京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13207号 / 論医博第2161号 / 新制||医||1031(附属図書館) / (主査)教授 福原 俊一, 教授 湊谷 謙司, 教授 小池 薫 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Made available in DSpace on 2014-07-29T15:07:09Z (GMT). No. of bitstreams: 1 Dissertacao Harley Fernandes Rodrigues.pdf: 5566711 bytes, checksum: 484423a034c8d6a3a3f34650b5036af1 (MD5) Previous issue date: 2011-08-23 / In this work we developed a Dip Coating method that could control the temperature gradient between a substrate and the material that one wants to adsorb at its surface. In particular, the adsorption of biocompatible magnetic nanoparticles at the surface of bare metal Stents, under different experimental conditions, was investigated. The magnetic nanoparticles consisted of magnetite coated with tripoliphosphate (mean diameter 7.68 nm and standard deviation 1.88 nm) dispersed in water at physiological conditions, while the Stent was a CoCr based-one (Cronus stent from Scitech with 16 mm length). Nine series of experiments were performed where it was controlled parameters as: time of adsorption, stent temperature and magnetic fluid temperature. The stents coated with nanoparticles were magnetically characterized using a vibrating sample magnetometer (VSM), which allowed us to determine the number of nanoparticles at the stent surface. The increase of the magnetic moment of the stent with the increase of the adsorption time was theoretically modeled, with an excellent experimental agreement, as a transient diffusion process of nanoparticles at the interface stent-magnetic fluid, which clearly indicates an important diffusive contribution. Strong evidences of thermal diffusion (Soret effect), i.e. nanoparticle diffusion due to temperature gradient between the stent and the magnetic fluid, were shown, suggesting the possibility of nanostructures vectorization through thermal induced mechanisms. The spatial distribution of nanoparticles at the surface of the stent was investigated by Scanning Electron Microscopy (SEM) and X-ray Spectroscopy by Dispersive Energy (EDS). Measurements of the compositional mapping and images of SEM revealed that the nanoparticles are not homogeneously distributed, being concentrated at the edges of the stents for the experimental conditions investigated in this work. As the VSM data, the EDS of the stents revealed an increase of the quantity of adsorbed magnetic nanoparticles at the surface with the increase of the adsorption time. The same theoretical model, know considering the amount of 26Fe in the chemical composition of the coated stent, was able to explain the experimental data. Finally, a comparison was made, using the compositional mapping study of the coated stents, between the Dip Coating and the Spray technique. The later showed a more homogeneous distribution of nanoparticles at the surface of the stent, suggesting that this technique is more adequate on the development of a biomedical nanoproduct for clinical tests. / Neste trabalho foi desenvolvida uma técnica de Dip Coating (deposição por via líquida) que permite controlar o gradiente de temperatura entre o substrato e o material que se quer depositar em sua superfície. Em particular, foi investigado o efeito de adsorção de nanopartículas magnéticas biocompatíveis na superfície de Stents nus em diversas condições experimentais. As nanopartículas magnéticas consistiam de magnetita recobertas com tripolifosfato (diâmetro médio ) dispersas em água em pH fisiológico, enquanto as endopróteses eram Stents de CoCr (Stent Cronus da empresa Scitech com 16mm). Ao todo foram realizadas 9 séries de experimentos onde controlou-se parâmetros como: tempo de adsorção, temperatura do Stent e temperatura do fluido magnético. Os Stents recobertos com nanopartículas foram então caracterizados magneticamente pela técnica de magnetometria de amostra vibrante (VSM Vibrating Sample Magnetometer ), que permitiu determinar o número de nanopartículas magnéticas adsorvidas na superfície da endoprótese. O aumento do momento magnético do Stent com o aumento do tempo de adsorção foi modelado teoricamente, com grande concordância experimental, como um processo de difusão transiente de nanopartículas na interface Stent-fluido magnético, evidenciando a forte contribuição difusiva. Fortes evidências de efeitos termodifusivos (efeito de Soret), ou seja mecanismos de difusão mássica de nanopartículas devido ao gradiente de temperatura entre Stent e FM, foram apresentados, sugerindo a possibilidade de vetorização de nanoestruturas por meio de fenômenos termoinduzidos. A distribuição das nanopartículas na superfície dos Stents foi investigada por medidas de Microscopia Eletrônica de Varredura (MEV) e espectroscopia de raios-X por energia dispersiva (EDS). As medidas de mapeamento composicional e imagens de MEV revelaram que as nanopartículas estão distribuídas de maneira não homogênea, estando concentradas nas bordas dos Stents para as condições experimentais utilizadas neste trabalho. Assim como os dados de MAV, o EDS dos Stents recobertos revelou um aumento da quantidade de nanopartículas magnéticas adsorvidas em sua superfície com o aumento do tempo de adsorção. O mesmo modelo teórico, agora considerando o percentual de 26Fe na composição química do revestimento, foi capaz de explicar os dados experimentais. Finalmente, foi feita uma comparação, por meio do mapeamento composicional de Stents recobertos, entre as técnicas de Dip Coating e Spray. Esta última apresentou uma distribuição de nanopartículas mais homogênea na superfície da endoprótese, sugerindo que possa ser mais adequada para a confecção de um nanoproduto médico voltado a testes clínicos.

Background: Drug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results. Methods: PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL). Results: Overall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months. Conclusion: In this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.

Coronary artery disease (CAD) affects every fifth person in the world. The gold-standard treatment for CAD is stent implantation, however, the existing therapy is not sufficient due to many reasons. For instance, in-stent restenosis, biocompatibility, controlled degradation rate, protein adsorption, and adequate endothelialization are still the main concerns. In the last two decades, the field of stent technology has been grown rapidly and many new stent types and in vitro testing methods for stent characterization have been developed to minimize the aforementioned issues. In this vicinity, there are still many unaddressed issues: i) the quantitative analysis of corrosion is conducted with simpler samples made of stent material instead of stents, in most cases due to the absence of a mathematical model to calculate the entire stent surface area (ESSA); ii) in vitro stent testing in environments that are very far from actual physiological environments; iii) Evaluation of the influence of in-vitro test conditions on coated metallic stents; iv) absence of flow-induced shear stress (FISS) corrosion model, to mention a few. This thesis presents the novel ESSA model, the fluid dynamic experimental setup with the integration of various sensors and pH control, the influence of in vitro degradation behavior of the titanium oxynitride (TiOxNy) coated stainless steel stents and anodized AZ31 samples, and the FISS corrosion model. The results show some important contributions in this field, however, there is still a huge potential for the development of promising stent characterization solutions. / Die koronare Herzkrankheit (KHK) betrifft jeden fünften Menschen auf der Welt. Der Goldstandard bei der Behandlung von KHK ist die Stent-Implantation, doch die bestehende Therapie ist aus vielen Gründen nicht ausreichend. So sind beispielsweise die Restenose im Stent, die Biokompatibilität, die kontrollierte Abbaugeschwindigkeit, die Proteinadsorption und die angemessene Endothelialisierung nach wie vor die Hauptprobleme. In den letzten zwei Jahrzehnten hat sich die Stenttechnologie rasant weiterentwickelt, und es wurden viele neue Stenttypen und In-vitro-Testmethoden zur Stentcharakterisierung entwickelt, um die oben genannten Probleme zu minimieren. In dieser Umgebung gibt es noch viele ungelöste Probleme: i) die quantitative Analyse der Korrosion wird mit einfacheren Proben aus Stentmaterial anstelle von Stents durchgeführt, in den meisten Fällen aufgrund des Fehlens eines mathematischen Modells zur Berechnung der gesamten Stentoberfläche (ESSA); ii) In-vitro-Stent-Tests in Umgebungen, die sehr weit von der tatsächlichen physiologischen Umgebung entfernt sind; iii) Bewertung des Einflusses von In-vitro-Testbedingungen auf beschichtete metallische Stents; iv) Fehlen eines FISS-Korrosionsmodells (flow-induced shear stress), um nur einige zu nennen. In dieser Arbeit werden das neuartige ESSA-Modell, der strömungsdynamische Versuchsaufbau mit der Integration verschiedener Sensoren und pH-Kontrolle, der Einfluss des In-vitro-Degradationsverhaltens der mit Titanoxynitrid (TiOxNy) beschichteten Edelstahlstents und anodisierten AZ31-Proben sowie das FISS-Korrosionsmodell vorgestellt. Die Ergebnisse zeigen einige wichtige Beiträge in diesem Bereich, jedoch gibt es noch ein großes Potenzial für die Entwicklung von vielversprechenden Lösungen zur Charakterisierung von Stents.