The incidence of restenosis has been shown to be correlated with the overstretching of the arterial wall during an angioplasty procedure. It has been proposed that slow balloon inflation results in lower intramural stresses, therefore minimizing vascular injury and restenosis rate. The analysis of the biomechanics of the arterial tissue might contribute to understand which factors trigger restenosis. However, few mechanical data are available on human arteries because of the difficulty of testing artery samples often obtained from autopsy while arteries are still considered "fresh". Various solutions mimicking the physiological environment have been used to preserve artery samples from harvesting to testing. In vitro mechanical testing is usually preferred since it is difficult to test arteries in vivo. Uniaxial and biaxial testing has been used to characterize anisotropic materials such as arteries, although methodological aspects are still debated. Several objectives were formulated and analyzed during the making of this thesis. In one study, the effect of deformation rate on the mechanical behavior of arterial tissue was investigated. The effect of several preservation methods, including cryopreservation, on the mechanical properties of porcine thoracic aortas was also analyzed. Finally, the differences in the mechanical behavior between three different types of sample geometry and boundary conditions were compared under uniaxial and equi-biaxial testing. Thoracic aortas were harvested within the day of death of pigs from a local slaughterhouse. Upon arrival, connective tissue was removed from the external wall of the artery. Then the artery was cut open along its length and cut out in rectangular samples for uniaxial testing, and square and cruciform samples for biaxial testing. Samples belonging to the freezing effect study were preserved for two months at -20°C and -80°C in isotonic saline solution, Krebs-Henseleit solution with 1.8 M dimethylsulfoxide, and dipped in liquid nitrogen. Samples belonging to the deformation rate effect study were tested uniaxially and equi-biaxially at deformation rates from 10 to 200 %/s. The uniaxial and biaxial experiments were simulated with the help of an inverse finite element software. The use of inverse modeling to fit the material properties by taking into account the non-uniform stress distribution was demonstrated. A rate-dependent isotropic hyperelastic constitutive equation, derived from the Mooney-Rivlin model, was fitted to the experimental results (i.e. deformation rate study). In the proposed model, one of the material parameters is a linear function of the deformation rate. Overall, inverse finite element simulations using the proposed constitutive relation accurately predict the mechanical properties of the arterial wall. In this thesis, it was found that easier attachment of samples (rectangular and cruciform) is accomplished using clamps rather than hooks. It was also found that the elastic behavior of arteries is nonlinear and non-isotropic when subjected to large deformations. Characterization of the arterial behavior at large deformations over a higherdeformation range was achieved using cruciform samples. The mechanical properties of arteries did not significantly change after preservation of arteries for two months. Under uniaxial and biaxial testing, loading forces were reduced up to 20% when the deformation rate was increased from 10 to 200 %/s, which is the opposite to the behaviour seen in other biological tissues. The differences observed in the mechanical behavior of fresh and thawed samples were not significant, independently of the storing medium or freezing temperature used. The lack of significant differences observed in the freezing study was likely due to the small number of samples tested per storing group. Further studies are required to clarify the impact of cryopreservation on extracellular matrix architecture to help tailor an optimized approach to preserve the mechanical properties of arteries. From the results obtained in the deformation rate study, it is concluded that the stiffness of arteries decreases with an increase in the deformation rate. In addition, the effect of deformation rate was observed to be higher than the effect of anisotropy. The inverse relationship between stiffness and deformation rate raises doubts on the hypothesized relationship between intramural stress, arterial injury, and restenosis.

Restenosis is the major cause of the failure of reconstruction methods to restore the blood flow in atherosclerotic arteries. Restenosis results from neointima formation and consequent constrictive remodelling. Vascular smooth muscle cell (VSMC) migration from the tunica media toward the intima is crucial in neointima genesis. The prerequisite for VSMC migratory activity is the modulation from the differentiated (contractile) to the de-differentiated (noncontractile) phenotype. VSMC phenotype change is associated with the altered expression of integrins. alpha8beta1 integrin is upregulated in cell types with contractile properties, including myofibroblasts and mesangial kidney cells. It is one of the integrins that is intensely expressed in mature VSMCs. alpha8beta1 integrin expression during vascular injury and its role in VSMC function have not been studied so far. / In this work, a rat model of carotid angioplasty was used to mimic vascular injury in humans. alpha8beta1 integrin was downregulated in the tunica media concomitantly with loss of the contractile phenotype. In vitro study revealed that it is a differentiation marker of VSMCs. To test the functional significance of the association between alpha8 integrin and the VSMC phenotype, short interference RNA was deployed to silence the alpha8 integrin gene. alpha8 integrin gene silencing heightened VSMC migratory activity as well as modulation of the VSMC phenotype in favour of the noncontractile state. In addition, alpha8 integrin overexpression induced re-differentiation of VSMCs and attenuated their migratory activity. It is, therefore, suggested that alpha8 integrin overexpression after vascular injury might control VSMC migration and neointima formation. On the other hand, alpha8 integrin gene silencing led to a reduced growth rate, which indicated a dichotomy between VSMC migration and proliferation. / In the later stages of neointima formation, constrictive remodeling plays a major role in late lumen loss. Our data demonstrated that alpha8 integrin is upregulated in the neointima during constrictive remodeling with concomitant luminal narrowing. The importance of this finding was highlighted by results showing that alpha8 integrin was required for the VSMC contractile phenotype evoked by transforming growth factor-beta (TFG-beta) and TFG-beta-induced myofibroblastic differentiation of Rat1 fibroblasts. Thus, it appears that alpha8 integrin expression blockade might reduce contractile remodeling and late lumen loss. Although the mechanism of alpha8 integrin signaling is not yet clear, our findings demonstrate that the alpha8 integrin-induced contractile phenotype is blocked by RhoA inhibitors. Furthermore, alpha8 integrin and RhoA are co-immunoprecipitated, and alpha8 integrin gene silencing reduces RhoA activity. Hence, it is postulated that alpha8-RhoA signaling might be closely intertwined. / Altogether, these studies indicate that alpha8 integrin is a contractile marker of VSMCs and a negative regulator of VSMC migration. Therefore, forced alpha8 integrin expression may be applied to reduce neointima formation. However, alpha8 integrin upregulation during constrictive remodeling concomitant with late lumen loss suggest that it could be involved in lumen narrowing. It seems likely that in therapeutic strategies to reduce restenosis the timeline of interference might be very important. Therefore, alpha8 integrin gene silencing in the later stages of neointima formation might be beneficial.

The incidence of restenosis has been shown to be correlated with the overstretching of the arterial wall during an angioplasty procedure. It has been proposed that slow balloon inflation results in lower intramural stresses, therefore minimizing vascular injury and restenosis rate. The analysis of the biomechanics of the arterial tissue might contribute to understand which factors trigger restenosis. However, few mechanical data are available on human arteries because of the difficulty of testing artery samples often obtained from autopsy while arteries are still considered "fresh". Various solutions mimicking the physiological environment have been used to preserve artery samples from harvesting to testing. In vitro mechanical testing is usually preferred since it is difficult to test arteries in vivo. Uniaxial and biaxial testing has been used to characterize anisotropic materials such as arteries, although methodological aspects are still debated. Several objectives were formulated and analyzed during the making of this thesis. In one study, the effect of deformation rate on the mechanical behavior of arterial tissue was investigated. The effect of several preservation methods, including cryopreservation, on the mechanical properties of porcine thoracic aortas was also analyzed. Finally, the differences in the mechanical behavior between three different types of sample geometry and boundary conditions were compared under uniaxial and equi-biaxial testing. Thoracic aortas were harvested within the day of death of pigs from a local slaughterhouse. Upon arrival, connective tissue was removed from the external wall of the artery. Then the artery was cut open along its length and cut out in rectangular samples for uniaxial testing, and square and cruciform samples for biaxial testing. Samples belonging to the freezing effect study were preserved for two months at -20°C and -80°C in isotonic saline solution, Krebs-Henseleit solution with 1.8 M dimethylsulfoxide, and dipped in liquid nitrogen. Samples belonging to the deformation rate effect study were tested uniaxially and equi-biaxially at deformation rates from 10 to 200 %/s. The uniaxial and biaxial experiments were simulated with the help of an inverse finite element software. The use of inverse modeling to fit the material properties by taking into account the non-uniform stress distribution was demonstrated. A rate-dependent isotropic hyperelastic constitutive equation, derived from the Mooney-Rivlin model, was fitted to the experimental results (i.e. deformation rate study). In the proposed model, one of the material parameters is a linear function of the deformation rate. Overall, inverse finite element simulations using the proposed constitutive relation accurately predict the mechanical properties of the arterial wall. In this thesis, it was found that easier attachment of samples (rectangular and cruciform) is accomplished using clamps rather than hooks. It was also found that the elastic behavior of arteries is nonlinear and non-isotropic when subjected to large deformations. Characterization of the arterial behavior at large deformations over a higherdeformation range was achieved using cruciform samples. The mechanical properties of arteries did not significantly change after preservation of arteries for two months. Under uniaxial and biaxial testing, loading forces were reduced up to 20% when the deformation rate was increased from 10 to 200 %/s, which is the opposite to the behaviour seen in other biological tissues. The differences observed in the mechanical behavior of fresh and thawed samples were not significant, independently of the storing medium or freezing temperature used. The lack of significant differences observed in the freezing study was likely due to the small number of samples tested per storing group. Further studies are required to clarify the impact of cryopreservation on extracellular matrix architecture to help tailor an optimized approach to preserve the mechanical properties of arteries. From the results obtained in the deformation rate study, it is concluded that the stiffness of arteries decreases with an increase in the deformation rate. In addition, the effect of deformation rate was observed to be higher than the effect of anisotropy. The inverse relationship between stiffness and deformation rate raises doubts on the hypothesized relationship between intramural stress, arterial injury, and restenosis.

Τις τελευταίες δεκαετίες υπάρχει μια αυξανόμενη ζήτηση για βιοσυμβατά υλικά ικανά να χρησιμοποιηθούν σαν πρόσθετα στο ανθρώπινο σώμα, σαν βάσεις για ελεγχόμενη χορήγηση βιοδραστικών ενώσεων, σαν εμφυτεύματα κ.α. χωρίς να προκαλούν ανοσοποιητική αντίδραση από τον αργανισμό. Μέχρι και σήμερα δεν έχει βρεθεί το υλικό που θα ξεγελάσει τους αμυντικούς μηχανισμούς του σώματος, με άλλα λόγια, να είναι αόρατο από το σώμα. Έχουν γίνει πολλές προσπάθειες και έχουν εφαρμοστεί διάφορες προσεγγίσεις. Τα τελευταία χρόνια όλο και περισσότερες ερευνητικές ομάδες επενδύουν σε υλικά τα οποία απελευθερώνουν ελεγχόμενα βιοδραστικές ουσίες που καταστέλουν την αντίδραση του οργανισμού. Μια τέτοια ουσία είναι η ηπαρίνη, ένα φυσικό αντιπηκτικό το οποίο μπορεί να χρησιμοποιηθεί για την αύξηση της αιμοσυμβατότητας αρτηριακών ενδοπροσθέσεων. Αναπτύξαμε μια μέθοδο για την ομοιοπολική, μη αναστρέψιμη πρόσδεση λιποσωμάτων σε μεταλλικές επιφάνειες, οι οποίες έχουν υποστεί επεξεργασία με τεχνολογία πλάσματος. Οι επιφάνειες φέρουν ελεύθερες καρβοξυλομάδες τις οποίες μπορούμε να εκμεταλλευτούμε για να συζεύξουμε πάνω τους λιποσώματα με αμινομάδες στην επιφάνειά τους (functionalized), μέσω δημιουργίας αμιδικού δεσμού. Οι μεταλλικές επιφάνειες που χρησιμοποιήσαμε ήταν SS-316 μεταλλικοί δίσκοι επεξεργασμένοι με τεχνολογία πλάσματος, και τις προμηθευτήκαμε από το Τμήμα Χημικών Μηχανικών του Πανεπιστημίου Πατρών και από το τμήμα Χημείας του Πανεπιστημίου του Μπάρι. Χρησιμοποιήσαμε μικρά μονοστιβαδιακά λιποσώματα (SUV) διαμέτρου της τάξης των 100 nm, με διάφορες λιπιδικές συστάσεις (PC, PC:Chol 4:1, DSPC:Chol 2:1). Χαρακτηρίσαμε τα functionalized λιποσώματά ως προς την ικανότητά τους να εγκλωβίζουν ηπαρίνη, το μέγεθος, τη διασπορά μεγέθους, το φορτίο της επιφάνειάς τους και τη σταθερότητά τους σε διάφορες συνθήκες. Τα αποτελέσματά μας δείχνουν ότι γενικά τα functionalized λιποσώματα συμπεριφέρονται σαν τυπικά λιποσώματα που φέρουν λιπίδιο με PEG ομάδα (pegylated λιποσώματα), ενώ για βέλτιστο εγκλωβισμό ηπαρίνης σημαντικό είναι το στάδιο λυοφιλοποίησης / επανασύστασης κατά την παρασκευή τους. Αποδείξαμε ότι τα functionalized λιποσώματα μπορούν να προσδεθούν σε μεταλλικές επιφάνειες (κατάλληλα επεξεργασμένες) διατηρώντας τη δομή τους και φέροντας ηπαρίνη ή άλλη υδρόφιλη ουσία στο εσωτερικό τους. Εφαρμόσαμε ένα απλό πρωτόκολλο δημιουργίας αμιδικού δεσμού, και το βελτιστοποιήσαμε ώστε να πάρουμε μέγιστη απόδοση στη σύνδεση των λιποσωμάτων στις επιφάνειες (58,4 ± 8.6 μg λιπιδίου ανά cm2 επιφάνειας). / Over the last couple of decades there has been an increasing need for more biocompatible, more “body friendly” materials that can be used in cases of subcutaneous, endoarterial or other type of implantations, as artificial body parts, drug releasing bases or biosensor implantations. The main desired quality of these materials is the lack to trigger the body’s defensive mechanisms and foreign body response reactions. Up to this date there has not been a material with the ability to camouflage itself and be invisible to the human body. Lately, scientists show an increasing interest in materials that can elute bioactive molecules, which can suppress the body’s immune reactions. One substance with this capability is heparin, a natural anticoagulant that can (and is currently being) used in order to improve the haemocombatibility of stents. We developed a method to covalently attach liposomes on metallic surfaces that have been treated with plasma technology so that they demonstrate free carboxyl- groups. We can manipulate these groups to attach amino-group containing liposomes (functionalized) on the metallic surfaces via amidic bond formation. The metallic surfaces that were used were SS-316 metallic rods treated with plasma. They were provided by two different research laboratories, one in the University of Patras (department of Chemical Engineering) and one in the University of Bari (department of Chemistry). The two groups employed different plasma treatment procedures. We used Small Unilamellar Vesicles (SUV liposomes) whose diameter was in the range of 100 nm and were consisted of various lipid compositions (PC, PC:Chol 4:1, DSPC:Chol 2:1). The functionalized liposomes were physicochemically characterized (size, size distribution, ζ potential, drug retention) under various conditions. We discovered that the amino-liposomes demonstrate typical pegylated liposome behavior. Moreover, we found that the amount of heparin trapped in the vesicles dramatically increases when a step of freeze-drying / rehydration is included in their preparation protocol. We encapsulated a hydrophilic dye, calcein, in the liposomes. This allowed us to easily detect the presence of intact liposomes on the metallic surfaces, as well as to accurately quantify the amount of lipid attached. We applied a simple and widely used protocol to create an amidic bond between the amino group of the liposomes and the carboxyl group of the metallic surfaces and we further optimized it to achieve the optimum reaction efficacy. (58,4 ± 8.6 μg lipid per cm2 surface)

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-07T13:45:11Z No. of bitstreams: 3 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) / Made available in DSpace on 2016-04-07T13:45:11Z (GMT). No. of bitstreams: 3 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) Previous issue date: 2015-05-26 / Introdução: O advento dos stents convencionais e daqueles liberadores de fármacos aboliu o recolhimento elástico provocado pela angioplastia por balão, porém, estes dispositivos apresentaram como consequência a hiperplasia neointimal, que é responsável pela reestenose angiográfica. O metotrexato, antagonista do folato, inibe a fase S do ciclo de mitose celular, reduzindo a produção de citocinas e outros mediadores inflamatórios que podem estar envolvidos na hiperplasia neointimal. Objetivo: Avaliar a segurança do Metotrexato (MTX) em pacientes com Doença Arterial Coronariana submetidos à Intervenção Coronariana Percutânea (ICP) com stents convencionais e o impacto da droga na reestenose clínica e angiográfica. Método: Estudo clínico de fase II aberto, prospectivo, não randomizado, realizado de setembro de 2011 a maio de 2014. Resultados: Foram recrutados 16 pacientes com indicação de implante de stent, sendo que estes tomaram 5 mg de MTX 15 dias antes e 30 após a ICP. Todos os pacientes foram submetidos à nova angiografia coronariana após 9 meses. A artéria coronária descendente anterior apresentou o maior número de lesões 16 (34%). O diâmetro médio dos stents foi de 3,0 ± 0,4 mm e o comprimento médio foi de 18,1 ± 5,9 mm. Não houve complicações relacionadas à ICP. As complicações do MTX foram menores e com prevalência de 18,7%. Nenhum paciente necessitou de interrupção no uso do medicamento e os sintomas desapareceram ao final do tratamento. A reestenose angiográfica foi 6,2% e a clínica foi zero (ausência de sintoma e de isquemia em cintilografia do miocárdio). Conclusão: O MTX foi seguro e gerou a hipótese de possível efeito benéfico na reestenose após implante de stent convencional. / Introduction: Bare metal stents (BMS) and those releasing drug abolished the elastic recoil caused by Plain Old Balloon Angioplasty (POBA), however, these devices showed the consequence of neointimal hyperplasia, which is responsible for angiographic restenosis. The methotrexate, folate antagonist inhibits S phase of mitotic cell cycle by reducing the production of cytokines and the other inflammatory mediators that may be involved in the neointimal hyperplasia. Objective: To evaluate the safety of Methotrexate (MTX) in patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI) with BMS and the impact of drugs in clinical and angiographic restenosis. Methods: Clinical phase II open, prospective, nonrandomized, held from September 2011 to May 2014. Results: We recruited 16 patients with stent implantation indication, and these took 5 mg of MTX 15 days before and 30 after PCI. All patients underwent coronary angiography after nine months. The anterior descending coronary artery had the highest number of lesions 16 (34%). The average diameter of the stents was 3.0 ± 0.4 mm and the average length was 18.1 ± 5.9 mm. There were no complications related to PCI. The MTX complications were minor and with a prevalence of 18.7%. No patient required interruption in the use of the drug, and the symptoms disappeared after the treatment. Angiographic restenosis was 6.2% and the clinic was zero (no symptoms and ischemia on myocardial scintigraphy). Conclusion: MTX was safe and led the hypothesis of possible beneficial effect on restenosis after conventional stent implantation.

The incidence of restenosis has been shown to be correlated with the overstretching of the arterial wall during an angioplasty procedure. It has been proposed that slow balloon inflation results in lower intramural stresses, therefore minimizing vascular injury and restenosis rate. The analysis of the biomechanics of the arterial tissue might contribute to understand which factors trigger restenosis. However, few mechanical data are available on human arteries because of the difficulty of testing artery samples often obtained from autopsy while arteries are still considered "fresh". Various solutions mimicking the physiological environment have been used to preserve artery samples from harvesting to testing. In vitro mechanical testing is usually preferred since it is difficult to test arteries in vivo. Uniaxial and biaxial testing has been used to characterize anisotropic materials such as arteries, although methodological aspects are still debated. Several objectives were formulated and analyzed during the making of this thesis. In one study, the effect of deformation rate on the mechanical behavior of arterial tissue was investigated. The effect of several preservation methods, including cryopreservation, on the mechanical properties of porcine thoracic aortas was also analyzed. Finally, the differences in the mechanical behavior between three different types of sample geometry and boundary conditions were compared under uniaxial and equi-biaxial testing. Thoracic aortas were harvested within the day of death of pigs from a local slaughterhouse. Upon arrival, connective tissue was removed from the external wall of the artery. Then the artery was cut open along its length and cut out in rectangular samples for uniaxial testing, and square and cruciform samples for biaxial testing. Samples belonging to the freezing effect study were preserved for two months at -20°C and -80°C in isotonic saline solution, Krebs-Henseleit solution with 1.8 M dimethylsulfoxide, and dipped in liquid nitrogen. Samples belonging to the deformation rate effect study were tested uniaxially and equi-biaxially at deformation rates from 10 to 200 %/s. The uniaxial and biaxial experiments were simulated with the help of an inverse finite element software. The use of inverse modeling to fit the material properties by taking into account the non-uniform stress distribution was demonstrated. A rate-dependent isotropic hyperelastic constitutive equation, derived from the Mooney-Rivlin model, was fitted to the experimental results (i.e. deformation rate study). In the proposed model, one of the material parameters is a linear function of the deformation rate. Overall, inverse finite element simulations using the proposed constitutive relation accurately predict the mechanical properties of the arterial wall. In this thesis, it was found that easier attachment of samples (rectangular and cruciform) is accomplished using clamps rather than hooks. It was also found that the elastic behavior of arteries is nonlinear and non-isotropic when subjected to large deformations. Characterization of the arterial behavior at large deformations over a higherdeformation range was achieved using cruciform samples. The mechanical properties of arteries did not significantly change after preservation of arteries for two months. Under uniaxial and biaxial testing, loading forces were reduced up to 20% when the deformation rate was increased from 10 to 200 %/s, which is the opposite to the behaviour seen in other biological tissues. The differences observed in the mechanical behavior of fresh and thawed samples were not significant, independently of the storing medium or freezing temperature used. The lack of significant differences observed in the freezing study was likely due to the small number of samples tested per storing group. Further studies are required to clarify the impact of cryopreservation on extracellular matrix architecture to help tailor an optimized approach to preserve the mechanical properties of arteries. From the results obtained in the deformation rate study, it is concluded that the stiffness of arteries decreases with an increase in the deformation rate. In addition, the effect of deformation rate was observed to be higher than the effect of anisotropy. The inverse relationship between stiffness and deformation rate raises doubts on the hypothesized relationship between intramural stress, arterial injury, and restenosis. / Applied Science, Faculty of / Chemical and Biological Engineering, Department of / Graduate

Angioplasty, or the use of rapidly deploying stents, is a common treatment for reopening narrowed vasculature often caused by atherosclerotic plaque. However, in-stent restenosis (ISR) induced by intimal hyperplasia is a common challenge to angioplasty. High impact stresses from current stent deployment processes have been linked to intimal hyperplasia; thus a stent that is gradually deployed over a longer period of time holds potential to mitigate these stresses. This work hypothesizes that resorbable polymeric links can be used as a triggering mechanism to enable repeatably controlled deployment of a compliant nitinol stent design with the eventual goal of reducing intimal hyperplasia. The aims of this work include the structured design process and design validation of a stent intended to meet this challenge. A structured design process was used to develop a multi-stage, gradually deploying nitinol stent in which PDLG (DL-lactide/Glycolide copolymer) bioresorbable links constrained specific mechanical cells within the stent geometry, thus limiting initial deployment to an intermediate diameter and allowing for secondary gradual deployment as the PDLG degraded via a combination of bioresorption and creep. A finite element analysis was carried out to design the link geometry to hold the stent at an intermediate stage (90% of final diameter) upon initial deployment, and enable a gradual secondary deployment phase lasting several minutes. Prototypes were then manufactured and the design was validated in a flow chamber mimicking the conditions of human blood flow and temperature. Using a camera and image processing methods, the diameter increase of the stents was tracked over time to characterize the secondary gradual deployment process of the stents. Results showed the links constrained the stents to an initial ~90% diameter upon initial deployment, followed by a gradual, secondary deployment with an average 63.2% rise time of 16.2 minutes. Creep was observed to be the primary driver of the gradual deployment, followed by subsequent bioresorption of the material. All prototypes exhibited gradual secondary deployment without any visible delamination of the bioresorbable links from the stent struts. Based on these findings it can be concluded our hypothesis has been demonstrated, and that a feasible gradually deploying stent design has been mechanically validated, preparatory to pre-clinical studies of its efficacy. Prior to clinical application, future in vivo work is needed to compare actual ISR rates with this stent design to other commonly used stent designs in preclinical trials. In addition, further preclinical work is needed to compare ISR rates through several stent design parameters such as initial deployment diameter, gradual deployment rate, final deployment diameter, and stent sizes to give insights into the optimal stent design. We anticipate that this gradually expanding stent design could reduce in-stent restenosis and improve clinical outcomes.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20797号 / 医博第4297号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 齊藤 博英, 教授 Shohab YOUSSEFIAN / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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