Surface engineering at the nanoscale: A way forward to improve coronary stent efficacy - PubMed (original) (raw)

Review

. 2021 Jun 1;5(2):021508.

doi: 10.1063/5.0037298. eCollection 2021 Jun.

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Review

Surface engineering at the nanoscale: A way forward to improve coronary stent efficacy

Aleena Mary Cherian et al. APL Bioeng. 2021.

Abstract

Coronary in-stent restenosis and late stent thrombosis are the two major inadequacies of vascular stents that limit its long-term efficacy. Although restenosis has been successfully inhibited through the use of the current clinical drug-eluting stent which releases antiproliferative drugs, problems of late-stent thrombosis remain a concern due to polymer hypersensitivity and delayed re-endothelialization. Thus, the field of coronary stenting demands devices having enhanced compatibility and effectiveness to endothelial cells. Nanotechnology allows for efficient modulation of surface roughness, chemistry, feature size, and drug/biologics loading, to attain the desired biological response. Hence, surface topographical modification at the nanoscale is a plausible strategy to improve stent performance by utilizing novel design schemes that incorporate nanofeatures via the use of nanostructures, particles, or fibers, with or without the use of drugs/biologics. The main intent of this review is to deliberate on the impact of nanotechnology approaches for stent design and development and the recent advancements in this field on vascular stent performance.

© 2021 Author(s).

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Figures

FIG. 1.

FIG. 1.

Various nanoscale surface engineering strategies (nanostructured surface and thin films, nanoparticulate, and nanofibrous) adopted as coatings on coronary bare-metal stents to prevent in-stent restenosis and promote re-endothelialization.

FIG. 2.

FIG. 2.

(a) Electron micrograph of titania nanotube coated stent. Inset: nanotubes with an average nanotube diameter of 90 nm (magnification ×250 000). Moffat trichrome-stained images of a stented artery. (b) Titania nanoengineered and (c) Ti stents, showing a 15.6% and 5.6% thinner neointima over the struts for TiO2 NT stents than Ti stent. Reprinted with permission from Nuhn_et al._, ACS Appl. Mater. Interfaces 9(23), 19677–19686 (2017). Copyright 2017 American Chemical Society.

FIG. 3.

FIG. 3.

(a) Electron micrograph of titania nanoleafy textured stent surface (magnification ×40 000). Fluorescence imaging of (b) endothelial cells stained for F-actin (red) and PECAM1 (green) and (c) smooth muscle cells stained for F-actin (red) and nucleus (blue) on nanotextured SS surfaces, showing preferential adsorption and proliferation of ECs over SMCs on nanoleafy SS surface. Reprinted with permission from Mohan et al., Adv. Healthcare Mater.6, 1601353 (2017). Copyright 2017 John Wiley and Sons. H&E images of rabbit iliac artery after 2 months implantation of (d) SS bare-metal stent and (e) nanotextured SS stent, showing nearly 50% decrease in neointimal stenosis for the nanotextured stent. (f) Immunofluorescent en-face stained images of wheat germ agglutinin on ECs in nanotextured stent implanted artery, showing complete endothelialization (scale bar: 10 _μ_m). (a) and (d)–(f) Reprinted with permission from Cherian et al., ACS Omega5, 17582–17591 (2020). Copyright 2020 American Chemical Society.

FIG. 4.

FIG. 4.

(a) SEM images of (i) BMS and (ii) N–TiO2 film deposited on a bare stent. (b) Histopathological H&E staining and (c) optical coherence tomography of porcine coronary arteries implanted with (i) BMS, (ii) N–TiO2, (iii) N–TiO2 with everolimus, and (iv) EES for 4 weeks. The restenosis area was significantly decreased in the N–TiO2-everolimus group compared to that in the BMS group and was at par with the commercial EES. Reprinted with permission from Park et al., Mater. Sci. Eng.: C 91, 615–623 (2018). Copyright 2018 Elsevier. (BMS: bare-metal stent; N–TiO2: nitrogen-doped TiO2 film; EES: everolimus-eluting stent.)

FIG. 5.

FIG. 5.

(a) Bare-metal stent with a nanofibrous membrane coating. (b) SEM micrographs of the electrospun nanofibrous membrane with ticagrelor. Magnification of ×3000. (c) SEM images of platelets on electrospun ticagrelor eluting membrane. Red arrow indicates activated platelets (scale bars = 10 _μ_m). Magnification 3000×. (d) Hematoxylin–eosin stained section of arterial lesions in ticagrelor group exhibiting a complete lining of endothelial cells (red arrows). (e) Pathological arterial lesions in the ticagrelor group stained using HES5 markers at 4 weeks following stent implantation. The amount of formed neointima suggests less proliferation of SMCs in the media. (f) SEM images of the stented vessel showing complete endothelial coverage in the ticagrelor group. Reprinted with permission from Lee et al., Int. J. Nanomed. 13, 6039–6048 (2018). Copyright 2018 Dove Medical Press.

FIG. 6.

FIG. 6.

SEM images of (a) heparin/NONOate nanoparticles immobilized on polyglycidyl methacrylate (PGMA)-coated SS stents. Strut coverage on (b) SS-PGMA-Hep/NONOates and (c) control 316L SS stents harvested at 1 month. Histological hematoxylin−eosin stained images of (d) SS-PGMA-Hep/NONOates and (e) 316L SS stent after implantation for 1 month (arrows point to the higher magnification images). Reprinted with permission from Zhu et al., Langmuir 36, 2901–2910 (2020). Copyright 2020 American Chemical Society.

FIG. 7.

FIG. 7.

Representative SEM images of clinically tested porous stents. (a-i) Microporous hydroxyapatite-coated stent filled with sirolimus formulation (a-ii) cross section of the nanothin hydroxyapatite coating (∼600 nm). Reprinted with permission from Costa_et al._, JACC: Cardiovasc. Interventions 2(5), 422–427 (2008). Copyright 2008, Elsevier. (b-i) Nano+TM polymer-free stent showing strut microstructure after expansion. Strut thickness is approximately 91_μ_m having a large number of sirolimus-filled pores (∼400 nm) on the abluminal stent surface. (b-ii) Electron microscopy images of the nanopores (magnification ×20 000). Reprinted with permission from Liu et al., Catheterization Cardiovasc. Interventions 95(S1), 658–664 (2020). Copyright 2020 John Wiley and Sons.

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