The utility of 3D-printed airway stents to improve treatment strategies for central airway obstructions

Airway stents are commonly used in the management of patients suffering from central airway obstruction (CAO). CAO may occur directly from airway strictures, obstructing airway cancers, airway fistulas or tracheobronchomalacia, resulting from the weakening and dynamic collapse of the airway wall. Current airway stents are constructed from biocompatible medical-grade silicone or from a nickel–titanium (nitinol) alloy with fixed geometry. The stents are inserted via the mouth during a bronchoscopic procedure. Existing stents have many shortcomings including the development of obstructing granulation tissue in the weeks and months following placement, mucous build up within the stent, and cough. Furthermore, airway stents are expensive and, if improperly sized for a given airway, may be easily dislodged (stent migration). Currently, in Australia, it is estimated that approximately 12,000 patients will develop CAO annually, many of whom will require airway stenting intervention. Of all stenting procedures, the rate of failure is currently reported to be at 22%. With a growing incidence of lung cancer prevalence globally, the need for updating airway stent technology is now greater than ever and personalizing stents using 3D-printing technology may offer the best chance of addressing many of the current limitations in stent design. This review article will assess what represents the gold standard in stent manufacture with regards to treatment of tracheobronchial CAO, the challenges of current airway stents, and outlines the necessity and challenges of incorporating 3D-printing technology into personalizing airway stents today.     

Influence of strut cross-section of stents on local hemodynamics in stented arteries

Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics(CFD) methods are performed to study how the shape and the aspect ratio(AR) of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress(WSS) in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.     

食管支架疲劳寿命体外测试实验装置的设计与分析

根据食管支架的受载特点,针对目前食管支架疲劳试验装置测试结果误差较大的现状,设计以液压系统为基础的食管支架疲劳实验装置。基于ANSYS-CFX流体分析,确定进口压力和支架表面所受载荷之间的关系,并在改变支架直径的情况下,确定进口压力与支架表面所受最大压力的关系。仿真结果表明:进口压力与支架表面所受压力的关系跟射程有关,当射程不变时,两者关系基本为线性关系;当射程改变时,两者关系成非线性关系。这些数据间的关系可以为实验装置液压系统实现自动控制提供参考依据。     

Ti和TiO2薄膜在血管支架表面附着状况的研究

采用非平衡磁控溅射法在316L不锈钢制成的血管支架表面制备Ti以及TiO2薄膜,初步研究了Ti薄膜厚度、TiO2薄膜沉积速率对薄膜在血管支架表面附着状况的影响.结果表明,支架表面较薄的Ti薄膜附着状况较厚的Ti薄膜好;低沉积速率制备的TiO2薄膜在支架表面附着状况好于高沉积速率制备的TiO2薄膜;对于Ti/TiO2复合薄膜,Ti层厚度过大不利于Ti/TiO2复合薄膜在支架表面附着.     

A novel polymer critical re-melting treatment for improving corrosion resistance of magnesium alloy stent

Polymer coating was widely used as a protective coating on Mg alloy stent due to its excellent deformability. However, the polymer coating with lots of macro- and micro-holes after solvent evaporation during forming process would make corrosion medium permeate easier and decrease the corrosion resistance of Mg alloy stent. In this study, a novel critical re-melting method was adopted to improve the polymer coating densification, which was evaluated by the surface morphology of coating. The corrosion resistance of Mg alloy stent after critical re-melting treatment was examined by the electrochemical and immersion tests. The results indicated that the corrosion resistance of Mg alloy stent with polymer coating was improved significantly by polymer critical re-melting treatment.     

Biodegradable Stent with mTOR Inhibitor-Eluting Reduces Progression of Ureteral Stricture

In this study, we investigated the effect of mTOR inhibitor (mTORi) drug-eluting biodegradable stent (DE stent), a putative restenosis-inhibiting device for coronary artery, on thermal-injury-related ureteral stricture in rabbits. In vitro evaluation confirmed the dose-dependent effect of mTORi, i.e., rapamycin, on fibrotic markers in ureteral component cell lines. Upper ureteral fibrosis was induced by ureteral thermal injury in open surgery, which was followed by insertion of biodegradable stents, with or without rapamycin drug-eluting. Immunohistochemistry and Western blotting were performed 4 weeks after the operation to determine gross anatomy changes, collagen deposition, expression of epithelial–mesenchymal transition markers, including Smad, α-SMA, and SNAI 1. Ureteral thermal injury resulted in severe ipsilateral hydronephrosis. The levels of type III collagen, Smad, α-SMA, and SNAI 1 were increased 28 days after ureteral thermal injury. Treatment with mTORi-eluting biodegradable stents significantly attenuated thermal injury-induced urinary tract obstruction and reduced the level of fibrosis proteins, i.e., type III collagen. TGF-β and EMT signaling pathway markers, Smad and SNAI 1, were significantly modified in DE stent-treated thermal-injury-related ureteral stricture rabbits. These results suggested that intra-ureteral administration of rapamycin by DE stent provides modification of fibrosis signaling pathway, and inhibiting mTOR may result in fibrotic process change.     

管腔内支架表面涂层的研究综述

本文针对介入治疗技术中管腔内支架表面改性的研究进展，评述了无机涂层、有机涂层、药物涂层及其他涂层的制备技术、实验结果与作用机理，并对未来管腔内支架表面涂层的研究趋势作了分析。     

心血管支架的光纤激光切割工艺

心血管支架植入手术是目前治疗心血管疾病的首选方案之一。采用光纤激光精密切割系统,研究了激光输出功率、切割速度、重复频率、脉冲宽度、辅助气体及气压等参数对心血管支架切割质量的影响。通过实验和分析,获得了最佳切割工艺参数:输出功率为7W,脉冲宽度为0.15ms,重复频率为1500Hz,扫描速度为8mm/s,辅助氧压为0.3MPa。采用该工艺参数,切割出了高质量的心血管支架。     

不同镁合金支架材料MAO/PLLA复合膜研究

两种系列的镁合金WE42与AM20微弧氧化(MAO)后用浸渍法对微弧氧化膜进行聚乳酸(PLLA)封孔处理制备复合涂层,通过扫描电镜(SEM)分析微弧氧化膜及聚乳酸封孔膜的表面形貌及结构,X射线衍射(XRD)分析微弧氧化膜的主要成分为MgSiO3和SiO2,通过腐蚀失重测定试样的失重率.在37℃的hank's模拟体液中测...