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Islam P, Schaly S, Abosalha AK, Boyajian J, Thareja R, Ahmad W, Shum-Tim D, Prakash S. Nanotechnology in development of next generation of stent and related medical devices: Current and future aspects. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2024; 16:e1941. [PMID: 38528392 DOI: 10.1002/wnan.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
Coronary stents have saved millions of lives in the last three decades by treating atherosclerosis especially, by preventing plaque protrusion and subsequent aneurysms. They attenuate the vascular SMC proliferation and promote reconstruction of the endothelial bed to ensure superior revascularization. With the evolution of modern stent types, nanotechnology has become an integral part of stent technology. Nanocoating and nanosurface fabrication on metallic and polymeric stents have improved their drug loading capacity as well as other mechanical, physico-chemical, and biological properties. Nanofeatures can mimic the natural nanofeatures of vascular tissue and control drug-delivery. This review will highlight the role of nanotechnology in addressing the challenges of coronary stents and the recent advancements in the field of related medical devices. Different generations of stents carrying nanoparticle-based formulations like liposomes, lipid-polymer hybrid NPs, polymeric micelles, and dendrimers are discussed highlighting their roles in local drug delivery and anti-restenotic properties. Drug nanoparticles like Paclitaxel embedded in metal stents are discussed as a feature of first-generation drug-eluting stents. Customized precision stents ensure safe delivery of nanoparticle-mediated genes or concerted transfer of gene, drug, and/or bioactive molecules like antibodies, gene mimics via nanofabricated stents. Nanotechnology can aid such therapies for drug delivery successfully due to its easy scale-up possibilities. However, limitations of this technology such as their potential cytotoxic effects associated with nanoparticle delivery that can trigger hypersensitivity reactions have also been discussed in this review. This article is categorized under: Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Therapeutic Approaches and Drug Discovery > Emerging Technologies.
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Affiliation(s)
- Paromita Islam
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Sabrina Schaly
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Kh Abosalha
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Pharmaceutical Technology Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Jacqueline Boyajian
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Rahul Thareja
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Waqar Ahmad
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Dominique Shum-Tim
- Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Centre, McGill University, Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Satya Prakash
- Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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Mohamad T, Jyotsna F, Farooq U, Fatima A, Kar I, Khuwaja S, Memon UA, Kumari V, Puri P, Aslam ZM, Elder Z, Varrassi G, Paladini A, Khatri M, Kumar S, Muzammil MA. Individualizing Medicinal Therapy Post Heart Stent Implantation: Tailoring for Patient Factors. Cureus 2023; 15:e43977. [PMID: 37746355 PMCID: PMC10516147 DOI: 10.7759/cureus.43977] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
The field of cardiovascular medicine is undergoing a transformative shift towards personalized medicinal therapy, particularly in the context of post stent implantation. This narrative review explores the significance, challenges, and future directions of individualized treatment strategies for patients with coronary stents. The review highlights the pivotal role of personalized approaches in optimizing treatment efficacy and minimizing adverse events. Real-world clinical studies and trials underscore the importance of tailoring antiplatelet therapy based on platelet function testing, genetic testing, and risk scoring. These studies reveal that personalized medicinal treatment improves clinical outcomes by balancing preventing thrombotic events and mitigating bleeding risks. Challenges, including cost, test availability, patient adherence, and ethical considerations, are discussed in depth, shedding light on the complexities of implementing personalized approaches. Technological advancements, including omics data integration, artificial intelligence, and big data analytics, shape the future of personalized medicinal therapy. These tools enable precise pharmacogenomic selection of medications and the development of integrated risk-scoring systems. Patient engagement and education are also central, with empowered patients and remote monitoring contributing to collaborative decision-making. In conclusion, the narrative review underscores that personalized medicinal therapy post stent implantation holds immense promise for revolutionizing cardiovascular care. By embracing a comprehensive approach that considers genetics, clinical factors, and patient preferences, healthcare providers can optimize treatment outcomes and improve patient quality of life. The evolving landscape of personalized medicine offers a glimpse into a future where tailored treatment strategies become the cornerstone of precision cardiovascular care.
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Affiliation(s)
| | - Fnu Jyotsna
- Medicine, Dr. B.R. Ambedkar State Institute of Medical Sciences, Mohali, IND
| | - Umer Farooq
- Medicine, CMH (Combined Military Hospital) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Aroob Fatima
- Medicine, Ejaz Sikandar Memorial Hospital, Kanganpur, PAK
| | - Indrani Kar
- Medicine, Lady Hardinge Medical College, New Delhi, IND
| | - Sundal Khuwaja
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Unaib Ahmed Memon
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Versha Kumari
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Piyush Puri
- Medicine, Adesh Institute of Medical Science and Research, Bathinda, IND
| | - Zaid M Aslam
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Zachary Elder
- Medical Education, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | | | - Antonella Paladini
- Department of MESVA (Life, Health, and Environmental Sciences), University of L'Aquila, L'Aquila, ITA
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
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Khatri M, Kumar S, Mahfooz K, Sugandh F, Dembra D, Mehak F, Rachna Panjwani GA, Islam H, Islam R, Ibn E Ali Jaffari SM, Patel T, Kumar A, Kumar N, Varrassi G. Clinical Outcomes of Polymer-Free Versus Polymer-Coated Drug-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e38215. [PMID: 37252538 PMCID: PMC10224769 DOI: 10.7759/cureus.38215] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Drug-eluting stents have transformed the treatment of coronary artery disease (CAD), and there are two types: polymer-free and polymer-coated stents. Polymer-free stents have a coating that is quickly absorbed by the body, whereas polymer-coated stents have a coating that remains on the stent surface. This meta-analysis and systematic review aimed to compare the clinical outcomes of these two stent types in patients with coronary artery disease. The literature and abstracts from significant databases were reviewed to compare polymer-free drug-eluting stents (PF-DES) and polymer-coated drug-eluting stents (PC-DES) for the treatment of coronary artery disease (CAD). The primary efficacy endpoints of the study were all-cause mortality and deaths from cardiovascular and non-cardiovascular causes. Among the secondary outcomes were incidences of myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis, stroke, and major adverse cardiovascular events (MACEs). In terms of the primary outcomes, the combined analysis revealed a marginally lower risk of all-cause mortality (relative risk, RR (95% CI) = 0.92 (0.85, 1.00), p = 0.05, I2 = 0%) with the use of PF-DES versus PC-DES. Nonetheless, there was no significant difference in cardiovascular mortality (RR (95% CI) = 0.97 (0.87, 1.08)) or non-cardiovascular mortality (RR (95% CI) = 0.87 (0.69, 1.10), p = 0.25, I2 = 9%) between the groups. Furthermore, univariate meta-regression revealed that male gender and prior myocardial infarction were independently associated with an increased risk of all-cause mortality and cardiovascular disease. According to the current meta-analysis, no statistically significant differences existed in PF-DES and PC-DES outcomes. More extensive research is needed to investigate these findings further and establish their validity.
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Affiliation(s)
- Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Kamran Mahfooz
- Internal Medicine, New York Health and Hospital Corporation, Lincoln Medical Center, New York, USA
| | - Fnu Sugandh
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
- Medicine, Civil Hospital Karachi, Sukkur, PAK
| | - Deepak Dembra
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Fnu Mehak
- Surgery, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | | | - Hamza Islam
- Research, Punjab Medical College, Faisalabad, PAK
| | - Rabia Islam
- Research, Faisalabad Medical University, Faisalabad, PAK
| | | | - Tirath Patel
- Surgery, American University of Antigua, St. John, ATG
| | - Ajay Kumar
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Nomesh Kumar
- Surgery, Detroit Medical Center-Wayne State University of Sinai Grace, Michigan, USA
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Koźlik M, Harpula J, Chuchra PJ, Nowak M, Wojakowski W, Gąsior P. Drug-Eluting Stents: Technical and Clinical Progress. Biomimetics (Basel) 2023; 8:biomimetics8010072. [PMID: 36810403 PMCID: PMC9944483 DOI: 10.3390/biomimetics8010072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Drug-eluting stents (DES) demonstrated superior efficacy when compared to bare metal stents and plain-old balloon angioplasty and are nowadays used in almost all percutaneous revascularization procedures. The design of the stent platforms is constantly improving to maximize its efficacy and safety. Constant development of DES includes adoption of new materials used for scaffold production, new design types, improved overexpansion abilities, new polymers coating and, finally, improved antiproliferative agents. Especially nowadays, with the immense number of available DES platforms, it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could impact the most important issue-clinical outcomes. This review discusses the current status of coronary stents and the impact of stent material, strut design and coating techniques on cardiovascular outcomes.
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Affiliation(s)
- Maciej Koźlik
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
- Correspondence:
| | - Jan Harpula
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Piotr J. Chuchra
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Magdalena Nowak
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Paweł Gąsior
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
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Baber U. Polymer-Based Versus Polymer-Free Stents in High Bleeding Risk Patients: Less Is Not Always More. JACC Cardiovasc Interv 2022; 15:1164-1166. [PMID: 35680196 DOI: 10.1016/j.jcin.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Usman Baber
- University of Oklahoma Health Sciences Center, Department of Medicine, Cardiovascular Section, Oklahoma City, Oklahoma, USA.
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Räber L, Häner JD, Lüscher TF, Moccetti M, Roffi M, Stortecky S, Muller O, Garcia-Garcia HM, Waksman R, Siegrist P. A prospective, multicentre first-in-man study of the polymer-free ultrathin-strut BIOrapid stent (BIOVITESSE). EUROINTERVENTION 2022; 18:e132-e139. [PMID: 34794936 PMCID: PMC9904374 DOI: 10.4244/eij-d-21-00537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Polymer-free drug-coated stents aim to avoid the inflammatory potential of durable polymers, thereby improving the long-term safety profile, and allowing a shorter duration of dual antiplatelet therapy. AIMS The BIOVITESSE study was conducted to assess the safety and clinical performance of the BIOrapid polymer-free coronary stent system coated with a novel highly lipophilic sirolimus derivate. METHODS BIOVITESSE was a prospective, multicentre, first-in-man study that enrolled subjects with de novo coronary lesions in two cohorts of 33 patients each. The primary endpoint of the first cohort was strut coverage at one month as assessed by optical coherence tomography. The primary endpoint of the second cohort was late lumen loss at nine-month follow-up. RESULTS Patients were on average 63 years old (range: 42-87) and 12% had diabetes. The 66 patients had 70 lesions with an average lesion length of 12.5±5.4 mm. Predilatation was performed in 91.4% and post-dilatation in 87.1% lesions; device success was obtained in 97.4%. At one month, 95.2±5.6% (95% CI: 93.2-97.2) of struts were covered and at nine months, in-stent late lumen loss was 0.31±0.30 mm (95% CI: 0.20-0.42) and in-segment late lumen loss was 0.20±0.29 mm. Two target lesion failures occurred (3.1%): one at day 1 (to cover an asymptomatic stent edge dissection), and one at day 288 post-procedure for restenosis. No stent thrombosis was reported during the 12-month study duration. CONCLUSIONS The BIOrapid stent system exhibited an excellent safety profile, high strut coverage at one-month, and moderate angiographic efficacy according to the late lumen loss at nine-month angiographic follow-up.
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Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Jonas Dominik Häner
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, University of Zurich, Schlieren Campus, Zurich, Switzerland,Heart Division, Royal Brompton and Harefield Hospitals, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Marco Roffi
- University Hospitals Geneva, Geneva, Switzerland
| | - Stefan Stortecky
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Ron Waksman
- MedStar Health Research Institute, Washington, D.C., USA
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Hassan S, Ali MN, Ghafoor B. Evolutionary perspective of drug eluting stents: from thick polymer to polymer free approach. J Cardiothorac Surg 2022; 17:65. [PMID: 35379273 PMCID: PMC8981810 DOI: 10.1186/s13019-022-01812-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Introduction of Bare Metal Stents (BMS) was itself a revolutionary step in the history of the medical industry; however, Drug Eluting Stents (DES) maintained its superiority over BMS in every aspect from restenosis rate to late lumen loss. The reason behind the magnanimous position of the DES in the stent market is the degree of improvement with which it evolves. New and better stents come into the market every year, surpassing their predecessors by many folds. Literature review This review paper discusses the journey of DES with supporting clinical trials in detail. In the first generation, there were stainless-steel stents with thicker coatings. Although they had superior results compared to BMS, there was still room for improvement. Afterward came the second-generation stents, which had superior metal platforms with thinner struts and thin coatings. The drugs were also changed from Paclitaxel and Sirolimus to Zotrolimus and Everolimus. These stents performed best; however, there was an issue of permanent coating, which remained intact over the stent surface after complete drug elution and started to cause issues in longer-term studies. Hence, an improved version of DES was introduced to these permanent coatings called the third generation of drug eluting stents, which initially utilized biodegradable polymer and ultimately moved towards polymer free drug coatings. This generation has introduced a unique amalgam of technologies to achieve its polymer free coatings; however, researchers have numerous prospects of growth in this field. This review paper highlights the major coups of stent technology evolution from BMS to DES, from thick polymeric coatings to thin coatings and from durable polymers to polymer free DES. Conclusion In conclusion, though the medical industry promptly accepted BMS as the best treatment option for cardiovascular diseases; however, DES has provided even better results than BMS. In DES, the first and second generation has ruled the technology for many years and are still on the shelves. Still, the issues aroused due to durable polymer shifted the attention towards biodegradable drug eluting stents, the third generation growing rapidly. But the scientific community has not restricted themselves and is investigating bioresorbable stents that completely eliminate the polymer intervention in drug eluting stent technology.
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Affiliation(s)
- Sadia Hassan
- Department of Biomedical Engineering and Sciences (BMES), School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Murtaza Najabat Ali
- Department of Biomedical Engineering and Sciences (BMES), School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Bakhtawar Ghafoor
- Department of Biomedical Engineering and Sciences (BMES), School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
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Ullah W, Zghouzi M, Ahmad B, Suleiman ARM, Zahid S, Faisaluddin M, Alabdalrazzak M, Sattar Y, Kalra A, Kapadia S, Fischman DL, Brilakis ES, Mamas MA, Alraies MC. Safety and efficacy of the polymer-free and polymer-coated drug-eluting stents in patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:E802-E813. [PMID: 34510705 DOI: 10.1002/ccd.29953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The relative safety and efficacy of polymer-free (PF) versus polymer-coated (PC) drug-eluting stents (DES) in patients with angina or acute coronary syndrome (ACS) undergoing percutaneous coronary intervention has received limited study. METHOD Digital databases were queried to identify relevant studies. Major adverse cardiovascular events (MACE) and secondary outcomes were compared using a random effect model to calculate unadjusted odds ratios (OR). RESULTS A total of 28 studies consisting of 23,198 patients were included in the final analysis. On pooled analysis, there was no significant difference in the odds of MACE (OR 0.98, 95% CI 0.91-1.08) and major bleeding (OR 0.87, 95% CI 0.61-1.24) between patients undergoing PF-DES versus PC-DES. Similarly, the odds of myocardial infarction, stroke, stent thrombosis, cardiovascular mortality and need for target vessel revascularization was similar between the two groups. PF-DES was favored due to significantly lower odds of non-cardiac death (OR 0.78, 95% CI 0.68-89) and all-cause mortality (OR 0.87, 95% CI 0.80-0.95), but had a higher need for target lesion revascularization (OR 1.2, 95% CI 1.02-1.42). A subgroup analysis based on follow up duration, clinical presentation, presence of diabetes and class of eluting drugs mirrored the net estimates for all outcomes with a few exceptions. A sensitivity and meta-regression analysis showed no influence of single-study and duration of antiplatelet therapy on pooled outcomes. CONCLUSION In patients presenting with angina or ACS, PF-DES might be favored due to lower all-cause mortality and equal risk of ischemic adverse cardiovascular and major bleeding events compared with PC-DES.
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Affiliation(s)
- Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mohamed Zghouzi
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Bachar Ahmad
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | | | - Salman Zahid
- Department of Cardiology, Rochester Regional Health, Rochester, New York, USA
| | | | - Mukhlis Alabdalrazzak
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Yasar Sattar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, New York, New York, USA
| | - Ankur Kalra
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David L Fischman
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mamas A Mamas
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Song J, Kouidri S, Bakir F. Review on the numerical investigations of mass transfer from drug eluting stent. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Arbeiter D, Reske T, Teske M, Bajer D, Senz V, Schmitz KP, Grabow N, Oschatz S. Influence of Drug Incorporation on the Physico-Chemical Properties of Poly(l-Lactide) Implant Coating Matrices-A Systematic Study. Polymers (Basel) 2021; 13:292. [PMID: 33477626 PMCID: PMC7831498 DOI: 10.3390/polym13020292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
Local drug delivery has become indispensable in biomedical engineering with stents being ideal carrier platforms. While local drug release is superior to systemic administration in many fields, the incorporation of drugs into polymers may influence the physico-chemical properties of said matrix. This is of particular relevance as minimally invasive implantation is frequently accompanied by mechanical stresses on the implant and coating. Thus, drug incorporation into polymers may result in a susceptibility to potentially life-threatening implant failure. We investigated spray-coated poly-l-lactide (PLLA)/drug blends using thermal measurements (DSC) and tensile tests to determine the influence of selected drugs, namely sirolimus, paclitaxel, dexamethasone, and cyclosporine A, on the physico-chemical properties of the polymer. For all drugs and PLLA/drug ratios, an increase in tensile strength was observed. As for sirolimus and dexamethasone, PLLA/drug mixed phase systems were identified by shifted drug melting peaks at 200 °C and 240 °C, respectively, whereas paclitaxel and dexamethasone led to cold crystallization. Cyclosporine A did not affect matrix thermal properties. Altogether, our data provide a contribution towards an understanding of the complex interaction between PLLA and different drugs. Our results hold implications regarding the necessity of target-oriented thermal treatment to ensure the shelf life and performance of stent coatings.
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Affiliation(s)
- Daniela Arbeiter
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Thomas Reske
- Institute for Implant Technology and Biomaterials e.V., Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany;
| | - Michael Teske
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Dalibor Bajer
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Volkmar Senz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Klaus-Peter Schmitz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
- Institute for Implant Technology and Biomaterials e.V., Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany;
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
| | - Stefan Oschatz
- Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119 Rostock, Germany; (M.T.); (D.B.); (V.S.); (K.-P.S.); (N.G.); (S.O.)
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Rykowska I, Nowak I, Nowak R. Drug-Eluting Stents and Balloons-Materials, Structure Designs, and Coating Techniques: A Review. Molecules 2020; 25:E4624. [PMID: 33050663 PMCID: PMC7594099 DOI: 10.3390/molecules25204624] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/19/2022] Open
Abstract
Controlled drug delivery is a matter of interest to numerous scientists from various domains, as well as an essential issue for society as a whole. In the treatment of many diseases, it is crucial to control the dosing of a drug for a long time and thus maintain its optimal concentration in the tissue. Heart diseases are particularly important in this aspect. One such disease is an obstructive arterial disease affecting millions of people around the world. In recent years, stents and balloon catheters have reached a significant position in the treatment of this condition. Balloon catheters are also successfully used to manage tear ducts, paranasal sinuses, or salivary glands disorders. Modern technology is continually striving to improve the results of previous generations of stents and balloon catheters by refining their design, structure, and constituent materials. These advances result in the development of both successive models of drug-eluting stents (DES) and drug-eluting balloons (DEB). This paper presents milestones in the development of DES and DEB, which are a significant option in the treatment of coronary artery diseases. This report reviews the works related to achievements in construction designs and materials, as well as preparation technologies, of DES and DEB. Special attention was paid to the polymeric biodegradable materials used in the production of the above-mentioned devices. Information was also collected on the various methods of producing drug release coatings and their effectiveness in releasing the active substance.
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Affiliation(s)
- I. Rykowska
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - I. Nowak
- Faculty of Chemistry, Adam Mickiewicz University, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
| | - R. Nowak
- Eye Department, J. Strus City Hospital, Szwajcarska 3, 61-285 Poznań, Poland;
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Bays HE. Ten things to know about ten cardiovascular disease risk factors ("ASPC Top Ten - 2020"). Am J Prev Cardiol 2020; 1:100003. [PMID: 34327447 PMCID: PMC8315360 DOI: 10.1016/j.ajpc.2020.100003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 12/20/2022] Open
Abstract
Preventive cardiology involves understanding and managing multiple cardiovascular disease (CVD) risk factors. Given the rapid advancements in medical science, it may be challenging for the busy clinician to remain up-to-date on the multifaceted and fundamental aspects of CVD prevention, and maintain awareness of the newest applicable guidelines. The "American Society for Preventive Cardiology (ASPC) Top Ten 2020" summarizes ten essential things to know about ten important CVD risk factors, listed in tabular formats. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and gender), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the "ASPC Top Ten 2020" to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
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Affiliation(s)
- Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288, Illinois Avenue, Louisville, KY, 40213, USA
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Liu Y, Zhang Y, Li Y, Qi T, Pan D, Wang H, Liu C, Ma D, Fang Z, Zhang R, Mou F, Tao L. One-year clinical results of the NANO registry: A multicenter, prospective all-comers registry study in patients receiving implantation of a polymer-free sirolimus-eluting stent. Catheter Cardiovasc Interv 2020; 95 Suppl 1:658-664. [PMID: 31961057 DOI: 10.1002/ccd.28734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to evaluate the safety and efficacy of Nano+™ (Lepu Medical, Beijing, China) stent implantation in all-comer patients at the 1-year follow-up. BACKGROUND The Nano+™ stent is a novel polymer-free sirolimus-eluting stent polymer that employs nanoporous stent surface technology to control drug-delivery. The Nano+™ stent is one of the most widely used drug-eluting stent (DES) in China. METHODS A total of 2,481 consecutive patients were included in the multicenter and prospective NANO registry. In this study, the primary endpoint was target lesion failure (TLF) at 1-year follow-up, defined as a composite of cardiac death, target vessel nonfatal myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). The safety endpoint was the occurrence of definite or probable stent thrombosis (ST). RESULTS Up to 40.2% of patients presented with acute myocardial infarction (AMI). A total of 63.9% of the 2,904 lesions were American College of Cardiology/American Heart Association (ACC/AHA) type B2 or C lesions. One-year follow-up data were available for 98.4% of patients. The 1-year rate of TLF was 3.1% with rates of 1.3, 1.8, and 0.4% for clinically driven TLR, cardiac death, and TV-MI, respectively. ST occurred in 0.4% of patients. Diabetes mellitus, AMI, left ventricular ejection fraction <40% and long lesions (>40 mm) were independent predictors of 1-year TLF. CONCLUSIONS The 1-year clinical outcomes were excellent for Nano+™ polymer-free SES implantation in an all-comer patient population. Follow-up will be extended up to 5 years, to further elucidate the potential long-term clinical benefits. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02929030.
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Affiliation(s)
- Yi Liu
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yaojun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianjun Qi
- Department of Cardiology, Central Hospital of Zibo, Zibo, Shandong, China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xu Zhou Medical University, Xuzhou, Jiangsu, China
| | - Haichang Wang
- Department of Cardiology, The Second Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changhui Liu
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Dengfeng Ma
- Department of Cardiology, Tai Yuan Central Hospital, Taiyuan, Shanxi, China
| | - Zhenfei Fang
- Department of Cardiology, The Second XIANGYA Hospital of Central South University, Changsha, Hunan, China
| | - Ruining Zhang
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fangjun Mou
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ling Tao
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
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