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Koolen JJ. Is It That Difficult to Follow the Instructions? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:7-8. [PMID: 34172401 DOI: 10.1016/j.carrev.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jacques J Koolen
- Catharina Hospital: Catharina Ziekenhuis, Keizersgracht, 56 NH, Amsterdam, Netherlands.
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52
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Recent advances and directions in the development of bioresorbable metallic cardiovascular stents: Insights from recent human and in vivo studies. Acta Biomater 2021; 127:1-23. [PMID: 33823325 DOI: 10.1016/j.actbio.2021.03.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
Over the past two decades, significant advancements have been made regarding the material formulation, iterative design, and clinical translation of metallic bioresorbable stents. Currently, magnesium-based (Mg) stent devices have remained at the forefront of bioresorbable stent material development and use. Despite substantial advances, the process of developing novel absorbable stents and their clinical translation is time-consuming, expensive, and challenging. These challenges, coupled with the continuous refinement of alternative bioresorbable metallic bulk materials such as iron (Fe) and zinc (Zn), have intensified the search for an ideal absorbable metallic stent material. Here, we discuss the most recent pre-clinical and clinical evidence for the efficacy of bioresorbable metallic stents and material candidates. From this perspective, strategies to improve the clinical performance of bioresorbable metallic stents are considered and critically discussed, spanning material alloy development, surface manipulations, material processing techniques, and preclinical/biological testing considerations. STATEMENT OF SIGNIFICANCE: Recent efforts in using Mg, Fe, and Zn based materials for bioresorbable stents include elemental profile changes as well as surface modifications to improve each of the three classes of materials. Although a variety of alloys for absorbable metallic stents have been developed, the ideal absorbable stent material has not yet been discovered. This review focuses on the state of the art for bioresorbable metallic stent development. It covers the three bulk materials used for degradable stents (Mg, Fe, and Zn), and discusses their advances from a translational perspective. Strategies to improve the clinical performance of bioresorbable metallic stents are considered and critically discussed, spanning material alloy development, surface manipulations, material processing techniques, and preclinical/biological testing considerations.
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Hou Z, Xiang M, Chen N, Cai X, Zhang B, Luo R, Yang L, Ma X, Zhou L, He F, Yu H, Wang Y. The biological responses and mechanisms of endothelial cells to magnesium alloy. Regen Biomater 2021; 8:rbab017. [PMID: 34211729 PMCID: PMC8240605 DOI: 10.1093/rb/rbab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 12/03/2022] Open
Abstract
Due to its good biocompatibility and degradability, magnesium alloy (Mg alloy) has shown great promise in cardiovascular stent applications. Rapid stent re-endothelialization is derived from migrated and adhered endothelial cells (ECs), which is an effective way to reduce late thrombosis and inhibit hyperplasia. However, fundamental questions regarding Mg alloy affecting migration and adhesion of ECs are not fully understood. Here, we evaluated the effects of Mg alloy on the ECs proliferation, adhesion and migration. A global gene expression profiling of ECs co-culturing with Mg alloy was conducted, and the adhesion- and migration-related genes were examined. We found that Mg alloy had no adverse effects on ECs viability but significantly affected ECs migration and adhesion. Co-cultured with Mg alloy extract, ECs showed contractive adhesion morphology and decreased motility, which was supported by the down-regulation of adhesion-related genes (Paxillin and Vinculin) and migration-related genes (RAC 1, Rho A and CDC 42). Accordingly, the re-endothelialization of Mg alloy stent was inhibited in vivo. Our results may provide new inspiration for improving the broad application of Mg alloy stents.
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Affiliation(s)
- Zhe Hou
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Maolong Xiang
- College of Life Sciences, Sichuan University, Chengdu 610064, China
| | - Nuoya Chen
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xiao Cai
- The Fourth People's Hospital of Chengdu, Chengdu 610036, China
| | - Bo Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Rifang Luo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xiaoyi Ma
- Beijing Key Laboratory of Cardiac Drug Device Technology and Evidence Based Medicine, Beijing 100021, China
| | - Lifeng Zhou
- Beijing Key Laboratory of Cardiac Drug Device Technology and Evidence Based Medicine, Beijing 100021, China
| | - Fugui He
- Beijing Key Laboratory of Cardiac Drug Device Technology and Evidence Based Medicine, Beijing 100021, China
| | - Hongchi Yu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
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54
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Shen D, Qi H, Lin W, Zhang W, Bian D, Shi X, Qin L, Zhang G, Fu W, Dou K, Xu B, Yin Z, Rao J, Alwi M, Wang S, Zheng Y, Zhang D, Gao R. PDLLA-Zn-nitrided Fe bioresorbable scaffold with 53-μm-thick metallic struts and tunable multistage biodegradation function. SCIENCE ADVANCES 2021; 7:7/23/eabf0614. [PMID: 34088662 PMCID: PMC8177708 DOI: 10.1126/sciadv.abf0614] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/19/2021] [Indexed: 05/02/2023]
Abstract
Balancing the biodegradability and mechanical integrity of a bioresorbable scaffold (BRS) with time after implantation to match the remodeling of the scaffolded blood vessel is important, but a key challenge in doing so remains. This study presents a novel intercalated structure of a metallic BRS by introducing a nanoscale Zn sacrificial layer between the nitrided Fe platform and the sirolimus-carrying poly(d,l-lactide) drug coating. The PDLLA-Zn-FeN BRS shows a multistage biodegradation behavior, maintaining mechanical integrity at the initial stage and exhibiting accelerated biodegradation at the subsequent stage in both rabbit abdominal aortas and human coronary arteries, where complete biodegradation was observed about 2 years after implantation. The presence of the nanoscale Zn sacrificial layer with an adjustable thickness also contributes to the tunable biodegradation of BRS and allows the reduction of the metallic strut thickness to 53 μm, with radial strength as strong as that of the current permanent drug-eluting stents.
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Affiliation(s)
- Danni Shen
- Beijing Advanced Innovation Center for Materials Genome Engineering and School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Haiping Qi
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Wenjiao Lin
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Wanqian Zhang
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200433, China
| | - Dong Bian
- Beijing Advanced Innovation Center for Materials Genome Engineering and School of Materials Science and Engineering, Peking University, Beijing 100871, China
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Xiaoli Shi
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Li Qin
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Gui Zhang
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Wenchao Fu
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhenyuan Yin
- BioMed-X Center, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jiancun Rao
- AIM Lab, Maryland NanoCenter, University of Maryland, College Park, MD 20742, USA
| | - Mazeni Alwi
- Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, Kuala Lumpur 50400, Malaysia
| | - Shuhan Wang
- Shen Zhen Testing Center of Medical Devices, Shenzhen 518057, China
| | - Yufeng Zheng
- Beijing Advanced Innovation Center for Materials Genome Engineering and School of Materials Science and Engineering, Peking University, Beijing 100871, China.
- BioMed-X Center, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Deyuan Zhang
- National and Local Joint Engineering Laboratory of Interventional Medical Biotechnology and System, Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen 518110, China.
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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Ozaki Y, Garcia-Garcia HM, Melaku GD, Joner M, Galli S, Verheye S, Lee MKY, Waksman R, Haude M. Effect of Procedural Technique on Cardiovascular Outcomes Following Second-Generation Drug-Eluting Resorbable Magnesium Scaffold Implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:1-6. [PMID: 34049817 DOI: 10.1016/j.carrev.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study sought to assess target lesion failure (TLF) and clinically driven target lesion revascularization (CD-TLR) through 1 year following second-generation drug-eluting magnesium scaffold (Magmaris) implantation using a dedicated technique (so-called "4 P's" strategy). METHODS AND RESULTS The 4 P's strategy stands for: correct patient selection, proper scaffold sizing, pre-dilatation (<20% residual stenosis), post-dilatation. All the patient and lesion characteristics, preparation, and sizing of the device were compared in patients with TLF and CD-TLR through 1-year follow-up. We analyzed 315 patients for this study. At 1 year, there were 14 TLFs and 10 CD-TLRs. The TLF rates were 7.7%, 4.9%, and 4.1%; while the CD-TLR rates were 7.7%, 2.5%, and 3.2% in the undersized, properly sized, and oversized vessel groups, correspondingly. Diameter stenosis (DS) after pre-dilatation in patients with TLF and CD-TLR was significantly greater than in those without TLF and CD-TLR. In patients with a properly sized scaffold, DS after pre-dilatation was similar in patients with and without TLF and CD-TLR. However, in patients with non-properly sized scaffolds, greater post-balloon DS was observed in patients with TLF and CD-TLR. CONCLUSIONS Improper sizing and poor lesion preparation before Magmaris implantation appear to be related to TLF during 1-year follow-up.
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Affiliation(s)
- Yuichi Ozaki
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Gebremedhin D Melaku
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
| | - Michael K Y Lee
- Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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Wang J, Kural MH, Wu J, Leiby KL, Mishra V, Lysyy T, Li G, Luo J, Greaney A, Tellides G, Qyang Y, Huang N, Niklason LE. An ex vivo physiologic and hyperplastic vessel culture model to study intra-arterial stent therapies. Biomaterials 2021; 275:120911. [PMID: 34087584 DOI: 10.1016/j.biomaterials.2021.120911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
Conventional in vitro methods for biological evaluation of intra-arterial devices such as stents fail to accurately predict cytotoxicity and remodeling events. An ex vivo flow-tunable vascular bioreactor system (VesselBRx), comprising intra- and extra-luminal monitoring capabilities, addresses these limitations. VesselBRx mimics the in vivo physiological, hyperplastic, and cytocompatibility events of absorbable magnesium (Mg)-based stents in ex vivo stent-treated porcine and human coronary arteries, with in-situ and real-time monitoring of local stent degradation effects. Unlike conventional, static cell culture, the VesselBRx perfusion system eliminates unphysiologically high intracellular Mg2+ concentrations and localized O2 consumption resulting from stent degradation. Whereas static stented arteries exhibited only 20.1% cell viability and upregulated apoptosis, necrosis, metallic ion, and hypoxia-related gene signatures, stented arteries in VesselBRx showed almost identical cell viability to in vivo rabbit models (~94.0%). Hyperplastic intimal remodeling developed in unstented arteries subjected to low shear stress, but was inhibited by Mg-based stents in VesselBRx, similarly to in vivo. VesselBRx represents a critical advance from the current static culture standard of testing absorbable vascular implants.
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Affiliation(s)
- Juan Wang
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Mehmet H Kural
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Jonathan Wu
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Katherine L Leiby
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Vinayak Mishra
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, 06269, USA
| | - Taras Lysyy
- Department of Surgery, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Guangxin Li
- Department of Surgery, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Jiesi Luo
- Yale Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT06519, USA
| | - Allison Greaney
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - George Tellides
- Department of Surgery, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Yibing Qyang
- Yale Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT06519, USA
| | - Nan Huang
- School of Material Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Laura E Niklason
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, 06519, USA; Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA.
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Ozaki Y, Kuku KO, Sakellarios A, Haude M, Hideo-Kajita A, Desale S, Siogkas P, Sioros S, Ince H, Abizaid A, Tölg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Escaned J, Michalis L, Fotiadis DI, Djikstra J, Waksman R, Garcia-Garcia HM. Impact of Endothelial Shear Stress on Absorption Process of Resorbable Magnesium Scaffold: A BIOSOLVE-II Substudy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:9-15. [PMID: 33863661 DOI: 10.1016/j.carrev.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Local hemodynamic forces such as endothelial shear stress (ESS) may have an influence on appropriate neointimal healing, vessel remodeling, and struts' absorption process following second-generation drug-eluting resorbable magnesium scaffold (RMS, Magmaris, Biotronik AG, Buelach, Switzerland) placement. The aim of this study was to investigate the impact of ESS assessed by optical coherence tomography (OCT)-based computational fluid dynamic (CFD) simulations on absorption process and coronary lumen dimension after Magmaris implantation. METHODS AND RESULTS A total of 22 patients who were enrolled in the BIOSOLVE-II trial and underwent serial OCT assessment immediately after Magmaris implantation and at 6- and 12-month follow-up were included. We evaluated qualitative OCT findings frame by frame, and CFD simulations were performed to calculate the ESS at 3-dimensional (3D) reconstructed arteries. For quantitative calculation, the average ESS within each 1-mm section was classified into three groups: low (<1.0 Pa), intermediate (1.0-2.5 Pa), or high (>2.5 Pa). A significant difference of percentage remnants of scaffold was observed among the 3 groups at 12-month follow-up (P = 0.001) but not at 6-month follow-up. Low-ESS segment at baseline resulted in a greater lumen change of -1.857 ± 1.902 mm2 at 1 year compared to -1.277 ± 1.562 mm2 in the intermediate-ESS segment (P = 0.017) and - 0.709 ± 1.213 mm2 in the high-ESS segment (P = 0.001). CONCLUSION After Magmaris implantation, the presence of higher ESS might be associated with slower strut absorption process but less luminal loss.
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Affiliation(s)
- Yuichi Ozaki
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Kayode O Kuku
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Antonis Sakellarios
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Alexandre Hideo-Kajita
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Sameer Desale
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Panagiotis Siogkas
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Spyros Sioros
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichschain and Am Urban, Berlin, Germany
| | | | - Ralph Tölg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração - HCFMUSP, University of Sao Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - William Wijns
- Cardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Lampros Michalis
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Dimitrios I Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA.
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Bian D, Zhou X, Liu J, Li W, Shen D, Zheng Y, Gu W, Jiang J, Li M, Chu X, Ma L, Wang X, Zhang Y, Leeflang S, Zhou J. Degradation behaviors and in-vivo biocompatibility of a rare earth- and aluminum-free magnesium-based stent. Acta Biomater 2021; 124:382-397. [PMID: 33508506 DOI: 10.1016/j.actbio.2021.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/14/2022]
Abstract
Biodegradable stents can provide scaffolding and anti-restenosis benefits in the short term and then gradually disappear over time to free the vessel, among which the Mg-based biodegradable metal stents have been prosperously developed. In the present study, a Mg-8.5Li (wt.%) alloy (RE- and Al-free) with high ductility (> 40%) was processed into mini-tubes, and further fabricated into finished stent through laser cutting and electropolishing. In-vitro degradation test was performed to evaluate the durability of this stent before and after balloon dilation. The influence of plastic deformation and residual stress (derived from the dilation process) on the degradation was checked with the assistance of finite element analysis. In addition, in-vivo degradation behaviors and biocompatibility of the stent were evaluated by performing implantation in iliac artery of minipigs. The balloon dilation process did not lead to deteriorated degradation, and this stent exhibited a decent degradation rate (0.15 mm/y) in vitro, but divergent result (> 0.6 mm/y) was found in vivo. The stent was almost completely degraded in 3 months, revealing an insufficient scaffolding time. Meanwhile, it did not induce possible thrombus, and it was tolerable by surrounding tissues in pigs. Besides, endothelial coverage in 1 month was achieved even under the severe degradation condition. In the end, the feasibility of this stent for treatment of benign vascular stenosis was generally discussed, and perspectives on future improvement of Mg-Li-based stents were proposed.
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Affiliation(s)
- Dong Bian
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaochen Zhou
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Jianing Liu
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Wenting Li
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Danni Shen
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Yufeng Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China; Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China.
| | - Wenda Gu
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Mei Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiao Chu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Limin Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaolan Wang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yu Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Sander Leeflang
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands
| | - Jie Zhou
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands
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Biosafety and efficacy evaluation of a biodegradable magnesium-based drug-eluting stent in porcine coronary artery. Sci Rep 2021; 11:7330. [PMID: 33795781 PMCID: PMC8016955 DOI: 10.1038/s41598-021-86803-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
Although the drug-eluting stent (DES) has become the standard for percutaneous coronary intervention (PCI)-based revascularization, concerns remain regarding the use of DES, mainly due to its permanent rigid constraint to vessels. A drug-eluting bioresorbable stent (BRS) was thus developed as an alternative to DES, which can be absorbed entirely after its therapeutic period. Magnesium (Mg)-based BRSs have attracted a great deal of attention due to their suitable mechanical properties, innovative chemical features, and well-proven biocompatibility. However, the primary disadvantage of Mg-based BRSs is the rapid degradation rate, resulting in the early loss of structural support long before the recovery of vascular function. Recently, a new type of patented Mg-Nd-Zn-Zr alloy (JDBM) was developed at Shanghai Jiao Tong University to reduce the degradation rate compared to commercial Mg alloys. In the present investigation, a poly(D,L-lactic acid)-coated and rapamycin eluting (PDLLA/RAPA) JDBM BRS was prepared, and its biosafety and efficacy for coronary artery stenosis were evaluated via in vitro and in vivo experiments. The degree of smooth muscle cell adhesion to the PDLLA/RAPA coated alloy and the rapamycin pharmacokinetics of JDBM BRS were first assessed in vitro. JDBM BRS and commercial DES FIREHAWK were then implanted in the coronary arteries of a porcine model. Neointimal hyperplasia was evaluated at 30, 90, and 180 days, and re-endothelialization was evaluated at 30 days. Furthermore, Micro-CT and optical coherence tomography (OCT) analyses were performed 180 days after stent implantation to evaluate the technical feasibility, biocompatibility, and degradation characteristics of JDBM BRS in vivo. The results show the ability of a PDLLA/RAPA coated JDBM to inhibit smooth muscle cell adhesion and moderate the drug release rate of JDBM BRS in vitro. In vivo, low local and systemic risks of JDBM BRS were demonstrated in the porcine model, with preserved mechanical integrity after 6 months of implantation. We also showed that this novel BRS was associated with a similar efficacy profile compared with standard DES and high anti-restenosis performance. These findings may confer long term advantages for using this BRS over a traditional DES.
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60
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Roshandel M, Dorkoosh F. Cardiac tissue engineering, biomaterial scaffolds, and their fabrication techniques. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5273] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marjan Roshandel
- School of Chemical Engineering, College of Engineering University of Tehran Tehran Iran
| | - Farid Dorkoosh
- Department of Pharmaceutics, Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran
- Medical Biomaterial Research Centre (MBRC) Tehran University of Medical Sciences Tehran Iran
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Galli S, Testa L, Montorsi P, Bedogni F, Pisano F, Palloshi A, Mauro C, Contarini M, Varbella F, Esposito G, Caramanno G, Secco GG, D'Amico G, Musumeci G, Tarantini G. SICI-GISE position document on the use of the Magmaris resorbable magnesium scaffold in clinical practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:11-16. [PMID: 33674219 DOI: 10.1016/j.carrev.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
Bioresorbable scaffolds have emerged as a potential breakthrough for the treatment of coronary artery lesions. The need for drug release and plaque scaffolding is temporary, and leaving a permanent stent once the process of plaque recoil and vessel healing has ended might be superfluous or even deleterious exposing the patient to the risk of very late thrombosis, eliminating vessel reactivity, impairing non-invasive imaging and precluding possible future surgical revascularization. This long-term potential limitation of permanent bare metal stents might be overcome by using a resorbable scaffold. The metallic and antithrombotic properties make the resorbable magnesium scaffold an appealing technology for the treatment of coronary artery lesions. Notwithstanding this, its mechanical properties substantially differ from those of conventional bare metal stents, and previous experience using polymer-based scaffolds has shown that a standardized implantation technique and optimal patient and lesion selection are key factors for a successful implantation. A panel of expert cardiologists gathered to find a consensus on the best practices for Magmaris implantation in a selected patient population and to discuss the rationale for new potential future indications.
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Affiliation(s)
- Stefano Galli
- Monzino Cardiology Centre Research and Teaching Hospital, University of Milan, Italy.
| | - Luca Testa
- Policlinico San Donato Research and Teaching Hospital, San Donato Milanese, Milan, Italy
| | - Piero Montorsi
- Monzino Cardiology Centre Research and Teaching Hospital, University of Milan, Italy
| | - Francesco Bedogni
- Policlinico San Donato Research and Teaching Hospital, San Donato Milanese, Milan, Italy
| | - Francesco Pisano
- Department of Cardiology, Umberto Parini Regional Hospital, Aosta, Italy
| | - Altin Palloshi
- Department of Cardiology, "Città Studi" Clinical Institute, Milan, Italy
| | | | - Marco Contarini
- Interventional Cardiology Unit, Umberto I Hospital, Syracuse, Italy
| | | | | | - Giovanni Caramanno
- Interventional Cardiology Unit, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Gioel Gabrio Secco
- Department of Cardiology, Ospedale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianpiero D'Amico
- Padua University Policlinico Hospital, Centro Gallucci, Padua, Italy
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Fallesen CO, Maehara A, Antonsen L, Nørregaard Hansen K, Noori M, Flensted Lassen J, Junker A, Hansen HS, Okkels Jensen L. Coronary Artery Healing Process after Bioresorbable Scaffold in Patients with Non-ST-Segment Elevation Myocardial Infarction: Rationale, Design, and Methodology of the HONEST Study. Cardiology 2021; 146:161-171. [PMID: 33524985 DOI: 10.1159/000512417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bioresorbable scaffolds (BRSs) is a relatively new approach in treating coronary artery stenosis. The initial results of the first commercially available scaffolds consisting of a backbone of poly-L-lactide raised safety concerns related to delayed resorption and healing. The magnesium alloy-based scaffold degrades via bio-corrosion within months, whereas it often takes several years for polymer scaffolds to degrade. The aim of the study was to assess the healing stage by optical coherence tomography (OCT) after 6 months in patients with non-ST-segment elevation myocardial infarct (NSTEMI) randomized to OCT or angiography-guided percutaneous coronary intervention with implantation of a magnesium sirolimus-eluting Magmaris scaffold (Magmaris; Biotronik, Bülach, Switzerland). METHODS We analyzed the healing process by comparing OCT at baseline and after 6 months. Five stages of healing were defined with stage 1 being the least healed and stage 5 demonstrating complete resorption and healing with no visible scaffold/remnant. The primary end point is a calculated healing score that is based on 5 subtypes of healing stage: (1) malapposed, (2) uncovered with no detection of smooth surface tissue on top of struts or remnants, (3) covered protruding, (4) covered embedded, and (5) complete healing with a smooth neointimal surface and no sign of struts or visible remnants assessed by OCT 6 months after the index procedure. RESULTS The impact of OCT-guided compared to angiography-guided scaffold implantation will be illuminated. CONCLUSION The present study will provide new information on midterm healing properties of the magnesium BRS in patients with NSTEMI.
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Affiliation(s)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York Presbyterian Hospital, New York, New York, USA
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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The Use of Bioactive Polymers for Intervention and Tissue Engineering: The New Frontier for Cardiovascular Therapy. Polymers (Basel) 2021; 13:polym13030446. [PMID: 33573282 PMCID: PMC7866823 DOI: 10.3390/polym13030446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/28/2022] Open
Abstract
Coronary heart disease remains one of the leading causes of death in most countries. Healthcare improvements have seen a shift in the presentation of disease with a reducing number of ST-segment elevation myocardial infarctions (STEMIs), largely due to earlier reperfusion strategies such as percutaneous coronary intervention (PCI). Stents have revolutionized the care of these patients, but the long-term effects of these devices have been brought to the fore. The conceptual and technologic evolution of these devices from bare-metal stents led to the creation and wide application of drug-eluting stents; further research introduced the idea of polymer-based resorbable stents. We look at the evolution of stents and the multiple advantages and disadvantages offered by each of the different polymers used to make stents in order to identify what the stent of the future may consist of whilst highlighting properties that are beneficial to the patient alongside the role of the surgeon, the cardiologist, engineers, chemists, and biophysicists in creating the ideal stent.
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Patted SV, Thakkar AS. Clinical outcomes of ultrathin strut biodegradable polymer-coated everolimus-eluting stent in patients with coronary artery disease. ARYA ATHEROSCLEROSIS 2021; 16:130-135. [PMID: 33447258 PMCID: PMC7778515 DOI: 10.22122/arya.v16i3.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evermine 50™ (Meril Life Sciences Pvt. Ltd., India) everolimus-eluting stent system (EES) is a novel ultrathin strut (50 µm) cobalt-chromium coronary drug-eluting stent (DES) platform with biodegradable polymer coating. The Evermine 50 EES-KLES study aimed to evaluate the Evermine 50 EES in terms of 24-month clinical safety and performance in patients with coronary artery disease (CAD). METHODS This retrospective study consisted of 171 patients (258 lesions) implanted with Evermine 50 EES for managing CAD. We analyzed the major adverse cardiac events (MACE) incidence, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven target lesion revascularization (ID-TLR) at 6-, 12-, and 24-month follow-up. RESULTS A total of 171 patients were included with a mean age of 57.85 ± 10.05 years, of which, 139 (81.29%) were men, 69 (40.35%) were hypertensive, and 70 (40.94%) were diabetic. The incidence of MACE was 1 (0.58%), 3 (1.81%), and 4 (2.42%) at 6-, 12-, and 24-month follow-up, respectively. There were three cases (1.82%) of cardiac death and one case (0.61%) of ID-TLR up to 24 months. None of the patients was presented with definite or probable stent thrombosis (ST). CONCLUSION This study demonstrated that implantation of ultrathin strut Evermine 50 EES resulted in a low rate of incidence of MACE, indicating a favourable clinical safety and performance profile of Evermine 50 EES in patients with CAD [Clinical Trials Registry-India (CTRI) Number: CTRI/2017/09/009939)].
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Affiliation(s)
- Suresh V Patted
- Professor, Department of Cardiology, KLE Academy of Higher Education & Research, Belagavi, Karnataka, India
| | - Ashok S Thakkar
- Head, Department of Clinical Research, Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India
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Zhou N, Li P, Qiu H, Wang J, Huang N, Zhao A, Wang J. Comparison of in Vascular Bioreactors and In Vivo Models of Degradation and Cellular Response of Mg-Zn-Mn Stents. Ann Biomed Eng 2021; 49:1551-1560. [PMID: 33409851 DOI: 10.1007/s10439-020-02699-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
Traditional in vitro evaluation criteria of magnesium (Mg)-based stents cannot reflect the degradation process in vivo, due to the interdependence and interference between biodegradable properties and bioenvironment. The current direct and indirect evaluation approaches of in vitro biocompatibility do not have a hydrodynamic environment and vascular biological structure existing in vivo. Herein, we designed a vascular bioreactor to provide an ex vivo culture environment for vessels, which reveals the degradation behavior of Mg-Zn-Mn stent and the effect of its degradation on cells. We reported that rabbit carotid arteries could maintain native morphology and viability in the bioreactor under the best condition within a flow rate of 5.4 mL min-1 and a culture time of one week. With this culture condition, Mg-Zn-Mn stents were implanted into the arteries in the bioreactors and compared with in vivo rabbit models. The arteries maintained cell survival in the bioreactor, but the cell attachment was absent on the stent struts, associated with a fast degradation. Conversely, the stents achieved a rapid and complete endothelialization in vivo for two weeks. This study could provide a correlation and difference of the degradation behavior and cellular response to the degradation of Mg-based stent between ex vivo and in vivo approaches.
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Affiliation(s)
- Ningling Zhou
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, People's Republic of China
| | - Ping Li
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, People's Republic of China
| | - Hua Qiu
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, People's Republic of China
| | - Jin Wang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, People's Republic of China
| | - Nan Huang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, People's Republic of China
| | - Ansha Zhao
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, Sichuan, People's Republic of China.
| | - Juan Wang
- Yale University School of Medicine, New Haven, CT, 06511, USA.
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Gomez-Lara J, Ortega-Paz L, Brugaletta S, Cuesta J, Romaní S, Serra A, Salinas P, García del Blanco B, Goicolea J, Hernandez-Antolín R, Antuña P, Romaguera R, Regueiro A, Rivero F, Cequier À, Alfonso F, Gómez-Hospital JA, Sabaté M. Bioresorbable scaffolds versus permanent sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction: vascular healing outcomes from the MAGSTEMI trial. EUROINTERVENTION 2020; 16:e913-e921. [DOI: 10.4244/eij-d-20-00198] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cerrato E, Belliggiano D, Quadri G, Erriquez A, Anselmino M, Quirós A, Franzè A, Ferrari F, Rolfo C, Mejia‐Renteria H, Escaned J, Gonzalo N, Campo G, Varbella F. Anatomical and functional healing after resorbable magnesium scaffold implantation in human coronary vessels: A combined optical coherence tomography and quantitative flow ratio analysis. Catheter Cardiovasc Interv 2020; 98:1038-1046. [DOI: 10.1002/ccd.29397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/18/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli Turin Italy
| | - Davide Belliggiano
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences University of Turin Turin Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli Turin Italy
| | - Andrea Erriquez
- Cardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara, Cona, Italy; Maria Cecilia Hospital, GVM Care & Research Cotignola Italy
| | - Matteo Anselmino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences University of Turin Turin Italy
| | - Alicia Quirós
- Departmento de Matemáticas Universidad de León León Spain
| | - Alfonso Franzè
- Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli Turin Italy
| | - Fabio Ferrari
- Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli Turin Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli Turin Italy
| | - Hernan Mejia‐Renteria
- Cardiology Department, Hospital Clinico San Carlos IDISSC & Universidad Complutense de Madrid Madrid Spain
| | - Javier Escaned
- Cardiology Department, Hospital Clinico San Carlos IDISSC & Universidad Complutense de Madrid Madrid Spain
| | - Nieves Gonzalo
- Cardiology Department, Hospital Clinico San Carlos IDISSC & Universidad Complutense de Madrid Madrid Spain
| | - Gianluca Campo
- Cardiovascular Institute Azienda Ospedaliero‐Universitaria di Ferrara, Cona, Italy; Maria Cecilia Hospital, GVM Care & Research Cotignola Italy
| | - Ferdinando Varbella
- Interventional Cardiology Unit San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli Turin Italy
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Properties of Titanium Oxide Coating on MgZn Alloy by Magnetron Sputtering for Stent Application. COATINGS 2020. [DOI: 10.3390/coatings10100999] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Constructing surface coatings is an effective way to improve the corrosion resistance and biocompatibility of magnesium alloy bioabsorbable implants. In this present work, a titanium oxide coating with a thickness of about 400 nm was successfully prepared on a MgZn alloy surface via a facile magnetron sputtering route. The surface features were characterized using scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and the contact angle method. The corrosion behavior and biocompatibility were evaluated. The results indicated that the amorphous TiO2 coating with a flat and dense morphology was obtained by magnetron-sputtering a titanium oxide target. The corrosion current density decreased from 1050 (bare MgZn alloy) to 49 μA/cm2 (sample with TiO2 coating), suggesting a significant increase in corrosion resistance. In addition, the TiO2 coating showed good biocompatibilities, including significant reduced hemolysis and platelet adhesion, and increased endothelial cell viability and adhesion.
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Rykowska I, Nowak I, Nowak R. Drug-Eluting Stents and Balloons-Materials, Structure Designs, and Coating Techniques: A Review. Molecules 2020; 25:E4624. [PMID: 33050663 PMCID: PMC7594099 DOI: 10.3390/molecules25204624] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/19/2022] Open
Abstract
Controlled drug delivery is a matter of interest to numerous scientists from various domains, as well as an essential issue for society as a whole. In the treatment of many diseases, it is crucial to control the dosing of a drug for a long time and thus maintain its optimal concentration in the tissue. Heart diseases are particularly important in this aspect. One such disease is an obstructive arterial disease affecting millions of people around the world. In recent years, stents and balloon catheters have reached a significant position in the treatment of this condition. Balloon catheters are also successfully used to manage tear ducts, paranasal sinuses, or salivary glands disorders. Modern technology is continually striving to improve the results of previous generations of stents and balloon catheters by refining their design, structure, and constituent materials. These advances result in the development of both successive models of drug-eluting stents (DES) and drug-eluting balloons (DEB). This paper presents milestones in the development of DES and DEB, which are a significant option in the treatment of coronary artery diseases. This report reviews the works related to achievements in construction designs and materials, as well as preparation technologies, of DES and DEB. Special attention was paid to the polymeric biodegradable materials used in the production of the above-mentioned devices. Information was also collected on the various methods of producing drug release coatings and their effectiveness in releasing the active substance.
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Affiliation(s)
- I. Rykowska
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - I. Nowak
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - R. Nowak
- Eye Department, J. Strus City Hospital, Szwajcarska 3, 61-285 Poznań, Poland;
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Shi J, Miao X, Fu H, Jiang A, Liu Y, Shi X, Zhang D, Wang Z. In vivo biological safety evaluation of an iron-based bioresorbable drug-eluting stent. Biometals 2020; 33:217-228. [PMID: 32935164 DOI: 10.1007/s10534-020-00244-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
Bioresorbable stents (BRS) are investigated and designed to revascularize occluded arteries. The iron-based bioresorbable stent is a promising device in interventional therapies, although it's corrosion and bioresorption rate remain challenging. In this work, we introduced a novel nitrided iron coronary stent (IBS) with enhanced degradation rate compared with pure iron stent. To evaluate the biosafety of this device, a sub-chronic systemic toxicity study was conducted and a stainless steel stent (Supporter™) served as a control. Here, the bioresorbable stent was first evaluated in rat abdominal aortic implantation model. When subjected to exaggerated exposure dose, no clinical signs of toxicity or mortality were observed in either, the IBS group or the control group. Histopathological examinations showed the corrosion particles of iron were encapsulated by fibrocytes and engulfed by macrophages, indicating that the degradation of iron was in the early stage. Our results demonstrated that the nitrided iron stent did not induce systemic toxicity under the experimental conditions.
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Affiliation(s)
- Jianfeng Shi
- Testing Department of Biomaterials, Chinese National Institutes for Food and Drug Control, Beijing, 102629, China
| | - Xuewen Miao
- College of Life Science, YanTai University, YanTai, 264005, China
| | - Haiyang Fu
- Testing Department of Biomaterials, Chinese National Institutes for Food and Drug Control, Beijing, 102629, China
| | - Aili Jiang
- College of Life Science, YanTai University, YanTai, 264005, China
| | - YanFen Liu
- R&D Center, Lifetech Scientific (Shenzhen) Co Ltd, Shenzhen, 518057, China
| | - XiaoLi Shi
- R&D Center, Lifetech Scientific (Shenzhen) Co Ltd, Shenzhen, 518057, China
| | - Deyuan Zhang
- R&D Center, Lifetech Scientific (Shenzhen) Co Ltd, Shenzhen, 518057, China.
| | - Zhaoxu Wang
- Testing Department of Biomaterials, Chinese National Institutes for Food and Drug Control, Beijing, 102629, China.
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Effect of strain on degradation behaviors of WE43, Fe and Zn wires. Acta Biomater 2020; 113:627-645. [PMID: 32574860 DOI: 10.1016/j.actbio.2020.06.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022]
Abstract
The biodegradable metallic devices undergo stress/strain-induced corrosion when they are used for load-bearing applications. The stress/strain induced-corrosion behavior causes differences in corrosion rate, corrosion morphology, strain distribution and mechanical performance of the devices. One representative example is the biodegradable stent. Biodegradable stents undergo complex inhomogeneous deformation that can cause dramatic non-uniform stent degradation, resulting in stress concentration and stents failure. The degradation of biodegradable devices requires special attention to the mutual effect between the applied strain and degradation. The quantitative relationship between strain and corrosion of the sample alloys (WE43, Fe and Zn), selected from three typical biodegradable metals, is firstly investigated and compared in this study. The in vitro degradation and the strength retention of WE43, Fe and Zn wires were investigated under different elastic and plastic strain levels ranging from 0.1% to 30%. The results indicated that the applied strain could bring down the corrosion potential, increase corrosion current and accelerate the degradation of three biodegradable metals. Specifically, remarkable enhanced localized corrosion was observed for plastic strained WE43 compared with those with elastic strains. This localized corrosion morphology significantly accelerated the strength decline at first, while the differences diminished with longer immersion period. Fe and Zn exhibited increased degradation with plastic strain applications than those under elastic strains. However, the degradation was not further increased with the increasing magnitude of plastic strains. Moreover, the bended wires were subcutaneously implanted in the dorsal aspect of the rats and the effect of bending deformation on in vitro and in vivo degradation of three metallic wires were also compared. The U-bended WE43 wires suffered more severe in vitro degradation at the stress concentrated region. Surprisingly, the early fracture of the undeformed regions was observed in the in vivo test. In conclusion, the corrosion rate, corrosion morphology and mechanical properties of WE43, Fe and Zn was sensitive to magnitude of the applied strains. The quantification results provided new insights into understanding the strain-dependent corrosion of three biodegradable metals both in vitro and in vivo. STATEMENT OF SIGNIFICANCE: Biodegradable implants are subjected to various mechanical environment during the deployment and subsequent physiological activity. It is necessary to have a clear understanding of the effects of the applied stress on degradation. This study addresses the quantitative effects of applied strain/stress on the in vitro and in vivo degradation of three typical biodegradable metals (Mg, Fe and Zn). These quantification results provide new insights into understanding the strain-induced corrosion of three metals.
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Advances in Antibacterial Functionalized Coatings on Mg and Its Alloys for Medical Use—A Review. COATINGS 2020. [DOI: 10.3390/coatings10090828] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As a revolutionary implant material, magnesium and its alloys have many exciting performances, such as biodegradability, mechanical compatibility, and excellent biosecurity. However, the rapid and uncontrollable degradation rate of magnesium greatly hampers its clinical use. Many efforts have been taken to enhance the corrosion resistance of magnesium. However, it must be noted that improving the corrosion resistance of magnesium will lead to the compromise of its antibacterial abilities, which are attribute and proportional to the alkaline pH during its degradation. Providing antibacterial functionalized coating is one of the best methods for balancing the degradation rate and the antibacterial ability of magnesium. Antibacterial functionalized magnesium is especially well-suited for patients with diabetes and infected wounds. Considering the extremely complex biological environment in the human body and the demands of enhancing corrosion resistance, biocompatibility, osteogenesis, and antibacterial ability, composite coatings with combined properties of different materials may be promising. The aim of this review isto collect and compare recent studies on antibacterial functionalized coatings on magnesium and its alloys. The clinical applications of antibacterial functionalized coatings and their material characteristics, antibacterial abilities, in vitro cytocompatibility, and corrosion resistance are also discussed in detail.
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Abellas-Sequeiros RA, Ocaranza-Sanchez R, Bayon-Lorenzo J, Santas-Alvarez M, Gonzalez-Juanatey C. 12-month clinical outcomes after Magmaris percutaneous coronary intervention in a real-world cohort of patients: Results from the CardioHULA registry. Rev Port Cardiol 2020; 39:421-425. [PMID: 32763098 DOI: 10.1016/j.repc.2019.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/04/2019] [Accepted: 09/22/2019] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Clinical evidence on the bioresorbable magnesium scaffolds (BRS) is still scarce. We aim to assess clinical outcomes after magnesium BRS deployment in a real-world cohort of patients. METHODS We included in a non-randomized, prospective, single-center registry of all patients treated with at least one Magmaris device in our cath lab. Pre and postdilatation with optical coherence tomography guidance, as part of the 4Ps strategy, were performed in all cases. The primary endpoint was target lesion failure (TLF) at 12 months. RESULTS 42 patients (with 42 lesions) underwent Magmaris percutaneous coronary intervention (PCI) between June 2016 to April 2017. PCI was performed in an acute setting in 54.76% cases; the most treated vessel was the anterior descending artery, with a mean diameter of 3.30±0.25 mm. All lesions underwent predilatation and postdilatation, with a mean postdilatation pressure of 19.2 atm. Procedural success rate was 100%. TLF rate was 4.7% at 12 months. None of our patients died or suffered myocardial infarction. Two patients (4.7%) underwent clinically-driven target lesion revascularization due to in-stent restenosis. No stent thrombosis was detected. CONCLUSION 12-months clinical outcomes after Magmaris PCI demonstrate its safety and feasibility when deployed in a 4Ps strategy.
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Affiliation(s)
- Rosa A Abellas-Sequeiros
- Interventional Cardiology Unit, Lucus Augusti Universitary Hospital, Lugo, Spain; Doctoral fellow, University of Santiago de Compostela (USC), Santiago de Compostela University, Spain
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Abellas-Sequeiros RA, Ocaranza-Sanchez R, Bayon-Lorenzo J, Santas-Alvarez M, Gonzalez-Juanatey C. 12-month clinical outcomes after Magmaris percutaneous coronary intervention in a real-world cohort of patients: Results from the CardioHULA registry. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hehrlein C, Schorch B, Haberstroh J, Bode C, Mey L, Schwarzbach H, Kinscherf R, Meckel S, Schiestel S, Kovacs A, Fischer H, Nennig E. Bioresorbable zinc stent with ultra-thin center struts attenuates stent jail in porcine femoral artery bifurcations. MINIM INVASIV THER 2020; 31:72-79. [DOI: 10.1080/13645706.2020.1770797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Christoph Hehrlein
- Department of Cardiology and Angiology I, Heart Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Björn Schorch
- Department of Cardiology and Angiology I, Heart Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Haberstroh
- Division of Experimental Surgery, Center for Experimental Models and Transgenic Services, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lilli Mey
- Institute for Anatomy and Cell Biology, Dept. of Medical Cell Biology, Philipps-University Marburg, Marburg, Germany
| | - Hans Schwarzbach
- Institute for Anatomy and Cell Biology, Dept. of Medical Cell Biology, Philipps-University Marburg, Marburg, Germany
| | - Ralf Kinscherf
- Institute for Anatomy and Cell Biology, Dept. of Medical Cell Biology, Philipps-University Marburg, Marburg, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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77
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Jiang W, Zhang C, Tran L, Wang SG, Hakim AD, Liu H. Engineering Nano-to-Micron-Patterned Polymer Coatings on Bioresorbable Magnesium for Controlling Human Endothelial Cell Adhesion and Morphology. ACS Biomater Sci Eng 2020; 6:3878-3898. [DOI: 10.1021/acsbiomaterials.0c00642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Wensen Jiang
- Materials Science and Engineering Program, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Chaoxing Zhang
- Materials Science and Engineering Program, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Larry Tran
- Department of Bioengineering, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
- Department of Chemical Engineering, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Sebo Gene Wang
- Department of Bioengineering, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
- Department of Chemistry, College of Natural and Agricultural Sciences, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Ammar Dilshad Hakim
- Department of Bioengineering, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Huinan Liu
- Materials Science and Engineering Program, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
- Department of Bioengineering, University of California at Riverside, 900 University Avenue, Riverside, California 92521, United States
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78
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Haude M, Ince H, Kische S, Toelg R, Van Mieghem NM, Verheye S, von Birgelen C, Christiansen EH, Barbato E, Garcia-Garcia HM, Waksman R. Sustained Safety and Performance of the Second-Generation Sirolimus-Eluting Absorbable Metal Scaffold: Pooled Outcomes of the BIOSOLVE-II and -III Trials at 3 Years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1150-1154. [PMID: 32917533 DOI: 10.1016/j.carrev.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE To avoid long-term effects associated with permanent implants, bioresorbable vascular scaffolds were developed, as they provide transient vessel support and disappear thereafter. The aim of the BIOSOLVE-II and -III studies was to assess the safety and performance of a magnesium-based sirolimus-eluting scaffold; we report the clinical outcomes at 3 years, 2 years after scaffold resorption. METHODS/MATERIALS BIOSOLVE-II and BIOSOLVE-III are international, prospective multi-center studies, including 184 patients with 189 de novo lesions and stable or unstable angina, or documented silent ischemia. Acute myocardial infarction, 3-vessel coronary artery disease, and heavily calcified lesions were excluded. Antiplatelet therapy was recommended for 6 months. RESULTS Patients were 65.5 ± 10.8 years old, and lesions were 12.1 ± 4.5 mm long and located in vessels with a diameter of 2.7 ± 0.4 mm. More than half of the lesions (56.5%) were type B2/C lesions. At 2 years, 92.5% (160/173) of patients were symptom-free and 91.5% (151/165) at 3 years; all the other patients had stable angina. At 3 years, target lesion failure occurred in 11 patients (6.3%), consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis. CONCLUSION In a low-risk patient population, treatment with a sirolimus-eluting magnesium bioresorbable scaffold can be considered safe, in particular with no definite or probable scaffold thrombosis. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II and -III are prospective, international, multi-center studies including 184 patients with de novo lesions. At 3 years, target lesion failure was 6.3%, consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany.
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Stefan Verheye
- Interventional Cardiology Middelheim Hospital, Antwerpen, Belgium
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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79
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Wu J, Zhao D, Lee B, Roy A, Yao R, Chen S, Dong Z, Heineman WR, Kumta PN. Effect of Lithium and Aluminum on the Mechanical Properties, In Vivo and In Vitro Degradation, and Toxicity of Multiphase Ultrahigh Ductility Mg-Li-Al-Zn Quaternary Alloys for Vascular Stent Application. ACS Biomater Sci Eng 2020; 6:1950-1964. [PMID: 33455316 DOI: 10.1021/acsbiomaterials.9b01591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Magnesium alloys are the most widely studied biodegradable metals for biodegradable vascular stent application. Two major issues with current magnesium alloy based stents are their low ductility and fast corrosion rates. Several studies have validated that introduction of Li into the magnesium alloys will significantly improve the ductility while alloying with Al will improve the corrosion resistance and strength. In the present study, we studied the effects of alloying different amounts of Li and Al on the Mg-Li-Al-Zn (LAZ) quaternary alloy system. Rods were made from four different LAZ alloys, namely, LAZ611, LAZ631, LAZ911, and LAZ931 following melting, casting, and then extrusion. Systematic assessment of mechanical properties, in vitro corrosion, cytotoxicity, and in vivo degradation including local and systemic toxicity conducted demonstrated the beneficial effects of Li and Al on the mechanical properties. Our results specifically suggest that alloying with Li significantly improved the ductility while Al enhanced the strength of the LAZ alloys. Four of the LAZ alloys exhibited different corrosion rates in Hank's balanced salt solution depending on the chemical composition. Indirect in vitro cytotoxicity tests also showed lower cytotoxicity for the alloys exhibiting higher corrosion resistance. In vivo corrosion rates in the mouse subcutaneous model showed different corrosion rates compared to the in vitro tests. Nevertheless, all of the four LAZ alloys displayed no local and systemic toxicity based on the histology analysis. This research study, therefore, demonstrated the benefits of using Li and Al as alloying elements in LAZ alloys and the potential use of LAZ alloys for vascular stent application.
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Affiliation(s)
- Jingyao Wu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States.,McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Daoli Zhao
- Department of Chemistry, University of Cincinnati, Cincinnati, Ohio 45221, United States
| | - Boeun Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Abhijit Roy
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States.,McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Raymon Yao
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Shauna Chen
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267, United States
| | - Zhongyun Dong
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267, United States
| | - William R Heineman
- Department of Chemistry, University of Cincinnati, Cincinnati, Ohio 45221, United States
| | - Prashant N Kumta
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States.,McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States.,Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
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80
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Acute treatment of critical vascular stenoses with a bioabsorbable magnesium scaffold in infants with CHDs. Cardiol Young 2020; 30:493-499. [PMID: 32079550 DOI: 10.1017/s1047951120000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-operative severe vascular stenosis and proliferating endothelial tissue lead to severe circulatory disorders and impair organ perfusion. Bioabsorbable magnesium scaffolds may help to overcome these obstructions without leaving obstructing stent material. We analyse their role in the treatment of vascular stenosis in infants. METHODS Since 2016, 15 magnesium scaffolds with a diameter of 3.5 mm were implanted in 9 patients aged 15 days to 7.6 years. Eight scaffolds were implanted in pulmonary venous restenoses, five in pulmonary arterial stenosis including one in-stent stenosis, one into a stenotic brachiocephalic artery, and one in a recurrent innominate vein thrombosis. RESULTS All patients clinically improved after the implantation of a scaffold. The magnesium scaffolds lost integrity after 30-48 days (mean 42 days). The innominate vein thrombosed early, while all other vessels remained open. Two patients died after 1.3 and 14 weeks not related to the scaffolds. Five patients needed further balloon dilations or stent implantations after the scaffold had fractured. At first recatheterisation after in mean 2.5 months, the mean minimum/maximum diameter in relation to the scaffold's original diameter was 89%/99% in the arterial implantations (n = 6) and 66%/77% in the pulmonary venous implantations. CONCLUSIONS The magnesium scaffolds can be used as a bridging solution to treat severe vascular stenosis in different locations. Restenosis can occur after degradation and make further interventions necessary, but neither vessel growth nor further interventions are hindered by stent material. Larger diameters may improve therapeutic options.
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81
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Guan Z, Linsley CS, Hwang I, Yao G, Wu BM, Li X. Novel Zinc / Tungsten Carbide Nanocomposite as Bioabsorbable Implant. MATERIALS LETTERS 2020; 263:127282. [PMID: 32647402 PMCID: PMC7346885 DOI: 10.1016/j.matlet.2019.127282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a lack of bioabsorbable materials with adequate mechanical strength suitable for implant applications that provide temporary support while tissue integrity is restored, especially for pediatric applications. Bioabsorbable metals have emerged as an attractive choice due to their combination of strength, ductility, and biocompatibility in vivo. Zinc has shown great promise as a bioabsorbable metal, but the weak mechanical properties of pure zinc limit its application as an implant material. This study investigates zinc-tungsten carbide (Zn-WC) nanocomposite as a novel material for bioabsorbable metallic implants. Ultrasound-assisted powder compaction was used to fabricate Zn-WC nanocomposites. This study includes the material characterization of microstructure, microhardness, and degradability. Results showed that tungsten carbide nanoparticles enhanced the mechanical properties of Zn, and maintained the favorable corrosion rate of pure Zn. These results encourage further investigation of Zn-WC nanocomposites for biomedical applications with the ultimate goal of creating safe and efficacious bioabsorbable metallic implants for many clinical applications.
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Affiliation(s)
- Zeyi Guan
- Department of Mechanical and Aerospace Engineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
| | - Chase S. Linsley
- Department of Bioengineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
| | - Injoo Hwang
- Department of Mechanical and Aerospace Engineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
| | - Gongcheng Yao
- Department of Materials Science and Engineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
| | - Benjamin M. Wu
- Department of Bioengineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
- Department of Materials Science and Engineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
- Division of Advanced Prosthodontics, School of Dentistry, University of California, Los Angeles, CA 90095, USA
- Department of Orthopedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Xiaochun Li
- Department of Mechanical and Aerospace Engineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
- Department of Materials Science and Engineering, Samueli School of Engineering, University of California, Los Angeles, CA 90095, USA
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82
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Ueki Y, Räber L, Otsuka T, Rai H, Losdat S, Windecker S, Garcia-Garcia HM, Landmesser U, Koolen J, Byrne R, Haude M, Joner M. Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis. Circ Cardiovasc Interv 2020; 13:e008657. [DOI: 10.1161/circinterventions.119.008657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia.
Methods:
Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography.
Results:
Serial data were available for analysis from 70 patients (LLL <0.5 mm: n=41; LLL ≥0.5 mm: n=29). Patient and lesion characteristics were comparable, and there was no significant difference in mean and minimal scaffold area between groups at post-intervention. Late absolute scaffold recoil was less among patients with LLL <0.5 mm (0.53±0.68 mm
2
) compared with those with LLL ≥0.5 mm (1.48±1.20 mm
2
;
P
<0.001). Neointimal hyperplasia area was smaller among patients with LLL <0.5 mm at follow-up (1.47±0.33 mm
2
) compared with patients with LLL ≥0.5 mm (1.68±0.34 mm
2
;
P
=0.013). In a matched-frame analysis (post-intervention and follow-up), late absolute scaffold recoil varied according to the underlying plaque type (lipid: 0.63±1.23 mm
2
; calcified: 0.81±1.44 mm
2
; and fibrous: 1.20±1.52 mm
2
;
P
<0.001), while there was no difference with regards to neointimal hyperplasia area (
P
=0.132).
Conclusions:
In addition to neointimal hyperplasia, late scaffold recoil contributed significantly to LLL of sirolimus-eluting absorbable metal scaffolds. The extent of late scaffold recoil was dependent on the underlying plaque morphology and was the highest among fibrotic lesions.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01960504.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Switzerland (S.L.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | | | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Germany (U.L.)
| | - Jacques Koolen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (J.K.)
| | - Robert Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany (M.H.)
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
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83
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Onuma Y, Serruys PW. Sustained safety and efficacy of the magnesium scaffold: does the Magmaris scaffold call for the return of BRS research… and randomised controlled trials? EUROINTERVENTION 2020; 15:e1307-e1311. [DOI: 10.4244/eijv15i15a238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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84
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Comparison of clinical outcomes between Magmaris and Orsiro drug eluting stent at 12 months: Pooled patient level analysis from BIOSOLVE II–III and BIOFLOW II trials. Int J Cardiol 2020; 300:60-65. [DOI: 10.1016/j.ijcard.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/30/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022]
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85
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Haude M, Ince H, Toelg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Neumann FJ, Eeckhout E, Garcia-Garcia HM, Waksman R. Safety and performance of the second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) in patients with de novo coronary lesions: three-year clinical results and angiographic findings of the BIOSOLVE-II first-in-man trial. EUROINTERVENTION 2020; 15:e1375-e1382. [DOI: 10.4244/eij-d-18-01000] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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86
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Florin Ferent I, Mester A, Hlinomaz O, Groch L, Rezek M, Sitar J, Semenka J, Novak M, Benedek I. Intracoronary Imaging for Assessment of Vascular Healing and Stent Follow-up in Bioresorbable Vascular Scaffolds. Curr Med Imaging 2020; 16:123-134. [PMID: 32003312 DOI: 10.2174/1573405614666180604093621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/10/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Bioresorbable Vascular Scaffolds (BVS) are polymer-based materials implanted in the coronary arteries in order to treat atherosclerotic lesions, based on the concept that once the lesion has been treated, the material of the implanted stent will undergo a process of gradual resorption that will leave, in several years, the vessel wall smooth, free of any foreign material and with its vasomotion restored. However, after the first enthusiastic reports on the efficacy of BVSs, the recently published trials demonstrated disappointing results regarding long-term patency following BVS implantation, which were mainly attributed to technical deficiencies during the stenting procedure. Intracoronary imaging could play a crucial role for helping the operator to correctly implant a BVS into the coronary artery, as well as providing relevant information in the follow-up period. This review aims to summarize the role of intracoronary imaging in the follow-up of coronary stents, with a particular emphasis on the role of intravascular ultrasound and optical coherence tomography for procedural guidance during stent implantation and also for follow-up of bioabsorbable scaffolds.
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Affiliation(s)
- Ioan Florin Ferent
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Andras Mester
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Ladislav Groch
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Michal Rezek
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jan Sitar
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jiri Semenka
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Martin Novak
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Imre Benedek
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
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87
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Liu J, Bian D, Zheng Y, Chu X, Lin Y, Wang M, Lin Z, Li M, Zhang Y, Guan S. Comparative in vitro study on binary Mg-RE (Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb and Lu) alloy systems. Acta Biomater 2020; 102:508-528. [PMID: 31722254 DOI: 10.1016/j.actbio.2019.11.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 12/21/2022]
Abstract
Correct selection of alloying elements is important for developing novel biodegradable magnesium alloys with superior mechanical and biological performances. In contrast to various reports on nutrient elements (Ca, Zn, Sr, etc.) as alloying elements of biomedical magnesium alloys, there is limited information about how to choose the right rare earth elements (REEs) as alloying elements of magnesium. In this work, 16 kinds of REEs were individually added into Mg, including Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Du, Ho, Er, Tm, Yb and Lu, to fabricate binary Mg-RE model alloys with different composition points. Under the same working history, comparative studies were undertaken and the impact of each kind of rare earth element on the microstructure, mechanical property, corrosion behavior and biocompatibility of Mg were investigated. The corresponding influence level for the 16 kinds of REEs were ranked. The results showed that the second phases were detected in some Mg-RE alloys, which were mainly composed of Mg12RE. By adding different REEs into Mg with proper contents, the mechanical properties of resulting Mg-RE binary alloys could be adjusted in wide range. The corrosion resistance of Mg-light REE alloys was generally better than Mg-heavy REE alloys. As for biocompatibility, Mg-RE model alloys showed no cytotoxic effect on MC3T3-E1 cells. The hemolysis rates of all experimental Mg-RE model alloys were lower than 5% except for Mg-Lu alloy model. In general, the addition of different REEs into Mg could improve its performance from different aspects. This work provides a better understanding on suitable REEs as alloying elements for magnesium, and the future R&D direction on biomedical Mg-RE alloys was proposed. STATEMENT OF SIGNIFICANCE: In contrast to various reports on nutrient elements (Ca, Zn, Sr, etc.) as alloying elements of biomedical magnesium alloys, until now there is limited information about how to choose the right rare earth elements (REEs) as alloying elements of magnesium. In this work, comparative studies were undertaken by individually adding 16 kinds of REEs, including Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Du, Ho, Er, Tm, Yb and Lu, into Mg to fabricate binary Mg-RE model alloys, with different composition points, then the impact of each kind of rare earth element on the microstructure, mechanical property, corrosion behavior and biocompatibility of Mg under the same working history were investigated, and the corresponding influence level for the 16 kinds of REEs were ranked. This work provides a better understanding on suitable REEs as alloying elements for magnesium, and the future R&D direction on biomedical Mg-RE alloys was proposed.
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88
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Abstract
Fully bioresorbable scaffolds (BRS) were designed to overcome the limitations of metallic drug-eluting stents, which permanently cage the vessel wall, thereby preventing normal coronary vasomotion, preclude bypass grafting and can provoke long-term foreign-body responses. Although multiple scaffolds have been or are in development, the Absorb Bioresorbable Vascular Scaffold (BVS; Abbott Vascular) was the first FDA-approved device and was widely expected to fulfil the dream of interventional cardiologists of a transient scaffold that would disappear 'when the job was done' and would not hamper further treatment options. Although early, small studies and even large, randomized trials showed beneficial outcomes up to 1 year of follow-up, longer-term results have been disappointing, with increased rates of device thrombosis and target-lesion revascularization. The Absorb BVS device was withdrawn from the market because of low demand. In this Review, we summarize the preclinical and clinical data available for BRS to understand how the vascular biological reactions to these devices differ from biological reactions to metallic drug-eluting stents and how these responses translate into clinical outcomes. We also discuss next-generation BRS and outline modifications that are needed to improve the long-term outcomes with these devices so that they eventually become a viable option for patients with symptomatic obstructive coronary artery disease.
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89
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Ozaki Y, Garcia-Garcia HM, Shlofmitz E, Hideo-Kajita A, Waksman R. Second-Generation Drug-Eluting Resorbable Magnesium Scaffold: Review of the Clinical Evidence. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:127-136. [DOI: 10.1016/j.carrev.2019.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
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90
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Jeżewski MP, Kubisa MJ, Eyileten C, De Rosa S, Christ G, Lesiak M, Indolfi C, Toma A, Siller-Matula JM, Postuła M. Bioresorbable Vascular Scaffolds-Dead End or Still a Rough Diamond? J Clin Med 2019; 8:E2167. [PMID: 31817876 PMCID: PMC6947479 DOI: 10.3390/jcm8122167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary interventions with stent-based restorations of vessel patency have become the gold standard in the treatment of acute coronary states. Bioresorbable vascular scaffolds (BVS) have been designed to combine the efficiency of drug-eluting stents (DES) at the time of implantation and the advantages of a lack of foreign body afterwards. Complete resolution of the scaffold was intended to enable the restoration of vasomotor function and reduce the risk of device thrombosis. While early reports demonstrated superiority of BVS over DES, larger-scale application and longer observation exposed major concerns about their use, including lower radial strength and higher risk of thrombosis resulting in higher rate of major adverse cardiac events. Further focus on procedural details and research on the second generation of BVS with novel properties did not allow to unequivocally challenge position of DES. Nevertheless, BVS still have a chance to present superiority in distinctive indications. This review presents an outlook on the available first and second generation BVS and a summary of results of clinical trials on their use. It discusses explanations for unfavorable outcomes, proposed enhancement techniques and a potential niche for the use of BVS.
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Affiliation(s)
- Mateusz P. Jeżewski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Michał J. Kubisa
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Günter Christ
- Department of Cardiology, 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, 31100 Vienna, Austria;
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 1061701 Poznań, Poland;
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Division of Cardiology, “Magna Graecia” University, 88100 Catanzaro, Italy; (S.D.R.); (C.I.)
| | - Aurel Toma
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Jolanta M. Siller-Matula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 231090 Vienna, Austria;
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, 02091 Warsaw, Poland; (M.P.J.); (M.J.K.); (C.E.); (M.P.)
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91
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Barkholt TØ, Webber B, Holm NR, Ormiston JA. Mechanical properties of the drug-eluting bioresorbable magnesium scaffold compared with polymeric scaffolds and a permanent metallic drug-eluting stent. Catheter Cardiovasc Interv 2019; 96:E674-E682. [PMID: 31710149 PMCID: PMC7754471 DOI: 10.1002/ccd.28545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 11/24/2022]
Abstract
Objectives To compare on the bench the physical and mechanical properties of Magmaris, a magnesium bioresorbable scaffold (BRS), with Absorb and DESolve polymeric BRS and a permanent metallic stent. Background Understanding the mechanical and physical properties of BRS is crucial for appropriate implantation and postdilatation. Methods Testing was performed in fluid at 37°C and in silicone bifurcation phantoms with a 30° angle between main branch (MB) and side branch. Results The 3.0‐mm Magmaris BRS did not fracture after MB postdilatation up to 4.4 mm in contrast to the Absorb where the safe postdilatation diameter was 3.7 mm. For dilatation through stent cells, there were no Magmaris fractures with 3.0‐mm noncompliant (NC) balloons inflated to nominal pressure. Mini‐kissing balloon postdilatation with two 3.0‐mm NC balloons up to 17 atm was without fracture except for an outlier. Longitudinal and radial strengths were similar for Magmaris and Absorb BRS. The crossing profile for the Magmaris was larger than other devices. Recoil 120 min after deployment was the greatest for Magmaris but 120 min after 3.5 mm postdilatation all devices had similar diameters. Conclusions The Magmaris BRS was more resistant to strut fracture than Absorb. It had a larger crossing profile than other devices and similar radial and longitudinal strengths to Absorb. While recoil after deployment was greater with Magmaris, 120 min after 3.5 mm postdilatation all devices had similar diameters.
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Affiliation(s)
| | | | | | - John A Ormiston
- Intra, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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92
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Chen C, Chen J, Wu W, Shi Y, Jin L, Petrini L, Shen L, Yuan G, Ding W, Ge J, Edelman ER, Migliavacca F. In vivo and in vitro evaluation of a biodegradable magnesium vascular stent designed by shape optimization strategy. Biomaterials 2019; 221:119414. [PMID: 31419654 PMCID: PMC6732791 DOI: 10.1016/j.biomaterials.2019.119414] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 01/25/2023]
Abstract
The performance of biodegradable magnesium alloy stents (BMgS) requires special attention to non-uniform residual stress distribution and stress concentration, which can accelerate localized degradation after implantation. We now report on a novel concept in stent shape optimization using a finite element method (FEM) toolkit. A Mg-Nd-Zn-Zr alloy with uniform degradation behavior served as the basis of our BMgS. Comprehensive in vitro evaluations drove stent optimization, based on observed crimping and balloon inflation performance, measurement of radial strength, and stress condition validation via microarea-XRD. Moreover, a Rapamycin-eluting polymer coating was sprayed on the prototypical BMgS to improve the corrosion resistance and release anti-hyperplasia drugs. In vivo evaluation of the optimized coated BMgS was conducted in the iliac artery of New Zealand white rabbit with quantitative coronary angiography (QCA), optical coherence tomography (OCT) and micro-CT observation at 1, 3, 5-month follow-ups. Neither thrombus or early restenosis was observed, and the coated BMgS supported the vessel effectively prior to degradation and allowed for arterial healing thereafter. The proposed shape optimization framework based on FEM provides an novel concept in stent design and in-depth understanding of how deformation history affects the biomechanical performance of BMgS. Computational analysis tools can indeed promote the development of biodegradable magnesium stents.
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Affiliation(s)
- Chenxin Chen
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, Milan, 20133, Italy
| | - Jiahui Chen
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wei Wu
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, Milan, 20133, Italy; Department of Mechanical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249-0669, USA
| | - Yongjuan Shi
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Liang Jin
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, Milan, 20133, Italy
| | - Li Shen
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China.
| | - Wenjiang Ding
- National Engineering Research Center of Light Alloy Net Forming & State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, Milan, 20133, Italy.
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93
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Qin Y, Wen P, Guo H, Xia D, Zheng Y, Jauer L, Poprawe R, Voshage M, Schleifenbaum JH. Additive manufacturing of biodegradable metals: Current research status and future perspectives. Acta Biomater 2019; 98:3-22. [PMID: 31029830 DOI: 10.1016/j.actbio.2019.04.046] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 12/23/2022]
Abstract
The combination of biodegradable metals and additive manufacturing (AM) leads to a revolutionary change of metal implants in many aspects including materials, design, manufacturing, and clinical applications. The AM of nondegradable metals such as titanium and CoCr alloys has proven to be a tremendous success in clinical applications. The AM of biodegradable metals including magnesium (Mg), iron (Fe), and zinc (Zn) is still in its infancy, although much progress has been made in the research field. Element loss and porosity are common processing problems for AM of biodegradable metals like Zn and Mg, which are mainly caused by evaporation during melting under a high-energy beam. The resulting formation quality and properties are closely related to material, design, and processing, making AM of biodegradable metals a typical interdisciplinary subject involving biomaterials, mechanical engineering, and medicine. This work reviews the state of research and future perspective on AM of biodegradable metals from extensive viewpoints such as material, processing, formation quality, design, microstructure, and properties. Effects of powder properties and processing parameters on formation quality are characterized in detail. The microstructure and metallurgical defects encountered in the AM parts are described. Mechanical and biodegradable properties of AM samples are introduced. Design principles and potential applications of biodegradable metal implants produced by AM are discussed. Finally, current research status is summarized together with some proposed future perspectives for advancing knowledge about AM of biodegradable metals. STATEMENT OF SIGNIFICANCE: Rapid development of research and applications on biodegradable metals and additive manufacturing (AM) has been made in recent years. Customized geometric shapes of medical metals with porous structure can be realized accurately and efficiently by laser powder bed fusion (L-PBF), which is beneficial to achieve reliable stress conduction and balanced properties. This review introduces the development history and current status of AM of biodegradable metals and then critically surveys L-PBF of Mg-, Fe-, and Zn-based metals from multiple viewpoints including materials, processing, formation quality, structural design, microstructure, and mechanical and biological properties. The present findings are summarized together with some proposed future challenges for advancing AM of biodegradable metals into real clinical applications.
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94
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Loffredo S, Paternoster C, Giguère N, Barucca G, Vedani M, Mantovani D. The addition of silver affects the deformation mechanism of a twinning-induced plasticity steel: Potential for thinner degradable stents. Acta Biomater 2019; 98:103-113. [PMID: 31004841 DOI: 10.1016/j.actbio.2019.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/11/2019] [Accepted: 04/11/2019] [Indexed: 01/24/2023]
Abstract
While Fe-based alloys have already been reported to possess all mechanical properties required for vascular stenting, their relatively low degradation rate in vivo still constitutes their main bottleneck. The inflammatory reaction generated by a stent is inversely proportional to its mass. Therefore, the tendency in stenting is to lower the section so to reduce the inflammatory reaction. Twinning-induced plasticity steels (TWIP) possess excellent mechanical properties for envisaging the next generation of thinner degradable cardiovascular stents. To accelerate the degradation, the addition of noble elements was proposed, aimed at promoting corrosion by galvanic coupling. In this context, silver was reported to generally increase the degradation rate. However, its impact on the deformation mechanism of TWIP steels has not been reported yet. Results show that the use of Ag significantly reduces the ductility without altering the strength of the material. Furthermore, the presence of Ag was found to promote a different deformation texture, thus stimulating the formation of mechanical martensite. Since a stent works in the deformed state, understanding the microstructure and texture resulting from plastic deformation can effectively help to forecast the degradation mechanisms taking place during implantation and the expected degradation time. Moreover, knowing the deformed microstructure allows to understand the formability of very small tubes, as precursors of the next generation of thin section degradable stents. STATEMENT OF SIGNIFICANCE: Commercial degradable magnesium stents are limited from their relatively big structure size. Twinning-induced plasticity steels possess outstanding mechanical properties, but their degradation time goes beyond the timeframe expected from clinics. The inclusion of noble Ag particles, which favor galvanic coupling, is known to promote corrosion and solve this limitation. However, it is necessary to understand the impact that Ag has on the deformation microstructure and on the mechanical properties. The addition of Ag reduces the ductility of a twinning-induced plasticity steel because of a different deformation microstructure. Since a stent works in a deformed state inside an artery, understanding the microstructural evolution after plastic deformation allows to better predict the device performances during service life.
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95
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Soderlind J, Cihova M, Schäublin R, Risbud S, Löffler JF. Towards refining microstructures of biodegradable magnesium alloy WE43 by spark plasma sintering. Acta Biomater 2019; 98:67-80. [PMID: 31254685 DOI: 10.1016/j.actbio.2019.06.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
Abstract
Microstructural refinement of magnesium (Mg) alloys is beneficial for mechanical and corrosion properties, both of which are critical for their successful application as temporary implant materials. One method of achieving a refined microstructure is through rapid solidification via gas-atomization-powder production. In this study we investigated spark plasma sintering (SPS) as a potential processing method for maintaining this refined microstructure while achieving a range of porosities up to full densification. We characterized the microstructural evolution as a function of sintering temperature from 250 to 450 °C for the alloy WE43 using multi-scale correlative microscopy techniques, including light microscopy and scanning and transmission electron microscopy-based methods. The spatial distribution of the two major alloying elements, neodymium (Nd) and yttrium (Y), was determined and the intermetallic phases they form identified using energy dispersive X-ray spectroscopy in conjunction with electron diffraction. The gas-atomized powder microstructure consists of Mg-rich dendrites and a percolating interdendritic Mg-Nd-Y ternary phase with structure Mg14Nd2Y, surrounded by a high Nd and Y content in solid solution. This microstructure is maintained up to a sintering temperature of 350 °C, while with higher sintering temperatures segregation of Nd and Y dominates. The percolating ternary phase breaks up into faceted globular precipitates with structure Mg5Nd, which is isomorphous to Mg14Nd2Y. Y comes out of solution and migrates to previous powder-particle surfaces, possibly forming Y2O3. Sample densities ranged from 64 to 100% for sintering temperatures of 250 to 450 °C, respectively, and the grain size remained constant at about 10 µm. SPS is demonstrated to be an attractive alternative method for processing Mg alloys to a wide range of porosities and fine microstructures. The microstructural refinement achieved by SPS holds the potential for slow and homogeneous corrosion. STATEMENT OF SIGNIFICANCE: This study presents the impact spark plasma sintering (SPS) has on the microstructure of WE43, a magnesium alloy used for biodegradable implants. SPS is of great interest in this context as it is scalable, rapid, and has the potential for tuning density while maintaining a refined microstructure. The microstructure and density are explored from the gas-atomized powder to the densified material using electron microscopy and chemical mapping from the macro- to the nano-level. The insights gained reveal an original evolution of rare-earth element distribution with an isomorphous chemistry change, while the microstructure develops from the non-equilibrium state (powder) towards an equilibrium structure upon sintering. This study, including measurements of mechanical performance, sets the premises of SPS for the fabrication of Mg-based implants with tunable characteristics.
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Affiliation(s)
- Julie Soderlind
- Department of Materials Science and Engineering, University of California, Davis, CA 95616, United States; Lawrence Livermore National Laboratory, Livermore, CA 94550, United States; Laboratory of Metal Physics and Technology, Department of Materials, ETH Zurich, 8093 Zurich, Switzerland
| | - Martina Cihova
- Laboratory of Metal Physics and Technology, Department of Materials, ETH Zurich, 8093 Zurich, Switzerland
| | - Robin Schäublin
- Laboratory of Metal Physics and Technology, Department of Materials, ETH Zurich, 8093 Zurich, Switzerland
| | - Subhash Risbud
- Department of Materials Science and Engineering, University of California, Davis, CA 95616, United States
| | - Jörg F Löffler
- Laboratory of Metal Physics and Technology, Department of Materials, ETH Zurich, 8093 Zurich, Switzerland.
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96
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Hong D, Zaky SH, Chong R, Lukashova L, Beniash E, Verdelis K, Witte F, Sfeir C. Controlling magnesium corrosion and degradation-regulating mineralization using matrix GLA protein. Acta Biomater 2019; 98:142-151. [PMID: 31330328 DOI: 10.1016/j.actbio.2019.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/10/2019] [Accepted: 05/19/2019] [Indexed: 01/07/2023]
Abstract
Magnesium (Mg) alloys are embraced for their biodegradability and biocompatibility. However, Mg degrades spontaneously in the biological environment in vivo and in vitro, triggering deposition of calcium phosphate on the metal. Upon complete metal absorption, minerals remain in the tissue, which could lead to pathogenic calcification. Hence, our aims are to test the feasibility of matrix GLA protein (MGP) to locally inhibit Mg mineralization that is induced by metal alloy degradation. MGP is a small secretory protein that has been shown to inhibit soft tissue calcification. We exposed Mg to MGP, stably transfected into mammalian cells. Results showed that less calcium and phosphorous deposition on the Mg surface when MGP was present relative to when it was not. In the in vivo mouse intramuscular model conducted for 4 and 6 weeks, Mg rods were embedded in collagen scaffolds, seeded with cells overexpressing MGP. Microtomography, electron dispersive x-ray spectroscopy, and histology assessments revealed lower deposited mineral volume around Mg rods from the MGP group. Compared to other groups, higher volume loss after implantation was observed from the MGP group at both time points, indicating a higher corrosion rate without the protective mineral layer. This study is the first to our knowledge to demonstrate that local exposure to a biomolecule, such as MGP, can modulate the corrosion of Mg-based implants. These findings may have important implications for the future design of endovascular stents and orthopedic devices.
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Affiliation(s)
- Dandan Hong
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA
| | - Samer H Zaky
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA
| | - Rong Chong
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lyudmila Lukashova
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elia Beniash
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA
| | - Konstantinos Verdelis
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frank Witte
- The McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA; Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Charles Sfeir
- The Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Periodontics and Preventive Dentistry, Pittsburgh, PA, USA; Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA; The McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA.
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97
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Boland EL, Grogan JA, McHugh PE. Computational modelling of magnesium stent mechanical performance in a remodelling artery: Effects of multiple remodelling stimuli. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3247. [PMID: 31393090 DOI: 10.1002/cnm.3247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 05/01/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
Significant research has been conducted in the area of coronary stents/scaffolds made from resorbable metallic and polymeric biomaterials. These next-generation bioabsorbable stents have the potential to completely revolutionise the treatment of coronary artery disease. The primary advantage of resorbable devices over permanent stents is their temporary presence which, from a theoretical point of view, means only a healed coronary artery will be left behind following degradation of the stent potentially eliminating long-term clinical problems associated with permanent stents. The healing of the artery following coronary stent/scaffold implantation is crucial for the long-term safety of these devices. Computational modelling can be used to evaluate the performance of complex stent devices in silico and assist in the design and development and understanding of the next-generation resorbable stents. What is lacking in computational modelling literature is the representation of the active response of the arterial tissue in the weeks and months following stent implantation, ie, neointimal remodelling, in particular for the case of biodegradable stents. In this paper, a computational modelling framework is developed, which accounts for two major physiological stimuli responsible for neointimal remodelling and combined with a magnesium corrosion model that is capable of simulating localised pitting (realistic) stent corrosion. The framework is used to simulate different neointimal growth patterns and to explore the effects the neointimal remodelling has on the mechanical performance (scaffolding support) of the bioabsorbable magnesium stent.
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Affiliation(s)
- Enda L Boland
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - James A Grogan
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Peter E McHugh
- Biomechanics Research Centre (BioMEC), Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
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98
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Sabaté M, Alfonso F, Cequier A, Romaní S, Bordes P, Serra A, Iñiguez A, Salinas P, García Del Blanco B, Goicolea J, Hernández-Antolín R, Cuesta J, Gómez-Hospital JA, Ortega-Paz L, Gomez-Lara J, Brugaletta S. Magnesium-Based Resorbable Scaffold Versus Permanent Metallic Sirolimus-Eluting Stent in Patients With ST-Segment Elevation Myocardial Infarction: The MAGSTEMI Randomized Clinical Trial. Circulation 2019; 140:1904-1916. [PMID: 31553204 DOI: 10.1161/circulationaha.119.043467] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of poly-l-lactide acid-based bioresorbable scaffolds is limited in daily clinical practice because of safety concerns and lack of physiological benefit. Magnesium-based bioresorbable scaffold (MgBRS) presents a short resorption period (<1 year) and have the potential of being thromboresistant and exhibiting early restoration of vasomotor function. To date, however, no randomized clinical trial has investigated the performance of MgBRS. Therefore, this study aimed to compare the in-stent/scaffold vasomotion between MgBRS and permanent metallic sirolimus-eluting stent (SES) at 12-month follow-up in ST-segment-elevation myocardial infarction patients. METHODS This investigator-driven, multicenter, randomized, single-blind, controlled trial randomized ST-segment-elevation myocardial infarction patients 1:1 to SES or MgBRS at 11 academic centers. The primary end point was the rate of increase (≥3%) after nitroglycerin in mean lumen diameter of the in-stent/scaffold segment at 12 months with superiority of MgBRS over SES in the as-treated population. The main secondary end points included angiographic parameters of restenosis, device-oriented composite end point, their individual components, and device thrombosis rate. Besides, endothelial-dependent vasomotor response to acetylcholine (ie, endothelial function) was also assessed in a subgroup of patients (n=69). RESULTS Between June 2017 and June 2018, 150 ST-segment-elevation myocardial infarction patients were randomized (MgBRS, n=74; SES, n=76). At 1 year, the primary end point was significantly higher in the MgBRS arm (56.5% versus 33.8%; P=0.010). Conversely, late lumen loss was significantly lower in the SES group (in-segment: 0.39±0.49mm versus 0.02±0.27mm, P<0.001; in-device: 0.61±0.55mm versus 0.06±0.21mm; P<0.001). The device-oriented composite end point was higher in the MgBRS arm driven by an increase in ischemia-driven target lesion revascularization rate (12[16.2%] versus 4[5.2%], P=0.030). Definite thrombosis rate was similar between groups (1[1.4%] in the MgBRS arm versus 2[2.6%] in the SES group; P=1.0). Endothelial function assessment at device segment evidenced a more pronounced vasoconstrictive response to maximal dose of acetylcholine in the MgBRS arm (-8.3±3.5% versus -2.4±1.3% in the SES group, P=0.003). CONCLUSIONS When compared to SES, MgBRS demonstrated a higher capacity of vasomotor response to pharmacological agents (either endothelium-independent or endothelium-dependent) at 1 year. However, MgBRS was associated with a lower angiographic efficacy, a higher rate of target lesion revascularization, without thrombotic safety concerns. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03234348.
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Affiliation(s)
- Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (M.S., S.B.)
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, Madrid, Spain (F.A., J.C.)
| | - Angel Cequier
- Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain (A.C., J.A.G.H.)
| | | | | | - Antonio Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.S.)
| | | | | | | | | | | | - Javier Cuesta
- Hospital Universitario de La Princesa, Madrid, Spain (F.A., J.C.)
| | | | - Luis Ortega-Paz
- Barcicore, Cardiac Imaging Corelab, Barcelona, Spain (L.O.P., J.G.L.)
| | - Josep Gomez-Lara
- Barcicore, Cardiac Imaging Corelab, Barcelona, Spain (L.O.P., J.G.L.)
| | - Salvatore Brugaletta
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (M.S., S.B.)
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Echeverry-Rendon M, Allain JP, Robledo SM, Echeverria F, Harmsen MC. Coatings for biodegradable magnesium-based supports for therapy of vascular disease: A general view. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 102:150-163. [DOI: 10.1016/j.msec.2019.04.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 01/22/2023]
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The Development of Magnesium-Based Resorbable and Iron-Based Biocorrodible Metal Scaffold Technology and Biomedical Applications in Coronary Artery Disease Patients. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9173527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In the treatment of atherosclerotic disease patients, the adoption of second-generation drug-eluting stents (DES) in percutaneous coronary intervention reduced the occurrence of in-stent restenosis (ISR) and acute stent thrombosis (ST) when compared to bare metal stents and 1st generation DES. However, the permanent encaging of the vessel wall by any of the metallic stents perpetuates the inflammation process and prevents vasomotion in the treated segment. Aiming to overcome this issue, the bioresorbable scaffold (BRS) concept was developed by providing transient vascular radial support to the target segment during the necessary time to heal and disappearing after a period of time. Close to 20 years since BRS technology was first reported, the interventional cardiology field saw the rise and fall of several BRS devices. Although iron-based BRS is an emerging technology, currently, magnesium-alloy resorbable scaffolds devices are supported with the most robust data. This manuscript aims to review the concept of magnesium-based BRS devices, as well as their bioresorption mechanisms and the status of this technology, and the clinical outcomes of patients treated with magnesium BRS and to review the available evidence on iron-based BRS technology.
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