based on the existing literature. Further, a mesh independence study was conducted to verify an optimal cell size and reduce the computational costs. For convective heat transfer, a worst-case scenario is evaluated where the minimum volumetric flow rate is applied alongside the zero-flux boundary conditions. In the flow simulations, we found a reduction of the average intra-aneurysmal flow of > 85% and a reduction of the maximum intra-aneurysmal flow of > 45% for all presented geometries. These findings were compared with the literature on numerical simulations of hemodynamic and heat transfer of SMPf devices. The results obtained from this study can serve as a guide for optimizing the design and development of patient-specific SMPf devices aimed at personalized endovascular embolization of intracranial aneurysms.

Single Component Polymers, Polymer Blends, and Polymer Composites for Interventional Endovascular Embolization of Intracranial Aneurysms

Intracranial aneurysm is the abnormal focal dilation in brain arteries. When untreated, it can enlarge to rupture points and account for subarachnoid hemorrhage cases. Intracranial aneurysms can be treated by blocking the flow of blood to the aneurysm sac with clipping of the aneurysm neck or endovascular embolization with embolics to promote the formation of the thrombus. Coils or an embolic device are inserted endovascularly into the aneurysm via a micro-catheter to fill the aneurysm. Many embolization materials have been developed. An embolization coil made of soft and thin platinum wire called the "Guglielmi detachable coil" (GDC) enables safer treatment for brain aneurysms. However, patients may experience aneurysm recurrence because of incomplete coil filling or compaction over time. Unsatisfactory recanalization rates and incomplete occlusion are the drawbacks of endovascular embolization. So, the fabrication of new medical devices with less invasive surgical techniques is mandatory to enhance the long-term therapeutic performance of existing endovascular procedures. For this aim, the current article reviews polymeric materials including blends and composites employed for embolization of intracranial aneurysms. Polymeric materials used in embolic agents, their advantages and challenges, results of the strategies used to overcome treatment, and results of clinical experiences are summarized and discussed.

Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms

Background

Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs.

Methods

A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.

Results

A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices.

Conclusions

We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the gold standard for endovascular treatment of unruptured saccular aneurysms.

Polymer Composites in 3D/4D Printing: Materials, Advances, and Prospects

Additive manufacturing (AM), commonly referred to as 3D printing, has revolutionized the manufacturing landscape by enabling the intricate layer-by-layer construction of three-dimensional objects. In contrast to traditional methods relying on molds and tools, AM provides the flexibility to fabricate diverse components directly from digital models without the need for physical alterations to machinery. Four-dimensional printing is a revolutionary extension of 3D printing that introduces the dimension of time, enabling dynamic transformations in printed structures over predetermined periods. This comprehensive review focuses on polymeric materials in 3D printing, exploring their versatile processing capabilities, environmental adaptability, and applications across thermoplastics, thermosetting materials, elastomers, polymer composites, shape memory polymers (SMPs), including liquid crystal elastomer (LCE), and self-healing polymers for 4D printing. This review also examines recent advancements in microvascular and encapsulation self-healing mechanisms, explores the potential of supramolecular polymers, and highlights the latest progress in hybrid printing using polymer-metal and polymer-ceramic composites. Finally, this paper offers insights into potential challenges faced in the additive manufacturing of polymer composites and suggests avenues for future research in this dynamic and rapidly evolving field.

Towards the development of a shape memory polymer for individualized endovascular therapy of intracranial aneurysms using a 3D-printing/leaching method

Endovascular treatment of intracranial aneurysms (ICA) aims to occlude the aneurysm space for preventing ICA growth/rupture. Modern endovascular techniques are still limited by lower complete occlusion rates, frequently leading to aneurysm growth, rupture and re-operation. In this work, we propose shape memory polymer (SMP)-based embolic devices that could advance the effectiveness of ICA therapy by facilitated individualized ICA occlusion. Specifically, we develop an 3D-printing/leaching method for the fabrication of 3D-SMP devices that can be tailored to patient-specific aneurysm geometries that are obtained from computed tomography angiography. We demonstrate that this method allows the fabrication of highly porous, compressible foams with unique shape memory properties and customizable microstructure. In addition, the SMP foams exhibit great shape recovery, anisotropic mechanical properties, and the capability to occlude in-vitro models with individualized geometries. Collectively, this study indicates that the proposed method will have the potential to advance the translation of coil- and stent-free embolic devices for individualized treatment of saccular ICAs, targeting complete and long-term durable aneurysm occlusion.

From Static to Dynamic: Smart Materials Pioneering Additive Manufacturing in Regenerative Medicine

The emerging field of regenerative medicine holds immense promise for addressing complex tissue and organ regeneration challenges. Central to its advancement is the evolution of additive manufacturing techniques, which have transcended static constructs to embrace dynamic, biomimetic solutions. This manuscript explores the pivotal role of smart materials in this transformative journey, where materials are endowed with dynamic responsiveness to biological cues and environmental changes. By delving into the innovative integration of smart materials, such as shape memory polymers and stimulus-responsive hydrogels, into additive manufacturing processes, this research illuminates the potential to engineer tissue constructs with unparalleled biomimicry. From dynamically adapting scaffolds that mimic the mechanical behavior of native tissues to drug delivery systems that respond to physiological cues, the convergence of smart materials and additive manufacturing heralds a new era in regenerative medicine. This manuscript presents an insightful overview of recent advancements, challenges, and future prospects, underscoring the pivotal role of smart materials as pioneers in shaping the dynamic landscape of regenerative medicine and heralding a future where tissue engineering is propelled beyond static constructs towards biomimetic, responsive, and regenerative solutions.

Application of 4D printing and bioprinting in cardiovascular tissue engineering

Cardiovascular diseases have remained the leading cause of death worldwide for the past 20 years. The current clinical therapeutic measures, including bypass surgery, stent implantation and pharmacotherapy, are not enough to repair the massive loss of cardiomyocytes after myocardial ischemia. Timely replenishment with functional myocardial tissue via biomedical engineering is the most direct and effective means to improve the prognosis and survival rate of patients. It is widely recognized that 4D printing technology introduces an additional dimension of time in comparison with traditional 3D printing. Additionally, in the context of 4D bioprinting, both the printed material and the resulting product are designed to be biocompatible, which will be the mainstream of bioprinting in the future. Thus, this review focuses on the application of 4D bioprinting in cardiovascular diseases, discusses the bottleneck of the development of 4D bioprinting, and finally looks forward to the future direction and prospect of this revolutionary technology.

Shape Memory Behaviour of PMMA-Coated NiTi Alloy under Thermal Cycle

Both poly(methyl methacrylate) (PMMA) and NiTi possess shape memory and biocompatibility behavior. The macroscale properties of PMMA–NiTi composites depend immensely on the quality of the interaction between two components. NiTi shape memory alloy (SMA) and superelastic (SE) sheets were spin coated on one side with PMMA. The composite was prepared by the spin coating method with an alloy-to-polymer-thickness ratio of 1:3. The bending stiffness and radius of curvature were calculated by using numerical and experimental methods during thermal cycles. The experimental radius curvatures in actuation have good agreement with the model. The change in shape results from the difference in coefficients of thermal expansion between PMMA and NiTi. Actuation temperatures were between 0 and 100 °C for the SMA–PMMA composite with a change in curvature from 10 to 120 mm with fixed Young’s modulus of PMMA at 3 GPa, and a change in Young’s modulus of NiTi from 30 to 70 GPa. PMMA–NiTi composites are useful as actuators and sensor elements.