Palliation therapy for dysphagia using esophageal stents is the current treatment of choice for those patients with inoperable esophageal malignancies. However, the stents currently used in the clinical setting, regardless of the type of metal mesh or plastic mesh stents (covered/uncovered), may cause complications, such as tumor ingrowth and stent migration into the stomach. Furthermore, metal mesh stents have limited capacities for loading anti-cancer drugs. To effectively reduce/overcome those complications and enhance the efficacy of drug release, we designed and 3D-printed a tubular, flexible polymer stent with spirals, and then load anti-cancer drug, paclitaxel, on the stent for drug release. Non- spiral 3D-printed tubular and mesh polymer stents served as controls. The self-expansion and anti migration properties, cytotoxicity, drug release profile, and cancer cell inhibition of the 3D-printed stent were fully characterized. Results showed the self-expansion force of the 3D-printed polymer stent with spirals was slightly higher than the stent without spirals. The anti-migration force of the 3D-printed stent with spirals was significantly higher than the anti-migration force of a non-spiral stent. Furthermore, the stent with spirals significantly decreased the migration distance compared to the migration distance of the non-spiral 3D-printed polymer stent. The in vitro cytotoxicity of the new stent was examined through the viability test of human esophagus epithelial cells, and results indicated that the polymer stent does not have any cytotoxicity. The results of in vitro cell viability of esophageal cancer cells further indicated that the paclitaxel in the spiral stent treated esophageal cancer cells much more efficiently than that in the mesh stent. Furthermore, the results of the in vitro drug release profile and drug permeation showed that the dense tubular drug-loaded stent could efficiently be delivered more paclitaxel through the esophageal mucosa/submucosa layers in a unidirectional way than mesh stent that delivered less paclitaxel to the esophageal mucosa/submucosa but more to the lumen. In summary, these results showed that the 3D-printed dense polymer stent with spirals has promising potential to treat esophageal malignancies. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

The success of endoluminal stent-graft treatment for abdominal aortic aneurysm relies on maintenance of an effective seal when the stent expands into the healthy artery. Clinical observation of aortic neck dilation following endoluminal grafting has led to the hypothesis that excessive stent expansion forces may cause remodelling and dilation of the artery to accommodate the strong forces. This may lead to failure of the seal, hence so-called endoleak. In this research, we analysed the force field generated by aortic stent-grafts and investigated in vitro approaches for studying the effects of these forces on cells within the vascular wall. The pressure-deformation behaviour of ovine arteries was examined experimentally and was found to vary with artery type. A finite element model of abdominal aorta (AA) characterised by Mooney-Rivlin hyperelastic material properties was validated. The property inputs were derived from the polynomial form of the strain energy density function proposed by Patel and Vaishnav. Stent-artery contact simulations revealed stresses 1.2-19 times higher than within a normal vessel at 120 mmHg when contacted by a zig-zag, square cross-section stent that expanded the AA by 3-16%. Streses 1.3-23 times normal were predicted for circular cross-section stents at the same range of expansions. The stress distribution was determined to be concentrated at the contacting surface and within the inner region of the aortic wall. These results confirmed that the forces within the vessel wall are likely to place unnatural physiological demands on the cells within. We then developed an in vitro system for studying the impact of this mechanical stress on cells within a three dimensional (3D) structure. A 20 wt% poly(vinyl alcohol) (PVA) - 5 wt% collagen tubular construct was developed to support cells, and was shown to sustain physiological blood pressures. Two cell-seeding techniques were examined, direct cell encapsulation and surface cell-seeding. Both demonstrated the capability of entrapping viable cells within the construct that remained viable for up to 4 days. In conclusion, stent contact does create abnormal stress concentrations within the vessel wall with a magnitude severely higher than physiological levels. A feasible tubular construct and an in vitro system were developed, enabling further assessments on the effects of these abnormality on the cells.

The impact of percutaneous renal artery angioplasty and stenting (PTRAS) for treatment of atherosclerotic renal artery stenosis (ARAS) is not fully understood, especially in patients with chronic kidney disease (CKD). We performed a retrospective cohort study of patients with significant ARAS and moderate to severe chronic kidney disease (estimated GFR 15-60 ml/min/1.73m2) who were treated medically or with PTRAS. The primary endpoint of this study was change in renal function over the first year after treatment. Secondary endpoints included hemodynamic outcomes, antihypertensive medication doses, end stage renal disease (ESRD), and death. We reviewed all patients with a diagnosis of significant ARAS and impaired GFR treated between 1997-2007 in the Veterans Affairs Connecticut Healthcare System (VACHS). A total of 118 patients met inclusion criteria (71 medical treatment, 47 PTRAS), with an average follow-up of 34 months. The students t-test was used to compare baseline characteristics, as well as renal and hemodynamic endpoints between the two treatment groups. The cohort had a mean age of 73 ± 9 years and average baseline GFR of 37.2 ± 14.9 ml/min/1.73m2. Demographic, clinical and laboratory characteristics at baseline were similar between the two groups, with the exception of higher diastolic blood pressure in the stent group at baseline (75 versus 70 mmHg, p=0.028). No statistically significant difference was found between the two treatment groups for any renal endpoints. After a steady decline in GFR in both the medical treatment and stent groups during the 12 months preceding diagnosis (-4.2 versus -4.0 ml/min/1.73m2, p=0.911), GFR stabilized in both groups over the year following diagnosis (decline in GFR of -1.6 versus -1.4 ml/min/1.73m2, p=0.938). Multivariate models did not reveal an association between treatment modality and percent change in GFR during follow-up. No difference was found in blood pressure outcomes at 12 months between the medical and stent groups. Antihypertensive therapy, measured in defined daily doses (DDDs), was significantly higher in the medical treatment group at 12 months (4.5 versus 3.5 DDDs, p=0.048), but lost significance thereafter. In addition, the number of deaths was significantly higher in the stented group on univariate analysis, although this did not remain significant on multivariable Cox analysis. No difference was found between treatment groups in the development of ESRD. These data suggest that, among patients with ARAS and CKD, medical therapy and renal artery stenting are comparable in stabilizing renal function.

Στόχος της παρούσας εργασίας είναι η ακινητοποίηση λιποσωμάτων με εγκλωβισμένη Tobramycin σε επιχρυσωμένες μεταλλικές επιφάνειες, με σκοπό την παρασκευή αντιμικροβιακών ενδοπροθέσεων του ουροποιητικού, που αποδεσμεύουν φάρμακο με ελεγχόμενο ρυθμό. / The aim of this study is to covalently link liposomes on metallic surfaces, as a method to prepare antimicrobial controlled (release) drug-eluting stents, using Tobramycin (TOB) as an anti-microbial drug. As a preliminary step for immobilization of TOB, different types of liposomes were constructed and evaluated for TOB loading efficiency, size distribution and ζ-potential. TOB concentrations were measured by a chemiluminescence immunoassay (ADVIA Centaur, Siemens), after modulating the technique as required for the specific samples. Results show that extruded DRV liposomes with similar sizes (mean diameter) with that of SUV liposomes (~95 nm), have 4 times higher drug loading efficiency.

The effect of waveform shape and extension of negative flowrate are studied at two Reynolds numbers (Re = 80, Re = 200) on stented channels by looking at the kinematics and dynamics of the flow. The waveforms are reconstructed by Fourier decomposition of a waveform corresponding to left anterior descending (LAD) of coronary artery. The stents are modeled by an immersed boundary method. Two stent geometries are created which are the idealizations of two clinical ones. The first geometry is an idealization of XIENCE V stent which is called Lambda stent and the second one is the idealization of Endeavor stent and is called X stent. The former has larger inter-strut spacing and smaller thickness than the latter one. The use of immersed boundary method for creating the stents is validated, and the spatial resolution requirements are determined. The shape of the waveform is changed by systematically filtering out the higher modes of Fourier decomposition and the negative flowrate extension is reduced by shifting the waveform to the positive flowrate. The presence of the stent causes vortical structures to be created between stent struts. These vortices are migrating to the centre of the channel and disappear. It is observed that the confined geometric feature of X stent and its larger thickness, leads to larger areas of flow recirculation which causes smaller wall-shear-stress parameters with respect to Lambda stent and more deviation of the flow from a healthy vessel. The importance of the convective terms of the Navier-Stokes equations was studied at the two Reynolds numbers for both stents. It is observed that at high Reynolds number (Re = 200), the convective terms play significant role throughout the waveform cycle while at low Reynolds number (Re = 80), the effect of convective terms become negligible during negative flowrate. Moreover the convective terms become more significant for flow in a channel with Lambda stent than X stent due to the specific shape and size of the stents. The kinematics of the flow corresponds to the study of vortex timing. It was found that this timing is mainly affected by the waveform and Reynolds number rather than the stent geometry. The time at which vortex creation occurs is coincident with the time at which wall shear stress changes its sign in an unstented channel. Therefore the analytical solution of unsteady channel flow can be used as a tool for analysing the kinematics of the flow, / Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2012-06-07 17:41:52.501

Metallic implants called stents are an important part of the treatment of coronary heart disease. While clinical trials are excellent indicators of outcomes, microscopic evaluation of the host tissue response to the implant is required to assess their safety and efficacy. However, the evaluation of human autopsy tissue containing metal implants presents unique challenges in order to obtain the best results. We used integrated microscopy techniques incorporating microCT and novel plastic histology techniques to demonstrate its effectiveness on human stented vessels obtained at autopsy. A total of seven cases are demonstrated where our analysis techniques were able to elucidate the pathogenesis of the host response and identify the specific cause of the complications with the stented vessel seen clinically. These techniques are more cost effective and efficient than other techniques currently in use, which could enable them to be used as part of routine autopsy evaluation. The expansion of the pool of stented vessels able to be analyzed to include the often overlooked large population of autopsy cases could provide an enormous amount of data to guide future clinical trials and improve patient care.

Thesis (M.S.)--University of Alabama at Birmingham, 2007. / Title from PDF of title page (viewed October 13, 2009). Additional advisors: Brigitta C. Brott, Jack E. Lemons, Steven G. Lloyd. Includes bibliographical references (p. 28-31).

Thesis (M.S.)--Medical College of Ohio, 2005. / "In partial fulfillment of the requirements for the degree of Master of Science in Biomedical Sciences." Major advisor: Christopher Cooper. Includes abstract. Document formatted into pages: iii, 150 p. Title from title page of PDF document. Title at ETD Web site : Acute renal injury after renal artery stenting. Bibliography: pages 136-147.

Thesis (M.S.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 48-51) and index.

Thesis (M.S.)--University of Alabama at Birmingham, 2006. / Description based on contents viewed June 25, 2007; title from title screen. Includes bibliographical references (p. 41-42).