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Ni N, Fan T, Ye W, Xia Q, Liu D, Qin J, Fan Z, Liu Q. 3D
printed peripheral vascular stents based on degradable poly(
trimethylene carbonate‐b‐(L‐lactide‐ran‐glycolide)
) terpolymer. POLYM ADVAN TECHNOL 2023. [DOI: 10.1002/pat.6007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Na Ni
- School of Mechanical Engineering Shanghai Jiao Tong University Shanghai China
| | - Tiantang Fan
- Department of Materials Science Fudan University Shanghai China
- College of medical Engineering & the Key Laboratory for Medical Functional Nanomaterials Jining Medical University Jining China
| | - Wuyou Ye
- Department of Materials Science Fudan University Shanghai China
| | - Qi Xia
- Department of Materials Science Fudan University Shanghai China
| | - Dongyang Liu
- Department of Materials Science Fudan University Shanghai China
| | - Jingwen Qin
- R&D Division Beijing Advanced Medical Technologies, Ltd. Inc. Beijing China
| | - Zhongyong Fan
- Department of Materials Science Fudan University Shanghai China
| | - Qing Liu
- R&D Division Beijing Advanced Medical Technologies, Ltd. Inc. Beijing China
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2
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Evaluation of coronary stents: A review of types, materials, processing techniques, design, and problems. Heliyon 2023; 9:e13575. [PMID: 36846695 PMCID: PMC9950843 DOI: 10.1016/j.heliyon.2023.e13575] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
In the world, one of the leading causes of death is coronary artery disease (CAD). There are several ways to treat this disease, and stenting is currently the most appropriate way in many cases. Nowadays, the use of stents has rapidly increased, and they have been introduced in various models, with different geometries and materials. To select the most appropriate stent required, it is necessary to have an analysis of the mechanical behavior of various types of stents. The purpose of this article is to provide a complete overview of advanced research in the field of stents and to discuss and conclude important studies on different topics in the field of stents. In this review, we introduce the types of coronary stents, materials, stent processing technique, stent design, classification of stents based on the mechanism of expansion, and problems and complications of stents. In this article, by reviewing the biomechanical studies conducted in this field and collecting and classifying their results, a useful set of information has been presented to continue research in the direction of designing and manufacturing more efficient stents, although the clinical-engineering field still needs to continue research to optimize the design and construction. The optimum design of stents in the future is possible by simulation and using numerical methods and adequate knowledge of stent and artery biomechanics.
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Seguchi M, Aytekin A, Lenz T, Nicol P, Alvarez-Covarrubias HA, Xhepa E, Klosterman GR, Beele A, Sabic E, Utsch L, Alyaqoob A, Joner M. Challenges of the newer generation of resorbable magnesium scaffolds: Lessons from failure mechanisms of the past generation. J Cardiol 2023; 81:179-188. [PMID: 36122642 DOI: 10.1016/j.jjcc.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
Bioresorbable scaffolds (BRS) were developed to overcome the obstacles of metallic stents, mostly related to sustained presence of metallic foreign body in the coronary vessel. Following earlier success of single-arm BRS studies, randomized controlled trials of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA, USA) showed poor long-term clinical outcomes, particularly in terms of scaffold thrombosis. BRS made from magnesium alloy provide a promising alternative in terms of radial force, strut thickness and, potentially lower thrombogenicity. A recent clinical study demonstrated that magnesium-based BRS seems to be promising with regards to the risk of scaffold thrombosis. In this review, our aim is to describe the issues that prevented Absorb BVS from achieving favorable outcomes, provide current status of existing BRS technologies and the challenges that newer generation BRSs need to overcome, and the results of clinical studies for commercially available magnesium-based BRS, which remain the only BRS actively studied in clinical practice.
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Affiliation(s)
- Masaru Seguchi
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany.
| | - Alp Aytekin
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Lenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Philipp Nicol
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Hector A Alvarez-Covarrubias
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMMS, Ciudad de México, México
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Grace R Klosterman
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Alicia Beele
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Emina Sabic
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Léa Utsch
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Aseel Alyaqoob
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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4
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Lin Z, Chen H, Xu J, Wang J, Wang H, Huang S, Xu S. A Review of the Release Profiles and Efficacies of Chemotherapy Drug-Loaded Electrospun Membranes. Polymers (Basel) 2023; 15:polym15020251. [PMID: 36679132 PMCID: PMC9865042 DOI: 10.3390/polym15020251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
Electrospun fibrous membranes loaded with chemotherapy drugs have been broadly studied, many of which have had promising data demonstrating therapeutic effects on cancer cell inhibition, tumor size reduction, the life extension of tumor-bearing animals, and more. Nevertheless, their drug release profiles are difficult to predict since their degradation pattern varies with crystalline polymers. In addition, there is room for improving their release performances, optimizing the release patterns, and achieving better therapeutic outcomes. In this review, the key factors affecting electrospun membrane drug release profiles have been systematically reviewed. Case studies of the release profiles of typical chemotherapy drugs are carried out to determine the preferred polymer choices and techniques to achieve the expected prolonged or enhanced release profiles. The therapeutic effects of these electrospun, chemo-drug-loaded membranes are also discussed. This review aims to assist in the design of future drug-loaded electrospun materials to achieve preferred release profiles with enhanced therapeutic efficacies.
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Affiliation(s)
- Zhenyu Lin
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Hao Chen
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
| | - Jiawei Xu
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
| | - Jie Wang
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
| | - Huijing Wang
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
| | - Shifen Huang
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
| | - Shanshan Xu
- Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
- Correspondence: ; Tel.: +86-755-26531165
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5
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Bioresorbable vascular metallic scaffolds: Current status and research trends. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022. [DOI: 10.1016/j.cobme.2022.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Polymer–Metal Composite Healthcare Materials: From Nano to Device Scale. JOURNAL OF COMPOSITES SCIENCE 2022. [DOI: 10.3390/jcs6080218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Metals have been investigated as biomaterials for a wide range of medical applications. At nanoscale, some metals, such as gold nanoparticles, exhibit plasmonics, which have motivated researchers’ focus on biosensor development. At the device level, some metals, such as titanium, exhibit good physical properties, which could allow them to act as biomedical implants for physical support. Despite these attractive features, the non-specific delivery of metallic nanoparticles and poor tissue–device compatibility have greatly limited their performance. This review aims to illustrate the interplay between polymers and metals, and to highlight the pivotal role of polymer–metal composite/nanocomposite healthcare materials in different biomedical applications. Here, we revisit the recent plasmonic engineered platforms for biomolecules detection in cell-free samples and highlight updated nanocomposite design for (1) intracellular RNA detection, (2) photothermal therapy, and (3) nanomedicine for neurodegenerative diseases, as selected significant live cell–interactive biomedical applications. At the device scale, the rational design of polymer–metallic medical devices is of importance for dental and cardiovascular implantation to overcome the poor physical load transfer between tissues and devices, as well as implant compatibility under a dynamic fluidic environment, respectively. Finally, we conclude the treatment of these innovative polymer–metal biomedical composite designs and provide a future perspective on the aforementioned research areas.
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7
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Systems, Properties, Surface Modification and Applications of Biodegradable Magnesium-Based Alloys: A Review. MATERIALS 2022; 15:ma15145031. [PMID: 35888498 PMCID: PMC9316815 DOI: 10.3390/ma15145031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023]
Abstract
In recent years, biodegradable magnesium (Mg) alloys have attracted the attention of many researchers due to their mechanical properties, excellent biocompatibility and unique biodegradability. Many Mg alloy implants have been successfully applied in clinical medicine, and they are considered to be promising biological materials. In this article, we review the latest research progress in biodegradable Mg alloys, including research on high-performance Mg alloys, bioactive coatings and actual or potential clinical applications of Mg alloys. Finally, we review the research and development direction of biodegradable Mg alloys. This article has a guiding significance for future development and application of high-performance biodegradable Mg alloys, promoting the future advancement of the magnesium alloy research field, especially in biomedicine.
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8
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Fabrication and Processing of Bioabsorbable Hybrid Zn/(Ag + Fe + Mg)-MMC on Developed Ultrasonic Vibration-Assisted Argon Atmosphere Stir Casting Set-up. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022. [DOI: 10.1007/s13369-021-06205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Capuana E, Lopresti F, Ceraulo M, La Carrubba V. Poly-l-Lactic Acid (PLLA)-Based Biomaterials for Regenerative Medicine: A Review on Processing and Applications. Polymers (Basel) 2022; 14:polym14061153. [PMID: 35335484 PMCID: PMC8955974 DOI: 10.3390/polym14061153] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
Synthetic biopolymers are effective cues to replace damaged tissue in the tissue engineering (TE) field, both for in vitro and in vivo application. Among them, poly-l-lactic acid (PLLA) has been highlighted as a biomaterial with tunable mechanical properties and biodegradability that allows for the fabrication of porous scaffolds with different micro/nanostructures via various approaches. In this review, we discuss the structure of PLLA, its main properties, and the most recent advances in overcoming its hydrophobic, synthetic nature, which limits biological signaling and protein absorption. With this aim, PLLA-based scaffolds can be exposed to surface modification or combined with other biomaterials, such as natural or synthetic polymers and bioceramics. Further, various fabrication technologies, such as phase separation, electrospinning, and 3D printing, of PLLA-based scaffolds are scrutinized along with the in vitro and in vivo applications employed in various tissue repair strategies. Overall, this review focuses on the properties and applications of PLLA in the TE field, finally affording an insight into future directions and challenges to address an effective improvement of scaffold properties.
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Affiliation(s)
- Elisa Capuana
- Department of Engineering, University of Palermo, RU INSTM, Viale delle Scienze, 90128 Palermo, Italy; (E.C.); (M.C.); (V.L.C.)
| | - Francesco Lopresti
- Department of Engineering, University of Palermo, RU INSTM, Viale delle Scienze, 90128 Palermo, Italy; (E.C.); (M.C.); (V.L.C.)
- Correspondence:
| | - Manuela Ceraulo
- Department of Engineering, University of Palermo, RU INSTM, Viale delle Scienze, 90128 Palermo, Italy; (E.C.); (M.C.); (V.L.C.)
| | - Vincenzo La Carrubba
- Department of Engineering, University of Palermo, RU INSTM, Viale delle Scienze, 90128 Palermo, Italy; (E.C.); (M.C.); (V.L.C.)
- ATeN Center, University of Palermo, Viale delle Scienze, 90128 Palermo, Italy
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10
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3D Printing of Polymeric Bioresorbable Stents: A Strategy to Improve Both Cellular Compatibility and Mechanical Properties. Polymers (Basel) 2022; 14:polym14061099. [PMID: 35335430 PMCID: PMC8954590 DOI: 10.3390/polym14061099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
One of the leading causes of death is cardiovascular disease, and the most common cardiovascular disease is coronary artery disease. Percutaneous coronary intervention and vascular stents have emerged as a solution to treat coronary artery disease. Nowadays, several types of vascular stents share the same purpose: to reduce the percentage of restenosis, thrombosis, and neointimal hyperplasia and supply mechanical support to the blood vessels. Despite the numerous efforts to create an ideal stent, there is no coronary stent that simultaneously presents the appropriate cellular compatibility and mechanical properties to avoid stent collapse and failure. One of the emerging approaches to solve these problems is improving the mechanical performance of polymeric bioresorbable stents produced through additive manufacturing. Although there have been numerous studies in this field, normalized control parameters for 3D-printed polymeric vascular stents fabrication are absent. The present paper aims to present an overview of the current types of stents and the main polymeric materials used to fabricate the bioresorbable vascular stents. Furthermore, a detailed description of the printing parameters' influence on the mechanical performance and degradation profile of polymeric bioresorbable stents is presented.
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Sirolimus Release from Biodegradable Polymers for Coronary Stent Application: A Review. Pharmaceutics 2022; 14:pharmaceutics14030492. [PMID: 35335869 PMCID: PMC8949664 DOI: 10.3390/pharmaceutics14030492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
Drug-eluting stents (DESs) are commonly used for the treatment of coronary artery disease. The evolution of the drug-eluting layer on the surface of the metal stent plays an important role in DES functionality. Here, the use of biodegradable polymers has emerged as an attractive strategy because it minimizes the occurrence of late thrombosis after stent implantation. Furthermore, understanding the drug-release behavior of DESs is also important for improving the safety and efficacy of stent treatments. Drug release from biodegradable polymers has attracted extensive research attention because biodegradable polymers with different properties show different drug-release behaviors. Molecular weight, composition, glass transition temperature, crystallinity, and the degradation rate are important properties affecting the behavior of polymers. Sirolimus is a conventional anti-proliferation drug and is the most widely used drug in DESs. Sirolimus-release behavior affects endothelialization and thrombosis formation after DES implantation. In this review, we focus on sirolimus release from biodegradable polymers, including synthetic and natural polymers widely used in the medical field. We hope this review will provide valuable up-to-date information on this subject and contribute to the further development of safe and efficient DESs.
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Toong DWY, Ng JCK, Cui F, Leo HL, Zhong L, Lian SS, Venkatraman S, Tan LP, Huang YY, Ang HY. Nanoparticles-reinforced poly-l-lactic acid composite materials as bioresorbable scaffold candidates for coronary stents: Insights from mechanical and finite element analysis. J Mech Behav Biomed Mater 2021; 125:104977. [PMID: 34814078 DOI: 10.1016/j.jmbbm.2021.104977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022]
Abstract
Current generation of bioresorbable coronary scaffolds (BRS) posed thrombogenicity and deployment issues owing to its thick struts and overall profile. To this end, we hypothesize that the use of nanocomposite materials is able to provide improved material properties and sufficient radial strength for the intended application even at reduced strut thickness. The nanocomposite formulations of tantalum dioxide (Ta2O5), L-lactide functionalized (LA)-Ta2O5, hydroxyapatite (HA) and LA-HA with poly-l-lactic acid (PLLA) were evaluated in this study. Results showed that tensile modulus and strength were enhanced with non-functionalized nanofillers up until 15 wt% loading, whereas ductility was compromised. On the other hand, functionalized nanofillers/PLLA exhibited improved nanofiller dispersion which resulted higher tensile modulus, strength, and ductility. Selected nanocomposite formulations were evaluated using finite element analysis (FEA) of a stent with varying strut thickness (80, 100 and 150 μm). FEA data has shown that nanocomposite BRS with thinner struts (80-100 μm) made with 15 wt% LA-Ta2O5/PLLA and 10 wt% LA-HA/PLLA have increased radial strength, stiffness and reduced recoil compared to PLLA BRS at 150 μm. The reduced strut thickness can potentially mitigate issues such as scaffold thrombosis and promote re-endothelialisation of the vessel.
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Affiliation(s)
- Daniel Wee Yee Toong
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Jaryl Chen Koon Ng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Fangsen Cui
- Institute of High Performance Computing, A*STAR, 1 Fusionopolis way, 138632, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Shaoliang Shawn Lian
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore
| | - Subbu Venkatraman
- Department of Material Science Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore
| | - Lay Poh Tan
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore
| | - Ying Ying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, 639798, Singapore.
| | - Hui Ying Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, 117583, Singapore; Duke-NUS Medical School, 8 College Road, 169857, Singapore.
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Computational Analysis of Mechanical Performance for Composite Polymer Biodegradable Stents. MATERIALS 2021; 14:ma14206016. [PMID: 34683608 PMCID: PMC8539075 DOI: 10.3390/ma14206016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
Bioresorbable stents (BRS) represent the latest generation of vascular scaffolds used for minimally invasive interventions. They aim to overcome the shortcomings of established bare-metal stents (BMS) and drug-eluting stents (DES). Recent advances in the field of bioprinting offer the possibility of combining biodegradable polymers to produce a composite BRS. Evaluation of the mechanical performance of the novel composite BRS is the focus of this study, based on the idea that they are a promising solution to improve the strength and flexibility performance of single material BRS. Finite element analysis of stent crimping and expansion was performed. Polylactic acid (PLA) and polycaprolactone (PCL) formed a composite stent divided into four layers, resulting in sixteen unique combinations. A comparison of the mechanical performance of the different composite configurations was performed. The resulting stresses, strains, elastic recoil, and foreshortening were evaluated and compared to existing experimental results. Similar behaviour was observed for material configurations that included at least one PLA layer. A pure PCL stent showed significant elastic recoil and less shortening compared to PLA and composite structures. The volumetric ratio of the materials was found to have a more significant effect on recoil and foreshortening than the arrangement of the material layers. Composite BRS offer the possibility of customising the mechanical behaviour of scaffolds. They also have the potential to support the fabrication of personalised or plaque-specific stents.
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Niu J, Huang H, Pei J, Jin Z, Guan S, Yuan G. Research and development strategy for biodegradable magnesium-based vascular stents: a review. BIOMATERIALS TRANSLATIONAL 2021; 2:236-247. [PMID: 35836652 PMCID: PMC9255809 DOI: 10.12336/biomatertransl.2021.03.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022]
Abstract
Magnesium alloys are an ideal material for biodegradable vascular stents, which can be completely absorbed in the human body, and have good biosafety and mechanical properties. However, the rapid corrosion rate and excessive localized corrosion, as well as challenges in the preparation and processing of microtubes for stents, are restricting the clinical application of magnesium-based vascular stents. In the present work we will give an overview of the recent progresses on biodegradable magnesium based vascular stents including magnesium alloy design, high-precision microtubes processing, stent shape optimisation and functional coating preparation. In particular, the Triune Principle in biodegradable magnesium alloy design is proposed based on our research experience, which requires three key aspects to be considered when designing new biodegradable magnesium alloys for vascular stents application, i.e. biocompatibility and biosafety, mechanical properties, and biodegradation. This review hopes to inspire the future studies on the design and development of biodegradable magnesium alloy-based vascular stents.
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Affiliation(s)
- Jialin Niu
- National Engineering Research Center of Light Alloy Net Forming and Key State Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Huang
- National Engineering Research Center of Light Alloy Net Forming and Key State Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Pei
- National Engineering Research Center of Light Alloy Net Forming and Key State Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaohui Jin
- National Engineering Research Center of Light Alloy Net Forming and Key State Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shaokang Guan
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloy Net Forming and Key State Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China,Corresponding author: Guangyin Yuan,
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Haude M, Toelg R, Lemos PA, Christiansen EH, Abizaid A, von Birgelen C, Neumann FJ, Wijns W, Ince H, Kaiser C, Lim ST, Escaned J, Eeckhout E, Garcia-Garcia HM, Waksman R. Sustained safety and performance of a second-generation sirolimus-eluting absorbable metal scaffold: Long-term data of the BIOSOLVE-II first-in-man trial at 5 years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:106-110. [PMID: 34364807 DOI: 10.1016/j.carrev.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Permanent drug-eluting stents are associated with a steady increase of late complications attributed to persistent inflammation and poor vessel remodelling. Bioresorbable scaffolds have been developed to overcome such long-term limitations by providing temporary vessel support and disappearing thereafter. We aimed to assess the long-term outcomes of an absorbable metallic scaffold at 5 years. METHODS BIOSOLVE-II is an international, multi-centre, first-in-human study assessing the safety and performance of the sirolimus-eluting absorbable metal scaffold DREAMS 2G (commercial name Magmaris) in patients with a maximum of two de novo lesions. After 3 years, follow-up was extended to 5 years with the endpoints target lesion failure and rate of definite or probable stent thrombosis. RESULTS 123 patients with 123 lesions were enrolled. Lesions were 12.6 ± 4.5 mm long and 2.7 ± 0.4 mm in diameter, 43.4% were class B2/C lesions, and calcification was moderate to severe in 10.6%. At 5 years, 5.4% of patients had stable angina and 94.6% had no symptoms or ischemia. Target lesion failure rate was 8.0% [95% CI:4.2;14.9], reflecting 2 cardiac deaths, 2 target-vessel myocardial infarction, and 6 clinically-driven target lesion revascularizations. Only one target lesion failure occurred beyond 3 years; a target-vessel myocardial infarction with clinically-driven TLR on post-procedure day 1157. One additional non-cardiac death beyond 3 years due to renal failure was reported on day 1777. No definite or probable scaffold thrombosis was observed. CONCLUSION The Magmaris scaffold showed favourable long-term safety and clinical performance with low target lesion failure rates and absence of definite or probable scaffold thrombosis throughout 5 years. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II is a prospective, multi-centre, first-in-man trial enrolling 123 patients with de novo coronary artery lesions. Target lesion failure rate at 5 years was low (8.0%), including 2 cardiac deaths, 2 target-vessel myocardial infarction and 6 clinically-driven target lesion revascularizations. No definite or probable scaffold thrombosis was observed.
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Affiliation(s)
- Michael Haude
- Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany.
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Pedro Alves Lemos
- Instituto do Coração - HCFMUSP, University of Sao Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Franz-Josef Neumann
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Christoph Kaiser
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Eric Eeckhout
- CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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16
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Tan LY, Chanthaset N, Nanto S, Soba R, Nagasawa M, Ohno H, Ajiro H. Synthesis and Preparation of Cross-linked Films with Ester-Free Poly(trimethylene carbonate) Bearing Aromatic Urea Moiety. Macromolecules 2021. [DOI: 10.1021/acs.macromol.1c00339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Lee Yae Tan
- Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, Nara 630-0192, Japan
| | - Nalinthip Chanthaset
- Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, Nara 630-0192, Japan
| | - Shinsuke Nanto
- Nishinomiya Municipal Central Hospital, 8-24 Hayashida-cho, Nishinomiya, Hhyogo 663-8014, Japan
| | - Ryoichi Soba
- Research and Development Department, Otsuka Medical Devices Co., Ltd., Kanda-Tsukasamachi,
Chiyoda-ku, Tokyo 101-0048, Japan
| | - Masakazu Nagasawa
- Research and Development Department, Otsuka Medical Devices Co., Ltd., Kanda-Tsukasamachi,
Chiyoda-ku, Tokyo 101-0048, Japan
| | - Hiroshi Ohno
- Research and Development Department, Otsuka Medical Devices Co., Ltd., Kanda-Tsukasamachi,
Chiyoda-ku, Tokyo 101-0048, Japan
| | - Hiroharu Ajiro
- Graduate School of Materials Science, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, Nara 630-0192, Japan
- Data Science Center, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, Nara 630-0192, Japan
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17
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Ivone R, Yang Y, Shen J. Recent Advances in 3D Printing for Parenteral Applications. AAPS J 2021; 23:87. [PMID: 34145513 PMCID: PMC8212901 DOI: 10.1208/s12248-021-00610-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022] Open
Abstract
3D printing has emerged as an advanced manufacturing technology in the field of pharmaceutical sciences. Despite much focus on enteral applications, there has been a lack of research focused on potential benefits of 3D printing for parenteral applications such as wound dressings, biomedical devices, and regenerative medicines. 3D printing technologies, including fused deposition modeling, vat polymerization, and powder bed printing, allow for rapid prototyping of personalized medications, capable of producing dosage forms with flexible dimensions based on patient anatomy as well as dosage form properties such as porosity. Considerations such as printing properties and material selection play a key role in determining overall printability of the constructs. These parameters also impact drug release kinetics, and mechanical properties of final printed constructs, which play a role in modulating immune response upon insertion in the body. Despite challenges in sterilization of printed constructs, additional post-printing processing procedures, and lack of regulatory guidance, 3D printing will continue to evolve to meet the needs of developing effective, personalized medicines for parenteral applications.
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Affiliation(s)
- Ryan Ivone
- grid.20431.340000 0004 0416 2242Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island 02881 USA
| | - Yan Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Jie Shen
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA. .,Department of Chemical Engineering, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA.
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18
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Antonini L, Berti F, Isella B, Hossain D, Mandelli L, Pennati G, Petrini L. From the real device to the digital twin: A coupled experimental-numerical strategy to investigate a novel bioresorbable vascular scaffold. PLoS One 2021; 16:e0252788. [PMID: 34086820 PMCID: PMC8177663 DOI: 10.1371/journal.pone.0252788] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022] Open
Abstract
The purpose of this work is to propose a workflow that couples experimental and computational activities aimed at developing a credible digital twin of a commercial coronary bioresorbable vascular scaffold when direct access to data about material mechanical properties is not possible. Such a situation is be faced when the manufacturer is not involved in the study, thus directly investigating the actual device is the only source of information available. The object of the work is the Fantom® Encore polymeric stent (REVA Medical) made of Tyrocore™. Four devices were purchased and used in mechanical tests that are easily reproducible in any mechanical laboratory, i.e. free expansion and uniaxial tension testing, the latter performed with protocols that emphasized the rate-dependent properties of the polymer. Given the complexity of the mechanical behaviour observed experimentally, it was chosen to use the Parallel Rehological Framework material model, already used in the literature to describe the behaviour of other polymers, such as PLLA. Calibration of the material model was based on simulations that replicate the tensile test performed on the device. Given the high number of material parameters, a plan of simulations was done to find the most suitable set, varying each parameter value in a feasible range and considering a single repetitive unit of the stent, neglecting residual stresses generated by crimping and expansion. This strategy resulted in a significant reduction of computational cost. The performance of the set of parameters thus identified was finally evaluated considering the whole delivery system, by comparing the experimental results with the data collected simulating free expansion and uniaxial tension testing. Moreover, radial force testing was numerically performed and compared with literature data. The obtained results demonstrated the effectiveness of the digital twin development pipeline, a path applicable to any commercial device whose geometric structure is based on repetitive units.
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Affiliation(s)
- Luca Antonini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Francesca Berti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Benedetta Isella
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Dipok Hossain
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Lorenzo Mandelli
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milano, Italy
- * E-mail:
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19
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Wang J, Kural MH, Wu J, Leiby KL, Mishra V, Lysyy T, Li G, Luo J, Greaney A, Tellides G, Qyang Y, Huang N, Niklason LE. An ex vivo physiologic and hyperplastic vessel culture model to study intra-arterial stent therapies. Biomaterials 2021; 275:120911. [PMID: 34087584 DOI: 10.1016/j.biomaterials.2021.120911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
Conventional in vitro methods for biological evaluation of intra-arterial devices such as stents fail to accurately predict cytotoxicity and remodeling events. An ex vivo flow-tunable vascular bioreactor system (VesselBRx), comprising intra- and extra-luminal monitoring capabilities, addresses these limitations. VesselBRx mimics the in vivo physiological, hyperplastic, and cytocompatibility events of absorbable magnesium (Mg)-based stents in ex vivo stent-treated porcine and human coronary arteries, with in-situ and real-time monitoring of local stent degradation effects. Unlike conventional, static cell culture, the VesselBRx perfusion system eliminates unphysiologically high intracellular Mg2+ concentrations and localized O2 consumption resulting from stent degradation. Whereas static stented arteries exhibited only 20.1% cell viability and upregulated apoptosis, necrosis, metallic ion, and hypoxia-related gene signatures, stented arteries in VesselBRx showed almost identical cell viability to in vivo rabbit models (~94.0%). Hyperplastic intimal remodeling developed in unstented arteries subjected to low shear stress, but was inhibited by Mg-based stents in VesselBRx, similarly to in vivo. VesselBRx represents a critical advance from the current static culture standard of testing absorbable vascular implants.
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Affiliation(s)
- Juan Wang
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Mehmet H Kural
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Jonathan Wu
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Katherine L Leiby
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Vinayak Mishra
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, 06269, USA
| | - Taras Lysyy
- Department of Surgery, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Guangxin Li
- Department of Surgery, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Jiesi Luo
- Yale Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT06519, USA
| | - Allison Greaney
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - George Tellides
- Department of Surgery, School of Medicine, Yale University, New Haven, CT, 06519, USA
| | - Yibing Qyang
- Yale Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT06519, USA
| | - Nan Huang
- School of Material Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, 610031, China
| | - Laura E Niklason
- Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, 06519, USA; Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, 06519, USA.
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20
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Scafa Udriște A, Niculescu AG, Grumezescu AM, Bădilă E. Cardiovascular Stents: A Review of Past, Current, and Emerging Devices. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2498. [PMID: 34065986 PMCID: PMC8151529 DOI: 10.3390/ma14102498] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
One of the leading causes of morbidity and mortality worldwide is coronary artery disease, a condition characterized by the narrowing of the artery due to plaque deposits. The standard of care for treating this disease is the introduction of a stent at the lesion site. This life-saving tubular device ensures vessel support, keeping the blood-flow path open so that the cardiac muscle receives its vital nutrients and oxygen supply. Several generations of stents have been iteratively developed towards improving patient outcomes and diminishing adverse side effects following the implanting procedure. Moving from bare-metal stents to drug-eluting stents, and recently reaching bioresorbable stents, this research field is under continuous development. To keep up with how stent technology has advanced in the past few decades, this paper reviews the evolution of these devices, focusing on how they can be further optimized towards creating an ideal vascular scaffold.
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Affiliation(s)
- Alexandru Scafa Udriște
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.S.U.); (E.B.)
- Cardiology Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| | - Elisabeta Bădilă
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.S.U.); (E.B.)
- Internal Medicine Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
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21
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Jang Y, Park T, Kim E, Park JW, Lee DY, Kim SJ. Implantable Biosupercapacitor Inspired by the Cellular Redox System. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/ange.202101388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yongwoo Jang
- Center for Self-powered Actuation and Department of Biomedical Engineering Hanyang University Seoul 04736 Korea
| | - Taegyu Park
- Center for Self-powered Actuation and Department of Biomedical Engineering Hanyang University Seoul 04736 Korea
| | - Eunyoung Kim
- Center for Self-powered Actuation and Department of Biomedical Engineering Hanyang University Seoul 04736 Korea
| | - Jong Woo Park
- Center for Self-powered Actuation and Department of Biomedical Engineering Hanyang University Seoul 04736 Korea
| | - Dong Yeop Lee
- Center for Self-powered Actuation and Department of Biomedical Engineering Hanyang University Seoul 04736 Korea
| | - Seon Jeong Kim
- Center for Self-powered Actuation and Department of Biomedical Engineering Hanyang University Seoul 04736 Korea
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22
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Jang Y, Park T, Kim E, Park JW, Lee DY, Kim SJ. Implantable Biosupercapacitor Inspired by the Cellular Redox System. Angew Chem Int Ed Engl 2021; 60:10563-10567. [PMID: 33565220 DOI: 10.1002/anie.202101388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 11/10/2022]
Abstract
The carbon nanotube (CNT) yarn supercapacitor has high potential for in vivo energy storage because it can be used in aqueous environments and stitched to inner parts of the body, such as blood vessels. The biocompatibility issue for frequently used pseudocapacitive materials, such as metal oxides, is controversial in the human body. Here, we report an implantable CNT yarn supercapacitor inspired by the cellular redox system. In all living cells, nicotinamide adenine dinucleotide (NAD) is a key redox biomolecule responsible for cellular energy transduction to produce adenosine triphosphate (ATP). Based on this redox system, CNT yarn electrodes were fabricated by inserting a twist in CNT sheets with electrochemically deposited NAD and benzoquinone for redox shuttling. Consequently, the NAD/BQ/CNT yarn electrodes exhibited the maximum area capacitance (55.73 mF cm-2 ) under physiological conditions, such as phosphate-buffered saline and serum. In addition, the yarn electrodes showed a negligible loss of capacitance after 10 000 repeated charge/discharge cycles and deformation tests (bending/knotting). More importantly, NAD/BQ/CNT yarn electrodes implanted into the abdominal cavity of a rat's skin exhibited the stable in vivo electrical performance of a supercapacitor. Therefore, these findings demonstrate a redox biomolecule-applied platform for implantable energy storage devices.
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Affiliation(s)
- Yongwoo Jang
- Center for Self-powered Actuation and Department of Biomedical Engineering, Hanyang University, Seoul, 04736, Korea
| | - Taegyu Park
- Center for Self-powered Actuation and Department of Biomedical Engineering, Hanyang University, Seoul, 04736, Korea
| | - Eunyoung Kim
- Center for Self-powered Actuation and Department of Biomedical Engineering, Hanyang University, Seoul, 04736, Korea
| | - Jong Woo Park
- Center for Self-powered Actuation and Department of Biomedical Engineering, Hanyang University, Seoul, 04736, Korea
| | - Dong Yeop Lee
- Center for Self-powered Actuation and Department of Biomedical Engineering, Hanyang University, Seoul, 04736, Korea
| | - Seon Jeong Kim
- Center for Self-powered Actuation and Department of Biomedical Engineering, Hanyang University, Seoul, 04736, Korea
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23
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Wu X, Wu S, Kawashima H, Hara H, Ono M, Gao C, Wang R, Lunardi M, Sharif F, Wijns W, Serruys PW, Onuma Y. Current perspectives on bioresorbable scaffolds in coronary intervention and other fields. Expert Rev Med Devices 2021; 18:351-365. [PMID: 33739213 DOI: 10.1080/17434440.2021.1904894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The first-generation bioresorbable scaffolds (BRSs) had a large strut profile to compensate for the insufficient radial strength of bioresorbable polymer materials, resulting in higher scaffold thrombosis rates than conventional drug-eluting stents. To improve the clinical safety and efficacy, the new generation BRSs have been improved by optimal structure design, post-processing of bioresorbable polymer materials, or altering bioresorbable metallic alloys.Areas covered: This review summarizes the lessons learned from the first-generation BRS, updates the clinical outcomes of trials evaluating ABSORB bioresorbable vascular scaffold at long-term and bioresorbable metallic alloy-based devices, and examines recent outcomes of BRS treated in STEMI patients. This review also provides an overview of the current clinical data of seven BRSs manufactured in Asia, and of the BRSs extended application in other clinical arenas.Expert opinion: Drawbacks of the first-generation BRSs need to be addressed by the next generation of these stents with novel materials and technologies. Clinical research, including randomized controlled trials, are required to further evaluate BRSs application in coronary artery disease. The encouraging results of BRSs innovation applied in the peripheral arteries and gastrointestinal tracts support other potential clinical applications of BRS technology.
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Affiliation(s)
- Xinlei Wu
- Institute of Cardiovascular Development and Translational Medicine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Sijing Wu
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Mattia Lunardi
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
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24
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Toh HW, Toong DWY, Ng JCK, Ow V, Lu S, Tan LP, Wong PEH, Venkatraman S, Huang Y, Ang HY. Polymer blends and polymer composites for cardiovascular implants. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2020.110249] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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25
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Giubilini A, Bondioli F, Messori M, Nyström G, Siqueira G. Advantages of Additive Manufacturing for Biomedical Applications of Polyhydroxyalkanoates. Bioengineering (Basel) 2021; 8:29. [PMID: 33672131 PMCID: PMC7926534 DOI: 10.3390/bioengineering8020029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022] Open
Abstract
In recent years, biopolymers have been attracting the attention of researchers and specialists from different fields, including biotechnology, material science, engineering, and medicine. The reason is the possibility of combining sustainability with scientific and technological progress. This is an extremely broad research topic, and a distinction has to be made among different classes and types of biopolymers. Polyhydroxyalkanoate (PHA) is a particular family of polyesters, synthetized by microorganisms under unbalanced growth conditions, making them both bio-based and biodegradable polymers with a thermoplastic behavior. Recently, PHAs were used more intensively in biomedical applications because of their tunable mechanical properties, cytocompatibility, adhesion for cells, and controllable biodegradability. Similarly, the 3D-printing technologies show increasing potential in this particular field of application, due to their advantages in tailor-made design, rapid prototyping, and manufacturing of complex structures. In this review, first, the synthesis and the production of PHAs are described, and different production techniques of medical implants are compared. Then, an overview is given on the most recent and relevant medical applications of PHA for drug delivery, vessel stenting, and tissue engineering. A special focus is reserved for the innovations brought by the introduction of additive manufacturing in this field, as compared to the traditional techniques. All of these advances are expected to have important scientific and commercial applications in the near future.
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Affiliation(s)
- Alberto Giubilini
- Department of Engineering and Architecture, University of Parma, 43124 Parma, Italy;
| | - Federica Bondioli
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Torino, Italy;
| | - Massimo Messori
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Gustav Nyström
- Cellulose & Wood Materials Laboratory, Empa—Swiss Federal Laboratories for Materials Science and Technology, 8600 Dübendorf, Switzerland;
- Department of Health Sciences and Technology, ETH Zürich, 8092 Zürich, Switzerland
| | - Gilberto Siqueira
- Cellulose & Wood Materials Laboratory, Empa—Swiss Federal Laboratories for Materials Science and Technology, 8600 Dübendorf, Switzerland;
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26
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Lin LH, Lee HP, Yeh ML. Characterization of a Sandwich PLGA-Gallic Acid-PLGA Coating on Mg Alloy ZK60 for Bioresorbable Coronary Artery Stents. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5538. [PMID: 33291735 PMCID: PMC7730464 DOI: 10.3390/ma13235538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
Absorbable magnesium stents have become alternatives for treating restenosis owing to their better mechanical properties than those of bioabsorbable polymer stents. However, without modification, magnesium alloys cannot provide the proper degradation rate required to match the vascular reform speed. Gallic acid is a phenolic acid with attractive biological functions, including anti-inflammation, promotion of endothelial cell proliferation, and inhibition of smooth muscle cell growth. Thus, in the present work, a small-molecule eluting coating is designed using a sandwich-like configuration with a gallic acid layer enclosed between poly (d,l-lactide-co-glycolide) layers. This coating was deposited on ZK60 substrate, a magnesium alloy that is used to fabricate bioresorbable coronary artery stents. Electrochemical analysis showed that the corrosion rate of the specimen was ~2000 times lower than that of the bare counterpart. The released gallic acid molecules from sandwich coating inhibit oxidation by capturing free radicals, selectively promote the proliferation of endothelial cells, and inhibit smooth muscle cell growth. In a cell migration assay, sandwich coating delayed wound closure in smooth muscle cells. The sandwich coating not only improved the corrosion resistance but also promoted endothelialization, and it thus has great potential for the development of functional vascular stents that prevent late-stent restenosis.
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Affiliation(s)
- Li-Han Lin
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan;
| | - Hung-Pang Lee
- Biomedical Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, TX 77843, USA;
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan;
- Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan
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27
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Multimodal Loading Environment Predicts Bioresorbable Vascular Scaffolds' Durability. Ann Biomed Eng 2020; 49:1298-1307. [PMID: 33123828 DOI: 10.1007/s10439-020-02673-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Bioresorbable vascular scaffolds were considered the fourth generation of endovascular implants deemed to revolutionize cardiovascular interventions. Yet, unexpected high risk of scaffold thrombosis and post-procedural myocardial infractions quenched the early enthusiasm and highlighted the gap between benchtop predictions and clinical observations. To better understand scaffold behavior in the mechanical environment of vessels, animal, and benchtop tests with multimodal loading environment were conducted using industrial standard scaffolds. Finite element analysis was also performed to study the relationship among structural failure, scaffold design, and load types. We identified that applying the combination of bending, axial compression, and torsion better reflects incidence observed in-vivo, far more than tranditional single mode loads. Predication of fracture locations is also more accurate when at least bending and axial compression are applied during benchtop tests (>60% fractures at connected peak). These structural failures may be initiated by implantation-induced microstructural damages and worsened by cyclic loads from the beating heart. Ignoring the multi-modal loading environment in benchtop fatigue tests and computational platforms can lead to undetected potential design defects, calling for redefining consensus evaluation strategies for scaffold performance. With the robust evaluation strategy presented herein, which exploits the results of in-vivo, in-vitro and in-silico investigations, we may be able to compare alternative designs of prototypes at the early stages of device development and optimize the performance of endovascular implants according to patients-specific vessel dynamics and lesion configurations in the future.
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28
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Verdoia M, Kedhi E, Suryapranata H, Galasso G, Dudek D, De Luca G. Poly (l-lactic acid) bioresorbable scaffolds versus metallic drug-eluting stents for the treatment of coronary artery disease: A meta-analysis of 11 randomized trials. Catheter Cardiovasc Interv 2020; 96:813-824. [PMID: 31730255 DOI: 10.1002/ccd.28594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/05/2019] [Accepted: 10/26/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) have been proposed for overcoming the long-term limitations of permanent metallic stents, while theoretically warranting similar advantages in plaque stabilization and anti-restenotic drug delivery in the early postrevascularization phase. However, increased rates of malapposition, restenosis, or thrombosis have emerged from initial trials with BVS, that were nevertheless underpowered for the evaluation of the real outcome benefits of these coronary devices. The recent completion of newer randomized clinical trials paves the way to the present meta-analysis, aiming at the comparison of Poly (l-Lactic acid) BVS (PLLA-BVS) versus metallic drug-eluting stents (DES) in the treatment of coronary stenoses. METHODS Literature and main scientific session abstracts were searched for randomized clinical trials (RCTs) comparing drug-eluting BVS versus metallic DES for the treatment of coronary artery disease (CAD). The primary efficacy endpoint was mortality, secondary endpoints were cardiovascular death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis and the composite of device-oriented target lesion failure (TLF). RESULTS We included 11 randomized trials, for a total population of 10,707 patients, 54.5% treated with BVS. The major indication for PCI was stable CAD, whereas acute coronary syndrome represented 30% of the patients. At a mean follow-up of 2.64 years (1-5 years), mortality occurred in 2.71% of the patients, with no difference according to the type of implanted stent (OR[95%CI] = 0.94 [0.74, 1.20], p = .62). No interaction was observed according to patients' risk profile or the rate of diabetes and ACS. However, a significant increase in myocardial infarction, stent thrombosis, TLR and TLF was observed with BVS as compared to DES. CONCLUSIONS The present meta-analysis provides the most updated data on the use of PLLA-BVS for the treatment of CAD. We documented a poorer performance of these new coronary devices, as compared to new generation metallic DES, being associated with an increased rate of recurrent cardiovascular events. However, such ischemic complications did not impact on mortality, with a comparable survival independently from the type of stent.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Elvin Kedhi
- Department of Cardiology, ISALA Hospital, Zwolle, the Netherlands
| | | | - Gennaro Galasso
- Divisione di Cardiologia, Università degli Studi di Salerno, Salerno, Italy
| | - Dariusz Dudek
- Institue of Cardiology, Jagiellonian University, Krakow, Poland
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
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Yeazel TR, Becker ML. Advancing Toward 3D Printing of Bioresorbable Shape Memory Polymer Stents. Biomacromolecules 2020; 21:3957-3965. [PMID: 32924443 DOI: 10.1021/acs.biomac.0c01082] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stents have evolved significantly since their introduction to the medical field in the early 1980s, becoming widely used in percutaneous coronary interventions and following nephrological procedures. However, the current commercially available stents do not degrade and remain in the body forever, leading to problems like restenosis in cardiovascular applications or requiring removal procedures in ureteral applications. Efforts to replace metal with resorbable materials have largely been halted after the commercial failure of and safety concerns elicited by Abbott's Absorb stent in 2017. Industry continues to use common polymers such as poly(l-lactide) (PLLA) and polycaprolactone (PCL) for biomedical products, but due to the weak mechanical properties of these bioresorbable materials in comparison to metals, these devices have struggled to accomplish the goals set, increasing risk of thrombosis. 3D printing stents using bioresorbable and shape memory materials could provide a method of patient-personalized production, remove the need for balloon expansion, and limit stent migration, thus bringing a new age of stent technology. The investigation of a range of 3D-printable and bioresorbable shape-memory polymers can provide solutions to the shortcomings of previously explored bioresorbable stents and revitalize the medical device industry efforts into advancing stent technology.
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Affiliation(s)
- Taylor R Yeazel
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708, United States
| | - Matthew L Becker
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina 27708, United States.,Departments of Chemistry, Biomedical Engineering, Orthopaedic Surgery, Duke University, Durham, North Carolina 27708, United States
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Low YJ, Andriyana A, Ang BC, Zainal Abidin NI. Bioresorbable and degradable behaviors of
PGA
: Current state and future prospects. POLYM ENG SCI 2020. [DOI: 10.1002/pen.25508] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yan Jie Low
- Center of Advanced Materials, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
- Department of Mechanical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
| | - Andri Andriyana
- Center of Advanced Materials, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
- Department of Mechanical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
| | - Bee Chin Ang
- Center of Advanced Materials, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
- Department of Chemical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
| | - Nor Ishida Zainal Abidin
- Center of Advanced Materials, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
- Department of Mechanical Engineering, Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
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Koolen J. Another Approach, Another Hope? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1155-1156. [DOI: 10.1016/j.carrev.2020.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Toong DWY, Toh HW, Ng JCK, Wong PEH, Leo HL, Venkatraman S, Tan LP, Ang HY, Huang Y. Bioresorbable Polymeric Scaffold in Cardiovascular Applications. Int J Mol Sci 2020; 21:E3444. [PMID: 32414114 PMCID: PMC7279389 DOI: 10.3390/ijms21103444] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in material science and innovative medical technologies have allowed the development of less invasive interventional procedures for deploying implant devices, including scaffolds for cardiac tissue engineering. Biodegradable materials (e.g., resorbable polymers) are employed in devices that are only needed for a transient period. In the case of coronary stents, the device is only required for 6-8 months before positive remodelling takes place. Hence, biodegradable polymeric stents have been considered to promote this positive remodelling and eliminate the issue of permanent caging of the vessel. In tissue engineering, the role of the scaffold is to support favourable cell-scaffold interaction to stimulate formation of functional tissue. The ideal outcome is for the cells to produce their own extracellular matrix over time and eventually replace the implanted scaffold or tissue engineered construct. Synthetic biodegradable polymers are the favoured candidates as scaffolds, because their degradation rates can be manipulated over a broad time scale, and they may be functionalised easily. This review presents an overview of coronary heart disease, the limitations of current interventions and how biomaterials can be used to potentially circumvent these shortcomings in bioresorbable stents, vascular grafts and cardiac patches. The material specifications, type of polymers used, current progress and future challenges for each application will be discussed in this manuscript.
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Affiliation(s)
- Daniel Wee Yee Toong
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
| | - Han Wei Toh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Jaryl Chen Koon Ng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Philip En Hou Wong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Subramanian Venkatraman
- Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117575, Singapore;
| | - Lay Poh Tan
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
| | - Hui Ying Ang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Yingying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
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Haude M, Ince H, Kische S, Toelg R, Van Mieghem NM, Verheye S, von Birgelen C, Christiansen EH, Barbato E, Garcia-Garcia HM, Waksman R. Sustained Safety and Performance of the Second-Generation Sirolimus-Eluting Absorbable Metal Scaffold: Pooled Outcomes of the BIOSOLVE-II and -III Trials at 3 Years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1150-1154. [PMID: 32917533 DOI: 10.1016/j.carrev.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE To avoid long-term effects associated with permanent implants, bioresorbable vascular scaffolds were developed, as they provide transient vessel support and disappear thereafter. The aim of the BIOSOLVE-II and -III studies was to assess the safety and performance of a magnesium-based sirolimus-eluting scaffold; we report the clinical outcomes at 3 years, 2 years after scaffold resorption. METHODS/MATERIALS BIOSOLVE-II and BIOSOLVE-III are international, prospective multi-center studies, including 184 patients with 189 de novo lesions and stable or unstable angina, or documented silent ischemia. Acute myocardial infarction, 3-vessel coronary artery disease, and heavily calcified lesions were excluded. Antiplatelet therapy was recommended for 6 months. RESULTS Patients were 65.5 ± 10.8 years old, and lesions were 12.1 ± 4.5 mm long and located in vessels with a diameter of 2.7 ± 0.4 mm. More than half of the lesions (56.5%) were type B2/C lesions. At 2 years, 92.5% (160/173) of patients were symptom-free and 91.5% (151/165) at 3 years; all the other patients had stable angina. At 3 years, target lesion failure occurred in 11 patients (6.3%), consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis. CONCLUSION In a low-risk patient population, treatment with a sirolimus-eluting magnesium bioresorbable scaffold can be considered safe, in particular with no definite or probable scaffold thrombosis. ANNOTATED TABLE OF CONTENTS BIOSOLVE-II and -III are prospective, international, multi-center studies including 184 patients with de novo lesions. At 3 years, target lesion failure was 6.3%, consisting of 4 cardiac deaths (2.3%), one target-vessel myocardial infarction (0.6%), and 6 clinically driven target lesion revascularizations (3.4%). There was no definite or probable scaffold thrombosis.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany.
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Department of Cardiology, Universitätsmedizin Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Ralph Toelg
- Herzzentrum Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Stefan Verheye
- Interventional Cardiology Middelheim Hospital, Antwerpen, Belgium
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | | | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Lelli L, Picchi A, Misuraca L, Massoni A, Calabria P, D'ubaldo F, Limbruno U. Myocardial temporary ischemia in bioresorbable scaffold implantation: a MIBI- scintigraphy and angiography case report. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03946-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Frattolin J, Roy R, Rajagopalan S, Walsh M, Yue S, Bertrand OF, Mongrain R. A manufacturing and annealing protocol to develop a cold-sprayed Fe-316L stainless steel biodegradable stenting material. Acta Biomater 2019; 99:479-494. [PMID: 31449928 DOI: 10.1016/j.actbio.2019.08.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
Biodegradable stents show promise to revolutionize coronary artery disease treatment. Its successful implementation in the global market remains limited due to the constraints of current generation biodegradable materials. Cold gas dynamic spraying (CGDS) has been proposed as a manufacturing approach to fabricate a metallic biodegradable amalgamate for stent application. Iron and 316L stainless steel powders are combined in a 4:1 ratio to create a novel biomaterial through cold spray. Cold spray processing however, produces a coating in a work hardened state, with limited ductility, which is a critical mechanical property in stent design. To this end, the influence of annealing temperature on the mechanical and corrosion performances of the proposed Fe-316L amalgamate is investigated. It was found that annealing at 1300 °C yielded a complex material microstructure, with an ultimate tensile strength of approximately 280 MPa and ductility of 23%. The static corrosion rate determined at this annealing temperature was equal to 0.22 mg cm-2 day-1, with multiple corrosion species identified within the degradation layers. Precipitates were observed throughout the microstructure, which appeared to accelerate the overall corrosion behaviour. It was shown that cold-sprayed Fe-316L has significant potential to be implemented in a clinical setting. STATEMENT OF SIGNIFICANCE: Biodegradable stents have potential to significantly improve treatment of coronary artery disease by decreasing or potentially eliminating late-term complications, including stent fracture and in-stent restenosis. Current generation polymer biodegradable stents have led to poorer patient outcomes in comparison to drug-eluting stents, however, and it is evident that metallic biomaterials are required, which have increased strength. To this end, a novel iron and stainless steel 316L biomaterial is proposed, fabricated through cold-gas dynamic spraying. This study analyses the effect of annealing on the Fe-316L biomaterial through corrosion, mechanical, and microstructural investigations. The quantitative data presented in this work suggests that Fe-316L, in its annealed condition, has the mechanical and corrosion properties necessary for biodegradable stent application.
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Echeverry-Rendon M, Allain JP, Robledo SM, Echeverria F, Harmsen MC. Coatings for biodegradable magnesium-based supports for therapy of vascular disease: A general view. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 102:150-163. [DOI: 10.1016/j.msec.2019.04.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 01/22/2023]
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Li H, Peng F, Wang D, Qiao Y, Xu D, Liu X. Layered double hydroxide/poly-dopamine composite coating with surface heparinization on Mg alloys: improved anticorrosion, endothelialization and hemocompatibility. Biomater Sci 2018; 6:1846-1858. [PMID: 29789824 DOI: 10.1039/c8bm00298c] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Magnesium (Mg) and its alloys are promising cardiovascular stent materials due to their favourable physical properties and complete degradation in vivo. However, rapid degradation and poor cytocompatibility hinder their clinical applications. To enhance the corrosion resistance and endothelialization of the AZ31 alloy, a layered double hydroxide (LDH)/poly-dopamine (PDA) composite coating (LDH/PDA) was successfully fabricated. Polarization curves and the electrochemical impedance spectroscopy Nyquist spectrum test proved that the corrosion resistance of the LDH/PDA sample was significantly improved in vitro. The LDH/PDA sample greatly improved the adherence process and the proliferation rate of human umbilical vein endothelial cells (HUVECs). After culturing for 10 days, the number of living HUVECs on the LDH/PDA sample was comparable to that on the Ti sample whereas the cells barely survived on the AZ31 or LDH coating. Furthermore, heparin was immobilized on LDH/PDA via a covalent bond (LDH/PDA/HEP). The corrosion resistance and long-term proliferation of HUVECs after the introduction of heparin were mildly decreased compared with the L/P sample, but were still greatly improved compared with AZ31, the LDH coating and the PDA coating. Furthermore, the LDH/PDA/HEP sample greatly improved the HUVEC migration rate compared with the LDH/PDA sample, and inhibited platelet adhesion which was intense on the LDH/PDA sample. Both LDH/PDA and LDH/PDA/HEP samples had a low hemolysis rate (2.52% and 0.65%, respectively) in vitro and eliminated the adverse biocompatible effects of the direct PDA coating on the AZ31 substrate in vivo. Our results suggest that the LDH/PDA composite coating with further heparinization is a promising method to modify the surface of Mg alloys by significantly improving corrosion resistance, endothelialization and hemocompatibility.
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Affiliation(s)
- Hua Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Feng G, Qin C, Yi X, Xia J, Chen J, Chen X, Chen T, Jiang X. Effect of novel bioresorbable scaffold composed of poly-L-lactic acid and amorphous calcium phosphate nanoparticles on inflammation and calcification of surrounding tissues after implantation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:112. [PMID: 30019182 DOI: 10.1007/s10856-018-6125-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
To study the effect of novel bioresorbable scaffold composed of poly-L-lactic acid (PLLA) and amorphous calcium phosphate (ACP) nanoparticles on inflammation and calcification of surrounding tissues after implantation. Ninety six PLLA/ACP scaffolds and 96 PLLA scaffolds were randomly implanted in the back muscle tissue of 48 SD rats. At the 1st, 2nd, 4th, and 12th weeks after implantation, the calcium, phosphorus, and alkaline phosphatase levels in the blood serum and the contents of calcium and alkaline phosphatase in the tissue surrounding the scaffolds were measured. Hematoxylin-eosin staining was performed to count the inflammatory cells. Von kossa staining was performed to observe calcification of the surrounding tissue around the scaffold. NF-κB staining was performed by immunohistochemistry to calculate the positive expression index of inflammatory cells. Western blot was used to detect the expression of IL-6 and BMP-2 in the tissues surrounding the scaffolds. At the 1st, 2nd, 4th, and 12th weeks after scaffold implantation, there were no significant difference in the serum concentration of calcium, phosphorus, alkaline phosphatase and in the tissue homogenate concentration of alkaline phosphatase between the two groups (P > 0.05). The level of calcium in tissue homogenates was lower in the PLLA/ACP group than in the PLLA group at 12-week (P < 0.05). The hematoxylin-eosin staining results showed that the inflammatory cell count in the PLLA/ACP group was lower than the PLLA group at 4-week and 12-week (P < 0.05). The results of NF-kB positive expression index showed that the PLLA group was significantly more than the PLLA/ACP group at 4-week and 12-week (P < 0.01). Western blot results showed that IL-6 expression levels in the PLLA/ACP group scaffolds were significantly lower than those in the control group at the 2-week, 4-week and 12-week (P < 0.05). The expression of BMP-2 in the PLLA group was significantly lower than that in the control group at 4-week and 12-week (P < 0.05). The PLLA/ACP composite material has good histocompatibility. The integration of nanoscale ACPs reduces the inflammatory response induced by acidic metabolites of PLLA material and may inhibit tissue calcification by reducing the amount of calcification factors in the body.
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Affiliation(s)
- Gaoke Feng
- Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, China
| | - Chaoshi Qin
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Xin Yi
- Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, China
| | - Jinggang Xia
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, 100053, Beijing, China
| | - Jingjing Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, China
| | - Xiyu Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, China
| | - Tao Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, China
| | - Xuejun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, 430060, Wuhan, China.
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Advances and Challenges of Biodegradable Implant Materials with a Focus on Magnesium-Alloys and Bacterial Infections. METALS 2018. [DOI: 10.3390/met8070532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Gao Y, Wang L, Gu X, Chu Z, Guo M, Fan Y. A quantitative study on magnesium alloy stent biodegradation. J Biomech 2018; 74:98-105. [DOI: 10.1016/j.jbiomech.2018.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 03/14/2018] [Accepted: 04/14/2018] [Indexed: 11/26/2022]
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