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Das A, Mehrotra S, Kumar A. Advances in Fabrication Technologies for the Development of Next-Generation Cardiovascular Stents. J Funct Biomater 2023; 14:544. [PMID: 37998113 PMCID: PMC10672426 DOI: 10.3390/jfb14110544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Coronary artery disease is the most prevalent cardiovascular disease, claiming millions of lives annually around the world. The current treatment includes surgically inserting a tubular construct, called a stent, inside arteries to restore blood flow. However, due to lack of patient-specific design, the commercial products cannot be used with different vessel anatomies. In this review, we have summarized the drawbacks in existing commercial metal stents which face problems of restenosis and inflammatory responses, owing to the development of neointimal hyperplasia. Further, we have highlighted the fabrication of stents using biodegradable polymers, which can circumvent most of the existing limitations. In this regard, we elaborated on the utilization of new fabrication methodologies based on additive manufacturing such as three-dimensional printing to design patient-specific stents. Finally, we have discussed the functionalization of these stent surfaces with suitable bioactive molecules which can prove to enhance their properties in preventing thrombosis and better healing of injured blood vessel lining.
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Affiliation(s)
- Ankita Das
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India;
| | - Shreya Mehrotra
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India;
- Centre for Environmental Sciences and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India;
- Centre for Environmental Sciences and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
- Centre of Excellence for Orthopaedics and Prosthetics, Gangwal School of Medical Sciences and Technology, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
- The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
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Raikar AS, Priya S, Bhilegaonkar SP, Somnache SN, Kalaskar DM. Surface Engineering of Bioactive Coatings for Improved Stent Hemocompatibility: A Comprehensive Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6940. [PMID: 37959540 PMCID: PMC10650382 DOI: 10.3390/ma16216940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Cardiovascular diseases continue to be a major contributor to illness and death on a global scale, and the implementation of stents has given rise to a revolutionary transformation in the field of interventional cardiology. The thrombotic and restenosis complications associated with stent implantation pose ongoing challenges. In recent years, bioactive coatings have emerged as a promising strategy to enhance stent hemocompatibility and reduce thrombogenicity. This review article provides an overview of the surface engineering techniques employed to improve the hemocompatibility of stents and reduce thrombus formation. It explores the mechanisms underlying thrombosis and discusses the factors influencing platelet activation and fibrin formation on stent surfaces. Various bioactive coatings, including anticoagulant agents, antiplatelet agents, and surface modifications, are discussed in detail, highlighting their potential in reducing thrombogenicity. This article also highlights a multitude of surface modification techniques which can be harnessed to enhance stent hemocompatibility including plasma treatment, physical vapor deposition (PVD), chemical vapor deposition (CVD), and electrodeposition. These techniques offer precise control over surface properties such as roughness, charge, and composition. The ultimate goal is to reduce platelet adhesion, tailor wettability, or facilitate the controlled release of bioactive agents. Evaluation methods for assessing hemocompatibility and thrombogenicity are also reviewed, ranging from in vitro assays to animal models. Recent advances in the field, such as nanotechnology-based coatings and bioactive coatings with controlled drug release systems, are highlighted. Surface engineering of bioactive coatings holds great promise for enhancing the long-term outcomes of stent implantation by enhancing hemocompatibility and reducing thrombogenicity. Future research directions and potential clinical applications are discussed, underscoring the need for continued advancements in this field.
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Affiliation(s)
- Amisha S. Raikar
- Department of Pharmaceutics, PES Rajaram and Tarabai Bandekar College of Pharmacy, Ponda 403401, India;
| | - Sushma Priya
- University College of London, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, Rowland Hill Street, London NW3 2PF, UK;
- Department of Biomedical Engineering, Regenerative Medicine and Stem Cell (RMS) Labs, Indian Institute of Technology, Hyderabad 502285, India
| | - Shilpa P. Bhilegaonkar
- Department of Pharmaceutics, PES Rajaram and Tarabai Bandekar College of Pharmacy, Ponda 403401, India;
| | - Sandesh N. Somnache
- Department of Pharmaceutics, SSPM’s VP College of Pharmacy, Madkhol 416510, India;
| | - Deepak M. Kalaskar
- University College of London, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, Rowland Hill Street, London NW3 2PF, UK;
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Muramatsu T, Kozuma K, Tanabe K, Morino Y, Ako J, Nakamura S, Yamaji K, Kohsaka S, Amano T, Kobayashi Y, Ikari Y, Kadota K, Nakamura M. Clinical expert consensus document on drug-coated balloon for coronary artery disease from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2023; 38:166-176. [PMID: 36847902 PMCID: PMC10020262 DOI: 10.1007/s12928-023-00921-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
Drug-coated balloon (DCB) technology was developed to deliver the antiproliferative drugs to the vessel wall without leaving any permanent prosthesis or durable polymers. The absence of foreign material can reduce the risk of very late stent failure, improve the ability to perform bypass-graft surgery, and reduce the need for long-term dual antiplatelet therapy, potentially reducing associated bleeding complications. The DCB technology, like the bioresorbable scaffolds, is expected to be a therapeutic approach that facilitates the "leave nothing behind" strategy. Although newer generation drug-eluting stents are the most common therapeutic strategy in modern percutaneous coronary interventions, the use of DCB is steadily increasing in Japan. Currently, the DCB is only indicated for treatment of in-stent restenosis or small vessel lesions (< 3.0 mm), but potential expansion for larger vessels (≥ 3.0 mm) may hasten its use in a wider range of lesions or patients with obstructive coronary artery disease. The task force of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) was convened to describe the expert consensus on DCBs. This document aims to summarize its concept, current clinical evidence, possible indications, technical considerations, and future perspectives.
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Affiliation(s)
- Takashi Muramatsu
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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Adhami M, Martin NK, Maguire C, Courtenay AJ, Donnelly RF, Domínguez-Robles J, Larrañeta E. Drug loaded implantable devices to treat cardiovascular disease. Expert Opin Drug Deliv 2023; 20:507-522. [PMID: 36924328 DOI: 10.1080/17425247.2023.2190580] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION It is widely acknowledged that cardiovascular diseases (CVDs) continue to be the leading cause of death globally. Furthermore, CVDs are the leading cause of diminished quality of life for patients, frequently as a result of their progressive deterioration. Medical implants that release drugs into the body are active implants that do more than just provide mechanical support; they also have a therapeutic role. Primarily, this is achieved through the controlled release of active pharmaceutical ingredients (API) at the implementation site. AREAS COVERED In this review, the authors discuss drug-eluting stents, drug-eluting vascular grafts, and drug-eluting cardiac patches with the aim of providing a broad overview of the three most common types of cardiac implant. EXPERT OPINION Drug eluting implants are an ideal alternative to traditional drug delivery because they allow for accurate drug release, local drug delivery to the target tissue, and minimise the adverse side effects associated with systemic administration. Despite the fact that there are still challenges that need to be addressed, the ever-evolving new technologies are making the fabrication of drug eluting implants a rewarding therapeutic endeavour with the possibility for even greater advances.
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Affiliation(s)
| | | | | | - Aaron J Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, UK
| | | | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, UK.,Department of Pharmacy and Pharmaceutical Technology, University of Seville, Seville, Spain
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Andreasen LN, Balleby IR, Barkholt TØ, Hebsgaard L, Terkelsen CJ, Holck EN, Jensen LO, Maeng M, Dijkstra J, Antonsen L, Kristensen SD, Tu S, Lassen JF, Christiansen EH, Holm NR. Early healing after treatment of coronary lesions by thin strut everolimus, or thicker strut biolimus eluting bioabsorbable polymer stents: The SORT-OUT VIII OCT study. Catheter Cardiovasc Interv 2023; 101:787-797. [PMID: 36740229 DOI: 10.1002/ccd.30579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
AIMS Early healing after drug-eluting stent (DES) implantation may reduce the risk of stent thrombosis. The aim of this study was to compare patterns of early healing after implantation of the thin strut everolimus-eluting Synergy DES (Boston Scientific) or the biolimus-eluting Biomatix Neoflex DES (Biosensors). METHODS AND RESULTS A total of 160 patients with the chronic or acute coronary syndrome were randomized 1:1 to Synergy or Biomatrix DES. Optical coherence tomography (OCT) was performed at baseline and at either 1- or 3-month follow-up. The primary endpoint was a coronary stent healing index (CSHI), a weighted index of strut coverage, neointimal hyperplasia, malapposition, and extrastent lumen. A total of 133 cases had OCT follow-up and 119 qualified for matched OCT analysis. The median CSHI score did neither differ significantly between the groups at 1 month: Synergy 8.0 (interquartile range [IQR]: 3.0; 14.0) versus Biomatrix 8.5 (IQR: 4.0; 15.0) (p = 0.47) nor at 3 months: Synergy 6.5 (IQR: 2.0; 13.0) versus Biomatrix 6.0 (IQR: 4.0; 11.0) (p = 0.83). Strut coverage was 84.6% (IQR: 72.0; 97.9) for Synergy versus 77.6% (IQR: 70.1; 90.3) for Biomatrix (p = 0.15) at 1 month and 90.3% (IQR 79.0; 98.8) (Synergy) versus 83.9% (IQR: 77.5; 92.6) (Biomatrix) (p = 0.068) at 3 months. Pooled 1- and 3-month coverage was 88.6% (IQR: 74.4; 98.4) for Synergy compared with 80.7% (IQR: 73.2; 90.8) for Biomatrix (p = 0.02). CONCLUSIONS The early healing response after treatment with the Synergy or Biomatrix DES did not differ significantly as determined by a healing index. The Synergy DES showed overall better early stent strut coverage.
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Affiliation(s)
- Lene N Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida R Balleby
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Hebsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jouke Dijkstra
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Shi L, Chen S, Zheng F, Mingming L, Yang H, Zhang B. Corrosion resistance evaluation of biodegradable magnesium alloy vascular stents optimized by mechanical adapted polymer coating strategy. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2022.130664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Delewi R, Winter RJ. The Biotronik Stent Family. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hasanpur E, Ghazavizadeh A, Sadeghi A, Haboussi M. In vitro corrosion study of PLA/Mg composites for cardiovascular stent applications. J Mech Behav Biomed Mater 2021; 124:104768. [PMID: 34607299 DOI: 10.1016/j.jmbbm.2021.104768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
The present investigation explores the impact of Mg volume fraction (VMg) as a controlling parameter of degradation rate in designing patient-specific cardiovascular stents made of PLA/Mg composites. For the purpose of this research, PLA/Mg composite plates containing 1, 3, 5, and 10% VMg are produced by melt blending and hot press molding. Characterization techniques such as scanning electron microscopy (SEM), differential scanning calorimetry (DSC) and X-ray diffraction (XRD) are employed to study the microstructure of PLA/Mg composites. For in vitro corrosion tests, stent prototypes and composite samples are immersed in baths of simulated body fluid (SBF). According to in vitro corrosion tests, increasing VMg increases the corrosion rate of the composites by accelerating the corrosion of the particles and the crystalline zones surrounding them. In addition, a 2% raise in the Mg content (from 1% to 3%), increases the overall Mg weight loss by more than 4 times. Composite samples and prototype stents containing more than 5% VMg exhibit cracking and brittleness after 7 days of immersion in SBF. In light of the compression tests results and also the failures and cracks observed during immersions, the upper limit of Mg content for PLA/Mg stent fabrication purposes is found to be below 3%.
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Affiliation(s)
- Ehsan Hasanpur
- School of Mechanical Engineering, College of Engineering, University of Tehran, Iran
| | - Akbar Ghazavizadeh
- Université Sorbonne Paris Nord, CNRS, UPR3407, LSPM, Sorbonne Paris Cité, avenue Jean-Baptiste Clément, 93430, Villetaneuse, France.
| | - Alireza Sadeghi
- School of Mechanical Engineering, College of Engineering, University of Tehran, Iran
| | - Mohamed Haboussi
- Université Sorbonne Paris Nord, CNRS, UPR3407, LSPM, Sorbonne Paris Cité, avenue Jean-Baptiste Clément, 93430, Villetaneuse, France
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Lee HI, Rhim WK, Kang EY, Choi B, Kim JH, Han DK. A Multilayer Functionalized Drug-Eluting Balloon for Treatment of Coronary Artery Disease. Pharmaceutics 2021; 13:614. [PMID: 33922861 PMCID: PMC8146216 DOI: 10.3390/pharmaceutics13050614] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
Drug-eluting balloons (DEBs) have been mostly exploited as an interventional remedy for treating atherosclerosis instead of cardiovascular stents. However, the therapeutic efficacy of DEB is limited due to their low drug delivery capability to the disease site. The aim of our study was to load drugs onto a balloon catheter with preventing drug loss during transition time and maximizing drug transfer from the surface of DEBs to the cardiovascular wall. For this, a multilayer-coated balloon catheter, composed of PVP/Drug-loaded liposome/PVP, was suggested. The hydrophilic property of 1st layer, PVP, helps to separate drug layer in hydrophilic blood vessel, and the 2nd layer with Everolimus (EVL)-loaded liposome facilitates drug encapsulation and sustained release to the targeted lesions during inflation time. Additionally, a 3rd layer with PVP can protect the inner layer during transition time for preventing drug loss. The deionized water containing 20% ethanol was utilized to hydrate EVL-loaded liposome for efficient coating processes. The coating materials showed negligible toxicity in the cells and did not induce pro-inflammatory cytokine in human coronary artery smooth muscle cells (HCASMCs), even in case of inflammation induction through LPS. The results of hemocompatibility for coating materials exhibited that protein adsorption and platelet adhesion somewhat decreased with multilayer-coated materials as compared to bare Nylon tubes. The ex vivo experiments to confirm the feasibility of further applications of multilayer-coated strategy as a DEB system demonstrated efficient drug transfer of approximately 65% in the presence of the 1st layer, to the tissue in 60 s after treatment. Taken together, a functional DEB platform with such a multilayer coating approach would be widely utilized for percutaneous coronary intervention (PCI).
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Affiliation(s)
| | | | | | | | | | - Dong-Keun Han
- Department of Biomedical Science, CHA University, 335 Pangyo-ro, Bundang-gu, Seongnam 13488, Gyenggi, Korea; (H.-I.L.); (W.-K.R.); (E.-Y.K.); (B.C.); (J.-H.K.)
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10
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Coronary Stents and Metal Allergy. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhang Z, Bai J, Huang Y, Wang L. Implementation of a clinical nursing pathway for percutaneous coronary intervention: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e22866. [PMID: 33120826 PMCID: PMC7581146 DOI: 10.1097/md.0000000000022866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Acute myocardial infarction is a very common disease in the emergency room. Emergency percutaneous coronary intervention (PCI) is the first choice to open infarct-related artery in time to regain the active blood flow of myocardial tissue. Clinical nursing pathway (CNP), namely clinical project, is an original nursing mode with good quality, outstanding efficiency, and low treatment spending, so it has attracted more and more attention. However, few studies have reported the implementation of a CNP in PCIs. The purpose of the protocol is to assess the impact of CNP on the clinical efficacy of transradial emergency PCI. METHODS This is a randomized controlled, single center trial which will be implemented from January 2021 to June 2021. Hundred samples diagnosed with acute myocardial infarction will be included in this study. It was authorized via the Ethics Committee of Changshan County People's Hospital (CCPH002348). Patients are assigned to the following groups: control group, given normal routine care; CNP group, treated with CNP plan. The time from door to balloon, hospitalization expenses, length of stay, postoperative complications, patients' satisfaction with treatment are compared and analyzed. All data are collected and analyzed by Social Sciences software version 21.0 (SPSS, Inc., Chicago, IL) program. RESULTS Differences of clinical outcomes between groups (). CONCLUSION This original evidence-based nursing model can be used as the foundation for further research. TRIAL REGISTRATION NUMBER researchregistry6030.
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Affiliation(s)
| | | | | | - Lingling Wang
- Department of Radiology, Changshan County People's Hospital, Zhejiang, China
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12
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Coronary Stents and Metal Allergy. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_81-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hydrophilic Stent Coating Inhibits Platelet Adhesion on Stent Surfaces: Initial Results In Vitro. Cardiovasc Intervent Radiol 2018; 41:1779-1785. [PMID: 30039502 PMCID: PMC6182755 DOI: 10.1007/s00270-018-2036-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/20/2018] [Indexed: 11/30/2022]
Abstract
Background Endovascular stents and flow diverter stents (FDS) have revolutionized the treatment of intradural aneurysms; however, the need for dual anti-platelet treatment (DAPT) limits their use and can cause additional issues. Therefore, there is a need to develop stent coatings that negate the need for DAPT. Methods Two different hydrophilic polymer coatings (HPC-I and HPC-II) were used to coat small nickel titanium plates to initially test the hydrophilic properties of these coatings when applied to nickel titanium. The plates were subsequently incubated with non-medicated whole blood from healthy volunteers for 10 min and stained with a CD61 immunofluorescent antibody that allows detection of adherent platelets. The coatings were applied to FDS wires and were again incubated with non-medicated whole blood from the same volunteers. Scanning electron microscopy was used to detect adherent platelets on the wire surface. Results The HPC-II coating (1.12 ± 0.4%) showed a significantly lower CD61 +ve cell count (p ≤ 0.001) compared to both uncoated NiTi plates (48.61 ± 7.3%) and those with the HPC-I coating (mean 40.19 ± 8.9%). Minimal adherent platelets were seen on the FDS nickel titanium wires coated with the HPC-II compared to uncoated FDS under electron microscopy. Conclusion There is a significant decrease in the number of adherent CD61 +ve platelets on nickel titanium surfaces coated with the HPC-II coating compared to uncoated surfaces. The coating can be successfully applied to the wires of flow diverters. The results of this study are promising with regard to the development of new anti-thrombogenic endovascular devices.
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Lee DH, de la Torre Hernandez JM. The Newest Generation of Drug-eluting Stents and Beyond. Eur Cardiol 2018; 13:54-59. [PMID: 30310472 DOI: 10.15420/ecr.2018:8:2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There has been a great evolution in the development of coronary stents in order to avoid both restenosis and thrombosis. Improvements have led to improvements in the design and conformation of metallic or resorbable structures, with an adequate balance between trackability and radial force, the development of antiproliferative drugs and the polymers to control release and allow adequate endothelialisation and an optimal duration of the antiplatelet regimen. Some suggestions are provided about the ideal characteristics of future coronary stents.
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Affiliation(s)
- Dae-Hyun Lee
- Cardiology Service, Interventional Cardiology Unit, University Hospital Marques de Valdecilla, Santander Spain
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17
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Bagheri M, Mohammadi M, Steele TW, Ramezani M. Nanomaterial coatings applied on stent surfaces. Nanomedicine (Lond) 2017; 11:1309-26. [PMID: 27111467 DOI: 10.2217/nnm-2015-0007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The advent of percutaneous coronary intervention and intravascular stents has revolutionized the field of interventional cardiology. Nonetheless, in-stent restenosis, inflammation and late-stent thrombosis are the major obstacles with currently available stents. In order to enhance the hemocompatibility of stents, advances in the field of nanotechnology allow novel designs of nanoparticles and biomaterials toward localized drug/gene carriers or stent scaffolds. The current review focuses on promising polymers used in the fabrication of newer generations of stents with a short synopsis on atherosclerosis and current commercialized stents, nanotechnology's impact on stent development and recent advancements in stent biomaterials is discussed in context.
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Affiliation(s)
- Mahsa Bagheri
- Shariati Hospital, Mashhad University of Medical Sciences, Mashhad, PO Box 935189-9983, Iran.,Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, PO Box 91775-1365, Iran
| | - Marzieh Mohammadi
- Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, PO Box 91775-1365, Iran
| | - Terry Wj Steele
- Division of Materials Technology, Materials & Science Engineering, Nanyang Technological University, Singapore
| | - Mohammad Ramezani
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, PO Box 91775-1365, Iran
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Kharlamov AN, Feinstein JA, Cramer JA, Boothroyd JA, Shishkina EV, Shur V. Plasmonic photothermal therapy of atherosclerosis with nanoparticles: long-term outcomes and safety in NANOM-FIM trial. Future Cardiol 2017. [PMID: 28644056 DOI: 10.2217/fca-2017-0009] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM The safety options in nanomedicine raise an issue of the optimal niche at the real-world clinical practice. METHODS This is an observational prospective cohort analysis of the 5-year clinical outcomes at the intention-to-treat population (nano vs ferro vs stenting; n = 180) of NANOM first-in-man trial (NCT01270139). RESULTS Mortality (6 vs 9 vs 10 cases of cardiac death in groups, p < 0.05), major adverse cardiovascular events (14.3 vs 20.9 vs 22.9%, p = 0.04), late thrombosis (2 vs 4 vs 6, p < 0.05) and target lesion revascularization (3.8 vs 4.8 vs 5.7%, p = 0.04) were significantly higher in ferro group and stent control at 60 months. CONCLUSION NANOM first-in-man trial demonstrates high safety with better rate of mortality, major adverse cardiovascular events and target lesion revascularization at the long-term follow-up if compare with stent XIENCE V.
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Affiliation(s)
- Alexander N Kharlamov
- Department of Interventional Cardiovascular Biomedicine, De Haar Research Foundation, Handelsplein 15, Rotterdam 3071PR, The Netherlands.,Departments of Science & Interventional Cardiology, Ural Institute of Cardiology, 8th March Street, 78A, Yekaterinburg 620144, Russia
| | - John A Feinstein
- Department of Interventional Cardiovascular Biomedicine, De Haar Research Foundation, Handelsplein 15, Rotterdam 3071PR, The Netherlands
| | - John A Cramer
- Department of Interventional Cardiovascular Biomedicine, De Haar Research Foundation, Handelsplein 15, Rotterdam 3071PR, The Netherlands
| | - John A Boothroyd
- Department of Interventional Cardiovascular Biomedicine, De Haar Research Foundation, Handelsplein 15, Rotterdam 3071PR, The Netherlands
| | - Ekaterina V Shishkina
- Ural Center of Modern Nanotechnologies, School of Natural Sciences & Mathematics, Ural Federal University, Yekaterinburg 620000, Russia
| | - Vladimir Shur
- Ural Center of Modern Nanotechnologies, School of Natural Sciences & Mathematics, Ural Federal University, Yekaterinburg 620000, Russia
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Kharlamov AN, Feinstein JA, Cramer JA, Boothroyd JA. WITHDRAWN: What exactly, regression of atherosclerosis or foreign body reaction with hyaline arteriosclerosis, drives transient scaffolding of coronary arteries? A pooled analysis of observational ABSORB studies with a serial multimodality imaging substudy of ABSORB cohort B1 trial. Int J Cardiol 2017:S0167-5273(16)32984-9. [PMID: 28629625 DOI: 10.1016/j.ijcard.2017.05.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/06/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023]
Affiliation(s)
| | - John A Feinstein
- De Haar Research Foundation, Rotterdam, The Netherlands, NYC, NY, USA
| | - John A Cramer
- De Haar Research Foundation, Rotterdam, The Netherlands, NYC, NY, USA
| | - John A Boothroyd
- De Haar Research Foundation, Rotterdam, The Netherlands, NYC, NY, USA
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20
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García-Granja PE, Amat-Santos IJ, Amado MG. Cardiopatía isquémica en inmigrantes de Europa del Este en España: experiencia unicéntrica. Med Clin (Barc) 2017; 148:476-478. [DOI: 10.1016/j.medcli.2017.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
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21
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Tijssen RY, Kraak RP, Lu H, Mifek JG, Carlyle WC, Donohoe DJ, De Winter RJ, Koch KT, Wykrzykowska JJ. Evaluation of the MiStent sustained sirolimus eluting biodegradable polymer coated stent for the treatment of coronary artery disease: does uniform sustained abluminal drug release result in earlier strut coverage and better safety profile? Expert Rev Med Devices 2017; 14:325-334. [DOI: 10.1080/17434440.2017.1318057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ruben Y.G. Tijssen
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin P. Kraak
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Huangling Lu
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Robbert J. De Winter
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karel T. Koch
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joanna J. Wykrzykowska
- AMC Heartcenter, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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22
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23
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Fabrication and Optimal Design of Biodegradable Polymeric Stents for Aneurysms Treatments. J Funct Biomater 2017; 8:jfb8010008. [PMID: 28264515 PMCID: PMC5371881 DOI: 10.3390/jfb8010008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/20/2016] [Accepted: 02/22/2017] [Indexed: 11/16/2022] Open
Abstract
An aneurysm is a balloon-like bulge in the wall of blood vessels, occurring in major arteries of the heart and brain. Biodegradable polymeric stent-assisted coiling is expected to be the ideal treatment of wide-neck complex aneurysms. This paper presents the development of methods to fabricate and optimally design biodegradable polymeric stents for aneurysms treatment. Firstly, a dispensing-based rapid prototyping (DBRP) system was developed to fabricate coil and zigzag structures of biodegradable polymeric stents. Then, compression testing was carried out to characterize the radial deformation of the stents fabricated with the coil or zigzag structure. The results illustrated the stent with a zigzag structure has a stronger radial stiffness than the one with a coil structure. On this basis, the stent with a zigzag structure was chosen for the development of a finite element model for simulating the real compression tests. The result showed the finite element model of biodegradable polymeric stents is acceptable within a range of radial deformation around 20%. Furthermore, the optimization of the zigzag structure was performed with ANSYS DesignXplorer, and the results indicated that the total deformation could be decreased by 35.7% by optimizing the structure parameters, which would represent a significant advance of the radial stiffness of biodegradable polymeric stents.
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24
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Stents: Biomechanics, Biomaterials, and Insights from Computational Modeling. Ann Biomed Eng 2017; 45:853-872. [PMID: 28160103 DOI: 10.1007/s10439-017-1806-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/28/2017] [Indexed: 01/02/2023]
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25
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Miswan Z, Lukman SK, Abd Majid FA, Loke MF, Saidin S, Hermawan H. Drug-eluting coating of ginsenoside Rg1 and Re incorporated poly(lactic- co -glycolic acid) on stainless steel 316L: Physicochemical and drug release analyses. Int J Pharm 2016; 515:460-466. [DOI: 10.1016/j.ijpharm.2016.10.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/05/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
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26
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Pavelková A, Kucharczyk P, Kuceková Z, Zedník J, Sedlařík V. Non-toxic polyester urethanes based on poly(lactic acid), poly(ethylene glycol) and lysine diisocyanate. J BIOACT COMPAT POL 2016. [DOI: 10.1177/0883911516672239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Poly(lactic acid)-based polymers are highly suitable for temporary biomedical applications, such as tissue support or drug delivery systems. Copolymers of different molecular weight based on poly(lactic acid) and poly(ethylene glycol) were prepared by polycondensation, catalysed by hydrochloric acid. A chain-extension reaction with l-lysine ethyl ester diisocyanate was employed afterwards to obtain polyester urethanes with enhanced properties. The GPC results showed that the molecular weights of the products reached about 50,000 g·mol−1 and the hydrolytic progress was rapid in the first 2 weeks; the drop in Mn equalled approximately 70%. Additionally, elemental analysis of the buffer medium proved that hydrolytic degradation was more rapid in the first stage. Tensile-strength testing revealed that ductility increased alongside reduced molecular weight of poly(ethylene glycol), also suggesting that polymer branching occurred due to side reactions of isocyanate. Based on the envisaged biomedical applications for these polymers, cytotoxicity tests were carried out and the cytotoxic effect was only moderate in the case of 100% polymer extract prepared according to ISO standard 10993-12. In their research, the authors focused on preparing metal-free, catalysed synthesis of polyester urethanes, which could prove useful to numerous biomedical applications.
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Affiliation(s)
- Alena Pavelková
- Centre of Polymer Systems, University Institute, Tomas Bata University in Zlín, Zlín, Czech Republic
| | - Pavel Kucharczyk
- Centre of Polymer Systems, University Institute, Tomas Bata University in Zlín, Zlín, Czech Republic
| | - Zdenka Kuceková
- Centre of Polymer Systems, University Institute, Tomas Bata University in Zlín, Zlín, Czech Republic
| | - Jiří Zedník
- Department of Physical and Macromolecular Chemistry, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Vladimír Sedlařík
- Centre of Polymer Systems, University Institute, Tomas Bata University in Zlín, Zlín, Czech Republic
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27
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The Biotronik Stent Family. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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28
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Bustamante J, Uribe P, Sosa M, Valencia R. [Proposed model of vascular trauma by mean of mechanical characterization of endovascular prostheses (stents) based on structural analysis by FEA]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:260-70. [PMID: 27238950 DOI: 10.1016/j.acmx.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 03/21/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The accumulated evidence on angioplasty techniques with stents has raised a controversy about the factors that influence the final vascular response. Indeed, several studies have shown there might be re-stenosis between 30% to 40% about 6 months after placement, relating to the design of the device as one of the main causes. This paper proposes the functional characterization of endovascular stents, analyzing its mechanical influence in the vascular system and predicting implicit traumatic factors in the vessel. METHODS A structural analysis was made for several computational models of endovascular stents using Finite Element Analysis in order to predict the mechanical behavior and the vascular trauma. In this way, the stents were considered as tubular devices composed of multiple links under radial pressure loads, reflecting stress concentration effects. RESULTS The analysis allowed to visualize how the geometry of stents is adjusted under several load conditions, in order to obtain the response of "solid-solid" interaction between the stent and the arterial wall. Thus, an analysis was performed in order to calculate stress, and a conceptual model that explains its mechanical impact on the stent-vessel interaction, was raised, to infer on the functionality from the design of the devices. CONCLUSIONS The proposed conceptual model allows to determine the relationship between the conditions of mechanical interaction of the stents, and warns about the effects in what would be the operation of the device on the vascular environment.
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Affiliation(s)
- John Bustamante
- Grupo de Dinámica Cardiovascular, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - Pablo Uribe
- Grupo de Dinámica Cardiovascular, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Mauricio Sosa
- Grupo de Dinámica Cardiovascular, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Raúl Valencia
- Grupo de Dinámica Cardiovascular, Universidad Pontificia Bolivariana, Medellín, Colombia
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29
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Ferreira-González I, Abu-Assi E, Arias MA, Gallego P, Sánchez-Recalde Á, Avanzas P, Bayes-Genis A, de Isla LP, Sanchis J. REVISTA ESPAÑOLA DE CARDIOLOGÍA. Estado actual y perspectiva futura. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Ferreira-González I, Abu-Assi E, Arias MA, Gallego P, Sánchez-Recalde Á, Avanzas P, Bayes-Genis A, de Isla LP, Sanchis J. Revista Española de Cardiología: Current Position and Future Directions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:327-336. [PMID: 26927537 DOI: 10.1016/j.rec.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | | | - Pablo Avanzas
- Former Associate Editor, Revista Española de Cardiología
| | | | | | - Juan Sanchis
- Former Editor-in-Chief, Revista Española de Cardiología
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31
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Kharlamov AN. Scaffold thrombosis: Exaggerated illusion, or when statistics rules. Int J Cardiol 2016; 209:206-9. [PMID: 26896624 DOI: 10.1016/j.ijcard.2016.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 12/24/2022]
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32
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Fu S, Wang L, Chen G, Yu D, Chen X. A tension-torsional fatigue testing apparatus for micro-scale components. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2016; 87:015111. [PMID: 26827357 DOI: 10.1063/1.4939856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mechanical characterization of micro-scale components under complex loading conditions is a great challenge. To meet such a challenge, a microtension-torsional fatigue testing apparatus is developed in this study that specializes in the evaluation of multiaxial fatigue behavior of thin stent wires. The actuation and measurement in two controlled directions are incorporated in the tensile and torsional load frames, respectively, and a thrust air bearing is applied for the coupling of the two frames. The axial deformation of specimens measured by a grating sensor built in the linear motor and by a non-contact displacement detect system is compared and corrected. The accuracy of the torque measurement is proved by torsion tests on thin wires of 316L stainless steel in nominal diameters of 100 μm. Multistep torsion test, multiaxial ratcheting test, and a fully strain controlled multiaxial cyclic test are performed on 100 μm and 200 μm-diameter 316L wires using this apparatus. The capability of the equipment in tension-torsional cyclic tests for micro-scale specimens is demonstrated by the experimental results.
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Affiliation(s)
- Sichao Fu
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China
| | - Lei Wang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China
| | - Gang Chen
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China
| | - Dunji Yu
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China
| | - Xu Chen
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People's Republic of China
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33
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Shen M, Xu YY, Sun Y, Han BS, Duan YR. Preparation of a Thermosensitive Gel Composed of a mPEG-PLGA-PLL-cRGD Nanodrug Delivery System for Pancreatic Tumor Therapy. ACS APPLIED MATERIALS & INTERFACES 2015; 7:20530-20537. [PMID: 26366977 DOI: 10.1021/acsami.5b06043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It is hypothesized that a gel (NP-Gel) composed of thermosensitive gel (Gel) and nanoparticles (NP) can prolong drug release time and overcome the drug resistance of pancreatic tumor cells. Paclitaxel (PTX)-loaded monomethoxy (polyethylene glycol)-poly(d,l-lactide-co-glycolide)-poly(l-lysine)-cyclic peptide (arginine-glycine-aspartic-glutamic-valine acid) (mPEG-PLGA-PLL-cRGD) NP and NP-Gel were designed, optimized, and characterized using dynamic light scattering, transmission electron microscopy, high efficiency liquid chromatography, and rheological analyses. Aspc-1/PTX cell was used in a cell uptake test. A 3D cell model was used to mimic PTX elimination in tissue. The in vivo sustained release and antitumor effects were studied in Aspc-1/PTX-loaded nude mice with xerographic and in situ tumors. The NP were 133.7 ± 28.3 nm with 85.03% entrapped efficiency, 1.612% loaded ratio, and suitable rheological properties. PTX was released as NP from NP-Gel, greatly prolonging the release and elimination times to afford long-term effects. NP-Gel enhanced the uptake of PTX by Aspc-1/PTX cells more than using NP or the Gel alone. Gel and NP-Gel remained solid in the tumor and stayed over 50 days versus the several days of NP in solution. NP-Gel exhibited a much higher inhibition rate in vivo than in solution, NP, or the Gel alone. In conclusion, the antitumor effects of NP-Gel might arise from synergic effects from NP and the Gel. NP primarily reversed drug resistance, while the Gel prolonged release time considerably in situ. This preparation proved effective with a very small PTX dose (250 μg/kg) and exhibited few toxic effects in normal tissue.
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Affiliation(s)
- Ming Shen
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai 200032, P. R. China
| | - Yuan-Yuan Xu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai 200032, P. R. China
| | - Ying Sun
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai 200032, P. R. China
| | - Bao-Shan Han
- Department of general Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University , Shanghai, 200092, P. R. China
| | - You-Rong Duan
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai 200032, P. R. China
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34
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Hu T, Yang J, Cui K, Rao Q, Yin T, Tan L, Zhang Y, Li Z, Wang G. Controlled Slow-Release Drug-Eluting Stents for the Prevention of Coronary Restenosis: Recent Progress and Future Prospects. ACS APPLIED MATERIALS & INTERFACES 2015; 7:11695-11712. [PMID: 26011753 DOI: 10.1021/acsami.5b01993] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drug-eluting stents (DES) have become more widely used by cardiologists than bare metal stents (BMS) because of their better ability to control restenosis. However, recognized negative events, particularly including delayed or incomplete endothelialization and late stent thrombosis, have caused concerns over the long-term safety of DES. Although stent-based drug delivery can facilitate a drug's release directly to the restenosis site, a burst of drug release can seriously affect the pharmacological action and is a major factor accounting for adverse effects. Therefore, the drug release rate has become an important criterion in evaluating DES. The factors affecting the drug release rate include the drug carrier, drug, coating methods, drug storage, elution direction, coating thickness, pore size in the coating, release conditions (release medium, pH value, temperature), and hemodynamics after the stent implantation. A better understanding of how these factors influence drug release is particularly important for the reasonable use of efficient control strategies for drug release. This review summarizes the factors influencing the drug release from DES and presents strategies for enhancing the control of the drug's release, including the stent design, the application of absorbable stents, the development of new polymers, and the application of nanocarriers and improvements in the coating technology. Therefore, this paper provides a reference for the preparation of novel controlled slow-release DES.
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Affiliation(s)
- Tingzhang Hu
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Jiali Yang
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Kun Cui
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Qiong Rao
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Tieying Yin
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Lili Tan
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Yuan Zhang
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Zhenggong Li
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Guixue Wang
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
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35
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Spitzer E, Windecker S. Paclitaxel-eluting stents in ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2014; 67:974-9. [PMID: 25444381 DOI: 10.1016/j.rec.2014.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ernest Spitzer
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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36
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Spitzer E, Windecker S. Stents liberadores de paclitaxel en el infarto agudo de miocardio con elevación del segmento ST. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Resultados clínicos a medio plazo de los stents de cobalto–cromo recubiertos de oxinitruro de titanio en pacientes con lesiones coronarias de novo: primer estudio humano de OPTIMAX. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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38
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Mid-term clinical outcome of titanium-nitride-oxide-coated cobalt-chromium stents in patients with de novo coronary lesions: OPTIMAX first-in-man study. ACTA ACUST UNITED AC 2014; 67:958-9. [PMID: 25241027 DOI: 10.1016/j.rec.2014.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
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39
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Recent advances in micro/nanoscale biomedical implants. J Control Release 2014; 189:25-45. [DOI: 10.1016/j.jconrel.2014.06.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 12/22/2022]
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40
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Ruiz-García J, Refoyo E, Cuesta-López E, Jiménez-Valero S, Portela A, Moreno R. Comparative results between metal stent and bioresorbable scaffold at two years postimplantation. ACTA ACUST UNITED AC 2014; 67:66-8. [PMID: 24774272 DOI: 10.1016/j.rec.2013.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Juan Ruiz-García
- Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Quirón, Pozuelo de Alarcón, Madrid, Spain.
| | - Elena Refoyo
- Sección de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Santiago Jiménez-Valero
- Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Quirón, Pozuelo de Alarcón, Madrid, Spain
| | - Angela Portela
- Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Raúl Moreno
- Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Quirón, Pozuelo de Alarcón, Madrid, Spain
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41
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1-year clinical outcomes of diabetic patients treated with everolimus-eluting bioresorbable vascular scaffolds: a pooled analysis of the ABSORB and the SPIRIT trials. JACC Cardiovasc Interv 2014; 7:482-93. [PMID: 24746650 DOI: 10.1016/j.jcin.2014.01.155] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/30/2013] [Accepted: 01/04/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate 1-year clinical outcomes of diabetic patients treated with the Absorb bioresorbable vascular scaffold (BVS). BACKGROUND Clinical outcomes of diabetic patients after BVS implantation have been unreported. METHODS This study included 101 patients in the ABSORB Cohort B trial and the first consecutive 450 patients with 1 year of follow-up in the ABSORB EXTEND trial. A total of 136 diabetic patients were compared with 415 nondiabetic patients. In addition, 882 diabetic patients treated with everolimus-eluting metal stents (EES) in pooled data from the SPIRIT trials (SPIRIT FIRST [Clinical Trial of the Abbott Vascular XIENCE V Everolimus Eluting Coronary Stent System], SPIRIT II [A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System], SPIRIT III [Clinical Trial of the XIENCE V Everolimus Eluting Coronary Stent System (EECSS)], SPIRIT IV Clinical Trial [Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System]) were used for the comparison by applying propensity score matching. The primary endpoint was a device-oriented composite endpoint (DoCE), including cardiac death, target vessel myocardial infarction, and target lesion revascularization at 1-year follow-up. RESULTS The cumulative incidence of DoCE did not differ between diabetic and nondiabetic patients treated with the BVS (3.7% vs. 5.1%, p = 0.64). Diabetic patients treated with the BVS had a similar incidence of the DoCE compared with diabetic patients treated with EES in the matched study group (3.9% for the BVS vs. 6.4% for EES, p = 0.38). There were no differences in the incidence of definite or probable scaffold/stent thrombosis (0.7% for both diabetic and nondiabetic patients with the BVS; 1.0% for diabetic patients with the BVS vs. 1.7% for diabetic patients with EES in the matched study group). CONCLUSIONS In the present analyses, diabetic patients treated with the BVS showed similar rates of DoCEs compared with nondiabetic patients treated with the BVS and diabetic patients treated with EES at 1-year follow-up. (ABSORB Clinical Investigation, Cohort B; NCT00856856; ABSORB EXTEND Clinical Investigation; NCT01023789; Clinical Trial of the Abbott Vascular XIENCE V Everolimus Eluting Coronary Stent System [SPIRIT FIRST]; NCT00180453; A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System [SPIRIT II]; NCT00180310; Clinical Trial of the XIENCE V Everolimus Eluting Coronary Stent System [EECSS] [SPIRIT III]; NCT00180479; Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System [SPIRIT IV Clinical Trial]; NCT00307047).
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Zhang YJ, Zhu LL, Bourantas CV, Iqbal J, Dong SJ, Campos CM, Li MH, Ye F, Tian NL, Garcia-Garcia HM, Serruys PW, Chen SL. Impact of everolimus versus other rapamycin derivative-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 16 randomized trials. J Cardiol 2014; 64:185-93. [PMID: 24560821 DOI: 10.1016/j.jjcc.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Everolimus-eluting stent (EES) are considered to have better clinical outcomes than other rapamycin derivative-eluting stents; however, the individual trials may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of EES against other rapamycin derivative-eluting stents. METHODS We searched Medline, the Cochrane Library, and other internet sources, without language or date restrictions for articles comparing clinical outcomes between EES and other rapamycin derivative-eluting stents. Safety endpoints were stent thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac events (MACE), target lesion revascularization (TLR), and target vessel revascularization (TVR). RESULTS We identified 16 randomized controlled trials with 23,481 patients and a weighted mean follow-up of 18 months. Compared with other rapamycin derivative-eluting stents, EES were associated with a significant reduction in definite ST [relative risk (RR): 0.45; 95% confidence interval (CI): 0.30-0.69; p<0.001] and TLR (RR: 0.87; 95% CI: 0.77-0.99; p=0.03). EES also showed a non-significant trend toward reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p=0.06). However, both groups had similar rates of mortality (RR: 0.95; 95% CI: 0.82-1.09; p=0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p=0.43), and MACE (RR: 0.94; 95% CI: 0.87-1.02; p=0.35). The stratified analysis of the included trials showed that EES was associated with significantly lower rate of definite ST compared with either zotarolimus-eluting stent (p=0.012) or sirolimus-eluting stent (p=0.006), but not biolimus-eluting stent (p=0.16). In longer follow-up (>1 year) stratification, EES was associated with a significant reduction in risk of definite ST (p<0.001). CONCLUSIONS EES is associated with a significant reduction in definite ST and TLR for treating patients with coronary artery disease, compared with a pooled group of other rapamycin derivative-eluting stents. Biolimus-eluting stent had similar safety and efficacy for treating patients with coronary artery disease, compared with the EES.
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Affiliation(s)
- Yao-Jun Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lin-Lin Zhu
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Javaid Iqbal
- Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiovascular Science, University of Sheffield, United Kingdom
| | | | - Carlos M Campos
- Erasmus Medical Center, Rotterdam, The Netherlands; Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ming-Hui Li
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nai-Liang Tian
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | | | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Ruiz-García J, Refoyo E, Cuesta-López E, Jiménez-Valero S, Portela Á, Moreno R. Resultados comparativos entre el stent metálico y el stent bioabsorbible a los dos años de su implante. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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