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Tanaka T, Kawai K, Ellis CR, Srivastava M, Kawakami R, Konishi T, Shiraki T, Sekimoto T, Virmani R, Finn AV. Challenges and advances in device-related thrombus in left atrial appendage occlusion. Future Cardiol 2024; 20:343-358. [PMID: 38948932 PMCID: PMC11457600 DOI: 10.1080/14796678.2024.2363063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Oral anticoagulation therapy (OAC) is a mainstay for mitigating stroke and other embolic events in patients with atrial fibrillation (AF). Despite the demonstrated efficacy of OAC in reducing events, many patients are unable to tolerate OAC due to bleeding risks. Left atrial appendage occlusion (LAAO) devices were developed as implantable technologies to moderate stroke risk in patients with intolerance to OAC. Despite clinical data supporting near-comparable protection against thromboembolic events with OAC, device-related thrombus formation has emerged as a critical complication following LAAO that remains a potential limitation to the safety and efficacy of LAAO. Improved biocompatibility of LAAO devices with fluoropolymers, a well-established stent-coating technology used to reduce thrombus formation and promote endothelialization, may optimize outcomes after LAAO.
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Affiliation(s)
| | - Kenji Kawai
- CVPath Institute, Gaithersburg, MD20878, USA
| | | | - Mukta Srivastava
- University of Maryland, School of Medicine, Baltimore, MD21201, USA
| | | | | | | | | | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD20878, USA
- University of Maryland, School of Medicine, Baltimore, MD21201, USA
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2
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Kawai K, Sato Y, Cornelissen A, Kolodgie FD, Cheng Q, Kawakami R, Konishi T, Perkins LEL, Virmani R, Finn AV. Comparison of thrombogenicity in different types of drug-eluting stents during transition from DAPT to SAPT. Catheter Cardiovasc Interv 2024; 104:10-20. [PMID: 38769726 DOI: 10.1002/ccd.31083] [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: 10/05/2023] [Revised: 04/13/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND During the transition from dual antiplatelet therapy (DAPT) to single antiplatelet therapy (SAPT), previous studies have raised concerns about a rebound effect. We compared platelet and inflammatory cell adhesion on different types of stents in the setting of clopidogrel presence and withdrawal. METHODS In Experiment 1, three pigs were administered with DAPT, that is, clopidogrel and acetylsalicylic acid (ASA), for 7 days. Each animal underwent an extracorporeal carotid arteriovenous shunt model implanted with fluoropolymer-coated everolimus-eluting stent (FP-EES), biodegradable-polymer sirolimus-eluting stent (BP-SES), and biodegradable-polymer everolimus-eluting stents (BP-EES). In Experiment 2, two pigs were administered DAPT, clopidogrel was then withdrawn at day 7, and SAPT with ASA was continued for next 21 days. Then flow-loop experiments with the drawn blood from each time point were performed for FP-EES, BioLinx-polymer zotarolimus-eluting stents (BL-ZES), and BP-EES. The rebound effect was defined as the statistical increase of inflammation and platelet adhesion assessed with immunohistochemistry on the stent-strut level basis from baseline to day-14 or 28. RESULTS Both experiments showed platelet adhesion value was highest in BP-EES, while the least in FP-EES during DAPT therapy. There was no increase in platelet or inflammatory cell adhesion above baseline values (i.e., no therapy) due to the cessation of clopidogrel on the stent-strut level. Monocyte adhesion was the least for FP-EES with the same trend observed for neutrophil adhesion. CONCLUSIONS No evidence of rebound effect was seen after the transition from DAPT to SAPT. FP-EES demonstrated the most favorable antithrombotic and anti-inflammatory profile regardless of the different experimental designs.
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Affiliation(s)
- Kenji Kawai
- CVPath Institute, Inc., Gaithersburg, Maryland
| | - Yu Sato
- CVPath Institute, Inc., Gaithersburg, Maryland
| | | | | | - Qi Cheng
- CVPath Institute, Inc., Gaithersburg, Maryland
| | | | | | | | | | - Aloke V Finn
- CVPath Institute, Inc., Gaithersburg, Maryland
- University of Maryland, Baltimore, Maryland
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3
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Tan M, Wang F, Yang J, Zhong Z, Chen G, Chen Z. Hydroxyl silicone oil grafting onto a rough thermoplastic polyurethane surface created durable super-hydrophobicity. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1359-1378. [PMID: 38490948 DOI: 10.1080/09205063.2024.2329453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Indwelling medical catheters are frequently utilized in medical procedures, but they are highly susceptible to infection, posing a vital challenge for both health workers and patients. In this study, the superhydrophobic micro-nanostructure surface was constructed on the surface of thermoplastic polyurethane (TPU) membrane using heavy calcium carbonate (CaCO3) template. To decrease the surface free energy, hydroxyl silicone oil was grafted onto the surface, forming a super-hydrophobic surface. The water contact angle (WCA) increased from 91.1° to 143 ± 3° when the concentration of heavy calcium CaCO3 was 20% (weight-to-volume (w/v)). However, the increased WCA was unstable and tended to decrease over time. After grafting hydroxyl silicone oil, the WCA rose to 152.05 ± 1.62° and remained consistently high for a period of 30 min. Attenuated total reflection infrared spectroscopy (ATR-FTIR) analysis revealed a chemical crosslinking between silicone oil and the surface of TPU. Furthermore, Scanning electron microscope (SEM) image showed the presence of numerous nanoparticles on the micro surface. Atomic force microscope (AFM) testing indicated a significant improvement in surface roughness. This method of creating a hydrophobic surface demonstrated several advantages, including resistance to cell, bacterial, protein, and platelet adhesion and good biosecurity. Therefore, it holds promising potential for application in the development of TPU-based medical catheters with antibacterial properties.
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Affiliation(s)
- Miaomiao Tan
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Fuping Wang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Jinlan Yang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Zhengpeng Zhong
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Guobao Chen
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Zhongmin Chen
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
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4
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Liu Y, Jin G, Miao H, Xu S. Preparation and characterization of polydopamine and n-butyl methacrylate copolymer coatings on titanium-nickel alloy stents. RSC Adv 2024; 14:15240-15248. [PMID: 38737972 PMCID: PMC11082937 DOI: 10.1039/d4ra01491j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024] Open
Abstract
Cardiovascular diseases pose a significant global health threat, and stents play a crucial role in managing these diseases. However, challenges exist with respect to the poor adhesion of stent coatings. Cardiac stents are often composed of titanium-nickel (TiNi) alloys as the metallic component and poly(n-butyl methacrylate) (PBMA) as the coating. The poor adhesion of PBMA to TiNi alloy surface may cause detachment and subsequent thrombosis post-implantation. This study utilizes Reversible Addition-Fragmentation Chain Transfer (RAFT) polymerization to synthesize a novel block copolymer, PBMA-b-PVP, composed of PBMA and poly(N-vinylpyrrolidone) (PVP). TiNi alloy surfaces are functionalized with polydopamine (PDA) to enhance polymer coating adhesion. PBMA-b-PVP exhibits a remarkable improvement in adhesion from class 5 to class 0 and high coating stability after a 15 days immersion in a phosphate buffer solution. The corrosion current density is reduced by 44% with the incorporation of PDA into PBMA-b-PVP coatings, suggesting high corrosion resistance. PDA-functionalized coatings promote cell viability without cytotoxicity, suggesting high biocompatibility. This study provides a robust strategy for preparing stent coatings with high adhesion, corrosion resistance, and biocompatibility.
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Affiliation(s)
- Yuanhui Liu
- School of Materials Science and Engineering, East China University of Science and Technology Shanghai 200237 China
| | - Guocheng Jin
- Shanghai Flowridge Material Technology Co., Ltd Shanghai 201318 China
| | - Han Miao
- School of Materials Science and Engineering, East China University of Science and Technology Shanghai 200237 China
| | - Shiai Xu
- School of Materials Science and Engineering, East China University of Science and Technology Shanghai 200237 China
- Qinghai Provincial Key Laboratory of Salt Lake Materials Chemical Engineering, School of Chemical Engineering, Qinghai University Xining 810016 China
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Udriște AS, Burdușel AC, Niculescu AG, Rădulescu M, Grumezescu AM. Coatings for Cardiovascular Stents-An Up-to-Date Review. Int J Mol Sci 2024; 25:1078. [PMID: 38256151 PMCID: PMC10817058 DOI: 10.3390/ijms25021078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) increasingly burden health systems and patients worldwide, necessitating the improved awareness of current treatment possibilities and the development of more efficient therapeutic strategies. When plaque deposits narrow the arteries, the standard of care implies the insertion of a stent at the lesion site. The most promising development in cardiovascular stents has been the release of medications from these stents. However, the use of drug-eluting stents (DESs) is still challenged by in-stent restenosis occurrence. DESs' long-term clinical success depends on several parameters, including the degradability of the polymers, drug release profiles, stent platforms, coating polymers, and the metals and their alloys that are employed as metal frames in the stents. Thus, it is critical to investigate new approaches to optimize the most suitable DESs to solve problems with the inflammatory response, delayed endothelialization, and sub-acute stent thrombosis. As certain advancements have been reported in the literature, this review aims to present the latest updates in the coatings field for cardiovascular stents. Specifically, there are described various organic (e.g., synthetic and natural polymer-based coatings, stents coated directly with drugs, and coatings containing endothelial cells) and inorganic (e.g., metallic and nonmetallic materials) stent coating options, aiming to create an updated framework that would serve as an inception point for future research.
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Affiliation(s)
- Alexandru Scafa Udriște
- Department 4 Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Alexandra Cristina Burdușel
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (A.C.B.); (A.-G.N.); (A.M.G.)
| | - Adelina-Gabriela Niculescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (A.C.B.); (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (A.C.B.); (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
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6
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Saliba WI, Kawai K, Sato Y, Kopesky E, Cheng Q, Ghosh SKB, Herbst TJ, Kawakami R, Konishi T, Virmani R, Jaber WA, Gibson DN, Shah M, Natale A, Gibson M, Holmes DR, Finn AV. Enhanced Thromboresistance and Endothelialization of a Novel Fluoropolymer-Coated Left Atrial Appendage Closure Device. JACC Clin Electrophysiol 2023; 9:1555-1567. [PMID: 37204356 DOI: 10.1016/j.jacep.2023.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) procedures is a rare but potentially serious event. Thrombogenicity and delayed endothelialization play a role in the development of DRT. Fluorinated polymers are known to have thromboresistant properties that may favorably modulate the healing response to an LAAC device. OBJECTIVES The goal of this study was to compare the thrombogenicity and endothelial coverage (EC) after LAAC between the conventional uncoated WATCHMAN FLX (WM) and a novel fluoropolymer-coated WATCHMAN FLX (FP-WM). METHODS Canines were randomized for implantation with WM or FP-WM devices and given no postimplant antithrombotic/antiplatelet agents. The presence of DRT was monitored by using transesophageal echocardiography and verified histologically. The biochemical mechanisms associated with coating were assessed by using flow loop experiments to quantify albumin adsorption, platelet adhesion, and porcine implants to quantify EC and the expression of markers of endothelial maturation (ie, vascular endothelial-cadherin/p120-catenin). RESULTS Canines implanted with FP-WM exhibited significantly less DRT at 45 days than those implanted with WM (0% vs 50%; P < 0.05). In vitro experiments showed significantly greater albumin adsorption (52.8 [IQR: 41.0-58.3] mm2 vs 20.6 [IQR: 17.2-26.6] mm2; P = 0.03) and significantly less platelet adhesion (44.7% [IQR: 27.2%-60.2%] vs 60.9% [IQR: 39.9%-70.1%]; P < 0.01) on FP-WM. Porcine implants showed significantly greater EC by scanning electron microscopy (87.7% [IQR: 83.4%-92.3%] vs 68.2% [IQR: 47.6%-72.8%]; P = 0.03), and higher vascular endothelial-cadherin/p120-catenin expression after 3 months on FP-WM compared with WM. CONCLUSIONS The FP-WM device showed significantly less thrombus and reduced inflammation in a challenging canine model. Mechanistic studies indicated that the fluoropolymer-coated device binds more albumin, leading to reduced platelet binding, less inflammation, and greater EC.
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Affiliation(s)
- Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kenji Kawai
- CVPath Institute, Gaithersburg, Maryland, USA
| | - Yu Sato
- CVPath Institute, Gaithersburg, Maryland, USA
| | - Edward Kopesky
- Boston Scientific Corporation, Maple Grove, Minnesota, USA
| | - Qi Cheng
- CVPath Institute, Gaithersburg, Maryland, USA
| | | | | | | | | | | | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas N Gibson
- Prebys Cardiovascular Institute, Scripps Clinic, San Diego, California, USA
| | - Manish Shah
- Department of Medicine, MedStar Georgetown Washington Hospital Center, Washington, DC
| | - Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Gibson
- Department of Medicine, Beth Israel Medical Center, Boston, Massachusetts, USA
| | - David R Holmes
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, Maryland, USA; University of Maryland, School of Medicine, Baltimore, Maryland, USA.
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7
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Ratner B. Vascular Grafts: Technology Success/Technology Failure. BME FRONTIERS 2023; 4:0003. [PMID: 37849668 PMCID: PMC10521696 DOI: 10.34133/bmef.0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/15/2022] [Indexed: 10/19/2023] Open
Abstract
Vascular prostheses (grafts) are widely used for hemodialysis blood access, trauma repair, aneurism repair, and cardiovascular reconstruction. However, smaller-diameter (≤4 mm) grafts that would be valuable for many reconstructions have not been achieved to date, although hundreds of papers on small-diameter vascular grafts have been published. This perspective article presents a hypothesis that may open new research avenues for the development of small-diameter vascular grafts. A historical review of the vascular graft literature and specific types of vascular grafts is presented focusing on observations important to the hypothesis to be presented. Considerations in critically reviewing the vascular graft literature are discussed. The hypothesis that perhaps the "biocompatible biomaterials" comprising our vascular grafts-biomaterials that generate dense, nonvascularized collagenous capsules upon implantation-may not be all that biocompatible is presented. Examples of materials that heal with tissue reconstruction and vascularity, in contrast to the fibrotic encapsulation, are offered. Such prohealing materials may lead the way to a new generation of vascular grafts suitable for small-diameter reconstructions.
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Affiliation(s)
- Buddy Ratner
- Center for Dialysis Innovation (CDI), Departments of Bioengineering and Chemical Engineering, University of Washington, Seattle, WA 98195, USA
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Hong SJ, Hong MK. Drug-eluting stents for the treatment of coronary artery disease: A review of recent advances. Expert Opin Drug Deliv 2022; 19:269-280. [PMID: 35180832 DOI: 10.1080/17425247.2022.2044784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention is a widely used procedure for the treatment of coronary artery disease to relieve narrowing or occlusion and improve blood supply. Although only balloon angioplasty was performed in the early period, coronary stents were developed later and coronary drug-eluting stents were introduced to decrease in-stent restenosis, which is related to the proliferation and migration of vascular smooth muscle cells. AREAS COVERED The drug-eluting stents are composed of a metallic or polymeric platform, specific drug, and polymers or coating for drug release. In this article, the recent advances in drug-eluting stent technologies for the treatment of coronary artery disease and adjunctive antiplatelet therapy after drug-eluting stent implantation will be reviewed. EXPERT OPINION The need for further advances in drug-eluting stents or fully bioresorbable coronary scaffolds still exists to improve patient survival or clinical outcomes. The use for different actions or of combinations of drugs with several actions can be potential. Technological refinement and progress in manufacturing to improve mechanical integrity are needed, particularly for fully bioresorbable scaffolds. For antiplatelet therapy after stenting, clinical bleeding reduction strategies, such as a shortened duration of dual-antiplatelet therapy, are in progress.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Korea
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9
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Ozimek J, Pielichowski K. Recent Advances in Polyurethane/POSS Hybrids for Biomedical Applications. Molecules 2021; 27:molecules27010040. [PMID: 35011280 PMCID: PMC8746980 DOI: 10.3390/molecules27010040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Advanced organic-inorganic materials-composites, nanocomposites, and hybrids with various compositions offer unique properties required for biomedical applications. One of the most promising inorganic (nano)additives are polyhedral oligomeric silsesquioxanes (POSS); their biocompatibility, non-toxicity, and phase separation ability that modifies the material porosity are fundamental properties required in modern biomedical applications. When incorporated, chemically or physically, into polyurethane matrices, they substantially change polymer properties, including mechanical properties, surface characteristics, and bioactivity. Hence, this review is dedicated to POSS-PU composites that have recently been developed for applications in the biomedical field. First, different modes of POSS incorporation into PU structure have been presented, then recent developments of PU/POSS hybrids as bio-active composites for scaffolds, cardiovascular stents, valves, and membranes, as well as in bio-imaging and cancer treatment, have been described. Finally, characterization and methods of modification routes of polyurethane-based materials with silsesquioxanes were presented.
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Chen X, Chen J, Huang N. The structure, formation, and effect of plasma protein layer on the blood contact materials: A review. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Xiao Chen
- Institute of Biomaterials and Surface Engineering Key Lab. for Advanced Technologies of Materials Ministry of Education Southwest Jiaotong University Chengdu China
| | - Jiang Chen
- Institute of Biomaterials and Surface Engineering Key Lab. for Advanced Technologies of Materials Ministry of Education Southwest Jiaotong University Chengdu China
| | - Nan Huang
- Institute of Biomaterials and Surface Engineering Key Lab. for Advanced Technologies of Materials Ministry of Education Southwest Jiaotong University Chengdu China
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Jinnouchi H, Kutyna M, Torii S, Cheng Q, Sakamoto A, Guo L, Cornelissen A, Perkins L, Hossainy S, Pacetti S, Kolodgie F, Virmani R, Finn A. Comparison of acute thrombogenicity and albumin adsorption in three different durable polymer coronary drug-eluting stents. EUROINTERVENTION 2021; 17:248-256. [PMID: 32149708 PMCID: PMC9725074 DOI: 10.4244/eij-d-19-00938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relative thrombogenicity and albumin adsorption and retention of different durable polymers used in coronary stents has not been tested. AIMS This study sought to compare the thromboresistance and albumin binding capacity of different durable polymer drug-eluting stents (DES) using dedicated preclinical and in vitro models. METHODS In an ex vivo swine arteriovenous shunt model, a fluoropolymer everolimus-eluting stent (FP-EES) (n=14) was compared with two durable polymer DES, the BioLinx polymer-coated zotarolimus-eluting stent (BL-ZES) (n=9) and a CarboSil elastomer polymer-coated ridaforolimus-eluting stent (EP-RES) (n=6), and bare metal stents (BMS) (n=10). Stents underwent immunostaining using a cocktail of antiplatelet antibodies and a marker for inflammation and were then evaluated by confocal microscopy (CM). Albumin retention was assessed using a flow loop model with labelled human serum albumin (FP-EES [n=8], BL-ZES [n=4], EP-RES [n=4], and BMS [n=7]), and scanned by CM. RESULTS The area of platelet adherence (normalised to total stent surface area) was lower in the order FP-EES (9.8%), BL-ZES (32.7%), EP-RES (87.6%) and BMS (202.0%), and inflammatory cell density was least for FP-EES <BL-ZES <EP-RES <BMS. Although nearly full coverage by albumin binding was shown for all durable polymer DES, FP-EES showed significantly greater intensity of albumin as compared to BL-ZES, EP-RES and BMS (FP-EES 79.0%; BL-ZES 13.2%; EP-RES 6.1%; BMS 1.5%). CONCLUSIONS These results suggest that thromboresistance and albumin retention vary by polymer type and that these differences might result in different suitability for short-term dual antiplatelet therapy.
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Affiliation(s)
| | | | - Sho Torii
- CVPath Institute, Gaithersburg, MD, USA
| | - Qi Cheng
- CVPath Institute, Gaithersburg, MD, USA
| | | | - Liang Guo
- CVPath Institute, Gaithersburg, MD, USA
| | | | | | | | | | | | | | - Aloke Finn
- CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA
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12
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Sato Y, Jinnouchi H, Kolodgie FD, Cheng Q, Janifer C, Kutyna M, Sakamoto A, Cornelissen A, Mori M, Kawakami R, Kawai K, Fernandez R, Ghosh SKB, Romero ME, Perkins LEL, Virmani R, Finn AV. Acute thrombogenicity of fluoropolymer coated stents versus competitive drug-eluting stents under single antiplatelet therapy. Int J Cardiol 2021; 338:42-49. [PMID: 34174338 DOI: 10.1016/j.ijcard.2021.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent clinical studies have suggested the feasibility of 1-month dual antiplatelet therapy (DAPT) for patients receiving drug-eluting stent (DES). Although our previous ex-vivo swine arteriovenous (AV) shunt studies under low dose heparin treatment suggested superior thromboresistance of fluoropolymer-coated everolimus-eluting stent (FP-EES) when compared to other polymer-based DESs, the relative thromboresistance of different DESs under single antiplatelet therapy (SAPT) has never been examined. This study aimed to evaluate platelet adhesion under SAPT in competitive DESs in the in vitro flow loop model and ex vivo swine AV shunt model. METHODS The thrombogenicity of FP-EES, BioLinx polymer zotarolimus-eluting stent (BL-ZES), and biodegradable polymer everolimus-eluting stent (BP-EES) was assessed acutely using the swine AV shunt model under aspirin or clopidogrel SAPT. Stents were immunostained using antibodies against platelets and inflammatory markers and evaluated by confocal microscopy. Also, the adhesion of platelet and albumin on the three DESs was assessed by an in-vitro flow loop model using human platelets under aspirin SAPT and fluorescent albumin, respectively. RESULTS In the shunt model, FP-EES showed significantly less platelet and inflammatory cell adhesion than BL-ZES and BP-EES. In the flow loop model, FP-EES showed significantly less platelet coverage and more albumin adsorption than BL-ZES and BP-EES. CONCLUSIONS These results suggest FP-EES may have particular advantage for short-term DAPT compared to other DESs.
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Affiliation(s)
- Yu Sato
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | | | | | - Qi Cheng
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | | | | | | | | | | | | | - Kenji Kawai
- CVPath Institute, Inc., Gaithersburg, MD, USA
| | | | | | | | | | | | - Aloke V Finn
- CVPath Institute, Inc., Gaithersburg, MD, USA; University of Maryland, Baltimore, MD, USA.
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13
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Koni E, Wanha W, Ratajczak J, Zhang Z, Podhajski P, Musci RL, Sangiorgi GM, Kaźmierski M, Buffon A, Kubica J, Wojakowski W, Navarese EP. Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. J Clin Med 2021; 10:jcm10061278. [PMID: 33808678 PMCID: PMC8003362 DOI: 10.3390/jcm10061278] [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: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54-0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58-0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42-0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53-0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.
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Affiliation(s)
- Endrin Koni
- Department of Interventional Cardiology, Santa
Corona Hospital, 17027 Pietra Ligure, Italy;
- SIRIO MEDICINE Research Network, 85094 Bydgoszcz,
Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Jakub Ratajczak
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
- Department of Health Promotion, Nicolaus Copernicus
University, 87100 Bydgoszcz, Poland
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw
Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
- Key Laboratory of Emergency and Trauma, Ministry of
Education, College of Emergency and Trauma, Hainan Medical University, Haikou 571199,
China
| | - Przemysław Podhajski
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
| | - Rita L. Musci
- Department of Biomedicine and Prevention,
University of Rome Tor Vergata, 00173 Rome, Italy;
| | - Giuseppe M. Sangiorgi
- Cardiac Cath Lab, Department of Cardiology, San
Gaudenzio Clinic, 28100 Novara, Italy;
| | - Maciej Kaźmierski
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Antonio Buffon
- Institute of Cardiology, Catholic University of
the Sacred Heart Rome, 00168 Rome, Italy;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart
Diseases, Medical University of Silesia, 40635 Katowice, Poland;
(W.W.);
(M.K.); (W.W.)
| | - Eliano P. Navarese
- SIRIO MEDICINE Research Network, 85094 Bydgoszcz,
Poland
- Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, 87100 Bydgoszcz, Poland;
(J.R.);
(P.P.); (J.K.)
- Faculty of Medicine, University of Alberta,
Edmonton, AB 13103, Canada
- Correspondence:
; Tel.: +48-52-585-4023; Fax:
+48-52-585-4024
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Vascular Wall Reactions to Coronary Stents-Clinical Implications for Stent Failure. Life (Basel) 2021; 11:life11010063. [PMID: 33477361 PMCID: PMC7829777 DOI: 10.3390/life11010063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/21/2022] Open
Abstract
Coronary stents belong to the most commonly implanted devices worldwide. A number of different types of stent exist, with very different mechanical and biochemical characteristics that influence their interactions with vascular tissues. Inappropriate inflammatory reactions are the major cause of the two major complications that follow implantation of stents in a percentage as high as 5-20%. It is therefore important to understand these reactions and how different they are among different generations of stents.
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15
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Mitsis A, Valgimigli M. Device profile of the XIENCE V and XIENCE Sierra stents for the treatment of coronary artery disease: an overview of safety and efficacy. Expert Rev Med Devices 2020; 17:383-390. [DOI: 10.1080/17434440.2020.1747434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andreas Mitsis
- Department of Cardiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland
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16
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Zhi B, Mao Y. Vapor-Deposited Nanocoatings for Sustained Zero-Order Release of Antiproliferative Drugs. ACS APPLIED BIO MATERIALS 2020; 3:1088-1096. [DOI: 10.1021/acsabm.9b01044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bin Zhi
- Departments of Biosystems Engineering, Oklahoma State University, Stillwater, Oklahoma 74078, United States
| | - Yu Mao
- Departments of Biosystems Engineering, Oklahoma State University, Stillwater, Oklahoma 74078, United States
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17
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Grainger DW. Fluorinated Biomaterials. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00012-x] [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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18
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Palmerini T, Barozzi C, Tomasi L, Riva DD, Marengo M, Cicoria G, Bruno AG, Bacchi-Reggiani ML, Naldi M, Bartolini M, Fanti S, Galiè N, Stone GW. In vitro thrombogenicity of drug-eluting and bare metal stents. Thromb Res 2020; 185:43-48. [DOI: 10.1016/j.thromres.2019.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
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Jinnouchi H, Kutyna M, Sakamoto A, Torii S, Guo L, Mori H, Cheng Q, Virmani R, Kolodgie FD, Finn AV. Imaging Human Platelet Adhesion and Albumin Retention to Coronary Stents in Real Time. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:245-248. [PMID: 31771813 DOI: 10.1016/j.carrev.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/24/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Matthew Kutyna
- CVPath Institute, Gaithersburg, MD, United States of America
| | | | - Sho Torii
- CVPath Institute, Gaithersburg, MD, United States of America
| | - Liang Guo
- CVPath Institute, Gaithersburg, MD, United States of America
| | - Hiroyoshi Mori
- CVPath Institute, Gaithersburg, MD, United States of America
| | - Qi Cheng
- CVPath Institute, Gaithersburg, MD, United States of America
| | - Renu Virmani
- CVPath Institute, Gaithersburg, MD, United States of America
| | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, United States of America.
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Gorbet M, Sperling C, Maitz MF, Siedlecki CA, Werner C, Sefton MV. The blood compatibility challenge. Part 3: Material associated activation of blood cascades and cells. Acta Biomater 2019; 94:25-32. [PMID: 31226478 DOI: 10.1016/j.actbio.2019.06.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/03/2019] [Accepted: 06/13/2019] [Indexed: 01/09/2023]
Abstract
Following protein adsorption/activation which is the first step after the contact of material surfaces and whole blood (part 2), fibrinogen is converted to fibrin and platelets become activated and assembled in the form of a thrombus. This thrombus formation is the key feature that needs to be minimized in the creation of materials with low thrombogenicity. Further aspects of blood compatibility that are important on their own are complement and leukocyte activation which are also important drivers of thrombus formation. Hence this review summarizes the state of knowledge on all of these cascades and cells and their interactions. For each cascade or cell type, the chapter distinguishes statements which are in widespread agreement from statements where there is less of a consensus. STATEMENT OF SIGNIFICANCE: This paper is part 3 of a series of 4 reviews discussing the problem of biomaterial associated thrombogenicity. The objective was to highlight features of broad agreement and provide commentary on those aspects of the problem that were subject to dispute. We hope that future investigators will update these reviews as new scholarship resolves the uncertainties of today.
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Affiliation(s)
- Maud Gorbet
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Claudia Sperling
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Manfred F Maitz
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Christopher A Siedlecki
- Departments of Surgery and Bioengineering, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States
| | - Carsten Werner
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Michael V Sefton
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
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21
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Drug-eluting coronary stents: insights from preclinical and pathology studies. Nat Rev Cardiol 2019; 17:37-51. [DOI: 10.1038/s41569-019-0234-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/02/2023]
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22
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Jinnouchi H, Mori H, Cheng Q, Kutyna M, Torii S, Sakamoto A, Guo L, Acampado E, Gupta A, Kolodgie FD, Virmani R, Finn AV. Thromboresistance and functional healing in the COBRA PzF stent versus competitor DES: implications for dual antiplatelet therapy. EUROINTERVENTION 2019; 15:e342-e353. [DOI: 10.4244/eij-d-18-00740] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Ferrone M, Cheng Y, Granada JF. Current concepts regarding drug dosing for peripheral stents. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:439-449. [PMID: 31062571 DOI: 10.23736/s0021-9509.19.10995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Drug-eluting stent (DES) are the mainstay therapy for the treatment of coronary artery disease. Stent design and drug-elution strategies have evolved over the years leading to the last generation DES which shows optimal safety and efficacy outcome. Peripheral arteries have different mechanical and biological features and the lessons learned from the coronary field have been difficult to introduce into the development of peripheral vascular technologies. First, due to its complex biomechanical behavior the use of metallic stents is limited in some vascular segments (i.e., distal superficial fermoral artery [SFA]). Also, peripheral vascular atherosclerosis is different containing higher levels of plaque burden and calcium. Finally, peripheral arterial disease tends to be more aggressive including longer lesions and higher incidence of total chronic occlusion. In general terms, restenosis in the peripheral vascular territory is more aggressive and occurs at a later time (~12 months) requiring a different pharmacokinetic profile compared to coronary technologies. Several strategies have been evaluated in the peripheral arteries raging from the bare metal stent to the drug coated balloon and drug eluting stent with outcome varying depending on the different field of application (i.e. SFA and below-the-knee). Results coming from the clinical trial are encouraging but further studies and direct comparison among the different technologies are demanded to determine the best therapy for peripheral vascular disease.
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Affiliation(s)
- Marco Ferrone
- Cardiovascular Research Foundation, Skirball Center for Innovation, Orangeburg, NY, USA.,Federico II University of Naples, Naples, Italy
| | - Yanping Cheng
- Cardiovascular Research Foundation, Skirball Center for Innovation, Orangeburg, NY, USA
| | - Juan F Granada
- Cardiovascular Research Foundation, Skirball Center for Innovation, Orangeburg, NY, USA -
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24
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Zhou Y, Tan J, Wu J, Zhang Q, Andre J, Xi C, Chen Z, Meyerhoff ME. Nitric oxide releasing poly(vinylidene fluoride-co-hexafluoropropylene) films using a fluorinated nitric oxide donor to greatly decrease chemical leaching. Acta Biomater 2019; 90:112-121. [PMID: 30980938 PMCID: PMC6513704 DOI: 10.1016/j.actbio.2019.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 02/05/2023]
Abstract
Nitric oxide (NO) releasing polymers have been widely applied as biomaterials for a variety of biomedical implants and devices. However, the chemical leaching of NO donors and their byproduct species is almost always observed during the application of polymers doped with NO donors, unless the donor is covalently linked to the polymer. Herein, we report the first NO releasing poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) fluorinated copolymer prepared by incorporating a fluorinated S-nitrosothiol as the NO donor. Under physiological conditions, the resulting polymeric films can release NO for 16 days. Importantly, due to both fluorine-fluorine and electrostatic charge interactions between the fluorinated NO donor and the PVDF-HFP copolymer, the total chemical leaching of the fluorinated NO donor and its disulfide product after 9 day was only 0.6% (mol%) of the initial amount of NO donor loaded into the film. These new NO release PVDF-HFP films exhibit antimicrobial and anti-biofilm activities against both Gram positive S. aureus and Gram negative P. aeruginosa strains. The NO-releasing PVDF-HFP polymer can also be coated on Teflon tubing to release NO under physiological conditions for extended time periods. This NO-releasing PVDF-HFP copolymer with greatly reduced chemical leaching could help enhance the biocompatibility and antimicrobial activity of various biomedical devices. STATEMENT OF SIGNIFICANCE: Fluoropolymers have been widely used in creating various biomedical implants and devices. However, nitric oxide (NO) release fluoropolymers have not been well studied to date. Additionally, in the application of biomaterials doped with NO donors, a significant amount of NO donors and their byproducts almost always leach into aqueous environment. We now report an NO releasing poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF-HFP) fluoropolymer by incorporating a new fluorinated S-nitrosothiol. The NO release can last for 16 days under physiological conditions. The total chemical leaching was determined to be only 0.6 mol% of the initial S-nitrosothiol loaded. As expected, significant antimicrobial/anti-biofilm activities of the NO release PVDF-HFP film were observed against Gram positive S. aureus and Gram negative P. aeruginosa bacterial strains.
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Affiliation(s)
- Yang Zhou
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jinyi Tan
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jianfeng Wu
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Qi Zhang
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - John Andre
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Zhan Chen
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA.
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Sotiri I, Robichaud M, Lee D, Braune S, Gorbet M, Ratner BD, Brash JL, Latour RA, Reviakine I. BloodSurf 2017: News from the blood-biomaterial frontier. Acta Biomater 2019; 87:55-60. [PMID: 30660001 DOI: 10.1016/j.actbio.2019.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 12/26/2022]
Abstract
From stents and large-diameter vascular grafts, to mechanical heart valves and blood pumps, blood-contacting devices are enjoying significant clinical success owing to the application of systemic antiplatelet and anticoagulation therapies. On the contrary, research into material and device hemocompatibility aimed at alleviating the need for systemic therapies has suffered a decline. This research area is undergoing a renaissance fueled by recent fundamental insights into coagulation and inflammation that are offering new avenues of investigation, the growing recognition of the limitations facing existing therapeutic approaches, and the severity of the cardiovascular disorders epidemic. This Opinion article discusses clinical needs for hemocompatible materials and the emerging research directions for fulfilling those needs. Based on the 2017 BloodSurf conference that brought together clinicians, scientists, and engineers from academia, industry, and regulatory bodies, its purpose is to draw the attention of the wider clinical and scientific community to stimulate further growth. STATEMENT OF SIGNIFICANCE: The article highlights recent fundamental insights into coagulation, inflammation, and blood-biomaterial interactions that are fueling a renaissance in the field of material hemocompatibility. It will be useful for clinicians, scientists, engineers, representatives of industry and regulatory bodies working on the problem of developing hemocompatible materials and devices for treating cardiovascular disorders.
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26
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Torii S, Cheng Q, Mori H, Lipinski MJ, Acampado E, Perkins LE, Hossainy SF, Pacetti SD, Kolodgie FD, Virmani R, Finn AV. Acute thrombogenicity of fluoropolymer-coated versus biodegradable and polymer-free stents. EUROINTERVENTION 2019; 14:1685-1693. [DOI: 10.4244/eij-d-17-00728] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Khalifehzadeh R, Ratner BD. Trifluoromethyl-functionalized poly(lactic acid): a fluoropolyester designed for blood contact applications. Biomater Sci 2019; 7:3764-3778. [DOI: 10.1039/c9bm00353c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fluorinated polymers are strong candidates for development of new cardiovascular medical devices, due to their lower thrombogenicity as compared to other polymers used for cardiovascular implants.
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Affiliation(s)
| | - Buddy D. Ratner
- Department of Chemical Engineering
- University of Washington
- Seattle
- USA
- Department of Bioengineering
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28
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Sato N, Minami Y, Shimohama T, Kameda R, Tojo T, Ako J. Vascular response and intrastent thrombus in the early phase after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: An observational, single-center study. Health Sci Rep 2019; 2:e105. [PMID: 30697598 PMCID: PMC6346990 DOI: 10.1002/hsr2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/03/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Second-generation drug-eluting stents (G2-DES) are associated with a lower rate of acute and subacute stent thrombosis compared with bare-metal stent (BMS) in the setting of ST-segment elevation myocardial infarction (STEMI). In this study, our aim was to compare the vascular response and thrombus burden between G2-DES and BMS in early-phase STEMI. METHODS Between May 2010 and August 2014, a total of 41 STEMI patients treated by either G2-DES (n = 26; everolimus-eluting stent [EES]: n = 15, zotarolimus-eluting stent [ZES]: n = 11) or BMS (n = 15) and, with multivessel disease requiring additional percutaneous coronary intervention (PCI), were prospectively enrolled. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation. RESULTS Baseline clinical characteristics, except for age (61.5 ± 9.3 vs 69.3 ± 9.8, P = 0.01, t test), were comparable between patients with drug-eluting stent (DES) and BMS. The incidence of residual thrombus after the stent implantation for STEMI was comparable between DES and BMS (7.7% vs 6.7%, P = 0.88, χ 2 test). At 1 month, thrombus burden, defined as the mean thrombus area divided by the mean lumen area, was significantly smaller with DES than with BMS (median interquartile range (IQR), 1.2 (0.0, 1.0) vs 1.2 (0.0, 2.2), P = 0.04, Mann-Whitney U test), despite a similar percentage of malapposed (median (IQR), 6.2 (2.4, 9.0) vs 2.6 (0.0, 5.8)%, P = 0.07, Mann-Whitney U test) or uncovered struts (median (IQR), 6.8 (1.8, 13.1) vs 6.14 (2.8, 18.5)%, P = 0.45, Mann-Whitney U test). No significant difference in thrombus burden was observed between EES and ZES. CONCLUSIONS Thrombus burden was significantly smaller with DES than with BMS at 1-month follow-up in STEMI cases, although the percentage of malapposed or uncovered struts was similar between the groups. This may partly explain the lower rate of acute and subacute stent thrombosis in G2-DES that has previously been reported in the literature.
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Affiliation(s)
- Nobuhiro Sato
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Yoshiyasu Minami
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Takao Shimohama
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Ryo Kameda
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Taiki Tojo
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University HospitalSagamiharaJapan
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Xu T, Zhang J, Zhu Y, Zhao W, Pan C, Ma H, Zhang L. A poly(hydroxyethyl methacrylate)-Ag nanoparticle porous hydrogel for simultaneous in vivo prevention of the foreign-body reaction and bacterial infection. NANOTECHNOLOGY 2018; 29:395101. [PMID: 29989569 DOI: 10.1088/1361-6528/aad257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The use of implants or indwelling medical devices has greatly enhanced the quality and efficacy of health care. However, foreign-body reactions (FBRs) and infections can lead to potential failure or removal of the devices, or increased morbidity and mortality of patients. Herein, we develop a silver nanoparticle (AgNP) loaded poly(hydroxyethyl methacrylate) hydrogel with spherical, interconnected 40 μm pores. The resulting hydrogels displayed good antibacterial properties regarding both gram positive bacteria (Staphylococcus aureus) and gram negative bacteria (Escherichia coli (E. coli)) in vitro and were highly efficient at inhibiting bacterial cell growth. Moreover, they exhibited an in vivo resistance to FBRs by reducing the immune responses, and completely prevented the formation of collagen capsules. Finally, in vivo studies of the E. coli infected mouse model demonstrated that the AgNP loaded porous hydrogels were highly efficient at resisting the bacterial FBRs and infections, while they promoted cell mitigation and infiltration. Findings from this work suggest that AgNP loaded porous hydrogels hold promise in various biomedical applications including in the new generation of implantable biomedical devices and tissue engineering scaffolds.
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Affiliation(s)
- Tong Xu
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, People's Republic of China. Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin 300072, People's Republic of China. Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin, 300072, People's Republic of China
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Surface fluorination of polylactide as a path to improve platelet associated hemocompatibility. Acta Biomater 2018; 78:23-35. [PMID: 30036719 DOI: 10.1016/j.actbio.2018.07.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
Surface-induced thrombosis is still a significant clinical concern for many types of blood-contacting medical devices. In particular, protein adsorption and platelet adhesion are important events due to their ability to trigger the coagulation cascade and initiate thrombosis. Poly(lactic acid) (PLA) has been the predominant polymer used for making bioresorbable stents. Despite long-term advantages, these stents are associated with higher rates of early thrombosis compared with permanent metallic stents. To address this issue, we modified the surface of PLA with a perfluoro compound facilitated by surface activation using radio frequency (RF) plasma. Fluoropolymers have been extensively used in blood contacting materials, such as blood vessel replacements due to their reduced thrombogenicity and reduced platelet reactivity. The compositions of plasma-treated surfaces were determined by electron spectroscopy for chemical analysis (ESCA). Also, contact angle measurements, cell cytotoxicity and the degradation profile of the treated polymers are presented. Finally, relevant blood compatibility parameters, including plasma protein adsorption, platelet adhesion and morphology, were evaluated. We hypothesized that tight binding of adsorbed albumin by fluoropolymers enhances its potential for blood-contacting applications. STATEMENT OF SIGNIFICANCE Although bioresorbable stents made from poly(lactic acid) (PLA) may have long-term clinical advantages, they have shown higher rates of early thrombosis as compared with permanent metallic stents. To improve the thromboresistance of PLA, we developed a novel method for surface fluorination of this polymer with a perfluoro compound. Fluoropolymers (e.g., expanded polytetrafluoroethylene) have long been used in blood-contacting applications due to their satisfactory clinical performance. This is the first report of PLA surface fluorination which might be applied to the fabrication of a new generation of fluorinated PLA stents with improved platelet interaction, tunable degradability and drug release capabilities. Also, we describe a general strategy for improving the platelet interactions with biomaterials based on albumin retention.
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Mori H, Jinnouchi H, Diljon C, Torii S, Sakamoto A, Kolodgie FD, Virmani R, Finn AV. A new category stent with novel polyphosphazene surface modification. Future Cardiol 2018; 14:225-235. [DOI: 10.2217/fca-2017-0103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The COBRA-PzF™ (CeloNova BioSciences, Inc., TX, USA) is a new type of coronary stent composed of a cobalt chromium metallic backbone surrounded by a nanothin layer of Polyzene-F (PzF) without any added drug. Evidence from basic studies supports antithrombotic and anti-inflammatory properties for the PzF surface coating. Preclinical studies support the thromboresistance of PzF-coated surfaces and clinical studies have shown good outcomes for patients receiving this device with very low rates of stent thrombosis. COBRA-PzF may be especially useful in patients at high risk for bleeding. Ongoing clinical trials will determine whether shortening the duration of dual antiplatelet therapy to less than 1 month is feasible and these data may represent a new paradigm with regards to patients at high risk for bleeding.
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Affiliation(s)
| | | | - Chahal Diljon
- University of Maryland, School of Medicine, Baltimore, MD 21201, USA
| | - Sho Torii
- CVPath Institute, Gaithersburg, MD 20878, USA
| | | | | | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD 20878, USA
- University of Maryland, School of Medicine, Baltimore, MD 21201, USA
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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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Mori H, Atmakuri DR, Torii S, Braumann R, Smith S, Jinnouchi H, Gupta A, Harari E, Shkullaku M, Kutys R, Fowler D, Romero M, Virmani R, Finn AV. Very Late Pathological Responses to Cobalt-Chromium Everolimus-Eluting, Stainless Steel Sirolimus-Eluting, and Cobalt-Chromium Bare Metal Stents in Humans. J Am Heart Assoc 2017; 6:JAHA.117.007244. [PMID: 29150493 PMCID: PMC5721792 DOI: 10.1161/jaha.117.007244] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background The “very late” clinical outcomes for durable polymer drug‐eluting stents and bare metal stents (BMSs) have been shown to be dissimilar in clinical studies. Conceptually, the long‐term vascular compatibility of BMSs is still regarded to be superior to drug‐eluting stents; however, no pathologic study to date has specifically addressed this issue. We evaluated the very late (≥1 year) pathologic responses to durable polymer drug‐eluting stents (cobalt–chromium [CoCr] everolimus‐eluting stents [EESs] and stainless steel sirolimus‐eluting stents [SS‐SESs]) versus BMSs (CoCr‐BMSs). Methods and Results From the CVPath stent registry, we studied a total of 119 lesions (40 CoCr‐EESs, 44 SS‐SESs, 35 CoCr‐BMSs) from 92 autopsy cases with a duration ranging from 1 to 5 years. Sections of stented coronary segments were pathologically analyzed. Inflammation score and the percentage of struts with giant cells were lowest in CoCr‐EESs (median inflammation score: 0.6; median percentage of struts with giant cells: 3.8%) followed by CoCr‐BMSs (median inflammation score: 1.3 [P<0.01]; median percentage of struts with giant cells: 8.9% [P=0.02]) and SS‐SESs (median inflammation score: 1.7 [P<0.01]; median percentage of struts with giant cells: 15.3% [P<0.01]). Polymer delamination was observed exclusively in SS‐SESs and was associated with increased inflammatory and giant cell reactions. The prevalence of neoatherosclerosis with CoCr‐EESs (50%) was significantly less than with SS‐SESs (77%, P=0.02) but significantly greater than with CoCr‐BMSs (20%, P<0.01). Conclusions CoCr‐EESs, SS‐SESs, and BMSs each demonstrated distinct vascular responses. CoCr‐EESs demonstrated the least inflammation, near‐equivalent healing to BMSs, and lower neointimal formation. These results challenge the belief that BMSs have superior biocompatibility compared with some polymeric coated drug‐eluting stents and may have implications for future stent design.
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Affiliation(s)
| | | | | | | | | | | | - Anuj Gupta
- School of Medicine, University of Maryland, Baltimore, MD
| | | | - Melsi Shkullaku
- CVPath institute, Gaithersburg, MD.,School of Medicine, University of Maryland, Baltimore, MD
| | | | - David Fowler
- Office of the Chief Medical Examiner, Baltimore, MD
| | | | | | - Aloke V Finn
- CVPath institute, Gaithersburg, MD .,School of Medicine, University of Maryland, Baltimore, MD
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Mori H, Otsuka F, Gupta A, Jinnouchi H, Torii S, Harari E, Virmani R, Finn AV. Revisiting the role of durable polymers in cardiovascular devices. Expert Rev Cardiovasc Ther 2017; 15:835-846. [DOI: 10.1080/14779072.2017.1386098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Hiroyoshi Mori
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Fumiyuki Otsuka
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Anuj Gupta
- Department of Cardiology, University of Maryland, School of Medicine, Baltimore, MD, USA
| | | | - Sho Torii
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Emanuel Harari
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Aloke V. Finn
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
- Department of Cardiology, University of Maryland, School of Medicine, Baltimore, MD, USA
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Mori H, Gupta A, Torii S, Harari E, Jinnouchi H, Virmani R, Finn AV. Clinical implications of blood-material interaction and drug eluting stent polymers in review. Expert Rev Med Devices 2017; 14:707-716. [PMID: 28770625 DOI: 10.1080/17434440.2017.1363646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite advances in drug-eluting stent (DES) technology, stent thrombosis (ST) remains the most feared complication with high morbidity and mortality. Areas covered: Stent related factors certainly play a role in the pathophysiology of ST and more recent data suggest coating technologies have the potential to favorable modify this risk though blood material interactions. Of the polymer coatings used in DES, fluorinated polymers in particular have shown significant promise in modifying the risk of ST through their preferential interactions with albumin which is believed to prevent the adhesion and aggregation of platelets to the stent surface and thus minimize thrombus formation. Preclinical data from the porcine arteriovenous fistula model and clinical data from large network meta-analysis support a role for fluorinated polymers in reducing ST. Expert commentary: The search for more biocompatible anti-thrombotic polymer coatings continues and it is likely that further modification of stent based surfaces will revolutionize the field of interventional cardiology by one day obviating the need for systemic anti-platelet therapies in patients receiving intravascular devices.
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Affiliation(s)
- Hiroyoshi Mori
- a Department of Pathology , CVPath institute , Gaithersburg , MD , USA
| | - Anuj Gupta
- b School of Medicine , University of Maryland , Baltimore , MD , USA
| | - Sho Torii
- a Department of Pathology , CVPath institute , Gaithersburg , MD , USA
| | - Emanuel Harari
- a Department of Pathology , CVPath institute , Gaithersburg , MD , USA
| | | | - Renu Virmani
- a Department of Pathology , CVPath institute , Gaithersburg , MD , USA
| | - Aloke V Finn
- a Department of Pathology , CVPath institute , Gaithersburg , MD , USA.,b School of Medicine , University of Maryland , Baltimore , MD , USA
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Toward a quantified, validated, and verifiable understanding of the Biointerface. Biointerphases 2016; 11:040201. [PMID: 28010113 DOI: 10.1116/1.4972550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Reviakine I, Jung F, Braune S, Brash JL, Latour R, Gorbet M, van Oeveren W. Stirred, shaken, or stagnant: What goes on at the blood-biomaterial interface. Blood Rev 2016; 31:11-21. [PMID: 27478147 DOI: 10.1016/j.blre.2016.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 01/15/2023]
Abstract
There is a widely recognized need to improve the performance of vascular implants and external medical devices that come into contact with blood by reducing adverse reactions they cause, such as thrombosis and inflammation. These reactions lead to major adverse cardiovascular events such as heart attacks and strokes. Currently, they are managed therapeutically. This need remains unmet by the biomaterials research community. Recognized stagnation of the blood-biomaterial interface research translates into waning interest from clinicians, funding agencies, and practitioners of adjacent fields. The purpose of this contribution is to stir things up. It follows the 2014 BloodSurf meeting (74th International IUVSTA Workshop on Blood-Biomaterial Interactions), offers reflections on the situation in the field, and a three-pronged strategy integrating different perspectives on the biological mechanisms underlying blood-biomaterial interactions. The success of this strategy depends on reengaging clinicians and on the renewed cooperation of the funding agencies to support long-term efforts.
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Affiliation(s)
- Ilya Reviakine
- Institute of Functional Interfaces (IFG), Karlsruhe Institute of Technology (KIT), Hermann von Helmholtz Platz 1, 76344 Eggenstein-Leopoldshafen, Germany; Department of Bioengineering, University of Washington, Seattle, WA 98105, USA.
| | - Friedrich Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Kantstrasse 55, 14513 Teltow, Germany
| | - Steffen Braune
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Helmholtz Zentrum Geesthacht, Kantstrasse 55, 14513 Teltow, Germany
| | - John L Brash
- Department of Chemical Engineering, School of Biomedical Engineering, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Robert Latour
- Rhodes Engineering Research Center, Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Maud Gorbet
- Department of Systems Design Engineering, Biomedical Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Wim van Oeveren
- HaemoScan, Stavangerweg 23-23, 9723JC Groningen, The Netherlands
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