Vascular stent with immobilized anti-inflammatory chemerin 15 peptides mitigates neointimal hyperplasia and accelerates vascular healing

Endovascular stenting is a safer alternative to open surgery for use in treating cerebral arterial stenosis and significantly reduces the recurrence of ischemic stroke, but the widely used bare-metal stents (BMSs) often result in in-stent restenosis (ISR). Although evidence suggests that drug-eluting stents are superior to BMSs in the short term, their long-term performances remain unknown. Herein, we propose a potential vascular stent modified by immobilizing clickable chemerin 15 (C15) peptides on the stent surface to suppress coagulation and restenosis. Various characterization techniques and an animal model were used to evaluate the surface properties of the modified stents and their effects on endothelial injury, platelet adhesion, and inflammation. The C15-immobilized stent could prevent restenosis by minimizing endothelial injury, promoting physiological healing, restraining the platelet-leukocyte-related inflammatory response, and inhibiting vascular smooth muscle cell proliferation and migration. Furthermore, in vivo studies demonstrated that the C15-immobilized stent mitigated inflammation, suppressed neointimal hyperplasia, and accelerated endothelial restoration. The use of surface-modified, anti-inflammatory, endothelium-friendly stents may be of benefit to patients with arterial stenosis. STATEMENT OF SIGNIFICANCE: Endovascular stenting is increasingly used for cerebral arterial stenosis treatment, aiming to prevent and treat ischemic stroke. But an important accompanying complication is in-stent restenosis (ISR). Persistent inflammation has been established as a hallmark of ISR and anti-inflammation strategies in stent modification proved effective. Chemerin 15, an inflammatory resolution mediator with 15-aa peptide, was active at picomolar through cell surface receptor, no need to permeate cell membrane and involved in resolution of inflammation by inhibiting inflammatory cells adhesion, modulating macrophage polarization into protective phenotype, and reducing inflammatory factors release. The implications of this study are that C15 immobilized stent favors inflammation resolution and rapid re-endothelialization, and exhibits an inhibitory role of restenosis. As such, it helps the decreased incidence of ISR.

Multifunctional nanocoatings with synergistic controlled release of zinc ions and cytokines for precise modulation of vascular intimal reconstruction

Vascular stent implantation remains the major therapeutic method for cardiovascular diseases currently. We here introduced crucial biological functional biological function factors (SDF-1α, VEGF) and vital metal ions (Zn2+) into the stent surface to explore their synergistic effect in the microenvironment. The combination of the different factors is known to effectively regulate cellular inflammatory response and selectively regulate cell biological behavior. Meanwhile, in the implemented method, VEGF and Zn2+ were loaded into heparin and poly-l-lysine (Hep-PLL) nanoparticles, ensuring a controlled release of functional molecules with a multi-factor synergistic effect and excellent biological functions in vitro and in vivo. Notably, after 150 days of implantation of the modified stent in rabbits, a thin and smooth new intima was obtained. This study offers a new idea for constructing a modified surface microenvironment and promoting tissue repair.

Fucoidan/collagen composite coating on magnesium alloy for better corrosion resistance and pro-endothelialization potential

Magnesium alloy stents (MAS) have broad application prospects in the treatment of cardiovascular diseases. However, poor corrosion resistance and biocompatibility greatly limit the clinical application of MAS. In this work, the coating consisting of MgF2 layer, polydopamine layer, fucoidan and collagen IV was constructed on Mg-Zn-Y-Nd (ZE21B) alloy to improve its corrosion resistance and pro-endothelialization potential. The fucoidan and collagen IV in the coating could obviously enhance the hemocompatibility and pro-endothelialization potential respectively. Compared with bare ZE21B alloy, the fucoidan/collagen composite coating modified ZE21B alloy possessed lower corrosion current density and better corrosion resistance. Moreover, the modified ZE21B alloy exhibited relatively low hemolysis rate, fibrinogen adsorption and platelet adhesion in the blood experiments, suggesting the improved hemocompatibility. Furthermore, the modified ZE21B alloy favorably supported the adhesion and proliferation of vascular endothelial cells (ECs) and effectively regulated the phenotype of smooth muscle cells (SMCs), thus improving the pro-endothelialization potential of vascular stent materials. The fucoidan/collagen composite coating can significantly improve the corrosion resistance and pro-endothelialization potential of ZE21B alloy, showing great potential in the development of degradable MAS.

Palliative interatrial septum stenting with a vascular stent in a chronic thromboembolic pulmonary hypertension patient: Is it beneficial?

BACKGROUND

Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease that can progress and lead to a deadly outcome. Despite optimal drug therapy, pulmonary hypertension (PH) remains fatal. Untreatable right heart failure (RHF) from CTEPH is eventually a significant cause of death. However, unloading the right heart and increasing systemic output are the treatment goals in these patients.

CASE PRESENTATION

A 42-year-old female presented to the emergency department with worsening dyspnea experienced for three days before admission. There were also complaints of leg edema, ascites, orthopnea, and palpitation. Physical examination revealed an attenuated second heart sound, abdominal ascites, and bilateral leg edema. She had a history of frequent readmissions due to RHF despite optimal medical therapy and was diagnosed with CTEPH 5 months ago. It was decided that the patient would undergo interatrial septal (IAS) stenting with a vascular stent of 8 mm × 39 mm × 135 cm. The results were good; her symptoms and signs of RHF improved, and she was eventually discharged from the hospital. Four months after the procedure, the patient was able to engage in physical activities without any limitations.

CONCLUSIONS

A palliative IAS stent is one of the choices for intractable RHF management in patients with CTEPH. The vascular stent can be used as an alternative in order to make the interatrial connection more stable and last longer.

[Three-dimensional printed 316L stainless steel cardiovascular stent's electrolytic polishing and its mechanical properties]

The interventional therapy of vascular stent implantation is a popular treatment method for cardiovascular stenosis and blockage. However, traditional stent manufacturing methods such as laser cutting are complex and cannot easily manufacture complex structures such as bifurcated stents, while three-dimensional (3D) printing technology provides a new method for manufacturing stents with complex structure and personalized designs. In this paper, a cardiovascular stent was designed, and printed using selective laser melting technology and 316L stainless steel powder of 0-10 µm size. Electrolytic polishing was performed to improve the surface quality of the printed vascular stent, and the expansion behavior of the polished stent was assessed by balloon inflation. The results showed that the newly designed cardiovascular stent could be manufactured by 3D printing technology. Electrolytic polishing removed the attached powder and reduced the surface roughness Ra from 1.36 µm to 0.82 µm. The axial shortening rate of the polished bracket was 4.23% when the outside diameter was expanded from 2.42 mm to 3.63 mm under the pressure of the balloon, and the radial rebound rate was 2.48% after unloading. The radial force of polished stent was 8.32 N. The 3D printed vascular stent can remove the surface powder through electrolytic polishing to improve the surface quality, and show good dilatation performance and radial support performance, which provides a reference for the practical application of 3D printed vascular stent.

Multi-functional plant flavonoids regulate pathological microenvironments for vascular stent surface engineering

In-stent restenosis (ISR) and late thrombosis, usually caused by excessive smooth muscle cell (SMC) proliferation and delayed endothelial layer repair, respectively, are the main risks for the failure of vascular stent implantation. For years, modification of stents with biomolecules that could selectively inhibit SMC proliferation and support endothelial cell (EC) growth had drawn extensive attention. However, the modulatory effect of these biomolecules faces the impact of oxidative stress, inflammation, and hyperlipidemia of the pathological vascular microenvironment, which is caused by the stent implantation injury and atherosclerosis lesions. Here, we modified stents with a natural and multi-functional flavonoid, baicalin (BCL), using poly-dopamine (PDA) coating technology to combat the harmful impact of the pathological microenvironment. Stent with an appropriate BCL immobilization density (approximately 2.03 μg/cm2) successfully supported ECs growth while inhibited SMC proliferation. Furthermore, baicalin-modified surfaces regulated the oxidative stress, inflammation, and high-lipid of the pathological microenvironment to inhibit endothelial dysfunction and the oxidized low-density lipoprotein (ox-LDL)-induced macrophage foam cells formation. In vivo results showed that baicalin-modified stents exhibited significant anti-ISR, anti-inflammatory, and endothelialization-promoting functions. Our study suggests that the multi-functional baicalin with pathological microenvironment-regulation (PMR) effect has potential use in the surface engineering of cardiovascular devices. STATEMENT OF SIGNIFICANCE: Empowering vascular stents with selective modulation of smooth muscle cells and endothelial cells by surface technology has become an important research direction for stent surface engineering. However, stent coatings that can furthermodulate the pathological microenvironment of blood vessels have been rarely reported. In this study, we constructed a multifunctional coating based on a flavonoid, baicalin, which can selectively modulate vascular wall cells and improve the pathological microenvironment. This study may provide a reference for developing advanced vascular stents.

A thermosensitive material coated resonant stent for drug delivery on demand

An electromagnetic energy source in the radio-frequency range delivers power to a stent circuit via resonant inductive coupling, allowing a thermally triggered release of gel via Joule heating. A gold-electroplated, medical-grade stainless steel stent, serving as the base of the prototype device, melts a coating made from an emulsion composed mainly of dodecanoic acid. These coated devices produce wirelessly controllable releases of a gel into thermally regulated, stirred water that is near body temperature. The gel is made from salt, water, and gelatine from porcine skin and used to simulate drug release in this study. Thus, this system serves as a proof of concept to show the viability of controlling local drug delivery using this prototype device. Dodecanoic acid, a fatty acid, has a phase transition from solid to liquid near 43[Formula: see text]C and has relatively good biocompatibility. The average melting temperature of two different emulsions was 40.8±0.7[Formula: see text]C, a suitable value for the targeted application. Demonstration of controllable releases used electromagnetic pulses of approximately 180 seconds in duration, illustrating reproducibility of a controllable release phase while remaining relatively inert in the absence of stimuli. Releases were observable through measuring the conductivity of the water, the water temperature, and the stent temperature. This electrothermally active stent device enables wirelessly controlled local delivery with controlled dosage and timing, a concept with a wide range of potential applications. Some relevant examples include inhibiting restenosis or cancer treatment via targeted chemotherapy.

Structural and mechanical aspects of hypoeutectic Zn-Mg binary alloys for biodegradable vascular stent applications

The study is concerned with the mechanical properties of Zn and three Zn–Mg double alloys with Mg concentrations: 0.5%, 1.0% and 1.5% in the form of rods with a diameter of 5 mm as potential materials for use in biodegradable medical implants, such as vascular stents. The materials were cast, next conventionally hot extruded at 250 °C and finally, hydrostatically extruded (HE) at ambient temperature. Occasionally HE process was carried at liquid nitrogen temperature or in combination with the ECAP process. After HE, the microstructure of the alloys was made up of fine-grained αZn of mean grain size ~1 μm in a 2-phase coat of 50–200 nm nano-grains of the fine αZn + Mg₂Zn₁₁ eutectic. The 3 to 4-fold reduction of grain size as a result of HE allowed an increase in yield strength from 100% to over 200%, elongation to fracture from 100% to thirty fold and hardness over 50% compared to the best literature results for similar alloys. Exceptions accounted for elongation to fracture in case of Zn-0.5 Mg alloy and hardness in case of Zn-1.5 Mg alloy, both of which fell by 20%. For the Zn-0.5 Mg and Zn–1Mg alloys, after immersion tests, no corrosive degradation of plasticity was observed. Achieving these properties was the result of generating large plastic deformations at ambient temperature due to the application of high pressure forming with the cumulative HE method. The results showed that Zn–Mg binary alloys after HE have mechanical and corrosive characteristics, qualifying them for applications in biodegradable implants, including vascular stents.

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Forming under high pressure allows to generate severe deformation in Zn–Mg alloys.

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HE reduces grain size of Zn alloys by 3–4 times in comparison to hot extrusion.

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HE increases YS by 200%, ε_f by 300% and HV by 50% in comparison to literature data.

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In Zn with 0.5 and 1% Mg no ductility reduction after the corrosion test was observed.

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Mechanical and corrosion properties qualify Zn alloys after HE for vascular stents.

Endothelialization of cardiovascular devices

Blood-contacting surfaces of cardiovascular devices are not biocompatible for creating an endothelial layer on them. Numerous research studies have mainly sought to modify these surfaces through physical, chemical and biological means to ease early endothelial cell (EC) adhesion, migration and proliferation, and eventually to build an endothelial layer on the surfaces. The first priority for surface modification is inhibition of protein adsorption that leads to inhibition of platelet adhesion to the device surfaces, which may favor EC adhesion. Surface modification through surface texturing, if applicable, can bring some hopeful outcomes in this regard. Surface modifications through chemical and/or biological means may play a significant role in easy endothelialization of cardiovascular devices and inhibit smooth muscle cell proliferation. Cellular engineering of cells relevant to endothelialization can boost the positive outcomes obtained through surface engineering. This review briefly summarizes recent developments and research in early endothelialization of cardiovascular devices. STATEMENT OF SIGNIFICANCE: Endothelialization of cardiovascular implants, including heart valves, vascular stents and vascular grafts is crucial to solve many problems in our health care system. Numerous research efforts have been made to improve endothelialization on the surfaces of cardiovascular implants, mainly through surface modifications in three ways - physically, chemically and biologically. This review is intended to highlight comprehensive research studies to date on surface modifications aiming for early endothelialization on the blood-contacting surfaces of cardiovascular implants. It also discusses future perspectives to help guide endothelialization strategies and inspire further innovations.

Fatigue behavior of stent in tapered arteries: The role of arterial tapering and stent material

Stenting has achieved great success in treating cardiovascular diseases due to its high efficiency and minimal invasiveness. However, fatigue of stents severely limits its long-term outcome. In this article, finite element method was adopted to study the effects of arterial tapering and stent material on the fatigue performance of stents. A series of tapered vessels with different taper levels and two sets of stents with different materials were modeled. The Goodman diagram was used to evaluate the fatigue resistance of stents. Results showed that the fatigue resistance of stents can be extremely improved by simply changing stent material. In addition, the taper of the arteries had an important influence on the fatigue resistance of the stent. The fatigue life of the stent will be shortened with the increase of the arterial taper. The method that predicted stent fatigue life in tapered vessels can help clinicians select stents that are more suitable for tapered vessels and help stent engineers design stents that are more resistant to fatigue.

Analysis of trends and prospects regarding stents for human blood vessels

Background

The purpose of this paper is to provide technology trends and information regarding market and prospects in stents used for human blood vessels in Korea and the world.

A stent is a medical device in the form of a cylindrical metal net used to normalize flow when blood or other bodily fluids such as biliary fluids are obstructed in blood vessels, gastrointestinal tracts, etc. by inserting the stent into a narrowed or clogged area. Stents are classified into vascular and non-vascular stents. The coronary artery stent is avascular stent that is used for coronary atherosclerosis.

The demand is increasing for stents to treat diseases such as those affecting the heart and blood vessels of elderly and middle-aged patients. Due to the current shift in the demographic structure caused by an aging society, the prospect for stents seems to be very bright.

The use of a stent designed to prevent acute vascular occlusion and restenosis, which is a side effect of conventional balloon angioplasty, has rapidly become popular because it can prevent acute complications and improve clinical outcomes. Since the initial release of this stent, there have been significant developments in its design, the most notable of which has been the introduction of drug-eluting stents (DES). Bioresorbable scaffolds (BRS) have the potential to introduce a paradigm shift in interventional cardiology, a true anatomical and functional “vascular restoration” instead of an artificial stiff tube encased by a persistent metallic foreign body.

Methods

Data for this research were gathered from primary and secondary sources as well as the databases of the Korea Institute of Science Technology Information (KISTI) located in Seoul, Korea like KISTI Market Report. The sources used for primary research included the databases available from the Korea Institute of Science Technology Information, past industry research services/studies, economic and demographic data, and trade and industry journals. Secondary research was used to supplement and complement the primary research. Interviews were conducted with physicians and surgeons from the key hospitals and senior sale/marketing managers from stent product suppliers in South Korea.

Results

The global stent market is estimated at US $ 7.98 billion in 2016 and is expected to grow at a Compound Annual Growth Rate (CAGR) of 3.8% over the next 5 years. As of 2016, the global market for vascular stents is estimated at $ 7.22 billion, with coronary artery stents accounting for 67.3% of the vascular stent market. Among the coronary artery stents, BRS is notably expected to grow at an annual average rate of 8.8% by 2020, but the global adoption rate of BRS remains low at present. In the Korean market, stents for blood vessels account for most of the market, and the market size of stents for blood vessels in Korea was estimated to be 145 billion won as of 2016.

Conclusions

In comparison to the sales growth rate of other medical devices, the future stent technology market is judged to be higher in growth potential.

[Proposed model of vascular trauma by mean of mechanical characterization of endovascular prostheses (stents) based on structural analysis by FEA]

OBJECTIVE

The accumulated evidence on angioplasty techniques with stents has raised a controversy about the factors that influence the final vascular response. Indeed, several studies have shown there might be re-stenosis between 30% to 40% about 6 months after placement, relating to the design of the device as one of the main causes. This paper proposes the functional characterization of endovascular stents, analyzing its mechanical influence in the vascular system and predicting implicit traumatic factors in the vessel.

METHODS

A structural analysis was made for several computational models of endovascular stents using Finite Element Analysis in order to predict the mechanical behavior and the vascular trauma. In this way, the stents were considered as tubular devices composed of multiple links under radial pressure loads, reflecting stress concentration effects.

RESULTS

The analysis allowed to visualize how the geometry of stents is adjusted under several load conditions, in order to obtain the response of "solid-solid" interaction between the stent and the arterial wall. Thus, an analysis was performed in order to calculate stress, and a conceptual model that explains its mechanical impact on the stent-vessel interaction, was raised, to infer on the functionality from the design of the devices.

CONCLUSIONS

The proposed conceptual model allows to determine the relationship between the conditions of mechanical interaction of the stents, and warns about the effects in what would be the operation of the device on the vascular environment.

Optimal conjugation of catechol group onto hyaluronic acid in coronary stent substrate coating for the prevention of restenosis

Although endovascular stenting has been used as an interventional therapy to treat cardio- and cerebro-vascular diseases, it is associated with recurrent vascular diseases following stent thrombosis and in-stent restenosis. In this study, a metallic stent was coated with dopamine-conjugated hyaluronic acid with different ratios of catechol group to improve hemocompatibility and re-endothelialization. Especially, we were interested in how much amount of catechol group is appropriate for the above-mentioned purposes. Therefore, a series of dopamine-conjugated hyaluronic acid conjugates with different ratios of catechol group were synthesized via a carbodiimide coupling reaction. Dopamine-conjugated hyaluronic acid conjugates were characterized with 1H-nuclear magnetic resonance and Fourier transform infrared spectroscopy, and the amount of catechol group in dopamine-conjugated hyaluronic acid was measured by ultraviolet spectrometer. Co-Cr substrates were polished and coated with various dopamine-conjugated hyaluronic acid conjugates under pH 8.5. Dopamine-conjugated hyaluronic acid amounts on the substrate were quantified by micro-bicinchoninic acid assay. Surface characteristics of dopamine-conjugated hyaluronic-acid-coated Co-Cr were evaluated by water contact angle, scanning electron microscopy, and atomic force microscopy. The hemocompatibility of the surface-modified substrates was assessed by protein adsorption and platelet adhesion tests. Adhesion and activation of platelets were confirmed with scanning electron microscopy and lactate dehydrogenase assay. Human umbilical vein endothelial cells were cultured on the substrates, and the viability, adhesion, and proliferation were investigated through cell counting kit-8 assay and fluorescent images. Obtained results demonstrated that optimal amounts of catechol group (100 µmol) in the dopamine-conjugated hyaluronic acid existed in terms of various properties such as hemocompatibility and cellular responses.

Effects of polydopamine functionalized titanium dioxide nanotubes on endothelial cell and smooth muscle cell

Previous investigations have demonstrated that TiO2 nanotubes (NTs) with particular structure cues could control the behavior of different types of cells, including endothelial cells (ECs) and smooth muscle cells (SMCs). Besides, polydopamine (PDA) modified surfaces were reported to be beneficial to increase the proliferation and viability of ECs and meanwhile could inhibit the proliferation of SMCs. The TiO2 nanotubes (NTs) were functionalized with polydopamine (PDA) (PDA/NTs) to study the synergetic effect of both nanotopography (NTs) and chemical cues (PDA) of TiO2 nanotubes on the regulation of cellular behavior of ECs and SMCs. The PDA-modified TiO2 nanotubes were subjected to field-emission scanning electron microscopy (FE-SEM), X-ray photoelectron spectroscopy (XPS), and water contact angle (WCA) analysis. In vitro cell culture tests confirmed that, comparing with flat titanium (Ti) and TiO2 nanotubes, PDA/NTs surface synergistically promoted ECs attachment, proliferation, migration and release of nitric oxide (NO). Meanwhile, the PDA/NTs performed well in reducing SMCs adhesion and proliferation. This novel approach might provide a new platform to investigate the synergistic effect of local chemistry and topography, as well as the applications for the development of titanium-based implants for enhanced endothelialization.