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Sim DS, Cho KH, Hyun DY, Park DS, Park JK, Byeon DH, Jo WI, Kim SW, Ahn JH, Lee SH, Kim MC, Hong YJ, Kim JH, Ahn Y, Jeong MH. First-in-Human Evaluation of a Polymer-Free Everolimus-Eluting Stent Using a Titanium Dioxide Film. J Korean Med Sci 2024; 39:e234. [PMID: 39189711 PMCID: PMC11347186 DOI: 10.3346/jkms.2024.39.e234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/27/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND In patients with coronary artery disease treated with permanent polymer-coated drug-eluting stents (DES), the persistent presence of a less biocompatible polymer might delay arterial healing. Thin strut polymer-free DES have the potential to improve clinical outcomes and reduce the duration of dual antiplatelet therapy (DAPT). The purpose of this first-in-human study was to assess the safety and effectiveness of a novel polymer-free DES in patients with de novo coronary lesions. The TIGERevolutioN® stent (CG Bio Co., Ltd., Seoul, Korea) consists of a cobalt chromium platform with a strut thickness of 70 μm and a surface treated with titanium dioxide onto which everolimus-eluting stent (EES) is applied abluminally (6 µg/mm of stent length) without utilization of a polymer. METHODS A total of 20 patients were enrolled, with de novo coronary lesions (stable or unstable angina) and > 50% diameter stenosis in a vessel 2.25 to 4.00 mm in diameter and ≤ 40 mm in length for angiographic, optical coherence tomography (OCT), and clinical assessment at 8 months. All patients received DAPT after stent implantation. The primary endpoint was angiographic in-stent late lumen loss (LLL) at 8 months. RESULTS Twenty patients with 20 lesions were treated with TIGERevolutioN®. At 8 months, in-stent LLL was 0.7 ± 0.4 mm. On OCT, percent area stenosis was 29.2 ± 9.4% and stent strut coverage was complete in all lesions. No adverse cardiovascular event occurred at 8 months. CONCLUSION The new polymer-free EES was safe and effective with low LLL and excellent strut coverage at 8 months of follow-up. TRIAL REGISTRATION Trial Registration: Clinical Research Information Service Identifier: KCT0005699.
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Affiliation(s)
- Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Institute, Jangseong, Korea
| | - Kyung Hoon Cho
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Institute, Jangseong, Korea
| | | | | | | | - Sang-Wook Kim
- Heart and Brain Hospital, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joon Ho Ahn
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hun Lee
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Institute, Jangseong, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Institute, Jangseong, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Institute, Jangseong, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Institute, Jangseong, Korea
- Gwangju Veterans Hospital, Gwangju, Korea.
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Hyun DY, Han X, Park DS, Kim M, Park JK, Cho KH, Sim DS, Hong YJ, Ahn Y, Jeong MH. A novel polymer-free everolimus-eluting stent with a nitrogen-doped titanium dioxide film inhibits restenosis and thrombosis in a swine coronary model. Cardiol J 2023; 30:VM/OJS/J/86222. [PMID: 36790043 PMCID: PMC10713211 DOI: 10.5603/cj.a2023.0006] [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: 10/22/2021] [Revised: 10/20/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Short-term outcomes regarding the safety and efficacy of a polymer-free everolimus-eluting stent (EES) with a nitrogen-doped titanium dioxide (N-TiO₂) film in a swine coronary model have been reported. However, the long-term results of the use of this type of stent have not yet been evaluated or compared to those of other polymer-free coronary stents. Therefore, this study aimed to determine the mid- to long-term safety and efficacy of a polymer-free EES with an N-TiO₂ film in a swine coronary model. METHODS Polymer-free EES with N-TiO₂ films (n = 30) and polymer-free sirolimus-eluting stents (SES; n = 30) were implanted in 30 pigs. Quantitative coronary analysis and optical coherence tomography were conducted immediately and at 1 (quantitative coronary analysis only), 3, and 6 months after stenting. Histopathologic examinations were performed at 1, 3, and 6 months after stenting. RESULTS The polymer-free EES group had a lower percentage of neointimal growth than the polymer-free SES group at 3 months (22.5% ± 11.4% vs. 32.1% ± 12.3%; p < 0.001). The polymer-free EES group had a lower fibrin score than the polymer-free SES group at 1 month (1.9 ± 0.45 vs. 2.5 ± 0.54; p = 0.001). The re-endothelialization rates were similar between groups. The polymer-free EES group had a lower percentage of the area of stenosis than the polymer-free SES group throughout the follow-up period. CONCLUSIONS The novel polymer-free EES with an N-TiO₂ film has superior safety and efficacy than the polymer-free SES at the 6-month follow-up in a swine model.
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Affiliation(s)
- Dae Young Hyun
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Xiongyi Han
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Munki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Kyu Park
- Cell and Growth Factor Biotechnology, Ltd., Seoul, Republic of Korea
| | - Kyung Hoon Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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Oh S, Jeong MH, Park DS, Kim M, Kim JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Successful implantation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film with good patency on follow-up angiography: A case report. Medicine (Baltimore) 2022; 101:e29666. [PMID: 35866823 PMCID: PMC9302256 DOI: 10.1097/md.0000000000029666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Despite technological advances in interventional cardiology during the last decades, many concerns remain regarding the narrowing and occlusion of the in-stent area. Particularly, polymer materials pose several problems, including chronic arterial inflammation, impaired arterial healing, and stent thrombosis. To avoid these complications, we invented the TIGEREVOLUTION stent with a cobalt-chromium alloy-based stent platform deposited with N-TiO2 film, which has demonstrated good biocompatibility. As this stent is not coated with polymer, it is expected to have decreased risk of stent thrombosis. PATIENT CONCERNS A 62-year-old Korean man visited our department because of angina. We commenced coronary angiography (CAG). DIAGNOSIS CAG revealed critical stenosis in the mid-portion of the right coronary artery, with a minimum lumen area of 1.08mm2 on optical coherence tomography (OCT). INTERVENTION Percutaneous coronary intervention was performed with implantation of a novel 3.5 × 26-mm polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film (TIGEREVOLUTION® stent). Post-percutaneous coronary intervention OCT showed good stent expansion and apposition, and the patient was discharged successfully and uneventfully. OUTCOMES Eight months later, follow-up coronary angiography demonstrated good stent patency with no definitive evidence of in-stent restenosis, with thin stent strut coverage demonstrated on OCT. LESSONS We report the first case of TIGEREVOLUTION stent implantation with follow-up OCT at 8 months.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
- *Correspondence: Myung Ho Jeong, Department of Cardiology, Chonnam National University Hospital; Department of Cardiology, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju 61469, Korea (e-mail: )
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Munki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Ha Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
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Shim JW, Kim SS, Kim HK, Bae IH, Park DS, Park JK, Kim JU, Kim HB, Lee MY, Kim JS, Kim JH, Koo BS, Jeong KJ, Kim SU, Kim MC, Sim DS, Hong YJ, Ahn Y, Lim KS, Jeong MH. Effect of Novel Polymer-Free Nitrogen-Doped Titanium Dioxide Film-Coated Coronary Stent Loaded With Mycophenolic Acid. Front Bioeng Biotechnol 2021; 9:650408. [PMID: 34778222 PMCID: PMC8585759 DOI: 10.3389/fbioe.2021.650408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 10/15/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Titanium is commonly used in blood-exposed medical devices because it has superior blood compatibility. Mycophenolic acid inhibits the proliferation of vascular smooth muscle cells. This study examined the effect of a non-polymer TiO2 thin film–coated stent with mycophenolic acid in a porcine coronary overstretch restenosis model. Methods: Thirty coronary arteries in 15 pigs were randomized into three groups in which the coronary arteries were treated with a TiO2 film–coated stent with mycophenolic acid (NTM, n = 10), everolimus-eluting stent with biodegradable polymer (EES, n = 10), or TiO2 film–coated stent (NT, n = 10). A histopathologic analysis was performed 28 days after the stenting. Results: There were no significant intergroup differences in injury score, internal elastic lamina area, or inflammation score. Percent area stenosis was significantly smaller in the NTM and EES groups than in the NT group (36.1 ± 13.63% vs. 31.6 ± 7.74% vs. 45.5 ± 18.96%, respectively, p = 0.0003). Fibrin score was greater in the EES group than in the NTM and NT groups [2.0 (range, 2.0–2.0) vs. 1.0 (range, 1.0–1.75) vs. 1.0 (range, 1.0–1.0), respectively, p < 0.0001]. The in-stent occlusion rate measured by micro-computed tomography demonstrated similar percent area stenosis rates on histology analysis (36.1 ± 15.10% in NTM vs. 31.6 ± 8.89% in EES vs. 45.5 ± 17.26% in NT, p < 0.05). Conclusion: The NTM more effectively reduced neointima proliferation than the NT. Moreover, the inhibitory effect of NTM on smooth muscle cell proliferation was not inferior to that of the polymer-based EES with lower fibrin deposition in this porcine coronary restenosis model.
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Affiliation(s)
- Jae Won Shim
- Korea Cardiovascular Stent Research Institute, Jangsung, South Korea.,Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Sung Soo Kim
- Division of Cardiology, Chosun University Hospital, Gwangju, South Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Chosun University Hospital, Gwangju, South Korea
| | - In Ho Bae
- Korea Cardiovascular Stent Research Institute, Jangsung, South Korea.,Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Dae Sung Park
- Korea Cardiovascular Stent Research Institute, Jangsung, South Korea.,Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea.,Research Institute of Medical Sciences, Chonnam National University, Gwangju, South Korea
| | | | - Jae Un Kim
- Korea Cardiovascular Stent Research Institute, Jangsung, South Korea.,Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Han Byul Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Min Young Lee
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Joong Sun Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Jung Ha Kim
- Korea Cardiovascular Stent Research Institute, Jangsung, South Korea.,Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Bon-Sang Koo
- Futuristic Animal Resource and Research Center, National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, South Korea
| | - Kang-Jin Jeong
- Futuristic Animal Resource and Research Center, National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, South Korea
| | - Sun-Uk Kim
- Futuristic Animal Resource and Research Center, National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, South Korea
| | - Min Chul Kim
- Futuristic Animal Resource and Research Center, National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, South Korea
| | - Doo Sun Sim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Young Joon Hong
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Youngkeun Ahn
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
| | - Kyung Seob Lim
- Futuristic Animal Resource and Research Center, National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Chungbuk, South Korea
| | - Myung Ho Jeong
- Korea Cardiovascular Stent Research Institute, Jangsung, South Korea.,Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, South Korea
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Cho KH, Jeong MH, Park DS, Kim M, Kim J, Park JK, Han X, Hyun DY, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Preclinical Evaluation of a Novel Polymer-free Everolimus-eluting Stent in a Mid-term Porcine Coronary Restenosis Model. J Korean Med Sci 2021; 36:e259. [PMID: 34664799 PMCID: PMC8524232 DOI: 10.3346/jkms.2021.36.e259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Titanium dioxide films exhibit good biocompatibility and may be effective as drug-binding matrices for drug-eluting stents. We conducted a mid-term evaluation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film deposition (TIGEREVOLUTION®) in comparison with a commercial durable polymer everolimus-eluting stent (XIENCE Alpine®) in a porcine coronary restenosis model. METHODS Twenty-eight coronary arteries from 14 mini-pigs were randomly allocated to TIGEREVOLUTION® stent and XIENCE Alpine® stent groups. The stents were implanted in the coronary artery at a 1.1-1.2:1 stent-to-artery ratio. Eleven stented coronary arteries in each group were finally analyzed using coronary angiography, optical coherence tomography, and histopathologic evaluation 6 months after stenting. RESULTS Quantitative coronary analysis showed no significant differences in the pre-procedural, post-procedural, and 6-month lumen diameters between the groups. In the volumetric analysis of optical coherence tomography at 6 months, no significant differences were observed in stent volume, lumen volume, and percent area stenosis between the groups. There were no significant differences in injury score, inflammation score, or fibrin score between the groups, although the fibrin score was zero in the TIGEREVOLUTION® stent group (0 vs. 0.07 ± 0.11, P = 0.180). CONCLUSION Preclinical evaluation, including optical coherence tomographic findings 6 months after stenting, demonstrated that the TIGEREVOLUTION® stent exhibited efficacy and safety comparable with the XIENCE Alpine® stent, supporting the need for further clinical studies on the TIGEREVOLUTION® stent.
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Affiliation(s)
- Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea.
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Moonki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - JungHa Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | | | - Xiongyi Han
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
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Park DS, Bae IH, Jeong MH, Lim KS, Sim DS, Hong YJ, Lee SY, Jang EJ, Shim JW, Park JK, Lim HC, Kim HB. In vitro and in vivo evaluation of a novel polymer-free everolimus-eluting stent by nitrogen-doped titanium dioxide film deposition. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 91:615-623. [PMID: 30033294 DOI: 10.1016/j.msec.2018.05.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
Inflammation and thrombosis are linked to the use of polymer-based drug-eluting stents (DES). The aim of this study was to develop a polymer-free everolimus (EVL)-eluting stent using nitrogen-doped titanium dioxide (N-TiO2) and verify its efficacy by in vitro and in vivo assessment in a porcine coronary model. Various analytical approaches such as scanning electron microscopy and atomic force microscopy, electron spectroscopy, Fourier transform infrared spectrometry and contact angle measurement were employed for the characterization. As a part of biocompatibility assessment, platelet adhesion and smooth muscle cell (SMC) proliferation were examined. Bare metal stent (BMS), N-TiO2 stent, everolimus-eluting N-TiO2 (N-TiO2-EVL) stent, and commercialized EVL-eluting stent (EES) were randomly placed in forty coronary arteries in twenty pigs. After four weeks of implantation, the stents were subjected to histological and quantitative analysis. The N-TiO2 film used in this study was well coated without any cracks or peeling. Surface hydrophilicity (88.8% of angle decrement) could be associated with the decrease in surface roughness post N-TiO2 deposition (37.0%). The platelet adhesion on the N-TiO2 surfaces was less than that on the BMS surface. The proliferation of SMC was suppressed in the N-TiO2-EVL group (30.2%) but not in the BMS group. In the animal study, the percent area restenosis was significantly decreased in the N-TiO2-EVL group compared to that in the BMS group. The results (BMS; 47.0 ± 11.00%, N-TiO2-EVL; 31.7 ± 10.50%, and EES; 29.1 ± 11.21%, n = 10, p < 0.05) were almost at par with those of the commercialized EVL-eluting stent. The introduction of N-TiO2 deposition during fabrication of polymer-free DES may be an efficient accessorial process for preventing in-stent restenosis and thrombosis.
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Affiliation(s)
- Dae Sung Park
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea; Research Institute of Medical Sciences, Chonnam National University, Republic of Korea
| | - In-Ho Bae
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Myung Ho Jeong
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea; Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea.
| | - Kyung Seob Lim
- Futuristic Animal Resource and Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang 28116, Chungbuk, Republic of Korea
| | - Doo Sun Sim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - So-Youn Lee
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Eun Jae Jang
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Jae-Won Shim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Jun-Kyu Park
- Department of Polymer Science and Engineering, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Han Chul Lim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Han Byul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
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Sim DS, Jeong MH. Development of Novel Drug-Eluting Stents for Acute Myocardial Infarction. Chonnam Med J 2017; 53:187-195. [PMID: 29026706 PMCID: PMC5636757 DOI: 10.4068/cmj.2017.53.3.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/02/2017] [Accepted: 06/11/2017] [Indexed: 11/06/2022] Open
Abstract
Delayed arterial healing at culprit sites after drug-eluting stent (DES) placement for acute myocardial infarction (AMI) is associated with increased risk of late stent thrombosis. The Korea Acute Myocardial Infarction Registry was established in commemoration of the 50th anniversary of Korea Circulation Society. Between November 2005 and December 2016, more than 62,000 patients were registered from 50 primary percutaneous coronary intervention (PCI) centers in Korea. DES in AMI may be safe and effective, however, there is concern about increased stent thrombosis after DES implantation in AMI patients, requiring longer-term dual anti-platelet therapy to reduce the risk of late stent thrombosis. Device innovation is needed to overcome issues such as stent thrombosis and restenosis by using new coating materials with biocompatible polymers, different coating methods using non-polymer techniques, bioabsorbable stents and pro-healing stents. In this review article, we describe the current usage of DES in AMI in Korea and introduce novel DES uses in development for patients with AMI. We have developed many types of DES in our research laboratory. Abciximab-coated stents inhibited platelet thrombi and restenosis. Furthermore, anti-oxidants (carvedilol, probucol and alpha-lipoic acid) were used for stent coating. Currently we are developing novel DESs using polymer-free and natural binding techniques, peptide coating stents, gene-and-drug delivery, bioabsorbable stents using 3D printing, endothelial progenitor cell capturing stents to promote reendothelialization and reduce stent thrombosis. New DESs in development may be safe and effective in preventing late stent thrombosis and restenosis in patients with AMI.
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Affiliation(s)
- Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
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9
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Sim DS, Jeong MH, Park DS, Kim JH, Lim KS, Bae IH, Zhehao P, Yang HY, Lee JH, Hyun DY, Hong YJ, Kim JH, Ahn Y, Kang JC. A novel polymer-free drug-eluting stent coated with everolimus using nitrogen-doped titanium dioxide film deposition in a porcine coronary restenosis model. Int J Cardiol 2016; 222:436-440. [DOI: 10.1016/j.ijcard.2016.07.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/13/2016] [Accepted: 07/30/2016] [Indexed: 12/16/2022]
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Abstract
Implantation of drug-eluting stents (DESs) via percutaneous coronary intervention is the most popular treatment option to restore blood flow to occluded vasculature. The many devices currently used in clinic and under examination in research laboratories are manufactured using a variety of coating techniques to create the incorporated drug release platforms. These coating techniques offer various benefits including ease of use, expense of equipment, and design variability. This review paper discusses recent novel DES designs utilizing individual or a combination of these coating techniques and their resulting drug release profiles.
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Affiliation(s)
- Megan Livingston
- Department of Regenerative Medicine and Orthopaedics, Houston Methodist Research Institute, Houston, USA
| | - Aaron Tan
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, UCL Medical School, University College London (UCL), London, UK
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11
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Abstract
Nanostructured TiO2 particles with different morphologies obtained by a universal method.
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Affiliation(s)
- Ruhua Zha
- Laboratory of Solid State Ionics
- School of Materials Science and Engineering
- Huazhong University of Science and Technology
- Wuhan 430074
- P.R. China
| | - Reddeppa Nadimicherla
- Laboratory of Solid State Ionics
- School of Materials Science and Engineering
- Huazhong University of Science and Technology
- Wuhan 430074
- P.R. China
| | - Xin Guo
- Laboratory of Solid State Ionics
- School of Materials Science and Engineering
- Huazhong University of Science and Technology
- Wuhan 430074
- P.R. China
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12
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Effect of polymer-free TiO2 stent coated with abciximab or alpha lipoic acid in porcine coronary restenosis model. J Cardiol 2014; 64:409-18. [DOI: 10.1016/j.jjcc.2014.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 11/21/2022]
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13
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Abstract
Restenosis and stent thrombosis remain major concerns after percutaneous coronary intervention for the treatment of coronary artery disease. The present review was undertaken in order to highlight the various coronary stents that have been investigated in our Heart Research Center, and how far we have come from the first heparin-coated stent first used in the late 1990s. Thereafter, from the abciximab-coated stent to the current gene-delivery stent and other newer agents, our group has applied a range of techniques in this field. However, in groups similar to ours, the restenosis rates of such stents are still high for second-generation drug-eluting stents (DESs). Moreover, our nation imports almost all of these types of stents from other countries. Thus, we need to develop domestic coronary stents. Research into newer DESs are warranted in Korea so as to achieve improved safety and efficacy outcomes.
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Affiliation(s)
- Jae Yeong Cho
- Korea Cardiovascular Stent Research Institute of Chonnam National University, Gwangju, Korea
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14
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Kwon JS, Song SJ, Yang EJ, Kim YS, Lim KS, Kim DG, Cho DL, Jeong MH, Ahn Y. Novel abciximab-Kruppel-like factor 4-plasmid dual-delivery titanium dioxide-coated coronary stent. Int J Cardiol 2013; 168:5104-6. [PMID: 23972361 DOI: 10.1016/j.ijcard.2013.07.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 07/25/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Jin Sook Kwon
- Heart Research Center, Chonnam National University Hospital, Gwangju, Republic of Korea
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15
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Lim KS, Bae IH, Kim JH, Park DS, Kim JM, Kim JH, Sim DS, Hong YJ, Jeong MH. Mechanical and Histopathological Comparison between Commercialized and Newly Designed Coronary Bare Metal Stents in a Porcine Coronary Restenosis Model. Chonnam Med J 2013; 49:7-13. [PMID: 23678471 PMCID: PMC3651989 DOI: 10.4068/cmj.2013.49.1.7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to compare the stent designed by Chonnam National University Hospital (designated as CNUH) with commercial cobalt-chromium coronary stent in a porcine coronary overstretch restenosis model. CNUH stent was subjected to mechanical performance tests. Pigs were randomized into two groups in which the coronary arteries (10 pigs, 10 coronaries in each group) had either CNUH stent or control commercial bare metal stent. Histopathologic analysis was assessed at 28 days after stenting. In mechanical performance tests, CNUH stent showed 2.65N, 35.1N, 0.52N, 1.94%, 4.29% in the flat plate radial compression, radial force, 3 point bending, Foreshortening and recoil test, respectively. There was no significant difference in the injury score, internal elastic lamina (IEL), lumen area, neointima area, percent area stenosis, inflammation score and fibrin score between the two groups (1.2±0.35, 4.1±0.41 mm2, 2.7±0.56 mm2, 1.6±0.47 mm2, 36.7±11.2%, 1.2±0.62, 0.2±0.34 in CNUH stent group vs. 1.2±0.38, 3.7±0.64 mm2, 2.5±0.49 mm2, 1.5±0.61 mm2, 36.3±12.17%, 1.1±0.12, 0.4±0.46 in commercial stent group, respectively). In the mechanical performance test, CNUH stent showed the moderated performance under the guideline of FDA. CNUH stent demonstrated similar histological reactions compared with commercial cobalt-chromium stent in a porcine coronary overstretch restenosis model.
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Affiliation(s)
- Kyung Seob Lim
- The Heart Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju, Korea
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16
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Huan Z, Fratila-Apachitei LE, Apachitei I, Duszczyk J. Porous TiO2surface formed on nickel-titanium alloy by plasma electrolytic oxidation: A prospective polymer-free reservoir for drug eluting stent applications. J Biomed Mater Res B Appl Biomater 2013; 101:700-8. [DOI: 10.1002/jbm.b.32872] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/27/2012] [Accepted: 11/18/2012] [Indexed: 11/11/2022]
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17
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Wise SG, Waterhouse A, Kondyurin A, Bilek MM, Weiss AS. Plasma-based biofunctionalization of vascular implants. Nanomedicine (Lond) 2012; 7:1907-16. [DOI: 10.2217/nnm.12.161] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Polymeric and metallic materials are used extensively in permanently implanted cardiovascular devices and devices that make temporary but often prolonged contact with body fluids and tissues. Foreign body responses are typically triggered by host interactions at the implant surface, making surface modifications to increase biointegration desirable. Plasma-based treatments are extensively used to modify diverse substrates; modulating surface chemistry, wettability and surface roughness, as well as facilitating covalent biomolecule binding. Each aspect impacts on facets of vascular compatibility including endothelialization and blood contact. These modifications can be readily applied to polymers such as Dacron® and expanded polytetrafluoroethylene, which are widely used in bypass grafting and the metallic substrates of stents, valves and pacemaker components. Plasma modification of metals is more challenging given the need for coating deposition in addition to surface activation, adding the necessity for robust interface adhesion. This review examines the evolving plasma treatment technology facilitating the biofunctionalization of polymeric and metallic implantable cardiovascular materials.
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Affiliation(s)
- Steven G Wise
- School of Molecular Bioscience, University of Sydney, NSW 2006, Australia; School of Molecular Bioscience G08, University of Sydney, NSW 2006, Australia
- The Heart Research Institute, Sydney, NSW 2042, Australia
| | - Anna Waterhouse
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | | | - Marcela M Bilek
- School of Physics, University of Sydney, NSW 2006, Australia
| | - Anthony S Weiss
- Bosch Institute, University of Sydney, Sydney, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, 2006, Australia
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18
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Gandhi PJ, Murthy ZVP. Investigation of Different Drug Deposition Techniques on Drug Releasing Properties of Cardiovascular Drug Coated Balloons. Ind Eng Chem Res 2012. [DOI: 10.1021/ie3006676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pankaj J. Gandhi
- Department
of Chemical Engineering, Sardar Vallabhbhai National Institute of Technology, Surat
395 007, Gujarat, India
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19
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Huan Z, Fratila-Apachitei LE, Apachitei I, Duszczyk J. Characterization of Porous TiO2 Surfaces Formed on 316L Stainless Steel by Plasma Electrolytic Oxidation for Stent Applications. J Funct Biomater 2012; 3:349-60. [PMID: 24955536 PMCID: PMC4047934 DOI: 10.3390/jfb3020349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/25/2012] [Accepted: 04/27/2012] [Indexed: 11/16/2022] Open
Abstract
In this study, a porous oxide layer was formed on the surface of 316L stainless steel (SS) by combining Ti magnetron sputtering and plasma electrolytic oxidation (PEO) with the aim to produce a polymer-free drug carrier for drug eluting stent (DES) applications. The oxidation was performed galvanostatically in Na3PO4 electrolyte. The surface porosity, average pore size and roughness varied with PEO treatment duration, and under optimum conditions, the surface showed a porosity of 7.43%, an average pore size of 0.44 µm and a roughness (Ra) of 0.34 µm. The EDS analyses revealed that the porous layer consisted of Ti, O and P. The cross-sectional morphology evidenced a double-layer structure, with a porous titania surface and an un-oxidized dense Ti film towards the interface with 316L SS. After the PEO treatment, wettability and surface free energy increased significantly. The results of the present study confirm the feasibility of forming a porous TiO2 layer on stainless steel by combining sputtering technology and PEO. Further, the resultant porous oxide layer has the potential to be used as a drug carrier for DES, thus avoiding the complications associated with the polymer based carriers.
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Affiliation(s)
- Zhiguang Huan
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands.
| | - Lidy E Fratila-Apachitei
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands.
| | - Iulian Apachitei
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands.
| | - Jurek Duszczyk
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands.
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20
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Fabrication and controlled release of electrosprayed ReoPro-loaded metal surface for vascular stent. Macromol Res 2011. [DOI: 10.1007/s13233-011-0516-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Song SJ, Jung KW, Park YJ, Park J, Cho MD, Jeong MH, Kim YS, Cho DL. Nitrogen-doped TiO2 films as drug-binding matrices for the preparation of drug-eluting stents. ACTA ACUST UNITED AC 2011. [DOI: 10.1039/c0jm03994b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Kumar PS, Nizar SAS, Sundaramurthy J, Ragupathy P, Thavasi V, Mhaisalkar SG, Ramakrishna S. Tunable hierarchical TiO2 nanostructures by controlled annealing of electrospun fibers: formation mechanism, morphology, crystallographic phase and photoelectrochemical performance analysis. ACTA ACUST UNITED AC 2011. [DOI: 10.1039/c1jm10859j] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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