Nickel Free Alloy for Cardiovascular Stents Application Against Restenosis Associated with Nickel: A Review

2020 ◽  
Vol 12 (1) ◽  
pp. 44-55 ◽  
Author(s):  
Yibin Ren
Keyword(s):  
Stainless Steels ◽  
Nickel Content ◽  
Good Choice ◽  
Coronary Stents ◽  
High Nitrogen ◽  
Nickel Ions ◽  
Cardiovascular Stents ◽  
Stent Restenosis ◽  
Good Potential ◽  
In Stent Restenosis

The commercialized coronary stents are generally made of biomedical stainless steels (316L) and biomedical cobalt-based alloy (for example L605 alloy) due to their good combination of properties, especially their excellent mechanical properties. However, there are above 10% nickel content in these stents materials, which was known to trigger the inflammation and allergic responses around stents implant location, and contradiction associated with in-stent restenosis when the nickel ions began to release from stents for various corrosion. Consequently, the potential adverse effect of nickel ions release has prompted the development of many nickel free alloy stents materials. In this paper, the controversy of nickel and in-stent restenosis, and the development of nickel free alloy for cardiovascular stents application are reviewed. Nickel free cobalt alloy maybe a good choice for stent materials, but further research is needed. Many research results have proved the high nitrogen nickel-free stainless steel is a good potential stents material and suitable for clinical use, therefore the austenitic high nitrogen nickel-free stainless steels may offer an alternative to further improve the performance of the current coronary stents.

In vivo and in vitro analyses of the effects of a novel high-nitrogen low-nickel coronary stent on reducing in-stent restenosis

2018 ◽  
Vol 33 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Jinpeng Wang ◽  
Chunli Song ◽  
Yanlong Xiao ◽  
Bin Liu
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Arteries ◽  
Coronary Intervention ◽  
Coronary Stent ◽  
High Nitrogen ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
In Stent Restenosis

Currently, percutaneous coronary intervention is an important treatment for coronary heart disease. However, the in-stent restenosis rate is still approximately 10–30% after stenting. Nickel ions from the stent are considered to be associated with in-stent restenosis. Therefore, in the present study, we quantitatively evaluated in-stent restenosis after implanting the novel high-nitrogen low-nickel coronary stent (HNS) and studied the mechanism underlying the reduction in in-stent restenosis by using ELISA and Western blot. The in vivo results showed that the HNS could significantly reduce neointima formation and inflammation as compared to SUS316L stents (316L) at 180 days after implantation in porcine coronary arteries and that vascular endothelial growth factor-A expression in porcine coronary arteries after HNS implantation also decreased. The in vitro results showed that, in the case of the HNS, human umbilical vein endothelial cell (HUVEC) proliferation was lower and lesser IL-6 release was noted from HUVECs at one and three days after culture than in the 316L group. Furthermore, p-STAT3 expression in HUVECs on the HNS surface was downregulated after culture for seven days. Thus, we conclude that the HNS could be a promising alternative coronary stent for percutaneous coronary intervention.

Coronary in-stent restenosis in diabetic patients after implantation of sirolimus or paclitaxel drug-eluting coronary stents

2008 ◽  
Vol 34 (1) ◽  
pp. 62-67 ◽  
Author(s):  
M. Kitoga ◽  
A. Pasquet ◽  
V. Preumont ◽  
J. Kefer ◽  
M.-P. Hermans ◽  
...  
Keyword(s):  
Coronary Stents ◽  
Diabetic Patients ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique

2007 ◽  
Vol 106 (5) ◽  
pp. 907-911 ◽  
Author(s):  
Seong-Rim Kim ◽  
Min-Woo Baik ◽  
Seung-Hoon Yoo ◽  
Ik-Seong Park ◽  
Sang-Don Kim ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Coronary Stents ◽  
Drug Eluting Stent ◽  
Stent Fracture ◽  
Stent Restenosis ◽  
Stent Strut ◽  
Drug Eluting ◽  
In Stent Restenosis

✓ The authors report two cases of stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.

Detection of In-Stent Restenosis of Coronary Stents Using 40-Detector Row Computed Tomography In Vitro

2008 ◽  
Vol 32 (2) ◽  
pp. 252-258 ◽  
Author(s):  
Shigeru Suzuki ◽  
Shigeru Furui ◽  
Sadatoshi Kuwahara ◽  
Tatsuro Kaminaga ◽  
Ryoji Takei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Stents ◽  
Stent Restenosis ◽  
In Stent Restenosis

scholarly journals Coronary In-Stent Restenosis: Assessment with Corrected Coronary Opacification Difference across Coronary Stents Measured with CT Angiography

Radiology ◽  
2015 ◽  
Vol 275 (2) ◽  
pp. 403-412 ◽  
Author(s):  
Yang Gao ◽  
Bin Lu ◽  
Zhi Hui Hou ◽  
Fang Fang Yu ◽  
Wei Hua Yin ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Coronary Stents ◽  
Stent Restenosis ◽  
In Stent Restenosis

scholarly journals Correlations Between the Contrast Density Gradient along the Coronary Stents and Functional Significance of In-stent Restenosis

2016 ◽  
Vol 1 (1) ◽  
pp. 79-82
Author(s):  
Marius Orzan ◽  
Edvin Benedek ◽  
András Mester ◽  
Theodora Benedek ◽  
Monica Chiţu ◽  
...  
Keyword(s):  
Smoking Status ◽  
Significant Risk ◽  
Study Groups ◽  
Coronary Stents ◽  
Stent Restenosis ◽  
Group 2 ◽  
The Right ◽  
In Stent Restenosis ◽  
Transluminal Attenuation Gradient ◽  
Group 1

Abstract Introduction: Coronary artery disease (CAD) is the leading cause of death worldwide and is associated with a significant socio-economic impact. In many cases, patients are treated with implanted coronary stents that carry a significant risk for reobstruction. The aim of our study was to evaluate the importance of coronary computed tomography angiography (CCTA) in evaluating the significance of in-stent restenosis lesions and for establishing the indication for reintervention in these cases. Materials and methods: We evaluated 25 patients who underwent CCTA examination. We determined the contrast density, expressed in Hounsfield units at two levels, proximal and distal to the stent. Results: There were no statistically significant differences between the study groups in terms of gender (41.17% females in Group 1 vs. 37.5% in Group 2, p = 1), presence of hypertension (41.17% in Group 1 vs. 62.5% in Group 2, p = 0.31), smoking status (41.17% in Group 1 vs. 37.5% in Group 2, p = 0.31), incidence of dyslipidemia (47.05% vs. 50%, p = 1) and diabetes mellitus (35.29% vs. 0%, p = 0.31). However, the age of the study population was significantly higher in the groups with significant ISR (58.94 ± 8.35 vs. 47.25 ± 11.2, p = 0.02). Patients who showed significant angiographic in-stent stenosis (more than 70%) were found to have a higher transluminal attenuation gradient, compared with those with less severe lesions (14.5 ± 5.4 vs. 5.14 ± 2.4, p = 0.02). Conclusions: The transluminal attenuation gradient, assessed by CCTA is a non-invasive-derived parameter that can help the clinician to determine the right time for revascularization in case of in-stent restenosis.

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