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Almas T, Ehtesham M, Basit J, Khedro T, Malik U, Nagarajan VR, Hur J, Alshareef N, Fathima A, Virk HUH, Hameed A, Li J. Prasugrel versus ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: A critical appraisal of randomized controlled trials. Ann Med Surg (Lond) 2022; 74:103330. [PMID: 35198169 PMCID: PMC8844802 DOI: 10.1016/j.amsu.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/30/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Corresponding author. RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin, Ireland.
| | - Maryam Ehtesham
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Janita Basit
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tarek Khedro
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Jung Hur
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Norah Alshareef
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Areen Fathima
- University Hospital, National University of Ireland Galway, Galway, Ireland
| | | | - Aamir Hameed
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Bio-Based Covered Stents: The Potential of Biologically Derived Membranes. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:135-151. [DOI: 10.1089/ten.teb.2018.0207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Doros G, Massaro JM, Kandzari DE, Waksman R, Koolen JJ, Cutlip DE, Mauri L. Rationale of a novel study design for the BIOFLOW V study, a prospective, randomized multicenter study to assess the safety and efficacy of the Orsiro sirolimus-eluting coronary stent system using a Bayesian approach. Am Heart J 2017; 193:35-45. [PMID: 29129253 DOI: 10.1016/j.ahj.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditional study design submitted to the Food and Drug Administration to test newer drug-eluting stents (DES) for marketing approval is the prospective randomized controlled trial. However, several DES have extensive clinical data from trials conducted outside the United States that have led to utilization of a novel design using the Bayesian approach. This design was proposed for testing DES with bioresorbable polymer compared with DES most commonly in use today that use durable polymers for drug elution. STUDY DESIGN AND OBJECTIVES This prospective, multicenter, randomized, controlled trial is designed to assess the safety and efficacy of the Orsiro bioresorbable polymer sirolimus-eluting stent (BP SES). Up to 1,334 subjects with up to 3 de novo or restenotic coronary artery lesions who qualify for percutaneous coronary intervention with stenting will be randomized 2:1 to the BP SES versus the Xience durable polymer everolimus-eluting stent (DP EES). Data from this trial will be combined with data from 2 similarly designed trials that also randomize subjects to BP SES and DP EES (BIOFLOW II, N=452 and BIOFLOW IV, N=579) by using a Bayesian approach. The primary end point is target lesion failure at 12 months post index procedure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization, and the primary analysis is a test of noninferiority of the BP SES versus DP EES on the primary end point according to a noninferiority delta of 3.85%. Secondary end points include stent thrombosis and the individual components of target lesion failure. Subjects will be followed for 5 years after randomization. CONCLUSIONS The BIOFLOW V trial offers an opportunity to assess clinical outcomes in patients treated with coronary revascularization using the Orsiro BP SES relative to a commonly used DP EES. The use of a Bayesian analysis combines a large randomized cohort of patients 2 two smaller contributing randomized trials to augment the efficiency of the comparison.
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Janjic M, Pappa F, Karagkiozaki V, Gitas C, Ktenidis K, Logothetidis S. Surface modification of endovascular stents with rosuvastatin and heparin-loaded biodegradable nanofibers by electrospinning. Int J Nanomedicine 2017; 12:6343-6355. [PMID: 28919738 PMCID: PMC5587164 DOI: 10.2147/ijn.s138261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study describes the development of drug-loaded nanofibrous scaffolds as a nanocoating for endovascular stents for the local and sustained delivery of rosuvastatin (Ros) and heparin (Hep) to injured artery walls after endovascular procedures via the electrospinning process. PURPOSE The proposed hybrid covered stents can promote re-endothelialization; improve endothelial function; reduce inflammatory reaction; inhibit neointimal hyperplasia of the injured artery wall, due to well-known pleiotropic actions of Ros; and prevent adverse events such as in-stent restenosis (ISR) and stent thrombosis (ST), through the antithrombotic action of Hep. METHODS Biodegradable nanofibers were prepared by dissolving cellulose acetate (AC) and Ros in N,N-dimethylacetamide (DMAc) and acetone-based solvents. The polymeric solution was electrospun (e-spun) into drug-loaded AC nanofibers onto three different commercially available stents (Co-Cr stent, Ni-Ti stent, and stainless steel stent), resulting in nonwoven matrices of submicron-sized fibers. Accordingly, Hep solution was further used for fibrous coating onto the engineered Ros-loaded stent. The functional encapsulation of Ros and Hep drugs into polymeric scaffolds further underwent physicochemical analysis. Morphological characterization took place via scanning electron microscopy (SEM) and atomic force microscopy (AFM) analyses, while scaffolds' wettability properties were obtained by contact angle (CA) measurements. RESULTS The morphology of the drug-loaded AC nanofibers was smooth, with an average diameter of 200-800 nm, and after CA measurement, we concluded to the superhydrophobic nature of the engineered scaffolds. In vitro release rates of the pharmaceutical drugs were determined using a high-performance liquid chromatography assay, which showed that after the initial burst, drug release was controlled slowly by the degradation of the polymeric materials. CONCLUSION These results imply that AC nanofibers encapsulated with Ros and Hep drugs have great potential in the development of endovascular grafts with anti-thrombogenic properties that can accelerate the re-endothelialization, reduce the neointimal hyperplasia and inflammatory reaction, and improve the endothelial function.
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Affiliation(s)
- Milka Janjic
- Department of Physics, Laboratory for Thin Films – Nanosystems and Nanometrology, University of Thessaloniki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Foteini Pappa
- Department of Physics, Laboratory for Thin Films – Nanosystems and Nanometrology, University of Thessaloniki
| | - Varvara Karagkiozaki
- Department of Physics, Laboratory for Thin Films – Nanosystems and Nanometrology, University of Thessaloniki
| | - Christakis Gitas
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Logothetidis
- Department of Physics, Laboratory for Thin Films – Nanosystems and Nanometrology, University of Thessaloniki
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Ichihashi S, Wolf F, Schmitz-Rode T, Kichikawa K, Jockenhoevel S, Mela P. In Vitro Quantification of Luminal Denudation After Crimping and Balloon Dilatation of Endothelialized Covered Stents. Cardiovasc Intervent Radiol 2017; 40:1229-1236. [DOI: 10.1007/s00270-017-1661-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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Wolf F, Vogt F, Schmitz-Rode T, Jockenhoevel S, Mela P. Bioengineered vascular constructs as living models for in vitro cardiovascular research. Drug Discov Today 2016; 21:1446-1455. [PMID: 27126777 DOI: 10.1016/j.drudis.2016.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/01/2016] [Accepted: 04/18/2016] [Indexed: 12/20/2022]
Abstract
Cardiovascular diseases represent the most common cause of morbidity and mortality worldwide. In this review, we explore the potential of bioengineered vascular constructs as living models for in vitro cardiovascular research to advance the current knowledge of pathophysiological processes and support the development of clinical therapies. Bioengineered vascular constructs capable of recapitulating the cellular and mechanical environment of native vessels represent a valuable platform to study cellular interactions and signaling cascades, test drugs and medical devices under (patho)physiological conditions, with the additional potential benefit of reducing the number of animals required for preclinical testing.
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Affiliation(s)
- Frederic Wolf
- Department of Tissue Engineering & Textile Implants, Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Felix Vogt
- Department of Cardiology, Pulmonology, Intensive Care and Vascular Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Thomas Schmitz-Rode
- Department of Tissue Engineering & Textile Implants, Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute Aachen, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Tissue Engineering & Textile Implants, Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany; Institut für Textiltechnik, RWTH Aachen University, Otto-Blumenthal-Str. 1, 52074 Aachen, Germany; Aachen-Maastricht Institute for Biobased Materials, Maastricht University at Chemelot Campus, Urmonderbaan 22, 6167 RD Geleen, The Netherlands.
| | - Petra Mela
- Department of Tissue Engineering & Textile Implants, Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
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Nanofiber-Coated Drug Eluting Stent for the Stabilization of Mast Cells. Pharm Res 2014; 31:2463-78. [DOI: 10.1007/s11095-014-1341-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/13/2014] [Indexed: 12/21/2022]
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Farhatnia Y, Tan A, Motiwala A, Cousins BG, Seifalian AM. Evolution of covered stents in the contemporary era: clinical application, materials and manufacturing strategies using nanotechnology. Biotechnol Adv 2013; 31:524-42. [DOI: 10.1016/j.biotechadv.2012.12.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/20/2012] [Accepted: 12/30/2012] [Indexed: 12/24/2022]
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Abstract
Mast cells are increasingly being recognized as effector cells in many cardiovascular conditions. Many mast-cell-derived products such as tryptase and chymase can, through their enzymic action, have detrimental effects on blood vessel structure while mast cell-derived mediators such as cytokines and chemokines can perpetuate vascular inflammation. Mice lacking mast cells have been developed and these are providing an insight into how mast cells are involved in cardiovascular diseases and, as knowledge increase, mast cells may become a viable therapeutic target to slow progression of cardiovascular disease.
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Naghavi N, de Mel A, Alavijeh OS, Cousins BG, Seifalian AM. Nitric oxide donors for cardiovascular implant applications. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2013; 9:22-35. [PMID: 23136136 DOI: 10.1002/smll.201200458] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/13/2012] [Indexed: 06/01/2023]
Abstract
In an era of increased cardiovascular disease burden in the ageing population, there is great demand for devices that come in to contact with the blood such as heart valves, stents, and bypass grafts that offer life saving treatments. Nitric oxide (NO) elution from healthy endothelial tissue that lines the vessels maintains haemostasis throughout the vasculature. Surgical devices that release NO are desirable treatment options and N-diazeniumdiolates and S-nitrosothiols are recognized as preferred donor molecules. There is a keen interest to investigate newer methods by which NO donors can be retained within biomaterials so that their release and kinetic profiles can be optimized. A range of polymeric scaffolds incorporating microparticles and nanomaterials are presenting solutions to current challenges, and have been investigated in a range of clinical applications. This review outlines the application of NO donors for cardiovascular therapy using biomaterials that release NO locally to prevent thrombosis and intimal hyperplasia (IH) and enhance endothelialization in the fabrication of next generation cardiovascular device technology.
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Affiliation(s)
- Noora Naghavi
- UCL Centre for Nanotechnology & Regenerative Medicine, University College London, UK
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Safety and Efficacy of the cobalt chromium PRO-Kinetik coronary stent system: Results of the MULTIBENE study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:316-20. [DOI: 10.1016/j.carrev.2012.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/25/2012] [Accepted: 09/28/2012] [Indexed: 01/24/2023]
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Keyes JT, Lockwood DR, Simon BR, Vande Geest JP. Deformationally dependent fluid transport properties of porcine coronary arteries based on location in the coronary vasculature. J Mech Behav Biomed Mater 2012; 17:296-306. [PMID: 23127633 DOI: 10.1016/j.jmbbm.2012.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/17/2012] [Accepted: 10/01/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Understanding coronary artery mass transport allows researchers to better comprehend how drugs or proteins move through, and deposit into, the arterial wall. Characterizing how the convective component of transport changes based on arterial location could be useful to better understand how molecules distribute in different locations in the coronary vasculature. METHODS AND RESULTS We measured the mechanical properties and wall fluid flux transport properties of de-endothelialized (similar to post-stenting or angioplasty) left anterior descending (LADC) and right (RC) porcine coronary arteries along their arterial lengths. Multiphoton microscopy was used to determine microstructural differences. Proximal LADC regions had a higher circumferential stiffness than all other regions. Permeability decreased by 198% in the LADC distal region compared to other LADC regions. The RC artery showed a decrease of 46.9% from the proximal to middle region, and 51.7% from the middle to distal regions. The porosity increased in the intima between pressure states, without differences through the remainder of the arterial thickness. CONCLUSIONS We showed that the permeabilities and mechanical properties do vary in the coronary vasculature. With variations in mechanical properties, overexpansion of stents can occur more easily while variations in permeability may lead to altered transport based on location.
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Affiliation(s)
- Joseph T Keyes
- Graduate Interdisciplinary Program in Biomedical Engineering 1657 E Helen St, The University of Arizona, Tucson, AZ 85721, USA.
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de Mel A, Murad F, Seifalian AM. Nitric oxide: a guardian for vascular grafts? Chem Rev 2011; 111:5742-67. [PMID: 21663322 DOI: 10.1021/cr200008n] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Achala de Mel
- Centre for Nanotechnology & Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, United Kingdom
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