patient likely to develop restenosis/buildup of plaque directly after the stent

lamater flow = layers

fluid begins to flow back onto itself, turbulence
reendothiliazation going on in the stent
want to delay growth of smooth muscle cells
anit-proliferative drugs delay growth of healthy endothelium
open circles = metal strut, embedded into wall
you WANT endothelialization for healing, but enough to inhibit smooth tissue
too much drug = can be tissue breakdown
carotid artery stenting for patients at risk for stroke-- plaque develops in carotid artery,
breaks off, goes to cerebral arteries and clots
coronary artery stent goes through femoral artery
patients do not experience symptoms until diameter of artery is decreased by 70-90%

degradable stents
ca naturally remodels itself
should leave no trace behind, affect future sugeries

how should things degrade?

hydrolytically degradable*
worried about chunks breaking off

bulk erosion - holes start to form, water diffuses in, degrades holes of polymer,
UNPREDICTABLE, CHAOTIC breaking
over time, holes get bigger and bigger
all of a sudden, breaks into chunks
forms debris
surface erosion - degradation only at the surface, faster than the diffusion of water
preferable
polymer washing away
no chunks
while any degredation products be toxic?
drug release profile**
enough mechanical strength to expand and hold artery open for 3-6 mo.?
different erosions a result of different polymer composition
how can you control deg rate?
polymers made up of monomers
degrade when they stop holding hand
alter it by altering number of crosslinks
trigger degredation by altering pH, catalyst, etc.

drugs that prevent clots:

antiplatelet drugs: aspirin, clopidogrel (plavix)
clot busting :
blow apart existing clot: streptokinase, urokinase, tissue plasminogen activator
(tPA)-- protein drugs, crazy expensive
too much delivery causes bleeding risk
theranostic? *
deg. stents w/o metal have thicker struts because they are weaker
 slide 14
after sterilization, is chemical comp still okay?
sheer?
draw diag. slide 16
aliphatic - charge?
define stereoisomers*
d-lactic and l-lactic* (l makes crystalline/toxic*?, d would be easier/quicker, more
naturally occuring)

cant see bioresorbable stent in x-rays

slide 18

slide 23
patients with coronary artery disease
current standard of care - bare metal or drug eluting stent
lower restinosis, overall survival

degradable drug eluting stents

now you can try

slide 31
compare against degradable and drug eluting
look at restinosis rates, number of major coronary events
diuretics helpful for congestive heart f, makes patients pee out extra fluid

end stage-- people have probably already had a heart attack

patients w/ right cad get back pain

criteria
we want the right tissue
not scar tissue
no quiero una arrethmia
youngs mod - stress v strength(strain?)
tensile strength
trying to match elasticity of cardiac tissue
in situ - you have a gel, combine in a syringe and inject into affected area

in situ: less invasive BUT less control over what happens with scaffold once implantation
occurs
in vitro: mechanical criteria more easily met, more control over what it looks like BUT
more invasive
cardiomyocytes, fibroblasts, myoblasts, adult stem cells, embryonic stems cells

slide 47
patients with heart failure
ventricular cyst device, current standard of treatment\
 overall survival