Reduced myofibroblast differentiation on femtosecond laser treated 316LS stainless steel

Research progress of metal biomaterials with potential applications as cardiovascular stents and their surface treatment methods to improve biocompatibility

Facing the growing issue of cardiovascular diseases, metallic materials with higher tensile strength and fatigue resistance play an important role in treating diseases. This review lists the advantages and drawbacks of commonly used medical metallic materials for vascular stents. To avoid post-procedural threats such as thrombosis and in-stent restenosis, surface treatments, and coating methods have been used to further improve the biocompatibility of these materials. Surface treatments including laser, plasma treatment, polishing, oxidization, and fluorination can improve biocompatibility by modifying the surface charges, surface morphology, and surface properties of the material. Coating methods based on polymer coatings, carbon-based coatings, and drug-functional coatings can regulate the surface properties, and also serve as an effective barrier to the interaction of metallic biomaterial surfaces with biomolecules, which can be used to improve corrosion resistance and stability, as well as improve their biocompatibility. Biocompatibility serves as the most fundamental property of cardiovascular stents, and maintaining the excellent and stable biocompatibility of cardiovascular stent surfaces is a current research bottleneck. Few reviews have been published on metallic biomaterials as cardiovascular stents and their surface treatments. For the purpose of advancing research on cardiovascular stents, common metal biomaterials, surface treatment methods, and coating methods to improve biocompatibility and comprehensive properties of the materials are described in this review. Finally, we suggest future directions for stent development, including continuously improving the durability and stability of permanent stents, accelerating the development of biodegradable stents, and strengthening feedback to improve the safety and reliability of cardiovascular stents.

Preparation of 4D printed peripheral vascular stent and its degradation behavior under fluid shear stress after deployment

Shape memory stents are mild intervention devices for vascular diseases as compared to balloon-dilated ones; however, their degradation behavior under blood shear stress after deployment also deserves further attention. To understand the degradation behavior, we first prepared 4D printed poly(lactic acid) (PLA) stents via 3D printing technology and studied their failure behavior in a dynamic condition after self-expandable deployment. Mechanical property tests showed that the 4D printed stents had a compression force of 0.06-0.39 N mm^-1 and a recovery ratio of 85.3-93.4%, respectively, which was verified to be wall thickness dependent. The stents were then implanted in simulated blood vessels with minimal microstructural damage at 60 °C followed by 8-week degradation tests. The results showed the microstructure damage caused by deployment could accelerate the degradation of stents faster than fluid shear stress. Furthermore, we conducted microstructural analysis and numerical simulation on the stent by finite element analysis (FEA) to explain the relationship between stent injury, vascular injury, and stent deployment temperature. A physical model derived from micro-morphologies on the degradation mechanism of PLA was also proposed. These results may provide new insights for the examination of the degradation behavior of 4D printed stents and minimize medical risk.

Surface engineering and the application of laser-based processes to stents - A review of the latest development

Late in-stent thrombus and restenosis still represent two major challenges in stents’ design. Surface treatment of stent is attracting attention due to the increasing importance of stenting intervention for coronary artery diseases. Several surface engineering techniques have been utilised to improve the biological response in vivo on a wide range of biomedical devices. As a tailorable, precise, and ultra-fast process, laser surface engineering offers the potential to treat stent materials and fabricate various 3D textures, including grooves, pillars, nanowires, porous and freeform structures, while also modifying surface chemistry through nitridation, oxidation and coatings. Laser-based processes can reduce the biodegradable materials' degradation rate, offering many advantages to improve stents’ performance, such as increased endothelialisation rate, prohibition of SMC proliferation, reduced platelet adhesion and controlled corrosion and degradation. Nowadays, adequate research has been conducted on laser surface texturing and surface chemistry modification. Laser texturing on commercial stents has been also investigated and a promotion of performance of laser-textured stents has been proved.

In this critical review, the influence of surface texture and surface chemistry on stents performance is firstly reviewed to understand the surface characteristics of stents required to facilitate cellular response. This is followed by the explicit illustration of laser surface engineering of stents and/or related materials. Laser induced periodic surface structure (LIPSS) on stent materials is then explored, and finally the application of laser surface modification techniques on latest generation of stent devices is highlighted to provide future trends and research direction on laser surface engineering of stents.

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Compared conventional surface engineering with laser-based methods for biomedical devices.

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Explained the influence of texture geometry and surface chemistry on stents biological response.

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Reviewed state of the art in laser surface engineering of stents for improved biological response.

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Reviewed state of the art in laser surface engineering to control degradation of bioresorbable stents.

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Highlighted novel laser surface engineering designs for improved stents'performance.

Surface modification of stainless steel for biomedical applications: Revisiting a century-old material

Stainless steel (SS) has been widely used as a material for fabricating cardiovascular stents/valves, orthopedic prosthesis, and other devices and implants used in biomedicine due to its malleability and resistance to corrosion and fatigue. Despite its good mechanical properties, SS (as other metals) lacks biofunctionality. To be successfully used as a biomaterial, SS must be made resistant to the biological environment by increasing its anti-fouling properties, preventing biofilm formation (passive surface modification), and imparting functionality for eluting a specific drug or capturing selected cells (active surface modification); these features depend on the final application. Various physico-chemical techniques, including plasma vapor deposition, electrochemical treatment, and attachment of different linkers that add functional groups, are used to obtain SS with increased corrosion resistance, improved osseointegration capabilities, added hemocompatibility, and enhanced antibacterial properties. Existing literature on this topic is extensive and has not been covered in an integrated way in previous reviews. This review aims to fill this gap, by surveying the literature on SS surface modification methods, as well as modification routes tailored for specific biomedical applications.

STATEMENT OF SIGNIFICANCE

Stainless steel (SS) is widely used in many biomedical applications including bone implants and cardiovascular stents due to its good mechanical properties, biocompatibility and low price. Surface modification allows improving its characteristics without compromising its important bulk properties. SS with improved blood compatibility (blood contacting implants), enhanced ability to resist bacterial infection (long-term devices), better integration with a tissue (bone implants) are examples of successful SS surface modifications. Existing literature on this topic is extensive and has not been covered in an integrated way in previous reviews. This review paper aims to fill this gap, by surveying the literature on SS surface modification methods, as well as to provide guidance for selecting appropriate modification routes tailored for specific biomedical applications.

PEGylated stereocomplex polylactide coating of stent for upregulated biocompatibility and drug storage

Treatment of coronary heart disease by percutaneous coronary intervention (PCT) is usually limited to the high restenosis rate after implantation of bare-metal stent. To solve the problem, the coating of PEGylated stereocomplex poly(l-lactide) (PEG-cPLA) was utilized on the surface modification of stainless steel (SS) sheet. Specifically, the 3-aminopropyltriethoxysilane (APTES)-modified methoxy-poly(ethylene glycol)-poly(d-lactide) (mPEG-PDLA) was grafted onto the surface of hydroxylated SS sheet through coupling reaction, and poly(l-lactide)-poly(ethylene glycol)-poly(l-lactide) (PLLA-PEG-PLLA) was coated onto the surface through stereocomplex interaction between DLA and LLA units. The increase of contact angle firstly confirmed the changes of surface composition and hydrophilicity for the PEG-scPLA-modified SS sheet. The decreased fibrinogen adsorption, down-regulated platelet activation, and improved adhesion of human umbilical vein endothelial cells (HUVECs) indicated the excellent biocompatibility of PEG-scPLA-modified SS sheet. In addition, the drug loading capability of SS sheet was greatly upregulated through the formation of scPLA coating on the surface, where fluorescein (FLU) was chosen as a model molecule. Overall, the surface modification of SS sheet with PEG-scPLA could enhance the comprehensive performances, such as biocompatibility and drug loading capability, demonstrating that PEG-scPLA is a promising coating of coronary stent for PCT.

Surface micro- and nano-texturing of stainless steel by femtosecond laser for the control of cell migration

The precise control over the interaction between cells and the surface of materials plays a crucial role in optimizing the integration of implanted biomaterials. In this regard, material surface with controlled topographic features at the micro- and nano-scales has been proved to affect the overall cell behavior and therefore the final osseointegration of implants. Within this context, femtosecond (fs) laser micro/nano machining technology was used in this work to modify the surface structure of stainless steel aiming at controlling cell adhesion and migration. The experimental results show that cells tend to attach and preferentially align to the laser-induced nanopatterns oriented in a specific direction. Accordingly, the laser-based fabrication method here described constitutes a simple, clean, and scalable technique which allows a precise control of the surface nano-patterning process and, subsequently, enables the control of cell adhesion, migration, and polarization. Moreover, since our surface-patterning approach does not involve any chemical treatments and is performed in a single step process, it could in principle be applied to most metallic materials.

Application of chemical mechanical polishing process on titanium based implants

Modification of the implantable biomaterial surfaces is known to improve the biocompatibility of metallic implants. Particularly, treatments such as etching, sand-blasting or laser treatment are commonly studied to understand the impact of nano/micro roughness on cell attachment. Although, the currently utilized surface modification techniques are known to improve the amount of cell attachment, it is critical to control the level of attachment due to the fact that promotion of bioactivity is needed for prosthetic implants while the cardiac valves, which are also made of titanium, need demotion of cells attachment to be able to function. In this study, a new alternative is proposed to treat the implantable titanium surfaces by chemical mechanical polishing (CMP) technique. It is demonstrated that the application of CMP on the titanium surface helps in modifying the surface roughness of the implant in a controlled manner (inducing nano-scale smoothness or controlled nano/micro roughness). Simultaneously, it is observed that the application of CMP limits the bacteria growth by forming a protective thin surface oxide layer on titanium implants. It is further shown that there is an optimal level of surface roughness where the cell attachment reaches a maximum and the level of roughness is controllable through CMP.

Al2O3micro- and nanostructures affect vascular cell response

Novel nano- and microstructured surfaces are fabricated for cardiovascular implant application. A topography driven selective cell response of ECs over SMCs was demonstrated successfully.

The effect of CO2 laser beam welded AISI 316L austenitic stainless steel on the viability of fibroblast cells, in vitro

It has been determined by the literature research that there is no clinical study on the in vivo and in vitro interaction of the cells with the laser beam welded joints of AISI 316L biomaterial. It is used as a prosthesis and implant material and that has adequate mechanical properties and corrosion resistance characteristics. Therefore, the interaction of the CO2 laser beam welded samples and samples of the base metal of AISI 316L austenitic stainless steel with L929 fibroblast cells as an element of connective tissue under in vitro conditions has been studied. To study the effect of the base metal and the laser welded test specimens on the viability of the fibroblast cells that act as an element of connective tissues in the body, they were kept in DMEMF-12 medium for 7, 14, 28 days and 18 months. The viability study was experimentally studied using the MTT method for 7, 14, 28 days. In addition, the direct interaction of the fibroblast cells seeded on 6 different plates with the samples was examined with an inverted microscope. The MTT cell viability experiment was repeated on the cells that were in contact with the samples. The statistical relationship was analyzed using a Tukey test for the variance with the GraphPad statistics software. The data regarding metallic ion release were identified with the ICP-MS method after the laser welded and main material samples were kept in cell culture medium for 18 months. The cell viability of the laser welded sample has been detected to be higher than that of the base metal and the control based on 7th day data. However, the laser welded sample's viability of the fibroblast cells has diminished by time during the test period of 14 and 28 days and base metal shows better viability when compared to the laser welded samples. On the other hand, the base metal and the laser welded sample show better cell viability effect when compared to the control group. According to the ICP-MS results of the main material and laser welded samples which were kept in the cell culture medium for 18 months, it was determined that the Fe, Ni and Cr ion concentration released to the cell culture medium from the laser welded test sample was less than that of the main material.

In vitro study on the response of RAW264.7 and MS-5 fibroblast cells on laser-induced periodic surface structures for stainless steel alloys

Cell attachment and growth can be controlled by stent surface topography. In some cases fibroblast cells attach while monocytes failed on the structured surface of Pt:SS and 316LSS stents.