Success, safety, and efficacy of implantation of diamond-like carbon-coated stents

Diamond-like Carbon Coatings in the Biomedical Field: Properties, Applications and Future Development

Repairment and replacement of organs and tissues are part of the history of struggle against human diseases, in addition to the research and development (R&D) of drugs. Acquisition and processing of specific substances and physiological signals are very important to understand the effects of pathology and treatment. These depend on the available biomedical materials. The family of diamond-like carbon coatings (DLCs) has been extensively applied in many industrial fields. DLCs have also been demonstrated to be biocompatible, both in vivo and in vitro. In many cases, the performance of biomedical devices can be effectively enhanced by coating them with DLCs, such as vascular stents, prosthetic heart valves and surgical instruments. However, the feasibility of the application of DLC in biomedicine remains under discussion. This review introduces the current state of research and application of DLCs in biomedical devices, their potential application in biosensors and urgent problems to be solved. It will be useful to build a bridge between DLC R&D workers and biomedical workers in order to develop high-performance DLC films/coatings, promote their practical use and develop their potential applications in the biomedical field.

In Vitro Biodegradation of a-C:H:SiOx Films on Ti-6Al-4V Alloy

This paper focuses mainly on the in vitro study of a five-week biodegradation of a-C:H:SiO_x films of different thickness, obtained by plasma-assisted chemical vapor deposition onto Ti-6Al-4V alloy substrate using its pulsed bipolar biasing. In vitro immersion of a-C:H:SiO_x films in a solution of 0.9% NaCl was used. It is shown how the a-C:H:SiO_x film thickness (0.5-3 µm) affects the surface morphology, adhesive strength, and Na⁺ and Cl^- precipitation on the film surface from the NaCl solution. With increasing film thickness, the roughness indices are reducing a little. The adhesive strength of the a-C:H:SiO_x films to metal substrate corresponds to quality HF1 (0.5 µm in thickness) and HF2-HF3 (1.5-3 µm in thickness) of the Rockwell hardness test (VDI 3198) that defines strong interfacial adhesion and is usually applied in practice. The morphometric analysis of the film surface shows that on a-C:H:SiO_x-coated Ti-6Al-4V alloy surface, the area occupied by the grains of sodium chloride is lower than on the uncoated surface. The reduction in the ion precipitation from 0.9% NaCl onto the film surface depended on the elemental composition of the surface layer conditioned by the thickness growth of the a-C:H:SiO_x film. Based on the results of energy dispersive X-ray spectroscopy, the multiple regression equations are suggested to explain the effect of the elemental composition of the a-C:H:SiO_x film on the decreased Na⁺ and Cl^- precipitation. As a result, the a-C:H:SiO_x films successfully combine good adhesion strength and rare ion precipitation and thus are rather promising for medical applications on cardiovascular stents and/or friction parts of heart pumps.

Overview on the Antimicrobial Activity and Biocompatibility of Sputtered Carbon-Based Coatings

Due to their outstanding properties, carbon-based structures have received much attention from the scientific community. Their applications are diverse and include use in coatings on self-lubricating systems for anti-wear situations, thin films deposited on prosthetic elements, catalysis structures, or water remediation devices. From these applications, the ones that require the most careful testing and improvement are biomedical applications. The biocompatibility and antibacterial issues of medical devices remain a concern, as several prostheses still fail after several years of implantation and biofilm formation remains a real risk to the success of a device. Sputtered deposition prevents the introduction of hazardous chemical elements during the preparation of coatings, and this technique is environmentally friendly. In addition, the mechanical properties of C-based coatings are remarkable. In this paper, the latest advances in sputtering methods and biocompatibility and antibacterial action for diamond-based carbon (DLC)-based coatings are reviewed and the greater outlook is then discussed.

Fabrication of a Micron-Scale Three-Dimensional Single Crystal Diamond Channel Using a Micro-Jet Water-Assisted Laser

Two types of a trench with conventional vertical and new reverse-V-shaped cross-sections were fabricated on single crystal diamond (SCD) substrate using a micro-jet water-assisted laser. In addition, a microwave plasma chemical vapor deposition device was used to produce multiple micrometer-sized channels using the epitaxial lateral overgrowth technique. Raman and SEM methods were applied to analyze both types of growth layer characterization. The hollowness of the microchannels was measured using an optical microscope. According to the findings, the epitaxial lateral overgrowth layer of the novel reverse-V-shaped trench produced improved SCD surface morphology and crystal quality.

Recent Advances in Manufacturing Innovative Stents

Cardiovascular diseases are the most distributed cause of death worldwide. Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis. As coating materials (i) organic polymers: polyurethanes, poly(ε-caprolactone), styrene-b-isobutylene-b-styrene, polyhydroxybutyrates, poly(lactide-co-glycolide), and phosphoryl choline; (ii) biological components: vascular endothelial growth factor (VEGF) and anti-CD34 antibody and (iii) inorganic coatings: noble metals, wide class of oxides, nitrides, silicide and carbide, hydroxyapatite, diamond-like carbon, and others are used. DES were developed to reduce the tissue hyperplasia and in-stent restenosis utilizing antiproliferative substances like paclitaxel, limus (siro-, zotaro-, evero-, bio-, amphi-, tacro-limus), ABT-578, tyrphostin AGL-2043, genes, etc. The innovative solutions aim at overcoming the main limitations of the stent technology, such as in-stent restenosis and stent thrombosis, while maintaining the prime requirements on biocompatibility, biodegradability, and mechanical behavior. This paper provides an overview of the existing stent types, their functionality, materials, and manufacturing conditions demonstrating the still huge potential for the development of promising stent solutions.

Nanotribological response of a-C:H coated metallic biomaterials: the cases of stainless steel, titanium, and niobium

Background Wear and corrosion have been identified as two of the major forms of medical implant failures. This study aims to improve the surface, protective and tribological characteristics of bare metals used for medical implants, so as to improve scratch resistance and increase lifetime. Methods Hydrogenated amorphous carbon (a-C:H) films were deposited, using plasma enhanced chemical vapor deposition (PECVD), on stainless steel (SS), titanium (Ti) and niobium (Nb) metal plates. Nanomechanical and nanotribological responses were investigated before and after a-C:H deposition. Film thickness and density were quantified through X-ray reflectivity, and surface morphology before and after deposition were measured using atomic force microscopy, whereas the tribomechanical characteristics were probed using instrumented indentation. Results and conclusions Films of approximately 40 nm in thickness and density of 1.7 g/cm³ were deposited. The a-C:H films reduce the roughness and coefficient of friction while improving the tribomechanical response compared with bare metals for Ti, SS and Nb plates. The very good tribomechanical properties of a-C:H make it a promising candidate material for protective coating on metallic implants.

Blood biocompatibility of surface-bound multi-walled carbon nanotubes

Blood clots when it contacts foreign surfaces following platelet activation. This can be catastrophic in clinical settings involving extracorporeal circulation such as during heart-lung bypass where blood is circulated in polyvinyl chloride tubing. Studies have shown, however, that surface-bound carbon nanotubes may prevent platelet activation, the initiator of thrombosis. We studied the blood biocompatibility of polyvinyl chloride, surface-modified with multi-walled carbon nanotubes in vitro and in vivo. Our results show that surface-bound multi-walled carbon nanotubes cause platelet activation in vitro and devastating thrombosis in an in vivo animal model of extracorporeal circulation. The mechanism of the pro-thrombotic effect likely involves direct multi-walled carbon nanotube-platelet interaction with Ca(2+)-dependant platelet activation. These experiments provide evidence, for the first time, that modification of surfaces with nanomaterials modulates blood biocompatibility in extracorporeal circulation.

Comparison of diamond-like carbon-coated nitinol stents with or without polyethylene glycol grafting and uncoated nitinol stents in a canine iliac artery model

OBJECTIVE

Neointimal hyperplasia is a major complication of endovascular stent placement with consequent in-stent restenosis or occlusion. Improvements in the biocompatibility of stent designs could reduce stent-associated thrombosis and in-stent restenosis. We hypothesised that the use of a diamond-like carbon (DLC)-coated nitinol stent or a polyethylene glycol (PEG)-DLC-coated nitinol stent could reduce the formation of neointimal hyperplasia, thereby improving stent patency with improved biocompatibility.

METHODS

A total of 24 stents were implanted, under general anaesthesia, into the iliac arteries of six dogs (four stents in each dog) using the carotid artery approach. The experimental study dogs were divided into three groups: the uncoated nitinol stent group (n = 8), the DLC-nitinol stent group (n = 8) and the PEG-DLC-nitinol stent group (n = 8).

RESULTS

The mean percentage of neointimal hyperplasia was significantly less in the DLC-nitinol stent group (26.7±7.6%) than in the nitinol stent group (40.0±20.3%) (p = 0.021). However, the mean percentage of neointimal hyperplasia was significantly greater in the PEG-DLC-nitinol stent group (58.7±24.7%) than in the nitinol stent group (40.0±20.3%) (p = 0.01).

CONCLUSION

Our findings indicate that DLC-coated nitinol stents might induce less neointimal hyperplasia than conventional nitinol stents following implantation in a canine iliac artery model; however, the DLC-coated nitinol stent surface when reformed with PEG induces more neointimal hyperplasia than either a conventional or DLC-coated nitinol stent.

Load-bearing biomedical applications of diamond-like carbon coatings - current status

The current status of diamond-like carbon (DLC) coatings for biomedical applications is reviewed with emphasis on load-bearing coatings. Although diamond-like carbon coating materials have been studied for decades, no indisputably successful commercial biomedical applications for high load situations exist today. High internal stress, leading to insufficient adhesion of thick coatings, is the evident reason behind this delay of the break-through of DLC coatings for applications. Excellent adhesion of thick DLC coatings is of utmost importance for load-bearing applications. According to this review superior candidate material for articulating implants is thick and adherent DLC on both sliding surfaces. With the filtered pulsed arc discharge method, all the necessary requirements for the deposition of thick and adherent DLC are fulfilled, provided that the substrate material is selected properly.