Beshchasna Natalia, Saqib Muhammad, Kraskiewicz Honorata, Wasyluk Łukasz, Kuzmin Oleg, Duta Oana Cristina, Ficai Denisa, Ghizdavet Zeno, Marin Alexandru, Ficai Anton, Sun Zhilei, Pichugin Vladimir F, Opitz Joerg, Andronescu Ecaterina
Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Maria-Reiche-Str. 2, 01109 Dresden, Germany.
Balton Sp. z o.o. Modlińska 294, 03-152 Warsaw, Poland.
Pharmaceutics. 2020 Apr 13;12(4):349. doi: 10.3390/pharmaceutics12040349.
Cardiovascular diseases are the most distributed cause of death worldwide. Stenting of arteries as a percutaneous transluminal angioplasty procedure became a promising minimally invasive therapy based on re-opening narrowed arteries by stent insertion. In order to improve and optimize this method, many research groups are focusing on designing new or improving existent stents. Since the beginning of the stent development in 1986, starting with bare-metal stents (BMS), these devices have been continuously enhanced by applying new materials, developing stent coatings based on inorganic and organic compounds including drugs, nanoparticles or biological components such as genes and cells, as well as adapting stent designs with different fabrication technologies. Drug eluting stents (DES) have been developed to overcome the main shortcomings of BMS or coated stents. Coatings are mainly applied to control biocompatibility, degradation rate, protein adsorption, and allow adequate endothelialization in order to ensure better clinical outcome of BMS, reducing restenosis and thrombosis. As coating materials (i) organic polymers: polyurethanes, poly(ε-caprolactone), styrene-b-isobutylene-b-styrene, polyhydroxybutyrates, poly(lactide-co-glycolide), and phosphoryl choline; (ii) biological components: vascular endothelial growth factor (VEGF) and anti-CD34 antibody and (iii) inorganic coatings: noble metals, wide class of oxides, nitrides, silicide and carbide, hydroxyapatite, diamond-like carbon, and others are used. DES were developed to reduce the tissue hyperplasia and in-stent restenosis utilizing antiproliferative substances like paclitaxel, limus (siro-, zotaro-, evero-, bio-, amphi-, tacro-limus), ABT-578, tyrphostin AGL-2043, genes, etc. The innovative solutions aim at overcoming the main limitations of the stent technology, such as in-stent restenosis and stent thrombosis, while maintaining the prime requirements on biocompatibility, biodegradability, and mechanical behavior. This paper provides an overview of the existing stent types, their functionality, materials, and manufacturing conditions demonstrating the still huge potential for the development of promising stent solutions.
心血管疾病是全球分布最为广泛的死因。动脉支架植入术作为一种经皮腔内血管成形术,通过插入支架重新打开狭窄动脉,成为一种很有前景的微创治疗方法。为了改进和优化这种方法,许多研究团队致力于设计新型支架或改进现有支架。自1986年开始研发支架以来,从裸金属支架(BMS)起步,这些装置通过应用新材料、开发基于无机和有机化合物(包括药物、纳米颗粒或生物成分如基因和细胞)的支架涂层,以及采用不同制造技术调整支架设计,不断得到改进。药物洗脱支架(DES)的研发旨在克服BMS或涂层支架的主要缺点。涂层主要用于控制生物相容性、降解速率、蛋白质吸附,并实现充分的内皮化,以确保BMS有更好的临床效果,减少再狭窄和血栓形成。作为涂层材料,使用了:(i)有机聚合物:聚氨酯、聚(ε-己内酯)、苯乙烯-异丁烯-苯乙烯、聚羟基丁酸酯、聚(丙交酯-共-乙交酯)和磷酸胆碱;(ii)生物成分:血管内皮生长因子(VEGF)和抗CD34抗体;以及(iii)无机涂层:贵金属、多种氧化物、氮化物、硅化物和碳化物、羟基磷灰石、类金刚石碳等。DES的研发利用紫杉醇、雷帕霉素(西罗莫司、佐他莫司、依维莫司、生物雷帕霉素、两性霉素、他克莫司)、ABT-578、酪氨酸磷酸化抑制剂AGL-2043、基因等抗增殖物质来减少组织增生和支架内再狭窄。这些创新解决方案旨在克服支架技术的主要局限性,如支架内再狭窄和支架血栓形成,同时保持对生物相容性、生物可降解性和机械性能的基本要求。本文概述了现有支架类型、其功能、材料和制造条件,展示了开发有前景的支架解决方案仍具有巨大潜力。