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SHEN XIANG, LU KAIKAI, ZHU HONGFEI, JIANG JIABAO, TIAN RUN, LI HANQING. TORSIONAL BEHAVIOR OF STENTS: THE ROLE OF LINKER AND STENT TAPERING INVESTIGATED WITH NUMERICAL SIMULATION. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The torsional performance is a major mechanical property of stent. A stent with good torsional performance is easy to deform along blood vessels without damaging the vascular wall to avoid in-stent restenosis (ISR). Therefore, this study aimed to study the effect of stent parameters on torsional performance. The effect of stent parameters on torsional performance was studied via finite element method (FEM). The twist metric (TM) and stress distribution of various stents were compared. The TM values of stents with I-, S-, M-, C-, and V-shaped linkers were 0.0190, 0.0191, 0.0184, 0.0141, and 0.0201[Formula: see text][Formula: see text], respectively. In addition, the TM value of the stent increased by 35.85 times when the number of linkers was increased from 2 to 8 and the stent was twisted at the same angular displacement in clockwise direction. The TM value of the stent with 1.13∘ tapering was 0.010 [Formula: see text], which was lower by 47.64% compared with that of cylindrical stent. Compared with the shape of the linker, the number of linkers had a more remarkable effect on torsional performance. Torsional performance was observably enhanced with the decrease in the number of linkers. Among the five stents with different linker shapes, the torsional performance of the stent with C-shaped linker was the best. Besides, the torsional performance of the tapered stent was better than that of the cylindrical stent. Moreover, the torsional performance increased by increasing the stent tapering. This work might provide insights into better stent design and clinical decisions.
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Affiliation(s)
- XIANG SHEN
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - KAIKAI LU
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - HONGFEI ZHU
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - JIABAO JIANG
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - RUN TIAN
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - HANQING LI
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
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Sharma YP, Uppal L, Panda P, Mohanty S, Kasinadhuni G, Krishnappa D, Mehrotra S, Gupta A, Prasad K, Santosh K, Bootla D, Ghosh S. One-year outcomes of novel BioMime Morph tapered stent in long and multiple coronary artery lesions. Anatol J Cardiol 2021; 25:896-901. [PMID: 34866584 DOI: 10.5152/anatoljcardiol.2021.05763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Even with the immense progress achieved in the field of percutaneous coronary interventions (PCIs), treatment of diffuse long atherosclerotic coronary artery disease continues to remain a challenge for durable outcomes. The downstream reduction in diameter along the lesion length of a coronary artery may compel the cardiologist to use either 2 overlapping stents of different diameters or a single long stent leading to stent-vessel mismatch at the edges. Recently, Meril Life Sciences Pvt. Ltd., India, has introduced a long-tapered sirolimus-eluting stent (SES) system, BioMime Morph, which conforms to the normal tapered geometry of coronary arteries along with adequate lesion coverage. In this study, we aimed to provide real world experience regarding the safety and efficacy of the BioMime Morph SES over a follow-up of one year. METHODS This was a single center, retrospective study involving 172 participants who underwent PCI with the BioMime Morph SES. Mean length of the target lesion was 34.4±10.4 mm, and mean stent length was 53.2±8.7 mm. The most frequent revascularized vessel was the left anterior descending artery (LAD) in 97 lesions (54.4%). RESULTS Major adverse cardiac events (MACE) (defined as a composite of target vessel myocardial infarction, target lesion revascularization, and death due to a cardiac cause) at 1, 6, and 12 months were seen in 4 (2.3%), 7 (4.0%), and 8 (4.7%) patients, respectively. Overall, 5 cardiac deaths and 2 definite stent thrombosis were observed in the study. CONCLUSION The study suggests that the novel BioMime Morph SES is an effective and a safe option for PCI in the treatment of long diffuse atherosclerotic lesions.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Soumitra Mohanty
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Darshan Krishnappa
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Saurabh Mehrotra
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Ankur Gupta
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Krishna Prasad
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Krishna Santosh
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
| | - Soumitra Ghosh
- Department of Cardiology, Post Graduate Institution of Medical Education and Research (PGIMER); Chandigarh-India
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Raghu TR, V A SR, Kharge J, H S NS, Patil RS, Manjunath CN. Feasibility and Outcomes of Left Main to Branch Vessel PCI with Novel Tapered Coronary Stent in a Tertiary Care Centre: A Real World Experience. Cardiovasc Hematol Disord Drug Targets 2021; 21:128-135. [PMID: 34387173 DOI: 10.2174/1871529x21666210812110944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/31/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of Novel tapered (BioMime™ Morph) sirolimus-eluting stent (SES) for left main PCI in a real-world scenario. BACKGROUND Currently no data is available on clinical usefulness of tapered ultrathin stents in left main PCI. METHODS This was a prospective, non-randomised, single centre study carried out between February 2018 and May 2020 at a tertiary cardiac care centre in southern India. The study included patients treated with BioMime Morph tapered stent for distal de novo LMB lesion or ostial LAD/LCX lesions with significant size disparity between reference segments based on the eligibility criteria. Primary endpoint of the study was the cumulative incidence of major adverse cardiovascular events (MACE) composed of cardiac death, myocardial infraction, and clinically driven target-lesion revascularisation at follow-up. RESULTS A total of 41 patients (average age of 54.83±9.81 years) were included in the study. Average SS-2 score was 23.17±5.42. Majority of the lesions (n=31; 75.61%) were of medina class (0.1.0). Provisional single stent strategy was adopted for treatment of LMB lesions. TIMI flow-3 was achieved in 40 patients (97.56%). Median clinical follow-up was 20 months (range 6-34 months) There was no periprocedural complication or MACE during follow-up.
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Affiliation(s)
- T R Raghu
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka. India
| | - Sathwik Raj V A
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka. India
| | - Jayashre Kharge
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka. India
| | - Natraj Setty H S
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka. India
| | - Rahul S Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka. India
| | - C N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka. India
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Shen X, Jiang J, Zhu H, Lu K, Dong P, Gu L. Comparative study of tapered versus conventional cylindrical balloon for stent implantation in stenotic tapered artery. Artif Organs 2020; 44:727-735. [DOI: 10.1111/aor.13661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/17/2019] [Accepted: 01/30/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Xiang Shen
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Jiabao Jiang
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Hongfei Zhu
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Kaikai Lu
- School of Mechanical Engineering Jiangsu University Zhenjiang China
| | - Pengfei Dong
- Department of Mechanical Engineering University of Nebraska-Lincoln Lincoln NE USA
| | - Linxia Gu
- Department of Mechanical Engineering University of Nebraska-Lincoln Lincoln NE USA
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Shen X, Jiang J, Deng Y, Zhu H, Lu K. Haemodynamics Study of Tapered Stents Intervention to Tapered Arteries. Cardiovasc Eng Technol 2019; 10:583-589. [DOI: 10.1007/s13239-019-00437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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Vazirpanah N, Ottria A, van der Linden M, Wichers CGK, Schuiveling M, van Lochem E, Phipps-Green A, Merriman T, Zimmermann M, Jansen M, Radstake TRDJ, Broen JCA. mTOR inhibition by metformin impacts monosodium urate crystal-induced inflammation and cell death in gout: a prelude to a new add-on therapy? Ann Rheum Dis 2019; 78:663-671. [PMID: 30814053 DOI: 10.1136/annrheumdis-2018-214656] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Gout is the most common inflammatory arthritis worldwide, and patients experience a heavy burden of cardiovascular and metabolic diseases. The inflammation is caused by the deposition of monosodium urate (MSU) crystals in tissues, especially in the joints, triggering immune cells to mount an inflammatory reaction. Recently, it was shown that MSU crystals can induce mechanistic target of rapamycin (mTOR) signalling in monocytes encountering these crystals in vitro. The mTOR pathway is strongly implicated in cardiovascular and metabolic disease. We hypothesised that inhibiting this pathway in gout might be a novel avenue of treatment in these patients, targeting both inflammation and comorbidities. METHODS We used a translational approach starting from ex vivo to in vitro and back to in vivo. RESULTS We show that ex vivo immune cells from patients with gout exhibit higher expression of the mTOR pathway, which we can mimic in vitro by stimulating healthy immune cells (B lymphocytes, monocytes, T lymphocytes) with MSU crystals. Monocytes are the most prominent mTOR expressers. By using live imaging, we demonstrate that monocytes, on encountering MSU crystals, initiate cell death and release a wide array of proinflammatory cytokines. By inhibiting mTOR signalling with metformin or rapamycin, a reduction of cell death and release of inflammatory mediators was observed. Consistent with this, we show that patients with gout who are treated with the mTOR inhibitor metformin have a lower frequency of gout attacks. CONCLUSIONS We propose mTOR inhibition as a novel therapeutic target of interest in gout treatment.
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Affiliation(s)
- Nadia Vazirpanah
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Ottria
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten van der Linden
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catharina G K Wichers
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark Schuiveling
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen van Lochem
- Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Tony Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Maili Zimmermann
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthijs Jansen
- Department of Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Rheumatology and Clinical Immunology, University Medical Center, Utrech, The Netherlands
| | - Jasper C A Broen
- Department of Rheumatology and Clinical Immunology, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Rheumatology and Clinical Immunology, University Medical Center, Utrech, The Netherlands
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Patted SV, Jain RK, Jiwani PA, Suryavanshi S, Raghu TR, Raveesh H, Rajalakshmi S, Thakkar AS, Turiya PK, Desai PJ, Patted AS, Sharma KH. Clinical Outcomes of Novel Long-Tapered Sirolimus-Eluting Coronary Stent System in Real-World Patients With Long Diffused De Novo Coronary Lesions. Cardiol Res 2018; 9:350-357. [PMID: 30627285 PMCID: PMC6306120 DOI: 10.14740/cr795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background When coronary lesions involve segments > 48 mm, the only treatment possibility is stent overlapping which is associated with higher neointimal proliferation that lead to more restenosis. Furthermore, tapering of coronary arteries is a major challenge observed with long diffuse coronary lesions. This study attempted to assess the safety and performance of world’s first commercialised long-tapered (60 mm) sirolimus-eluting coronary stent (SES) system for the treatment of long diffused de novo coronary lesions in real world scenario. Methods This was a retrospective, non-randomised, multicentre study which included 362 consecutive patients implanted with long-tapered BioMime™ Morph SES system for the treatment of long diffused de novo coronary lesions. Safety endpoint was major adverse cardiac events (MACE), which was defined as composite of cardiac death, myocardial infarction (MI) and ischemic-driven target lesion revascularization (ID-TLR), at 12-month follow-up. Results Out of 362 patients included, 170 (47.0%) were diabetic and 159 (43.9%) were hypertensive. The mean age of all patients was 61.09 ± 9.04 years. A total of 625 lesions were identified; out of which 402 lesions were intervened successfully using BioMime Morph. The cumulative incidence of MACE was 7 (2.0%) at 12-month follow-up which included four (1.1%) cardiac deaths, one (0.3%) case of MI and two (0.6%) ID-TLR. Acute stent thrombosis was reported in one (0.3%) patient. Conclusions The present study confirms the safety and performance of BioMime Morph, and hence, can be considered as a treatment of choice for long diffused tapered de novo coronary lesions in routine clinical practice.
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Affiliation(s)
- Suresh V Patted
- KLE Academy of Higher Education and Research Centre (KLE University), Belgaum, Karnataka, 590010, India
| | | | - P A Jiwani
- KIMS Hospital, Hyderabad, Telangana, 500003, India
| | | | - T R Raghu
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, 560069, India
| | - Hema Raveesh
- Sri Jayadeva Institute of Cardiovascular Sciences and Research K.R. Hospital Campus, Mysore, Karnataka, 570016, India
| | - S Rajalakshmi
- SUT Hospital Pattom, Trivandrum, Kerala, 695004, India
| | | | | | | | - Anmol Suresh Patted
- KLE Academy of Higher Education and Research Centre (KLE University), Belgaum, Karnataka, 590010, India
| | - Kamal H Sharma
- U.N. Mehta Institute of Cardiology, Civil Hospital, Ahmedabad, Gujarat, 380016, India
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Patted S. Treatment of long coronary lesions with single stent: BioMime Morph sirolimus-eluting tapered coronary stent system. HEART INDIA 2018. [DOI: 10.4103/heartindia.heartindia_24_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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