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The Emerging Paradigm of Stent Biocompatibility: Current Status and Future Directions Dr Miles Dalby Consultant Cardiolo

The Emerging Paradigm of Stent Biocompatibility: Current Status and Future Directions Dr Miles Dalby Consultant Cardiologist Honorary Senior Lecturer Royal Brompton & Harefield NHS Trust Imperial College. Conflicts of Interest. Biotonik Speaker Bureau Conor Speaker Bureau

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The Emerging Paradigm of Stent Biocompatibility: Current Status and Future Directions Dr Miles Dalby Consultant Cardiolo

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  1. The Emerging Paradigm of Stent Biocompatibility: Current Status and Future Directions Dr Miles Dalby Consultant Cardiologist Honorary Senior Lecturer Royal Brompton & Harefield NHS Trust Imperial College

  2. Conflicts of Interest Biotonik Speaker Bureau Conor Speaker Bureau MSD Speaker Bureau Translumina Research Grant Boston Scientific Research Funding Volcano Research support

  3. What makes a good stent……. Acute performance: OK Anti-Restenotic Efficacy: OK Safety………………..n=????? t=?????

  4. Evolution in Stent Biocompatibility Coated Bare Metal Stent: Prokinetic Drug Eluting Erodable Polymer Stent: Costar Bioabsorbable stent: Magic

  5. Silicon Carbide and Thromboresistance 316L steel stent tube in fibrinogen solution with applied current via electrode (time wrapping 1:10) A-SiC:H 316L

  6. Silicon Carbide Stainless Steel Silicon Carbide and Thromboresistance 0.5 µm Biocompatibility 0.25 µm 0 µm 0.5 µm 0.25 µm 0 µm

  7. Silicon Carbide and Thromboresistance Chandler loop Silicon Carbide Stainless Steel

  8. Silicon Carbide and Endothelialisation Exposure of 316L and SiC to endothelial cells for 24h: Light microscopy Atomic Force Microscopy SiC 316L

  9. Co-Star Paclitaxel eluting stent Poly (lactide co-glycolide) Bioresorbable polymer Bridge Elements Nanodroplet injection method Explant at 180 days

  10. Costar architecture and apposition: OCT

  11. Costar Stent Overlap: OCT Costar II Blind aggregate d30 MACE 2 x 3mm 12 atm overlap no post dilatation <100um • Costar: • Good acute performance (clinical experience and OCT) • Fully absorbable Polymer resulting in BMS • Platform for future drug release strategies

  12. Magnesium Alloy Bioabsorbable Stent • Biocompatibility • Imaging • Re-Intervention • Surgery • ?Reduction in late thrombosis risk • Return of vascular function

  13. PROGRESS AMS-1: FIM Primary Endpoint: Feasibility and safety at 4 months with MACE<30%. N=63 In Hospital 30-Day 4-Month Negative Remodeling / Recoil

  14. IVUS 15 Months after AMS implantation in human • Very thin neointima • perfect ingrow of AMS • completed healing of the stented vessel OCT Courtesy of Pr. Carlo di Mario

  15. A B C D AMS: 16-row MSCT Compatible Bare Metal Stent Absorbable Metal Stent Lind et al Heart 91:1604, 2005

  16. Pre-ISDN Post-ISDN Stent Resorption and Vasoreactivity? Stent segment

  17. The future of the AMS platform Mid / long term Short term: AMS2 Optimization of mechanical stability DREAMS Increase of Radial Force Reduction of Degradation Rate Inhibition of side effects Addition of suitable drug Improved Geometrical Design Improved Alloy / Metallography Use AMS2 as basic platform passivating matrix Passivating coating

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