Rigberg David, Tulloch Allan, Chun Youngjae, Mohanchandra Kotekar Panduranga, Carman Greg, Lawrence Peter
Division of Vascular Surgery, UCLA School of Medicine, Los Angeles, Calif 90402, USA.
J Vasc Surg. 2009 Aug;50(2):375-80. doi: 10.1016/j.jvs.2009.03.028.
Although technological improvements continue to advance the designs of aortic stent grafts, miniaturization of the required delivery systems would allow their application to be available to a wider range of patients and potentially decrease the access difficulties that are encountered. We performed this feasibility study to determine if thin-film NiTi (Nitinol) could be used as a covering for stent grafts ranging from 16 mm to 40 mm in diameter. Specifically, we wished to determine the profile reduction attainable and improve the flexibility of our design.
Using a novel hot-sputter deposition technique, we created sheets of thin-film NiTi (TFN) with a tensile strength of >500 Megapascal (MPa) and thickness of 5-10 microns. TFN was used to cover stents, which were then deployed in vitro. Patterned thin film was fabricated via a lift-off technique; grafts were constructed with stents ranging from 16-40 mm and deployed in a pulsatile flow system from the smallest diameter polymer tubing into which the stent and TFN would fit. The bending/stiffness ratio vs similar sized expanded polytetrafluoroethylene (ePTFE)-covered stents was also determined.
TFN was created in both non-patterned and patterned forms, with a tensile strength of >100 MPa for the latter. We created devices that were successfully deployed via delivery systems half the size of fabric-covered stent grafts (ie, the 16 mm stent graft that originally was delivered via a 16French (F) system was reduced to 8F, and the 40 mm stent graft delivered via a 24F system was reduced to 12F). No migration of the devices was observed with deployment in both straight and curved tubing, which was sized so that the stent grafts were oversized by 20%. Both forms of the thin-film were noted to be more flexible than the same sized ePTFE stent graft, and the patterned graft had an additional 15-30% flexibility vs the non-patterned film.
These in vitro results demonstrate the feasibility of TFN for covering stent grafts designed for placement in the aorta. The delivery profile can be significantly reduced across a wide range of sizes, while the material remained more flexible than ePTFE.
尽管技术进步不断推动主动脉覆膜支架的设计发展,但所需输送系统的小型化将使其能应用于更广泛的患者群体,并有可能减少所遇到的接入困难。我们开展了这项可行性研究,以确定薄膜镍钛合金(镍钛诺)是否可用于覆盖直径为16毫米至40毫米的覆膜支架。具体而言,我们希望确定可实现的外形尺寸缩减,并提高我们设计的柔韧性。
使用一种新颖的热溅射沉积技术,我们制作了拉伸强度大于500兆帕斯卡(MPa)且厚度为5 - 10微米的薄膜镍钛合金(TFN)片材。TFN用于覆盖支架,然后在体外展开。通过剥离技术制造图案化薄膜;构建了直径为16 - 40毫米的支架的覆膜支架,并在脉动流系统中从支架和TFN能够适配的最小直径聚合物管开始展开。还测定了弯曲/刚度比与类似尺寸的膨体聚四氟乙烯(ePTFE)覆盖支架的比较情况。
制作出了无图案和有图案两种形式的TFN,后者的拉伸强度大于100 MPa。我们制造的装置通过尺寸为织物覆盖覆膜支架一半大小的输送系统成功展开(即,原本通过16法式(F)系统输送的16毫米覆膜支架减小到了8F,通过24F系统输送的40毫米覆膜支架减小到了12F)。在直管和弯管中展开时均未观察到装置移位,弯管尺寸设计为使覆膜支架尺寸过大20%。两种形式的薄膜都比相同尺寸的ePTFE覆膜支架更具柔韧性,并且有图案的覆膜支架比无图案薄膜的柔韧性额外增加了15 - 30%。
这些体外研究结果证明了TFN用于覆盖设计用于放置在主动脉中的覆膜支架的可行性。在广泛的尺寸范围内,输送外形尺寸可显著减小,同时该材料比ePTFE更具柔韧性。