Stents Endovascular

One relevant application involves vascular stents (endovascular prostheses), where thrombosis and restenosis remain a problem. So far, drug eluting coatings have been developed and applied with mixed results. One therapeutical approach involved ion implantation and cyclotron activation of stents to render them radioactive so as to inhibit neointimal formation and reduce restenosis, e.g. ion implantation to subsequently obtain radioactive or direct P ion implantation. 

Malek AM, Higashida RT, Phatouros CC, Lempert TE, Meyers PM, Smith WS, Dowd CP, Halbach VV. Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol 2000 21 ... 

Rogers C, Edelman ER. Endovascular stent design dictates experimental restenosis and thrombosis. Circulation 1995 91 2995-3001. 

Baily SR, Paige S, Lunn A, et al. Heparin coating of endovascular stents decreases subacute thrombosis in a rabbit model, Circulation I 992 86(suppl) l I 86. 

Thierry B, Winnik FM, Merhi Y et al, Bioactive coatings of endovascular stents based on polyelectrolyte multilayers. Biomacromolecules 2003 4 1564-1571. 

With the ongoing refinement of endovascular devices and techniques for carotid revascularization, catheter-based therapy has become technically feasible in most patients. Notwithstanding, appropriate case selection is required to ensure procedural safety, Here within we review new concepts pertaining to patient selection and technical procedural considerations that we consider crucial for enhancing clinical outcomes following carotid stenting,... 

Bush RL, Lin PH, Bianco CC, HurtJE, Lawhorn Tl, Lumsden AB. Reevaluation of temporary transvenous cardiac pacemaker usage during carotid angioplasty and stenting a safe and valuable adjunct. Vase Endovascular Surg 2004 38 229-235. 

Wholey MH, Jarmolowski CR, Eles G, Levy D, Buecthel J. Endovascular stents for carotid artery occlusive disease. J Endovasc Surg 1997 4 326-338. 

I I Wolf YG, Arko FR, Hill BB, et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J Vase Surg 2002 35(5) 882-886. 

Fransen GA, Desgranges R Laheij RJ, etal. Frequency, predictive factors, and consequences of stent-graft kink following endovascular AAA repair. J Endovasc TFier 2003 10(5) 913-918. 

Zarins CK, Bloch DA, Crabtree T, et al. Stent graft migration after endovascular aneurysm repair importance of proximal fixation. J Vase Surg 2003 38(6) 1264-1272 discussion 72. 

MECHANOPHARMACOLOGICAL THERAPY DRUG-ELUTING ENDOVASCULAR STENTS... 

The treatment of patients with symptomatic intracranial atherosclerotic disease can be summarized into prevention of occurrence of intraluminal thrombosis, plaque stabilization, and control of risk factors for atherosclerosis. Anticoagulation (compared with aspirin) has not shown to be beneficial in patients with intracranial atherosclerotic disease [24]. Current guidelines recommend that aspirin alone, the combination of aspirin and extended release dipyridamole, and clopidogrel monotherapy (rather than oral anticoagulants) are aU acceptable options [24]. hi patients with hemodynamically sigifificant intracranial stenosis who have symptoms despite medical therapies (antithrombotics, statins, and other treatments for risk factors), the usefulness of endovascular therapy (angioplasty and/or stent placement) is uncertain and is considered investigational [22, 25],... 

Imaging of the cervical vessels is helpful to detect steno-occlusive disease that may be the embolic source and may need to be addressed during the endovascular procedure (e.g., carotid stent placement)... 

Lubicz B, Leclerc X, Levivier M et al. Retractable self-expandable stent for endovascular treatment of widenecked intracranial aneurysms prehminary experience. Neurosurgery. 2006 58 451-457 discussion 451-457... 

Yavuz K, Geyik S, Pamuk AG et al. Immediate and midterm follow-up results of using an electrodetachable, fuUy retrievable SOLO stent system in the endovascular coU occlusion of widenecked cerebral aneurysms. J Neurosutg. 2(X)7 107 49-55... 

As noted in Section 12.5.1, a family of polyaxial copolyesters described in Chapter 2 can be used to prepare two or more of the critical components of a femoral sealing device. Other compliant members of this family of polymers, which can be converted to compliant, stretchable membranes and strong, stretchable monofilament fibers, can be used to construct a mantle or cover for metallic endovascular stents. Thus, a composite of thin film, reinforced with a monofilament in cross-coiled configuration, can be assembled into a highly compliant, expandable, tubular mantle or sleeve. This can be placed tightly as a cover outside an expandable metallic or polymeric stent so that under concentric irreversible expansion at the desired site of... 

The regeneration of normal filament structure of restored tissues was observed by immunohistochemical methods after PHB devices implantation [66]. The immunohistochemical demonstration of cytokeratine, an intermediate filament, which is a constituent of epithelial and mesodermal cells, agreed with observations on intact mesothelium. Heparin sulfate proteoglycan, a marker of basement membrane, was also identified [66]. However, in spite of good tissue reaction to implantation of cardiovascular PHB patches, PHB endovascular stents in the rabbit iliac arteria caused intensive inflammatory vascular reactions [80]. 

Transluminally Placed Endovascular Prostheses (Stent-Grafts)... 

Dake M.D., Miller D.C., Semba C.P. et al. 1994. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N. Engl. J. Med. 331 1729-34. 

Marin, M.L., Veith, F.J., Panetta, T.F. et al. 1994. Transluminally placed endovascular stented graft repair for arterial trauma. /. Vase. Surg. 20 466-73. 

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