U.S. patent application number 11/751268 was filed with the patent office on 2008-04-24 for drug-delivery endovascular stent and method of use.
This patent application is currently assigned to BIOSENSORS INTERNATIONAL GROUP. Invention is credited to Ronald E. Betts, Sepehr Fariabi, Douglas R. Savage, John E. Shulze, Shih-Horng Su.
Application Number | 20080097591 11/751268 |
Document ID | / |
Family ID | 39204880 |
Filed Date | 2008-04-24 |
United States Patent
Application |
20080097591 |
Kind Code |
A1 |
Savage; Douglas R. ; et
al. |
April 24, 2008 |
DRUG-DELIVERY ENDOVASCULAR STENT AND METHOD OF USE
Abstract
An improvement in drug-eluting stents, and method of their
making are disclosed. The surface of a metal stent is roughened to
have a surface roughness of at least about 20 .mu.in (0.5 .mu.m)
and a surface roughness range of between about 300-700 .mu.in
(7.5-17.5 .mu.m). The roughened stent surface is covered with a
polymer-free coating of a limus drug, to a coating thickness
greater than the range of surface roughness of the roughened stent
surface.
Inventors: |
Savage; Douglas R.; (Del
Mar, CA) ; Shulze; John E.; (Rancho Santa Margarita,
CA) ; Betts; Ronald E.; (La Jolla, CA) ;
Fariabi; Sepehr; (Newport Coast, CA) ; Su;
Shih-Horng; (Irvine, CA) |
Correspondence
Address: |
PERKINS COIE LLP
P.O. BOX 2168
MENLO PARK
CA
94026
US
|
Assignee: |
BIOSENSORS INTERNATIONAL
GROUP
Hamilton
BM
|
Family ID: |
39204880 |
Appl. No.: |
11/751268 |
Filed: |
May 21, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11690768 |
Mar 23, 2007 |
|
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11751268 |
|
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60853077 |
Oct 20, 2006 |
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Current U.S.
Class: |
623/1.43 |
Current CPC
Class: |
A61F 2220/0025 20130101;
A61L 31/10 20130101; A61F 2/848 20130101; A61F 2/915 20130101; A61L
31/022 20130101; A61F 2002/91541 20130101; A61F 2/89 20130101; A61F
2250/0023 20130101; A61F 2210/0014 20130101; A61F 2250/0036
20130101; A61F 2/91 20130101; A61F 2250/0051 20130101; A61F
2002/825 20130101; A61F 2250/0067 20130101; A61F 2250/0025
20130101; A61F 2250/0068 20130101; A61F 2250/0096 20130101; A61F
2240/001 20130101; A61F 2230/0013 20130101; A61F 2250/0037
20130101; A61L 2300/416 20130101; A61L 2420/02 20130101; A61F
2002/91566 20130101; A61L 2300/606 20130101; A61L 31/16 20130101;
A61F 2210/0004 20130101; A61F 2/82 20130101; A61F 2250/0026
20130101 |
Class at
Publication: |
623/1.43 |
International
Class: |
A61F 2/06 20060101
A61F002/06 |
Claims
1. In a method for reducing the rate of occurrence and/or extent of
restenosis or thrombosis resulting from vascular injury in a
subject, relative to that observed by placing at the site of
injury, a bare-metal expandable stent formed of interconnected
metal filaments, by the step of coating the outer surface of the
stent filaments with a polymer carrier containing a limus drug, an
improvement which maintains or further reduces the rate of
occurrence and/or extent of restenosis or thrombosis relative to
that achieved with a polymer-coated, limus-eluting stent, but
without the presence of a polymer carrier, comprising roughening
outer surface regions of the stent filaments to a surface roughness
of at least about 20 .mu.in (0.5 .mu.m), and a surface roughness
range of between about 300-700 .mu.in (7.5-17.5 .mu.m), and coating
the roughened regions of the stent filaments with a polymer-free
coating of the limus drug, to a coating thickness greater than the
range of surface roughness of the roughened stent surface.
2. The improvement of claim 1, wherein the stent filaments are
roughened to a surface roughness of between about 20-40 .mu.in (0.5
to 1 .mu.m).
3. The improvement of claim 1, wherein the stent filaments are
roughened to have a surface roughness range of between about
300-500 .mu.in (7.5-12.5 .mu.m).
4. The improvement of claim 1, said roughening is carried out by
abrading the outer surface regions of the stent filaments with a
pressurized stream of abrasive particles.
5. The improvement of claim 1, wherein said roughening is carried
out by forming a hydrocarbon-film mask over outer surface regions
of the stent filaments, selectively removing stent material exposed
by the mask, and removing the mask.
6. The improvement of claim 1, wherein said roughening is carried
out by laser etching the outer surface regions of the stent
filaments.
7. The improvement of claim 1, wherein said roughening is carried
out by peening the outer surface regions of the filaments to
imprint a pattern thereon.
8. The improvement of claim 1, wherein said coating is carried out
by applying a viscous solution of the drug onto the outer surfaces
of the stent filament, and drying the applied solution to form a
solid drug coating on the stent filaments.
9. The improvement of claim 1, wherein said coating is carried out
to apply a final amount of limus drug on the stent between 80 to
240 ug/cm stent length.
10. The improvement of claim 10, wherein said coating is carried
out to produce a final drug coating having a thickness between 5
and 15 .mu.m.
11. The improvement of claim 1, wherein the limus drug coating said
stent is Biolimus A9.
12. In a method for administering an anti-restenosis drug from an
expandable stent formed of inter connected metal filaments, by
coating the outer surface of the stent with a polymer-free limus
drug coating, an improvement which reduces the occurrence and/or
extent of restenosis or thrombosis, comprising roughening outer
surface regions of the stent filaments which are coated by the
limus drug, to a surface roughness of at least about 20 .mu.in (0.5
.mu.m), and a surface roughness range of between about 300-700
.mu.in (7.5-17.5 .mu.m).
13. The improvement of claim 12, wherein the stent filaments are
roughened to a surface roughness of between about 20-40 .mu.in (0.5
to 1 .mu.m).
14. The improvement of claim 12, wherein the stent filaments are
roughened to have a surface roughness range of between about
300-500 .mu.in (7.5-12.5 .mu.m).
15. The improvement of claim 12, wherein the limus drug is Biolimus
A9.
16. An expandable stent for use in reducing the rate of occurrence
and/or extent of restenosis or thrombosis, without the inflammatory
response produced by a stent having a limus-drug-eluting polymer
coating, when the stent is placed at a site of vascular injury,
comprising an expandable stent body formed of interconnected metal
filaments, formed on outer surface regions of the stent filaments a
roughened surface characterized by a surface roughness of at least
about 20 .mu.in (0.5 .mu.m), and a surface roughness range of
between about 300-700 .mu.in (7.5-17.5 .mu.m), and carried on the
roughened regions of the stent filaments, a polymer-free coating of
the limus drug having a coating thickness greater than the range of
surface roughness of the roughened stent surface.
17. The stent of claim 16, wherein the stent filaments are
roughened to a surface roughness of between about 20-40 .mu.in (0.5
to 1 .mu.m).
18. The stent of claim 16, wherein the stent filaments are
roughened to have a surface roughness range of between about
300-500 .mu.in (7.5-12.5 .mu.m).
19. The stent of claim 16, wherein the limus drug is Biolimus A9.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of priority to U.S.
Provisional Application No. 60/853,077, filed Oct. 20, 2006, and
U.S. patent application Ser. No. 11/690,768, filed Mar. 27, 2007,
both of which are incorporated herein by reference in their
entirety.
TECHNICAL FIELD
[0002] The present application relates to an endovascular stent at
least partly including a textured or abraded surface, and a method
of making and using the stent.
BACKGROUND
[0003] Complications such as restenosis are a recurring problem in
patients who have received artherosclerosis therapy in the form of
medical procedures such as percutaneous translumenal coronary
angioplasty (PTCA). Restenosis is commonly treated by a procedure
known as stenting, where a medical device is surgically implanted
in the affected artery to prevent it from occluding post
procedure.
[0004] A stent is typically cylindrical in shape and is usually
made from a biocompatible metal, such as cobalt chromium or
surgical steel. Most stents are collapsible and are delivered to
the occluded artery via a translumenal catheter. The stent is
affixed to the catheter and can be either self expanding or
expanded by inflation of a balloon inside the stent that is then
removed with the catheter once the stent is in place.
[0005] Complications that can arise from stent therapy include
restenosis and thrombosis. In an effort to overcome these
complications, stents may contain a layer or coating of an
anti-restenosis drug that is released in a controlled fashion at
the stent-implantation site. Typically, the drug is contained in a
permanent or bioerodable polymer carrier, as disclosed, for
example, in U.S. Pat. No. 5,716,981 issued to Hunter entitled
"Anti-angiogenic Compositions and Methods of Use." Examples of
typical therapies that are proposed to be delivered in this manner
are antiproliferatives, anticoagulants, anti-inflammatory agents
and immunosuppressive agents, although there are many other
chemical and biological agents also mentioned in the patent
literature. It has been suggested that the polymer carrier with
drug may be covered by a porous biodegradable layer that serves to
regulate controlled release of the drug into the body, as disclosed
for example, in U.S. Pat. Nos. 6,774,278 and 6,730,064.
[0006] More recently, stents in which an anti-restenosis drug is
carried in channels, grooves or pores for release in "polymer-free"
i.e. pure-drug form have been proposed. Alternatively, stents
having roughened surface intended to anchor a drug layer on the
surface of the stent, for release in pure-drug form have been
proposed, for example, in U.S. Pat. Nos. 6,805,898 and 6,918,927.
None of these patents show or suggest that with particular classes
of anti-restenosis compounds, it is possible to enhance the
anti-restenosis activity of the compounds by selection of surface
roughness features within certain ranges on the stent surface.
[0007] In light of the complications associated with stent therapy,
it would be desirable to develop a stent having at least one
roughened or textured surface for increased surface area, which can
be manufactured in such a way as to maximize structural integrity,
drug loading capacity, and ability to deliver drug to the vessel
wall in a therapeutically enhanced way, as evidenced by a reduced
risk of rate of occurrence or extent of restenosis following stent
placement at the site of vascular injury.
SUMMARY
[0008] The invention includes, in one embodiment, an improvement in
a method for reducing the rate of occurrence and/or extent of
restenosis or thrombosis resulting from vascular injury in a
subject, relative to that observed by placing at the site of
injury, a smooth-surfaced expandable stent formed of interconnected
metal filaments, by coating the outer surface of the stent
filaments with a polymer carrier containing a limus drug. The
improvement, which is intended to maintain or further reduce the
rate of occurrence and/or extent of restenosis or thrombosis,
relative to that achieved with a polymer-coated, limus-eluting
stent, but without the presence of a polymer carrier, includes the
steps of:
[0009] (a) roughening outer surface regions of the stent filaments
to a surface roughness of at least about 20 .mu.in (0.5 .mu.m), and
a surface roughness range (maximum peak-to-valley) of between about
300-700 .mu.in (7.5-17.5 .mu.m), and
[0010] (b) coating the roughened regions of the stent filaments
with a polymer-free coating of the limus drug, to a coating
thickness greater than the surface roughness range of the roughened
stent surface, that is, to a thickness that covers the roughened
surface.
[0011] The stent filaments may be roughened to have a surface
roughness of between about 20-40 .mu.in (0.5 to 1 .mu.m), and/or a
surface roughness range of between about 300-500 .mu.in (7.5-12.5
.mu.m).
[0012] The surface roughening may be carried out by abrading the
outer surface regions of the stent filaments with a pressurized
stream of abrasive particles, by forming a hydrocarbon-film mask
over outer surface regions of the stent filaments, selectively
removing stent material exposed by the mask, and removing the mask,
by laser etching the outer surface regions of the stent filaments,
or by peening the outer surface regions of the filaments to imprint
a pattern thereon.
[0013] The drug coating may be applied as a viscous solution of the
drug onto the outer surfaces of the stent filament, with drying to
form a solid drug coating on the stent filaments. The coating may
be applied to a final amount of limus drug on the stent between 25
to 240 ug/cm stent length, and to a final coating thickness between
5 and 15 .mu.m. One preferred class of limus drugs are the
42-0-alkoxyalkyl limus compounds, as exemplified by the
42-O-ethoxyethyl compound referred to herein as Biolimus A9.
[0014] In another aspect, the invention includes an improvement in
a method for administering an anti-restenosis drug from an
expandable stent formed of interconnected metal filaments, by
coating the outer surface of the stent with a polymer-free limus
drug coating. The improvement, which is intended to reduce the rate
of occurrence and/or extent of restenosis or thrombosis achieved
with the polymer-free limus drug coating, comprises roughening the
outer surface regions of the stent filaments which are coated by
the limus drug, to a surface roughness of at least about 20 .mu.in
(0.5 .mu.m), and a surface roughness range of between about 300-700
.mu.in (7.5-17.5 .mu.m).
[0015] Also disclosed is an expandable stent for use in reducing
the rate of occurrence and/or extent of restenosis or thrombosis
resulting when the stent is placed at a site of vascular injury.
The stent includes an expandable stent body formed of
interconnected metal filaments, and formed on outer surface regions
of the stent filaments, a roughened surface characterized by a
surface roughness of at least about 20 .mu.in (0.5 .mu.m), and a
surface roughness range of between about 300-700 .mu.in (7.5-17.5
.mu.m), and carried on the roughened regions of the stent
filaments, a polymer-free coating of the limus drug having a
coating thickness greater than the range of surface roughness of
the roughened stent surface.
[0016] These and other aspects and embodiments of the present
invention will become better apparent in view of the detailed
description in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] FIG. 1 is a scanned image of an endovascular stent having a
metal filament body;
[0018] FIG. 2A is a scanning electron micrograph of an abraded
stent surface;
[0019] FIG. 2B is a scanning electron micrograph of the surface of
FIG. 2A showing quantification of peaks generated on the stent
surface after abrasion;
[0020] FIG. 2C is a scanning electron micrograph of the surface of
FIG. 2A showing quantification of valleys generated on the stent
surface after abrasion;
[0021] FIG. 3A is an illustration of a pneumatic press treating a
stent surface;
[0022] FIG. 3B is a close up frontal view of the fixed-head punch
assembly of FIG. 3A showing the pneumatic press with multiple
peeners;
[0023] FIG. 3C is close up side view of the fixed head punch
assembly of FIG. 3B;
[0024] FIG. 3D is a close up frontal of the fixed-head attachment
for the punch assembly of the pneumatic press of FIG. 3A showing an
exemplary pattern;
[0025] FIG. 4 is a scanning electron micrograph of a drug-coated,
treated stent;
[0026] FIG. 5 is an elution profile of the drug Biolimus A9.RTM.
from the present stent and the Biomatrix.RTM. II stent as measured
by the percentage of the total amount of drug released over
cumulative time in hours;
[0027] FIG. 6 is a graph showing the percentage of the drug
Biolimus A9.RTM. released from the present stent and a
Biomatrix.RTM. II in a porcine implant model at three and two
months, respectively;
[0028] FIG. 7 is a graph showing the peak concentration in ng/mL of
the drug Biolimus A9.RTM. in peripheral blood over time in hours as
released from the present stent and a Biomatrix.RTM. II stent in a
porcine implant model as measured by mass spectroscopy;
[0029] FIG. 8 is a graph showing the percentage of area occlusion
for a stent having no drug and a stent having the Biolimus A9.RTM.
drug;
[0030] FIGS. 9A-9F are scanned images of histological sections of a
vessel 28 days after implantation of a bare-metal stent (FIGS.
9A-9B), a metal-filament stent with a polymer coating containing
Biolimus A9.RTM. (FIGS. 9C-9D), and metal-filament microstructure
stent with a coating of Biolimus A9.RTM. (FIGS. 9E-9F);
[0031] FIGS. 10A-10K are graphs of the histomorphometry of an
explanted vessel containing the microstructure stent; and
[0032] FIGS. 11A-11E are micrographs of mechanical injector laser
surface treatments.
DETAILED DESCRIPTION
I. Definitions
[0033] Unless indicated otherwise, the terms below have the
following meanings herein.
[0034] "Surface roughness" or "roughness average" or "Ra" is the
arithmetic average of absolute values of the measured profile
height deviations taken within the sampling length or area measured
from the graphical centerline or centerplane (the mean line or
plane). It is measured typically by a non-contact surface optical
profilometer, as discussed below, but may also be measured by a
contact profilometer or by estimating peak and valley heights from
a surface micrograph.
[0035] "Surface roughness range" or "Rt" is the maximum
peak-to-valley distance, calculated as the sum of the maximum peak
and maximum valley measurements of roughness with respect to a
centerline or centerplane. It is typically measured by non-contact
surface optical profilometer, but can also be measured by the other
methods noted above.
[0036] "Limus drug" refers to a macrocyclic triene
immunosuppressive compound having the general structure shown, for
example, in U.S. Pat. Nos. 4,650,803, 5,288,711, 5,516,781,
5,665,772 and 6,153,252, in PCT Publication No. WO 97/35575, in
U.S. Pat. No. 6,273,913B1, and in U.S. Patent Application Nos.
60/176,086, 2000/021217A1, and 2001/002935A1.
[0037] "42-O-alkoxyalkyl limus drug" refers to the 42-O alkoxyalkyl
derivative of rapamycin described in U.S. patent application
20050101624, published May 12, 2005, which is incorporated herein
in its entirety. As exemplary "42-O-alkoxyalkyl limus drug" is
"42-O-ethoxyethyl rapamycin, also referred to herein as Biolimus
A9.
[0038] "Polymer-free coating" means a coating whose structure and
cohesiveness are provided by the drug itself, with or without the
presence of one or more binding agents, rather than by a polymer
matrix in which the drug is embedded, i.e., a polymer carrier.
II. Endovascular Stent
[0039] FIG. 1 shows a stent constructed in accordance with the
invention, in the stent's contracted state. The stent includes a
structural member or body with at least one surface being at least
partly roughened or abraded at least for holding and releasing an
anti-restenosis compound, as will be described further below.
[0040] In the embodiment shown, the stent body is formed of a
series of tubular members called struts 3 connected to each other
by filaments called linkers 4. Each strut 3 has an expandable
zig-zag, sawtooth, helical ribbon coil or sinusoidal wave
structure, and the connections to each linker 4 serve to increase
overall stent flexibility. The contracted-state diameter of the
stent is between approximately 0.5 mm-2.0 mm, preferably 0.71 to
1.65 mm, and a length of between 5-100 mm. The expanded stent
diameter is at least twice and up to 8-9 times that of the stent in
its contracted state, for example, a stent with a contracted
diameter of between 0.7 to 1.5 mm may expand radially to a selected
expanded state of between 2.0-8.0 mm or more. Stents having this
general stent-body architecture of linked, expandable tubular
members are known, for example, as described in PCT Publication No.
WO 99/07308, which is commonly owned with the present application
and expressly incorporated by reference herein.
[0041] Preferably, the stent structure is made of a biocompatible
material, such as stainless steel. Further examples of
biocompatible materials that are typically used for the stent
structure are, cobalt chromium, nickel, magnesium, tantalum,
titanium, nitinol, gold, platinum, inconel, iridium, silver,
tungsten, or another biocompatible metal, or alloys of any of
these; carbon or carbon fiber; cellulose acetate, cellulose
nitrate, silicone, polyethylene teraphthalate, polyurethane,
polyamide, polyester, polyorthoester, polyanhydride, polyether
sulfone, polycarbonate, polypropylene, high molecular weight
polyethylene, polytetrafluoroethylene, or another biocompatible
polymeric material, or mixtures or copolymers of these;
poly-L-lactic acid, poly-DL-lactic acid, polyglycolic acid or
copolymers thereof, a polyanhydride, polycaprolactone,
polyhydroxybutyrate valerate or another biodegradable polymer, or
mixtures or copolymers of these; a protein, an extracellular matrix
component, collagen, fibrin or another biologic agent; or a
suitable mixture of any of these. An example of a typical stent is
described in U.S. Pat. No. 6,730,064. The dimensions of each stent
will vary depending on the body lumen in which they are to be
delivered. For example, a stent may have a diameter ranging from
approximately 0.5 mm to approximately 25.0 mm and a length that
ranges from approximately 4 mm to approximately 100 mm or longer.
An example of stent measurements is described in co-owned U.S. Pat.
No. 6,939,376, which is commonly owned and expressly incorporated
by reference herein.
[0042] As seen in FIG. 2A, at least a portion of at least one of
the surfaces of the stent has a roughened or abraded microstructure
or textured surface. This microstructure can include at least one
therapeutic agent that elutes from the microstructure. As seen in
FIGS. 2B-2C, the roughened or textured surface provides interstices
or vertically projecting surface features and/or regions of
undercuts or recesses. It will be appreciated that a solution
containing a therapeutic agent can be drawn, e.g., by capillary
forces into such recesses and coat the projecting surfaces. In this
manner, the surface area for coating the stent may be increased.
The thickness of such layer refers to the average thickness of the
layer, e.g., average depth of the infusible portion of the layer.
Preferably, and as seen in FIG. 2A, at least a portion of the
ablumenal surface of the stent, i.e., the surface in contact with
the treated vessel after stent placement, includes the
microstructure surfacing.
III. Methods of Preparing Textured Surface
[0043] In one embodiment, the method includes use of a mask to
prevent at least a portion of the stent from being abraded.
Preferably, the mask is a hydrocarbon film, such as PARAFILM.RTM.,
however, it will be appreciated that any suitable barrier to
abrasion is suitable for use in these methods. Accordingly, in a
preferred embodiment, at least the lumenal surface of the stent is
not abraded. In one embodiment, a sheet of the mask approximately 5
mm by 60 mm is rolled around the diameter of a mandrel such as a
1.4 mm glass capillary tube. The stent is positioned onto the
mandrel and hand-crimped into the hydrocarbon mask. A stereo
microscope set between 10.times. and 40.times. may be used to
ensure that the portion of the stent that is not to be abraded is
covered by the mask. In a preferred embodiment, at least 80% of the
stent wall thickness on all surfaces is masked by the hydrocarbon
film layer.
[0044] In one embodiment, the stent surface 5 is then treated by
utilizing microblasting systems, such as the MICRO BLASTER.RTM. and
PROCENTER.RTM. by Comco, Inc. or an equivalent. In one embodiment,
25 .mu.m of an abrasive, such as aluminum oxide, is used to roughen
the stent surface 5. The pressure is adjusted to 40 psi.+-.5 psi,
and a spray nozzle is positioned approximately 2.5 cm to 5.0 cm
from the stent surface 5, making multiple passes over the
stent.
[0045] In another embodiment, the mask is removed by any
appropriate means such as via ultrasonic cleaning. Typically the
ultrasonic cleaner is filled with deionized water which is heated
to 45.degree. C. A sample vial of HPLC grade chloroform is heated
to between 50-60.degree. C. on a hotplate. A glass capillary tube
mandrel with a treated stent is incubated in a vial of 40.degree.
C. and 50.degree. C. HPLC grade chloroform for 5-10 minutes. The
vial containing the chloroform and mandrel is then sonicated in
45.degree. C. deionized water for two minutes.
[0046] Due to the roughening of the stent surface 5, different
elements are expressed on the metal surface, which can increase the
susceptibility to corrosion. As a result, the treated stent is
generally passivated according to ASTM standards and cleaned in a
series of solvents such as Chloroform, Acetone and/or Isopropyl
Alcohol. In one embodiment, after the mask is removed and the
treated stent is sonicated, it is removed from the vial of
chloroform. A sample vial is rinsed with Acetone and then refilled
with Acetone. The treated stent is placed in the vial and sonicated
in the ultrasonic cleaner for two minutes. The vial is rinsed with
isopropyl alcohol and then refilled with isopropyl alcohol. The
stent is sonicated in the ultrasonic cleaner for two more minutes.
The treated stent is then passivated in a 60.degree.
C..+-.3.degree. C. 20% by volume Nitric Acid bath for 30 minutes.
The stent is then rinsed 10 times with copious amounts of deionized
water. The stent is then placed in 600 mL of a solvent such as
isopropyl alcohol and sonicated in the ultrasonic cleaner for 5
minutes and allowed to air dry.
[0047] In another embodiment, the surface of the stent is uniformly
abraded in a controlled manner via shot peening. Roughening of a
stent surface 5 is accomplished using metal particles called shot
that range in size from approximately 1 to 5 microns and is made
from an atomic element having at least a weight of 43 g/mol. For
example, the shot may be in the form of particulate tantalum,
particulate tungsten, particulate platinum, particulate iridium,
particulate gold, particulate bismuth, particulate barium,
particulate zirconium and alloys thereof. Examples of suitable
alloys include a platinum/nickel alloy and a platinum/iridium
alloy.
[0048] In another embodiment, a stent surface 5 can be treated to
create mechanical injectors that range in size from about 3 to
about 10 microns.
[0049] In another embodiment, a stent surface 5 can be laser etched
to create regular or irregular patterns of asperities/mechanical
injectors of about 5 to about 25 microns.
[0050] In another embodiment, the stent surface can be treated to
have a different roughness factor on the ablumenal surface than the
lumen surface. For example the whole surface may be treated via any
of the above disclosed methods. Then a subsequent masking of the
lumen surface is performed so that a second surface treatment can
be directed to the ablumenal surface. The subsequent treatment
would typically utilize the more aggressive texturing process. The
differing surfaces thus obtained can be used to impart differing
useful properties to the inside (i.e. lumenal) vs. outside
(ablumenal) surfaces of the stent. In one embodiment, the lumenal
surface roughness is optimized to improve cell ingrowth and
adhesion for example as described in (US Patent Application No.
2005/0211680), and the ablumenal surface roughness may be optimized
to provide drug transfer from the ablumenal surface of the stent to
the surrounding tissues as described herein.
[0051] The stent surface 5 may be treated by placing desired amount
of shot over a predetermined portion of the stent surface 5 and in
the desired pattern. Pressure is applied to the particles using
plates or rollers to make indentations in the stent surface 5.
Roughness can also be achieved by jet blasting the particles at the
stent surface 5 at a velocity sufficient to make indentations. An
example of shot peening a metal surface is described in U.S. Pat.
No. 6,911,100.
[0052] In a further embodiment, this uniform, controlled surface
roughness can also be achieved similar to above by employing a
laser rather than the use of shot. A series of electric discharges
are applied to the desired portion of the outer or inner stent
surface 5. The electric discharges contact the surface with
sufficient energy to vaporize the material on the surface of the
stent, creating pits, sometimes called voids, the combined effect
of which is a rough surface having increased surface area. An
example of this process is described in U.S. Pat. No.
6,913,617.
[0053] In another embodiment, the surface of the stent is uniformly
treated by compression. The stent is affixed to a mandrel, which is
inserted into a die that is equipped with preformed raised portions
that form indentations in the desired amount, shape, size and
pattern on the stent surface 5. The indentations may be made in a
number of ways such as welding them onto the stent surface 5 or
sandblasting. The die is then closed around the stent forming
indentations of the desired depth and covering the desired surface
area. The stent is treated over its entire surface, or a portion of
the surface, depending on the manufacture of the die. An example of
this process is described in U.S. Pat. No. 7,055,237.
[0054] In another embodiment, a stent surface 5 is treated with a
pneumatic press or hydraulic press. Pneumatic presses are well
known in the art as described in U.S. Pat. No. 4,079,617. Hydraulic
presses are also well-known in the art as described in U.S. Pat.
No. 7,033,155. As seen in FIGS. 3A-3D, the stent is positioned on a
mandrel 1 that is either stationary or rotating. A computer
controlled pneumatic or hydraulic press 8 is configured to treat
the surface of the stent in one of several predetermined ways, for
example, randomly or in a desired pattern. The punch assembly 9 of
the press may be configured to contain one or more peeners 10, 11
here defined as indentation creating mechanisms. In a preferred
embodiment, the punch assembly contains a plurality of peeners. It
will be appreciated that the peeners may be of uniform or varied
length in order to form the surface microstructure. Each peener 10,
11 remains in a retracted position until the computer is programmed
to treat the stent surface 5. According to the selected program,
the peeners 10, 11 will be depressed onto the stent surface 5 with
enough force to result in an indentation. Generally, the punch
assembly 9 is configured to be no more than width of the desired
stent, for example if the stent strut 3 is 15 micron, the plurality
of peeners 10, 11, will total no more than 15 micron on width as
well. The number of peeners 10, 11 on a given punch assembly 9 will
vary depending on the width of the stent. Similarly, the punch
assembly 9 may be configured to be a preformed head affixed to the
press the heads are interchangeable depending on which pattern is
desired. Also, the head can be stationary and the stent is turned
or in the alternative, the head can be moveable, this is embodied
in a single peener 10, 11 affixed to the press that will randomly
make impressions on the stent surface 5.
[0055] In another embodiment, the entire length of the tubing used
to create stents, for example tubing that is 2.5 meters in length,
is treated prior to laser cutting it into a plurality of desired
stent lengths. The stent is horizontally or vertically attached to
one or more mandrels 1 and abraded using one of the methods
disclosed in this application. In terms of the abrading techniques,
the stent is treated randomly, uniformly or in a desired pattern.
Further, the length and sides of the stent is treated lengthwise,
vertically or spirally. Moreover, the stent surface 5 is treated
either by moving it over a stationary roughening mechanism, or in
the alternative, the entire stent tube length is stationary and the
roughening mechanism may be moved over the length of the tube in
one of the manners disclosed, for example horizontally, vertically,
spirally.
[0056] Potentiodynamic corrosion testing was performed on the
treated stent to confirm the desirability of the passivation step
and its effectiveness. The data shows that the treated, passivated
stent breakdown potential is well within ASTM specified voltage
levels standards. Therefore, after the roughening process and
passivation, the treated stent does not exhibit a greater
likelihood of corrosion when compared to the untreated control
stent, and the roughening process does not increase the potential
for restenosis and thrombosis. After passivation, the
biocompatibility of the microstructured metal surface was observe d
to be equivalent to that observed with stents having smooth
electropolished surfaces.
[0057] The approximate thickness of an untreated stent wall is
generally around 0.05 mm. As seen in FIGS. 2B-2C, the treatment of
the stent surface 5 in the manner disclosed results in a treated
stent surface with an average peak 6 height of approximately 1.30
.mu.m and an average valley 7 depth of 2.08 .mu.m. To measure the
effects, if any, that the roughening process has on the stent's
structural integrity, axial fatigue testing and auger analysis was
performed on a treated stent. Axial fatigue testing was focused at
the portion of the stent that is the most susceptible to breakage,
which is the link 4 between stent struts 3. After over 3 million
cycles in simulated physiological conditions, the untreated stent
control and the roughed stent both remained intact. Since a portion
of the treated stent is removed in the roughening process, and it
has been discovered that the treated stent is able to withstand the
same fatigue conditions as an untreated intact stent with more
surface area is able to withstand, it is understood that the
roughening process actually increases the fatigue resistance of the
stent due to the disrupted microcrystalline structures of the stent
body. Finally, auger analysis was performed on the treated stent to
characterize the surface chemistry, which revealed similar ratios
of identical elements in the passivated unroughened stent and the
passivated roughened stent. This demonstrates that the process of
passivating the untreated control stent in the manner disclosed has
no deleterious effects on the surface chemistry of the stent.
[0058] Example 2 provides surface roughness Ra and roughness factor
Rt measurements for 4 stents prepared as above by surface abrasion
with a pressurized particle blast. As seen, the surface roughness
values were all at least 20 .mu.in (0.5 .mu.m) and are typically
between about 20-40 .mu.in. (0.5 .mu.m-1.0 .mu.m), and a roughness
range between 300-700 .mu.inch (7.5 to 17.5 .mu.m), and typically
between 300 and 500 0.5 .mu.inch (7.5 and 12.5 .mu.mm). In
accordance with one aspect of the invention, these roughness
values, and particularly the roughness range values, have been
found optimal for achieving optimal anti-restenosis results in
subjects.
[0059] Without wishing to be limited to a particular theory as to
this effect, it appears that the surface asperities or projections
in the 300-700 .mu.inch peak to valley range are optimal for
"injecting" drug in the drug coating into the surrounding vessel.
Thus, for example, as the projections are exposed, either by drug
dissolution from the coating or by fractures in the coating during
stent placement, the projections, by impacting or penetrating the
local vessel area, may facilitate entry of the drug into the
vessel. The result is that the defined roughness range of the stent
surface, combined with the polymer-free drug coating, maintains or
further reduces the rate of occurrence and/or extent of restenosis
or thrombosis seen with a polymer-coated, limus-eluting stent, but
without the presence of a polymer carrier, and further reduces the
rate of occurrence and/or extent of restenosis or thrombosis seen
with a polymer-free coating on a less-roughened surface, i.e.
having a lower surface roughness range. Further, studies conducted
in support of the present invention indicate that a stent having
surface-roughness features with peak-to-height values in the range
800-1,000 .mu.inch (20-25 .mu.m or more) may be less effective in
reducing restenosis.
[0060] Thus, in one aspect, the invention is directed to improving
the effectiveness, in terms of reduced incidence and/or extent of
restenosis in treating a vascular injury with a drug-eluting stent,
e.g., a limus-eluting stent. The improvement includes the steps of
roughening at least the ablumenal surface portions of the stent to
a surface roughness of at least about 20 .mu.in (0.5 .mu.m), and a
surface roughness range of between about 300-700 .mu.in (7.5-17.5
.mu.m), and coating the roughened regions of the stent filaments
with a polymer-free coating of the limus drug, to a coating
thickness greater than the range of surface roughness of the
roughened stent surface, that is, to a coating thickness that forms
a substantially unbroken drug coating.
[0061] Preferably, an API (i.e. active pharmaceutical ingredient)
such as the antiproliferative Biolimus A9.RTM. is applied at least
to the ablumenal portion of the stent. The API may be applied to
the stent surface by any appropriate means including by spraying
the treated surface of the stent with a solution of the API. The
API solution may also be applied by dipping the entire stent into
the desired API or by applying it directly to the stent surface 5
manually. Biolimus A9.RTM. has an amorphous to semi-crystalline
structure that does not crack or fracture like some other
crystalline limus compounds. Therefore, the properties of Biolimus
A9.RTM. permit adhesion to the stent's roughened treated surface in
the unexpanded state and the expanded state.
[0062] Preferably, the API material is applied to the ablumenal
portion of the stent via autopipetting as described in co-owned
U.S. Pat. No. 6,939,376. A solution ranging in a concentration of
approximately 100 mg/ml to approximately 200 mg/ml is made by
dissolving the desired API in an appropriate solvent, such as ethyl
acetate or acetonitrile. The solution is placed in a reservoir with
a pump designed to deliver the solution at a predetermined rate.
The pump is controlled by a microcontroller, such as the 4-Axis
Dispensing Robot Model available from I&J Fisnar Inc. A
solution delivery tube for delivery of the solvent mixture to the
stent surface 5 is attached to the bottom of the reservoir. The
reservoir and delivery tube are mounted to a moveable support that
moves the solvent delivery tube continuously or in small steps, for
example, 0.2 mm per step along the longitudinal axis.
[0063] An uncoated stent is gripped by a rotating chuck contacting
the inner surface of the stent at least at one end. Axial rotation
of the stent is accomplished by rotating the stent continuously, or
in small degree steps, such as 0.5 degree per step. Alternatively,
the delivery tube is held at a fixed position and, in addition to
the rotation movement, the stent is moved along its longitudinal
direction to accomplish the coating process.
[0064] Prior to use, the solution delivery tubes are drawn and
shaped under a Bunsen burner to form a small tapered opening at the
tip of the tube to facilitate precise application of the
drug/solvent mixture, which can then be applied over the length and
sides of the stent as needed with the formed tip of the tube. It is
within the scope of the invention to use more than one of the fluid
dispensing tube types working in concert to form the coating, or
alternately to use more than one moveable solution reservoir
equipped with different tips, or containing different viscosity
solutions or different chemical makeup of the multiple solutions in
the same process to form the coating.
[0065] In another embodiment, a non-porous layer of parylene,
parylene derivative, or another biocompatible polymer is applied to
the treated stent surface, and the desired API is applied or
layered onto that. Optionally, an additional layer of slightly
non-porous polymer is applied directly over the API, which aids in
controlled release over time. According to the present invention,
the stent comprises at least one layer of an API posited on its
surface, and the other surfaces will either contain no API or one
or more different APIs. In this manner, one or more APIs may be
delivered to the blood stream from the lumenal surface of the
stent, while different treatments for different conditions are
delivered on the vascular injury site outside surface of the
stent.
[0066] In another embodiment the stent is capable of being coated
with an API molecule without the need of a polymer. As seen in FIG.
4, the process of roughening all or a portion of the stent in one
of the methods disclosed above allows for the API to adhere
directly to the surface of the treated stent 14. In one general
embodiment, the API is a limus drug, such as described in U.S. Pat.
Nos. 4,650,803, 5,288,711, 5,516,781, 5,665,772 and 6,153,252, in
PCT Publication No. WO 97/35575, in U.S. Pat. No. 6,273,913B1, and
in U.S. Patent Application Nos. 60/176,086, 2000/021217A1, and
2001/002935A1. Exemplary limus drugs are the 42-O-alkoxyalkyl
drugs, such as Biolimus A9. Additional API drugs that may be
employed, either alone, or in combination with a limus drug,
include antiplatelet or antithrombotic agents, or anti-inflammatory
agents such as dexamethasone, dexamethasone acetate, dexamethasone
sodium phosphate, or another dexamethasone derivative or an
anti-inflammatory steroid. Either the inside and/or outside
surfaces of the stent can also be used to deliver other types of
API molecules such as thrombolytics, vasodilators, antihypertensive
agents, antimicrobials or antibiotics, antimitotics,
antiproliferatives, antisecretory agents, non-steroidal
anti-inflammatory drugs, immunosuppressive agents, growth factors
and growth factor antagonists, antitumor and/or chemotherapeutic
agents, antipolymerases, antiviral agents, photodynamic therapy
agents, antibody targeted therapy agents, prodrugs, sex hormones,
free radical scavengers, antioxidants, biologic agents,
radiotherapeutic agents, radiopaque agents and radiolabelled
agents.
[0067] The stent may be included in an assembly consisting of a
stent body surrounding a deflated balloon affixed to the distal
portion of a catheter which is used to implant the stent at the
vascular injury site. The stent is introduced into the
cardiovascular system of a patient via the brachial or femoral
artery using the catheter. The catheter assembly is advanced
through the coronary vasculature until the deflated balloon and
stent combination is positioned across the vascular injury site or
site of vascular disease or site of vascular narrowing. The balloon
is then inflated to a predetermined size to expand the stent to a
diameter large enough to be in continuous contact with the lumen.
The balloon is then deflated to a smaller profile to allow the
catheter to be withdrawn from the patient's vasculature, leaving
the stent in place. An example of a typical stent implantation
procedure is described in U.S. Pat. No. 6,913,617.
IV. Methods of Use
[0068] This section describes vascular treatment methods in
accordance with the invention, and the performance characteristics
of stents constructed in accordance with the invention.
[0069] The methods of the invention are designed to minimize the
risk and/or extent of restenosis in a patient who has received
localized vascular injury, or who is at risk of vascular occlusion
due to the presence of advanced atherosclerotic disease. Typically
the vascular injury is produced during an angiographic procedure to
open a partially occluded vessel, such as a coronary or peripheral
vascular artery. Alternately, the stent may be introduced into a
site of vascular narrowing, and expanded using the balloon to
directly open up the narrowed portion of the vessel (i.e. the
vascular injury disease site). In the first mentioned angiographic
procedure, a balloon catheter is first placed at the occlusion
site, and a distal-end balloon is inflated and deflated one or more
times to force the occluded vessel open. This vessel expansion,
particularly involving surface trauma at the vessel wall where
plaque may be dislodged, often produces enough localized injury
that the vessel responds over time by cell proliferation and
reocclusion in the vicinity of the implanted stent. Not
surprisingly, the occurrence or severity of restenosis is often
related to the extent of vessel stretching involved in the
angioplasty procedure. Particularly where overstretching is 10% or
more, restenosis occurs with high frequency and often with
substantial severity, i.e., vascular occlusion. In the second
mentioned alternative procedure of direct stent placement without
prior angioplasty (i.e. "direct stenting") there is nevertheless
still vascular injury induced by the expansion of the stent and
balloon at the vascular injury disease site which results in
restenosis and cellular proliferation at the site of the stent
implantation, very similar in severity to that seen from the first
mentioned procedure.
[0070] The present invention is intended to be used without
limitations to any particular method of treating and injuring the
vascular site, and can be used with either of the techniques
described above, or with alternative techniques for vascular
disease and injury as is known. In practicing the present
invention, the stent is placed in its contracted state typically at
the distal end of a catheter, either within the catheter lumen, or
in a contracted state on a distal end balloon. The distal catheter
end is then guided to the injury site, or to the site of potential
occlusion, and released from the catheter, e.g., by pulling back a
sheath covering the stent to release the stent into the site, if
the stent is self-expanding, or by expanding the stent on a balloon
by balloon inflation, until the stent contacts the vessel walls, in
effect, implanting the stent into the tissue wall at the site.
[0071] Once deployed at the site, the drug coated stent begins to
release active compound (API) into the cells lining the vascular
site, to inhibit cellular proliferation and/or for other
therapeutic benefits such as reduction of inflammation, limitation
of thrombosis formation, reduction in cell apoptosis, etc. FIG. 5
shows Biolimus A9.RTM. release kinetics from two stents, one with
the drug coated onto a textured surface and the other a
Biomatrix.RTM. II stent with a polymer coating containing Biolimus
A9.RTM..
[0072] FIG. 6 shows the percentage of drug release of Biolimus
A9.RTM. from a polymer coated and textured stent. As seen in the
graph, after only two months, 100% of the Biolimus A9.RTM. was
released from the textured stent. In contrast, after three months
approximately 30% of the drug remained on the polymer coated
stent.
[0073] FIG. 7 shows the peak blood concentration of Biolimus
A9.RTM. as measured by mass spectroscopy for each of the polymer
coated Biomatrix.RTM. II and textured non-polymeric stent. As seen
in the figure, the Biolimus A9.RTM. blood concentration peaks at
about four hours with the textured stent. The peak blood
concentration of Biolimus A9.RTM. with the polymer coated
Biomatrix.RTM. II is at about two months.
[0074] FIGS. 9A-9F shows in cross-section, a vascular region having
an implanted bare metal stent (FIGS. 9A-9B), a metal Biomatrix.RTM.
II stent having a polymer coating of 225 .mu.g PLA and 225 .mu.g
Biolimus A9.RTM. (FIGS. 9C-9D), and a textured stent with 225 .mu.g
Biolimus A9.RTM. (FIGS. 9E-9F), where the coated filaments are seen
in cross section. The figure illustrates the release of
anti-restenosis compound from each filament region into the
surrounding vascular wall region. Over time, the smooth muscle
cells forming the vascular wall begin to grow into and through the
lattice or helical openings in the stent, ultimately forming a
continuous inner cell layer that engulfs the stent on both sides.
If the stent implantation has been successful, the extent of late
vascular occlusion at the site will be less than 50%, that is, the
cross-sectional diameter of flow channel remaining inside the
vessel will be at least 50% of expanded stent diameter at time of
implant.
[0075] Trials in a porcine restenosis animal model as generally
described by Schwartz et al. ("Restenosis After Balloon
Angioplasty--A Practical Proliferative Model in Porcine Coronary
Arteries", Circulation 82:(6) 2190-2200, December 1990.) Studies
have been conducted in the Porcine model which demonstrate the
ability of the stent of this invention to limit the extent of
restenosis, and the other advantages of the stent over currently
proposed and tested stents. The studies are summarized in Example
3.
[0076] Briefly, the studies compare the extent of restenosis at 28
days in an animal model following stent implantation, in bare metal
stents, polymer-coated stents, and textured stents.
[0077] FIGS. 9A-9F show that both the polymer coated and textured
stent greatly reduced levels of restenosis. In general, the vessels
with polymer drug-coated and textured stent treatment appeared to
be well-healed with a well established endothelial layer. There is
evidence of complete healing and vessel homeostasis at 28 days post
implant.
[0078] Further trials demonstrate the ability of the stents
described herein to limit the extent of restenosis over an extended
period of at least three months. The studies are summarized in
Example 4.
[0079] Briefly, the studies compare the extent of restenosis at 3
months following stent implantation with bare metal stents (BMS)
and polymer free drug eluting (pfDES) stents. Histomorphometry data
shown in Table 4 shows the pfDES greatly reduced levels of
restenosis as compared to the BMS.
[0080] The following examples illustrate various aspects of the
making and using the stent invention herein. They are not intended
to limit the scope of the invention.
EXAMPLE 1
In Vitro Drug Release of Biolimus A9.RTM. from Stents
[0081] In vitro drug release was conducted with Biomatrix.RTM. II
stents coated with a polymer containing the antiproliferative drug
Biolimus A9.RTM. and with stents containing an ablumenal
microstructure including Biolimus A9.RTM. in a PBS pH 7.4/Tween
medium at 37.degree. C. Sampling was periodically conducted and the
total amount of Biolimus A9.RTM. was measured by HPLC. FIG. 5
illustrates drug release from the Biomatrix.RTM. II stent and the
microstructure stent.
EXAMPLE 2
Roughness Factor Bench Test
[0082] The outer surface of a Bioflex II 6 crown stent was treated
with an abrasive to create a selectively micro-structured outer
surface of the stent for drug loading capacity, called Bio-Freedom
Stent (FS). The therapeutic agent can be coated directly on the
selectively microstructured surface of the stent.
[0083] The roughness factor of the FS was characterized using a
commercially available Veeco Metrology Group (Tucson, Ariz.) WYKO
NT-2000 system, which is a non-contact optical profiler. VSI
(vertical scanning interferometer) mode with Vision 32 software,
removing cylinder and tilt terms so that the stent surface appears
flat. A low pass filter is used which removes the effects of high
spatial frequency roughness, smoothing over features that are
smaller than a nine pixel window. The results are given in the
table below for four different stents whose surface roughness is
produced by sand blasting, where Ra is the mean surface roughness,
and Rt is the range in surface roughness, as defined above.
TABLE-US-00001 Sand Blast 3 Sand Blast 4 Sand Blast 5 Sand Blast 6
in .mu.inches in .mu.inches in .mu.inches in .mu.inches Ra 30.2
25.4 25.0 28.3 Rt 688.8 336.8 406.9 358.9
EXAMPLE 3
Animal Implant Tests
[0084] Textured stents from Example 2 with and without Biolimus
A9.RTM. were implanted in out-bred juvenile swine. A balloon
catheter was used to place the stent according to the standard
porcine overstretch model with 10-20% overstretch. The juvenile
swine target vessels were predilated by known angioplasty
techniques prior to stent placement.
[0085] After 28 days, the animals were euthanized according to
approved protocols, the heart and surrounding tissue was removed
from the animals.
[0086] A microscope containing a digital camera was used to
generate high resolution images of the vessel cross-sections which
had been mounted to slides with the results shown in FIGS. 9A-9F.
The images were subjected to histomorphometric analysis by the
procedure as follows:
[0087] The stent and artery were dissected, and micro-tomed by a
histologist. The samples were stained for various growth signals,
cell proliferation, and other cellular debris. Histomorphometric
measurements were made of:
[0088] The artery area in mm.sup.2 (FIG. 10A), IEL (FIG. 10B),
intimal area in mm.sup.2 (FIG. 10C), lumen area in mm.sup.2 (FIG.
10D), intimal thickness in microns (FIG. 10E), % area stenosis
(FIG. 10F), histologic grading based on injury and inflammation
(FIG. 10G), histologic grading based on intimal extracellular
matrix and EB/GC reaction (FIG. 10H), histologic grading based on
endothelialization and intimal fibrin (FIG. 10I), histologic
grading based on medial inflammation, necrosis and fibrosis (FIG.
10J), and histologic grading based on adventitial inflammation and
fibrosis (FIG. 10K).
[0089] The following table shows the results of the treatment
effect at 28 days follow-up. The data in the tables below under
column heading "Lumen Area mm.sup.2" report the results of
morphometric analysis of stents and vessels removed from the pigs
at 28 days follow-up (f/u):
TABLE-US-00002 TABLE 1 Histomorphometry results Arterial Area
Lumen/Artery Injury Lumen Area Stent mm.sup.2 Ratio Score mm.sup.2
Textured stent 7.76 mm.sup.2 1.08 0.57 3.35 .+-. 0.66 without BA9
(textured ablation surface) Textured stent with 8.49 mm.sup.2 1.08
0.50 5.68 .+-. 0.68 textured ablation surface and 225 .mu.g
Biolimus A9 .RTM.
[0090] FIG. 8 shows the graph of the % area occlusion for each of
the stent with textured surface and the stent with textured surface
and 225 .mu.g Biolimus A9.RTM..
EXAMPLE 4
Three Month Porcine Implant Study
[0091] A. Stent Implantation
[0092] Polymer Free BioMatrix Stents sandblasted as in Example 2
with 225 .mu.g Biolimus A9.RTM. or a bare BioFlex II stent was
implanted in a Crossbred Farm Pig Model according to Table 3.
TABLE-US-00003 TABLE 3 Animal Implant Matrix for Porcine Coronary
Artery Stents Location/Stent Type Pig No. LAD LCX RCA Duration 1
BMS pf DES pf DES Early death 2 BMS pf DES pf DES 3 months 3 BMS
n/a* Pf DES 3 months 4 pf DES pf DES BMS 3 months 5 BMS pf DES pf
DES 3 months BMS = bare metal stent, pf DES = polymer free drug
eluting stent *LCX was not stented because of unsuitable size for
stenting.
[0093] CV Path Institute, Inc. received hearts from 5 pigs.
Non-overlapping stenting was performed in 5 pigs, and stents were
explanted for light microscopic analysis at three months. Animal 1
died before scheduled follow up at three months for reasons not
associated with stent implant procedure at 2 months. The left
circumflex coronary artery (LCX) of animal #3 was not stented in
this animal because the LCX, which was of an unsuitable size.
[0094] B. Materials and Methods Light Microscopy
[0095] For light microscopy, the stented vessel segments were
embedded in methylmethacrylate plastic and sections from the
proximal, middle, and distal stent were cut, mounted on charged
slides, and stained with hematoxylin & eosin and Elastic Van
Gieson (EVG). The non-stented proximal and distal sections of the
artery were embedded in paraffin, sectioned at four to five
microns, and stained with hematoxylin and eosin and EVG. All
sections were examined by light microscopy for the presence of
inflammation, thrombus, neointimal formation and vessel wall
injury. Morphometric Analysis Morphometric software (IP Lab for
Macintosh, Scanalytics, Rockville, Md.) was calibrated using NIST
traceable microscope stage micrometers of 2.0 mm linear and 2.0 mm
diameter circle with all objectives. Klarmann Rulings, Inc.,
(Manchester, N.H.) certified all micrometer graduations. Areas of
measurement included the EEL (external elastic lamina), IEL
(internal elastic lamina) and lumen. The neointimal thickness was
measured at and between stent struts and averaged for each animal.
By subtracting IEL from EEL, the medial area was determined.
Percent stenosis was derived from the formula [1-(lumen area/stent
area)].times.lOO. Vessel injury score was determined using the
Schwartz method (Schwartz R S et al., J Am Coll Cardiol 1992;
19:267-274). Inflammation, fibrin, and injury scores were generated
for each section based on a graded analysis of 0=no
inflammation/fibrin/injury to value 3=marked
Inflammation/fibrin/injury. An inflammation score of 4 was given to
sections with 2 or more granulomatous reactions present.
Endothelial coverage was semi-quantified and expressed as the
percentage of the lumen circumference.
[0096] C. Statistical Analysis
[0097] The morphometric continuous data were expressed as mean
.+-.SD. Statistical analysis of the normally distributed parameters
was performed using a Student's t-test. The Wilcoxon test was used
in the analysis for non-normally distributed parameters or discrete
values. Normality of distribution was tested with the Wilk-Shapiro
test. A p value of <0.05 was considered statistically
significant.
[0098] D. Radiographic Findings
[0099] All stents appeared widely and evenly expanded without
evidences of fracture or bent.
[0100] E. Light Microscopy Observations
[0101] 1. Polymer Free DES
[0102] All stents were widely expanded and patent without any
evidence of thrombus at 3 months after implantation. Neointimal
formation was mild with a mean neointimal thickness of 0.16 mm and
composed by loosely packed smooth muscle cells and
proteoglycan-rich matrix. Vessel injury was mild. Mild fibrin
deposition localized around the struts was observed. Although
granulomatous response was seen in the LCX of animal #5,
inflammation was minimal overall in the other vessels. Giant cells
were occasionally observed and documented. Endothelialization was
complete without lumenal inflammatory cells and/or platelets
adhesion. Notably, a dense calcification was seen in neointima at
the proximal section in LCX of animal #2 which contained a bare
metal stent.
[0103] 2. Bare Metal Stents
[0104] All stents were widely expanded and patent without any
evidence of thrombus at 3 months after implantation. Neointimal
formation was mild with a mean neointimal thickness of 0.21 mm and
composed of tightly packed smooth muscle cell. Medial rupture was
observed in the Left Anterior Descending coronary artery (LAD) of
animal #2. This vessel showed severe inflammation mainly around the
struts probably due to the injury created by the implant procedure.
However, except for this animal, vessel injury and inflammation was
mild overall. Fibrin deposition and malapposition were not seen in
any stents. Endothelialization was completed without presence of
lumenal inflammatory cells and/or platelets adhesion.
[0105] F. Histomorphometry
TABLE-US-00004 TABLE 4 Morphometric comparison of BMS and polymer
free DES at 3 months Treatment Polymer free DES (n = 7) BMS (n = 4)
p-value EEL Area (mm.sup.2) 9.52 .+-. 1.27 7.32 .+-. 0.86 0.01 IEL
Area (mm.sup.2) 8.16 .+-. 1.09 6.15 .+-. 0.81 0.01 Lumen Area
(mm.sup.2) 6.27 .+-. 1.59 4.17 .+-. 0.98 0.04 *p-value derived by
Wilcoxon test statistical analysis
[0106] The results of this animal study demonstrated a significant
increase in Lumen Area (i.e. reduction in restenosis) at 3 months
after stent implant in a porcine model for the Polymer Free drug
eluting stent (Freedom DES) as compared to bare metal control stent
implants (BMS).
[0107] The description of the invention is merely exemplary in
nature and thus, variations that do not depart from the gist of the
invention are intended to be within the scope of the invention.
Such variations are not to be regarded as a departure from the
spirit and scope of the invention.
* * * * *