An experimental investigation into the physical, thermal and mechanical degradation of a polymeric bioresorbable scaffold

Drug-eluting resorbable coronary scaffolds: a review of recent advances

INTRODUCTION

Device-related persistent adverse events with current DES-use have refocused the attention on a 'leave-nothing-behind' philosophy, in which it is hypothesized that treating coronary stenosis without permanently caging the vessel with a metallic implant would lead to superior clinical outcomes. One of these uncaging technologies is bioresorbable scaffolds (BRS).

AREAS COVERED

In this article, we describe the technical specifications and clinical data of currently available BRS devices.

EXPERT OPINION

Newer BRS devices have thinner struts and more biocompatible scaffold backbones (either polymer-based or metal-based), resulting in improved radial strength, faster resorption times, and more antithrombogenic properties (e.g. magnesium-based scaffolds). Results of BRS in the treatment of simple coronary artery disease demonstrate favorable clinical efficacy and safety outcome data. It is probable that over the next 5 years more fourth-generation devices with ever-increasing biocompatibility and safety profiles will be investigated and released commercially, resulting in a much more prominent role for BRS, especially in the treatment of simple coronary artery disease in younger patients.

Clinical safety and performance of the third-generation Fantom Encore sirolimus-eluting bioresorbable scaffold: Insights from a single-center study

BACKGROUND

The third-generation Fantom Encore bioresorbable scaffold (BRS), made with Tyrocore polymer, features full radiopacity, 95-115 μm strut thickness, and high expansion capacity. Currently, there is a lack of real-world data on this device.

METHODS AND RESULTS

We conducted a retrospective, single-center study involving 28 elective patients undergoing percutaneous coronary intervention (PCI) for 43 de novo coronary lesions with implantation of the Fantom Encore BRS. Mean age was 66.6 ± 8.5 years (male 82.1 %). Number of target lesions/patient was 1.54 ± 0.99, and 89.3 % of patients had single-vessel disease; most lesions were type C (58.1 %). Number of BRS/lesion was 1.02 ± 0.15, with a mean maximum scaffold diameter/lesion of 3.39 ± 0.41 mm and a mean scaffold length/lesion of 24.8 ± 8.17 mm. Plaque debulking was necessary in 32.6 % of lesions and IVUS was employed in 74.4 % of lesions. Acute technical success was achieved in 97.7 % of cases. Clinical follow-up was available in 96.4 % of cases. At a median of 18 months (range: 9-31 months) no patient experienced major adverse cardiovascular events (MACE); notably, no scaffold thrombosis was reported. Angiographic follow-up was performed in 50 % of patients at a median of 17 months (range: 6-35), with no documented cases of target lesion failure.

CONCLUSION

Fantom Encore BRS shows good potential in delivering safe and effective PCI outcomes in patients with stable coronary artery disease, including those with complex coronary lesions.

Shape-Setting of Self-Expanding Nickel-Titanium Laser-Cut and Wire-Braided Stents to Introduce a Helical Ridge

PURPOSE

Altered hemodynamics caused by the presence of an endovascular device may undermine the success of peripheral stenting procedures. Flow-enhanced stent designs are under investigation to recover physiological blood flow patterns in the treated artery and reduce long-term complications. However, flow-enhanced designs require the development of customised manufacturing processes that consider the complex behaviour of Nickel-Titanium (Ni-Ti). While the manufacturing routes of traditional self-expanding Ni-Ti stents are well-established, the process to introduce alternative stent designs is rarely reported in the literature, with much of this information (especially related to shape-setting step) being commercially sensitive and not reaching the public domain, as yet.

METHODS

A reliable manufacturing method was developed and improved to induce a helical ridge onto laser-cut and wire-braided Nickel-Titanium self-expanding stents. The process consisted of fastening the stent into a custom-built fixture that provided the helical shape, which was followed by a shape-setting in air furnace and rapid quenching in cold water. The parameters employed for the shape-setting in air furnace were thoroughly explored, and their effects assessed in terms of the mechanical performance of the device, material transformation temperatures and surface finishing.

RESULTS

Both stents were successfully imparted with a helical ridge and the optimal heat treatment parameters combination was found. The settings of 500 °C/30 min provided mechanical properties comparable with the original design, and transformation temperatures suitable for stenting applications (Af = 23.5 °C). Microscopy analysis confirmed that the manufacturing process did not alter the surface finishing. Deliverability testing showed the helical device could be loaded onto a catheter delivery system and deployed with full recovery of the expanded helical configuration.

CONCLUSION

This demonstrates the feasibility of an additional heat treatment regime to allow for helical shape-setting of laser-cut and wire-braided devices that may be applied to further designs.

An integrated mechanical degradation model to explore the mechanical response of a bioresorbable polymeric scaffold

Simulation of bioresorbable medical devices is hindered by the limitations of current material models. Useful simulations require that both the short- and long-term response must be considered; existing models are not physically-based and provide limited insight to guide performance improvements. This study presents an integrated degradation framework which couples a physically-based degradation model, which predicts changes in both crystallinity (Xc) and molecular weight (Mn), with the results of a micromechanical model, which predicts the effective properties of the semicrystalline polymer. This degradation framework is used to simulate the deployment of a bioresorbable PLLA (Poly (L-lactide) stent into a mock vessel and the subsequent mechanical response during degradation under different diffusion boundary conditions representing neointimal growth. A workflow is established in a commercial finite element code that couples both the immediate and long-term responses. Clinically relevant lumen loss is reported and used to compare different responses and the effect of neo-intimal tissue regrowth post-implantation on degradation and on the mechanical response is assessed. In addition, the effects of possible changes in Xc, which could occur during processing and stent deployment, are explored.

Mechanical Enhancement of the Gelatin/Poly(zinc acrylate) Hydrogel Stent in Bile

Hydrogels with the features of softness, biocompatibility, and modifiability have emerged as excellent materials in the biomedical field. However, the poor mechanical properties of the hydrogels limit their further practical applications. Double-network and metal ion coordination, such as Cu2+ and Zn2+, have achieved a significant reinforcement of the mechanical strength of the hydrogels. Herein, we report a Zn2+-enhanced polyelectrolyte double-network hydrogel stent with a mechanical enhancement phenomenon in bile. The gelatin/poly(zinc acrylate) (PZA) stent was constructed by dip-coating and UV irradiation. Although the mechanical strength of the as-prepared stent was quite weak, it was discovered to be mechanically enhanced by the natural bile. After exploring the effect of different components on the stents according to the components of bile, we found that Ca2+ in bile made a contribution to the mechanical enhancement of the stent. It is envisioned that this bile-enhanced gelatin/PZA stent provides a train of thought for the potential application of hydrogels in the biliary environment.

An experimental investigation of the mechanical performance of PLLA wire-braided stents

Much of our current understanding of the performance of self-expanding wire-braided stents is based on mechanical testing of Nitinol-based or polymeric non-bioresorbable (e.g. PET, PP etc.) devices. The small amount of data present for bioresorbable devices characterizes stents with big nominal diameters (D>6mm), with a distinct lack of data describing the mechanical performance of small-diameter wire-braided bioresorbable devices (D≤5mm). This study presents a systematic investigation of the mechanical performance of wire-braided bioresorbable Poly-L-Lactic Acid (PLLA) stents having different braiding angles (α=45° , α=30°, and α=20°), wire diameters (d=100μm, and d=150μm), wire count (n=24 and n=48), braiding patterns (1:1-1, 2:2-1 and 1:1-2) and stent diameters (D=5mm, D=4mm, and D=2.5mm). Mechanical characterisation was carried out by evaluating the radial, longitudinal and bending response of the devices. Our results showed that smaller braid angles, larger wire diameters, higher number of wires and smaller stent diameter led to an increase in the stent mechanical properties across each of the three mechanical tests performed. It was found that geometrical features of a polymeric braided stent could be adapted to achieve a similar performance to the one of a metallic device. In particular, substantial increases in stent mechanical properties were found for a low braiding angle and when the braiding pattern followed a one-over-one-under configuration with two wires in parallel (1:1-2). Finally, it was shown that a mathematical model proposed in literature for metal braided stents can provide reasonable predictions also of polymeric stent performance but just in circumstances where wire friction does not have a dominant role. This study presents a wide range of experimental data that can provide an important reference for further development of wire-braided bioresorbable devices.

An in silico trials platform for the evaluation of stent design effect in post-implantation outcomes

Bioresorbable Vascular Scaffolds (BVS), developed to allow drug deliver and mechanical support, followed by complete resorption, have revolutionized atherosclerosis treatment. InSilc is a Cloud platform for in silico clinical trials (ISCT) used in the design, development and evaluation pipeline of stents. The platform integrates beyond the state-of-the-art multi-disciplinary and multiscale models, which predict the scaffold's performance in the short/acute and medium/long term. In this study, a use case scenario of two Bioabsorbable Vascular Stents (BVSs) implanted in the same arterial anatomy is presented, allowing the whole InSilc in silico pipeline to be applied and predict how the different aspects of this intervention affect the success of stenting process.

Manufacturing, characterization, and degradation of a poly(lactic acid) warp-knitted spacer fabric scaffold as a candidate for tissue engineering applications

Three-dimensional bioabsorbable textiles represent a novel technology for the manufacturing of tissue engineering scaffolds. In the present study, 3D bioabsorbable poly(lactic acid) (PLA) spacer fabric scaffolds are fabricated by warp-knitting and their potential for tissue engineering is explored in vitro. Changes in physical properties and mechanical performance with different heat setting treatments are assessed. To characterize the microenvironment experienced by cells in the scaffolds, yarn properties are investigated prior to, and during, hydrolytic degradation. The differences in yarn morphology, thermal properties, infrared spectra, and mechanical properties are investigated and monitored during temperature accelerated in vitro degradation tests in phosphate buffered saline (PBS) solution at 58 °C and pH 7.4 for 55 days. Yarn and textile cytocompatibility are tested to assess the effect of materials employed, manufacturing conditions, post processing and sterilization on cell viability, together with the cytocompatibility of the textile degradation products. Results show that the heat setting process can be used to modify scaffold properties, such as thickness, porosity, pore size and stiffness within the range useful for tissue regeneration. Scaffold degradation rate in physiological conditions is estimated by comparing yarn degradation data with PLA degradation data from literature. This will potentially allow the prediction of scaffold mechanical stability in the long term and thus its suitability for the remodelling of different tissues. Mouse calvaria preosteoblast MC3T3-E1 cells attachment and proliferation are observed on the scaffold over 12 days of in vitro culture by 4',6-diamidino-2-phenylindole (DAPI) fluorescent staining and DNA quantification. The present work shows the potential of spacer fabric scaffolds as a versatile and scalable scaffold fabrication technique, having the ability to create a microenvironment with appropriate physical, mechanical, and degradation properties for 3D tissue engineering. The high control and tunability of spacer fabric properties makes it a promising candidate for the regeneration of different tissues in patient-specific applications.