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Torii S, Yamamoto A, Yoshikawa A, Lu L, Sasaki M, Obuchi S, Wada A, Tsukamoto H, Nakazawa G. Degradation of a novel magnesium alloy-based bioresorbable coronary scaffold in a swine coronary artery model. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01023-3. [PMID: 39034338 DOI: 10.1007/s12928-024-01023-3] [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: 03/21/2024] [Accepted: 06/13/2024] [Indexed: 07/23/2024]
Abstract
The objective of the study is to investigate the safety, feasibility, and degradation profile of a novel Mg alloy-based bioresorbable coronary scaffold (JFK-PRODUCT BRS) with thin struts (110 μm). Polymer- or Mg alloy-based BRSs have not replaced nondegradable metal stents because of the higher prevalence of scaffold thrombosis and restenosis in clinical practice; these poor clinical outcomes were due to inadequate scaffold designs, including thick struts (more than 150 μm) and their inappropriate degradation processes. Fourteen healthy pigs received 17 JFK-PRODUCT BRSs in the coronary arteries and were sacrificed at 1, 6, 12, 18, and 26 months after implantation. Angiography, optical coherence tomography, microfocus X-ray computed tomography (µCT), scanning electron microscopy with energy-dispersive X-ray spectrometry (SEM-EDX), and histopathological evaluation were performed. The JFK-PRODUCT had a median percent late recoil of 11.28% at 1 month. The µCT observation confirmed that scaffold discontinuity reached 64.8% at 12 months with increased scaffold inner area thereafter, suggesting artery positive remodeling. The inflammation was mild, peaked at 18 months, and decreased thereafter. The SEM-EDX analysis demonstrated gradual degradation of the scaffold with formation of inorganic deposits, presumed to be calcium phosphates. It also revealed the disappearance of calcium phosphates at 26 months, achieving almost complete replacement of the scaffold by biocomponents. The current study demonstrated the safety and feasibility of JFK-PRODUCT with a lower acute recoil rate despite its thin struts. The scaffolds were almost completely disappeared at 26 months after implantation.
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Affiliation(s)
- Sho Torii
- Department of Cardiology, School of Medicine, Faculty of Medicine, Tokai University, 143 Shimokasuya, Kanagawa, 2591193, Japan
| | - Akiko Yamamoto
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Ibaraki, Japan
| | - Ayako Yoshikawa
- Department of Cardiology, School of Medicine, Faculty of Medicine, Tokai University, 143 Shimokasuya, Kanagawa, 2591193, Japan
| | - Linhai Lu
- Shanghai Kepan Investment and Management CO., LTD, Shanghai, China
| | - Makoto Sasaki
- Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan
| | - Shoko Obuchi
- Japan Medical Device Technology Co., Ltd, Kumamoto, Japan
| | - Akira Wada
- Japan Medical Device Technology Co., Ltd, Kumamoto, Japan
| | | | - Gaku Nakazawa
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan.
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Qiu B, Cheng Q, Chen R, Liu C, Qin J, Jiang Q. Mussel-Mimetic Hydrogel Coating with Anticoagulant and Antiinflammatory Properties on a Poly(lactic acid) Vascular Stent. Biomacromolecules 2024; 25:3098-3111. [PMID: 38606583 DOI: 10.1021/acs.biomac.4c00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Biodegradable stents are the most promising alternatives for the treatment of cardiovascular disease nowadays, and the strategy of preparing functional coatings on the surface is highly anticipated for addressing adverse effects such as in-stent restenosis and stent thrombosis. Yet, inadequate mechanical stability and biomultifunctionality limit their clinical application. In this study, we developed a multicross-linking hydrogel on the polylactic acid substrates by dip coating that boasts impressive antithrombotic ability, antibacterial capability, mechanical stability, and self-healing ability. Gelatin methacryloyl, carboxymethyl chitosan, and oxidized sodium alginate construct a double-cross-linking hydrogel through the dynamic Schiff base chemical and in situ blue initiation reaction. Inspired by the adhesion mechanism employed by mussels, a triple-cross-linked hydrogel is formed with the addition of tannic acid to increase the adhesion and antibiofouling properties. The strength and hydrophilicity of hydrogel coating are regulated by changing the composition ratio and cross-linking degree. It has been demonstrated in tests in vitro that the hydrogel coating significantly reduces the adhesion of proteins, MC3T3-E1 cells, platelets, and bacteria by 85% and minimizes the formation of blood clots. The hydrogel coating also exhibits excellent antimicrobial in vitro and antiinflammatory properties in vivo, indicating its potential value in vascular intervention and other biomedical fields.
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Affiliation(s)
- Biwei Qiu
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Qianqian Cheng
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Rukun Chen
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
- Faculty of Medicine, University of Southampton, University Road, Southampton SO17 1BJ, United Kingdom
| | - Chunling Liu
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Jinchao Qin
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Qixia Jiang
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
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Wan YD, Wang DY, Deng WQ, Lai SJ, Wang X. Bioresorbable scaffolds vs. drug-eluting stents on short- and mid-term target lesion outcomes in patients after PCI: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:949494. [PMID: 36158817 PMCID: PMC9492944 DOI: 10.3389/fcvm.2022.949494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background While current concerns about bioresorbable scaffolds (BRS) are centered on late or very late scaffold thrombosis, less attention had been paid to short- and mid-term clinical outcomes. This review aimed to compare the short- and mid-term outcomes between BRS and drug-eluting stents (DES). Methods A systematic review of randomized controlled trials (RCTs) that compared BRS vs. DES was conducted by searching PubMed, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases from inception until 19 April 2022 (language limited to English or Chinese). The primary outcome was target lesion failure (TLF) within 12 months, defined as a composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death. The secondary outcomes were in-stent diameter stenosis (DS%) provided by intraluminal imaging. Results A total of 13 studies were eligible and were included in this review (N = 9,702 patients). The follow-up duration ranged from 6 months to 1 year. A significantly higher rate of TLF [RR, 1.22, 95% CI (1.03, 1.44)] driven by the higher rate of TVMI [RR, 1.39, 95% CI (1.09, 1.76)] was observed in the BRS group than in the DES group. The risk of TLR and cardiac death was similar between the groups. Also, compared with the DES group, the BRS group had a significantly higher in-stent DS% within 1 year [MD = 5.23, 95%CI (3.43, 7.04); I2 = 97%; p < 0.00001]. Conclusion Bioresorbable scaffolds were associated with an increased risk of target lesion failure within 1 year as compared with DES, driven by the increased rates of target vessel myocardial infarction. Also, the in-stent DS% seemed to be higher with BRS. Therefore, BRS was inferior to DES in terms of target lesion outcomes at short- or mid-term follow-up. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=327966, PROSPERO (CRD42022327966).
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Affiliation(s)
- Yan-di Wan
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Da-yang Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Cardiology, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-qi Deng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Si-jia Lai
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Cardiology, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xian Wang
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Echeverry-Rendon M, Echeverria F, Buikema H, Harmsen MC, Krenning G. Endothelial function after the exposition of magnesium degradation products. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2022; 134:112693. [DOI: 10.1016/j.msec.2022.112693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022]
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Khalaj R, Tabriz AG, Okereke MI, Douroumis D. 3D printing advances in the development of stents. Int J Pharm 2021; 609:121153. [PMID: 34624441 DOI: 10.1016/j.ijpharm.2021.121153] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
3D printing technologies have found several applications within the biomedical sector including in the fabrication of medical devices, advanced visualization, diagnosis planning and simulation of surgical procedures. One of the areas in which of 3D printing is anticipated to revolutionised is the manufacturing of implantable bioresorbable drug-eluting scaffolds (stents). The ability to customize and create personalised tailor-made bioresorbable scaffolds has the potential to help solve many of the challenges associated with stenting, such as inappropriate stent sizing and design, abolish late stent thrombosis and help artery growth; 3D printing offers a rapid prototyping and effective method of producing stents making customization of designs feasible. This review provides an overview of the subjects and summarizes the latest research in the 3D printing technologies employed for the design and fabrication of bioresorbable stents including materials with the required printable and mechanical properties. Finally, we present a regulatory perspective on the development and engineering of 3D printed implantable stents.
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Affiliation(s)
- Roxanne Khalaj
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK; CIPER Centre for Innovation and Process Engineering Research, Kent ME4 4TB, UK
| | - Atabak Ghanizadeh Tabriz
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK; CIPER Centre for Innovation and Process Engineering Research, Kent ME4 4TB, UK
| | - Michael I Okereke
- Mathematical Modelling for Engineering Research Group, Department of Engineering Science, University of Greenwich, UK
| | - Dennis Douroumis
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK; CIPER Centre for Innovation and Process Engineering Research, Kent ME4 4TB, UK.
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Liu Y, Liu P, Song Y, Li S, Shi Y, Quan K, Yu G, Li P, An Q, Zhu W. A heparin-rosuvastatin-loaded P(LLA-CL) nanofiber-covered stent inhibits inflammatory smooth-muscle cell viability to reduce in-stent stenosis and thrombosis. J Nanobiotechnology 2021; 19:123. [PMID: 33926468 PMCID: PMC8086342 DOI: 10.1186/s12951-021-00867-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background An endovascular covered-stent has unique advantages in treating complex intracranial aneurysms; however, in-stent stenosis and late thrombosis have become the main factors affecting the efficacy of covered-stent treatment. Smooth-muscle-cell phenotypic modulation plays an important role in late in-stent stenosis and thrombosis. Here, we determined the efficacy of using covered stents loaded with drugs to inhibit smooth-muscle-cell phenotypic modulation and potentially lower the incidence of long-term complications. Methods Nanofiber-covered stents were prepared using coaxial electrospinning, with the core solution prepared with 15% heparin and 20 µM rosuvastatin solution (400: 100 µL), and the shell solution prepared with 120 mg/mL hexafluoroisopropanol. We established a rabbit carotid-artery aneurysm model, which was treated with covered stents. Angiography and histology were performed to evaluate the therapeutic efficacy and incidence rate of in-stent stenosis and thrombosis. Phenotype, function, and inflammatory factors of smooth-muscle cells were studied to explore the mechanism of rosuvastatin action in smooth-muscle cells. Result Heparin–rosuvastatin-loaded nanofiber scaffold mats inhibited the proliferation of synthetic smooth-muscle cells, and the nanofiber-covered stent effectively treated aneurysms in the absence of notable in-stent stenosis. Additionally, in vitro experiments showed that rosuvastatin inhibited the smooth-muscle-cell phenotypic modulation of platelet-derived growth factor-BB induction and decreased synthetic smooth-muscle-cell viability, as well as secretion of inflammatory cytokines. Conclusion Rosuvastatin inhibited the abnormal proliferation of synthetic smooth-muscle cells, and heparin–rosuvastatin-loaded covered stents reduced the incidence of stenosis and late thrombosis, thereby improving the healing rates of stents used for aneurysm treatment. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12951-021-00867-8.
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Affiliation(s)
- Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yaying Song
- Department of Neurology, Renji Hospital of Shanghai Jiao Tong University, Shanghai, China.,Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Sichen Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Kai Quan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Guo Yu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Peiliang Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. .,Neurosurgical Institute of Fudan University, Shanghai, China. .,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. .,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
| | - Qingzhu An
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. .,Neurosurgical Institute of Fudan University, Shanghai, China. .,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. .,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. .,Neurosurgical Institute of Fudan University, Shanghai, China. .,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. .,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
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Tarrahi I, Colombo M, Hartman EMJ, Tovar Forero MN, Torii R, Chiastra C, Daemen J, Gijsen FJH. Impact of bioresorbable scaffold design characteristics on local haemodynamic forces: an ex vivo assessment with computational fluid dynamics simulations. EUROINTERVENTION 2020; 16:e930-e937. [PMID: 31951204 DOI: 10.4244/eij-d-19-00657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS Bioresorbable scaffold (BRS) regions exposed to flow recirculation, low time-averaged wall shear stress (TAWSS) and high oscillatory shear index (OSI) develop increased neointima tissue. We investigated haemodynamic features in four different BRSs. METHODS AND RESULTS Fantom (strut height [SH] = 125 µm), Fantom Encore (SH = 98 µm), Absorb (SH = 157 µm) and Magmaris (SH = 150 µm) BRSs were deployed in phantom tubes and imaged with microCT. Both 2D and 3D geometrical scaffold models were reconstructed. Computational fluid dynamics (CFD) simulation was performed to compute TAWSS and OSI. Thicker struts had larger recirculation zones and lower TAWSS in 2D. Absorb had the largest recirculation zone and the lowest TAWSS (240 µm and -0.18 Pa), followed by Magmaris (170 µm and -0.15 Pa), Fantom (140 µm and -0.14 Pa) and Fantom Encore (100 µm and -0.13 Pa). Besides strut size, stent design played a dominant role in 3D. The highest percentage area adverse TAWSS (<0.5 Pa) and OSI (>0.2) were found for Fantom (56% and 30%) and Absorb (53% and 33%), followed by Fantom Encore (30% and 25%) and Magmaris (25% and 20%). Magmaris had the smallest areas due to a small footprint and rounded struts. CONCLUSIONS Due to stent design, both Fantom Encore and Magmaris showed smaller TAWSS and OSI than Fantom and Absorb. This study quantifies which scaffold features are most important to reduce long-term restenosis.
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Affiliation(s)
- Imane Tarrahi
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
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Al Nooryani AA, Abdelrahman NA, Helmy HA, Kishk YT, Hassan AKM. The role of optical coherence tomography guidance in scaffold versus stent optimization. Egypt Heart J 2020; 72:77. [PMID: 33151451 PMCID: PMC7644726 DOI: 10.1186/s43044-020-00110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Optical coherence tomography showed a great ability to identify adverse features during percutaneous coronary intervention with drug-eluting stents and resulted in better clinical outcomes. The study aimed to assess the impact of optical coherence tomography on intraoperative decision-making during implantation of Absorb bioresorbable scaffolds versus everolimus drug-eluting stents. RESULTS We performed an observational study that included 223 consecutive patients post optical coherence tomography-guided implantation of either Absorb bioresorbable scaffolds (162 patients) or everolimus drug-eluting stents (61 patients). We studied the influence of optical coherence tomography on intraoperative decision-making during implantation of bioresorbable scaffolds versus drug-eluting stents by analyzing the total rate of optical coherence tomography-dependent modifications in each device. After satisfactory angiographic results, the total rate of required intervention for optical coherence tomography detected complications was significantly higher in the bioresorbable scaffolds arm compared to drug-eluting stents arm (47.8% versus 32.9%, respectively; p = 0.019). The additional modifications encompassed further optimization in the case of device underexpansion or struts malapposition, and even stenting in the case of strut fractures, or significant edge dissection. CONCLUSIONS Compared to drug-eluting stents, Absord scaffold was associated with a significantly higher rate of optical coherence tomography-identified intraprocedural complications necessitating further modifications. The study provides some hints on the reasons of scaffolds failure in current PCI practice; it offers a new insight for the enhancement of BRS safety and presents and adds to the growing literature for successful BRS utilization.
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Affiliation(s)
- Arif A. Al Nooryani
- Cardiovascular Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Nagwa A. Abdelrahman
- Cardiovascular Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
- Cardiovascular Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Hatem A. Helmy
- Cardiovascular Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Yehia T. Kishk
- Cardiovascular Department, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Ayman K. M. Hassan
- Cardiovascular Department, Faculty of Medicine, Assiut University, Asyut, Egypt
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Forrestal B, Case BC, Yerasi C, Musallam A, Chezar-Azerrad C, Waksman R. Bioresorbable Scaffolds: Current Technology and Future Perspectives. Rambam Maimonides Med J 2020; 11:RMMJ.10402. [PMID: 32374257 PMCID: PMC7202443 DOI: 10.5041/rmmj.10402] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Metallic drug-eluting stents have led to significant improvements in clinical outcomes but are inherently limited by their caging of the vessel wall. Fully bioresorbable scaffolds (BRS) have emerged in an effort to overcome these limitations, allowing a "leave nothing behind" approach. Although theoretically appealing, the initial experience with BRS technology was limited by increased rates of scaffold thrombosis compared with contemporary stents. This review gives a broad outline of the current BRS technologies and outlines the refinements in BRS design, procedural approach, lesion selection, and post-procedural care that resulted from early BRS trials.
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Affiliation(s)
| | | | | | | | | | - Ron Waksman
- To whom correspondence should be addressed. E-mail:
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Jang TS, Cheon KH, Ahn JH, Song EH, Kim HE, Jung HD. In-vitro blood and vascular compatibility of sirolimus-eluting organic/inorganic hybrid stent coatings. Colloids Surf B Biointerfaces 2019; 179:405-413. [DOI: 10.1016/j.colsurfb.2019.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/08/2019] [Indexed: 12/19/2022]
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Waksman R, Lipinski MJ, Acampado E, Cheng Q, Adams L, Torii S, Gai J, Torguson R, Hellinga DM, Westman PC, Joner M, Zumstein P, Kolodgie FD, Virmani R. Comparison of Acute Thrombogenicity for Metallic and Polymeric Bioabsorbable Scaffolds: Magmaris Versus Absorb in a Porcine Arteriovenous Shunt Model. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004762. [PMID: 28801538 DOI: 10.1161/circinterventions.116.004762] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comparison in acute thrombogenicity between the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold and the Absorb bioresorbable vascular scaffold has not been performed. This study assessed acute thrombogenicity of Magmaris compared with Absorb and the Orsiro hybrid drug-eluting stent in a porcine arteriovenous shunt model. METHODS AND RESULTS An ex vivo porcine carotid jugular arteriovenous shunt was established and connected to SYLGARD tubing containing the Magmaris, Absorb, and Orsiro scaffolds/stents and allowed to run in the shunt for a maximum of 1 hour. Twelve shunts (2 shunt runs per pig) were run comparing the 3 scaffolds in alternating order. Nested generalized linear mixed models were used to compare variables between scaffold groups while adjusting for variability between shunt runs. Confocal fluorescent microscopy costaining CD61/CD42b demonstrated that both Magmaris (3.0%) and Orsiro (4.6%) had less platelet coverage of the total scaffold compared with Absorb (21.8%). Scanning electron microscopy demonstrated significantly less thrombus deposition to Magmaris as a percentage of the total scaffold compared with Absorb (5.0% versus 16.1%, P=0.02). Magmaris had significantly less PM-1-positive neutrophil and CD14-positive monocyte adherence compared with both Orsiro and Absorb. Orsiro had significantly less monocyte deposition compared with Absorb. CONCLUSIONS Despite a similar scaffold strut thickness, the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold was significantly less thrombogenic compared with the Absorb bioresorbable vascular scaffold in an ex vivo porcine arteriovenous shunt model. Further studies are needed to determine whether the reduced thrombogenicity of Magmaris will result in reductions in major cardiovascular events.
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Affiliation(s)
- Ron Waksman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.).
| | - Michael J Lipinski
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Eduardo Acampado
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Qi Cheng
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Lila Adams
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Sho Torii
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Jiaxiang Gai
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Rebecca Torguson
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - David M Hellinga
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Peter C Westman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Michael Joner
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Philine Zumstein
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Frank D Kolodgie
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Renu Virmani
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
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12
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Im SH, Jung Y, Kim SH. Current status and future direction of biodegradable metallic and polymeric vascular scaffolds for next-generation stents. Acta Biomater 2017; 60:3-22. [PMID: 28716610 DOI: 10.1016/j.actbio.2017.07.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/04/2017] [Accepted: 07/12/2017] [Indexed: 01/18/2023]
Abstract
Because of the increasing incidence of coronary artery disease, the importance of cardiovascular stents has continuously increased as a treatment of this disease. Biodegradable scaffolds fabricated from polymers and metals have emerged as promising materials for vascular stents because of their biodegradability. Although such stent framework materials have shown good clinical efficacy, it is difficult to decide whether polymers or metals are better vascular scaffolds because their properties are different. Therefore, there are still obstacles in the development of biodegradable vascular scaffolds in terms of improving clinical efficacy. This review analyzes the pros and cons of current stent materials with respect to five key factors for next-generation stent and discusses methods of improvement. Furthermore, we discuss biodegradable electronic stents with electrical conductivity, which has been considered unimportant until now, and highlight electrical conductivity as a key factor in the development of next-generation stents.
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Bowen PK, Seitz JM, Guillory RJ, Braykovich JP, Zhao S, Goldman J, Drelich JW. Evaluation of wrought Zn-Al alloys (1, 3, and 5 wt % Al) through mechanical and in vivo testing for stent applications. J Biomed Mater Res B Appl Biomater 2017; 106:245-258. [PMID: 28130871 DOI: 10.1002/jbm.b.33850] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/26/2016] [Accepted: 01/01/2017] [Indexed: 11/09/2022]
Abstract
Special high grade zinc and wrought zinc-aluminum (Zn-Al) alloys containing up to 5.5 wt % Al were processed, characterized, and implanted in rats in search of a new family of alloys with possible applications as bioabsorbable endovascular stents. These materials retained roll-induced texture with an anisotropic distribution of the second-phase Al precipitates following hot-rolling, and changes in lattice parameters were observed with respect to Al content. Mechanical properties for the alloys fell roughly in line with strength (190-240 MPa yield strength; 220-300 MPa ultimate tensile strength) and elongation (15-30%) benchmarks, and favorable elastic ranges (0.19-0.27%) were observed. Intergranular corrosion was observed during residence of Zn-Al alloys in the murine aorta, suggesting a different corrosion mechanism than that of pure zinc. This mode of failure needs to be avoided for stent applications because the intergranular corrosion caused cracking and fragmentation of the implants, although the composition of corrosion products was roughly identical between non- and Al-containing materials. In spite of differences in corrosion mechanisms, the cross-sectional reduction of metals in murine aorta was nearly identical at 30-40% and 40-50% after 4.5 and 6 months, respectively, for pure Zn and Zn-Al alloys. Histopathological analysis and evaluation of arterial tissue compatibility around Zn-Al alloys failed to identify areas of necrosis, though both chronic and acute inflammatory indications were present. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 245-258, 2018.
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Affiliation(s)
- Patrick K Bowen
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jan-Marten Seitz
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jacob P Braykovich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Shan Zhao
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
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Lipinski MJ, Escarcega RO, Baker NC, Benn HA, Gaglia MA, Torguson R, Waksman R. Scaffold Thrombosis After Percutaneous Coronary Intervention With ABSORB Bioresorbable Vascular Scaffold: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2016; 9:12-24. [PMID: 26762906 DOI: 10.1016/j.jcin.2015.09.024] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to determine the risk of scaffold thrombosis (ST) after percutaneous coronary intervention (PCI) with placement of an ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) by conducting a systematic review and meta-analysis. BACKGROUND PCI with BVS placement holds great potential, but concern has recently been raised regarding the risk of ST. METHODS MEDLINE/PubMed, Cochrane CENTRAL, and meeting abstracts were searched for all studies that included outcomes data for patients after PCI with BVS placement. For studies comparing BVSs with drug-eluting stents (DES), pooled estimates of outcomes, presented as odds ratios (ORs) with 95% confidence intervals (CIs), were generated with random-effects models. RESULTS Our analysis included 10,510 patients (8,351 with a BVS and 2,159 with DES) with a follow-up of 6.4 ± 5.1 months and 60 ± 11 years of age; 78% were male, 36% had stable angina, and 59% had acute coronary syndrome (ACS). Among patients with a BVS, cardiovascular death occurred in 0.6%, myocardial infarction (MI) in 2.1%, target lesion revascularization in 2.0%, and definite/probable ST in 1.2% of patients. Of BVS patients, 0.27% had acute ST and 0.57% had subacute ST. Meta-analysis demonstrated that patients who received a BVS were at a higher risk of MI (OR: 2.06, 95% CI: 1.31 to 3.22, p = 0.002) and definite/probable ST (OR: 2.06, 95% CI: 1.07 to 3.98, p = 0.03) compared with patients who received DES, whereas there was a trend toward decreased all-cause mortality with a BVS (OR: 0.40, 95% CI: 0.15 to 1.06, p = 0.06). CONCLUSIONS Patients undergoing PCI with a BVS had increased definite/probable ST and MI during follow-up compared with DES. Further studies with long-term follow-up are needed to assess the risk of ST with a BVS.
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Affiliation(s)
- Michael J Lipinski
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Ricardo O Escarcega
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Nevin C Baker
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Hadiya A Benn
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Michael A Gaglia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC.
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Abstract
The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis - although lower with the second generation than with the first generation of drug-eluting stents - remains a major concern. This complication is mainly related to the presence of permanent metallic implants, chronic degeneration triggered by an inflammatory response to the coating polymer, and/or adverse effects of antiproliferative drugs on endothelial regeneration. In 2011, self-degrading coronary stents - the bioresorbable vascular scaffolds (BVS) - were introduced into clinical practice, showing good short-term results owing to their adequate strength. The advantage of these devices is the transient nature of vascular scaffolding, which avoids permanent vessel caging. In this Review, we summarize the latest research on BVS, with a particular emphasis on the implantation technique (which is different from that used with metallic stents) to outline the concept that BVS deployment methods have a major effect on procedural success and prognosis of patients with coronary artery stenosis. Furthermore, the clinical outcome of BVS in randomized clinical trials and in phase IV studies are discussed in different pathophysiological settings, such as stable or acute coronary disease. Finally, all the available data on the safety profile of BVS regarding scaffold thrombosis are discussed.
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Pighi M, Tomai F, Petrolini A, de Luca L, Tarantini G, Barioli A, Colombo P, Klugmann S, Ferlini M, Ormezzano MF, Loi B, Calabrò P, Bianchi RM, Faggian G, Forni A, Vassanelli C, Valgimigli M, Ribichini F. Everolimus-Eluting Bioresorbable Vascular Scaffold System in the Treatment of Cardiac Allograft Vasculopathy: the CART (Cardiac Allograft Reparative Therapy) Prospective Multicenter Pilot Study. J Cardiovasc Transl Res 2015; 9:40-8. [DOI: 10.1007/s12265-015-9665-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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Barbato E, Barton PJ, Bartunek J, Huber S, Ibanez B, Judge DP, Lara-Pezzi E, Stolen CM, Taylor A, Hall JL. Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine. J Cardiovasc Transl Res 2015; 8:466-74. [DOI: 10.1007/s12265-015-9657-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
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