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Giakoumi M, Stephanou PS, Kokkinidou D, Papastefanou C, Anayiotos A, Kapnisis K. A Predictive Toxicokinetic Model for Nickel Leaching from Vascular Stents. ACS Biomater Sci Eng 2024; 10:2534-2551. [PMID: 38525821 PMCID: PMC11005016 DOI: 10.1021/acsbiomaterials.3c01436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
In vitro testing methods offer valuable insights into the corrosion vulnerability of metal implants and enable prompt comparison between devices. However, they fall short in predicting the extent of leaching and the biodistribution of implant byproducts under in vivo conditions. Physiologically based toxicokinetic (PBTK) models are capable of quantitatively establishing such correlations and therefore provide a powerful tool in advancing nonclinical methods to test medical implants and assess patient exposure to implant debris. In this study, we present a multicompartment PBTK model and a simulation engine for toxicological risk assessment of vascular stents. The mathematical model consists of a detailed set of constitutive equations that describe the transfer of nickel ions from the device to peri-implant tissue and circulation and the nickel mass exchange between blood and the various tissues/organs and excreta. Model parameterization was performed using (1) in-house-produced data from immersion testing to compute the device-specific diffusion parameters and (2) full-scale animal in situ implantation studies to extract the mammalian-specific biokinetic functions that characterize the time-dependent biodistribution of the released ions. The PBTK model was put to the test using a simulation engine to estimate the concentration-time profiles, along with confidence intervals through probabilistic Monte Carlo, of nickel ions leaching from the implanted devices and determine if permissible exposure limits are exceeded. The model-derived output demonstrated prognostic conformity with reported experimental data, indicating that it may provide the basis for the broader use of modeling and simulation tools to guide the optimal design of implantable devices in compliance with exposure limits and other regulatory requirements.
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Affiliation(s)
- Matheos Giakoumi
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | - Pavlos S. Stephanou
- Department
of Chemical Engineering, Cyprus University
of Technology, Limassol 3036, Cyprus
| | - Despoina Kokkinidou
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | | | - Andreas Anayiotos
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | - Konstantinos Kapnisis
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
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2
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Lee DH, Oh S, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y, Han JB, Kim IS, Jeong MH. Comparative treatment outcomes of a single long stent vs. overlapped short stents in acute myocardial infarction. Front Cardiovasc Med 2023; 10:1284396. [PMID: 38179505 PMCID: PMC10766367 DOI: 10.3389/fcvm.2023.1284396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives There is no consensus regarding the optimal choice between single long stent (SLS) and overlapped double short stents (DSS) in patients with acute myocardial infarction (AMI). Therefore, we aimed to compare treatment outcomes among patients with AMI treated with these two different stenting methods. Methods In total, 537 patients with AMI from a single tertiary center were categorized into two groups: (1) those who received an SLS (stent length ≥38 mm) (n = 254; 47.3%) and (2) those who received overlapped DSS (individual stent lengths <38 mm) (n = 283; 52.7%). The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCEs) within 1 year. Results The mean age of participants was 65.4 years, and 75.0% were male. Patients receiving an SLS had a higher rate of serum creatinine level ≥1.5 mg/dl (16.3% vs. 8.9%, p = 0.009) but a lower rate of hypertension (46.8% vs. 55.8%, p = 0.038), lesser total stent length (38.26 ± 1.31 vs. 45.20 ± 9.25 mm, p < 0.001), total procedure time (41.40 ± 15.74 vs. 53.31 ± 21.75 min, p < 0.001) and total contrast volume (134.13 ± 30.72 vs. 160.57 ± 39.77 ml, p < 0.001) than in those receiving DSS. One-year MACCEs were comparable between the two groups before [hazard ratio (HR), 1.33; 95% confidence interval (CI), 0.80-2.24] and after adjusting for covariates (HR, 1.21; 95% CI, 0.67-2.19). Conclusions Stenting with an SLS demonstrated similar outcomes compared to those achieved when using stenting with overlapped DSS in patients with AMI. Therefore, if the deliverability is acceptable, stenting with an SLS appears to be a safe and effective strategy for AMI treatment.
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Affiliation(s)
- Doo Hwan Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Radiological Science, Dongshin University, Naju, Republic of Korea
| | - Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Jae Bok Han
- Department of Radiological Science, Dongshin University, Naju, Republic of Korea
| | - In Soo Kim
- Department of Radiological Science, Dongshin University, Naju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Nominated by Korea Ministry for Health and Welfare, Gwangju, Republic of Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Republic of Korea
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3
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Giakoumi M, Stephanou PS, Kapnisis K, Anayiotos A. On the development of physiologically based toxicokinetic (PBTK) models for cardiovascular implants. Regul Toxicol Pharmacol 2023; 144:105489. [PMID: 37659713 DOI: 10.1016/j.yrtph.2023.105489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
Local and systemic contamination caused by metal ions leaching from medical device materials is a significant and continuing health problem. The increasing need for verification and validation, and the imposition of stringent government regulations to ensure that the products comply with the quality, safety, and performance standards, have led regulatory bodies worldwide to strongly recommend the use of modeling and simulation tools to support medical device submissions. A previously published physiologically based toxicokinetic (PBTK) model, is here expanded and enriched by an additional separate tissue compartment to better resemble normal physiology and by the introduction of time-dependent functions to describe all biokinetic parameters. The new model is exercised in conjunction with state-of-the-art probabilistic, Monte Carlo methodology to calculate the predictions' confidence intervals and incorporate variability associated with toxicological biodistribution studies. The quantitative consistency of the model-derived predictions is validated against reported data following the implantation of nickel-containing cardiovascular devices in humans and minipigs. Finally, a new methodology for compartmental toxicological risk assessment is presented that can be used for forward or reverse dosimetry. Our work is aimed at providing a computational tool to optimize the device design characteristics and safeguard that the substances released do not exceed permissible exposure limits.
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Affiliation(s)
- Matheos Giakoumi
- Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol, 3036, Cyprus.
| | - Pavlos S Stephanou
- Department of Chemical Engineering, Cyprus University of Technology, Limassol, 3036, Cyprus.
| | - Konstantinos Kapnisis
- Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol, 3036, Cyprus.
| | - Andreas Anayiotos
- Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol, 3036, Cyprus.
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4
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Kapnisis K, Stylianou A, Kokkinidou D, Martin A, Wang D, Anderson PG, Prokopi M, Papastefanou C, Brott BC, Lemons JE, Anayiotos A. Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue. ACS Biomater Sci Eng 2023; 9:4747-4760. [PMID: 37480152 PMCID: PMC10428095 DOI: 10.1021/acsbiomaterials.3c00540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
A recent U.S. Food and Drug Administration report presented the currently available scientific information related to biological response to metal implants. In this work, a multilevel approach was employed to assess the implant-induced and biocorrosion-related inflammation in the adjacent vascular tissue using a mouse stent implantation model. The implications of biocorrosion on peri-implant tissue were assessed at the macroscopic level via in vivo imaging and histomorphology. Elevated matrix metalloproteinase activity, colocalized with the site of implantation, and histological staining indicated that stent surface condition and implantation time affect the inflammatory response and subsequent formation and extent of neointima. Hematological measurements also demonstrated that accumulated metal particle contamination in blood samples from corroded-stetted mice causes a stronger immune response. At the cellular level, the stent-induced alterations in the nanostructure, cytoskeleton, and mechanical properties of circulating lymphocytes were investigated. It was found that cells from corroded-stented samples exhibited higher stiffness, in terms of Young's modulus values, compared to noncorroded and sham-stented samples. Nanomechanical modifications were also accompanied by cellular remodeling, through alterations in cell morphology and stress (F-actin) fiber characteristics. Our analysis indicates that surface wear and elevated metal particle contamination, prompted by corroded stents, may contribute to the inflammatory response and the multifactorial process of in-stent restenosis. The results also suggest that circulating lymphocytes could be a novel nanomechanical biomarker for peri-implant tissue inflammation and possibly the early stage of in-stent restenosis. Large-scale studies are warranted to further investigate these findings.
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Affiliation(s)
- Konstantinos Kapnisis
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | - Andreas Stylianou
- School
of Sciences, European University Cyprus, Nicosia 2404, Cyprus
- Department
of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia 1678, Cyprus
| | - Despoina Kokkinidou
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | - Adam Martin
- Department
of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Dezhi Wang
- Department
of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Peter G. Anderson
- Department
of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Marianna Prokopi
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
| | | | - Brigitta C. Brott
- Department
of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Jack E. Lemons
- Department
of Biomedical Engineering, University of
Alabama at Birmingham, Birmingham, Alabama 35294-0111, United States
| | - Andreas Anayiotos
- Department
of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Limassol 3036, Cyprus
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5
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Marian M, Berman D, Nečas D, Emani N, Ruggiero A, Rosenkranz A. Roadmap for 2D materials in biotribological/biomedical applications – A review. Adv Colloid Interface Sci 2022; 307:102747. [DOI: 10.1016/j.cis.2022.102747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/01/2023]
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6
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Jaziri H, Mokhtar S, Kyosev Y, Chakfe N, Heim F, Ben Abdessalem S. Influence of fatigue stress on the radial strength of polymeric braided vascular stents. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiba Jaziri
- Textile Materials and Processes Research Unit (MPTex) ENIM, University of Monastir Monastir Tunisia
| | - Sofiene Mokhtar
- Textile Materials and Processes Research Unit (MPTex) ENIM, University of Monastir Monastir Tunisia
| | - Yordan Kyosev
- Institute of Textile Machinery and High‐Performance Material Technology TU Dresden Dresden Germany
| | - Nabil Chakfe
- Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire (GEPROVAS) Hôpitaux Universitaires de Strasbourg Strasbourg France
- Department of Vascular Surgery and Kidney Transplantation University of Strasbourg Strasbourg France
| | - Frederic Heim
- Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire (GEPROVAS) Hôpitaux Universitaires de Strasbourg Strasbourg France
- Laboratoire de Physique et Mécanique Textiles (LPMT) ENSISA, Université de Haute‐Alsace Mulhouse France
| | - Saber Ben Abdessalem
- Textile Materials and Processes Research Unit (MPTex) ENIM, University of Monastir Monastir Tunisia
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7
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Mazzaccaro D, Berti F, Antonini L, Pennati G, Petrini L, Migliavacca F, Nano G. Biomechanical interpretation of observed fatigue fractures of peripheral Nitinol stents in the superficial femoral arteries through in silico modelling. Med Hypotheses 2020; 142:109771. [PMID: 32408069 DOI: 10.1016/j.mehy.2020.109771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/22/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To suggest an in silico modelling approach to estimate the fatigue failure on peripheral Nitinol stents implanted in the superficial femoral artery (SFA) and interpret the clinically observed stent fractures of a retrospective series of patients. MATERIALS AND METHODS Preoperative data of 27 patients who underwent SFA Nitinol stenting were retrospectively analyzed. Data about preoperative features of the SFA and the lesion were collected. Follow-up data were also collected about the occurrence of restenosis/occlusion and stent fracture. RESULTS After a lengthening of the entire vessel, the occluded region was slightly stretched due to its high stiffness, whereas the healthy regions accommodated the artery length variation. The stent fatigue was predicted to be higher in the regions of low stiffness and higher shortening. In 7 out of 27 patients a stent fracture was clinically recorded. The model resulted to be accurate in 90% of the cases. CONCLUSIONS The clinical outcomes in terms of biomechanical fatigue behavior of peripheral Nitinol stents of the SFA could be interpreted by our new approach.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.
| | - Francesca Berti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Luca Antonini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy; Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
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8
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Shen X, Zhu H, Ji S, Jiang J, Deng Y. Fatigue behavior of stent in tapered arteries: The role of arterial tapering and stent material. Proc Inst Mech Eng H 2019; 233:989-998. [PMID: 31277553 DOI: 10.1177/0954411919862400] [Citation(s) in RCA: 2] [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
Stenting has achieved great success in treating cardiovascular diseases due to its high efficiency and minimal invasiveness. However, fatigue of stents severely limits its long-term outcome. In this article, finite element method was adopted to study the effects of arterial tapering and stent material on the fatigue performance of stents. A series of tapered vessels with different taper levels and two sets of stents with different materials were modeled. The Goodman diagram was used to evaluate the fatigue resistance of stents. Results showed that the fatigue resistance of stents can be extremely improved by simply changing stent material. In addition, the taper of the arteries had an important influence on the fatigue resistance of the stent. The fatigue life of the stent will be shortened with the increase of the arterial taper. The method that predicted stent fatigue life in tapered vessels can help clinicians select stents that are more suitable for tapered vessels and help stent engineers design stents that are more resistant to fatigue.
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Affiliation(s)
- Xiang Shen
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Hongfei Zhu
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Song Ji
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Jiabao Jiang
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Yongquan Deng
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
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9
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Fretting damage of Ni-rich ultrafine grained NiTi superelastic wires. J Mech Behav Biomed Mater 2018; 90:655-664. [PMID: 30502674 DOI: 10.1016/j.jmbbm.2018.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/12/2018] [Accepted: 11/18/2018] [Indexed: 01/16/2023]
Abstract
The effects of fretting on Ni-rich ultra-fine grained NiTi superelastic wires have been characterized. Fretting tests have been performed using wire on wire in 90° cross-cylinder configuration until 105 cycles in air at 25 °C. Constant displacement amplitude of 50 µm and normal loads of 10, 20 and 50 N were considered. For a normal load of 10 N, the tribosystem performed in Gross Slip Regime and the predominance of wear damage was observed. Mixed Fretting Regime was instead observed for normal loads of 20 N and 50 N. In these cases, the predominant damage mechanism was crack formation with the cracks oriented normal to the displacement direction. Occurrence of martensitic transformation in the contact region was inferred from the particular shape of the fretting loops. Due to their possible impact on biocompatibility, the debris detached from the tribosystem during the different experiments were collected and characterized by TEM. They consisted in agglomerations of nano-crystalline TiO2 (rutile) and NiO oxide particles sized between 10 and 20 nm.
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10
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Conway C. Coronary Stent Fracture: Clinical Evidence Vs. the Testing Paradigm. Cardiovasc Eng Technol 2018; 9:752-760. [DOI: 10.1007/s13239-018-00384-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
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11
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Kapnisis K, Constantinou M, Kyrkou M, Nikolaou P, Anayiotos A, Constantinides G. Nanotribological response of a-C:H coated metallic biomaterials: the cases of stainless steel, titanium, and niobium. J Appl Biomater Funct Mater 2018; 16:230-240. [PMID: 29974806 DOI: 10.1177/2280800018782840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Wear and corrosion have been identified as two of the major forms of medical implant failures. This study aims to improve the surface, protective and tribological characteristics of bare metals used for medical implants, so as to improve scratch resistance and increase lifetime. Methods Hydrogenated amorphous carbon (a-C:H) films were deposited, using plasma enhanced chemical vapor deposition (PECVD), on stainless steel (SS), titanium (Ti) and niobium (Nb) metal plates. Nanomechanical and nanotribological responses were investigated before and after a-C:H deposition. Film thickness and density were quantified through X-ray reflectivity, and surface morphology before and after deposition were measured using atomic force microscopy, whereas the tribomechanical characteristics were probed using instrumented indentation. Results and conclusions Films of approximately 40 nm in thickness and density of 1.7 g/cm3 were deposited. The a-C:H films reduce the roughness and coefficient of friction while improving the tribomechanical response compared with bare metals for Ti, SS and Nb plates. The very good tribomechanical properties of a-C:H make it a promising candidate material for protective coating on metallic implants.
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Affiliation(s)
- Konstantinos Kapnisis
- 1 Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Lemesos, Cyprus
| | - Marios Constantinou
- 1 Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Lemesos, Cyprus.,2 Research Unit for Nanostructured Materials Systems, Cyprus University of Technology, Lemesos, Cyprus
| | - Maria Kyrkou
- 1 Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Lemesos, Cyprus
| | - Petros Nikolaou
- 1 Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Lemesos, Cyprus.,2 Research Unit for Nanostructured Materials Systems, Cyprus University of Technology, Lemesos, Cyprus
| | - Andreas Anayiotos
- 1 Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Lemesos, Cyprus
| | - Georgios Constantinides
- 1 Department of Mechanical Engineering and Materials Science and Engineering, Cyprus University of Technology, Lemesos, Cyprus.,2 Research Unit for Nanostructured Materials Systems, Cyprus University of Technology, Lemesos, Cyprus
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12
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Marrey R, Baillargeon B, Dreher ML, Weaver JD, Nagaraja S, Rebelo N, Gong XY. Validating Fatigue Safety Factor Calculation Methods for Cardiovascular Stents. J Biomech Eng 2018; 140:2672191. [PMID: 29392299 DOI: 10.1115/1.4039173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluating risk of fatigue fractures in cardiovascular implants via nonclinical testing is essential to provide an indication of their durability. This is generally accomplished by experimental accelerated durability testing and often complemented with computational simulations to calculate fatigue safety factors (FSFs). While many methods exist to calculate FSFs, none have been validated against experimental data. The current study presents three methods for calculating FSFs and compares them to experimental fracture outcomes under axial fatigue loading, using cobalt-chromium test specimens designed to represent cardiovascular stents. FSFs were generated by calculating mean and alternating stresses using a simple scalar method, a tensor method which determines principal values based on averages and differences of the stress tensors, and a modified tensor method which accounts for stress rotations. The results indicate that the tensor method and the modified tensor method consistently predicted fracture or survival to 107 cycles for specimens subjected to experimental axial fatigue. In contrast, for one axial deformation condition, the scalar method incorrectly predicted survival even though fractures were observed in experiments. These results demonstrate limitations of the scalar method and potential inaccuracies. A separate computational analysis of torsional fatigue was also completed to illustrate differences between the tensor method and the modified tensor method. Because of its ability to account for changes in principal directions across the fatigue cycle, the modified tensor method offers a general computational method that can be applied for improved predictions for fatigue safety regardless of loading conditions.
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Affiliation(s)
- Ramesh Marrey
- Cordis Corporation, a Cardinal Health company, 1820 McCarthy Boulevard, Milpitas, CA 95035 e-mail:
| | | | - Maureen L. Dreher
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993
| | - Jason D. Weaver
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993
| | - Srinidhi Nagaraja
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993
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13
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Weaver JD, Ramirez L, Sivan S, Di Prima M. Characterizing fretting damage in different test media for cardiovascular device durability testing. J Mech Behav Biomed Mater 2018; 82:338-344. [PMID: 29653383 DOI: 10.1016/j.jmbbm.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/09/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
In vitro durability tests of cardiovascular devices are often used to evaluate the potential for fretting damage during clinical use. Evaluation of fretting damage is important because severe fretting can concentrate stress and lead to the loss of structural integrity. Most international standards call for the use of phosphate buffered saline (PBS) for such tests although there has been little evidence to date that the use of PBS is appropriate in terms of predicting the amount of fretting damage that would occur in vivo. In order to determine an appropriate test media for in vitro durability tests where fretting damage is being evaluated, we utilized an in vitro test that is relevant to cardiovascular devices both in terms of dimensions and materials (nitinol, cobalt-chromium, and stainless steel) to characterize fretting damage in PBS, deionized water (DIW), and heparinized porcine blood. Overall, tests conducted in blood were found to have increased levels of fretting damage over tests in DIW or PBS, although the magnitude of this difference was smaller than the variability for each test media. Tests conducted in DIW and PBS led to mostly similar amounts of fretting damage with the exception of one material combination where DIW had greatly reduced damage compared to PBS and blood. Differences in fretting damage among materials were also observed with nitinol having less fretting damage than stainless steel or cobalt-chromium. In general, evaluating fretting damage in PBS or DIW may be appropriate although caution should be used when selecting test media and interpreting results given some of the differences observed across different materials.
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Affiliation(s)
- J D Weaver
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA.
| | - L Ramirez
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - S Sivan
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - M Di Prima
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
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14
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Xu J, Yang J, Sohrabi S, Zhou Y, Liu Y. Finite Element Analysis of the Implantation Process of Overlapping Stents. J Med Device 2017; 11:0210101-210109. [PMID: 28690712 DOI: 10.1115/1.4036391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 03/15/2017] [Indexed: 11/08/2022] Open
Abstract
Overlapping stents are widely used in vascular stent surgeries. However, the rate of stent fractures (SF) and in-stent restenosis (ISR) after using overlapping stents is higher than that of single stent implantations. Published studies investigating the nature of overlapping stents rely primarily on medical images, which can only reveal the effect of the surgery without providing insights into how stent overlap influences the implantation process. In this paper, a finite element analysis of the overlapping stent implantation process was performed to study the interaction between overlapping stents. Four different cases, based on three typical stent overlap modes and two classical balloons, were investigated. The results showed that overlapping contact patterns among struts were edge-to-edge, edge-to-surface, and noncontact. These were mainly induced by the nonuniform deformation of the stent in the radial direction and stent tubular structures. Meanwhile, the results also revealed that the contact pressure was concentrated in the edge of overlapping struts. During the stent overlap process, the contact pattern was primarily edge-to-edge contact at the beginning and edge-to-surface contact as the contact pressure increased. The interactions between overlapping stents suggest that the failure of overlapping stents frequently occurs along stent edges, which agrees with the previous experimental research regarding the safety of overlapping stents. This paper also provides a fundamental understanding of the mechanical properties of overlapping stents.
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Affiliation(s)
- Jiang Xu
- School of Mechanics and Engineering, Southwest Jiaotong University, Chengdu 610031, China e-mail:
| | - Jie Yang
- School of Mechanics and Engineering, Southwest Jiaotong University, Chengdu 610031, China e-mail:
| | - Salman Sohrabi
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA 18015 e-mail:
| | - Yihua Zhou
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA 18015 e-mail:
| | - Yaling Liu
- Bioengineering Program, Lehigh University, Bethlehem, PA 18015
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15
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Bryant M, Neville A. Fretting corrosion of CoCr alloy: Effect of load and displacement on the degradation mechanisms. Proc Inst Mech Eng H 2017; 231:114-126. [PMID: 28233505 DOI: 10.1177/0954411916680237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fretting corrosion of medical devices is of growing concern, yet, the interactions between tribological and electrochemical parameters are not fully understood. Fretting corrosion of CoCr alloy was simulated, and the components of damage were monitored as a function of displacement and contact pressure. Free corrosion potential (Ecorr), intermittent linear polarisation resistance and cathodic potentiostatic methods were used to characterise the system. Interferometry was used to estimate material loss post rubbing. The fretting regime influenced the total material lost and the dominant degradation mechanism. At high contact pressures and low displacements, pure corrosion was dominant with wear and its synergies becoming more important as the contact pressure and displacement decreased and increased, respectively. In some cases, an antagonistic effect from the corrosion-enhanced wear contributor was observed suggesting that film formation and removal may be present. The relationship between slip mechanism and the contributors to tribocorrosion degradation is presented.
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Affiliation(s)
- Michael Bryant
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Anne Neville
- Institute of Functional Surfaces (iFS), School of Mechanical Engineering, University of Leeds, Leeds, UK
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16
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A biokinetic model for nickel released from cardiovascular devices. Regul Toxicol Pharmacol 2016; 80:1-8. [DOI: 10.1016/j.yrtph.2016.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/20/2022]
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17
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Siddiqui DA, Sivan S, Weaver JD, Di Prima M. Effect of wire fretting on the corrosion resistance of common medical alloys. J Biomed Mater Res B Appl Biomater 2016; 105:2487-2494. [PMID: 27660927 DOI: 10.1002/jbm.b.33788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/27/2016] [Accepted: 09/01/2016] [Indexed: 11/07/2022]
Abstract
Metallic medical devices such as intravascular stents can undergo fretting damage in vivo that might increase their susceptibility to pitting corrosion. As a result, the US Food and Drug Administration has recommended that such devices be evaluated for corrosion resistance after the devices have been fatigue tested in situations where significant micromotion can lead to fretting damage. Three common alloys that cardiovascular implants are made from [MP35N cobalt chromium (MP35N), electropolished nitinol (EP NiTi), and 316LVM stainless steel (316LVM)] were selected for this study. In order to evaluate the effect of wire fretting on the pitting corrosion susceptibility of these medical alloys, small and large fretting scar conditions of each alloy fretting against itself, and the other alloys in phosphate buffered saline (PBS) at 37°C were tested per ASTM F2129 and compared against as received or PBS immersed control specimens. Although the general trend observed was that fretting damage significantly lowered the rest potential (Er ) of these specimens (p < 0.01), fretting damage had no significant effect on the breakdown potential (Eb , p > 0.05) and hence did not affect the susceptibility to pitting corrosion. In summary, our results demonstrate that fretting damage in PBS alone is not sufficient to cause increased susceptibility to pitting corrosion in the three common alloys investigated. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2487-2494, 2017.
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Affiliation(s)
- Danyal A Siddiqui
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD.,Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Shiril Sivan
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD.,Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Jason D Weaver
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD
| | - Matthew Di Prima
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD
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18
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Impact of alterations in target vessel curvature on branch durability after endovascular repair of thoracoabdominal aortic aneurysms. J Vasc Surg 2016; 63:634-41. [DOI: 10.1016/j.jvs.2015.09.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/23/2015] [Indexed: 11/21/2022]
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19
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Xie D, Leng Y, Jing F, Huang N. A brief review of bio-tribology in cardiovascular devices. BIOSURFACE AND BIOTRIBOLOGY 2015. [DOI: 10.1016/j.bsbt.2015.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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20
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Fatigue of Metallic Stents: From Clinical Evidence to Computational Analysis. Ann Biomed Eng 2015; 44:287-301. [PMID: 26438450 DOI: 10.1007/s10439-015-1447-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
The great success of stents in treating cardiovascular disease is actually undermined by their long-term fatigue failure. The high variability of stent failure incidence suggests that it is due to several correlated aspects, such as loading conditions, material properties, component design, surgical procedure, and patient functional anatomy. Numerical and experimental non-clinical assessments are included in the recommendations and requirements of several regulatory bodies and they are thus exploited in the analysis of stent fatigue performance. Optimization-based simulation methodologies have been developed as well, to improve the fatigue endurance of novel designs. This paper presents a review on the fatigue issue in metallic stents, starting from a description of clinical evidence about stent fracture up to the analysis of computational approaches available from the literature. The reported discussion on both the experimental and numerical framework aims at providing a general insight into stent lifetime prediction as well as at understanding the factors which affect stent fatigue performance for the design of novel components.
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21
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Kapnisis KK, Pitsillides CM, Prokopi MS, Lapathitis G, Karaiskos C, Eleftheriou PC, Brott BC, Anderson PG, Lemons JE, Anayiotos AS. In vivomonitoring of the inflammatory response in a stented mouse aorta model. J Biomed Mater Res A 2015; 104:227-38. [DOI: 10.1002/jbm.a.35560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/07/2015] [Accepted: 09/03/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos K. Kapnisis
- Department of Mechanical Engineering and Materials Science and Engineering; Cyprus University of Technology; Limassol 3036 Cyprus
| | - Costas M. Pitsillides
- Department of Mechanical Engineering and Materials Science and Engineering; Cyprus University of Technology; Limassol 3036 Cyprus
| | | | - George Lapathitis
- Neurology Clinic E; Cyprus Institute of Neurology and Genetics; Nicosia 2370 Cyprus
| | - Christos Karaiskos
- Neurology Clinic E; Cyprus Institute of Neurology and Genetics; Nicosia 2370 Cyprus
| | - Polyvios C. Eleftheriou
- Department of Mechanical Engineering and Materials Science and Engineering; Cyprus University of Technology; Limassol 3036 Cyprus
| | - Brigitta C. Brott
- Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama 35294-0111
| | - Peter G. Anderson
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama 35294-0111
| | - Jack E. Lemons
- Department of Prosthodontics; University of Alabama at Birmingham; Birmingham Alabama 35294-0111
| | - Andreas S. Anayiotos
- Department of Mechanical Engineering and Materials Science and Engineering; Cyprus University of Technology; Limassol 3036 Cyprus
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22
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Kapnisis K, Constantinides G, Georgiou H, Cristea D, Gabor C, Munteanu D, Brott B, Anderson P, Lemons J, Anayiotos A. Multi-scale mechanical investigation of stainless steel and cobalt–chromium stents. J Mech Behav Biomed Mater 2014; 40:240-251. [DOI: 10.1016/j.jmbbm.2014.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/05/2014] [Accepted: 09/07/2014] [Indexed: 01/28/2023]
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23
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Affiliation(s)
- Ian B Menown
- Craigavon Cardiac Centre, Southern Trust, Northern Ireland, BT63 5QQ, UK.
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