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Aziz MK, Herrmann J, Marmagkiolis K, Balanescu DV, Donisan T, Pushparaji B, Lin HY, Tomakin G, Hoyt T, Pham M, Dijkstra J, Cilingiroglu M, Lopez-Mattei J, Zaha V, Anderson HV, Feldman MD, Molony DA, Iliescu CA. Coronary Stent Healing in Cancer Patients-An Optical Coherence Tomography Perspective. Front Cardiovasc Med 2021; 8:665303. [PMID: 34164440 PMCID: PMC8215158 DOI: 10.3389/fcvm.2021.665303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study assessed stent healing patterns and cardiovascular outcomes by optical coherence tomography (OCT) in cancer patients after drug-eluting stent (DES) placement. Background: Cancer treatment, owing to its cytotoxic and antiproliferative effects, could delay stent healing and increase stent thrombosis risk, especially when dual antiplatelet therapy (DAPT) is discontinued early for oncological treatment. OCT can assess stent endothelialization and other healing parameters, which may provide clinical guidance in these challenging scenarios. Methods: This single-center retrospective study enrolled all cancer patients who underwent OCT for assessment of vascular healing patterns after prior DES placement from November 2009 to November 2018. Primary study endpoints were stent healing parameters, including stent coverage, apposition, degree of expansion, neointimal hyperplasia heterogeneity, in-stent restenosis, stent thrombosis, and overall survival (OS). Results: A total of 67 patients were included in this study. Mean time between DES placement and OCT evaluation was 154 ± 82 days. Stent healing matched published values for DES in non-cancer patients (P ≥ 0.063). At 1 year, the OS was 86% (95% confidence interval [CI]: 78–96%) with 0% incidence of acute coronary syndrome. Advanced cancers and active chemotherapies were associated with inferior OS (P = 0.024, hazard ratio [HR]: 3.50, 95% CI: 1.18–10.42 and P = 0.026, HR: 2.65, 95% CI: 1.13–6.22, respectively), while stent healing parameters were unassociated with OS. Forty-one patients (61%) had DAPT duration ≤6 months. Conclusions: Stent healing of contemporary DES appears similar in cancer and non-cancer patients. Cardiovascular risk of cancer patients after DES placement can be managed to facilitate timely cancer therapies, as the underlying malignancy and active chemotherapy ultimately determine survival.
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Affiliation(s)
- Moez Karim Aziz
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States
| | - Bala Pushparaji
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Heather Y Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gerryross Tomakin
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Taylor Hoyt
- Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Martin Pham
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vlad Zaha
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - H Vernon Anderson
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marc D Feldman
- Division of Cardiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Donald A Molony
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cezar A Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
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102
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Azzalini L, Baber U, Johal GS, Farhan S, Barman N, Kapur V, Hasan C, Vijay P, Jhaveri V, Mehran R, Kini AS, Sharma SK. One-year outcomes of patients undergoing complex percutaneous coronary intervention with three contemporary drug-eluting stents. Catheter Cardiovasc Interv 2021; 97:1341-1351. [PMID: 32478459 DOI: 10.1002/ccd.28996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI). BACKGROUND It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES). METHODS Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. RESULTS We included n = 5,446 patients (CoCr-DP-EES, n = 3,177; PtCr-DP-EES, n = 1,555; PtCr-BP-EES, n = 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. CONCLUSIONS We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.
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Affiliation(s)
- Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gurpreet S Johal
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Kapur
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Choudhury Hasan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pooja Vijay
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vaishvi Jhaveri
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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103
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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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104
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Diaz-Rodriguez S, Rasser C, Mesnier J, Chevallier P, Gallet R, Choqueux C, Even G, Sayah N, Chaubet F, Nicoletti A, Ghaleh B, Feldman LJ, Mantovani D, Caligiuri G. Coronary stent CD31-mimetic coating favours endothelialization and reduces local inflammation and neointimal development in vivo. Eur Heart J 2021; 42:1760-1769. [PMID: 33580685 PMCID: PMC8106951 DOI: 10.1093/eurheartj/ehab027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/12/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS The rapid endothelialization of bare metal stents (BMS) is counterbalanced by inflammation-induced neointimal growth. Drug-eluting stents (DES) prevent leukocyte activation but impair endothelialization, delaying effective device integration into arterial walls. Previously, we have shown that engaging the vascular CD31 co-receptor is crucial for endothelial and leukocyte homeostasis and arterial healing. Furthermore, we have shown that a soluble synthetic peptide (known as P8RI) acts like a CD31 agonist. The aim of this study was to evaluate the effect of CD31-mimetic metal stent coating on the in vitro adherence of endothelial cells (ECs) and blood elements and the in vivo strut coverage and neointimal growth. METHODS AND RESULTS We produced Cobalt Chromium discs and stents coated with a CD31-mimetic peptide through two procedures, plasma amination or dip-coating, both yielding comparable results. We found that CD31-mimetic discs significantly reduced the extent of primary human coronary artery EC and blood platelet/leukocyte activation in vitro. In vivo, CD31-mimetic stent properties were compared with those of DES and BMS by coronarography and microscopy at 7 and 28 days post-implantation in pig coronary arteries (n = 9 stents/group/timepoint). Seven days post-implantation, only CD31-mimetic struts were fully endothelialized with no activated platelets/leukocytes. At day 28, neointima development over CD31-mimetic stents was significantly reduced compared to BMS, appearing as a normal arterial media with the absence of thrombosis contrary to DES. CONCLUSION CD31-mimetic coating favours vascular homeostasis and arterial wall healing, preventing in-stent stenosis and thrombosis. Hence, such coatings seem to improve the metal stent biocompatibility.
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Affiliation(s)
- Sergio Diaz-Rodriguez
- Laboratory for Biomaterials and Bioengineering (CRC-I) Department of Min-Met-Mat Engineering and the CHU de Québec Research Center, Laval University, PLT-1745G, Québec, QC G1V 0A6, Canada
| | - Charlotte Rasser
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Jules Mesnier
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Pascale Chevallier
- Laboratory for Biomaterials and Bioengineering (CRC-I) Department of Min-Met-Mat Engineering and the CHU de Québec Research Center, Laval University, PLT-1745G, Québec, QC G1V 0A6, Canada
| | - Romain Gallet
- Institut Mondor de Recherche Biomédicale, école nationale vétérinaire de Maisons-Alfort (ENVA), Institut National de la Santé et de la Recherche Médicale U955, GHU (Groupe Hospitalo-Universitaire) A. Chenevier, Henri Mondor Faculty of Medicine Paris Est, 8 Rue du Général Sarrail, Créteil 94010, France
| | - Christine Choqueux
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Guillaume Even
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Neila Sayah
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Frédéric Chaubet
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Antonino Nicoletti
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France
| | - Bijan Ghaleh
- Institut Mondor de Recherche Biomédicale, école nationale vétérinaire de Maisons-Alfort (ENVA), Institut National de la Santé et de la Recherche Médicale U955, GHU (Groupe Hospitalo-Universitaire) A. Chenevier, Henri Mondor Faculty of Medicine Paris Est, 8 Rue du Général Sarrail, Créteil 94010, France
| | - Laurent J Feldman
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France.,Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val-de-Seine, Site Bichat, 46 rue Henri Huchard, Paris 75018, France
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering (CRC-I) Department of Min-Met-Mat Engineering and the CHU de Québec Research Center, Laval University, PLT-1745G, Québec, QC G1V 0A6, Canada
| | - Giuseppina Caligiuri
- Laboratory for Vascular Translational Science, Université de Paris, Inserm U1148, 46 rue Henri HUCHARD, Paris 75018, France.,Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val-de-Seine, Site Bichat, 46 rue Henri Huchard, Paris 75018, France
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105
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Somszor K, Allison-Logan S, Karimi F, McKenzie T, Fu Q, O'Connor A, Qiao G, Heath D. Amphiphilic Core Cross-Linked Star Polymers for the Delivery of Hydrophilic Drugs from Hydrophobic Matrices. Biomacromolecules 2021; 22:2554-2562. [PMID: 33983713 DOI: 10.1021/acs.biomac.1c00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The delivery of hydrophilic drugs from hydrophobic polymers is a long-standing challenge in the biomaterials field due to the limited solubility of the therapeutic agent within the polymer matrix. In this work, we develop a drug delivery mechanism that enables the impregnation and subsequent elution of hydrophilic drugs from a hydrophobic polymer material. This was achieved by synthesizing core cross-linked star polymer amphiphiles with hydrophilic cores and hydrophobic coronas. While significant work has been done to create nanocarriers for hydrophilic drugs, this work is distinct from previous work in that it designs amphiphilic and core cross-linked particles for controlled release from hydrophobic matrices. Ultraviolet-mediated atom transfer radical polymerization was used to synthesize the poly(ethylene glycol) (PEG)-based hydrophilic cores of the star polymers, and hydrophobic coronas of poly(caprolactone) (PCL) were then built onto the stars using ring-opening polymerization. We illustrated the cytocompatibility of PCL loaded with these star polymers through human endothelial cell adhesion and proliferation for up to 7 days, with star loadings of up to 40 wt %. We demonstrated successful loading of the hydrophilic drug heparin into the star polymer core, achieving a loading efficiency and content of 50 and 5%, respectively. Finally, the heparin-loaded star polymers were incorporated into a PCL matrix and sustained release of heparin was illustrated for over 40 days. These results support the use of core cross-linked star polymer amphiphiles for the delivery of hydrophilic drugs from hydrophobic polymer matrices. These materials were developed for application as drug-eluting and biodegradable coronary artery stents, but this flexible drug delivery platform could have impact in a broad range of medical applications.
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Affiliation(s)
- Katarzyna Somszor
- Department of Biomedical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia
| | - Stephanie Allison-Logan
- Department of Biomedical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia.,Department of Chemical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia
| | - Fatemeh Karimi
- Department of Chemical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Thomas McKenzie
- Department of Chemical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia
| | - Qiang Fu
- Department of Chemical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia.,Centre for Technology in Water and Wastewater (CTWW), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Andrea O'Connor
- Department of Biomedical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia
| | - Greg Qiao
- Department of Chemical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia
| | - Daniel Heath
- Department of Biomedical Engineering, University of Melbourne, Parkville, 3010 VIC, Australia
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106
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Effects of stent generation on clinical outcomes after acute myocardial infarction compared between prediabetes and diabetes patients. Sci Rep 2021; 11:9364. [PMID: 33931673 PMCID: PMC8087777 DOI: 10.1038/s41598-021-88593-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
We investigated the effects of stent generation on 2-year clinical outcomes between prediabetes and diabetes patients after acute myocardial infarction (AMI). A total of 13,895 AMI patients were classified into normoglycemia (group A: 3673), prediabetes (group B: 5205), and diabetes (group C: 5017). Thereafter, all three groups were further divided into first-generation (1G)-drug-eluting stent (DES) and second-generation (2G)-DES groups. Patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization were the primary outcome. Stent thrombosis (ST) was the secondary outcome. In both prediabetes and diabetes groups, the cumulative incidences of POCOs, any repeat revascularization, and ST were higher in the 1G-DES than that in the 2G-DES. In the diabetes group, all-cause death and cardiac death rates were higher in the 1G-DES than that in the 2G-DES. In both stent generations, the cumulative incidence of POCOs was similar between the prediabetes and diabetes groups. However, in the 2G-DES group, the cumulative incidences of Re-MI and all-cause death or MI were significantly higher in the diabetes group than that in the prediabetes group. To conclude, 2G-DES was more effective than 1G-DES in reducing the primary and secondary outcomes for both prediabetes and diabetes groups.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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107
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Affiliation(s)
- Antonio Colombo
- Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Antonio Mangieri
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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108
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Eruptive Calcified Nodules as a Potential Mechanism of Acute Coronary Thrombosis and Sudden Death. J Am Coll Cardiol 2021; 77:1599-1611. [PMID: 33795033 DOI: 10.1016/j.jacc.2021.02.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Calcified nodule (CN) has a unique plaque morphology, in which an area of nodular calcification causes disruption of the fibrous cap with overlying luminal thrombus. CN is reported to be the least frequent cause of acute coronary thrombosis, and the pathogenesis of CN has not been well studied. OBJECTIVES The purpose of this study is to provide a comprehensive morphologic assessment of the CN in addition to providing an evolutionary perspective as to how CN causes acute coronary thrombosis in patients with acute coronary syndromes. METHODS A total of 26 consecutive CN lesions from 25 subjects from our autopsy registry were evaluated. Detailed morphometric analysis was performed to understand the plaque characteristics of CN and nodular calcification. RESULTS The mean age was 70 years, with a high prevalence of diabetes and chronic kidney disease. CNs were equally distributed between men and women, with 61.5% of CNs found in the right coronary artery (n = 16), mainly within its mid-portion (56%). All CNs demonstrated surface nonocclusive luminal thrombus, consisting of multiple nodular fragments of calcification, protruding and disrupting the overlying fibrous cap, with evidence of endothelial cell loss. The degree of circumferential sheet calcification was significantly less in the culprit section (89° [interquartile range: 54° to 177°]) than in the adjacent proximal (206° [interquartile range: 157° to 269°], p = 0.0034) and distal (240° [interquartile range: 178° to 333°], p = 0.0004) sections. Polarized picrosirius red staining showed the presence of necrotic core calcium at culprit sites of CNs, whereas collagen calcium was more prevalent at the proximal and distal regions of CNs. CONCLUSIONS Our study suggests that fibrous cap disruption in CN with overlying thrombosis is initiated through the fragmentation of necrotic core calcifications, which is flanked-proximally and distally-by hard, collagen-rich calcification in coronary arteries, which are susceptible to mechanical stress.
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Koni E, Wanha W, Ratajczak J, Zhang Z, Podhajski P, Musci RL, Sangiorgi GM, Kaźmierski M, Buffon A, Kubica J, Wojakowski W, Navarese EP. Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. J Clin Med 2021; 10:jcm10061278. [PMID: 33808678 PMCID: PMC8003362 DOI: 10.3390/jcm10061278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54-0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58-0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42-0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53-0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.
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Affiliation(s)
- Endrin Koni
- Department of Interventional Cardiology, Santa
Corona Hospital, 17027 Pietra Ligure, Italy;
- SIRIO MEDICINE Research Network, 85094 Bydgoszcz,
Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
- Department of Health Promotion, Nicolaus Copernicus
University, 87100 Bydgoszcz, Poland
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw
Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
- Key Laboratory of Emergency and Trauma, Ministry of
Education, College of Emergency and Trauma, Hainan Medical University, Haikou 571199,
China
| | - Przemysław Podhajski
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
| | - Rita L. Musci
- Department of Biomedicine and Prevention,
University of Rome Tor Vergata, 00173 Rome, Italy;
| | - Giuseppe M. Sangiorgi
- Cardiac Cath Lab, Department of Cardiology, San
Gaudenzio Clinic, 28100 Novara, Italy;
| | - Maciej Kaźmierski
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Antonio Buffon
- Institute of Cardiology, Catholic University of
the Sacred Heart Rome, 00168 Rome, Italy;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Eliano P. Navarese
- SIRIO MEDICINE Research Network, 85094 Bydgoszcz,
Poland
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
- Faculty of Medicine, University of Alberta,
Edmonton, AB 13103, Canada
- Correspondence:
; Tel.: +48-52-585-4023; Fax:
+48-52-585-4024
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110
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Early coronary healing in ST segment elevation myocardial infarction: sirolimus-eluting stents vs. drug-coated balloons after bare-metal stents. The PEBSI-2 optical coherence tomography randomized study. Coron Artery Dis 2021; 32:673-680. [PMID: 33826537 DOI: 10.1097/mca.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Drug-coated balloons (DCBs) have theoretical advantages over drug-eluting stents (DESs) to facilitate stent healing. We studied whether, in patients undergoing primary coronary interventions (pPCIs), a strategy of DCB after bare-metal stent improves early healing as determined by optical coherence tomography (OCT) compared with new-generation DES. METHODS pPCI patients were randomized (1:1) to treatment with new-generation sirolimus-eluting stents (DES group) or DCB-strategy. Vessel healing was assessed by OCT at 90 days. RESULTS Fifty-three patients were randomized (26 DES vs. 27 DCB). At 90 days, both strategies showed a low rate of uncovered struts (3.2 vs. 3.2%, P = 0.64) and a very high and similar rate of covered and apposed struts (96.6 vs. 96.1%, respectively; P = 0.58). However, DCB group had a significantly lower rate of major coronary evaginations (68 vs. 37%, P = 0.026), and more frequently developed a thin homogeneous neointimal layer (20 vs. 70.4%, P = 0.001) suggesting distinct superior healing at 3 months compared to DES. CONCLUSIONS In pPCI both, sirolimus-DES and DCB-strategy, provide excellent strut coverage at 3 months. However, DCB ensures more advanced and optimal stent healing compared to sirolimus-DES. Further research is needed to determine whether, in patients undergoing pPCI, DCB offers superior long-term clinical and angiographic outcomes than new-generation DES (NCT03610347).
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111
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Faes S, Demartines N, Dormond O. Mechanistic Target of Rapamycin Inhibitors in Renal Cell Carcinoma: Potential, Limitations, and Perspectives. Front Cell Dev Biol 2021; 9:636037. [PMID: 33791295 PMCID: PMC8005589 DOI: 10.3389/fcell.2021.636037] [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: 11/30/2020] [Accepted: 02/15/2021] [Indexed: 12/16/2022] Open
Abstract
Several elements highlight the importance of the mechanistic target of rapamycin (mTOR) in the biology of renal cell carcinoma (RCC). mTOR signaling pathway is indeed frequently activated in RCC, inducing cancer cell proliferation and survival. In addition, mTOR promotes tumor angiogenesis and regulates the expression of hypoxia-inducible factors that play an important role in a subset of RCC. Despite mTOR protumorigenic effects, mTOR inhibitors have failed to provide long-lasting anticancer benefits in RCC patients, highlighting the need to readdress their role in the treatment of RCC. This review aims to present the rationale and limitations of targeting mTOR in RCC. Future roles of mTOR inhibitors in the treatment of RCC are also discussed, in particular in the context of immunotherapies.
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Affiliation(s)
- Seraina Faes
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Olivier Dormond
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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112
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Liu H, Sama GR, Robinson A, Mountford S, E Thompson P, Rodda A, Forsythe J, Mornane PJ, Pasic P, Thissen H, Byrne M, Kaye DM, Dear AE. Design, Development, In Vitro and Preliminary In Vivo Evaluation of a Novel Photo-Angioplasty Device: Lumi-Solve. Cardiovasc Eng Technol 2021; 12:466-473. [PMID: 33709249 DOI: 10.1007/s13239-021-00525-y] [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: 09/07/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Paclitaxel (PTX)-coated drug eluting balloon catheters (DEBc) used in the management of neointimal hyperplasia (NIH) have been associated with safety concerns. Alternative coating agents and targeted delivery systems may improve safety and DEBc efficacy. Utilizing a multi-platform approach we designed, developed and evaluated Lumi-Solve, a novel DEBc, coated with ultraviolet (UV) 365 nm-activated caged metacept-3 (c-MCT-3), an epigenetic agent from the histone deacetylase inhibitor (HDACi) class. METHODS In vitro catheter and contrast media transmission of UV365nm was evaluated spectroscopically. UV365nm conversion of c-MCT-3 to MCT-3 was evaluated chromatographically. Cellular toxicity and HDACi activity of c-MCT-3 ∓UV365nm was evaluated in vitro. In vivo UV365nm conversion of c-MCT-3 to MCT-3 was evaluated in an ovine carotid artery model. RESULTS Catheter material and dilute contrast media did not attenuate UV365nm transmission or c-MCT-3 activation. c-MCT-3 demonstrated less cellular toxicity than MCT-3 and PTX. UV365nm-activated c-MCT-3 demonstrated HDACi activity. In vivo activation of c-MCT-3 produced MCT-3. CONCLUSIONS Lumi-Solve, a novel DEBc device developed utilizing a combination of chemical, fibre-optic and catheter based technology platforms, demonstrated potential for targeted delivery of bioactive HDACi to the blood vessel wall supporting direct application to the management of NIH and warranting additional in vivo studies.
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Affiliation(s)
- HongBin Liu
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Gopal R Sama
- Department of Chemistry, Monash University, Clayton, Australia
| | - Andrea Robinson
- Department of Chemistry, Monash University, Clayton, Australia
| | - Simon Mountford
- Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, Australia
| | - Philip E Thompson
- Monash Institute of Pharmaceutical Sciences, Monash University, Clayton, Australia
| | - Andrew Rodda
- Monash Institute of Medical Engineering, Monash University, Clayton, Australia
| | - John Forsythe
- Monash Institute of Medical Engineering, Monash University, Clayton, Australia
| | | | - Paul Pasic
- CSIRO Biomedical Translational Facility, Melbourne, Australia
| | - Helmut Thissen
- CSIRO Biomedical Translational Facility, Melbourne, Australia
| | - Melissa Byrne
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Anthony E Dear
- Eastern Health Clinical School, Monash University, Box Hill, Australia.
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Arbeiter D, Reske T, Teske M, Bajer D, Senz V, Schmitz KP, Grabow N, Oschatz S. Influence of Drug Incorporation on the Physico-Chemical Properties of Poly(l-Lactide) Implant Coating Matrices-A Systematic Study. Polymers (Basel) 2021; 13:292. [PMID: 33477626 PMCID: PMC7831498 DOI: 10.3390/polym13020292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
Local drug delivery has become indispensable in biomedical engineering with stents being ideal carrier platforms. While local drug release is superior to systemic administration in many fields, the incorporation of drugs into polymers may influence the physico-chemical properties of said matrix. This is of particular relevance as minimally invasive implantation is frequently accompanied by mechanical stresses on the implant and coating. Thus, drug incorporation into polymers may result in a susceptibility to potentially life-threatening implant failure. We investigated spray-coated poly-l-lactide (PLLA)/drug blends using thermal measurements (DSC) and tensile tests to determine the influence of selected drugs, namely sirolimus, paclitaxel, dexamethasone, and cyclosporine A, on the physico-chemical properties of the polymer. For all drugs and PLLA/drug ratios, an increase in tensile strength was observed. As for sirolimus and dexamethasone, PLLA/drug mixed phase systems were identified by shifted drug melting peaks at 200 °C and 240 °C, respectively, whereas paclitaxel and dexamethasone led to cold crystallization. Cyclosporine A did not affect matrix thermal properties. Altogether, our data provide a contribution towards an understanding of the complex interaction between PLLA and different drugs. Our results hold implications regarding the necessity of target-oriented thermal treatment to ensure the shelf life and performance of stent coatings.
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Affiliation(s)
- Daniela Arbeiter
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Thomas Reske
- Institute for Implant Technology and Biomaterials e.V., Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany;
| | - Michael Teske
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Dalibor Bajer
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Volkmar Senz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Klaus-Peter Schmitz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
- Institute for Implant Technology and Biomaterials e.V., Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany;
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Stefan Oschatz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
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Ben-Yehuda O. Long-Term Outcomes With Drug-Eluting Stents: Beyond Stent Choice. J Am Coll Cardiol 2021; 76:159-161. [PMID: 32646564 DOI: 10.1016/j.jacc.2020.05.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York; Sulpizio Cardiovascular Center, University of California, San Diego, California.
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115
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Blessing R, Ahoopai M, Geyer M, Brandt M, Zeiher AM, Münzel T, Wenzel P, Gori T, Dimitriadis Z. The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis. J Clin Med 2020; 10:jcm10010080. [PMID: 33379321 PMCID: PMC7794972 DOI: 10.3390/jcm10010080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due to angiographic restenosis in 40% (14 of 35) of patients. OCT analysis detected neointima proliferation in 23 (76.6%) patients. Neointima formation was often associated with microvessels in 18 patients (60%). Neoatheroslcerosis was observed in 2 (6.6%) patients. Malapposition was found in 4 patients (13.3%), and stent fractures were found in 11 patients (36.6%). Rate of strut coverage was 96.3% at follow-up. In conclusion, the implantation of a Combo® DTS after successful CTO recanalization was associated with a restenosis rate of 40% despite good stent implantation at baseline, proven by OCT. Neointima formation was found as a main contributor to restenosis. Nevertheless, we observed a low rate of major cardiovascular events in our follow-up.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Majid Ahoopai
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Moritz Brandt
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, 55131 Mainz, Germany
| | - Andreas M. Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany;
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Zisis Dimitriadis
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany;
- Correspondence: ; Tel.: +49-69-6301-7387; Fax: +49-69-6301
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116
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Corduas F, Mancuso E, Lamprou DA. Long-acting implantable devices for the prevention and personalised treatment of infectious, inflammatory and chronic diseases. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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117
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Kim HS, Kang J, Hwang D, Han JK, Yang HM, Kang HJ, Koo BK, Kim SY, Park KH, Rha SW, Shin WY, Lim HS, Park K, Park KW. Durable Polymer Versus Biodegradable Polymer Drug-Eluting Stents After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: The HOST-REDUCE-POLYTECH-ACS Trial. Circulation 2020; 143:1081-1091. [PMID: 33205662 DOI: 10.1161/circulationaha.120.051700] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Large-scale randomized comparison of drug-eluting stents (DES) based on durable polymer versus biodegradable polymer technology is currently insufficient in patients with acute coronary syndrome (ACS). The present study aimed to prove the noninferiority of the durable polymer DES (DP-DES) compared with the biodegradable polymer DES (BP-DES) in such patients. METHODS The HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment of Coronary Artery Diseases-Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) trial is an investigator-initiated, randomized, open-label, adjudicator-blinded, multicenter, noninferiority trial comparing the efficacy and safety of DP-DES and BP-DES in patients with ACS. The primary end point was a patient-oriented composite outcome (a composite of all-cause death, nonfatal myocardial infarction, and any repeat revascularization) at 12 months. The key secondary end point was device-oriented composite outcome (a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization) at 12 months. RESULTS A total of 3413 patients were randomized to receive the DP-DES (1713 patients) and BP-DES (1700 patients). At 12 months, patient-oriented composite outcome occurred in 5.2% in the DP-DES group and 6.4% in the BP-DES group (absolute risk difference, -1.2%; Pnoninferiority<0.001). The key secondary end point, device-oriented composite outcome, occurred less frequently in the DP-DES group (DP-DES vs BP-DES, 2.6% vs 3.9%; hazard ratio, 0.67 [95% CI, 0.46-0.98]; P=0.038), mostly because of a reduction in target lesion revascularization. The rate of spontaneous nonfatal myocardial infarction and stent thrombosis were extremely low, with no significant difference between the 2 groups (0.6% versus 0.8%; P=0.513 and 0.1% versus 0.4%; P=0.174, respectively). CONCLUSIONS In ACS patients receiving percutaneous coronary intervention, DP-DES was noninferior to BP-DES with regard to patient-oriented composite outcomes at 12 months after index percutaneous coronary intervention. Registration: URL: https://wwwclinicaltrials.gov; Unique identifier: NCT02193971.
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Affiliation(s)
- Hyo-Soo Kim
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Jeehoon Kang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Doyeon Hwang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Jung-Kyu Han
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Han-Mo Yang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Hyun-Jae Kang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Bon-Kwon Koo
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | | | - Keun-Ho Park
- Chosun University Hospital, Gwangju, Korea (K-H.P.)
| | | | - Won-Yong Shin
- Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea (W-Y.S.)
| | - Hong-Seok Lim
- Ajou University School of Medicine, Suwon, Korea (H-S.L.)
| | | | - Kyung Woo Park
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
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118
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Zhang B, Yao R, Hu C, Maitz MF, Wu H, Liu K, Yang L, Luo R, Wang Y. Epigallocatechin gallate mediated sandwich-like coating for mimicking endothelium with sustained therapeutic nitric oxide generation and heparin release. Biomaterials 2020; 269:120418. [PMID: 33143876 DOI: 10.1016/j.biomaterials.2020.120418] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
In-stent restenosis after stenting is generally characterized by an inflammatory response, excessive proliferation of smooth muscle cells, and delayed healing of the endothelium layer. In this study, inspired by catechol/gallol surface chemistry, a sandwich-like layer-by-layer (LBL) coating was developed using chitosan and heparin as polyelectrolytes, along with the embedding of an epigallocatechin gallate/copper (EGCG/Cu) complex. The embedding of EGCG stabilized the coating by various intermolecular interactions in the LBL coating (e.g., π-π stacking, weak intermolecular crosslinking, and enriched hydrogen bonding) and supported the sustained release of the cargo heparin over 90 days. This design enabled a biomimetic endothelium function in terms of the sustained release of heparin and continuous in situ generation of nitric oxide, driven by the catalytic decomposition of endogenous S-nitrostothiols by copper ions. The result showed enhanced durability of anticoagulation and suppressed inflammatory response. Moreover, the "sandwich-like" coating supported the growth of endothelial cells and up-regulated the protein expression of vascular endothelial growth factor, while effectively suppressing the proliferation and migration of smooth muscle cells (SMCs) via the up-regulation of cyclic guanosine monophosphate. Ex vivo and in vivo experiments demonstrated the effectiveness of the sandwich-like coating in preventing thrombosis formation, suppressing the growth of SMCs, reducing the infiltration and activation of inflammatory cells, and ultimately achieving rapid in situ endothelialization. Hence, the EGCG-assisted sandwich-like coating might be used as a robust and versatile surface modification strategy for implantable cardiovascular devices.
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Affiliation(s)
- Bo Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China
| | - Ruijuan Yao
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China
| | - Cheng Hu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China
| | - Manfred F Maitz
- Max Bergmann Center of Biomaterials, Leibniz Institute of Polymer Research Dresden, Dresden, 01069, Germany; Key Lab. for Advanced Technologies of Materials, Ministry of Education, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Haoshuang Wu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China
| | - Kunpeng Liu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China
| | - Rifang Luo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China.
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, China.
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Moreno-Estar S, Serrano S, Arévalo-Martínez M, Cidad P, López-López JR, Santos M, Pérez-Garcia MT, Arias FJ. Elastin-like recombinamer-based devices releasing Kv1.3 blockers for the prevention of intimal hyperplasia: An in vitro and in vivo study. Acta Biomater 2020; 115:264-274. [PMID: 32771595 DOI: 10.1016/j.actbio.2020.07.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/25/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022]
Abstract
Coronary artery disease (CAD) is the most common cardiovascular disorder. Vascular surgery strategies for coronary revascularization (either percutaneous or open) show a high rate of failure because of restenosis of the vessel, due to phenotypic switch of vascular smooth muscle cells (VSMCs) leading to proliferation and migration. We have previously reported that the inhibition of Kv1.3 channel function with selective blockers represents an effective strategy for the prevention of restenosis in human vessels used for coronary angioplasty procedures. However, delivery systems for controlled release of these drugs have not been investigated. Here we tested the efficacy of several formulations of elastin like recombinamers (ELRs) hydrogels to deliver the Kv1.3 blocker PAP-1 in various restenosis models. The dose and time course of PAP-1 release from ELRs click hydrogels was able to inhibit human VSMC proliferation in vitro as well as remodeling of human vessels in organ culture and restenosis in in vivo models. We conclude that this combination of active compound and advanced delivery method could improve the outcomes of vascular surgery in patients. STATEMENT OF SIGNIFICANCE: Vascular surgery strategies for coronary revascularization show a high rate of failure, because of occlusion (restenosis) of the vessel, due to vascular smooth muscle cells proliferation and migration. We have previously reported that blockers of Kv1.3 channels represent an effective anti-restenosis therapy, but delivery systems for their controlled release have not being explored. Here we tested the efficacy of several formulations of elastin like recombinamers (ELRs) hydrogels to deliver the Kv1.3 blocker PAP-1 in various restenosis models, both in vivo and in vitro, and also in human vessels. We demonstrated that combination of active compound and advanced delivery method could improve the outcomes of vascular surgery in patients.
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Vishnu J, Manivasagam G. Perspectives on smart stents with sensors: From conventional permanent to novel bioabsorbable smart stent technologies. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/mds3.10116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jithin Vishnu
- Centre for Biomaterials Cellular and Molecular Theranostics CBCMT Vellore Institute of Technology Vellore India
| | - Geetha Manivasagam
- Centre for Biomaterials Cellular and Molecular Theranostics CBCMT Vellore Institute of Technology Vellore India
- IBTN/In ‐ Indian branch of Institute of Biomaterials Tribocorrosion and Nanomedicine Vellore Institute of Technology Vellore India
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Comparison of First- and Second-Generation Drug-Eluting Stents in Patients with Acute Myocardial Infarction and Prediabetes Based on the Hemoglobin A1c Level. J Interv Cardiol 2020; 2020:1710439. [PMID: 32733169 PMCID: PMC7383308 DOI: 10.1155/2020/1710439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/27/2020] [Accepted: 06/20/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To compare major clinical outcomes after successful percutaneous coronary intervention (PCI) with first-generation (1G) drug-eluting stents (DES) and second-generation (2G) DES in patients with acute myocardial infarction (AMI) and prediabetes. BACKGROUND Patients with prediabetes are associated with an increased incidence of coronary artery disease. The relative superiority of 1G- and 2G-DES in these patients is not well established. METHODS A total of 4997 patients with AMI and prediabetes were divided into two groups: the 1D-DES group (n = 726) and the 2G-DES group (n = 4271). The primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any disease revascularization at 2-year follow-up. The secondary outcome was probable or definite stent thrombosis (ST). RESULTS After propensity score-matching (PSM) analysis, two PSM groups (698 pairs, n = 1396, C-statistics = 0.725) were generated. The cumulative incidence rates of POCOs (hazard ratio (HR): 1.467; 95% confidence interval (CI): 1.068-2.015; p = 0.018), any disease revascularization (HR: 2.259; 95% CI: 1.397-3.654; p = 0.001), and ST (HR: 4.361; 95% CI: 1.243-15.30; p = 0.021) in the 1G-DES group were significantly higher than those in the 2G-DES group. However, the cumulative incidence rates of all-cause death, cardiac death, and Re-MI were similar between the two groups. CONCLUSIONS In patients with AMI and prediabetes, 2G-DES implantation was more efficacious than 1G-DES implantation over a 2-year follow-up period. However, further studies are needed to confirm these results.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seuol, Republic of Korea
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Gherbesi E, Danzi GB. The Ultimaster coronary stent system: 5-year worldwide experience. Future Cardiol 2020; 16:251-261. [DOI: 10.2217/fca-2019-0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Newer generation drug-eluting stents have significantly improved outcomes in patients undergoing percutaneous coronary intervention by reducing the risk of restenosis and stent thrombosis. In comparison with first-generation ones, contemporary drug-eluting stents have thinner struts and more biocompatible polymers, which reduce inflammation, promote endothelialization and decrease neointimal proliferation. The Ultimaster™/Ultimaster™ Tansei™ coronary stent system is a cobalt–chromium, biodegradable polymer, sirolimus-eluting stent (Terumo, Tokyo, Japan) that received the Conformitè Européenne mark approval for clinical use in 2014/2018. This device has been the object of intense clinical evaluation in controlled randomized studies and observational registries. In this article, we analytically reviewed the available clinical data with a focus on the latest real-world evidence that demonstrates excellent performance in all of the clinical subsets.
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Affiliation(s)
- Elisa Gherbesi
- Department of Cardiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
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Jinnouchi H, Guo L, Sakamoto A, Sato Y, Cornelissen A, Kawakami R, Mori M, Torii S, Kuntz S, Harari E, Mori H, Fuller D, Gadhoke N, Fernandez R, Paek KH, Surve D, Romero M, Kolodgie FD, Virmani R, Finn AV. Advances in mammalian target of rapamycin kinase inhibitors: application to devices used in the treatment of coronary artery disease. Future Med Chem 2020; 12:1181-1195. [PMID: 32431177 PMCID: PMC7333590 DOI: 10.4155/fmc-2019-0304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
Mammalian target of rapamycin (mTOR) inhibitors have been applied to vascular coronary devices to avoid neointimal growth and have become the predominant pharmacological agents used to prevent restenosis. mTOR inhibitors can affect not only proliferating vascular smooth muscle cells but also endothelial cells and therefore can result in delayed healing of the vessel including endothelialization. Emerging evidence suggests accelerated atherosclerosis due to the downstream negative effects on endothelial barrier functional recovery. The development of neoatherosclerosis within the neointima of drug-eluting stents can result in late thrombotic events. This type of problematic healing response may open the way for specific mTOR kinase inhibitors, such as ATP-competitive mTOR inhibitors. These inhibitors demonstrate a better healing profile than traditional limus-based drug-eluting stent and their clinical efficacy remains unknown.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Liang Guo
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Atsushi Sakamoto
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Yu Sato
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Anne Cornelissen
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Rika Kawakami
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Masayuki Mori
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Sho Torii
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Salome Kuntz
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Emanuel Harari
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Hiroyoshi Mori
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Daniela Fuller
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Neel Gadhoke
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Raquel Fernandez
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Ka Hyun Paek
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Dipti Surve
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Maria Romero
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Frank D Kolodgie
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
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Guillory RJ, Kolesar TM, Oliver AA, Stuart JA, Bocks ML, Drelich JW, Goldman J. Zn 2+-dependent suppression of vascular smooth muscle intimal hyperplasia from biodegradable zinc implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 111:110826. [PMID: 32279804 PMCID: PMC7962177 DOI: 10.1016/j.msec.2020.110826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 11/18/2022]
Abstract
Biodegradable arterial implants based on zinc have been found to suppress neointimal hyperplasia, suggesting that biodegradable materials containing zinc may be used to construct vascular implants with a reduced rate of restenosis. However, the molecular mechanism has remained unclear. In this report, we show that zinc-containing materials can be used to prevent neointimal formation when implanted into the rat aorta. Indeed, neointimal cells were significantly more TUNEL positive and alpha-actin negative at the interface of biodegradable zinc vs. biostable platinum implants, in association with greater caspase-3 activity. Although zinc stimulated extensive neointimal smooth muscle cell (SMC) death, macrophage and proinflammatory markers CD68 and iNOS were not increased in neointimal tissue relative to biostable platinum control implants. Using arterial explants, ionic zinc was confirmed to promote SMC apoptosis by activating the caspase apoptotic signaling pathway. These observations suggest that zinc-containing materials can be used to construct vascular implants such as stents with reduced neointimal hyperplasia.
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Affiliation(s)
- Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, USA.
| | - Timothy M Kolesar
- Department of Biomedical Engineering, Michigan Technological University, USA
| | - Alexander A Oliver
- Department of Biomedical Engineering, Michigan Technological University, USA
| | | | - Martin L Bocks
- Case Western Reserve University School of Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, USA
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, USA.
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Wu Y, Chang L, Li J, Wang L, Guan S. Conjugating heparin, Arg–Glu–Asp–Val peptide, and anti-CD34 to the silanic Mg–Zn–Y–Nd alloy for better endothelialization. J Biomater Appl 2020; 35:158-168. [DOI: 10.1177/0885328220926655] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Magnesium alloy is generally accepted as a potential cardiovascular stent material due to its good mechanical properties, biocompatibility, and biodegradability, and has become one of the research hotspots in this field. However, too fast degradation rate and delayed surface endothelialization have been the bottleneck of further application of magnesium alloy stent. In this study, we selected Mg–Zn–Y–Nd, a kind of biodegradable magnesium alloy for cardiovascular stent, and passivated its surface by alkali heat treatment and silane treatment to improve the corrosion resistance, subsequently conjugated Arg–Glu–Asp–Val (REDV) peptide and anti-CD34 to promote endothelial cells adhesion and capture endothelial progenitor cells respectively, further improving surface endothelialization. In addition, the heparin was also immobilized to the Mg–Zn–Y–Nd surface for the consideration of anti-coagulation and anti-inflammation. Systematic material characterization and biological evaluation show that we have successfully developed this composite surface on Mg–Zn–Y–Nd alloy, and achieved multiple functions such as corrosion resistance, promoting endothelialization, and inhibiting platelet/macrophage adhesion.
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Affiliation(s)
- Yuxiang Wu
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Lei Chang
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Jingan Li
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Liguo Wang
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Shaokang Guan
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
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Jinnouchi H, Otsuka F, Sato Y, Bhoite RR, Sakamoto A, Torii S, Yahagi K, Cornelissen A, Mori M, Kawakami R, Kolodgie FD, Virmani R, Finn AV. Healthy Strut Coverage After Coronary Stent Implantation: An Ex Vivo Human Autopsy Study. Circ Cardiovasc Interv 2020; 13:e008869. [PMID: 32338525 DOI: 10.1161/circinterventions.119.008869] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Struts have been considered as covered when tissue overlying the struts is >0 μm by optical coherence tomography (OCT). However, there is no confirmatory study to validate this definition by histology which is the gold standard. The aim of the present study was to assess the appropriate cutoff value of neointimal thickness of stent strut coverage by OCT with histology confirmation. METHODS We performed ex vivo OCT imaging of human coronary arteries with stents at autopsy. A total of 46 stents in 39 vessels from 25 patients were examined in this study, and a total of 165 cross-sectional images were co-registered with histology to determine the optimal cutoff value for strut coverage by OCT which was defined as luminal endothelial cells with 2 abluminal layers of smooth muscles cells and matrix. Considering the resolution of OCT is 10 to 20 μm, the cutoff values were assessed at ≥20, ≥40, and ≥60 μm. RESULTS A total of 2235 struts were reviewed by histology, 1216 were considered as well-matched struts which were analyzed in this study. By histology, 160 struts were identified as uncovered, while 1056 struts were covered. The OCT assessment without consideration of neointimal thickness yielded a poor specificity of 37.5% and sensitivity 100%. Of 3 cutoff values, the cutoff value of ≥40 μm yielded the best sensitivity (99.3%), specificity (91.0%), positive predictive value (98.6%), and negative predictive value (95.6%) as compared with ≥20 and ≥60 μm. CONCLUSIONS Neointimal thickness ≥40 μm by OCT yielded the most accurate cutoff value to identify stent strut coverage validated by histology.
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Affiliation(s)
- Hiroyuki Jinnouchi
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Fumiyuki Otsuka
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Yu Sato
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Rahul R Bhoite
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Atsushi Sakamoto
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Sho Torii
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Kazuyuki Yahagi
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Anne Cornelissen
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Masayuki Mori
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Rika Kawakami
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Frank D Kolodgie
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Renu Virmani
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.)
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD (H.J., F.O., Y.S., R.R.B., A.S., S.T., K.Y., A.C., M.M., R.K., F.D.K., R.V., A.V.F.).,University of Maryland, School of Medicine, Baltimore (A.V.F.)
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Riascos-Bernal DF. Perking Up Strategies to Control Restenosis. JACC Basic Transl Sci 2020; 5:264-266. [PMID: 32215377 PMCID: PMC7091502 DOI: 10.1016/j.jacbts.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dario F. Riascos-Bernal
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, Bronx, New York
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York
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Torii S, Jinnouchi H, Sakamoto A, Mori H, Park J, Amoa FC, Sawan M, Sato Y, Cornelissen A, Kuntz SH, Kutyna M, Paek KH, Fernandez R, Braumann R, Mont EK, Surve D, Romero ME, Kolodgie FD, Virmani R, Finn AV. Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing. Eur Heart J 2020; 41:786-796. [PMID: 31803916 PMCID: PMC7828465 DOI: 10.1093/eurheartj/ehz850] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/18/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Abstract
AIMS Vascular calcification is routinely encountered in percutaneous coronary intervention (PCI) and severe coronary calcification is a known predictor of in-stent restenosis and stent thrombosis. However, the histopathologic mechanisms behind such events have not been systematically described. METHODS AND RESULTS From our registry of 1211 stents, a total of 134 newer-generation drug-eluting stents (DES) (Xience, Resolute-Integrity, PROMUS-Element, and Synergy) with duration of implant ≥30 days were histologically analysed. The extent of calcification of the stented lesions was evaluated radiographically and divided into severe (SC, n = 46) and non-severely calcified lesions (NC, n = 88). The percent-uncovered struts per section {SC vs. NC; median 2.4 [interquartile range (IQR) 0.0-19.0] % vs. 0.0 (IQR 0.0-4.6) %, P = 0.02} and the presence of severe medial tears (MTs) (59% vs. 44%, respectively, P = 0.03) were greater in SC than NC. In addition, SC had a higher prevalence of ≥3 consecutive struts lying directly in contact with surface calcified area (3SC) (52% vs. 8%, respectively, P < 0.0001). Multivariate analysis demonstrated that sections with duration of implantation ≤6 months [odds ratio (OR): 7.7, P < 0.0001], 3SC (OR: 6.5, P < 0.0001), strut malapposition (OR: 5.0, P < 0.0001), and lack of MTs (OR: 2.5, P = 0.0005) were independent predictors of uncovered struts. Prevalence of neoatherosclerosis was significantly lower in SC than that of NC (24% vs. 44%, P = 0.02). CONCLUSION Severe calcification, especially surface calcified area is an independent predictor of uncovered struts and delayed healing after newer-generation DES implantation. These data expand of knowledge of the vascular responses of stenting of calcified arteries and suggests further understand of how best to deal with calcification in patients undergoing PCI.
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Affiliation(s)
- Sho Torii
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Hiroyuki Jinnouchi
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Atsushi Sakamoto
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Hiroyoshi Mori
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Joohyung Park
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Falone C Amoa
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Mariem Sawan
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA
| | - Yu Sato
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Anne Cornelissen
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Salome H Kuntz
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Matthew Kutyna
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Ka Hyun Paek
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Raquel Fernandez
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Ryan Braumann
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Eric K Mont
- Forensic Pathology, Nova Scotia Medical Examiner Service, 51 Garland Ave, Dartmouth, NS B3B 0A6, Nova Scotia, Canada
| | - Dipti Surve
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Maria E Romero
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Frank D Kolodgie
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- Department of Cardiovascular Pathology, CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA
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Naseri E, Butler H, MacNevin W, Ahmed M, Ahmadi A. Low-temperature solvent-based 3D printing of PLGA: a parametric printability study. Drug Dev Ind Pharm 2020; 46:173-178. [DOI: 10.1080/03639045.2019.1711389] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Emad Naseri
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, Canada
| | - Haley Butler
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, Canada
| | - Wyatt MacNevin
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, Canada
| | - Marya Ahmed
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, Canada
| | - Ali Ahmadi
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, Canada
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132
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Huang Y, Li T, Gao W, Wang Q, Li X, Mao C, Zhou M, Wan M, Shen J. Platelet-derived nanomotor coated balloon for atherosclerosis combination therapy. J Mater Chem B 2020; 8:5765-5775. [DOI: 10.1039/d0tb00789g] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A nanorobot is used to realize deep penetration of drugs in atherosclerotic plaque, photothermal ablation of inflammatory macrophages and long-term anti-proliferation effects.
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Affiliation(s)
- Yangyang Huang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
| | - Ting Li
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
| | - Wentao Gao
- Department of Vascular Surgery
- Nanjing Drum Tower Hospital
- The Affiliated Hospital of Nanjing University Medical School
- P. R. China
| | - Qi Wang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
| | - Xiaoyun Li
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
| | - Chun Mao
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
| | - Min Zhou
- Department of Vascular Surgery
- Nanjing Drum Tower Hospital
- The Affiliated Hospital of Nanjing University Medical School
- P. R. China
| | - Mimi Wan
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
| | - Jian Shen
- National and Local Joint Engineering Research Center of Biomedical Functional Materials
- School of Chemistry and Materials Science
- Nanjing Normal University
- P. R. China
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133
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Li JA, Chen L, Zhang XQ, Guan SK. Enhancing biocompatibility and corrosion resistance of biodegradable Mg-Zn-Y-Nd alloy by preparing PDA/HA coating for potential application of cardiovascular biomaterials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 109:110607. [PMID: 32228927 DOI: 10.1016/j.msec.2019.110607] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/27/2022]
Abstract
In this paper the poly-dopamine (PDA)/hyaluronic acid (HA) coatings with different HA molecular weight (MW, 4 × 103, 1 × 105, 5 × 105 and 1 × 106 Da) were prepared onto the NaOH passivated Mg-Zn-Y-Nd alloy aiming at potential application of cardiovascular implants. The characterization of weight loss, polarization curves and surface morphology indicated that the coatings with HA MW of 1 × 105 (PDA/HA-2) and 1 × 106 Da (PDA/HA-4) significantly enhanced the corrosion resistance of Mg-Zn-Y-Nd. In vitro biological test also suggested better hemocompatibility, pro-endothelialization, anti-hyperplasia and anti-inflammation functions of the PDA/HA-2- and PDA/HA-4-coated Mg-Zn-Y-Nd alloy. Nevertheless, the in vivo implantation of SD rats' celiac artery demonstrated that the PDA/HA-2 had preferable corrosion resistance and biocompatibility.
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Affiliation(s)
- Jing-An Li
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, 100 Science Road, Zhengzhou 450001, PR China.
| | - Li Chen
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, 100 Science Road, Zhengzhou 450001, PR China
| | - Xue-Qi Zhang
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, 100 Science Road, Zhengzhou 450001, PR China
| | - Shao-Kang Guan
- School of Materials Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold Technology (Ministry of Education), Zhengzhou University, 100 Science Road, Zhengzhou 450001, PR China.
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