Enabling Angioplasty-Ready "Smart" Stents to Detect In-Stent Restenosis and Occlusion

Detection of Blood Clots Using a Whole Stent as an Active Implantable Biosensor

Many cardiovascular problems stem from blockages that form within the vasculature and often treatment includes fitting a stent through percutaneous coronary intervention. This offers a minimally invasive therapy but re-occlusion through restenosis or thrombosis formation often occurs post-deployment. Research is ongoing into the creation of smart stents that can detect the occurrence of further problems. In this study, it is shown that selectively metalizing a non-conductive stent can create a set of electrodes that are capable of detecting a build-up of material around the stent. The associated increase in electrical impedance across the electrodes is measured, testing the stent with blood clot to mimic thrombosis. It is shown that the device is capable of sensing different amounts of occlusion. The stent can reproducibly sense the presence of clot showing a 16% +/-3% increase in impedance which is sufficient to reliably detect the clot when surrounded by explanted aorta (one sample t-test, p = 0.009, n = 9). It is demonstrated that this approach can be extended beyond the 3D printed prototypes by showing that it can be applied to a commercially available stent and it is believed that it can be further utilized by other types of medical implants.

Design and Characterisation of a Read-Out System for Wireless Monitoring of a Novel Implantable Sensor for Abdominal Aortic Aneurysm Monitoring

Abdominal aortic aneurysm (AAA) is a dilation of the aorta artery larger than its normal diameter (>3 cm). Endovascular aneurysm repair (EVAR) is a minimally invasive treatment option that involves the placement of a graft in the aneurysmal portion of the aorta artery. This treatment requires multiple follow-ups with medical imaging, which is expensive, time-consuming, and resource-demanding for healthcare systems. An alternative solution is the use of wireless implantable sensors (WIMSs) to monitor the growth of the aneurysm. A WIMS capable of monitoring aneurysm size longitudinally could serve as an alternative monitoring approach for post-EVAR patients. This study has developed and characterised a three-coil inductive read-out system to detect variations in the resonance frequency of the novel Z-shaped WIMS implanted within the AAA sac. Specifically, the spacing between the transmitter and the repeater inductors was optimised to maximise the detection of the sensor by the transmitter inductor. Moreover, an experimental evaluation was also performed for different orientations of the transmitter coil with reference to the WIMS. Finally, the FDA-approved material nitinol was used to develop the WIMS, the transmitter, and repeater inductors as a proof of concept for further studies. The findings of the characterisation from the air medium suggest that the read-out system can detect the WIMS up to 5 cm, regardless of the orientation of the Z-shape WIMS, with the detection range increasing as the orientation approaches 0°. This study provides sufficient evidence that the proposed WIMS and the read-out system can be used for AAA expansion over time.

Digitalomics, digital intervention, and designing future: The next frontier in cardiology

The discipline of cardiology stands at a transformative juncture, primarily influenced by the surge in digital health technologies. These innovations hold the promise to redefine the realms of cardiovascular research and patient care, ushering in an era of individualized and data-driven treatments. This review delves into the heart of this evolution, introducing a comprehensive design for the future of cardiology. Emphasizing the emerging domains of "digitalomics" and "digital intervention", it explores how the integration of patient data, artificial intelligence-enabled diagnostics, and telehealth can lead to more streamlined and personalized cardiovascular health. The "digital-twin" model, a highlight of this approach, encapsulates individual patient characteristics, allowing for targeted treatments. The role of interdisciplinary collaboration in cardiovascular medicine is also underlined, emphasizing the importance of merging traditional cardiology with technological advancements. The convergence of traditional cardiology methods and digital health technologies, facilitated by a transdisciplinary approach, is set to chart a new course in cardiovascular health, emphasizing individualized care and improved clinical outcomes.

Simultaneous detection of the shuttling motion of liquid metal droplets in channels under alternating pressure and capacitive sensor signals

Implementing a signal-switching mechanism for the selective use of integrated sensors and actuators plays a crucial role in streamlining the functionality of miniaturized devices. Here, a liquid metal droplet (LMD)-based signal-switching mechanism is introduced to achieve such functionality. Pressure modulation with a 100-μm spatial resolution enabled precise control of the position of the LMDs within a channel. After integrating the channel with asymmetrically structured electrodes, the effect of the shuttle-like movement of LMD on the temporal changes in the overall capacitance was investigated. Consequently, analysis of the capacitive peaks revealed the directional movement of the LMDs, enabling estimation of the position of the LMDs without direct observation. In addition, we achieved successful signal extraction from the capacitive sensor that was linked to the activated electrodes, thereby enabling selective data retrieval. The proposed signal-switching mechanism method achieved a detection accuracy of ~0.1 pF. The sensor's ability to simultaneously detect the LMD position and generate a signal underscores its significant potential for multiplexing in multisensing systems, particularly in concealed environments, such as in vivo settings.

Haemodynamics of stent-mounted neural interfaces in tapered and deformed blood vessels

The endovascular neural interface provides an appealing minimally invasive alternative to invasive brain electrodes for recording and stimulation. However, stents placed in blood vessels have long been known to affect blood flow (haemodynamics) and lead to neointimal growth within the blood vessel. Both the stent elements (struts and electrodes) and blood vessel wall geometries can affect the mechanical environment on the blood vessel wall, which could lead to unfavourable vascular remodelling after stent placement. With increasing applications of stents and stent-like neural interfaces in venous blood vessels in the brain, it is necessary to understand how stents affect blood flow and tissue growth in veins. We explored the haemodynamics of a stent-mounted neural interface in a blood vessel model. Results indicated that blood vessel deformation and tapering caused a substantial change to the lumen geometry and the haemodynamics. The neointimal proliferation was evaluated in sheep implanted with an endovascular neural interface. Analysis showed a negative correlation with the mean Wall Shear Stress pattern. The results presented here indicate that the optimal stent oversizing ratio must be considered to minimise the haemodynamic impact of stenting.

Millimeter-scale magnetic implants paired with a fully integrated wearable device for wireless biophysical and biochemical sensing

Implantable sensors can directly interface with various organs for precise evaluation of health status. However, extracting signals from such sensors mainly requires transcutaneous wires, integrated circuit chips, or cumbersome readout equipment, which increases the risks of infection, reduces biocompatibility, or limits portability. Here, we develop a set of millimeter-scale, chip-less, and battery-less magnetic implants paired with a fully integrated wearable device for measuring biophysical and biochemical signals. The wearable device can induce a large amplitude damped vibration of the magnetic implants and capture their subsequent motions wirelessly. These motions reflect the biophysical conditions surrounding the implants and the concentration of a specific biochemical depending on the surface modification. Experiments in rat models demonstrate the capabilities of measuring cerebrospinal fluid (CSF) viscosity, intracranial pressure, and CSF glucose levels. This miniaturized system opens the possibility for continuous, wireless monitoring of a wide range of biophysical and biochemical conditions within the living organism.

Ultraconformable Capacitive Strain Sensor Utilizing Network Structure of Single-Walled Carbon Nanotubes for Wireless Body Sensing

Capture and real-time recording of precise body movements using strain sensors provide personal information for healthcare monitoring and management. To acquire this information, a sensor that conforms to curved irregular surfaces, including biological tissue, is desired to record complex body movements while acting like a second skin to avoid interference with the movements. In this study, we developed a thin-film-type capacitive strain sensor that is flexible and stretchable on the surface of a living body. We fabricated conductive polymeric ultrathin films ("nanosheets") comprising polystyrene-block-polybutadiene (SB) elastomers and single-walled carbon nanotubes (SWCNTs) (i.e., SWCNT-SB nanosheets) via gravure coating; the SWCNT-SB-coated nanosheets were used as the flexible electrode in a capacitive strain sensor. The dielectric (DE) layer was then prepared using the silicone elastomer Ecoflex 00-30 because its Young's modulus is comparable to that of the epidermis. The normalized capacitance changes (ΔC/C0) in the sensor increased with increasing tensile strain over a range from 0-100%, indicating that the proposed sensor can measure the strain of biological movements, including those of skin and blood vessels. To improve sensor conformability further, the effect of sensor thickness on the gauge factor (GF) was investigated using thinner DE layers by focusing on their flexural rigidity. As a result, the GF increased from 0.64 to 1.13 as the DE layer thickness decreased from 260 to 40 μm. Finally, we evaluated the fabricated sensor's signal stability and mechanical durability, including during wireless sensing when applied to human skin and a vascular model. The ΔC/C0 values varied in response to the bending motion of a finger, dilation of a blood vessel, and the swallowing movement of the throat. These results indicate that our capacitive strain sensor is conformable and functional on biological tissue to enable monitoring of dynamic biological movements (e.g., pulse rate and arterial dilation) without wearer discomfort.

Chinese Herbal Medicines for Coronary Heart Disease: Clinical Evidence, Pharmacological Mechanisms, and the Interaction with Gut Microbiota

Coronary heart disease (CHD) is a common type of cardiovascular disease (CVD) that has been on the rise in terms of both incidence and mortality worldwide, presenting a significant threat to human health. An increasing body of studies has shown that traditional Chinese medicine (TCM), particularly Chinese herbal medicines (CHMs), can serve as an effective adjunctive therapy to enhance the efficacy of Western drugs in treating CHD due to their multiple targets and multiple pathways. In this article, we critically review data available on the potential therapeutic strategies of CHMs in the intervention of CHD from three perspectives: clinical evidence, pharmacological mechanisms, and the interaction with gut microbiota. We identified 20 CHMs used in clinical practice and it has been found that the total clinical effective rate of CHD patients improved on average by 17.78% with the intervention of these CHMs. Subsequently, six signaling pathways commonly used in treating CHD have been identified through an overview of potential pharmacological mechanisms of these 20 CHMs and the eight representative individual herbs selected from them. CHMs could also act on gut microbiota to intervene in CHD by modulating the composition of gut microbiota, reducing trimethylamine-N-oxide (TMAO) levels, increasing short-chain fatty acids (SCFAs), and maintaining appropriate bile acids (BAs). Thus, the therapeutic potential of CHMs for CHD is worthy of further study in view of the outcomes found in existing studies.

Implantable Self-Reporting Stents for Detecting In-Stent Restenosis and Cardiac Functional Dynamics

Despite the increasing number of stents implanted each year worldwide, patients remain at high risk for developing in-stent restenosis. Various self-reporting stents have been developed to address this challenge, but their practical utility has been limited by low sensitivity and limited data collection. Herein, we propose a next-generation self-reporting stent that can monitor blood pressure and blood flow inside the blood arteries. This proposed self-reporting stent utilizes a larger inductor coil encapsulated on the entire surface of the stent strut, resulting in a 2-fold increase in the sensing resolution and coupling distance between the sensor and external antenna. The dual-pressure sensors enable the detection of blood flow in situ. The feasibility of the proposed self-reporting stent is successfully demonstrated through in vivo analysis in rats, verifying its biocompatibility and multifunctional utilities. This multifunctional self-reporting stent has the potential to greatly improve cardiovascular care by providing real-time monitoring and unprecedented insight into the functional dynamics of the heart.

Antimicrobial and Antiproliferative Coatings for Stents in Veterinary Medicine-State of the Art and Perspectives

Microbial colonization in veterinary stents poses a significant and concerning issue in veterinary medicine. Over time, these pathogens, particularly bacteria, can colonize the stent surfaces, leading to various complications. Two weeks following the stent insertion procedure, the colonization becomes observable, with the aggressiveness of bacterial growth directly correlating with the duration of stent placement. Such microbial colonization can result in infections and inflammations, compromising the stent's efficacy and, subsequently, the animal patient's overall well-being. Managing and mitigating the impact of these pathogens on veterinary stents is a crucial challenge that veterinarians and researchers are actively addressing to ensure the successful treatment and recovery of their animal patients. In addition, irritation of the tissue in the form of an inserted stent can lead to overgrowth of granulation tissue, leading to the closure of the stent lumen, as is most often the case in the trachea. Such serious complications after stent placement require improvements in the procedures used to date. In this review, antibacterial or antibiofilm strategies for several stents used in veterinary medicine have been discussed based on the current literature and the perspectives have been drawn. Various coating strategies such as coating with hydrogel, antibiotic, or other antimicrobial agents have been reviewed.

Current state of the art and future directions for implantable sensors in medical technology: Clinical needs and engineering challenges

Implantable sensors have revolutionized the way we monitor biophysical and biochemical parameters by enabling real-time closed-loop intervention or therapy. These technologies align with the new era of healthcare known as healthcare 5.0, which encompasses smart disease control and detection, virtual care, intelligent health management, smart monitoring, and decision-making. This review explores the diverse biomedical applications of implantable temperature, mechanical, electrophysiological, optical, and electrochemical sensors. We delve into the engineering principles that serve as the foundation for their development. We also address the challenges faced by researchers and designers in bridging the gap between implantable sensor research and their clinical adoption by emphasizing the importance of careful consideration of clinical requirements and engineering challenges. We highlight the need for future research to explore issues such as long-term performance, biocompatibility, and power sources, as well as the potential for implantable sensors to transform healthcare across multiple disciplines. It is evident that implantable sensors have immense potential in the field of medical technology. However, the gap between research and clinical adoption remains wide, and there are still major obstacles to overcome before they can become a widely adopted part of medical practice.

Electromechanically Functionalized Ureteral Stents for Wireless Obstruction Monitoring

While millions of ureteral stents are placed in patients with urinary tract issues around the world every year, hydronephrosis still poses great danger to these patients as a common complication. In the present work, an intelligent double-J ureteral stent equipped with a micro pressure sensor and antenna circuitry is investigated and prototyped toward enabling continuous wireless monitoring of kidney pressure to detect a ureteral obstruction and the resultant hydronephrosis via the indwelling stent. This electromechanically functionalized "intelligent" ureteral stent acts as a radiofrequency resonator with a pressure-sensitive resonant frequency that can be interrogated using an external antenna to track the local pressure. The prototype passes mechanical bending tests of up to 15 cm radius of curvature and shows wireless sensing with a sensitivity of 3.1 kHz/mmHg in artificial urine, which represents 25× enhancement over the preceding design, using an in vitro model with test tissue layers and a pressure range that functions within the conditions found in hydronephrotic conditions. These promising results are expected to propel intelligent ureteral stent technology into further clinical research.

Machine Learning-Enhanced Flexible Mechanical Sensing

To realize a hyperconnected smart society with high productivity, advances in flexible sensing technology are highly needed. Nowadays, flexible sensing technology has witnessed improvements in both the hardware performances of sensor devices and the data processing capabilities of the device's software. Significant research efforts have been devoted to improving materials, sensing mechanism, and configurations of flexible sensing systems in a quest to fulfill the requirements of future technology. Meanwhile, advanced data analysis methods are being developed to extract useful information from increasingly complicated data collected by a single sensor or network of sensors. Machine learning (ML) as an important branch of artificial intelligence can efficiently handle such complex data, which can be multi-dimensional and multi-faceted, thus providing a powerful tool for easy interpretation of sensing data. In this review, the fundamental working mechanisms and common types of flexible mechanical sensors are firstly presented. Then how ML-assisted data interpretation improves the applications of flexible mechanical sensors and other closely-related sensors in various areas is elaborated, which includes health monitoring, human-machine interfaces, object/surface recognition, pressure prediction, and human posture/motion identification. Finally, the advantages, challenges, and future perspectives associated with the fusion of flexible mechanical sensing technology and ML algorithms are discussed. These will give significant insights to enable the advancement of next-generation artificial flexible mechanical sensing.

Sensors-based monitoring and treatment approaches for in-stent restenosis

Cardiovascular disease (CVD) can progressively narrow arteries due to plaque accumulation on the inner walls of the blood vessels, which results in an obstructed blood flow, leading to heart attack, stroke, and even death if the obstruction is severe. A popular treatment for the disease is to use an intravascular mechanical device called the stent to achieve an immediate restoration of blood flow. However, the physical stimulation induced by the stent expansion can cause inflammation of the vessel tissue. As one of the most common post-stenting complications, re-narrowing of the vessel is the main pathology that leads to in-stent restenosis (ISR), induced by the excess growth of the tissue over the deployed stent. The ISR is widely recognized as a significant cause of death globally if early symptoms are not detected. Hence, monitoring and early diagnosis indeed matter when it comes to treatment. The latest technologies for monitoring and treatments of ISR were reviewed in this work, and the potential issues and suggestions related to the reported technologies were presented. The target of this review aims to positively prompt researchers to develop an advanced stent system in terms of its electromechanical performance, size, functional feature, feasibility, and reliability.

Ultrasoft and Biocompatible Magnetic-Hydrogel-Based Strain Sensors for Wireless Passive Biomechanical Monitoring

Implantable flexible mechanical sensors have exhibited great potential in health monitoring and disease diagnosis due to continuous and real-time monitoring capability. However, the wires and power supply required in current devices cause inconvenience and potential risks. Magnetic-based devices have demonstrated advantages in wireless and passive sensing, but the mismatched mechanical properties, poor biocompatibility, and insufficient sensitivity have limited their applications in biomechanical monitoring. Here, a wireless and passive flexible magnetic-based strain sensor based on a gelatin methacrylate/Fe₃O₄ magnetic hydrogel has been fabricated. The sensor exhibits ultrasoft mechanical properties, strong magnetic properties, and long-term stability in saline solution and can monitor strains down to 50 μm. A model of the sensing process is established to identify the optimal detection location and the relation between the relative magnetic permeability and the sensitivity of the sensors. Moreover, an in vitro tissue model is developed to investigate the potential of the sensor in detecting subtle biomechanical signals and avoiding interference with bioactivities. Furthermore, a real-time and high-throughput biomonitoring platform is built and implements passive wireless monitoring of the drug response and cultural status of the cardiomyocytes. This work demonstrates the potential of applying magnetic sensing for biomechanical monitoring and provides ideas for the design of wireless and passive implantable devices.

Switch mode capacitive pressure sensors

Switch mode capacitive pressure sensors are proposed as a new class of microfabricated devices that transform pressure into a mechanically switching capacitance to form an analog-to-digital signal with zero power, high sensitivity, and a high signal-to-noise ratio. A pressure-sensitive gold membrane suspended over a capacitive cavity makes ohmic contact with patterned gold leads on the substrate, closing circuits to fixed on-chip capacitors outside the cavity and leading to significant step responses. This function is achieved by allocating the switch leads on the part of the counter electrode area, while the remaining area is used for touch mode analog capacitive sensing. The sensor microchip is prototyped through a novel design approach to surface micromachining that integrates micro-Tesla valves for vacuum sealing the sensor cavity, showing an unprecedented response to applied pressure. For a gauge pressure range of 0-120 mmHg, the sensor exhibits an increase of 13.21 pF with resultant switch events, each of which ranges from 2.53-3.96 pF every 12-38 mmHg, in addition to the touch mode linear capacitive increase between switches. The equivalent sensitivity is 80-240 fF/mmHg, which is 11-600× more than commercial and reported touch mode sensors operating in similar pressure ranges. The sensor is further demonstrated for wireless pressure tracking by creating a resonant tank with the sensor, showing a 32.5-101.6 kHz/mmHg sensitivity with frequency jumps led by the switch events. The developed sensor, with its promising performance, offers new application opportunities in a variety of device areas, including health care, robotics, industrial control, and environmental monitoring.

Actuators for Implantable Devices: A Broad View

The choice of actuators dictates how an implantable biomedical device moves. Specifically, the concept of implantable robots consists of the three pillars: actuators, sensors, and powering. Robotic devices that require active motion are driven by a biocompatible actuator. Depending on the actuating mechanism, different types of actuators vary remarkably in strain/stress output, frequency, power consumption, and durability. Most reviews to date focus on specific type of actuating mechanism (electric, photonic, electrothermal, etc.) for biomedical applications. With a rapidly expanding library of novel actuators, however, the granular boundaries between subcategories turns the selection of actuators a laborious task, which can be particularly time-consuming to those unfamiliar with actuation. To offer a broad view, this study (1) showcases the recent advances in various types of actuating technologies that can be potentially implemented in vivo, (2) outlines technical advantages and the limitations of each type, and (3) provides use-specific suggestions on actuator choice for applications such as drug delivery, cardiovascular, and endoscopy implants.

Fully implantable batteryless soft platforms with printed nanomaterial-based arterial stiffness sensors for wireless continuous monitoring of restenosis in real time

Atherosclerosis is a common cause of coronary artery disease and a significant factor in broader cardiovascular diseases, the leading cause of death. While implantation of a stent is a prevalent treatment of coronary artery disease, a frequent complication is restenosis, where the stented artery narrows and stiffens. Although early detection of restenosis can be achieved by continuous monitoring, no available device offers such capability without surgeries. Here, we report a fully implantable soft electronic system without batteries and circuits, which still enables continuous wireless monitoring of restenosis in real-time with a set of nanomembrane strain sensors in an electronic stent. The low-profile system requires minimal invasive implantation to deploy the sensors into a blood vessel through catheterization. The entirely printed, nanomaterial-based set of soft membrane strain sensors utilizes a sliding mechanism to offer enhanced sensitivity and detection of low strain while unobtrusively integrating with an inductive stent for passive wireless sensing. The performance of the soft sensor platform is demonstrated by wireless monitoring of restenosis in an artery model and an ex-vivo study in a coronary artery of ovine hearts. The capacitive sensor-based artery implantation system offers unique advantages in wireless, real-time monitoring of stent treatments and arterial health for cardiovascular disease.

Monitoring cardiovascular disease severity using near-infrared mechanoluminescent materials as a built-in indicator

Artificial vascular grafts (AVGs) are widely used to treat cardiovascular diseases (CVDs). But none of the reported AVGs can also monitor the CVD severity. Because CVDs affect the blood pressure, we proposed to employ a force-sensing material that emits near-infrared (NIR) light upon force loading, a NIR mechanoluminescent (ML) material (CaZnOS:Nd³⁺), as an indicator in AVGs to tackle this challenge. Specifically, we used a polydimethylsiloxane AVG modified with this ML material, termed ML-AVG, to achieve the rapid and convenient monitoring of two CVD models (vascular occlusion and hypertension) in real time. The NIR ML material showed good blood and tissue compatibility without causing an inflammatory response. By implanting the ML-AVGs into the common carotid artery (CCA) of rats, we observed the NIR ML signals emitted from the AVGs by a thermal camera, a NIR spectrometer, and a NIR camera. The NIR ML signal was linearly correlated with the degree of vascular opening (in the vascular occlusion model) or the degree of hypertension (in the hypertension model). Our work suggests that NIR ML materials can monitor the severity of diseases with force or pressure as biomarkers.

Fully implantable wireless batteryless vascular electronics with printed soft sensors for multiplex sensing of hemodynamics

The continuous monitoring of hemodynamics attainable with wireless implantable devices would improve the treatment of vascular diseases. However, demanding requirements of size, wireless operation, and compatibility with endovascular procedures have limited the development of vascular electronics. Here, we report an implantable, wireless vascular electronic system, consisting of a multimaterial inductive stent and printed soft sensors capable of real-time monitoring of arterial pressure, pulse rate, and flow without batteries or circuits. Developments in stent design achieve an enhanced wireless platform while matching conventional stent mechanics. The fully printed pressure sensors demonstrate fast response times, high durability, and sensing at small bending radii. The device is monitored via inductive coupling at communication distances notably larger than prior vascular sensors. The wireless electronic system is validated in artery models, while minimally invasive catheter implantation is demonstrated in an in vivo rabbit study. Overall, the vascular system offers an adaptable framework for comprehensive monitoring of hemodynamics.

Predicting Cardiovascular Stent Complications Using Self-Reporting Biosensors for Noninvasive Detection of Disease

Self-reporting implantable medical devices are the future of cardiovascular healthcare. Cardiovascular complications such as blocked arteries that lead to the majority of heart attacks and strokes are frequently treated with inert metal stents that reopen affected vessels. Stents frequently re-block after deployment due to a wound response called in-stent restenosis (ISR). Herein, an implantable miniaturized sensor and telemetry system are developed that can detect this process, discern the different cell types associated with ISR, distinguish sub plaque components as demonstrated with ex vivo samples, and differentiate blood from blood clot, all on a silicon substrate making it suitable for integration onto a vascular stent. This work shows that microfabricated sensors can provide clinically relevant information in settings closer to physiological conditions than previous work with cultured cells.

Multifunctional Meta-Tribomaterial Nanogenerators for Energy Harvesting and Active Sensing

Discovering novel multifunctional metamaterials with energy harvesting and sensing functionalities is likely to be the next technological evolution of the metamaterial science. Here, we introduce a novel concept called self-aware composite mechanical metamaterial (SCMM) that can transform mechanical metamaterials into nanogenerators and active sensing mediums. In pursuit of this goal, we examine new paradigms where finely tailored and seamlessly integrated self-recovering snapping microstructures composed of topologically different triboelectric materials can form self-powering and self-sensing meta-tribomaterial systems. We explore various deformation mechanisms required to induce contact electrification between these snapping microstructures under periodic deformations. The multifunctional meta-tribomaterial systems created under the SCMM concept will act as triboelectric nanogenerators capable of generating electrical signals in response to the applied mechanical excitations. The generated electrical signal can be used for active sensing of the applied force and can be stored for empowering sensors and embedded electronics. We conduct theoretical and experimental studies to understand the mechanical and electrical behavior of the multifunctional SCMM systems. The broad application of the proposed SCMM concept for designing artificial materials with novel properties and functionalities is highlighted via prototyping self-powering and self-sensing blood vessel stents and shock absorbers.

Structural Design of Vascular Stents: A Review

Percutaneous Coronary Intervention (PCI) is currently the most conventional and effective method for clinically treating cardiovascular diseases such as atherosclerosis. Stent implantation, as one of the ways of PCI in the treatment of coronary artery diseases, has become a hot spot in scientific research with more and more patients suffering from cardiovascular diseases. However, vascular stent implanted into vessels of patients often causes complications such as In-Stent Restenosis (ISR). The vascular stent is one of the sophisticated medical devices, a reasonable structure of stent can effectively reduce the complications. In this paper, we introduce the evolution, performance evaluation standards, delivery and deployment, and manufacturing methods of vascular stents. Based on a large number of literature pieces, this paper focuses on designing structures of vascular stents in terms of “bridge (or link)” type, representative volume unit (RVE)/representative unit cell (RUC), and patient-specific stent. Finally, this paper gives an outlook on the future development of designing vascular stents.

Non-Invasive Treatment for Coronary In-Stent Restenosis via Wireless Revascularization With Nitinol Active Stent

This paper reports a novel shape memory alloy (SMA) nitinol type active stent for non-invasive restenosis treatment, which operates using a radiofrequency (RF) electro-thermo-mechanical actuation technique for wireless revascularization. The developed stent is equipped with a capacitive pressure sensor for in-artery blood pressure measurement and can provide multiple expansion to restore the blood pressure flow. The device design, working principle, fabrication, and characterization of the nitinol active stent are reported in this work. The wireless monitoring feature is achieved via peak shifting in the reflection coefficient of the S₁₁ parameter. The active stent with initial diameter and resonant frequency of 2 mm and 315 MHz, respectively, is expanded uniformly in stages up to 4.2 mm in diameter when excited with an RF power of ∼30 W for 320 s. The active stent is delivered and deployed ex vivo inside the left coronary artery of a cervine heart. The stented cervine heart before and after wireless actuation is inspected via penetration of X-rays. Endoscopic images reveal the expansion of the stent strut profile within the lumen of the stented artery. The active stent expands in stages up to 3.7 mm in diameter to scaffold the cervine coronary artery after excited with an RF power of 46.7 W. The achievable wireless revascularization capability eradicates the necessity of reintervention and repeat stenting procedure, whereas real-time wireless monitoring provides rapid indication of in-artery re-narrowing occurrence.

A thermosensitive material coated resonant stent for drug delivery on demand

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

A Smart Stent for Monitoring Eventual Restenosis: Computational Fluid Dynamic and Finite Element Analysis in Descending Thoracic Aorta

Even though scientific studies of smart stents are extensive, current smart stents focus on pressure sensors. This paper presents a novel implantable biocompatible smart stent for monitoring eventual restenosis. The device is comprised of a metal mesh structure, a biocompatible and adaptable envelope, and pair-operated ultrasonic sensors for restenosis monitoring through flow velocity. Aside from continuous monitoring of restenosis post-implantation, it is also important to evaluate whether the stent design itself causes complications such as restenosis or thrombosis. Therefore, computational fluid dynamic (CFD) analysis before and after stent implantation were carried out as well as finite element analysis (FEA). The proposed smart stent was put in the descending thoracic section of a virtually reconstructed aorta that comes from a computed tomography (CT) scan. Blood flow velocity showed that after stent implantation, there is not liquid retention or vortex generation. In addition, blood pressures after stent implantation were within the normal blood pressure values. The stress and the factor of safety (FOS) analysis showed that the stress values reached by the stent are very far from the yield strength limit of the materials and that the stent is stiff enough to support the applied loads exported from the CFD results.

Role of gold nanoparticles in advanced biomedical applications

Gold nanoparticles (GNPs) have generated keen interest among researchers in recent years due to their excellent physicochemical properties. In general, GNPs are biocompatible, amenable to desired functionalization, non-corroding, and exhibit size and shape dependent optical and electronic properties. These excellent properties of GNPs exhibit their tremendous potential for use in diverse biomedical applications. Herein, we have evaluated the recent advancements of GNPs to highlight their exceptional potential in the biomedical field. Special focus has been given to emerging biomedical applications including bio-imaging, site specific drug/gene delivery, nano-sensing, diagnostics, photon induced therapeutics, and theranostics. We have also elaborated on the basics, presented a historical preview, and discussed the synthesis strategies, functionalization methods, stabilization techniques, and key properties of GNPs. Lastly, we have concluded this article with key findings and unaddressed challenges. Overall, this review is a complete package to understand the importance and achievements of GNPs in the biomedical field.

Impedimetric Detection and Electromediated Apoptosis of Vascular Smooth Muscle Using Microfabricated Biosensors for Diagnosis and Therapeutic Intervention in Cardiovascular Diseases

Cardiovascular diseases remain a significant global burden with 1-in-3 of all deaths attributable to the consequences of the disease. The main cause is blocked arteries which often remain undetected. Implantable medical devices (IMDs) such as stents and grafts are often used to reopen vessels but over time these too will re-block. A vascular biosensor is developed that can report on cellularity and is amenable to being mounted on a stent or graft for remote reporting. Moreover, the device is designed to also receive currents that can induce a controlled form of cell death, apoptosis. A combined diagnostic and therapeutic biosensor would be transformational for the treatment of vascular diseases such as atherosclerosis and central line access. In this work, a cell sensing and cell apoptosing system based on the same interdigitated electrodes (IDEs) is developed. It is shown that the device is scalable and that by miniaturizing the IDEs, the detection sensitivity is increased. Apoptosis of vascular smooth muscle cells is monitored using continuous impedance measurements at a frequency of 10 kHz and rates of cell death are tracked using fluorescent dyes and live cell imaging.

Impedimetric Detection and Electromediated Apoptosis of Vascular Smooth Muscle Using Microfabricated Biosensors for Diagnosis and Therapeutic Intervention in Cardiovascular Diseases

Cardiovascular diseases remain a significant global burden with 1-in-3 of all deaths attributable to the consequences of the disease. The main cause is blocked arteries which often remain undetected. Implantable medical devices (IMDs) such as stents and grafts are often used to reopen vessels but over time these too will re-block. A vascular biosensor is developed that can report on cellularity and is amenable to being mounted on a stent or graft for remote reporting. Moreover, the device is designed to also receive currents that can induce a controlled form of cell death, apoptosis. A combined diagnostic and therapeutic biosensor would be transformational for the treatment of vascular diseases such as atherosclerosis and central line access. In this work, a cell sensing and cell apoptosing system based on the same interdigitated electrodes (IDEs) is developed. It is shown that the device is scalable and that by miniaturizing the IDEs, the detection sensitivity is increased. Apoptosis of vascular smooth muscle cells is monitored using continuous impedance measurements at a frequency of 10 kHz and rates of cell death are tracked using fluorescent dyes and live cell imaging.

Health Care Monitoring and Treatment for Coronary Artery Diseases: Challenges and Issues

In-stent restenosis concerning the coronary artery refers to the blood clotting-caused re-narrowing of the blocked section of the artery, which is opened using a stent. The failure rate for stents is in the range of 10% to 15%, where they do not remain open, thereby leading to about 40% of the patients with stent implantations requiring repeat procedure within one year, despite increased risk factors and the administration of expensive medicines. Hence, today stent restenosis is a significant cause of deaths globally. Monitoring and treatment matter a lot when it comes to early diagnosis and treatment. A review of the present stent monitoring technology as well as the practical treatment for addressing stent restenosis was conducted. The problems and challenges associated with current stent monitoring technology were illustrated, along with its typical applications. Brief suggestions were given and the progress of stent implants was discussed. It was revealed that prime requisites are needed to achieve good quality implanted stent devices in terms of their size, reliability, etc. This review would positively prompt researchers to augment their efforts towards the expansion of healthcare systems. Lastly, the challenges and concerns associated with nurturing a healthcare system were deliberated with meaningful evaluations.

New Innovations and Devices in the Management of Chronic Limb-Threatening Ischemia

As the number of patients afflicted by chronic limb-threatening ischemia (CLTI) continues to grow, new solutions are necessary to provide effective, durable treatment options that will lead to improved outcomes. The diagnosis of CLTI remains mostly clinical, and endovascular revascularization remains mostly balloon-based. Multiple innovative techniques and technologies are in development or in early usage that may provide new solutions. This review categorizes areas of advancement, highlights recent developments in the management of CLTI and looks forward to novel devices that are currently under investigation.

Novel capacitive MEMS sensor for monitoring in-stent restenosis

Cardiovascular is a disorder of the heart and its blood vessels that causes millions of deaths around the world. Implanting stent in patient's artery is a typical procedure of treatment. However, a major problem associated with stents is the buildup of plaque/fatty acids deposits, a condition known as in-stent restenosis. Therefore, one of the preventive solutions is the development of "smart" stents that contain pressure sensors for monitoring stent blockage at early stages. Such sensors need to be associated with high sensitivity for early detection of flow abnormalities within the stent. Here, we propose several capacitive pressure sensor plate designs and analyze their sensitivities. Our results show that a square-shaped plate with straight slots on its edges can drastically improve sensitivity. Several analyses were carried out to optimize dimensions of the proposed design for monitoring in-stent restenosis.

Wirelessly Heating Stents via Radiofrequency Resonance toward Enabling Endovascular Hyperthermia

Thermal therapy known as hyperthermia has served as an effective method for cancer treatment. This therapeutic approach has also been attracting attention for treatment of in-stent restenosis, the most common complication of stenting. Mild heating of stents has been shown to be a possible path to addressing this problem. Despite various studies on stent-based thermotherapy, this area still lacks a clinically viable method and technology. Here, a radiofrequency-powered "hot" stent prototype is reported in vitro and in vivo. An implantable stent device based on medical-grade stainless steel acts as an electrical resonator, or an efficient wireless heater operating only when resonated using tuned external electromagnetic fields. The system architecture uses a custom-developed power transmitter for wireless resonant powering/heating of the stent. An eight-shaped antenna is shown to be highly effective for near-field power transfer to the device and potentially to other smart implants, revealing stent heating efficiencies of up to 120 °C W^-1 , 206% of the level provided by a conventional loop antenna. Testing with swine models, the prototyped system achieves stent heating in blood flow by powering through air and skin tissue in vivo in a fully controlled manner. The results advance stent hyperthermia technology toward possible future clinical application.

A Single-Connector Stent Antenna for Intravascular Monitoring Applications

Recently, smart stents have been developed by integrating various sensors with intravascular stents for detecting vascular restenosis or monitoring intravascular biomedical conditions such as blood pressure or blood flow velocity. The information on biomedical signals is then transmitted to external monitoring systems via wireless communications. Due to the limited volumes of blood vessels and limited influence of blood flow, antennas with good radiation performance are required for intravascular applications. In this paper, we propose a stent antenna composed of multiple rings containing crowns and struts, where each ring is connected with one connector. Unlike a conventional stent, wherein each ring is connected with several connectors, the single connector prevents the random distribution of electrical current and thus achieves good radiation performance. The implantable stent antenna is designed for the frequency range of 2 to 3 GHz for minimum penetration loss in the human body and tissues. Mechanical FEM simulations were conducted to ensure that the mechanical deformation was within specific limits during balloon expansions. A prototype was fabricated with laser cutting techniques and its radiation performance experimentally characterized. It was demonstrated that the fabricated stent antenna had an omnidirectional radiation pattern for arbitrary receiving angles, a gain of 1.38 dBi, and a radiation efficiency of 74.5% at a resonant frequency of 2.07 GHz. The main contribution of this work was the manipulation of the current distributions of the stent for good EM radiation performances which needed to be further examined while inserted inside human bodies. These research results should contribute to the further development of implantable wireless communications and intravascular monitoring of biomedical signals such as blood pressure and blood flow velocity.

The Future of Cardiovascular Stents: Bioresorbable and Integrated Biosensor Technology

Cardiovascular disease is the greatest cause of death worldwide. Atherosclerosis is the underlying pathology responsible for two thirds of these deaths. It is the age-dependent process of "furring of the arteries." In many scenarios the disease is caused by poor diet, high blood pressure, and genetic risk factors, and is exacerbated by obesity, diabetes, and sedentary lifestyle. Current pharmacological anti-atherosclerotic modalities still fail to control the disease and improvements in clinical interventions are urgently required. Blocked atherosclerotic arteries are routinely treated in hospitals with an expandable metal stent. However, stented vessels are often silently re-blocked by developing "in-stent restenosis," a wound response, in which the vessel's lumen renarrows by excess proliferation of vascular smooth muscle cells, termed hyperplasia. Herein, the current stent technology and the future of biosensing devices to overcome in-stent restenosis are reviewed. Second, with advances in nanofabrication, new sensing methods and how researchers are investigating ways to integrate biosensors within stents are highlighted. The future of implantable medical devices in the context of the emerging "Internet of Things" and how this will significantly influence future biosensor technology for future generations are also discussed.

Fully Printed, Wireless, Stretchable Implantable Biosystem toward Batteryless, Real-Time Monitoring of Cerebral Aneurysm Hemodynamics

This study introduces a high-throughput, large-scale manufacturing method that uses aerosol jet 3D printing for a fully printed stretchable, wireless electronics. A comprehensive study of nanoink preparation and parameter optimization enables a low-profile, multilayer printing of a high-performance, capacitance flow sensor. The core printing process involves direct, microstructured patterning of biocompatible silver nanoparticles and polyimide. The optimized fabrication approach allows for transfer of highly conductive, patterned silver nanoparticle films to a soft elastomeric substrate. Stretchable mechanics modeling and seamless integration with an implantable stent display a highly stretchable and flexible sensor, deployable by a catheter for extremely low-profile, conformal insertion in a blood vessel. Optimization of a transient, wireless inductive coupling method allows for wireless detection of biomimetic cerebral aneurysm hemodynamics with the maximum readout distance of 6 cm through meat. In vitro demonstrations include wireless monitoring of flow rates (0.05-1 m s-1) in highly contoured and narrow human neurovascular models. Collectively, this work shows the potential of the printed biosystem to offer a high throughput, additive manufacturing of stretchable electronics with advances toward batteryless, real-time wireless monitoring of cerebral aneurysm hemodynamics.

Reduction-Responsive Nucleic Acid Delivery Systems To Prevent In-Stent Restenosis in Rabbits

Cardiovascular and cerebrovascular ischemic diseases seriously affect human health. Endovascular stent placement is an effective treatment but always leads to in-stent restenosis (ISR). Gene-eluting stent, which combines gene therapy with stent implantation, is a potential method to prevent ISR. In this study, an efficient gene-eluting stent was designed on the basis of one new nucleic acid delivery system to decrease the possibility of ISR. The reduction-responsive branched nucleic acid vector (SKP) with low cytotoxicity was first synthesized via ring-opening reaction. The impressive in vitro transfection performances of SKP were proved using luciferase reporter, enhanced green fluorescent protein plasmid, and vascular endothelial growth factor plasmid (pVEGF). Subsequently, SKP/pVEGF complexes were coated on the surfaces of pretreated clinical stents to construct gene-eluting stents (S-SKP/pVEGF). Antirestenosis performance of S-SKP/pVEGF was evaluated via implanting stents into rabbit aortas. S-SKP/pVEGF could lead to the localized upregulation of VEGF proteins, improve the progress of re-endothelialization, and inhibit the development of ISR in vivo. Such efficient pVEGF-eluting stent with responsive nucleic acid delivery systems is very promising to prevent in-stent restenosis of cerebrovascular diseases.

An Implantable Sensorized Lead for Continuous Monitoring of Cardiac Apex Rotation

Changes in the pattern or amplitude of cardiac rotation have been associated with important cardiovascular diseases, including Heart Failure (HF) which is one of the major health problems worldwide. Recent advances in echocardiographic techniques have allowed for non-invasive quantification of cardiac rotation; however, these examinations do not address the continuous monitoring of patient status. We have presented a newly developed implantable, transvenous lead with a tri-axis (3D) MEMS gyroscope incorporated near its tip to measure cardiac apex rotation in the three-dimensional space. We have named it CardioMon for its intended use for cardiac monitoring. If compared with currently proposed implantable systems for HF monitoring based on the use of pressure sensors that can have reliability issues, an implantable motion sensor like a gyroscope holds the premise for more reliable long term monitoring. The first prototypal assembly of the CardioMon lead has been tested to assess the reliability of the 3D gyroscope readings. In vitro results showed that the novel sensorized CardioMon lead was accurate and reliable in detecting angular velocities within the range of cardiac twisting velocities. Animal experiments will be planned to further evaluate the CardioMon lead in in vivo environments and to investigate possible endocardial implantation sites.

Future of Smart Cardiovascular Implants

Cardiovascular disease remains the leading cause of death in Western society. Recent technological advances have opened the opportunity of developing new and innovative smart stent devices that have advanced electrical properties that can improve diagnosis and even treatment of previously intractable conditions, such as central line access failure, atherosclerosis and reporting on vascular grafts for renal dialysis. Here we review the latest advances in the field of cardiovascular medical implants, providing a broad overview of the application of their use in the context of cardiovascular disease rather than an in-depth analysis of the current state of the art. We cover their powering, communication and the challenges faced in their fabrication. We focus specifically on those devices required to maintain vascular access such as ones used to treat arterial disease, a major source of heart attacks and strokes. We look forward to advances in these technologies in the future and their implementation to improve the human condition.