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Mehta RI, Mehta RI. Hydrophilic Polymer Embolism: Implications for Manufacturing, Regulation, and Postmarket Surveillance of Coated Intravascular Medical Devices. J Patient Saf 2021; 17:e1069-e1079. [PMID: 29557931 PMCID: PMC6146079 DOI: 10.1097/pts.0000000000000473] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
ABSTRACT Hydrophilic polymers are ubiquitously applied as surface coatings on catheters and intravascular medical technologies. Recent clinical literature has heightened awareness on the complication of hydrophilic polymer embolism, the phenomenon wherein polymer coating layers separate from catheter and device surfaces, and may be affiliated with a range of unanticipated adverse reactions. Significant system barriers have limited and delayed reporting on this iatrogenic complication, the full effects of which remain underrecognized by healthcare providers and manufacturers of various branded devices. In 2015, the United States Food and Drug Administration acknowledged rising clinical concerns and stated that the agency would work with stakeholders to further evaluate gaps that exist in current national and international device standards for coated intravascular medical technologies. The present article reviews current knowledge on this complication as well as factors that played a role in delaying detection and dissemination of information and new knowledge once hazards and clinical risks were identified. Furthermore, organ-specific effects and adverse reaction patterns are summarized, along with implications for device manufacturing, safety assurance, and regulation. Qualitative and quantitative particulate testing are needed to optimize coated intravascular device technologies. Moreover, general enhanced processes for medical device surveillance are required for timely adverse event management and to ensure patient safety.
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Affiliation(s)
| | - Rupal I. Mehta
- University of Rochester Department of Pathology and Laboratory Medicine
- Department of Neuroscience
- Center for Neurotherapeutics Discovery (CND)
- Center for Translational Neuromedicine (CTN)
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Brescia F, Fabiani F, Borsatti E, Parisella L, Roveredo L, Pittiruti M. Preprocedural ultrasound vascular assessment is essential to decision-making. J Vasc Access 2020. [PMID: 32605409 DOI: 10.1177/1129729820938179.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reliable venous access should be part of the clinical-therapeutic path of all cancer patients. A correct preliminary ultrasound evaluation of the patient's veins and the choice of the suitable vein are the fundamental requirements to guarantee a stable and long-lasting venous access.
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Fabio Fabiani
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Laura Parisella
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Laura Roveredo
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Brescia F, Fabiani F, Borsatti E, Parisella L, Roveredo L, Pittiruti M. Preprocedural ultrasound vascular assessment is essential to decision-making. J Vasc Access 2020; 22:849-851. [PMID: 32605409 DOI: 10.1177/1129729820938179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reliable venous access should be part of the clinical-therapeutic path of all cancer patients. A correct preliminary ultrasound evaluation of the patient's veins and the choice of the suitable vein are the fundamental requirements to guarantee a stable and long-lasting venous access.
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Affiliation(s)
- Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Fabio Fabiani
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Eugenio Borsatti
- Nuclear Medicine Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Laura Parisella
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Laura Roveredo
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Jinnouchi H, Guo L, Sakamoto A, Sato Y, Cornelissen A, Kawakami R, Mori M, Torii S, Kuntz S, Harari E, Mori H, Fuller D, Gadhoke N, Fernandez R, Paek KH, Surve D, Romero M, Kolodgie FD, Virmani R, Finn AV. Advances in mammalian target of rapamycin kinase inhibitors: application to devices used in the treatment of coronary artery disease. Future Med Chem 2020; 12:1181-1195. [PMID: 32431177 PMCID: PMC7333590 DOI: 10.4155/fmc-2019-0304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
Mammalian target of rapamycin (mTOR) inhibitors have been applied to vascular coronary devices to avoid neointimal growth and have become the predominant pharmacological agents used to prevent restenosis. mTOR inhibitors can affect not only proliferating vascular smooth muscle cells but also endothelial cells and therefore can result in delayed healing of the vessel including endothelialization. Emerging evidence suggests accelerated atherosclerosis due to the downstream negative effects on endothelial barrier functional recovery. The development of neoatherosclerosis within the neointima of drug-eluting stents can result in late thrombotic events. This type of problematic healing response may open the way for specific mTOR kinase inhibitors, such as ATP-competitive mTOR inhibitors. These inhibitors demonstrate a better healing profile than traditional limus-based drug-eluting stent and their clinical efficacy remains unknown.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Liang Guo
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Atsushi Sakamoto
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Yu Sato
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Anne Cornelissen
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Rika Kawakami
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Masayuki Mori
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Sho Torii
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Salome Kuntz
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Emanuel Harari
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Hiroyoshi Mori
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Daniela Fuller
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Neel Gadhoke
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Raquel Fernandez
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Ka Hyun Paek
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Dipti Surve
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Maria Romero
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Frank D Kolodgie
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
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Wang L, Erişen DE, Yang K, Zhang B, Guan H, Chen S. Anticoagulation and antibacterial functional coating on vascular implant interventional medical catheter. J Biomed Mater Res B Appl Biomater 2020; 108:2868-2877. [PMID: 32420689 DOI: 10.1002/jbm.b.34618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2020] [Accepted: 04/13/2020] [Indexed: 01/12/2023]
Abstract
Vascular implant interventional medical catheter will contact with blood firstly after implantation. The anticoagulation and antibacterial functions of this device will determine the success or failure. Copper (Cu) has been verified to possess multi-biofunctions, but it was challenging to add the Cu metal to most materials. Take advantage of its functionality; Cu has been grafted on the material surface to improve the anticoagulation function and accelerate endothelialization. In this study, a Cu-bearing chitosan coating was prepared on the catheter to endow the anticoagulation and anti-infection functions. Besides, properties characterization and functional evaluation of the coated medical catheter were investigated. Dynamic blood clotting and platelet adhesion tests were carried out to evaluate the anticoagulation property. Besides this, the antibacterial test was used to estimate the anti-infection function. The surface energy and Cu ions release from the coating were detected and calculated by contact angles and immersion tests, respectively. The results of attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and X-ray photoelectron spectroscopy (XPS) revealed that Cu ions were grafted in the chitosan coating. Thermogravimetric analysis (TA) result showed the concentration of Cu ions in the coating. The results of dynamic blood clotting, platelet adhesion, and antibacterial tests revealed that Cu grafted in chitosan would improve the blood compatibility and anti-infection property. The surface properties and Cu ions release behavior of Cu-bearing coating revealed the reasons for multi-biofunctions. This study indicated that the Cu-bearing chitosan coating could endow the vascular implant interventional device anticoagulation and anti-infection functions, which has excellent potential for clinical application.
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Affiliation(s)
- Lirong Wang
- College of Chemistry, Liaoning University, Shenyang, China
| | - Deniz E Erişen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China.,University of Science and Technology of China, Hefei, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Bingchun Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Hongyu Guan
- College of Chemistry, Liaoning University, Shenyang, China
| | - Shanshan Chen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
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