Role of polymers in improving the results of stenting in coronary arteries

Surface modification strategies for improved hemocompatibility of polymeric materials: a comprehensive review

Polymeric biomaterials are a widely used class of materials due to their versatile properties. However, as with all other types of materials used for biomaterials, polymers also have to interact with blood. When blood comes into contact with any foreign body, it initiates a cascade which leads to platelet activation and blood coagulation. The implant surface also has to encounter a thromboinflammatory response which makes the implant integrity vulnerable, this leads to blood coagulation on the implant and obstructs it from performing its function. Hence, the surface plays a pivotal role in the design and application of biomaterials. In particular, the surface properties of biomaterials are responsible for biocompatibility with biological systems and hemocompatibility. This review provides a report on recent advances in the field of surface modification approaches for improved hemocompatibility. We focus on the surface properties of polysaccharides, proteins, and synthetic polymers. The blood coagulation cascade has been discussed and blood - material surface interactions have also been explained. The interactions of blood proteins and cells with polymeric material surfaces have been discussed. Moreover, the benefits as well as drawbacks of blood coagulation on the implant surface for wound healing purposes have also been studied. Surface modifications implemented by other researchers to enhance as well as prevent blood coagulation have also been analyzed.

Evolution of metallic cardiovascular stent materials: A comparative study among stainless steel, magnesium and zinc

A cardiovascular stent is a small mesh tube that expands a narrowed or blocked coronary artery. Unfortunately, current stents, regardless metallic or polymeric, still largely fall short to the ideal clinical needs due to late restenosis, thrombosis and other clinical complications. Nonetheless, metallic stents are preferred clinically thanks to their superior mechanical property and radiopacity to their polymeric counterparts. The emergence of bioresorbable metals opens a window for better stent materials as they may have the potential to reduce or eliminate late restenosis and thrombosis. In fact, some bioresorbable magnesium (Mg)-based stents have obtained regulatory approval or under trials with mixed clinical outcomes. Some major issues with Mg include the too rapid degradation rate and late restenosis. To mitigate these problems, bioresorbable zinc (Zn)-based stent materials are being developed lately with the more suitable degradation rate and better biocompatibility. The past decades have witnessed the unprecedented evolution of metallic stent materials from first generation represented by stainless steel (SS), to second generation represented by Mg, and to third generation represented by Zn. To further elucidate their pros and cons as metallic stent materials, we systematically evaluated their performances in vitro and in vivo through direct side-by-side comparisons. Our results demonstrated that tailored Zn-based material with proper configurations could be a promising candidate for a better stent material in the future.

Cardiovascular stents: overview, evolution, and next generation

Compared to bare-metal stents (BMSs), drug-eluting stents (DESs) have been regarded as a revolutionary change in coronary artery diseases (CADs). Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Despite supreme advantages over BMSs, in-stent restenosis (ISR) and long-term safety of DESs are still deemed ongoing concerns over clinically application of DESs. The failure of DESs for long-term clinical use is associated with following factors including permanent polymeric coating materials, metallic stent platforms, non-optimal drug releasing condition, and factors that have recently been supposed as contributory factors such as degradation products of polymers, metal ions due to erosion and degradation of metals and their alloys utilizing in some stents as metal frameworks. Discovering the direct relation between stent materials and associating adverse effects is a complicated process, and yet it has not been resolved. For clinical success it is of significant importance to optimize DES design and explore novel strategies to overcome all problems including inflammatory response, delay endothelialization, and sub-acute stent thrombosis (ST) simultaneously. In this work, scientific reports are reviewed particularly focusing on recent advancements in DES design which covers both potential improvements of existing and recently novel prototype stent fabrications. Covering a wide range of information from the BMSs to recent advancement, this study mostly sheds light on DES's concepts, namely stent composition, drug release mechanism, and coating techniques. This review further reports different forms of DES including fully biodegradable DESs, shape-memory ones, and polymer-free DESs.

Radial Compressive Property and the Proof-of-Concept Study for Realizing Self-expansion of 3D Printing Polylactic Acid Vascular Stents with Negative Poisson's Ratio Structure

Biodegradable stents offer the potential to reduce the in-stent restenosis by providing support long enough for the vessel to heal. The polylactic acid (PLA) vascular stents with negative Poisson's ratio (NPR) structure were manufactured by fused deposition modeling (FDM) 3D printing in this study. The effects of stent diameter, wall thickness and geometric parameters of arrowhead NPR structure on radial compressive property of 3D-printed PLA vascular stent were studied. The results showed that the decrease of stent diameter, the increase of wall thickness and the increase of the surface coverage could enhance the radial force (per unit length) of PLA stent. The radial and longitudinal size of PLA stent with NPR structure decreased simultaneously when the stent was crimped under deformation temperature. The PLA stent could expand in both radial and longitudinal direction under recovery temperature. When the deformation temperature and recovery temperature were both 65 °C, the diameter recovery ratio of stent was more than 95% and the maximum could reach 98%. The length recovery ratio was above 97%. This indicated the feasibility of utilizing the shape memory effect (SME) of PLA to realize the expansion of 3D-printed PLA vascular stent under temperature excitation.

Molybdenum Disulfide Surface Modification of Ultrafine-Grained Titanium for Enhanced Cellular Growth and Antibacterial Effect

The commercially pure Ti (CP Ti) and equal-channel angular pressing (ECAP) processed Ti can contribute to the downsizing of medical devices with their superior mechanical properties and negligible toxicity. However, the ECAP-processed pure Ti has the risk of bacterial infection. Here, the coarse- and ultrafine-grained Ti substrates were surface-modified with molybdenum disulfide (MoS2) to improve the cell proliferation and growth with antibacterial effect for further dental applications. According to in vitro tests using the pre-osteoblast of MC3T3-E1 cell and a bacterial model of Escherichia coli (E. coli), MoS2 nanoflakes coated and ECAP-processed Ti substrates showed a significant increase in surface energy and singlet oxygen generation resulting in improved cell attachment and antibacterial effect. In addition, we confirmed the stability of the surface modified Ti substrates in a physiological solution and an artificial bone. Taken together, MoS2 modified and ECAP-processed Ti substrates might be successfully harnessed for various dental applications.

Immiscible poly(lactic acid)/poly(ε-caprolactone) for temporary implants: Compatibility and cytotoxicity

This manuscript focuses on the effect of the addition of a low molecular weight triblock copolymer derived from ε-caprolactone and tetrahydrofuran (CT) on the compatibility and cytotoxicity of immiscible poly(lactic acid) (PLA) and poly(ε-caprolactone) (PCL) blends. Binary and tertiary PLA/PCL blends were prepared by melt mixing in a twin-screw extruder and their morphological, mechanical and thermal behaviors were investigated by scanning electron microscopy (SEM), tensile and Izod impact test, dynamic mechanical analysis (DMA) and differential scanning calorimetry (DSC). SEM micrographs showed the CT copolymer suppressed the coalescence phenomena and maintained the size of dispersed PCL domains at approximately 0.35µm. Bioresorbable PLA/PCL blends containing 5wt% of CT copolymer exhibited a remarkable increase in ductility and improved toughness at room temperature. Although the CT copolymer increased the interfacial adhesion, the DMA results suggest it also acts as a plasticizer exclusively for the PCL phase. The cell viability evaluated by the XTT assay confirmed PLA/PCL blends compatibilized by CT copolymer exerted no cytotoxic effect.

Interfacial Engineering of Hierarchically Porous NiTi/Hydrogels Nanocomposites with Exceptional Antibiofouling Surfaces

Seamlessly bridging the hard and the soft, a strategy to fabricate hierarchically porous NiTi/hydrogels nanocomposites is reported. The nanocomposite surface can hold high-content water while keeping its hierarchical nanoscale topography, thus showing exceptional antibiofouling performance. This strategy will lead to antibiofouling alloy (e.g., NiTi)/hydrogel nanocomposites for improved stents and other blood-contacting implants and medical devices.

Drug Eluting Stent Technology

The authors discuss the mechanism of action, clinical trial data, and economic impact of both the paclitaxel and sirolimus drug eluting stents (DESs). Both DESs have been approved by the Food and Drug Administration for the treatment of native coronary arteries to prevent in-stent restenosis (ISR), which patients have experienced since the advent of balloon angioplasty and the bare metal stent. In-stent restenosis, which manifests itself as ischemic symptoms in patients, occurs as a result of the healing process after stent implantation. Until now, there has not been an effective method to prevent ISR. The sirolimus and paclitaxel DESs elute agents that act locally by different mechanisms to reduce neointimal hyperplasia, which is primarily responsible for ISR. Both DESs are capable of reducing the rate of ISR. There are certain physical and mechanistic differences between the 2 stents; the stents have not been compared head to head. Currently, they are indicated for uncomplicated native coronary lesions. Further investigation is needed to define their roles in the treatment of more complex lesions.

The development of carotid stent material

Endovascular angioplasty with stenting is a promising option for treating carotid artery stenosis. There exist a rapidly increasing number of different stent types with different materials. The bare-metal stent is the most commonly used stent with acceptable results, but it leaves us with the problems of thrombosis and restenosis. The drug-eluting stent is a breakthrough as it has the ability to reduce the restenosis rate, but the problem of late thrombosis still has to be addressed. The biodegradable stent disappears after having served its function. However, restenosis and degradation rates remain to be studied. In this article, we review every stent material with its characteristics, clinical results and complications and point out the standards of an ideal carotid stent.

A new dextran-graft-polybutylmethacrylate copolymer coated on 316L metallic stents enhances endothelial cell coverage

Amphiphilic copolymers based on the copolymerization of hydrophilic and hydrophobic moieties offer versatility in various biomedical material applications. Here, a new biocompatible copolymer of dextran-graft-polybutylmethacrylate is synthesized for the coating of metallic endovascular stents. Coating of metallic surfaces is performed and analyzed by X-ray photoelectron spectroscopy, attenuated total reflection Fourier transform infrared spectroscopy, contact angle measurement, atomic force microscopy and scanning electron microscopy before and after deformation corresponding to stent deployment by a balloon catheter. In the conditions described here, the resulting coating is smooth and uniform with neither cracks nor detachment after stent expansion. Interestingly, surfaces coated with the copolymer greatly improve in vitro adhesion and growth of endothelial cells. This copolymer provides new opportunities for implanted biomaterials.

The effect of VEGF-immobilized nickel-free high-nitrogen stainless steel on viability and proliferation of vascular endothelial cells

Using ester bonds, vascular endothelial growth factor-A (VEGF-A) was immobilized on the surface of a novel biometal, nickel-free high-nitrogen stainless steel (HNS). The biological activity of immobilized VEGF-A was investigated after the culture of human umbilical vein endothelial cells (HUVECs) on the substrate. Immobilization of VEGF-A onto the HNS surface was performed using trisuccinimidyl citrate (TSC) as a linker. Firstly, UV irradiation was employed to amplify hydroxyl groups on the HNS surface. Next, the HNS was dipped into TSC/dimethyl sulfoxide solution at room temperature. From the results of water contact angle measurement and X-ray photoelectron spectroscopy (XPS) analysis, TSC was found to be immobilized on the HNS surface via ester bonds. Quantitative analysis demonstrated that immobilized VEGF-A remained even after immersion in culture medium for 7 days; however, it was gradually deimmobilized by hydrolysis of the ester bonds at the TSC-metal interface. As a result, VEGF-A-immobilized HNS significantly contributed to the stimulation of HUVEC growth for the initial stage of culture, even though the gradual reduction in growth stimulation of HUVECs occurred by the sequential deimmobilization of VEGF-A, which was caused by the hydrolysis of the ester groups. Therefore, VEGF-A-immobilized HNS could be applied as a basic material for coronary stents.

Modeling of Deformation-Accelerated Breakdown of Polylactic Acid Biodegradable Stents

The use of biodegradable polymers in biomedical applications has been successful in nonload bearing applications, such as biodegradable implants for local drug delivery, and in simple load bearing situations such as surgical sutures and orthopedic fixation screws. The desire to incorporate these materials in more complex load bearing situations, such as tissue engineering scaffolds and endovascular or urethral stents, is strong, but the lack of constitutive models describing the evolution of biodegradable polymers over the course of degradation has severely hampered the rational design process for these more complex biodegradable medical applications. With the objective of predicting biodegradable stent behavior, we incorporated constitutive models of biodegradable polymeric materials in a computational setting and the mechanical response of three different stent designs were analyzed as degradation progressed. A thermodynamically consistent constitutive model for materials undergoing deformation-induced degradation was applied to a commonly employed biodegradable polymer system, poly(L-lactic acid), and its specific form was determined by corroboration against experimental data. Depreciation of mechanical properties due to degradation confers time-dependent characteristics to the response of the biodegradable material: the deformation imparted by a constant load increases over time, i.e. the body creeps, and the stress necessary to keep a fixed deformation decreases, i.e. the body relaxes. Biodegradable stents, when subjected to constant pressure in its exterior, deflect inwards and ultimately fail as the structure loses its mechanical integrity. The complex geometry of endovascular stents and their physiological loading conditions lead to inhomogeneous deformations, and consequently, inhomogeneous degradation ensues. Degradation is mostly confined to the bends of the stent rings and junction points, which are the locations that carry most of the deformation, whereas mostly undeformed connector bars remain less degraded. If failure occurs, it will occur most likely at those sensitive locations and large, nondegraded pieces can provoke severe embolic problems. Highly nonuniform degradation indicates that some stent designs are at higher risk for complications. Deformation patterns of stents made of a material that loses its integrity are different than those of permanent stents. Blind adaptation of permanent stent design concepts is ill-suited for biodegradable stent design. The time-dependent aspect of the implant not only must be taken into account but should also be used to interact with the body’s reaction and to enhance healing.

Influence of unsaturated carbonic acids on hemocompatibility and cytotoxicity of poly-vinylacetate based co-polymers

The aim of this study was to investigate hemocompatibility and cytotoxicity properties of synthetic polymer coatings containing various unsaturated carbonic acids with vinylacetate. Co-polymers of vinylacetate and crotonic acid (CA), maleic acid (MA), and itaconic acid (IA) were made. The materials were characterized in terms of their adhesion to metal supports (titanium and stainless steel) as well as hemocompatibility (% hemolysis, wettability, erythrocyte aggregation, hemoglobin content, thrombocyte count and lipid peroxidation levels) and cytotoxicity (human endothelial cell activity in vitro and chromosome aberrations, bone marrow proliferation and cell ploidy in rats). Co-polymers of unsaturated carbonic acids with vinylacetate exhibited good hemocompatibility properties, as opposed to vinylacetate homopolymer for which substantial levels of hemolysis were observed. By coating the metal supports with co-polymers the cytotoxic effects associated with the bare metal samples were markedly reduced. MA samples showed excellent hemocompatibility and no cytotoxicity, yet they lacked good adhesion properties to metal substrate, probably due to high water content. CA samples, having the highest density of carboxylic groups among the samples under investigation, showed increased bone marrow proliferation activity and cell ploidy in rats, as compared to controls. The most promising results in the present study were obtained for the samples with IA, which showed good adhesion to metal substrates, good hemocompatibility and low cytotoxicity. Thus, co-polymers of vinylacetate and IA rich in carboxylic groups are promising materials for the design of novel drug-eluting stents.

Polyurethane/polycaprolactane blend with shape memory effect as a proposed material for cardiovascular implants

Shape memory materials have been proposed for cardiovascular stents due to their self-expansion ability. The most ideal way to anchor a stent is using self-expansion in the range of body temperature. This work, for the first time, reports the use of polyurethane/polycaprolactone (PU/PCL) blend as a proposed material for shape memory stents. Polyurethane copolymer based on poly(epsilon-caprolactone) diol was melt blended with PCL in four different ratios of 20, 30, 40 and 50 wt.% and their shape memory behaviors were examined. All blends except for PU/PCL(80/20) showed shape memory effects with recovery temperatures of around the melting temperature of PCL in the blends. The melting behavior of the PCL in the blends is strongly influenced by composition. Changing the composition of the blend system and crystallization conditions adjusted shape recovery to the range of body temperature for PU/PCL(70/30) blend. The in vitro biocompatibility of PU/PCL(70/30) blend was evaluated in this study using human bone marrow mesenchymal stem cells (hBMSCs). The adhesion, morphology and mitochondrial function were analyzed in order to investigate the cell viability during cell culture on PU/PCL(70/30) blend surface. The results showed that the blend supported cell adhesion and proliferation, which indicated good biocompatibility. Our results suggested that this blend might be a potential material as a stent implant.

Electropolymerized tricopolymer based on N-pyrrole derivatives as a primer coating for improving the performance of a drug-eluting stent

The coating of medical implants by polymeric films aims at increasing their biocompatibility as well as providing a durable matrix for the controlled release of a drug. In many cases, the coating is divided into a primer layer, which bridges between the medical implant and the drug-eluting matrix. The primer coating must be very carefully designed in order to provide optimal interactions with the surface of the medical implant and the outer layer. Here we present a simple and versatile approach for designing the primer layer based on electropolymerization of a carefully chosen blend of three different pyrrole derivatives: N-methylpyrrole (N-me), N-(2-carboxyethyl)pyrrole (PPA), and the butyl ester of N-(2-carboxyethyl)pyrrole (BuOPy). The composition and physical properties of the primer layer were studied in detail by atomic force microscopy (AFM) and a nano scratch tester. The latter provides the in-depth analysis of the adhesion and viscoelasticity of the coating. AFM phase imaging reveals a uniform distribution of the three monomers forming rough morphology. This primer layer significantly improved the morphology, stability, and paclitaxel release profile of a paclitaxel-eluting matrix based on methyl and lauryl methacrylates.

A new wave in treatment of vascular occlusive disease: biodegradable stents--clinical experience and scientific principles

Stent-based therapies in percutaneous vascular intervention are associated with significant long-term complications related to in-stent restenosis. A growing body of literature demonstrates the feasibility of biodegradable materials for endovascular stents, which may, in theory, circumvent many of the immunologic and inflammatory response issues seen with long-term metallic stent failure in coronary and peripheral applications. This review describes the history of endovascular stents and the challenges encountered with metallic, drug-eluting, and biodegradable stents. A review of the basic engineering principles of biodegradable stents is provided, along with a discussion of the cellular mechanisms of restenosis.

Nanoscale architectural tuning of parylene patch devices to control therapeutic release rates

The advent of therapeutic functionalized implant coatings has significantly impacted the medical device field by enabling prolonged device functionality for enhanced patient treatment. Incorporation of drug release from a stable, biocompatible surface is instrumental in decreasing systemic application of toxic therapeutics and increasing the lifespan of implants by the incorporation of antibiotics and anti-inflammatories. In this study, we have developed a parylene C-based device for controlled release of Doxorubicin, an anti-cancer chemotherapy and definitive read-out for preserved drug functionality, and further characterized the parylene deposition condition-dependent tunability of drug release. Drug release is controlled by the deposition of a layer of 20-200 nm thick parylene over the drug layer. This places a porous layer above the Doxorubicin, limiting drug elution based on drug accessibility to solvent and the solvent used. An increase in the thickness of the porous top layer prolongs the elution of active drug from the device from, in the conditions tested, the order of 10 min to the order of 2 d in water and from the order of 10 min to no elution in PBS. Thus, the controlled release of an anti-cancer therapeutic has been achieved via scalably fabricated, parylene C-encapsulated drug delivery devices.

In vitro genotoxicity tests for polyhydroxybutyrate – A synthetic biomaterial

The aims of this study are to determine the mutagenicity of a locally produced polyhydroxybutyrate (PHB) using Salmonella mutagenicity test and to find out if PHB altered the expression of p53 and c-myc proto-oncogenes and bcl-xl and bcl-xs anti-apoptotic genes in the human fibroblast cell line, MRC-5. Different concentrations of PHB were incubated with special genotypic variants of Salmonella strains (TA1535, TA1537, TA1538, TA98 and TA100) carrying mutations in several genes both with and without metabolic activation (S9) and the test was assessed based on the number of revertant colonies. The average number of revertant colonies per plate treated with PHB was less than double as compared to that of negative control. For the gene expression analyses, fibroblast cell lines were treated with PHB at different concentrations and incubated for 1, 12, 24 and 48 h separately. The total RNA was isolated and analysed for the expression of p53, c-myc, bcl-xl and bcl-xs genes. The PHB did not show over or under expression of the genes studied. The above tests indicate that the locally produced PHB is non-genotoxic and does not alter the expression of the proto-oncogenes and anti-apoptotic genes considered in this study.

Delivery of large biopharmaceuticals from cardiovascular stents: a review

This review focuses on new and emerging large-molecule bioactive agents delivered from stent surfaces in drug-eluting stents (DESs) to inhibit vascular restenosis in the context of interventional cardiology. New therapeutic agents representing proteins, nucleic acids (small interfering RNAs and large DNA plasmids), viral delivery vectors, and even engineered cell therapies require specific delivery designs distinct from traditional smaller-molecule approaches on DESs. While small molecules are currently the clinical standard for coronary stenting, extension of the DESs to other lesion types, peripheral vasculature, and nonvasculature therapies will seek to deliver an increasingly sophisticated armada of drug types. This review describes many of the larger-molecule and biopharmaceutical approaches reported recently for stent-based delivery with the challenges associated with formulating and delivering these drug classes compared to the current small-molecule drugs. It also includes perspectives on possible future applications that may improve safety and efficacy and facilitate diversification of the DESs to other clinical applications.

Poly(lactic acid) (PLA) based nanocomposites--a novel way of drug-releasing

In this communication, poly(lactic acid) nanofibers have been fabricated by electrospinning and then poly(lactic acid) (PLA) based nanocomposites have been prepared by accumulating anticancer drug daunorubicin on PLA nanofibers combined with TiO2 nanoparticles. Our atomic force microscopy (AFM) and laser-scanning confocal microscope (LSCM) studies demonstrate that the respective drug molecules could be readily self-assembled on the surface of the blends of nano-TiO2 with PLA polymer nanocomposites, which could further efficiently facilitate the drug permeation and accumulation on the target leukemia K562 cells. Besides, the respective new nanocomposites have good biocompatibility, ease of surface chemistry modification and very high surface area, which may afford the possibility for their promising application in pharmacology and biomedical engineering areas.

UV surface modification of a new nanocomposite polymer to improve cytocompatibility

A novel modified nanocomposite was studied for the adhesion and proliferation of the human umbilical vein endothelial cell (HUVEC) line EA.hy926. The nanocomposite under investigation was poly(carbonate-urea)urethane with silsesquioxane nano-cages, here in the form of a mixture of two polyhedral oligomeric silsesquioxanes. The nanocomposite surfaces were exposed to ultraviolet (UV) light of a Xe(*)(2)-excimer lamp at a wavelength of 172 nm in an ammonia atmosphere. The effects of the irradiation were characterized by atomic force and scanning electron microscopy (AFM, SEM), X-ray photo-electron spectroscopy (XPS), Fourier-transform infrared spectroscopy (FT-IR) using an attenuated total reflection (ATR) device and measurements of advancing water contact angle (CA). The irradiation resulted in the introduction of new hydrophilic N- and O-containing groups into the surface, which was initially amphiphilic, while surface morphology remained mainly unchanged. Slight chemical changes were also observed for the silsesquioxane nano-cages at the surface. Onto the untreated and irradiated samples HUVECs were seeded and grown for various durations in culture. Standard tissue-culture polystyrene (PS) was employed as a positive control to check the efficiency of the cell-culture methods. Viability and proliferation of the cells were then assessed using a non-radioactive assay. Compared to the untreated nanocomposite polymer, irradiation times of at least 5 min resulted in a significantly increased cell proliferation between 3 and 8 days after seeding with the HUVEC line EA.hy926.

Viscoelastic properties of fibrinogen adsorbed to the surface of biomaterials used in blood-contacting medical devices

The hemocompatibility of polymeric vascular implants is in part dependent on the propensity of fibrinogen to adsorb to the implant surface. Fibrinogen surface adsorption was measured in real time using a quartz crystal microbalance with dissipation monitoring (QCM-D). Six new, biodegradable tyrosine-derived polycarbonates were used as test surfaces. Stainless steel, poly(L-lactic acid), poly(D,L-lactide-co-glycolide), and poly(ethylene terephthalate) surfaces served as controls and provided a comparison of the test surfaces with those of commonly used biomaterials. Our study addressed the question regarding to which extent systematic variations in polymer structure can be used to optimize X-ray visibility and provide tunable degradation rates while generating protein-repellant surface properties that minimize fibrinogen adsorption. QCM-D revealed surface-dependent changes in fibrinogen layer thickness (2 to 37 nm), adsorbed wet mass (0.2 to 4.3 microg/cm2), and viscosity (0.001 to 0.005 kg/ms). While we did not find an overall correlation between surface air-water contact angle measurements and fibrinogen adsorption (R2 = 0.08), our data demonstrate that gradually increasing the poly(ethylene glycol) content within a subgroup of polymers having the same polymer backbone will lead to decreased fibrinogen adsorption. Within this subgroup of polymers, there was a strong correlation between decreasing air-water contact angles and decreasing fibrinogen adsorption (R2 = 0.95). We conclude that it is possible to minimize fibrinogen adsorption to tyrosine-derived polycarbonates while optimizing X-ray visibility and degradation rates. Some of the tyrosine-derived polycarbonates were identified as useful materials for the design of blood-contacting implants on the basis of their substantially lower levels of fibrinogen adsorption relative to the commonly used controls.

Poly(ethylene carbonate): A thermoelastic and biodegradable biomaterial for drug eluting stent coatings?

A first feasibility study exploring the utility of poly(ethylene carbonate) (PEC) as coating material for drug eluting stents under in vitro conditions is reported. PEC (Mw 242 kDa, Mw/Mn=1.90) was found to be an amorphous polymer with thermoelastic properties. Tensile testing revealed a stress to strain failure of more than 600%. These properties are thought to be advantageous for expanding coated stents. In vitro cytotoxicity tests showed excellent cytocompatibility of PEC. Based on these findings, a new stenting concept was suggested, pre-coating a bare-metal stent with PPX-N as non-biodegradable basis and applying a secondary PEC coating using an airbrush method. After manual expansion, no delamination or destruction of the coating could be observed using scanning electron microscopy. The surface degradation-controlled release mechanism of PEC may provide the basis for "on demand" drug eluting stent coatings, releasing an incorporated drug predominantly at an inflamed implantation site upon direct contact with superoxide-releasing macrophages. As a release model, metal plates of a defined size and area were coated under the same conditions as the stents with PEC containing radiolabelled paclitaxel. An alkaline KO(2-) solution served as a superoxide source. Within 12 h, 100% of the incorporated paclitaxel was released, while only 20% of the drug was released in non-superoxide releasing control buffer within 3 weeks.

Coronary stents: a materials perspective

The objective of this review is to describe the suitability of different biomaterials as coronary stents. This review focuses on the following topics: (1) different materials used for stents, (2) surface characteristics that influence stent-biology interactions, (3) the use of polymers in stents, and (4) drug-eluting stents, especially those that are commercially available.

Collapse pressures of bilayered biodegradable stents

Biodegradable helicoidal stent prototypes made up of layers of poly-L-lactic acid (PLLA) and poly(L-lactic-co-glycolic acid) (PLGA) polymers were fabricated by temperature conditioning the stents at different stages of fabrication. The process incorporated elastic memory, or self-expandability in the stent, which is desirable to minimize stent recoil. The collapse pressures of such stents were studied, with and without in vitro degradation. The effects of thickness and the composition of each layer on the collapse pressure were modeled using the simple series model. Results of the in vitro studies for over 3 months showed that collapse pressure of the stents depended mainly on the degradation and other side-effects brought about by the degradation of different polymer compositions. Generally, the trend is dominated by the thicker of the two layers that were used to form the stents.

Coating of Poly(p-xylylene) by PLA-PEO-PLA Triblock Copolymers with Excellent Polymer−Polymer Adhesion for Stent Applications

Poly(p-xylylene) (PPX) was deposited by chemical vapor deposition (CVD) on stainless steel substrates. These PPX films were coated by solution casting of poly(lactide)-poly(ethylene oxide)-poly(lactide) triblock copolymers (PLA-PEO-PLA) loaded with 14C-labeled paclitaxel. Adhesion of PLA-PEO-PLA on PPX substrate coatings was measured using the blister test method. Excellent adhesion of the block copolymers on PPX substrates was found. Stress behavior and film integrity of PLA-PEO-PLA was compared to pure PLA on unexpanded and expanded stent bodies and was found to be superior for the block copolymers. The release of paclitaxel from the biodegradable coatings was studied under physiological conditions using the scintillation counter method. Burst release of paclitaxel was observed from PLA-PEO-PLA layers regardless of composition, but an increase in paclitaxel loading was observed with increasing content of PEO.

PLA stereocopolymers as sources of bioresorbable stents: Preliminary investigation in rabbit

The aim of the present work was to evaluate whether the degradation of PLA-based bioresorbable stents can be modulated via the configuration of repeating units as it is the case in other applications like osteosynthesis. The first obstacle was finding a stent design that could allow implantation in the aorta of a rabbit taken as a model of a human coronary artery. In the absence of guidelines other than those tentatively proposed in patents, several simple designs were considered that allowed us to evaluate the fate of the stents made of poly(lactic acid) stereocopolymers with L/(L + D) ratio of 0.92 (PLA92) and 0.50 (PLA50) up to 6 months post in vivo implantation. Our findings show the feasibility of bioresorbable stenting using PLA stereocopolymers and that PLA50 degraded faster than PLA92. Therefore, using stereocopolymers appears as a means to vary the degradation rate and adapt it to the artery remodelling process that is very much dependent on the release of the stenting stress protection.

Influence of DL-beta-hydroxybutyric acid on cell proliferation and calcium influx

Poly(hydroxybutyrate-co-hydroxyhexanoate) (PHBHHx), a member of the polyhydroxyalkanoate family of biopolyesters, has superior mechanical properties and biocompatibilities that enable it to meet diverse biomedical requirements. The main component of PHBHHx is DL-beta-hydroxybutyric acid (HB), a ketone body that is also produced in vivo. The effects of HB treatment on murine fibroblast L929 cells, human umbilical vein endothelial cells, and rabbit articular cartilages were investigated. HB (0.005-0.10 g/L) promoted cell proliferation for each cell line. Cell cycle analysis indicated that HB had a stimulatory effect on DNA synthesis. Flow cytometric analysis of L929 cells revealed changes in the [Ca2+]i for different stages of the cell cycle. In L929 cells, HB (0.02 g/L) stimulated a rapid increase in the concentration of cytosolic calcium that was blocked by verapamil and diltiazem, inhibitors of L-type Ca2+ channels. Finally, verapamil inhibited HB-induced L929 cell proliferation. Collectively, these results indicated that HB had a stimulatory effect on cell cycle progression that is mediated by a signaling pathway dependent upon increases in [Ca2+]i. This trophic effect may underlie the good biocompatibility observed for PHBHHx.

Current status of prosthetic bypass grafts: A review

Polymers such as Dacron and polytetrafluoroethylene (PTFE) have been used in high flow states with relative success but with limited application at lower flow states. Newer polymers with greater compliance, biomimicry, and ability to evolve into hybrid prostheses, suitable as smaller vessels, are now being introduced. In view of the advances in tissue engineering, this makes possible the creation of an ideal off-the-shelf bypass graft. We present a broad overview of the current state of prosthetic bypass grafts.

In vitro study of release mechanisms of paclitaxel and rapamycin from drug-incorporated biodegradable stent matrices

We have studied the in vitro release kinetics of two important antirestenosis drugs from biodegradable stent matrices. A helical stent incorporating drugs was exposed to buffer, and both degradation-controlled and diffusion-controlled drug releases were observed. New methods for in vitro drug release for both paclitaxel and rapamycin have been developed. The release profile shows a slow diffusion-controlled phase, followed by a more rapid degradation-controlled region. In the early part of the drug release, no burst effect is observed for either drug. This might be significant for paclitaxel administration, where cardiotoxicity has been sometimes of concern. By suitable polymer/drug formulations, it is possible to develop controlled release stent matrices that can exhibit a variety of release profiles. These release profiles may have relevance to antirestenotic effects and to local or systemic toxic effects.

Differentiation Pattern of Vero Cells Cultured on Poly(L-Lactic Acid)/Poly(Hydroxybutyrate-co-Hydroxyvalerate) Blends

This study evaluates the effect of poly(L-lactic acid) (PLLA) and poly(hydroxybutyrate-cohydroxyvalerate) (PHBV) bioabsorbable polymers and their blends on the induction of alteration of cell growth pattern in vitro. Vero cells were cultured on PLLA, PHBV, and different blends (100/0, 60/40, 50/50, 40/60, and 0/100). The cell adhesion assay showed that the best results were obtained with the (60/40, 50/50) blends. Scanning electron microscopy showed that the cells on (100/0) and (60/40) samples grew with a round morphology preferentially in the porous areas. The (50/50) blends had cells in the porous and smooth areas in a similar way. The (40/60) blends showed spreading cells on the smooth areas. The (0/100) sample, which had no pores, had spreading cells interconnected by filaments. Histological sections showed a confluent cell monolayer and the immunocytochemistry showed that the cells produced collagen IV and fibronectin on all substrates. Thus, we conclude that PLLA/PHBV blends were efficient in maintaining cell growth and producing an extracellular matrix on them.