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Jo WI, Youn JH, Kang SY, Byeon DH, Lee HI, Yang HM, Park JK. Performance evaluation of biodegradable polymer sirolimus and ascorbic acid eluting stent systems. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:77. [PMID: 36308635 PMCID: PMC9617831 DOI: 10.1007/s10856-022-06699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate the performance of biodegradable polymer sirolimus and ascorbic acid eluting stent systems with four commercially available drug-eluting stents (DES). We investigated the characterization of mechanical properties by dimension, foreshortening, recoil, radial force, crossing profile, folding shape, trackability, and dislodgement force. Additionally, we identify the safety and efficacy evaluation through registry experiments. Each foreshortening and recoil of D + Storm® DES is 1.3 and 3.70%, which has better performance than other products. A post-marketing clinical study to evaluate the performance and safety of D + Storm® DES is ongoing in real-world clinical settings. Two hundred one patients were enrolled in this study and have now completed follow-up for up to 1 month. No major adverse cardiovascular event (MACE) occurred in any subjects, confirming the safety of D + Storm® DES in the clinical setting. An additional approximately 100 subjects will be enrolled in the study and the final safety profile will be assessed in 300 patients. In conclusion, this study reported the objective evaluation of DES performance and compared the mechanical responses of four types of DES available in the market. There is little difference between the four cardiovascular stents in terms of mechanical features, and it can help choose the most suitable stent in a specific clinical situation if those features are understood. Graphical abstract.
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Affiliation(s)
| | | | | | | | | | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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Tang Y, Li M, Wang T, Dong X, Hu W, Sitti M. Wireless Miniature Magnetic Phase-Change Soft Actuators. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2204185. [PMID: 35975467 PMCID: PMC7613683 DOI: 10.1002/adma.202204185] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/09/2022] [Indexed: 05/28/2023]
Abstract
Wireless miniature soft actuators are promising for various potential high-impact applications in medical, robotic grippers, and artificial muscles. However, these miniature soft actuators are currently constrained by a small output force and low work capacity. To address such challenges, a miniature magnetic phase-change soft composite actuator is reported. This soft actuator exhibits an expanding deformation and enables up to a 70 N output force and 175.2 J g-1 work capacity under remote magnetic radio frequency heating, which are 106 -107 times that of traditional magnetic soft actuators. To demonstrate its capabilities, a wireless soft robotic device is first designed that can withstand 0.24 m s-1 fluid flows in an artery phantom. By integrating it with a thermally-responsive shape-memory polymer and bistable metamaterial sleeve, a wireless reversible bistable stent is designed toward future potential angioplasty applications. Moreover, it can additionally locomote inside and jump out of granular media. At last, the phase-change actuator can realize programmable bending deformations when a specifically designed magnetization profile is encoded, enhancing its shape-programming capability. Such a miniature soft actuator provides an approach to enhance the mechanical output and versatility of magnetic soft robots and devices, extending their medical and other potential applications.
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Affiliation(s)
- Yichao Tang
- School of Mechanical Engineering Tongji University Shanghai 201804, China; Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany
| | - Mingtong Li
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; Institute of Functional Nano & Soft Materials (FUNSOM) Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices Soochow University Suzhou, Jiangsu 215123, China
| | - Tianlu Wang
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; Institute for Biomedical Engineering ETH Zurich Zurich 8092, Switzerland
| | - Xiaoguang Dong
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; of Mechanical Engineering Vanderbilt University Nashville, TN 37215, USA; Vanderbilt Institute for Surgery and Engineering Vanderbilt University Nashville, TN 37215, USA
| | - Wenqi Hu
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany
| | - Metin Sitti
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; Institute for Biomedical Engineering ETH Zurich Zurich 8092, Switzerland; School of Medicine and College of Engineering Koç University Istanbul 34450, Turkey
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Determination of the Influence of Strut Connector on Stent Deployment. Appl Bionics Biomech 2022; 2022:7232809. [PMID: 35800119 PMCID: PMC9256422 DOI: 10.1155/2022/7232809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Coronary artery stents are tubular structures employed together with angioplasty. Stented angioplasty is a clinical procedure widely applied in the treatment of atherosclerosis to reopen the blocked artery. It is a simple and fast curing minimally invasive clinical procedure. However, it is essential to understand the expansion characteristics of a stent before implantation since the stent geometry, inflating pressure, etc., influence the performance of stents. Finite element analysis and in vitro experiments are simultaneously employed before clinical testing to predict the characteristics during deployment. In this paper, the expansion and deployment characteristics of Meril Osum
coronary stent and Envision
stent were investigated to study the influence of strut connector on the expansion behaviour of the stent by experimental and computational methods. The current study analyzes the real-time deployment characteristics such as rate of expansion, stress on stent, recoil, dog boning, and foreshortening. The stent expansion characteristics obtained from experiments and simulations were found matching and observed that strut connector has a significant effect on stent expansion. Further, the curved connector of small radius of curvature shows better performance with high patency rate.
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SHEN XIANG, LU KAIKAI, ZHU HONGFEI, JIANG JIABAO, TIAN RUN, LI HANQING. TORSIONAL BEHAVIOR OF STENTS: THE ROLE OF LINKER AND STENT TAPERING INVESTIGATED WITH NUMERICAL SIMULATION. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500385] [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 torsional performance is a major mechanical property of stent. A stent with good torsional performance is easy to deform along blood vessels without damaging the vascular wall to avoid in-stent restenosis (ISR). Therefore, this study aimed to study the effect of stent parameters on torsional performance. The effect of stent parameters on torsional performance was studied via finite element method (FEM). The twist metric (TM) and stress distribution of various stents were compared. The TM values of stents with I-, S-, M-, C-, and V-shaped linkers were 0.0190, 0.0191, 0.0184, 0.0141, and 0.0201[Formula: see text][Formula: see text], respectively. In addition, the TM value of the stent increased by 35.85 times when the number of linkers was increased from 2 to 8 and the stent was twisted at the same angular displacement in clockwise direction. The TM value of the stent with 1.13∘ tapering was 0.010 [Formula: see text], which was lower by 47.64% compared with that of cylindrical stent. Compared with the shape of the linker, the number of linkers had a more remarkable effect on torsional performance. Torsional performance was observably enhanced with the decrease in the number of linkers. Among the five stents with different linker shapes, the torsional performance of the stent with C-shaped linker was the best. Besides, the torsional performance of the tapered stent was better than that of the cylindrical stent. Moreover, the torsional performance increased by increasing the stent tapering. This work might provide insights into better stent design and clinical decisions.
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Affiliation(s)
- XIANG SHEN
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - KAIKAI LU
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - HONGFEI ZHU
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - JIABAO JIANG
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - RUN TIAN
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
| | - HANQING LI
- School of Mechanical Engineering, Jiangsu University, No. 301, Xuefu Road, Zhenjiang, China
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Mathieu PS, Fitzpatrick E, Di Luca M, Cahill PA, Lally C. Native extracellular matrix orientation determines multipotent vascular stem cell proliferation in response to cyclic uniaxial tensile strain and simulated stent indentation. Biochem Biophys Rep 2022; 29:101183. [PMID: 35005255 PMCID: PMC8715293 DOI: 10.1016/j.bbrep.2021.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide, with multipotent vascular stem cells (MVSC) implicated in contributing to diseased vessels. MVSC are mechanosensitive cells which align perpendicular to cyclic uniaxial tensile strain. Within the blood vessel wall, collagen fibers constrain cells so that they are forced to align circumferentially, in the primary direction of tensile strain. In these experiments, MVSC were seeded onto the medial layer of decellularized porcine carotid arteries, then exposed to 10%, 1 Hz cyclic tensile strain for 10 days with the collagen fiber direction either parallel or perpendicular to the direction of strain. Cells aligned with the direction of the collagen fibers regardless of the orientation to strain. Cells aligned with the direction of strain showed an increased number of proliferative Ki67 positive cells, while those strained perpendicular to the direction of cell alignment showed no change in cell proliferation. A bioreactor system was designed to simulate the indentation of a single, wire stent strut. After 10 days of cyclic loading to 10% strain, MVSC showed regions of densely packed, highly proliferative cells. Therefore, MVSC may play a significant role in in-stent restenosis, and this proliferative response could potentially be controlled by controlling MVSC orientation relative to applied strain. ECM constrained MVSC align with collagen fibers when cells are strained parallel to collagen. Straining MVSC aligned parallel to the direction of strain increased cell proliferation. Simulated stent strut indentation showed increased cell density surrounding the indented wire.
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Affiliation(s)
- P S Mathieu
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - E Fitzpatrick
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - M Di Luca
- School of Biotechnology, Vascular Biology & Therapeutics Group, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - P A Cahill
- School of Biotechnology, Vascular Biology & Therapeutics Group, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - C Lally
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
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Cho KH, Jeong MH, Park DS, Kim M, Kim J, Park JK, Han X, Hyun DY, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Preclinical Evaluation of a Novel Polymer-free Everolimus-eluting Stent in a Mid-term Porcine Coronary Restenosis Model. J Korean Med Sci 2021; 36:e259. [PMID: 34664799 PMCID: PMC8524232 DOI: 10.3346/jkms.2021.36.e259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Titanium dioxide films exhibit good biocompatibility and may be effective as drug-binding matrices for drug-eluting stents. We conducted a mid-term evaluation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film deposition (TIGEREVOLUTION®) in comparison with a commercial durable polymer everolimus-eluting stent (XIENCE Alpine®) in a porcine coronary restenosis model. METHODS Twenty-eight coronary arteries from 14 mini-pigs were randomly allocated to TIGEREVOLUTION® stent and XIENCE Alpine® stent groups. The stents were implanted in the coronary artery at a 1.1-1.2:1 stent-to-artery ratio. Eleven stented coronary arteries in each group were finally analyzed using coronary angiography, optical coherence tomography, and histopathologic evaluation 6 months after stenting. RESULTS Quantitative coronary analysis showed no significant differences in the pre-procedural, post-procedural, and 6-month lumen diameters between the groups. In the volumetric analysis of optical coherence tomography at 6 months, no significant differences were observed in stent volume, lumen volume, and percent area stenosis between the groups. There were no significant differences in injury score, inflammation score, or fibrin score between the groups, although the fibrin score was zero in the TIGEREVOLUTION® stent group (0 vs. 0.07 ± 0.11, P = 0.180). CONCLUSION Preclinical evaluation, including optical coherence tomographic findings 6 months after stenting, demonstrated that the TIGEREVOLUTION® stent exhibited efficacy and safety comparable with the XIENCE Alpine® stent, supporting the need for further clinical studies on the TIGEREVOLUTION® stent.
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Affiliation(s)
- Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea.
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Moonki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - JungHa Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | | | - Xiongyi Han
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
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Multi-Objective Optimization Design of Balloon-Expandable Coronary Stent. Cardiovasc Eng Technol 2019; 10:10-21. [PMID: 30673977 DOI: 10.1007/s13239-019-00401-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/11/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Recent studies suggested that suboptimal delivery and longitudinal stent deformation can result in in-stent restenosis. Therefore, the purpose of this paper was to study the effect of stent geometry on stent flexibility and longitudinal stiffness (LS) and optimize the two metrics simultaneously. Then, the reliable and accurate relationships between metrics and design variables were established. METHODS A multi-objective optimization method based on finite element analysis was proposed for the investigation and improvement of stent flexibility and LS. The relative influences of design variables on the two metrics were evaluated on the basis of the main effects. Three surrogate models, namely, the response surface model (RSM), radial basis function neural network (RBF), and Kriging were employed and compared. RESULTS The accuracies of the three models in fitting flexibility were nearly similar, although Kriging made more accurate prediction in LS. The link width played important roles in flexibility and LS. Although the flexibility of the optimal stent decreased by 13%, the LS increased by 48.3%. CONCLUSIONS The obtained results showed that the multi-objective optimization method is efficient in predicting an optimal stent design. The method presented in this paper can be useful in optimizing stent design and improving the comprehensive mechanical properties of stents.
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SHEN XIANG, DENG YONGQUAN, JI SONG, XIE ZHONGMIN, ZHU HONGFEI. FLEXIBILITY BEHAVIOR OF CORONARY STENTS: THE ROLE OF LINKER INVESTIGATED WITH NUMERICAL SIMULATION. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519417501123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flexibility is a vital property of stents and different stent structures lead to different flexibility behaviors. In this study, the finite element analysis was adopted and a virtual bending deformation was imposed to quantify the effects of linker pattern, linker number, bending direction and linker location on flexibility. Stent performance indicators, including stress distribution, deformation patterns and bending stiffness, were examined. Results indicate that higher levels of stresses are found on the linker struts, associated with much larger deformation. The linker number plays the most significant role in flexibility, and simply decreasing linker number could result in a sharp increase in flexibility and a decrease in stress. The linker pattern has great impact on stent flexibility, especially on the behavior of self-contact. Stents with different linker patterns could respond differently in the course of bending, and the stent with an offset peak-to-peak linker pattern is the best choice. It is also found that stent flexibility can be improved when fewer linkers lie in the compression area and the linker directions between two adjacent rows are consistent. The results obtained could provide useful information for the improvement of stent design and clinical choice.
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Affiliation(s)
- XIANG SHEN
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - YONG-QUAN DENG
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - SONG JI
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - ZHONG-MIN XIE
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - HONG-FEI ZHU
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
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Long-term preclinical evaluation of bioabsorbable polymer-coated drug-eluting stent in a porcine model. Macromol Res 2017. [DOI: 10.1007/s13233-017-5067-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sim DS, Jeong MH, Park DS, Kim JH, Lim KS, Bae IH, Zhehao P, Yang HY, Lee JH, Hyun DY, Hong YJ, Kim JH, Ahn Y, Kang JC. A novel polymer-free drug-eluting stent coated with everolimus using nitrogen-doped titanium dioxide film deposition in a porcine coronary restenosis model. Int J Cardiol 2016; 222:436-440. [DOI: 10.1016/j.ijcard.2016.07.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/13/2016] [Accepted: 07/30/2016] [Indexed: 12/16/2022]
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