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Ryu H, Seo M, Rogers JA. Bioresorbable Metals for Biomedical Applications: From Mechanical Components to Electronic Devices. Adv Healthc Mater 2021; 10:e2002236. [PMID: 33586341 DOI: 10.1002/adhm.202002236] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/29/2021] [Indexed: 01/16/2023]
Abstract
Bioresorbable metals and metal alloys are of growing interest for myriad uses in temporary biomedical implants. Examples range from structural elements as stents, screws, and scaffolds to electronic components as sensors, electrical stimulators, and programmable fluidics. The associated physical forms span mechanically machined bulk parts to lithographically patterned conductive traces, across a diversity of metals and alloys based on magnesium, zinc, iron, tungsten, and others. The result is a rich set of opportunities in healthcare materials science and engineering. This review article summarizes recent advances in this area, starting with an historical perspective followed by a discussion of materials options, considerations in biocompatibility, and device applications. Highlights are in system level bioresorbable electronic platforms that support functions as diagnostics and therapeutics in the context of specific, temporary clinical needs. A concluding section highlights challenges and emerging research directions.
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Affiliation(s)
- Hanjun Ryu
- Center for Bio‐Integrated Electronics Querrey Simpson Institute for Bioelectronics Northwestern University Evanston IL 60208 USA
| | - Min‐Ho Seo
- School of Biomedical Convergence Engineering College of Information & Biomedical Engineering Pusan National University 49 Busandaehak‐ro Yangsan‐si Gyeongsangnam‐do 50612 Republic of Korea
| | - John A. Rogers
- Center for Bio‐Integrated Electronics Querrey Simpson Institute for Bioelectronics Northwestern University Evanston IL 60208 USA
- Department of Mechanical Engineering Northwestern University Evanston IL 60208 USA
- Department of Civil and Environmental Engineering Northwestern University Evanston IL 60208 USA
- Department of Materials Science and Engineering Northwestern University Evanston IL 60208 USA
- Department of Biomedical Engineering Northwestern University Evanston IL 60208 USA
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2
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Huang CC, Lam TN, Amalia L, Chen KH, Yang KY, Muslih MR, Singh SS, Tsai PI, Lee YT, Jain J, Lee SY, Lai HJ, Huang WC, Chen SY, Huang EW. Tailoring grain sizes of the biodegradable iron-based alloys by pre-additive manufacturing microalloying. Sci Rep 2021; 11:9610. [PMID: 33953260 PMCID: PMC8100099 DOI: 10.1038/s41598-021-89022-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
We demonstrated the design of pre-additive manufacturing microalloying elements in tuning the microstructure of iron (Fe)-based alloys for their tunable mechanical properties. We tailored the microalloying stoichiometry of the feedstock to control the grain sizes of the metallic alloy systems. Two specific microalloying stoichiometries were reported, namely biodegradable iron powder with 99.5% purity (BDFe) and that with 98.5% (BDFe-Mo). Compared with the BDFe, the BDFe-Mo powder was found to have lower coefficient of thermal expansion (CTE) value and better oxidation resistance during consecutive heating and cooling cycles. The selective laser melting (SLM)-built BDFe-Mo exhibited high ultimate tensile strength (UTS) of 1200 MPa and fair elongation of 13.5%, while the SLM-built BDFe alloy revealed a much lower UTS of 495 MPa and a relatively better elongation of 17.5%, indicating the strength enhancement compared with the other biodegradable systems. Such an enhanced mechanical behavior in the BDFe-Mo was assigned to the dominant mechanism of ferrite grain refinement coupled with precipitate strengthening. Our findings suggest the tunability of outstanding strength-ductility combination by tailoring the pre-additive manufacturing microalloying elements with their proper concentrations.
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Affiliation(s)
- Chih-Chieh Huang
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30013, Taiwan
| | - Tu-Ngoc Lam
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30013, Taiwan
- Department of Physics, College of Education, Can Tho University, Can Tho City, 900000, Vietnam
| | - Lia Amalia
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30013, Taiwan
- Teknik Material dan Metalurgi, Institut Teknologi Kalimantan, Balikpapan, 76127, Indonesia
| | - Kuan-Hung Chen
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30013, Taiwan
| | - Kuo-Yi Yang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, 310, Taiwan
| | - M Rifai Muslih
- Neutron Scattering Lab. PSTBM-BATAN, Kawasan PUSPIPTEK Serpong, 15314, Indonesia
| | - Sudhanshu Shekhar Singh
- Department of Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur, UP, 208016, India
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, 310, Taiwan
| | - Yuan-Tzu Lee
- Department of Materials Science and Engineering, National Taiwan University, Taipei, 10607, Taiwan
| | - Jayant Jain
- Department of Materials Science and Engineering, Indian Institute of Technology, New Delhi, 110016, India.
| | - Soo Yeol Lee
- Department of Materials Science and Engineering, Chungnam National University, Daejeon, 34134, Republic of Korea.
| | - Hong-Jen Lai
- Material and Chemical Research Laboratories, Industrial Technology Research Institute, Hsinchu, 310, Taiwan
| | - Wei-Chin Huang
- Laser and Additive Manufacturing Technology Center, Industrial Technology Research Institute, Hsinchu, 31040, Taiwan
| | - San-Yuan Chen
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30013, Taiwan
| | - E-Wen Huang
- Department of Materials Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30013, Taiwan.
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Holman H, Kavarana MN, Rajab TK. Smart materials in cardiovascular implants: Shape memory alloys and shape memory polymers. Artif Organs 2020; 45:454-463. [PMID: 33107042 DOI: 10.1111/aor.13851] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
Smart materials have intrinsic properties that change in a controlled fashion in response to external stimuli. Currently, the only smart materials with a significant clinical impact in cardiovascular implant design are shape memory alloys, particularly Nitinol. Recent prodigious progress in material science has resulted in the development of sophisticated shape memory polymers. In this article, we have reviewed the literature and outline the characteristics, advantages, and disadvantages of shape memory alloys and shape memory polymers which are relevant to clinical cardiovascular applications, and describe the potential of these smart materials for applications in coronary stents and transcatheter valves.
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Affiliation(s)
- Heather Holman
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Minoo Naozer Kavarana
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Taufiek Konrad Rajab
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
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Budak K, Sogut O, Aydemir Sezer U. A review on synthesis and biomedical applications of polyglycolic acid. JOURNAL OF POLYMER RESEARCH 2020. [DOI: 10.1007/s10965-020-02187-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ye SH, Chen Y, Mao Z, Gu X, Shankarraman V, Hong Y, Shanov V, Wagner WR. Biodegradable Zwitterionic Polymer Coatings for Magnesium Alloy Stents. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2019; 35:1421-1429. [PMID: 30056712 DOI: 10.1021/acs.langmuir.8b01623] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Degradable metallic stents, most commonly composed of Mg-based alloys, are of interest as an alternative to traditional metallic stents for application in cardiac and peripheral vasculature. Two major design challenges with such stents are control of the corrosion rate and acute presentation of a nonthrombogenic surface to passing blood. In this study, several types of sulfobetaine (SB)-bearing biodegradable polyurethanes were developed and assessed as physical, chemical, and combination-type coatings for a model degradable Mg alloy, AZ31. For physical coatings, poly(ester sulfobetaine)urethane ureas, PESBUUs were synthesized using variable monomers that allowed the incorporation of a varying extent of carboxyl groups. Introduction of the carboxyl groups was associated with faster polymer degradation time. Simple physical coating of PESBUUs reduced macro- and microscopic thrombogenic deposition together with good stability of the coating attachment compared to a control coating of polylactic- co-glycolic acid. For PESBUUs incorporating carboxyl groups (PESBUUs-COOH), these groups could be converted to siloxane groups (PESBUUs-Si), thus creating polymers that could be surface reacted with the oxidized or phytic acid treated AZ31 surface. Chemical (silanization) attachment of these polymers reduced underlying alloy corrosion rates, but following the salination reaction with physical coating most reduced corrosion rates and protected the surface better from the consequences of oxidation occurring under the coating, such as blistering. The application of a multilayered coating approach using a sulfobetaine-based biodegradable elastomer thus offers options for degradable metallic stent design where thromboresistance is desired in combination with a means to control both polymeric coating degradation rates and underlying alloy corrosion rates.
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Affiliation(s)
| | | | | | | | | | | | - Vesselin Shanov
- Department of Bioengineering , University of Texas at Arlington , Arlington , Texas 76019 , United States
- College of Engineering and Applied Science , University of Cincinnati , Cincinnati , Ohio 45221 , United States
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Mollazadeh-Moghaddam K, Rezaei Nejad H, Chen AZ, Ju J, Tamayol A, Liu X, Zhang YS, Oklu R, Khademhosseini A. Fracture-Resistant and Bioresorbable Drug-Eluting Poly(glycerol Sebacate) Coils. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kamyar Mollazadeh-Moghaddam
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Hojatollah Rezaei Nejad
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Ai-Zheng Chen
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Institute of Biomaterials and Tissue Engineering; Huaqiao University; Xiamen Fujian 362021 P. R. China
| | - Jie Ju
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Ali Tamayol
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Department of Mechanical and Materials Engineering; University of Nebraska-Lincoln; Lincoln NE 68508 USA
| | - Xiao Liu
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Beijing Advanced Innovation Center for Biomedical Engineering; Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education; School of Biological Science and Medical Engineering; Beihang University; Beijing 100083 P. R. China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology; Minimally Invasive Therapeutics Laboratory; Mayo Clinic, 5777 E. Mayo Blvd Phoenix AZ 85054 USA
| | - Ali Khademhosseini
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Center for Minimally Invasive Therapeutics; University of California-Los Angeles; Los Angeles CA 90095 USA
- Department of Radiology, David Geffen School of Medicine; University of California-Los Angeles; Los Angeles CA 90095 USA
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences; University of California-Los Angeles; Los Angeles CA 90095 USA. California NanoSystems Institute; University of California-Los Angeles; Los Angeles 90095 CA USA. Department of Bioindustrial Technologies; Konkuk University; Seoul 143-701 Republic of Korea
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Biodegradable stents for coronary artery disease treatment: Recent advances and future perspectives. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 91:163-178. [DOI: 10.1016/j.msec.2018.04.100] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 04/11/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
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Experimental use of new absorbable tracheal stent. J Pediatr Surg 2018; 53:1305-1309. [PMID: 29223669 DOI: 10.1016/j.jpedsurg.2017.11.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/07/2017] [Accepted: 11/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Silicone and metallic stents are not effective in children with tracheobronchial stenosis or tracheomalacia. Herein, we aimed to evaluate the clinical manifestations and histological reaction of rabbit trachea to the presence of a new poly(lactic-co-glycolic acid) with polyisoprene (PLGA/PI) polymer absorbable stent. METHODS Fourteen adult white rabbits (weight, 3.0-3.5kg) were randomly assigned to three groups: Group I (n=6): PLGA/PI spiral stent; Group II (n=6): PLGA/PI fragment; and Group III (n=2): controls. After a longitudinal incision on three cervical tracheal rings, the stents and fragments were inserted into the trachea and fixed onto the lateral wall with nonabsorbable sutures. RESULTS The stented group showed significantly more stridor at rest (p=0.0041), agitation (p=0.014), and use of accessory muscles (p=0.0002) and required more emergency endoscopies than the fragment group. Further, it showed significantly more remarkable histological inflammatory damage than the fragment and control groups (p=0.002). CONCLUSIONS The new PLGA/PI polymeric stent implanted into the trachea of rabbits caused more clinical manifestations and histologically verified inflammatory reaction than the PLGA/PI polymeric fragment. Future studies should be aimed at reducing the stent-wall thickness.
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Oderinde O, Liu S, Li K, Kang M, Imtiaz H, Yao F, Fu G. Multifaceted polymeric materials in three-dimensional processing (3DP) technologies: Current progress and prospects. POLYM ADVAN TECHNOL 2018. [DOI: 10.1002/pat.4281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Olayinka Oderinde
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
| | - Shunli Liu
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
| | - Kewen Li
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
| | - Mengmeng Kang
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
| | - Hussain Imtiaz
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
| | - Fang Yao
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
| | - Guodong Fu
- School of Chemistry and Chemical Engineering Southeast University; Jiangning District Nanjing 211189 China
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Zhang J, Li H, Wang W, Huang H, Pei J, Qu H, Yuan G, Li Y. The degradation and transport mechanism of a Mg-Nd-Zn-Zr stent in rabbit common carotid artery: A 20-month study. Acta Biomater 2018; 69:372-384. [PMID: 29369807 DOI: 10.1016/j.actbio.2018.01.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/18/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
Abstract
Mg-based stent is a promising candidate of the next generation fully degradable vascular stents. The latest progress includes the CE approval of the Magmaris ® WE43 based drug eluting stent. However, so far, the long term (more than 1 year implantation) in vivo degradation and the physiological effects caused by the degradation products were still unclear. In this study, a 20 month observation was carried out after the bare Mg-Nd-Zn-Zr (abbr. JDBM) stent prototype was implanted into the common carotid artery of New Zealand white rabbit in order to evaluate its safety, efficacy and especially degradation behavior. The degradation of the main second phase Mg12Nd was also studied. Results showed that the bare JDBM stent had good safety and efficacy with a complete re-endothelialization within 28 days. The JDBM stent struts were mostly replaced in situ by degradation products in 4 month. The important finding was that the volume and Ca concentration of the degradation products decreased in the long term, eliminating the clinicians' concern of possible vessel calcification. In addition, the alloying elements Mg and Zn in the stent could be safely metabolized as continuous enrichment in any of the main organs were not detected although Nd and Zr showed an abrupt increase in spleen and liver after 1 month implantation. Collectively, the long term in vivo results showed the rapid re-endothelialization of JDBM stent and the long term safety of the degradation products, indicating its great potential as the backbone of the fully degradable vascular stent. STATEMENT OF SIGNIFICANCE Mg-based stent is a promising candidate of the next generation fully degradable stents, especially after the recent market launch of one of its kind (Magmaris). However the fundamental question about the long term degradation and metabolic mechanism of Mg-based stent and its degradation products remain unanswered. We implanted our patented Mg-Nd-Zn-Zr bare stent into the common carotid artery of rabbits and conducted a 20 months observation. We found that the Ca containing degradation products could be further degraded in vivo. All the alloying elements showed no continuous enrichment in the main organs of rabbits. These findings eliminate the clinicians' concern of possible vessel calcification and element enrichment after the implantation of Mg alloy based stents to some extent.
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Affiliation(s)
- Jian Zhang
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China; Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Haiyan Li
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wu Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Hua Huang
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Haiyun Qu
- Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Yongdong Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
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Qi Y, Qi H, He Y, Lin W, Li P, Qin L, Hu Y, Chen L, Liu Q, Sun H, Liu Q, Zhang G, Cui S, Hu J, Yu L, Zhang D, Ding J. Strategy of Metal-Polymer Composite Stent To Accelerate Biodegradation of Iron-Based Biomaterials. ACS APPLIED MATERIALS & INTERFACES 2018; 10:182-192. [PMID: 29243907 DOI: 10.1021/acsami.7b15206] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The new principle and technique to tune biodegradation rates of biomaterials is one of the keys to the development of regenerative medicine and next-generation biomaterials. Biodegradable stents are new-generation medical devices applied in percutaneous coronary intervention, etc. Recently, both corrodible metals and degradable polymers have drawn much attention in biodegradable stents or scaffolds. It is, however, a dilemma to achieve good mechanical properties and appropriate degradation profiles. Herein, we put forward a metal-polymer composite strategy to achieve both. Iron stents exhibit excellent mechanical properties but low corrosion rate in vivo. We hypothesized that coating of biodegradable aliphatic polyester could accelerate iron corrosion due to the acidic degradation products, etc. To demonstrate the feasibility of this composite material technique, we first conducted in vitro experiments to affirm that iron sheet corroded faster when covered by polylactide (PLA) coating. Then, we fabricated three-dimensional metal-polymer stents (MPS) and implanted the novel stents in the abdominal aorta of New Zealand white rabbits, setting metal-based stents (MBS) as a control. A series of in vivo experiments were performed, including measurements of residual mass and radial strength of the stents, histological analysis, micro-computed tomography, and optical coherence tomography imaging at the implantation site. The results showed that MPS could totally corrode in some cases, whereas iron struts of MBS in all cases remained several months after implantation. Corrosion rates of MPS could be easily regulated by adjusting the composition of PLA coatings.
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Affiliation(s)
- Yongli Qi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Haiping Qi
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Yao He
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Wenjiao Lin
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Peize Li
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Li Qin
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Yiwen Hu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Liping Chen
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Qingsong Liu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Hongtao Sun
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Qiong Liu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Gui Zhang
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Shuquan Cui
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Jun Hu
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Lin Yu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
| | - Deyuan Zhang
- R&D Center, Lifetech Scientific (Shenzhen) Co., Ltd. , Shenzhen 518057, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University , Shanghai 200433, China
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Kim YS, Yoon D, Byun J, Park H, Lee A, Kim IH, Lee S, Lim HS, Park RW. Extracting information from free-text electronic patient records to identify practice-based evidence of the performance of coronary stents. PLoS One 2017; 12:e0182889. [PMID: 28800599 PMCID: PMC5553787 DOI: 10.1371/journal.pone.0182889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background and objective Percutaneous coronary intervention (PCI) using drug-eluting stents (DES) is an indispensable treatment for coronary artery disease. However, to evaluate the performance of various types of stents for PCI, numerous resources are required. We extracted clinical information from free-text records and, using practice-based evidence, compared the efficacy of various DES. Materials and methods We developed a text mining tool based on regular expression and applied it to PCI reports stored in the electronic health records (EHRs) of Ajou University Hospital from 2010–2014. The PCI data were extracted from EHRs with a sensitivity of 0.996, a specificity of 1.000, and an F-measure of 0.995 when compared with a sample of 200 reports. Using these data, we compared the performance of stents by Kaplan-Meier analysis and the Cox hazard proportional regression. Results In the self-validation analysis comparing the first-generation to the second-generation DES, the second-generation DES was superior to the first-generation DES (hazard ratio [HR]: 0.423, 95% confidence interval [CI]: 0.284–0.630) in terms of target vessel revascularization (TVR), showing similar findings to the established results of previous studies. Among the second-generation DES, the biodegradable-polymer DES tended to be superior, with a risk of TVR (HR: 0.568, 95% CI: 0.281–1.147) falling below than that for the durable-polymer DES approximately 1 year after the index procedure. The Endeavor stent had the highest TVR risk among the newer generation DES (HR: 2.576, 95% CI: 1.273–5.210). Conclusions In this study, we demonstrated how to construct a PCI data warehouse of PCI-related parameters obtained from free-text electronic records with high accuracy for use in the post surveillance of coronary stents in a time- and cost effective manner. Post surveillance of the practice based evidence in the PCI data warehouse indicated that the biodegradable-polymer DES might have a lower risk of TVR than the durable-polymer DES.
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Affiliation(s)
- Yoon Seob Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - JungHyun Byun
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Hojun Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Ahram Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Il Hyun Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Sukhoon Lee
- Department of Software Convergence Engineering, Kunsan National University, Gunsan Jeollabuk-do, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
- * E-mail: (HSL); (RWP)
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
- * E-mail: (HSL); (RWP)
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Zhao S, Seitz JM, Eifler R, Maier HJ, Guillory RJ, Earley EJ, Drelich A, Goldman J, Drelich JW. Zn-Li alloy after extrusion and drawing: Structural, mechanical characterization, and biodegradation in abdominal aorta of rat. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 76:301-312. [PMID: 28482531 PMCID: PMC5459357 DOI: 10.1016/j.msec.2017.02.167] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/19/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
Zinc shows great promise as a bio-degradable metal. Our early in vivo investigations implanting pure zinc wires into the abdominal aorta of Sprague-Dawley rats revealed that metallic zinc does not promote restenotic responses and may suppress the activities of inflammatory and smooth muscle cells. However, the low tensile strength of zinc remains a major concern. A cast billet of the Zn-Li alloy was produced in a vacuum induction caster under argon atmosphere, followed by a wire drawing process. Two phases of the binary alloy identified by x-ray diffraction include the zinc phase and intermetallic LiZn4 phase. Mechanical testing proved that incorporating 0.1wt% of Li into Zn increased its ultimate tensile strength from 116±13MPa (pure Zn) to 274±61MPa while the ductility was held at 17±7%. Implantation of 10mm Zn-Li wire segments into abdominal aorta of rats revealed an excellent biocompatibility of this material in the arterial environment. The biodegradation rate for Zn-Li was found to be about 0.008mm/yr and 0.045mm/yr at 2 and 12months, respectively.
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Affiliation(s)
- Shan Zhao
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, USA
| | - Jan-M Seitz
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, USA
| | - Rainer Eifler
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, Garbsen, Germany
| | - Hans J Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, Garbsen, Germany
| | - Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Elisha J Earley
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Adam Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, USA
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI, USA.
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14
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Kounis NG, Koniari I, Roumeliotis A, Tsigkas G, Soufras G, Grapsas N, Davlouros P, Hahalis G. Thrombotic responses to coronary stents, bioresorbable scaffolds and the Kounis hypersensitivity-associated acute thrombotic syndrome. J Thorac Dis 2017; 9:1155-1164. [PMID: 28523173 DOI: 10.21037/jtd.2017.03.134] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Percutaneous transluminal coronary angioplasty with coronary stent implantation is a life-saving medical procedure that has become, nowadays, the most frequent performed therapeutic procedure in medicine. Plain balloon angioplasty, bare metal stents, first and second generation drug-eluting stents, bioresorbable and bioabsorbable scaffolds have offered diachronically a great advance against coronary artery disease and have enriched our medical armamentarium. Stented areas constitute vulnerable sites for endothelial damage, endothelial dysfunction, flow turbulence, hemorheologic changes, platelet dysfunction, coagulation changes and fibrinolytic disturbances. Implant surface attracts several proteins such as albumin, fibronectin, fibrinogen, and complement that lead to complement system activation. Macrophages recognize the implant as foreign substance due to protein adsorption and its continuous presence results in macrophage differentiation and fusion into foreign body giant cells. Polymer coating, stent metallic platforms and the released drugs can act as strong antigenic complex that apply continuous, repetitive, persistent and chronic hypersensitivity irritation to the coronary intima. The concomitant administration of oral antiplatelet drugs and environmental exposures can induce hypersensitivity inflammation. A class of platelets, activated via high-affinity and low-affinity IgE hypersensitivity receptors FCγRI, FCγRII, FCεRI and FCεRII, can induce Kounis hypersensitivity-associated thrombotic syndrome inside the stented coronaries. Type III variant of this syndrome is diagnosed when coronary artery stent thrombosis is associated with thrombus infiltrated by eosinophils or mast cells and/or when coronary intima, media and adventitia adjacent to stent, is infiltrated by eosinophils or mast cells. Careful history of hypersensitivity reactions to all implanted materials and concomitant drugs with monitoring of inflammatory mediators as well as lymphocyte transformation studies to detect hypersensitivity must be undertaken in order to avoid disastrous consequences. Food and Drug Administration recommendations for coronary stent implantation should be applied also to bioresorbable scaffolds. Further studies with inert and non-allergenic implants are necessary.
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Ioanna Koniari
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Anastasios Roumeliotis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - George Soufras
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Nicholas Grapsas
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - Periklis Davlouros
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Rion, Achaia, Greece
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15
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Finotti PFM, Costa LC, Capote TSO, Scarel-Caminaga RM, Chinelatto MA. Immiscible poly(lactic acid)/poly(ε-caprolactone) for temporary implants: Compatibility and cytotoxicity. J Mech Behav Biomed Mater 2017; 68:155-162. [PMID: 28171812 DOI: 10.1016/j.jmbbm.2017.01.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
Abstract
This manuscript focuses on the effect of the addition of a low molecular weight triblock copolymer derived from ε-caprolactone and tetrahydrofuran (CT) on the compatibility and cytotoxicity of immiscible poly(lactic acid) (PLA) and poly(ε-caprolactone) (PCL) blends. Binary and tertiary PLA/PCL blends were prepared by melt mixing in a twin-screw extruder and their morphological, mechanical and thermal behaviors were investigated by scanning electron microscopy (SEM), tensile and Izod impact test, dynamic mechanical analysis (DMA) and differential scanning calorimetry (DSC). SEM micrographs showed the CT copolymer suppressed the coalescence phenomena and maintained the size of dispersed PCL domains at approximately 0.35µm. Bioresorbable PLA/PCL blends containing 5wt% of CT copolymer exhibited a remarkable increase in ductility and improved toughness at room temperature. Although the CT copolymer increased the interfacial adhesion, the DMA results suggest it also acts as a plasticizer exclusively for the PCL phase. The cell viability evaluated by the XTT assay confirmed PLA/PCL blends compatibilized by CT copolymer exerted no cytotoxic effect.
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Affiliation(s)
- Pablo F M Finotti
- Department of Materials Engineering, Engineering School of São Carlos, University of São Paulo - USP, São Carlos, São Paulo 13563-120, Brazil
| | - Lidiane C Costa
- Department of Materials Engineering, Federal University of São Carlos - UFSCar, São Carlos, São Paulo 13565-905, Brazil
| | - Ticiana S O Capote
- Department of Morphology, School of Dentistry at Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo 14801-603, Brazil
| | - Raquel M Scarel-Caminaga
- Department of Morphology, School of Dentistry at Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo 14801-603, Brazil
| | - Marcelo A Chinelatto
- Department of Materials Engineering, Engineering School of São Carlos, University of São Paulo - USP, São Carlos, São Paulo 13563-120, Brazil.
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16
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Koniari I, Kounis NG, Hahalis G. In-stent restenosis and thrombosis due to metal hypersensitivity: implications for Kounis syndrome. J Thorac Dis 2017; 8:3056-3058. [PMID: 28066582 DOI: 10.21037/jtd.2016.11.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ioanna Koniari
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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17
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Lin ST, Kimble L, Bhattacharyya D. Polymer Blends and Composites for Biomedical Applications. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2017. [DOI: 10.1007/978-3-662-53574-5_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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18
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Mostavan A, Paternoster C, Tolouei R, Ghali E, Dubé D, Mantovani D. Effect of electrolyte composition and deposition current for Fe/Fe-P electroformed bilayers for biodegradable metallic medical applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 70:195-206. [DOI: 10.1016/j.msec.2016.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 07/08/2016] [Accepted: 08/12/2016] [Indexed: 11/15/2022]
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19
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Fogarty TJ, Arko FR, Zarins CK. Ten Years of Advancements in Interventional Cardiology. J Endovasc Ther 2016; 11 Suppl 2:II192-9. [PMID: 15760266 DOI: 10.1177/15266028040110s604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The past decade has seen the evolution of an exciting technology that has changed forever the treatment of aortic aneurysmal disease. From rather crude homemade stent-grafts constructed in the surgical suite to elegant commercially manufactured devices in a variety of configurations and sizes, the aortic endograft has experienced a meteoric rise in popularity to become a beneficial, minimally invasive therapy that can obviate the risk of rupture and death. There are now 3 approved endovascular devices on the market for infrarenal abdominal aortic aneurysm repair, and it is likely that additional and improved devices will become available in the future. This review revisits the developmental history of the aortic endograft, noting the ongoing refinements that have arisen from our experiences with the growing population of stent-graft patients. Although research continues to search for solutions to the problems of endoleak and migration, long-term results even with the earlier second and third-generation devices are better than has been achieved with open surgical repair.
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Affiliation(s)
- Thomas J Fogarty
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, California 94305, USA
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20
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Mechanical Properties and In Vitro Degradation of Sputtered Biodegradable Fe-Au Foils. MATERIALS 2016; 9:ma9110928. [PMID: 28774049 PMCID: PMC5457263 DOI: 10.3390/ma9110928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022]
Abstract
Iron-based materials proved being a viable candidate material for biodegradable implants. Magnetron sputtering combined with UV-lithography offers the possibility to fabricate structured, freestanding foils of iron-based alloys and even composites with non-solvable elements. In order to accelerate the degradation speed and enhance the mechanical properties, the technique was used to fabricate Fe-Au multilayer foils. The foils were annealed after the deposition to form a homogeneous microstructure with fine Au precipitates. The characterization of the mechanical properties was done by uniaxial tensile tests. The degradation behavior was analyzed by electrochemical tests and immersion tests under in vitro conditions. Due to the noble Au precipitates it was possible to achieve high tensile strengths between 550 and 800 MPa depending on the Au content and heat treatment. Furthermore, the Fe-Au foils showed a significantly accelerated corrosion compared to pure iron samples. The high mechanical strength is close to the properties of SS316L steel. In combination with the accelerated degradation rate, sputtered Fe-Au foils showed promising properties for use as iron-based, biodegradable implants.
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21
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Abstract
Drug-eluting stents are an effective therapy for symptomatic arterial obstructions, substantially reducing the incidence of restenosis by suppressing the migration and proliferation of vascular smooth muscle cells into the intima. However, current drug-eluting stents also inhibit the growth of endothelial cells, which are required to cover the vascular stent to reduce an excessive inflammatory response. As a result, the endothelial lining of the lumen is not regenerated. Since the loss of this homeostatic monolayer increases the risk of thrombosis, patients with drug-eluting stents require long-term antithrombotic therapy. Thus, there is a need for improved devices with enhanced effectiveness and physiological compatibility towards endothelial cells. Current developments in nanomaterials may enhance the function of commercially available vascular devices. In particular, modified design schemes might incorporate nanopatterns or nanoparticle-eluting features that reduce restenosis and enhance re-endothelialization. The intent of this review is to discuss emerging nanotechnologies that will improve the performance of vascular stents.
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Affiliation(s)
| | - John P Cooke
- Houston Methodist Research Institute, Houston, Texas
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22
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Huang T, Zheng Y, Han Y. Accelerating degradation rate of pure iron by zinc ion implantation. Regen Biomater 2016; 3:205-15. [PMID: 27482462 PMCID: PMC4966292 DOI: 10.1093/rb/rbw020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 12/19/2022] Open
Abstract
Pure iron has been considered as a promising candidate for biodegradable implant applications. However, a faster degradation rate of pure iron is needed to meet the clinical requirement. In this work, metal vapor vacuum arc technology was adopted to implant zinc ions into the surface of pure iron. Results showed that the implantation depth of zinc ions was about 60 nm. The degradation rate of pure iron was found to be accelerated after zinc ion implantation. The cytotoxicity tests revealed that the implanted zinc ions brought a slight increase on cytotoxicity of the tested cells. In terms of hemocompatibility, the hemolysis of zinc ion implanted pure iron was lower than 2%. However, zinc ions might induce more adhered and activated platelets on the surface of pure iron. Overall, zinc ion implantation can be a feasible way to accelerate the degradation rate of pure iron for biodegradable applications.
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Affiliation(s)
- Tao Huang
- State Key Laboratory for Turbulence and Complex System and Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yufeng Zheng
- State Key Laboratory for Turbulence and Complex System and Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yong Han
- State Key Laboratory for Mechanical Behavior of Materials, Xian Jiaotong University, Xian 710049, China
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23
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Mouzou E, Paternoster C, Tolouei R, Purnama A, Chevallier P, Dubé D, Prima F, Mantovani D. In vitro degradation behavior of Fe–20Mn–1.2C alloy in three different pseudo-physiological solutions. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 61:564-73. [DOI: 10.1016/j.msec.2015.12.092] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/26/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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24
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Uniform and accelerated degradation of pure iron patterned by Pt disc arrays. Sci Rep 2016; 6:23627. [PMID: 27033380 PMCID: PMC4817040 DOI: 10.1038/srep23627] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/09/2016] [Indexed: 01/09/2023] Open
Abstract
Pure iron has been confirmed as a promising biodegradable metal. However, the degradation rate of pure iron should be accelerated to meet the clinical requirements. In this work, two different designs of platinum disc arrays, including sizes of Φ20 μm × S5 μm and Φ4 μm × S4 μm, have been coated on the surface of pure iron. Corrosion tests showed the platinum discs formed plenty of galvanic cells with the iron matrix which significantly accelerated the degradation of pure iron. Simultaneously, due to the designability of the shape, size as well as distribution of Pt discs, the degradation rate as well as degradation uniformity of pure iron can be effectively controlled by coating with platinum discs. The cytotoxicity test results unveiled that Pt discs patterned pure iron exhibited almost no toxicity to human umbilical vein endothelial cells, but a significant inhibition on proliferation of vascular smooth muscle cells. In addition, the hemolysis rate of Pt discs patterned pure iron was lower than 1%. Moreover, Pt discs also effectively reduced the number of adhered platelets. All these results indicated that Pt discs patterning is an effective way to accelerate degradation and improve biocompatibility of pure iron.
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25
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Modelling pH-Optimized Degradation of Microgel-Functionalized Polyesters. JOURNAL OF HEALTHCARE ENGINEERING 2016; 2016:8125416. [PMID: 29062470 PMCID: PMC5058564 DOI: 10.1155/2016/8125416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022]
Abstract
We establish a novel mathematical model to describe and analyze pH levels in the vicinity of poly(N-vinylcaprolactam-co-acetoacetoxyethyl methacrylate-co-N-vinylimidazole) (VCL/AAEM/VIm) microgel-functionalized polymers during biodegradation. Biodegradable polymers, especially aliphatic polyesters (polylactide/polyglycolide/polycaprolactone homo- and copolymers), have a large range of medical applications including delivery systems, scaffolds, or stents for the treatment of cardiovascular diseases. Most of those applications are limited by the inherent drop of pH level during the degradation process. The combination of polymers with VCL/AAEM/VIm-microgels, which aims at stabilizing pH levels, is innovative and requires new mathematical models for the prediction of pH level evaluation. The mathematical model consists of a diffusion-reaction PDE system for the degradation including reaction rate equations and diffusion of acidic degradation products into the vicinity. A system of algebraic equations is coupled to the degradation model in order to describe the buffering action of the microgel. The model is validated against the experimental pH-monitored biodegradation of microgel-functionalized polymer foils and is available for the design of microgel-functionalized polymer components.
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26
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Yu Y, Wise SG, Celermajer DS, Bilek MMM, Ng MKC. Bioengineering stents with proactive biocompatibility. Interv Cardiol 2015. [DOI: 10.2217/ica.15.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Soares JS, Moore JE. Biomechanical Challenges to Polymeric Biodegradable Stents. Ann Biomed Eng 2015; 44:560-79. [DOI: 10.1007/s10439-015-1477-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
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28
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Ferdous J, Kolachalama VB, Kolandaivelu K, Shazly T. Degree of bioresorbable vascular scaffold expansion modulates loss of essential function. Acta Biomater 2015; 26:195-204. [PMID: 26277377 PMCID: PMC4584207 DOI: 10.1016/j.actbio.2015.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/03/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022]
Abstract
Drug-eluting bioresorbable vascular scaffolds (BVSs) have the potential to restore lumen patency, enable recovery of the native vascular environment, and circumvent late complications associated with permanent endovascular devices. To ensure therapeutic effects persist for sufficient times prior to scaffold resorption and resultant functional loss, many factors dictating BVS performance must be identified, characterized and optimized. While some factors relate to BVS design and manufacturing, others depend on device deployment and intrinsic vascular properties. Importantly, these factors interact and cannot be considered in isolation. The objective of this study is to quantify the extent to which degree of radial expansion modulates BVS performance, specifically in the context of modifying device erosion kinetics and evolution of structural mechanics and local drug elution. We systematically varied degree of radial expansion in model BVS constructs composed of poly dl-lactide-glycolide and generated in vitro metrics of device microstructure, degradation, erosion, mechanics and drug release. Experimental data permitted development of computational models that predicted transient concentrations of scaffold-derived soluble species and drug in the arterial wall, thus enabling speculation on the short- and long-term effects of differential expansion. We demonstrate that degree of expansion significantly affects scaffold properties critical to functionality, underscoring its relevance in BVS design and optimization. STATEMENT OF SIGNIFICANCE Bioresorbable vascular scaffold (BVS) therapy is beginning to transform the treatment of obstructive artery disease, owing to effective treatment of short term vessel closure while avoiding long term consequences such as in situ, late stent thrombosis - a fatal event associated with permanent implants such as drug-eluting stents. As device scaffolding and drug elution are temporary for BVS, the notion of using this therapy in lieu of existing, clinically approved devices seems attractive. However, there is still a limited understanding regarding the optimal lifetime and performance characteristics of erodible endovascular implants. Several engineering criteria must be met and clinical endpoints confirmed to ensure these devices are both safe and effective. In this manuscript, we sought to establish general principles for the design and deployment of erodible, drug-eluting endovascular scaffolds, with focus on how differential expansion can modulate device performance.
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Affiliation(s)
- Jahid Ferdous
- Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Vijaya B Kolachalama
- Charles Stark Draper Laboratory, Cambridge, MA 02139, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Kumaran Kolandaivelu
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Tarek Shazly
- Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA; Department of Mechanical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA.
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29
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Hiebl B, Nennig E, Schiestel S, Kovacs A, Jung F, Fischer H. Biocompatibility of a novel zinc stent with a closed-cell-design. Clin Hemorheol Microcirc 2015; 61:205-11. [DOI: 10.3233/ch-151983] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bernhard Hiebl
- Center for Medical Basic Research, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ernst Nennig
- OPTIMED Medizinische Instrumente GmbH, Ettlingen, Germany
| | | | | | - Friedrich Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Kantstrasse, Teltow, Germany
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30
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Computational Bench Testing to Evaluate the Short-Term Mechanical Performance of a Polymeric Stent. Cardiovasc Eng Technol 2015; 6:519-32. [DOI: 10.1007/s13239-015-0235-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
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31
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Wang Y, Zhang X. Vascular restoration therapy and bioresorbable vascular scaffold. Regen Biomater 2014; 1:49-55. [PMID: 26816624 PMCID: PMC4669005 DOI: 10.1093/rb/rbu005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
This article describes the evolution of minimally invasive intervention technologies for vascular restoration therapy from early-stage balloon angioplasty in 1970s, metallic bare metal stent and metallic drug-eluting stent technologies in 1990s and 2000s, to bioresorbable vascular scaffold (BVS) technology in large-scale development in recent years. The history, the current stage, the challenges and the future of BVS development are discussed in detail as the best available approach for vascular restoration therapy. The criteria of materials selection, design and processing principles of BVS, and the corresponding clinical trial results are also summarized in this article.
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Affiliation(s)
- Yunbing Wang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xingdong Zhang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
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32
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Biomaterials in cardiovascular research: applications and clinical implications. BIOMED RESEARCH INTERNATIONAL 2014; 2014:459465. [PMID: 24895577 PMCID: PMC4033350 DOI: 10.1155/2014/459465] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/29/2014] [Accepted: 03/31/2014] [Indexed: 12/13/2022]
Abstract
Cardiovascular biomaterials (CB) dominate the category of biomaterials based on the demand and investments in this field. This review article classifies the CB into three major classes, namely, metals, polymers, and biological materials and collates the information about the CB. Blood compatibility is one of the major criteria which limit the use of biomaterials for cardiovascular application. Several key players are associated with blood compatibility and they are discussed in this paper. To enhance the compatibility of the CB, several surface modification strategies were in use currently. Some recent applications of surface modification technology on the materials for cardiovascular devices were also discussed for better understanding. Finally, the current trend of the CB, endothelization of the cardiac implants and utilization of induced human pluripotent stem cells (ihPSCs), is also presented in this review. The field of CB is growing constantly and many new investigators and researchers are developing interest in this domain. This review will serve as a one stop arrangement to quickly grasp the basic research in the field of CB.
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33
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Gundogan B, Tan A, Farhatnia Y, Alavijeh MS, Cui Z, Seifalian AM. Bioabsorbable stent quo vadis: a case for nano-theranostics. Am J Cancer Res 2014; 4:514-33. [PMID: 24672583 PMCID: PMC3966055 DOI: 10.7150/thno.8137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/28/2014] [Indexed: 12/11/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is one of the most commonly performed invasive medical procedures in medicine today. Since the first coronary balloon angioplasty in 1977, interventional cardiology has seen a wide array of developments in PCI. Bare metal stents (BMS) were soon superseded by the revolutionary drug-eluting stents (DES), which aimed to address the issue of restenosis found with BMS. However, evidence began to mount against DES, with late-stent thrombosis (ST) rates being higher than that of BMS. The bioabsorbable stent may be a promising alternative, providing vessel patency and support for the necessary time required and thereafter degrade into safe non-toxic compounds which are reabsorbed by the body. This temporary presence provides no triggers for ST, which is brought about by non-endothelialized stent struts and drug polymers remaining in vivo for extended periods of time. Likewise, nano-theranostics incorporated into a bioabsorbable stent of the future may provide an incredibly valuable single platform offering both therapeutic and diagnostic capabilities. Such a stent may allow delivery of therapeutic particles to specific sites thus keeping potential toxicity to a minimum, improved ease of tracking delivery in vivo by embedding imaging agents, controlled rate of therapy release and protection of the implanted therapy. Indeed, nanocarriers may allow an increased therapeutic index as well as offer novel post-stent implantation imaging and diagnostic methods for atherosclerosis, restenosis and thrombosis. It is envisioned that a nano-theranostic stent may well form the cornerstone of future stent designs in clinical practice.
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Mullen MJ, Devellian CA, Jux C. BioSTAR®bioabsorbable septal repair implant. Expert Rev Med Devices 2014; 4:781-92. [DOI: 10.1586/17434440.4.6.781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kohn J, Zeltinger J. Degradable, drug-eluting stents: a new frontier for the treatment of coronary artery disease. Expert Rev Med Devices 2014; 2:667-71. [PMID: 16293093 DOI: 10.1586/17434440.2.6.667] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reviews the clinical use of stents in the treatment of coronary artery disease and the rationale for the use of degradable, drug-eluting polymer stents. The authors note the challenges of using off-the-shelf polymers for the development of degradable stents, as well as the interplay between polymer properties and a functional stent design. Drug-eluting metal stents are the most significant advancement in the treatment of coronary artery disease, and have significantly reduced the occurrence of in-stent restenosis after placement. Some regard drug-eluting metal stents as the final technologic advancement in the treatment of coronary artery disease, others consider the future development of degradable, drug-eluting stents as the next logical step.
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Affiliation(s)
- Joachim Kohn
- New Jersey Center for Biomaterials, Rutgers University, 145 Bevier Road, Piscataway, NJ 08854, USA.
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Santos A, Sinn Aw M, Bariana M, Kumeria T, Wang Y, Losic D. Drug-releasing implants: current progress, challenges and perspectives. J Mater Chem B 2014; 2:6157-6182. [DOI: 10.1039/c4tb00548a] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review presents the different types and concepts of drug-releasing implants using new nanomaterials and nanotechnology-based devices.
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Affiliation(s)
- Abel Santos
- School of Chemical Engineering
- The University of Adelaide
- 5005 Adelaide, Australia
| | - Moom Sinn Aw
- School of Chemical Engineering
- The University of Adelaide
- 5005 Adelaide, Australia
| | - Manpreet Bariana
- School of Chemical Engineering
- The University of Adelaide
- 5005 Adelaide, Australia
- School of Dentistry
- The University of Adelaide
| | - Tushar Kumeria
- School of Chemical Engineering
- The University of Adelaide
- 5005 Adelaide, Australia
| | - Ye Wang
- School of Chemical Engineering
- The University of Adelaide
- 5005 Adelaide, Australia
| | - Dusan Losic
- School of Chemical Engineering
- The University of Adelaide
- 5005 Adelaide, Australia
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Schaffer JE, Nauman EA, Stanciu LA. Cold drawn bioabsorbable ferrous and ferrous composite wires: an evaluation of in vitro vascular cytocompatibility. Acta Biomater 2013; 9:8574-84. [PMID: 22885027 DOI: 10.1016/j.actbio.2012.07.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/22/2012] [Accepted: 07/30/2012] [Indexed: 11/16/2022]
Abstract
A systematic approach is applied to quantify the impact of bioabsorbable metals on human vascular endothelial cells (EC) and aortic smooth muscle cells (SMC) with the aim of optimizing bioabsorbable endovascular stent development. Composite wires comprising novel combinations of Fe, Mn, Mg, and Zn were produced and fabricated into tubular mesh stents. The stents were incubated with primary EC in order to assess attachment and cell proliferation. Migration of SMCs from the vessel medial wall to the target lesion site following recanalization of an atherosclerotic artery is important in the process of neointimal hyperplasia. Metal ion species were assayed for their impact on cell migration and survival at concentrations ranging from 0.037 to 10 mM. An MTT-based assay was used to assess cytotoxicity after insult with various metal ion concentrations. Fe(2+) and Fe(3+) ion species were found to repress the migration of SMCs across a porous polycarbonate track etch membrane at concentrations of 1 mM. Mn(2+) promoted SMC migration at a concentration of 1 mM, however, this effect was quenched when Fe(2+) was included. Mg(2+) was found to significantly increase SMC migration at concentrations above 1 mM. Cell survival was not reduced after 24 h insult with concentrations of Mg(2+) up to 10 mM. LD50 concentrations of greater than 1 mM were found for Mg(2+), Fe(2+), Fe(3+), and Fe(2+) with 35 wt.% Mn(2+). Significantly greater numbers of EC attached to bioabsorbable metal species compared with 316L stainless steel. Good EC coverage and proliferation were observed for all tested materials up to 120 h.
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Affiliation(s)
- Jeremy E Schaffer
- Fort Wayne Metals, Research and Development, 9609 Ardmore Avenue, Fort Wayne, IN 46809, USA.
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Wang J, He Y, Maitz MF, Collins B, Xiong K, Guo L, Yun Y, Wan G, Huang N. A surface-eroding poly(1,3-trimethylene carbonate) coating for fully biodegradable magnesium-based stent applications: toward better biofunction, biodegradation and biocompatibility. Acta Biomater 2013; 9:8678-89. [PMID: 23467041 DOI: 10.1016/j.actbio.2013.02.041] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/11/2013] [Accepted: 02/22/2013] [Indexed: 12/19/2022]
Abstract
Biodegradable magnesium-based materials have a high potential for cardiovascular stent applications; however, there exist concerns on corrosion control and biocompatibility. A surface-eroding coating of poly(1,3-trimethylene carbonate) (PTMC) on magnesium (Mg) alloy was studied, and its dynamic degradation behavior, electrochemical corrosion, hemocompatibility and histocompatibility were investigated. The PTMC coating effectively protected the corrosion of the Mg alloy in the dynamic degradation test. The corrosion current density of the PTMC-coated alloy reduced by three orders and one order of magnitude compared to bare and poly(ε-caprolactone) (PCL)-coated Mg alloy, respectively. Static and dynamic blood tests in vitro indicated that significantly fewer platelets were adherent and activated, and fewer erythrocytes attached on the PTMC-coated surface and showed less hemolysis than on the controls. The PTMC coating after 16 weeks' subcutaneous implantation in rats maintained ~55% of its original thickness and presented a homogeneously flat surface demonstrating surface erosion, in contrast to the PCL coated control, which exhibited non-uniform bulk erosion. The Mg alloy coated with PTMC showed less volume reduction and fewer corrosion products as compared to the controls after 52 weeks in vivo. Excessive inflammation, necrosis and hydrogen gas accumulation were not observed. The homogeneous surface erosion of the PTMC coating from exterior to interior (surface-eroding behavior) and its charge neutral degradation products contribute to its excellent protective performance. It is concluded that PTMC is a promising candidate for a surface-eroding coating applied to Mg-based implants.
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Vieira AC, Guedes RM, Tita V. Considerations for the design of polymeric biodegradable products. JOURNAL OF POLYMER ENGINEERING 2013. [DOI: 10.1515/polyeng-2012-0150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Several biodegradable polymers are used in many products with short life cycles. The performance of a product is mostly conditioned by the materials selection and dimensioning. Strength, maximum strain and toughness will decrease along its degradation, and it should be enough for the predicted use. Biodegradable plastics can present short-term performances similar to conventional plastics. However, the mechanical behavior of biodegradable materials, along the degradation time, is still an unexplored subject. The maximum strength failure criteria, as a function of degradation time, have traditionally been modeled according to first order kinetics. In this work, hyperelastic constitutive models are discussed. An example of these is shown for a blend composed of poly(L-lactide) acid (PLLA) and polycaprolactone (PCL). A numerical approach using ABAQUS is presented, which can be extended to other 3D geometries. Thus, the material properties of the model proposed are automatically updated in correspondence to the degradation time, by means of a user material subroutine. The parameterization was achieved by fitting the theoretical curves with the experimental data of tensile tests made on a PLLA-PCL blend (90:10) for different degradation times. The results obtained by numerical simulations are compared to experimental data, showing a good correlation between both results.
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In-Stent Restenosis in the Superficial Femoral Artery. Ann Vasc Surg 2013; 27:510-24. [DOI: 10.1016/j.avsg.2012.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/07/2012] [Accepted: 09/16/2012] [Indexed: 11/20/2022]
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Mechanical Properties and Tensile Failure Analysis of Novel Bio-absorbable Mg-Zn-Cu and Mg-Zn-Se Alloys for Endovascular Applications. METALS 2013; 3:23-40. [PMID: 23543822 DOI: 10.3390/met3010023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this paper, the mechanical properties and tensile failure mechanism of two novel bio-absorbable as-cast Mg-Zn-Se and Mg-Zn-Cu alloys for endovascular medical applications are characterized. Alloys were manufactured using an ARC melting process and tested as-cast with compositions of Mg-Zn-Se and Mg-Zn-Cu, being 98/1/1 wt.% respectively. Nanoindentation testing conducted at room temperature was used to characterize the elastic modulus (E) and surface hardness (H) for both the bare alloys and the air formed oxide layer. As compared to currently available shape memory alloys and degradable as-cast alloys, these experimental alloys possess superior as-cast mechanical properties that can increase their biocompatibility, degradation kinetics, and the potential for medical device creation.
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Bourantas CV, Zhang Y, Farooq V, Garcia-Garcia HM, Onuma Y, Serruys PW. Bioresorbable scaffolds: current evidence and ongoing clinical trials. Curr Cardiol Rep 2013; 14:626-34. [PMID: 22810889 PMCID: PMC3432788 DOI: 10.1007/s11886-012-0295-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bioresorbable scaffolds (BRS) represent a novel approach in coronary stent technology. In contrast to the metallic stents, they provide transient scaffolding, thereby safeguarding early vessel patency and acute gain. Subsequently a process of “decomposition” occurs, that results in the complete absorption of the scaffold. This reduces the risk of late complications, allowing the vessel to maintain its integrity and physiological function. This unique ability has attracted interest and nowadays several BRS are available. The aim of this review article is to describe the advances in the field, present the evidence from the preclinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Christos V Bourantas
- Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Abstract
Aliphatic polyesters, like PGA, PLA, PCL and PDO, among others, are biodegradable materials that find applications in many biomedical devices, from fibers for subcutaneous sutures to other regenerative surgery implants. The main concept among these applications is to use a biodegradable device that temporarily replace the biomechanical functions, avoiding this way the chirurgical procedures to remove the device. However, the dimensioning of these devices is complex, not only because the mechanical properties evolve during degradation, but also because these biodegradable materials cannot be assumed as elastic materials. In more precise terms, the response of an elastic material implies that the loading and unloading paths coincide, the material responds instantaneously to an applied load, its behavior is time-independent and the material returns to its former unloaded configuration upon the removal of external loads. In this work, fibers of non-degraded PLA-PCL were submitted to tensile testing at different rates, to load-unloading cycles at different load levels and with or without delay before reloading, creep and fatigue tests at different levels of load. These results elucidate the viscoelastic/viscoplastic nature of this class of materials. The load-unloading cyclic test results allow determining the different components of the strain: elastic, plastic and viscous. The visco-plastic nature was also reflected on the creep and fatigue results. The findings discussed in this work must be taken into account when designing biomedical devices, to avoid common causes of failure such as laxity or premature rupture.
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Puranik AS, Dawson ER, Peppas NA. Recent advances in drug eluting stents. Int J Pharm 2012; 441:665-79. [PMID: 23117022 DOI: 10.1016/j.ijpharm.2012.10.029] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 12/18/2022]
Abstract
One of the most common medical interventions to reopen an occluded vessel is the implantation of a coronary stent. While this method of treatment is effective initially, restenosis, or the re-narrowing of the artery frequently occurs largely due to neointimal hyperplasia of smooth muscle cells. Drug eluting stents were developed in order to provide local, site-specific, controlled release of drugs that can inhibit neointima formation. By implementing a controlled release delivery system it may be possible to control the time release of the pharmacological factors and thus be able to bypass some of the critical events associated with stent hyperplasia and prevent the need for subsequent intervention. However, since the advent of first-generation drug eluting stents, long-term adverse effects have raised concerns regarding their safety. These limitations in safety and efficacy have triggered considerable research in developing biodegradable stents and more potent drug delivery systems. In this review, we shed light on the current state-of-the-art in drug eluting stents, problems related to them and highlight some of the ongoing research in this area.
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Affiliation(s)
- Amey S Puranik
- Department of Chemical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
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Degradation and adhesive/cohesive strengths of a reservoir-based drug eluting stent. J Mech Behav Biomed Mater 2012; 14:208-15. [DOI: 10.1016/j.jmbbm.2012.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/09/2012] [Indexed: 11/18/2022]
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47
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PerFix™ plug versus 4DDOME® implants for inguinal hernia repair: prospective multicentric randomised controlled trial. Hernia 2012; 16:561-6. [DOI: 10.1007/s10029-012-0943-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
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48
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Nie FL, Zheng YF. Surface chemistry of bulk nanocrystalline pure iron and electrochemistry study in gas-flow physiological saline. J Biomed Mater Res B Appl Biomater 2012; 100:1404-10. [DOI: 10.1002/jbm.b.32713] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 03/18/2012] [Indexed: 01/17/2023]
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Jabara R, Pendyala L, Geva S, Chen J, Chronos N, Robinson K. Novel fully bioabsorbable salicylate-based sirolimus-eluting stent. EUROINTERVENTION 2012; 5 Suppl F:F58-64. [PMID: 22100678 DOI: 10.4244/eijv5ifa10] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The concept of fully biodegradable stents has emerged as an attractive alternative to current permanent metallic stents, mainly as a potential solution to avoid late stent thrombotic events. We sought to evaluate a novel, fully bioabsorbable sirolimus-eluting stent (SES) synthesised entirely from a unique salicylic-acid polymer, in a clinically relevant animal model. METHODS AND RESULTS Fully biodegradable balloon-expandable stents (n=45) were implanted in a porcine coronary arteries using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) to optimise stent apposition. Dose density of sirolimus was 8.3 µg/mm of stent length with in vitro studies demonstrating elution over 30 days and complete stent degradation over 12 months. Animals were terminated at 7, 14, 30, 90, and 180 days for complete histological analysis. Optical coherence tomography (OCT) was also performed for the 90- and 180-days samples. All stents were deployed successfully without notable mechanical difficulties. Angiographic diameter stenosis (DS) was 20±16%, 24±4%, and 23±17%, at one, three, and six months, respectively. In parallel, IVUS showed good stent apposition with DS of 21±9%, 25±7%, and 18±3%; and area stenosis (AS) of 35±13%, 33±7%, and 32±4% at one, three, and six months,respectively. OCT further demonstrated good stent apposition with DS of 28±7% and 20±6%, and AS of 37±10% and 33±13% at three and six months, respectively. OCT showed reduction of stent thickness by 23% from three to six months. Histologic analysis confirmed these in vivo findings and revealed a favourable healing process of absorbable stent incorporation into the arterial wall, without excessive thrombotic or inflammatory reactions. CONCLUSIONS This study shows favourable vascular compatibility and efficacy for a novel fully bioabsorbable salicylate-based SES. This device has good mechanical performance during deployment and stays well-apposed to the vessel wall at long-term follow-up. These initial results are highly encouraging and support progress into more extensive preclinical studies as well as early clinical testing.
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Affiliation(s)
- Refat Jabara
- Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Lee CH, Chen CJ, Liu SJ, Hsiao CY, Chen JK. The Development of Novel Biodegradable Bifurcation Stents for the Sustainable Release of Anti-Proliferative Sirolimus. Ann Biomed Eng 2012; 40:1961-70. [DOI: 10.1007/s10439-012-0556-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 03/21/2012] [Indexed: 12/18/2022]
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