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Cecen B, Hassan S, Li X, Zhang YS. Smart Biomaterials in Biomedical Applications: Current Advances and Possible Future Directions. Macromol Biosci 2024; 24:e2200550. [PMID: 37728061 DOI: 10.1002/mabi.202200550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/02/2023] [Indexed: 09/21/2023]
Abstract
Smart biomaterials with the capacity to alter their properties in response to an outside stimulus or from within the environment around them have picked up significant attention in the biomedical community. This is primarily due to the interest in their biomedical applications that may be anticipated from them in a considerable number of dynamic structures and devices. Shape-memory materials are some of these materials that have been exclusively used for these applications. They exhibit unique structural reconfiguration features they adapt as per the provided environmental conditions and can be designed for their enhanced biocompatibility. Numerous research initiatives have focused on these smart biocompatible materials over the last few decades to enhance their biomedical applications. Shape-memory materials play a significant role in this regard to meet new surgical and medical devices' requirements for special features and utility cases. Because of the favorable design variety, different biomedical shape-memory materials can be developed by modifying their chemical and physical behaviors to accommodate the desired requirements. In this review, recent advances and characteristics of smart biomaterials for biomedical applications are described. The authors also discuss about their clinical translations in tissue engineering, drug delivery, and medical devices.
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Affiliation(s)
- Berivan Cecen
- Department of Mechanical Engineering, Rowan University, Glassboro, New Jersey, 08028, USA
- Department of Biomedical Engineering, Rowan University, Glassboro, New Jersey, 08028, USA
| | - Shabir Hassan
- Department of Biology, Khalifa University, Main Campus, Abu Dhabi, 127788, UAE
- Advanced Materials Chemistry Center (AMCC), Khalifa University, SAN Campus, Abu Dhabi, 127788, UAE
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Xin Li
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
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Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211970. [PMID: 34831726 PMCID: PMC8617716 DOI: 10.3390/ijerph182211970] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.
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Affiliation(s)
- Grzegorz K. Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38 St., 41-800 Zabrze, Poland;
| | - Grzegorz Cieślar
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
- Correspondence:
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Colombo M, He Y, Corti A, Gallo D, Ninno F, Casarin S, Rozowsky JM, Migliavacca F, Berceli S, Chiastra C. In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics. Ann Biomed Eng 2021; 49:2349-2364. [PMID: 33928465 PMCID: PMC8455500 DOI: 10.1007/s10439-021-02776-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
In-stent restenosis (ISR) represents a major drawback of stented superficial femoral arteries (SFAs). Motivated by the high incidence and limited knowledge of ISR onset and development in human SFAs, this study aims to (i) analyze the lumen remodeling trajectory over 1-year follow-up period in human stented SFAs and (ii) investigate the impact of altered hemodynamics on ISR initiation and progression. Ten SFA lesions were reconstructed at four follow-ups from computed tomography to quantify the lumen area change occurring within 1-year post-intervention. Patient-specific computational fluid dynamics simulations were performed at each follow-up to relate wall shear stress (WSS) based descriptors with lumen remodeling. The largest lumen remodeling was found in the first post-operative month, with slight regional-specific differences (larger inward remodeling in the fringe segments, p < 0.05). Focal re-narrowing frequently occurred after 6 months. Slight differences in the lumen area change emerged between long and short stents, and between segments upstream and downstream from stent overlapping portions, at specific time intervals. Abnormal patterns of multidirectional WSS were associated with lumen remodeling within 1-year post-intervention. This longitudinal study gave important insights into the dynamics of ISR and the impact of hemodynamics on ISR progression in human SFAs.
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Affiliation(s)
- Monika Colombo
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Yong He
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Anna Corti
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Federica Ninno
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
- Department of Medical Physics and Biomedical Engineering, University College of London, London, UK
| | - Stefano Casarin
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
- Center for Computational Surgery, Houston Methodist Research Institute, Houston, TX, USA
- Houston Methodist Academic Institute, Houston, TX, USA
| | - Jared M Rozowsky
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Scott Berceli
- Department of Surgery, University of Florida, Gainesville, FL, USA
- Malcom Randall VAMC, Gainesville, FL, USA
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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Baseline local hemodynamics as predictor of lumen remodeling at 1-year follow-up in stented superficial femoral arteries. Sci Rep 2021; 11:1613. [PMID: 33452294 PMCID: PMC7810829 DOI: 10.1038/s41598-020-80681-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/24/2020] [Indexed: 11/08/2022] Open
Abstract
In-stent restenosis (ISR) is the major drawback of superficial femoral artery (SFA) stenting. Abnormal hemodynamics after stent implantation seems to promote the development of ISR. Accordingly, this study aims to investigate the impact of local hemodynamics on lumen remodeling in human stented SFA lesions. Ten SFA models were reconstructed at 1-week and 1-year follow-up from computed tomography images. Patient-specific computational fluid dynamics simulations were performed to relate the local hemodynamics at 1-week, expressed in terms of time-averaged wall shear stress (TAWSS), oscillatory shear index and relative residence time, with the lumen remodeling at 1-year, quantified as the change of lumen area between 1-week and 1-year. The TAWSS was negatively associated with the lumen area change (ρ = - 0.75, p = 0.013). The surface area exposed to low TAWSS was positively correlated with the lumen area change (ρ = 0.69, p = 0.026). No significant correlations were present between the other hemodynamic descriptors and lumen area change. The low TAWSS was the best predictive marker of lumen remodeling (positive predictive value of 44.8%). Moreover, stent length and overlapping were predictor of ISR at follow-up. Despite the limited number of analyzed lesions, the overall findings suggest an association between abnormal patterns of WSS after stenting and lumen remodeling.
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Tanaka R. Recent Update on Peripheral Arterial Endovascular Therapy for Peripheral Arterial Occlusive Disease. INTERVENTIONAL RADIOLOGY 2020; 5:120-127. [PMID: 36284758 PMCID: PMC9550384 DOI: 10.22575/interventionalradiology.2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
Endovascular treatment is effective for symptomatic peripheral arterial disease (PAD). Following recent device improvements, favorable long-term outcomes have been achieved in iliac arteries as well as small arteries such as the femoral and popliteal arteries. This paper outlines the history and recent advances in endovascular treatment of peripheral vascular diseases as well as the characteristics and usage of devices. The history and the advances in endovascular treatment of peripheral vascular disease have been parallel, with the development of devices such as catheters and stents. Accordingly, endovascular treatment is now recommended in guidelines as the first-line for PAD.
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Affiliation(s)
- Ryoichi Tanaka
- Division of Dental Radiology, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University, Iwate
- Department of Radiology, Iwate Medical University, Iwate
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Hendriks JM, Dubois M, Lauwers P, de Vleeschauwer P, Vanbetsbrugge M, Deleersnijder R, Wustenberghs K, Robijn J, Jacobs B, Willaert W, Vandekerkhof J, Keirse K, Gabriëls K, Hoppenbrouwers M, Haesen D. Endovascular treatment of atherosclerotic lesions in the superficial femoral artery and proximal popliteal artery using the sinus-SuperFlex-635 stent: twelve-month results from the HERO Registry. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:84-92. [PMID: 32079379 DOI: 10.23736/s0021-9509.19.11028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and performance of the sinus-SuperFlex-635 self-expandable nitinol stent (Optimed GmbH) for the treatment of steno-occlusive lesions in the superficial femoral artery (SFA) and proximal popliteal artery (PPA). METHODS The prospective, multicenter, observational HERO study recruited 117 eligible patients (83 men; mean age 69.4±9.7y) from 7 centers in Belgium. RESULTS A total of 129 stents were successfully deployed in 121 lesions in 117 patients (100%). The patients presented with symptomatic ≥50% stenosis or chronic total occlusion (CTO) (30.6%). Mean lesion length was 71.4±56.3 mm. Moderate to severe calcification was present in 82.6% of the lesions. Acute lesion success (<30% residual stenosis) was achieved in 96.0%. There were no in-hospital serious adverse events. Duplex ultrasound-driven primary patency at 12 months was recorded in 84 of 107 (78.5%) lesions. The overall target lesion revascularization (TLR) rate was 8.4% at 12 months; the target extremity revascularization (TER) rate was 4.7%. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford class, without the need for TLR (i.e. primary sustained clinical improvement) in 83.9% of patients and with the need for TLR in 90.6% of patients (i.e. secondary sustained clinical improvement). CONCLUSIONS Based on the high primary patency, low stent fracture rate and significant clinical improvement, combined with refined stent design and long stent availability, the sinus-SuperFlex-635 self-expandable nitinol stent proves its value in the treatment of complex femoropopliteal lesions.
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Affiliation(s)
- Jeroen M Hendriks
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium -
| | - Marc Dubois
- Department of Thorax and Vascular Surgery, Heilig-Hartziekenhuis Lier, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | | | - Michiel Vanbetsbrugge
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Roderik Deleersnijder
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Karen Wustenberghs
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Jorn Robijn
- Department of Vascular and Thorax Surgery, General Hospital Jan Portaels Vilvoorde, Flemish Brabant, Belgium
| | - Bart Jacobs
- Department of Vascular Surgery, General Hospital Maria Middelares Gent, East Flanders, Belgium
| | - Willem Willaert
- Department of Vascular Surgery, General Hospital Maria Middelares Gent, East Flanders, Belgium
| | - Jos Vandekerkhof
- Department of Vascular Surgery, Jessa Hospital Hasselt, Limburg, Belgium
| | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Tienen, Flemish Brabant, Belgium
| | | | - Mieke Hoppenbrouwers
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Tabaza L, Janzer S, George JC. Stent crush: A novel endovascular approach for treatment of complex in-stent femoropopliteal chronic total occlusion. Catheter Cardiovasc Interv 2019; 95:E66-E70. [PMID: 31313483 DOI: 10.1002/ccd.28401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/27/2019] [Accepted: 07/04/2019] [Indexed: 11/11/2022]
Abstract
Femoropopliteal in-stent chronic total occlusions (CTOs) remain one of the most challenging subsets of peripheral arterial disease to treat percutaneously. Advances in available CTO crossing technology and operator experience have increased percutaneous intervention success rates. We report a case of critical limb ischemia in a patient with chronically occluded femoropopliteal nonoverlapping stents treated with a novel percutaneous approach of subintimal retrograde angioplasty using high compression resistant nitinol stents to crush the occluded previous stents to create a neo-lumen.
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Affiliation(s)
- Luai Tabaza
- Einstein Medical Center, Philadelphia, Pennsylvania
| | - Sean Janzer
- Interventional Cardiology fellowship, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Jon C George
- Cardiac Cath Laboratory, Einstein Medical Center, Philadelphia, Pennsylvania
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