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Wiyono AV, Ardinal AP. Revolutionizing Cardiovascular Frontiers: A Dive Into Cutting-Edge Innovations in Coronary Stent Technology. Cardiol Rev 2024:00045415-990000000-00255. [PMID: 38709038 DOI: 10.1097/crd.0000000000000705] [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: 05/07/2024]
Abstract
Plain balloon angioplasty was the initial method used to enlarge the intracoronary lumen size. However, it was linked to acute coronary closure due to early vessel recoil. This led to the invention of coronary stents, which offer mechanical support to open and maintain the vascular lumen. Nevertheless, the metallic scaffold introduced other issues, such as thrombosis and restenosis caused by neointimal proliferation. To address these concerns, polymers were employed to cover the scaffold, acting as drug reservoirs and regulators for controlled drug release. The use of polymers prevents direct contact between blood and metallic scaffolds. Drugs within the stent were incorporated to inhibit proliferation and expedite endothelialization in the healing process. Despite these advancements, adverse effects still arise due to the inflammatory reaction caused by the polymer material. Consequently, resorbable polymers and scaffolds were later discovered, but they have limitations and are not universally applicable. Various scaffold designs, thicknesses, materials, polymer components, and drugs have their own advantages and complications. Each stent generation has been designed to address the shortcomings of the preceding generation, yet new challenges continue to emerge. Conflicting data regarding the long-term safety and efficacy of coronary stents, especially in the extended follow-up, further complicates the assessment.
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Affiliation(s)
- Alice Valeria Wiyono
- Faculty of Life Sciences & Medicine, King's College London, School of Cardiovascular and Metabolic Medicine, London, United Kingdom
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2
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Feng X, Jiang T. Mathematical and numerical analysis for PDE systems modeling intravascular drug release from arterial stents and transport in arterial tissue. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:5634-5657. [PMID: 38872551 DOI: 10.3934/mbe.2024248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
This paper is concerned with the PDE (partial differential equation) and numerical analysis of a modified one-dimensional intravascular stent model. It is proved that the modified model has a unique weak solution by using the Galerkin method combined with a compactness argument. A semi-discrete finite-element method and a fully discrete scheme using the Euler time-stepping have been formulated for the PDE model. Optimal order error estimates in the energy norm are proved for both schemes. Numerical results are presented, along with comparisons between different decoupling strategies and time-stepping schemes. Lastly, extensions of the model and its PDE and numerical analysis results to the two-dimensional case are also briefly discussed.
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Affiliation(s)
- Xiaobing Feng
- Department of Mathematics, The University of Tennessee, Knoxville, TN 37996, USA
| | - Tingao Jiang
- Department of Mathematics, The University of Tennessee, Knoxville, TN 37996, USA
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3
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Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [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: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
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4
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Ge X, Jiang F, Wang M, Chen M, Li Y, Phipps J, Cai J, Xie J, Ong J, Dubovoy V, Masters JG, Pan L, Ma S. Naringin@Metal-Organic Framework as a Multifunctional Bioplatform. ACS APPLIED MATERIALS & INTERFACES 2023; 15:677-683. [PMID: 36562661 DOI: 10.1021/acsami.2c19904] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Naringin, a natural product, can be used as a therapeutic agent due to its low systemic toxicity and negligible adverse effect. However, due to its hydrophobic nature and thereby low solubility, high-dose treatment is required when used for human therapy. Herein, we demonstrate the employment of a metal-organic framework (MOF) as a nontoxic loading carrier to encapsulate naringin, and the afforded nairngin@MOF composite can serve as a multifunctional bioplatform capable of treating Gram-positive bacteria and certain cancers by slowly and progressively releasing the encapsulated naringin as well as improving and modulating immune system functions through synergy between naringin and the MOF.
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Affiliation(s)
- Xueying Ge
- Department of Chemistry, University of North Texas, 1508 W Mulberry St, Denton, Texas 76201, United States
| | - Fangchao Jiang
- Department of Chemistry, University of Georgia, 140 Cedar Street, Athens, Georgia 30602, United States
| | - Minghui Wang
- Department of Chemistry, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Meng Chen
- Department of Chemistry, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Yiming Li
- Department of Chemistry, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Joshua Phipps
- Department of Chemistry, University of North Texas, 1508 W Mulberry St, Denton, Texas 76201, United States
| | - Jianfeng Cai
- Department of Chemistry, University of South Florida, 4202 E. Fowler Avenue, Tampa, Florida 33620, United States
| | - Jin Xie
- Department of Chemistry, University of Georgia, 140 Cedar Street, Athens, Georgia 30602, United States
| | - Jane Ong
- Colgate Palmolive Co, 909 River Road, Piscataway, New Jersey 08855, United States
| | - Viktor Dubovoy
- Colgate Palmolive Co, 909 River Road, Piscataway, New Jersey 08855, United States
| | - James G Masters
- Colgate Palmolive Co, 909 River Road, Piscataway, New Jersey 08855, United States
| | - Long Pan
- Colgate Palmolive Co, 909 River Road, Piscataway, New Jersey 08855, United States
| | - Shengqian Ma
- Department of Chemistry, University of North Texas, 1508 W Mulberry St, Denton, Texas 76201, United States
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5
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Hemodynamic Impact of Stenting on Carotid Bifurcation: A Potential Role of the Stented Segment and External Carotid Artery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:7604532. [PMID: 34868344 PMCID: PMC8642019 DOI: 10.1155/2021/7604532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
Carotid stenting near the bifurcation carina is associated with adverse events, especially in-stent restenosis, thrombosis, and side branch occlusion in clinical data. This study is aimed at determining the potential biomechanical mechanisms for these adverse events after carotid stenting. The patient-specific carotid models were constructed with different stenting scenarios to study the flow distribution and hemodynamic parameters, such as wall shear stress (WSS), flow velocity, relative residence time (RRT), and oscillating shear index (OSI) in the carotid bifurcation. The results suggested that the existing stents surely reduced blood flow to the external carotid artery (ECA) but enhanced local flow disturbance both in ECA and stented internal carotid artery (ICA), and the inner posterior wall of the stented ICA and the outer posterior wall of ECA might endure a relatively low level of WSS and remarkably elevated OSI and RRT. In addition, the implanted stent leads to more ECA adverse flow than ICA after stenting. While disturbed flow near the strut increased as stent length increased, blood flow and areas of local flow disturbance in ECA slightly decreased as stent length increased. In conclusion, the results revealed that ECA might be in relatively high levels of abnormal local hemodynamics after stenting, followed by stented ICA, leading to potential adverse events after intervention.
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6
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Atigh MK, Goel E, Erwin M, Greer R, Ohayon J, Pettigrew RI, Yazdani SK. Precision delivery of liquid therapy into the arterial wall for the treatment of peripheral arterial disease. Sci Rep 2021; 11:18676. [PMID: 34548563 PMCID: PMC8455692 DOI: 10.1038/s41598-021-98063-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 01/04/2023] Open
Abstract
Perfusion catheters have recently emerged as a novel approach to deliver liquid anti-proliferative agents into flow obstructed arterial segments. The purpose of this study was to determine the impact of luminal delivery pressure on liquid drug penetration into the vessel wall. An ex vivo model using harvested porcine carotid arteries and a two-dimensional computational model were utilized to determine the impact of delivery pressure of liquid therapy into the arterial wall. A pig peripheral injury model determined the impact of intra-luminal delivery pressure on drug retention. Ex vivo results demonstrated that depth of fluid penetration varies from 6.93 ± 1.90% at 0 atm to 27.75 ± 6.61% penetration of the medial layer at 0.4 atm. Computational results had similar outcomes, as penetration varied between 4.4% and 22.84%. The in vivo results demonstrated significant increase in drug delivery to the arterial tissue at 0.4 atm versus 0.1 atm at 1 h (23.43 ± 13.59 ng/mg vs. 2.49 ± 1.81 ng/mg, p = 0.026) and 7 days (0.50 ± 0.39 ng/mg vs. 0.018 ± 0.023 ng/mg, p = 0.0496). The result of this study provides an innovative strategic and technical approach to enable targeted liquid therapy.
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Affiliation(s)
- Marzieh K Atigh
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Emily Goel
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Megan Erwin
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Ricky Greer
- Department of Mechanical Engineering, University of South Alabama, Mobile, AL, 36688, USA
| | - Jacques Ohayon
- Savoie Mont-Blanc University, Polytech Annecy-Chambéry, Le Bourget du Lac, France.,Laboratory TIMC-IMAG, CNRS, UMR 5525, Grenoble-Alpes University, Grenoble, France
| | - Roderic I Pettigrew
- Texas A&M University and Houston Methodist Hospital, Engineering Medicine (EnMed), Houston, TX, USA
| | - Saami K Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC, 27101, USA.
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Ahn SW, Ferland B, Jonas OH. An Interactive Pipeline for Quantitative Histopathological Analysis of Spatially Defined Drug Effects in Tumors. J Pathol Inform 2021; 12:34. [PMID: 34760331 PMCID: PMC8529341 DOI: 10.4103/jpi.jpi_17_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tumor heterogeneity is increasingly being recognized as a major source of variability in the histopathological assessment of drug responses. Quantitative analysis of immunohistochemistry (IHC) and immunofluorescence (IF) images using biomarkers that capture spatialpatterns of distinct tumor biology and drug concentration in tumors is of high interest to the field. METHODS We have developed an image analysis pipeline to measure drug response using IF and IHC images along spatial gradients of local drug release from a tumor-implantable drug delivery microdevice. The pipeline utilizes a series of user-interactive python scripts and CellProfiler pipelines with custom modules to perform image and spatial analysis of regions of interest within whole-slide images. RESULTS Worked examples demonstrate that intratumor measurements such as apoptosis, cell proliferation, and immune cell population density can be quantitated in a spatially and drug concentration-dependent manner, establishing in vivo profiles of pharmacodynamics and pharmacokinetics in tumors. CONCLUSIONS Spatial image analysis of tumor response along gradients of local drug release is achievable in high throughput. The major advantage of this approach is the use of spatially aware annotation tools to correlate drug gradients with drug effects in tumors in vivo.
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Affiliation(s)
- Sebastian W Ahn
- Department of Radiology, Laboratory for Bio-Micro Devices, Brigham and Women’s Hospital, Boston, MA, USA
| | - Benjamin Ferland
- Department of Radiology, Laboratory for Bio-Micro Devices, Brigham and Women’s Hospital, Boston, MA, USA
| | - Oliver H Jonas
- Department of Radiology, Laboratory for Bio-Micro Devices, Brigham and Women’s Hospital, Boston, MA, USA
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8
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SARIFUDDIN, ALSEMIRY REIMAD, MANDAL PRASHANTAKUMAR. EFFECTS OF COATING PROPERTIES ON CONTROLLED DELIVERY FROM AN EMBEDDED DRUG-ELUTING STENT: A SIMULATION STUDY. J BIOL SYST 2021. [DOI: 10.1142/s0218339021500145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present investigation deals with the effects of biodegradable, biodurable and polymer-free coating of a stent on the release mechanism of the drug in a porous medium. The Brinkman equations for the interstitial fluid, the unsteady convection-diffusion-reaction equation for the transport of free drug in the tissue and the unsteady reaction equations for the bound as well as the internalized drug have been considered. In the coating, the transport of drug has been modeled as a diffusion process. Effects of different percentages of the embedment, convection and various coating properties of the stent on the transport of free drug, its retention and the internalization of the bound drug have been studied. Immersed Boundary Method (IBM) in the staggered grid formulation (IBM-MAC) has been used to tackle numerically the system of nonlinear governing equations. Simulated results predict the fastest release of drug from a biodegradable coating, but the averaged concentrations of all drug forms do reach a quasi-steady state in case of a biodurable coating irrespective of the degrees of embedment. Moreover, for all embedment levels of the stent, a biodegradable coating is superior to that of biodurable and polymer-free coating in the presence/absence of convection for larger times, but this superiority is lost for smaller times. Unlike biodurable coating, it is also predicted that the more the embedment level does not necessarily imply the more the effectiveness of delivery for biodegradable and polymer-free coatings of a stent.
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Affiliation(s)
- SARIFUDDIN
- Department of Mathematics, Berhampore College, P.O.-Berhampore, Dist.-Murshidabad, WB 742101, India
| | - REIMA D. ALSEMIRY
- Department of Mathematics, Faculty of Science, Taibah University, P.O. Box 89, Yanbu 41911, Saudi Arabia
- Department of Mathematical Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
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9
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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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Zhang M, Wang S, Zhu Y, Zhu Z, Si T, Xu RX. Programmable dynamic interfacial spinning of bioinspired microfibers with volumetric encoding. MATERIALS HORIZONS 2021; 8:1756-1768. [PMID: 34846505 DOI: 10.1039/d1mh00125f] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While artificially encoded microfibers inspired by biosynthetic fibrous microstructures are drawing considerable research attention, their practical applications are hindered by multiple limitations. Here, a programmable dynamic interfacial spinning (DIS) process is proposed for producing volume-encoded microfibers with superior encoding capacity and reliability. The produced microfibers comprise a sheath of deformed hydrogel encapsulating sequentially aligned droplets, with their morphologies controllable by adjusting the flow rates of the corresponding fluids and the vibration parameters of the spinning nozzle. In particular, microfibers with volumetric encoding of inner droplet sequence are constructed for information storage and encryption. With appropriate functionalization of volume-encoded microfibers, we have also demonstrated magnetic guidance and selective activation to simulate intravascular drug delivery. Our study implies the potential applications of the volume-encoded microfibers in information communication, drug delivery and biomedical engineering.
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Affiliation(s)
- Ming Zhang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui 230026, China.
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11
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Milewski K, Takahashi K, Asano T, Katagiri Y, Hochul M, Buszman P, Tomaniak M, Gorycki B, Zurakowski A, Janas A, Mlodziankowski A, Kachel M, Wykrzykowska JJ, Wijns W, de Winter RJ, Buszman P, Onuma Y, Serruys P. Neointimal hyperplasia of ultra-thin stents with microcrystalline sirolimus or durable polymer everolimus-eluting stents: 6- and 24-month results of the DESSOLVE III OCT study. EUROINTERVENTION 2021; 16:1187-1194. [PMID: 31062697 PMCID: PMC9724984 DOI: 10.4244/eij-d-18-01201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The DESSOLVE III OCT substudy aimed to compare serially neointimal hyperplasia volume obstruction (%VO) between the thin-strut MiStent with early polymer elimination and nine-month sustained drug release from microcrystalline sirolimus and the durable polymer-coated everolimus-eluting XIENCE stent at six and 24 months after implantation. METHODS AND RESULTS The efficacy endpoint was %VO, calculated as abluminal neointimal volume/stent volume. Thirty-six patients (MiStent 16 patients, 16 lesions; XIENCE 20 patients, 22 lesions) underwent serial OCT evaluation at both six and 24 months. At six months, mean abluminal %VO was significantly lower in the MiStent group than in the XIENCE group (14.54±3.70% vs 19.11±6.70%; p=0.011), whereas the difference in %VO between the two groups decreased at 24 months (20.88±5.72% vs 23.50±7.33%; p=0.24). There was no significant difference in percentage malapposed struts and percentage uncovered struts between the two groups at both time points. CONCLUSIONS In the serial comparative OCT analysis of the MiStent versus the XIENCE, the MiStent showed a more favourable efficacy for preventing neointimal formation with comparable strut tissue coverage, as compared with the XIENCE at six months, but this difference in %VO decreased at 24 months so that the difference in neointima at 24 months was no longer significant.
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Affiliation(s)
- Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland,The Jerzy Kukuczka Academy of Physical Education, Faculty of Physiotherapy, Katowice, Poland
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mariusz Hochul
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | - Piotr Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | - Mariusz Tomaniak
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Bogdan Gorycki
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | - Aleksander Zurakowski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | - Adam Janas
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | - Adam Mlodziankowski
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | - Mateusz Kachel
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, National University of Ireland Galway, Galway, Ireland
| | | | - Pawel Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Ustron, Poland,Medical University of Silesia in Katowice, Katowice, Poland
| | - Yoshinobu Onuma
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland,Cardialysis, Rotterdam, the Netherlands
| | - Patrick Serruys
- Department of Cardiology, National University of Ireland, University Road, Galway, H91 TK33, Ireland
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The Use of Bioactive Polymers for Intervention and Tissue Engineering: The New Frontier for Cardiovascular Therapy. Polymers (Basel) 2021; 13:polym13030446. [PMID: 33573282 PMCID: PMC7866823 DOI: 10.3390/polym13030446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/28/2022] Open
Abstract
Coronary heart disease remains one of the leading causes of death in most countries. Healthcare improvements have seen a shift in the presentation of disease with a reducing number of ST-segment elevation myocardial infarctions (STEMIs), largely due to earlier reperfusion strategies such as percutaneous coronary intervention (PCI). Stents have revolutionized the care of these patients, but the long-term effects of these devices have been brought to the fore. The conceptual and technologic evolution of these devices from bare-metal stents led to the creation and wide application of drug-eluting stents; further research introduced the idea of polymer-based resorbable stents. We look at the evolution of stents and the multiple advantages and disadvantages offered by each of the different polymers used to make stents in order to identify what the stent of the future may consist of whilst highlighting properties that are beneficial to the patient alongside the role of the surgeon, the cardiologist, engineers, chemists, and biophysicists in creating the ideal stent.
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13
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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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Abstract
Dental implants are frequently used to support fixed or removable dental prostheses to replace missing teeth. The clinical success of titanium dental implants is owed to the exceptional biocompatibility and osseointegration with the bone. Therefore, the enhanced therapeutic effectiveness of dental implants had always been preferred. Several concepts for implant coating and local drug delivery had been developed during the last decades. A drug is generally released by diffusion-controlled, solvent-controlled, and chemical controlled methods. Although a range of surface modifications and coatings (antimicrobial, bioactive, therapeutic drugs) have been explored for dental implants, it is still a long way from designing sophisticated therapeutic implant surfaces to achieve the specific needs of dental patients. The present article reviews various interdisciplinary aspects of surface coatings on dental implants from the perspectives of biomaterials, coatings, drug release, and related therapeutic effects. Additionally, the various types of implant coatings, localized drug release from coatings, and how released agents influence the bone–implant surface interface characteristics are discussed. This paper also highlights several strategies for local drug delivery and their limitations in dental implant coatings as some of these concepts are yet to be applied in clinical settings due to the specific requirements of individual patients.
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15
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Al-Attar T, Madihally SV. Modeling the impact of fluid flow on resveratrol release from electrospun fibers. Comput Biol Med 2020; 117:103622. [PMID: 32072965 DOI: 10.1016/j.compbiomed.2020.103622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/30/2019] [Accepted: 01/12/2020] [Indexed: 02/06/2023]
Abstract
Using electrospun fibers to deliver therapeutic agents has gained significant attention in various applications including cancer treatment and tissue regeneration. However, the effect of fluid flow and uptake by cells on the concentration profile is not well understood. In this study, we evaluated the release of lipophilic resveratrol from poly(ε-caprolactone) (PCL)-gelatin (GT) electrospun fibers experimentally and by using computational fluid dynamics (CFD). Resveratrol containing PCL-GT electrospun fibers were formed and used in a custom-built tubular bioreactor, to assess flow effect on concentration profile over 5 days. CFD model was developed to simulate release in both static cultures and under fluid flow conditions. Resveratrol stability in the culture medium and uptake by human umbilical vein endothelial cells and K562 cells over 3 days were used in the model. The concentration profile as a function of time was simulated and validated by experiments. The effects of inlet velocity, cellular uptake rate, bioreactor's length, and surrounding tissue porosity were assessed. The release profile was mainly affected by cellular uptake and the presence of porous media. The model suggests that the perfusion velocity might not have a significant effect relative to the cellular uptake rate and porosity of the surrounding tissue.
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Affiliation(s)
- Thikrayat Al-Attar
- School of Chemical Engineering, Oklahoma State University, 420 Engineering North, Stillwater, OK, 74078, USA.
| | - Sundararajan V Madihally
- School of Chemical Engineering, Oklahoma State University, 420 Engineering North, Stillwater, OK, 74078, USA.
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Zhi B, Mao Y. Vapor-Deposited Nanocoatings for Sustained Zero-Order Release of Antiproliferative Drugs. ACS APPLIED BIO MATERIALS 2020; 3:1088-1096. [DOI: 10.1021/acsabm.9b01044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bin Zhi
- Departments of Biosystems Engineering, Oklahoma State University, Stillwater, Oklahoma 74078, United States
| | - Yu Mao
- Departments of Biosystems Engineering, Oklahoma State University, Stillwater, Oklahoma 74078, United States
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17
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Maxwell EA, Phillips H, Clark-Price SC, Vieson MD, Selmic LE, Schaeffer DJ, Fan TM. Pharmacokinetics of platinum and safety evaluation of carboplatin-impregnated calcium sulfate hemihydrate beads after implantation in healthy cats. Vet Surg 2020; 49:748-757. [PMID: 31944331 DOI: 10.1111/vsu.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/16/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the pharmacokinetics (PK) of platinum (Pt) and safety of carboplatin-impregnated calcium sulfate hemihydrate (C-I CSH) beads after implantation in healthy cats. STUDY DESIGN In vivo experimental study. ANIMALS Six healthy adult cats. METHODS Three C-I CSH beads were implanted in muscle pockets over the right and left hemithoraces of each cat (~3.9 mg/kg of Pt; 60.4 mg/m2 of calculated carboplatin). Hematology and blood chemistry were tested at baseline and 3, 7, 14, and 21 days postimplantation. Serum was analyzed for Pt at specific times from 1 hour to 21 days. Tissue was obtained for histopathology and analysis of Pt at 3, 7, 14, and 21 days at standardized distances from implantation sites. RESULTS Platinum was detected in tissues at all times and distances (range, 0.1-4.19 μg/g). Serum Pt increased up to 2.6 hours (3.25 μg/mL) then decreased sharply. Samples containing muscle had higher Pt compared with samples without muscle (P = .004). Mild hypercalcemia was noted in four cats, and mild inflammatory reaction was noted on histopathology of all samples. CONCLUSION Platinum was released from C-I CSH beads differentially into surrounding tissues over 21 days. Systemic absorption of Pt was minimal, but mild hypercalcemia occurred. CLINICAL SIGNIFICANCE Implantation was well tolerated by healthy adult cats. Securing beads within muscle may limit Pt diffusion to targeted tissue. Although Pt concentrations did not achieve levels reported to be cytotoxic for feline sarcoma cells in culture, results provide evidence to support evaluation of efficacy in the tumor microenvironment of cats with locally invasive cancers.
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Affiliation(s)
- Elizabeth A Maxwell
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida
| | - Heidi Phillips
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois
| | - Stuart C Clark-Price
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Miranda D Vieson
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois
| | - Timothy M Fan
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois
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18
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Drug-Eluting Balloon Versus Drug-Eluting Stent for Complex Femoropopliteal Arterial Lesions. J Am Coll Cardiol 2019; 74:205-215. [DOI: 10.1016/j.jacc.2019.04.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/24/2022]
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19
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Flow-Mediated Drug Transport from Drug-Eluting Stents is Negligible: Numerical and In-vitro Investigations. Ann Biomed Eng 2018; 47:878-890. [PMID: 30552528 DOI: 10.1007/s10439-018-02176-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/27/2018] [Indexed: 12/21/2022]
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20
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In vitro release study of sirolimus from a PDLLA matrix on a bioresorbable drug-eluting stent. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Strobel HA, Qendro EI, Alsberg E, Rolle MW. Targeted Delivery of Bioactive Molecules for Vascular Intervention and Tissue Engineering. Front Pharmacol 2018; 9:1329. [PMID: 30519186 PMCID: PMC6259603 DOI: 10.3389/fphar.2018.01329] [Citation(s) in RCA: 16] [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: 03/15/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the leading cause of death in the United States. Treatment often requires surgical interventions to re-open occluded vessels, bypass severe occlusions, or stabilize aneurysms. Despite the short-term success of such interventions, many ultimately fail due to thrombosis or restenosis (following stent placement), or incomplete healing (such as after aneurysm coil placement). Bioactive molecules capable of modulating host tissue responses and preventing these complications have been identified, but systemic delivery is often harmful or ineffective. This review discusses the use of localized bioactive molecule delivery methods to enhance the long-term success of vascular interventions, such as drug-eluting stents and aneurysm coils, as well as nanoparticles for targeted molecule delivery. Vascular grafts in particular have poor patency in small diameter, high flow applications, such as coronary artery bypass grafting (CABG). Grafts fabricated from a variety of approaches may benefit from bioactive molecule incorporation to improve patency. Tissue engineering is an especially promising approach for vascular graft fabrication that may be conducive to incorporation of drugs or growth factors. Overall, localized and targeted delivery of bioactive molecules has shown promise for improving the outcomes of vascular interventions, with technologies such as drug-eluting stents showing excellent clinical success. However, many targeted vascular drug delivery systems have yet to reach the clinic. There is still a need to better optimize bioactive molecule release kinetics and identify synergistic biomolecule combinations before the clinical impact of these technologies can be realized.
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Affiliation(s)
- Hannah A. Strobel
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Elisabet I. Qendro
- Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Eben Alsberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Marsha W. Rolle
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
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22
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Abstract
Cardiovascular complications are leading causes of most fatalities. Coronary artery disease and surgical failures contribute to the death of the majority of patients. Advanced research in the field of medical devices like stents has efficiently resolved these problems. Clinically, drug-eluting stents have proven their efficacy and safety compared to bare metal stents, which have problems of in-stent restenosis. However, drug-loaded stents coated with polymers have shown adverse effects related to the stability and deterioration of the polymer coating over time. This results in late stent thrombosis and immunogenicity. These reasons laid the foundation for the development of non-polymeric drug-eluting stents. This review focuses on non-polymer drug-eluting stents loaded with different drugs like anti-inflammatory agents, anti-thrombotic, anti-platelet agents, immune suppressants and others. Surface modification techniques on stents like crystalline coating; microporous, macroporous, and nanoporous coatings; and chemically modified self-assembled monolayers are described in detail. There is also an update on clinically approved products and those under development.
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Affiliation(s)
- Nagavendra Kommineni
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Raju Saka
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India
| | - Wahid Khan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, 500037, India.
| | - Abraham J Domb
- School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, 91120, Jerusalem, Israel.
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23
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Saha R. A Computational Approach for Stent Elution Rate Determined Specific Drug Binding and Receptor-mediated Effects in Arterial Tissue. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2018; 3:105-118. [DOI: 10.14218/jerp.2018.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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24
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Borhani S, Hassanajili S, Ahmadi Tafti SH, Rabbani S. Cardiovascular stents: overview, evolution, and next generation. Prog Biomater 2018; 7:175-205. [PMID: 30203125 PMCID: PMC6173682 DOI: 10.1007/s40204-018-0097-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/25/2018] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Setareh Borhani
- Department of Chemical Engineering, School of Chemical and Petroleum Engineering, Shiraz University, Shiraz, Iran
| | - Shadi Hassanajili
- Department of Nanochemical Engineering, School of New Science and Technology, Shiraz University, Shiraz, Iran.
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar, Tehran, Iran
| | - Shahram Rabbani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar, Tehran, Iran
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25
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Tzafriri AR, Garcia-Polite F, Li X, Keating J, Balaguer JM, Zani B, Bailey L, Markham P, Kiorpes TC, Carlyle W, Edelman ER. Defining drug and target protein distributions after stent-based drug release: Durable versus deployable coatings. J Control Release 2018; 274:102-108. [PMID: 29421608 DOI: 10.1016/j.jconrel.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/31/2017] [Accepted: 02/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Innovations in drug eluting stent designs make it increasingly important to develop models for differentiating performance through spatial definition of drug, receptor binding and cell state. METHODS Two designs of sirolimus analog eluting stents were implanted into porcine coronary arteries for 28, 60 or 90 days (n = 9/time point), durable coating (Xience) and deployable absorbable coating (MiStent). Explanted arteries were evaluated for drug content (n = 3/time point) by LC-MS/MS and for drug and target protein (mTOR) distributions by immunofluorescence (IF, n = 6/time point). A computational model was developed to predict drug release and arterial distribution maps. RESULTS Both stents released the majority of drug load by 28 days, with different tissue retention efficiencies (91.4 ± 4.9% MiStent versus 21.5 ± 1.9% Xience, P < 0.001). Computational modeling of MiStent coating deployment and microcrystal dissolution recapitulated in vivo drug release and net tissue content and predicted that >98.5% of deployed drug remains crystalline through 90 days. Immunofluorescence and computational modeling showed peristrut drug localization for both stents, with similar peaks, but high interstrut levels only at sites of coating deployment from the absorbable coating. Co-localization of mTOR-IF with drug-IF for both devices showed persistent drug effects, though with differential drug-receptor pharmacokinetics. CONCLUSIONS Immunofluorescence and computational modeling provide insights into drug distribution and binding status that can help differentiate drug delivery technologies. Herein we found that tissue deployment of slow dissolving crystalline drug particles results in temporally and spatially more uniform drug delivery to interstrut zones that might otherwise be under-dosed without excess peristrut drug.
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Affiliation(s)
| | | | - Xiaojian Li
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | | | | | - Brett Zani
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | - Lynn Bailey
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | | | | | | | - Elazer R Edelman
- IMES, MIT, 77 Massachusetts Avenue, Cambridge, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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26
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Tzafriri AR, Garcia-Polite F, Zani B, Stanley J, Muraj B, Knutson J, Kohler R, Markham P, Nikanorov A, Edelman ER. Calcified plaque modification alters local drug delivery in the treatment of peripheral atherosclerosis. J Control Release 2017; 264:203-210. [PMID: 28867375 DOI: 10.1016/j.jconrel.2017.08.037] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/07/2017] [Accepted: 08/29/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Calcific atherosclerosis is a major challenge to intraluminal drug delivery in peripheral artery disease (PAD). OBJECTIVES We evaluated the effects of orbital atherectomy on intraluminal paclitaxel delivery to human peripheral arteries with substantial calcified plaque. METHODS Diagnostic angiography and 3-D rotational imaging of five fresh human lower limbs revealed calcification in all main arteries. The proximal or distal segment of each artery was treated using an orbital atherectomy system (OAS) under simulated blood flow and fluoroscopy. Explanted arterial segments underwent either histomorphometric assessment of effect or tracking of 14C-labeled or fluorescent-labeled paclitaxel. Radiolabeled drug quantified bulk delivery and fluorescent label established penetration of drug over finer spatial domain in serial microscopic sections. Results were interpreted using a mathematical model of binding-diffusion mediated arterial drug distribution. RESULTS Lesion composition affected paclitaxel absorption and distribution in cadaveric human peripheral arteries. Pretreatment imaging calcium scores in control femoropopliteal arterial segments correlated with a log-linear decline in the bulk absorption rate-constant of 14C-labeled, declining 5.5-fold per calcified quadrant (p=0.05, n=7). Compared to controls, OAS-treated femoropopliteal segments exhibited 180μm thinner intima (p<0.001), 45% less plaque calcification, and 2 log orders higher paclitaxel bulk absorption rate-constants. Correspondingly, fluorescent paclitaxel penetrated deeper in OAS-treated femoropopliteal segments compared to controls, due to a 70% increase in diffusivity (p<0.001). CONCLUSIONS These data illustrate that calcified plaque limited intravascular drug delivery, and controlled OAS treatment of calcific plaques resulted in greater drug permeability and improved adjunct drug delivery to diseased arteries.
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Affiliation(s)
- Abraham R Tzafriri
- CBSET Inc., 500 Shire Way, Lexington, MA, USA; IMES, MIT, 77 Massachusetts Avenue, Cambridge, MA, USA.
| | - Fernando Garcia-Polite
- CBSET Inc., 500 Shire Way, Lexington, MA, USA; IMES, MIT, 77 Massachusetts Avenue, Cambridge, MA, USA
| | - Brett Zani
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | | | - Benny Muraj
- CBSET Inc., 500 Shire Way, Lexington, MA, USA
| | - Jennifer Knutson
- CBSET Inc., 500 Shire Way, Lexington, MA, USA; Cardiovascular Systems, Inc., 1225 Old Hwy 8NW, Saint Paul, MN, USA
| | - Robert Kohler
- Cardiovascular Systems, Inc., 1225 Old Hwy 8NW, Saint Paul, MN, USA
| | | | | | - Elazer R Edelman
- IMES, MIT, 77 Massachusetts Avenue, Cambridge, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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27
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ZHENG QUAN, CHU ZHAOWEI, LI XIAOMING, KANG HONGYAN, YANG XIAO, FAN YUBO. EFFECTS OF AQUEOUS MEDIUM, TWEEN-20 AND FLOW ON THE STABILITY OF SIROLIMUS. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sirolimus-eluting stents have been widely used in the treatment of coronary artery disease. Prior to the clinical application, the in vitro drug release test is a mandatory requirement for the quality control of sirolimus-eluting stents. How to maintain the stability of sirolimus in the release medium is an important issue throughout the drug release research. In this study, the stability tests of sirolimus in three aqueous media (ultrapure water (UPW), normal saline (NS) and phosphate-buffered saline (PBS, pH 7.4)) were carried out. It was found that the half-lives of sirolimus in UPW, NS and PBS (pH 7.4) were, respectively, 111.8, 43.6 and 11.5[Formula: see text]h. Tween-20 was then added to the above-mentioned three aqueous media and was shown to improve the solubility and stability of sirolimus in aqueous solutions. Under static conditions, the half-life value for sirolimus was significantly increased in the presence of Tween-20 (UPW, 3.5-fold; NS, 2.0-fold; PBS (pH 7.4), 2.7-fold). The effect of solution flow on the stability of sirolimus was also investigated in a flow loop apparatus to mimic vessel-like flow conditions. There was a significant decrease in the stability of sirolimus in aqueous media with the increase of flow rate. The results suggest that aqueous solution supplemented with Tween-20 could be used as the release medium for sirolimus-eluting stents, and that the circulation of the release medium should be controlled at low flow rate.
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Affiliation(s)
- QUAN ZHENG
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P. R. China
| | - ZHAOWEI CHU
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P. R. China
| | - XIAOMING LI
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P. R. China
| | - HONGYAN KANG
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P. R. China
| | - XIAO YANG
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P. R. China
| | - YUBO FAN
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, P. R. China
- National Research Center for Rehabilitation Technical Aids, Beijing 100176, P. R. China
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28
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Stents: Biomechanics, Biomaterials, and Insights from Computational Modeling. Ann Biomed Eng 2017; 45:853-872. [PMID: 28160103 DOI: 10.1007/s10439-017-1806-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/28/2017] [Indexed: 01/02/2023]
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29
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Drug deposition in coronary arteries with overlapping drug-eluting stents. J Control Release 2016; 238:1-9. [PMID: 27432751 DOI: 10.1016/j.jconrel.2016.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023]
Abstract
Drug-eluting stents are accepted as mainstream endovascular therapy, yet concerns for their safety may be under-appreciated. While failure from restenosis has dropped to below 5%, the risk of stent thrombosis and associated mortality remain relatively high. Further optimization of drug release is required to minimize thrombosis risk while maintaining therapeutic dose. The complex three-dimensional geometry of deployed stents together with the combination of diffusive and advective drug transport render an intuitive understanding of the situation exceedingly difficult. In situations such as this, computational modeling has proven essential, helping define the limits of efficacy, determine the mode and mechanism of drug release, and identify alternatives to avoid toxicity. A particularly challenging conformation is encountered in coronary arteries with overlapping stents. To study hemodynamics and drug deposition in such vessels we combined high-resolution, multi-scale ex vivo computed tomography with a flow and mass transfer computational model. This approach ensures high geometric fidelity and precise, simultaneous calculation of blood flow velocity, shear stress and drug distribution. Our calculations show that drug uptake by the arterial tissue is dependent both on the patterns of flow disruption near the wall, as well as on the relative positioning of drug-eluting struts. Overlapping stent struts lead to localized peaks of drug concentration that may increase the risk of thrombosis. Such peaks could be avoided by anisotropic stent structure or asymmetric drug release designed to yield homogeneous drug distribution along the coronary artery and, at the least, suggest that these issues need to remain in the forefront of consideration in clinical practice.
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30
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Tzafriri AR, Edelman ER. Endovascular Drug Delivery and Drug Elution Systems: First Principles. Interv Cardiol Clin 2016; 5:307-320. [PMID: 28582029 DOI: 10.1016/j.iccl.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular drug delivery continues to revolutionize the treatment of atherosclerosis in coronary and peripheral vasculature. The key has been to identify biologic agents that can counter the hyperplastic tissue responses to device expansion/implantation and to develop effective local delivery strategies that can maintain efficacious drug levels across the artery wall over the course of device effects. This article reviews the evolution of endovascular drug delivery technology, explains the mechanisms they use for drug release, and provides a quantitative mechanistic framework for relating drug release mode to arterial drug distribution and effect.
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Affiliation(s)
- Abraham Rami Tzafriri
- Department of Applied Sciences, CBSET, Lexington, MA, USA; IMES, MIT, 77 Massachusetts Avenue, Building E25-438, Cambridge, MA 02139, USA.
| | - Elazer Reuven Edelman
- IMES, MIT, 77 Massachusetts Avenue, Building E25-438, Cambridge, MA 02139, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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31
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Chen Y, Xiong Y, Jiang W, Wong MS, Yan F, Wang Q, Fan Y. Numerical simulation on the effects of drug-eluting stents with different bending angles on hemodynamics and drug distribution. Med Biol Eng Comput 2016; 54:1859-1870. [PMID: 27048391 DOI: 10.1007/s11517-016-1488-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
Implantation of drug-eluting stents in curved blood vessels may cause changes in hemodynamics and drug distribution, and even provoke in-stent restenosis. Due to the complexity of building three-dimensional (3-D) curved stent model, few studies have gone through such numerical simulations. In this study, three virtual stent models with different bending angles (0°, 30° and 90°) were developed to numerically investigate the distribution of wall shear stress (WSS) and drug concentration. The results showed that (1) the low-WSS regions in the inner bend of the stent models increased with the bending angles; (2) the drug concentration differed between the inner and outer bends of the stents but irrespective to the changes of bending angle; (3) the pattern of drug concentration for the curved stents found similar to that of the straight stents, and the phenomenon, 'proximal part low and distal part high' in the drug concentration showed in both the straight and curved stents. The increase in bending angles from 30° to 90° had little effect on the WSS and drug concentration; however, the largest effect of the curved stents was the remarkable difference of drug concentration between the inner and outer bends of the stents-about 20 %. Hence, it is feasible that quick analysis focused on the straight stents instead of the curved stents.
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Affiliation(s)
- Yu Chen
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China
| | - Yan Xiong
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu, 610065, China
| | - Wentao Jiang
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China.
| | - Man Sang Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Fei Yan
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China
| | - Qingyuan Wang
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu, 610065, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
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32
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Saito N, Mori Y, Uchiyama S. Drug diffusion and biological responses of arteries using a drug-eluting stent with nonuniform coating. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:33-43. [PMID: 27051322 PMCID: PMC4803265 DOI: 10.2147/mder.s102094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to determine the effect of a nonuniform coating, abluminal-gradient coating (AGC), which leaves the abluminal surface of the curves and links parts of the stent free from the drug coating, on the diffusion direction of the drug and the biological responses of the artery to drug-eluting stent (DES) by comparing the AGC-sirolimus stent and the conventional full-surface coating (CFC) sirolimus stent. The study aimed to verify whether the AGC approach was appropriate for the development of a safer DES, minimizing the risks of stent thrombosis due to delayed endothelialization by the drug and distal embolization due to cracking of the coating layer on the hinge parts of the DES on stent expansion. In the in vitro local drug diffusion study, we used rhodamine B as a model drug, and rhodamine B released from the AGC stent diffused predominantly into the abluminal side of the alginate artery model. Conversely, rhodamine B released from the CFC stent quickly spread to the luminal side of the artery model, where endothelial cell regeneration is required. In the biological responses study, the luminal surface of the iliac artery implanted with the AGC-sirolimus stent in a rabbit iliac artery for 2 weeks was completely covered with endothelial-like cells. On the other hand, the luminal surface of the iliac artery implanted with the CFC-sirolimus stent for 2 weeks only showed partial coverage with endothelial-like cells. While thrombosis was observed in two of the three CFC-sirolimus stents, it was observed in only one of the three AGC-sirolimus stents. Taken together, these findings indicate that the designed nonuniform coating (AGC) is an appropriate approach to ensure a safer DES. However, the number of studies is limited and a larger study should be conducted to reach a statistically significant conclusion.
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Affiliation(s)
- Noboru Saito
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
| | - Yuhei Mori
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
| | - Sayaka Uchiyama
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
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Integrated Stent Models Based on Dimension Reduction: Review and Future Perspectives. Ann Biomed Eng 2015; 44:604-17. [PMID: 26452562 DOI: 10.1007/s10439-015-1459-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/12/2015] [Indexed: 10/22/2022]
Abstract
Stent modeling represents a challenging task from both the theoretical and numerical viewpoints, due to its multi-physics nature and to the complex geometrical configuration of these devices. In this light, dimensional model reduction enables a comprehensive geometrical and physical description of stenting at affordable computational costs. In this work, we aim at reviewing dimensional model reduction of stent mechanics and drug release. Firstly, we address model reduction techniques for the description of stent mechanics, aiming to illustrate how a three-dimensional stent model can be transformed into a collection of interconnected one-dimensional rods, called a "stent net". Secondly, we review available model reduction methods similarly applied to drug release, in which the "stent net" concept is adopted for modeling of drug elution. As a result, drug eluting stents are described as a distribution of concentrated drug release sources located on a graph that fully represents the stent geometry. Lastly, new results about the extension of these model reduction approaches to biodegradable stents are also discussed.
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Controlling drug delivery from coronary stents: are we aiming for the right targets? Ther Deliv 2015; 6:705-20. [PMID: 26149786 DOI: 10.4155/tde.15.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this review article, the currently employed or explored delivery concepts for local intravascular drug delivery with drug-eluting stents (DES) are discussed with a special emphasis on clinical evidence regarding the desired release profiles. Traditional concepts to control drug release from DES include diffusion through polymers, polymer degradation and erosion as well as dissolution of particulate drug. Published clinical studies do not always reveal fine mechanistic details. The long duration of release favored for DES and the short duration of release favored for drug-eluting balloons require further investigation in experimental studies and clinical trials.
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Chen W, Habraken TCJ, Hennink WE, Kok RJ. Polymer-Free Drug-Eluting Stents: An Overview of Coating Strategies and Comparison with Polymer-Coated Drug-Eluting Stents. Bioconjug Chem 2015; 26:1277-88. [PMID: 26041505 DOI: 10.1021/acs.bioconjchem.5b00192] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinical evaluations have proven the efficacy of drug-elution stents (DES) in reduction of in-stent restenosis rates as compared to drug-free bare metal stents (BMS). Typically, DES are metal stents that are covered with a polymer film loaded with anti-inflammatory or antiproliferative drugs that are released in a sustained manner. However, although favorable effects of the released drugs have been observed, the polymer coating as such has been associated with several adverse clinical effects, such as late stent thrombosis. Elimination of the polymeric carrier of DES may therefore potentially lead to safer DES. Several technologies have been developed to design polymer-free DES, such as the use of microporous stents and inorganic coatings that can be drug loaded. Several drugs, including sirolimus, tacrolimus, paclitaxel, and probucol have been used in the design of carrier-free stents. Due to the function of the polymeric coating to control the release kinetics of a drug, polymer-free stents are expected to have a faster drug elution rate, which may affect the therapeutic efficacy. However, several polymer-free stents have shown similar efficacy and safety as the first-generation DES, although the superiority of polymer-free DES has not been established in clinical trials.
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Affiliation(s)
- Weiluan Chen
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Tom C J Habraken
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Robbert J Kok
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
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Bozsak F, Gonzalez-Rodriguez D, Sternberger Z, Belitz P, Bewley T, Chomaz JM, Barakat AI. Optimization of Drug Delivery by Drug-Eluting Stents. PLoS One 2015; 10:e0130182. [PMID: 26083626 PMCID: PMC4470631 DOI: 10.1371/journal.pone.0130182] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/18/2015] [Indexed: 01/30/2023] Open
Abstract
Drug-eluting stents (DES), which release anti-proliferative drugs into the arterial wall in a controlled manner, have drastically reduced the rate of in-stent restenosis and revolutionized the treatment of atherosclerosis. However, late stent thrombosis remains a safety concern in DES, mainly due to delayed healing of the endothelial wound inflicted during DES implantation. We present a framework to optimize DES design such that restenosis is inhibited without affecting the endothelial healing process. To this end, we have developed a computational model of fluid flow and drug transport in stented arteries and have used this model to establish a metric for quantifying DES performance. The model takes into account the multi-layered structure of the arterial wall and incorporates a reversible binding model to describe drug interaction with the cells of the arterial wall. The model is coupled to a novel optimization algorithm that allows identification of optimal DES designs. We show that optimizing the period of drug release from DES and the initial drug concentration within the coating has a drastic effect on DES performance. Paclitaxel-eluting stents perform optimally by releasing their drug either very rapidly (within a few hours) or very slowly (over periods of several months up to one year) at concentrations considerably lower than current DES. In contrast, sirolimus-eluting stents perform optimally only when drug release is slow. The results offer explanations for recent trends in the development of DES and demonstrate the potential for large improvements in DES design relative to the current state of commercial devices.
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Affiliation(s)
- Franz Bozsak
- Laboratoire d’Hydrodynamique (LadHyX), École Polytechnique—CNRS, Palaiseau cedex, France
| | | | - Zachary Sternberger
- Laboratoire d’Hydrodynamique (LadHyX), École Polytechnique—CNRS, Palaiseau cedex, France
| | - Paul Belitz
- UCSD Flow Control and Coordinated Robotics Labs Dept of MAE, UC San Diego, La Jolla, CA, USA
| | - Thomas Bewley
- UCSD Flow Control and Coordinated Robotics Labs Dept of MAE, UC San Diego, La Jolla, CA, USA
| | - Jean-Marc Chomaz
- Laboratoire d’Hydrodynamique (LadHyX), École Polytechnique—CNRS, Palaiseau cedex, France
| | - Abdul I. Barakat
- Laboratoire d’Hydrodynamique (LadHyX), École Polytechnique—CNRS, Palaiseau cedex, France
- * E-mail:
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Hu T, Yang J, Cui K, Rao Q, Yin T, Tan L, Zhang Y, Li Z, Wang G. Controlled Slow-Release Drug-Eluting Stents for the Prevention of Coronary Restenosis: Recent Progress and Future Prospects. ACS APPLIED MATERIALS & INTERFACES 2015; 7:11695-11712. [PMID: 26011753 DOI: 10.1021/acsami.5b01993] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drug-eluting stents (DES) have become more widely used by cardiologists than bare metal stents (BMS) because of their better ability to control restenosis. However, recognized negative events, particularly including delayed or incomplete endothelialization and late stent thrombosis, have caused concerns over the long-term safety of DES. Although stent-based drug delivery can facilitate a drug's release directly to the restenosis site, a burst of drug release can seriously affect the pharmacological action and is a major factor accounting for adverse effects. Therefore, the drug release rate has become an important criterion in evaluating DES. The factors affecting the drug release rate include the drug carrier, drug, coating methods, drug storage, elution direction, coating thickness, pore size in the coating, release conditions (release medium, pH value, temperature), and hemodynamics after the stent implantation. A better understanding of how these factors influence drug release is particularly important for the reasonable use of efficient control strategies for drug release. This review summarizes the factors influencing the drug release from DES and presents strategies for enhancing the control of the drug's release, including the stent design, the application of absorbable stents, the development of new polymers, and the application of nanocarriers and improvements in the coating technology. Therefore, this paper provides a reference for the preparation of novel controlled slow-release DES.
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Affiliation(s)
- Tingzhang Hu
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Jiali Yang
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Kun Cui
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Qiong Rao
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Tieying Yin
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Lili Tan
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Yuan Zhang
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Zhenggong Li
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Guixue Wang
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
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Cortese B, Granada JF, Scheller B, Schneider PA, Tepe G, Scheinert D, Garcia L, Stabile E, Alfonso F, Ansel G, Zeller T. Drug-coated balloon treatment for lower extremity vascular disease intervention: an international positioning document. Eur Heart J 2015; 37:1096-103. [PMID: 26009594 DOI: 10.1093/eurheartj/ehv204] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/03/2015] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Juan F Granada
- Skirball Center for Innovation, Cardiovascular Research Foundatiuon, Columbia University Medical Center, New York, USA
| | - Bruno Scheller
- Klinische und Experimentelle Interventionelle Kardiologie, Universität des Saarlandes, Homburg, Germany
| | - Peter A Schneider
- Kaiser Permanente - Moanalua Medical Center and Clinic, Honolulu, HI, USA
| | | | | | - Lawrence Garcia
- St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Fernando Alfonso
- Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gary Ansel
- Ohio Health/Riverside Methodist Hospital, Columbus, OH, USA
| | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
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Zhu X, Braatz RD. Modeling and analysis of drug-eluting stents with biodegradable PLGA coating: consequences on intravascular drug delivery. J Biomech Eng 2015; 136:1894901. [PMID: 25084767 DOI: 10.1115/1.4028135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Indexed: 11/08/2022]
Abstract
Increasing interests have been raised toward the potential applications of biodegradable poly(lactic-co-glycolic acid) (PLGA) coatings for drug-eluting stents in order to improve the drug delivery and reduce adverse outcomes in stented arteries in patients. This article presents a mathematical model to describe the integrated processes of drug release in a stent with PLGA coating and subsequent drug delivery, distribution, and drug pharmacokinetics in the arterial wall. The integrated model takes into account the PLGA degradation and erosion, anisotropic drug diffusion in the arterial wall, and reversible drug binding. The model simulations first compare the drug delivery from a biodegradable PLGA coating with that from a biodurable coating, including the drug release profiles in the coating, average arterial drug levels, and arterial drug distribution. Using the model for the PLGA stent coating, the simulations further investigate drug internalization, interstitial fluid flow in the arterial wall, and stent embedment for their impact on drug delivery. Simulation results show that these three factors, while imposing little change in the drug release profiles, can greatly change the average drug concentrations in the arterial wall. In particular, each of the factors leads to significant and yet distinguished alterations in the arterial drug distribution that can potentially influence the treatment outcomes. The detailed integrated model provides insights into the design and evaluation of biodegradable PLGA-coated drug-eluting stents for improved intravascular drug delivery.
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Chen Y, Xiong Y, Jiang W, Yan F, Guo M, Wang Q, Fan Y. Numerical simulation on the effects of drug eluting stents at different Reynolds numbers on hemodynamic and drug concentration distribution. Biomed Eng Online 2015; 14 Suppl 1:S16. [PMID: 25602685 PMCID: PMC4306105 DOI: 10.1186/1475-925x-14-s1-s16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The changes of hemodynamics and drug concentration distribution caused by the implantation of drug eluting stents (DESs) in curved vessels have significant effects on In-Stent Restenosis. Methods A 3D virtual stent with 90°curvature was modelled and the distribution of wall shear stress (WSS) and drug concentration in this model were numerically studied at Reynolds numbers of 200, 400, 600, 800. Results The results showed that (1) the intensity of secondary flow at the 45° cross-section was stronger than that at the 90° cross-section; (2) As the Reynolds number increases, the WSS decreases. When the Reynolds number reaches 600, the low-WSS region only accounts for 3% of the total area. (3) The effects of Reynolds number on drug concentration in the vascular wall decreases in proportionally and then the blood velocity increased 4 times, the drug concentration in the vascular wall decreased by about 30%. (4) The size of the high drug concentration region is inversely proportional to the Reynolds number. As the blood velocity increases, the drug concentration in the DES decreases, especially at the outer bend. Conclusions It is beneficial for the patient to decrease vigorous activities and keep calm at the beginning of the stent implantation, because a substantial amount of the drug is released in the first two months of stent implantation, thus a calm status is conducive to drug release and absorption; Subsequently, appropriate exercise which increases the blood velocity is helpful in decreasing regions of low-WSS.
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Granada JF, Stenoien M, Buszman PP, Tellez A, Langanki D, Kaluza GL, Leon MB, Gray W, Jaff MR, Schwartz RS. Mechanisms of tissue uptake and retention of paclitaxel-coated balloons: impact on neointimal proliferation and healing. Open Heart 2014; 1:e000117. [PMID: 25332821 PMCID: PMC4189287 DOI: 10.1136/openhrt-2014-000117] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/05/2014] [Accepted: 05/28/2014] [Indexed: 01/08/2023] Open
Abstract
Background The efficacy of paclitaxel-coated balloons (PCB) for restenosis prevention has been demonstrated in humans. However, the mechanism of action for sustained drug retention and biological efficacy following single-time drug delivery is still unknown. Methods and results The pharmacokinetic profile and differences in drug concentration (vessel surface vs arterial wall) of two different paclitaxel coating formulations (3 µg/mm2) displaying opposite solubility characteristics (CC=crystalline vs AC=amorphous) were tested in vivo and compared with paclitaxel-eluting stents (PES). Also, the biological effect of both PCB formulations on vascular healing was tested in the porcine coronary injury model. One hour following balloon inflation, both formulations achieved similar arterial paclitaxel levels (CC=310 vs AC=245 ng/mg; p=NS). At 24 h, the CC maintained similar tissue concentrations, whereas the AC tissue levels declined by 99% (p<0.01). At this time point, arterial levels were 20-fold (CC) and 5-fold (AC) times higher compared to the PES group (p<0.05). At 28 days, arterial levels retained were 9.2% (CC) and 0.04% (AC, p<0.01) of the baseline levels. Paclitaxel concentration on the vessel surface was higher in the CC at 1 (CC=36.7% vs AC=13.1%, p<0.05) and 7 days (CC=38.4% vs AC=11%, p<0.05). In addition, the CC induced higher levels of neointimal inhibition, fibrin deposition and delayed healing compared with the AC group. Conclusions The presence of paclitaxel deposits on the vessel surface driving diffusion into the arterial tissue in a time-dependent fashion supports the mechanism of action of PCB. This specific pharmacokinetic behaviour influences the patterns of neointimal formation and healing.
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Affiliation(s)
- Juan F Granada
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation , Orangeburg, New York , USA
| | - Mark Stenoien
- MEDRAD Interventional , Indianola, Pennsylvania , USA
| | - Piotr P Buszman
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation , Orangeburg, New York , USA
| | - Armando Tellez
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation , Orangeburg, New York , USA
| | - Dan Langanki
- MEDRAD Interventional , Indianola, Pennsylvania , USA
| | - Greg L Kaluza
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation , Orangeburg, New York , USA
| | - Martin B Leon
- Columbia University Medical Center, Center for Interventional Vascular Therapy, New York Presbyterian Hospital , New York, New York , USA
| | - William Gray
- Columbia University Medical Center, Center for Interventional Vascular Therapy, New York Presbyterian Hospital , New York, New York , USA
| | - Michael R Jaff
- Harvard Medical School, Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Robert S Schwartz
- Minneapolis Heart Institute and Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota , USA
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Semmling B, Nagel S, Sternberg K, Weitschies W, Seidlitz A. Impact of different tissue-simulating hydrogel compartments on in vitro release and distribution from drug-eluting stents. Eur J Pharm Biopharm 2014; 87:570-8. [DOI: 10.1016/j.ejpb.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/13/2014] [Accepted: 04/27/2014] [Indexed: 12/21/2022]
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CHEN YU, XIONG YAN, JIANG WENTAO, CHEN JIAN, GUO MENG, WANG QINGYUAN, FAN YUBO. NUMERICAL STUDY ON THE EFFECTS OF THE NUMBER AND GEOMETRIES OF DRUG-ELUTING STENT LINKS ON THE DRUG CONCENTRATION. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414500778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paper investigated the effects of the link numbers and geometries of drug-eluting stents (DESs) on the hemodynamics and the distribution of drug concentration, and the final results could be used as a guide for the optimization of DES design. Four 3D virtual stents with different numbers and geometries of links were modeled and numerically studied with respect to the distribution of wall shear stress (WSS) and drug concentration. Results have showed (1) The geometries of links have big impact on the distribution of WSS regions and the uniform drug concentration distribution on the vascular wall, but little effect on the mean drug concentration on the vascular wall; the S-shaped link stents had less low-WSS regions and the reason is that the flow direction was considered in the design of this type of stents. (2) The drug concentration distribution on the vascular wall had remarkable difference from that in blood. (3) The 6S link stent had the least low-WSS regions and with high and uniformly distributed drug concentration, so this type of stent was concluded to be the best design in four stents. Overall, it is not reliable to use the drug concentration in blood to deduce the drug concentration on the vascular wall. In DES design, the configuration of links should be, as much as possible, in line with the blood flow direction, so it can decrease the low-WSS regions. Meanwhile, in order to get more uniformly distributed drug on the vascular wall, the distribution of drug on the stent surface should be taken into account. Additionally, because of the increment of contact area between the stents and vascular wall, the drug concentration on the vascular wall increased with the number of links.
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Affiliation(s)
- YU CHEN
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu 610065, P. R. China
| | - YAN XIONG
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - WENTAO JIANG
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu 610065, P. R. China
| | - JIAN CHEN
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia
| | - MENG GUO
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, XueYuan Road No. 37, HaiDian District, Beijing 100191, P. R. China
| | - QINGYUAN WANG
- Department of Applied Mechanics, Sichuan University, NanYihuan Road No. 24, WuHou District, Chengdu 610065, P. R. China
| | - YUBO FAN
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, XueYuan Road No. 37, HaiDian District, Beijing 100191, P. R. China
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Numerical modelling of the physical factors that affect mass transport in the vasculature at early time periods. Med Eng Phys 2014; 36:308-17. [PMID: 24462324 DOI: 10.1016/j.medengphy.2013.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/11/2013] [Accepted: 11/20/2013] [Indexed: 11/21/2022]
Abstract
Coronary artery disease results in blockages or narrowing of the artery lumen. Drug eluting stents were developed to replace bare metal stents in an effort to combat re-blocking of the lumen. A key element in determining the therapeutic success of a drug eluting stent is an in-depth understanding of the physical factors that affect mass transport of the drug into the arterial wall, over early time periods. The numerical models developed within this study focus on assessing the influence of a host of physical factors that either facilitate or impede therapeutic drug delivery into the arterial wall from the unit cell of an idealised stent. This study demonstrates that model reduction strategies to 2D and 1D can still adequately represent a 3D curved arterial wall and strut polymer coating, respectively, using an idealistic stent geometry. It was shown that the level of strut compression can have a significant impact on therapeutic drug delivery in the arterial wall.
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Bozsak F, Chomaz JM, Barakat AI. Modeling the transport of drugs eluted from stents: physical phenomena driving drug distribution in the arterial wall. Biomech Model Mechanobiol 2014; 13:327-47. [DOI: 10.1007/s10237-013-0546-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 12/12/2013] [Indexed: 01/09/2023]
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46
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Denny WJ, Walsh MT. Numerical modelling of mass transport in an arterial wall with anisotropic transport properties. J Biomech 2014; 47:168-77. [DOI: 10.1016/j.jbiomech.2013.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 08/28/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
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O'Connell BM, Cunnane EM, Denny WJ, Carroll GT, Walsh MT. Improving smooth muscle cell exposure to drugs from drug-eluting stents at early time points: a variable compression approach. Biomech Model Mechanobiol 2013; 13:771-81. [PMID: 24101254 DOI: 10.1007/s10237-013-0533-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 09/22/2013] [Indexed: 11/29/2022]
Abstract
The emergence of drug-eluting stents (DES) as a viable replacement for bare metal stenting has led to a significant decrease in the incidence of clinical restenosis. This is due to the transport of anti-restenotic drugs from within the polymer coating of a DES into the artery wall which arrests the cell cycle before restenosis can occur. The efficacy of DES is still under close scrutiny in the medical field as many issues regarding the effectiveness of DES drug transport in vivo still exist. One such issue, that has received less attention, is the limiting effect that stent strut compression has on the transport of drug species in the artery wall. Once the artery wall is compressed, the stents ability to transfer drug species into the arterial wall can be reduced. This leads to a reduction in the spatial therapeutic transfer of drug species to binding sites within the arterial wall. This paper investigates the concept of idealised variable compression as a means of demonstrating how such a stent design approach could improve the spatial delivery of drug species in the arterial wall. The study focused on assessing how the trends in concentration levels changed as a result of artery wall compression. Five idealised stent designs were created with a combination of thick struts that provide the necessary compression to restore luminal patency and thin uncompressive struts that improve the transport of drugs therein. By conducting numerical simulations of diffusive mass transport, this study found that the use of uncompressive struts results in a more uniform spatial distribution of drug species in the arterial wall.
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Affiliation(s)
- Barry M O'Connell
- Centre for Applied Biomedical Engineering (CABER), Department of Mechanical, Aeronautical and Biomedical Engineering and The Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
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Keyes JT, Simon BR, Vande Geest JP. A finite element study on variations in mass transport in stented porcine coronary arteries based on location in the coronary arterial tree. J Biomech Eng 2013; 135:61008-11. [PMID: 23699720 DOI: 10.1115/1.4024137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/04/2013] [Indexed: 11/08/2022]
Abstract
Drug-eluting stents have a significant clinical advantage in late-stage restenosis due to the antiproliferative drug release. Understanding how drug transport occurs between coronary arterial locations can better help guide localized drug treatment options. Finite element models with properties from specific porcine coronary artery sections (left anterior descending (LAD), right (RCA); proximal, middle, distal regions) were created for stent deployment and drug delivery simulations. Stress, strain, pore fluid velocity, and drug concentrations were exported at different time points of simulation (0-180 days). Tests indicated that the highest stresses occurred in LAD sections. Higher-than-resting homeostatic levels of stress and strain existed at upwards of 3.0 mm away from the stented region, whereas concentration of species only reached 2.7 mm away from the stented region. Region-specific concentration showed 2.2 times higher concentrations in RCA artery sections at times corresponding to vascular remodeling (peak in the middle segment) compared to all other segments. These results suggest that wall transport can occur differently based on coronary artery location. Awareness of peak growth stimulators and where drug accumulation occurs in the vasculature can better help guide local drug delivery therapies.
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Affiliation(s)
- Joseph T Keyes
- Graduate Interdisciplinary Program in Biomedical Engineering, The University of Arizona,Tucson, AZ 85721, USA.
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O'Brien CC, Kolachalama VB, Barber TJ, Simmons A, Edelman ER. Impact of flow pulsatility on arterial drug distribution in stent-based therapy. J Control Release 2013; 168:115-24. [PMID: 23541929 DOI: 10.1016/j.jconrel.2013.03.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
Abstract
Drug-eluting stents reside in a dynamic fluid environment where the extent to which drugs are distributed within the arterial wall is critically modulated by the blood flowing through the arterial lumen. Yet several factors associated with the pulsatile nature of blood flow and their impact on arterial drug deposition have not been fully investigated. We employed an integrated framework comprising bench-top and computational models to explore the factors governing the time-varying fluid dynamic environment within the vasculature and their effects on arterial drug distribution patterns. A custom-designed bench-top framework comprising a model of a single drug-eluting stent strut and a poly-vinyl alcohol-based hydrogel as a model tissue bed simulated fluid flow and drug transport under fully apposed strut settings. Bench-top experiments revealed a relative independence between drug distribution and the factors governing pulsatile flow and these findings were validated with the in silico model. Interestingly, computational models simulating suboptimal deployment settings revealed a complex interplay between arterial drug distribution, Womersley number and the extent of malapposition. In particular, for a stent strut offset from the wall, total drug deposition was sensitive to changes in the pulsatile flow environment, with this dependence increasing with greater wall displacement. Our results indicate that factors governing pulsatile luminal flow on arterial drug deposition should be carefully considered in conjunction with device deployment settings for better utilization of drug-eluting stent therapy.
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Affiliation(s)
- Caroline C O'Brien
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia.
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50
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Thakkar A, Raval A, Mandal R, Parmar S, Jariwala A, Tailor J, Mehta A. Development and Evaluation of Drug Eluting Stent Having Biphasic Release From a Single Layer of Biodegradable Polymer. J Med Device 2013. [DOI: 10.1115/1.4023414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In stent restenosis is the major disadvantage of percutaneous transluminal angioplasty. To overcome this limitation, drug eluting stents were introduced. We have developed novel sirolimus eluting stent using biocompatible and biodegradable polymer matrix. Developed stent have biphasic release profile for sirolimus from a single layer of polymer matrix, having blend of slow and fast degrading polymers. Coating integrity of coated stents were evaluated after crimping and postexpansion with the help of scanning electron microscopy while thickness of coated stent was measured using destructive test method. This shows that drug-polymers bilayer was uniformly coated with the average thickness of 5.2 μms. There was no deformation after crimping and expansion of the stent. We have also measured in vitro and in vivo release profiles of sirolimus from stents which shows biphasic release characteristics, i.e., initial burst period followed by sustained release. In vitro release profile is well correlated with in vivo release in blood and arterial tissues. Developed stents showed good efficacy and safety in porcine coronary artery model.
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Affiliation(s)
| | | | - Ramila Mandal
- Sahajanand Medical Technologies Pvt. Ltd., Surat, India
| | | | | | - Jaynish Tailor
- Sahajanand Medical Technologies Pvt. Ltd., Surat, 395004, India
| | - Anita Mehta
- L. M. College of Pharmacy, Ahmedabad, 380009, India
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