Technical overview on the MiStent coronary stent.

Drug-eluting stents (DES) have dramatically improved the long-term efficacy of percutaneous coronary intervention (PCI). Over the last decade there have been numerous advances in DES platforms, however, all but one currently approved DES in the United States and many of the approved DES worldwide still have 3 common features: a metal stent platform, an anti-proliferative drug, and a permanent polymer. In this context, the polymer is critical to control drug release, but the polymer serves no purpose after the drug is eluted. While designed to be completely biocompatible, synthetic polymers have the potential to illicit an inflammatory response within the vessel including but not limited to delayed healing and hypersensitivity. Adverse vascular reactions to these polymers have been implicated as a cause of very late stent thrombosis, ongoing intimal hyperplasia and late "catch-up" in addition to neoatherosclerosis. To avoid the long-term risks associated with prolonged polymer exposure, DES with bioabsorbable polymers have been developed. The MiStent® Sirolimus-Eluting Absorbable Polymer Coronary Stent System (MiStent SES) (MiCell Technologies, Durham, NC, USA) combines crystalline sirolimus, a rapidly absorbing polylactide-co-glycolic acid (PLGA) coating and a thin-strut cobalt chromium alloy stent platform (Genius MAGIC® Stent System, EuroCor GmbH, Germany). MiCell's supercritical fluid technology allows a rigorously controlled, solvent-free drug and polymer coating to be applied to a bare-metal stent. This solvent-free application of drug uniquely allows a crystalline form of sirolimus to be used on the MiStent SES potentially providing improved clinical benefits. It avoids the uncontrolled burst of drug seen with other DES, provides uniform drug delivery around and between the stent struts, and allows the anti-inflammatory and anti-restenotic drug (sirolimus) to be present in the tissue through the entire polymer absorption period and for months after the polymer has been absorbed. On the MiStent SES, the PLGA/crystalline sirolimus combination is cleared from the stent within 45-60 days and PLGA is fully absorbed within 90 days. The crystalline form of sirolimus uniquely remains in the tissue and continues to expose the surrounding tissue to therapeutic levels of drug for up to 9 months which is long after the polymer is resorbed.

Serial Evaluation of Vascular Response After Implantation of a New Sirolimus-Eluting Stent With Bioabsorbable Polymer (MISTENT): an optical coherence tomography and histopathological study.

BACKGROUND: Novel vascular scaffolds aim at equipoise between safety and efficacy. Intravascular optical coherence tomography (OCT) allows in-vivo serial assessment of stent-vessel interactions with high resolution and frequent sampling and may complement histology assessment. We investigated the vascular response to a novel absorbable coating sirolimus-eluting stent (AC-SES) by means of serial OCT and histology evaluation in a porcine model. METHODS: One AC-SES and one bare-metal stent (BMS) were implanted in separate coronary arteries of three Yucatan mini-swine. Serial OCT was performed post procedure and at 3-, 28-, 90-, and 180-day follow-up. Normalized optical density (NOD) was used for the assessment of tissue response over time. Histological evaluation was performed at day 180. RESULTS: A total of 6408 stent struts were analyzed. OCT revealed 100% of struts covered at 28 days, and a significant difference in NOD from 3 to 28 days (0.64 ± 0.07 vs 0.71 ± 0.05, respectively; P<.001) in the AC-SES group. Neointimal thickness was 0.14 ± 0.08 mm, 0.17 ± 0.11 mm, and 0.16 ± 0.09 mm in the AC-SES group and 0.18 ± 0.10 mm, 0.14 ± 0.09 mm, and 0.10 ± 0.08 mm in the BMS group, while rates of uncovered struts were 0%, 0%, and 3.1% and 1.4%, 7.8%, and 21.5%, respectively, at 28, 90, and 180 days. Minimal inflammation and a mature endothelialization were demonstrated in both groups by histology. CONCLUSION: OCT serial assessment of vascular response suggested NIH maturation 28 days following AC-SES implantation in pigs. These findings, coupled with histological demonstration of low inflammation scores and complete endothelial coverage as measured at 180 days, suggest a satisfactory healing response to AC-SES.

Enhanced drug delivery capabilities from stents coated with absorbable polymer and crystalline drug.

Current drug eluting stent (DES) technology is not optimized with regard to the pharmacokinetics of drug delivery. A novel, absorbable-coating sirolimus-eluting stent (AC-SES) was evaluated for its capacity to deliver drug more evenly within the intimal area rather than concentrating drug around the stent struts and for its ability to match coating erosion with drug release. The coating consisted of absorbable poly-lactide-co-glycolic acid (PLGA) and crystalline sirolimus deposited by a dry-powder electrostatic process. The AC-SES demonstrated enhanced drug stability under simulated use conditions and consistent drug delivery balanced with coating erosion in a porcine coronary implant model. The initial drug burst was eliminated and drug release was sustained after implantation. The coating was absorbed within 90 days. Following implantation into porcine coronary arteries the AC-SES coating is distributed in the surrounding intimal tissue over the course of several weeks. Computational modeling of drug delivery characteristics demonstrates how distributed coating optimizes the load of drug immediately around each stent strut and extends drug delivery between stent struts. The result was a highly efficient arterial uptake of drug with superior performance to a clinical bare metal stent (BMS). Neointimal thickness (0.17±0.07 mm vs. 0.28±0.11 mm) and area percent stenosis (22±9% vs. 35±12%) were significantly reduced (p<0.05) by the AC-SES compared to the BMS 30 days after stent implantation in an overlap configuration in porcine coronary arteries. Inflammation was significantly reduced in the AC-SES compared to the BMS at both 30 and 90 days after implantation. Biocompatible, rapidly absorbable stent coatings enable the matching of drug release with coating erosion and provide for the controlled migration of coating material into tissue to reduce vicissitudes in drug tissue levels, optimizing efficacy and reducing potential toxicity.

NMR and SANS studies of aggregation and microemulsion formation by phosphorus fluorosurfactants in liquid and supercritical carbon dioxide.

(1)H NMR relaxation and diffusion studies were performed on water-in-CO(2) (W/C) microemulsion systems formed with phosphorus fluorosurfactants of bis[2-(F-hexyl)ethyl] phosphate salts (DiF(8)), having different counterions (Na(+), NH(4)(+), N(CH(3))(4)(+)) by means of high-pressure in situ NMR. Water has a low solubility in CO(2) and is mainly solubilized by the microemulsion droplets formed with surfactants added to CO(2) and water mixtures. There is rapid exchange of water between the bulk CO(2) and the microemulsion droplets; however, NMR relaxation measurements show that the entrapped water has restricted motion, and there is little "free" water in the core. Counterions entrapped by the droplets are mostly associated with the surfactant headgroups: diffusion measurements show that counterions and the surfactant molecules move together with a diffusion coefficient that is associated with the droplet. The outer shell of the microemulsion droplets consists of the surfactant tails with some associated CO(2). For W/C microemulsions formed with the phosphate-based surfactant having the ammonia counterion (A-DiF(8)), the (1)H NMR signal for NH(4)(+) shows a much larger diffusion coefficient than that of the surfactant tails. This apparent paradox is explained on the basis of proton exchange between water and the ammonium ion. The observed dependence of the relaxation time (T(2)) on W(0) (mole ratio of water to surfactant in the droplets) for water and NH(4)(+) can also be explained by this exchange model. The average hydrodynamic radius of A-DiF(8) microemulsion droplets estimated from NMR diffusion measurements (25 degrees C, 206 bar, W(0) = 5) was R(h) = 2.0 nm. Assuming the theoretical ratio of R(g)/R(h) = 0.775 for a solid sphere, where R(g) is the radius of gyration, the equivalent hydrodynamic radius from SANS is R(h) = 1.87 nm. The radii measured by the two techniques are in reasonable agreement, as the two techniques are weighted to measure somewhat different parts of the micelle structure.