Controlled delivery of paclitaxel from stent coatings using novel styrene maleic anhydride copolymer formulations

The controlled release of paclitaxel (PTx) from stent coatings comprising an elastomeric polymer blended with a styrene maleic anhydride (SMA) copolymer is described. The coated stents were characterized for morphology by scanning electron microscopy (SEM) and atomic force microscopy (AFM), and for drug release using high-performance liquid chromatography (HPLC). Differential scanning calorimetry (DSC) was used to measure the extent of interaction between the PTx and polymers in the formulation. Coronary stents were coated with blends of poly(b-styrene-b-isobutylene-b-styrene) (SIBS) and SMA containing 7% or 14% maleic anhydride (MA) by weight. SEM examination of the stents showed that the coating did not crack or delaminate either before or after stent expansion. Examination of the coating surface via AFM after elution of the drug indicated that PTx resides primarily in the SMA phase and provided information about the mechanism of PTx release. The addition of SMA altered the release profile of PTx from the base elastomer coatings. In addition, the presence of the SMA enabled tunable release of PTx from the elastomeric stent coatings, while preserving mechanical properties. Thermal analysis reveled no shift in the glass transition temperatures for any of the polymers at all drug loadings studied, indicating that the PTx is not miscible with any component of the polymer blend. An in vivo evaluation indicated that biocompatibility and vascular response results for SMA/SIBS-coated stents (without PTx) are similar to results for SIBS-only-coated and bare stainless steel control stents when implanted in the non-injured coronary arteries of common swine for 30 and 90 days.     

Controlled drug release through a plasma polymerized tetramethylcyclo-tetrasiloxane coating barrier

A plasma polymerized tetramethylcyclo-tetrasiloxane (TMCTS) coating was deposited onto a metallic biomaterial, 316 stainless steel, to control the release rate of drugs, including daunomycin, rapamycin and NPC-15199 (N-(9-fluorenylmethoxy-carbonyl)-leucine), from the substrate surface. The plasma-state polymerized TMCTS thin film was deposited in a vacuum plasma reactor operated at a radio-frequency of 13.56 MHz, and was highly adhesive to the stainless steel, providing a smooth and hard coating layer for drugs coated on the substrate. To investigate the influence of plasma coating thickness on the drug diffusion profile, coatings were deposited at various time lengths from 20 s to 6 min, depending on the type of drug. Atomic force spectroscopy (AFM) was utilized to characterize coating thickness. Drug elution was measured using a spectrophotometer or high-performance liquid chromatography (HPLC) system. The experimental results indicate that plasma polymerized TMCTS can be used as an over-coating to control drug elution at the desired release rate. The drug-release rate was also found to be dependent on the molecular weight of the drug with plasma coating barrier on top of it. The in vitro cytotoxicity test result suggested that the TMCTS plasma coatings did not produce a cytotoxic response to mammalian cells. The non-cytotoxicity of TMCTS coating plus its high thrombo-resistance and biocompatibility are very beneficial to drug-eluting devices that contact blood.     

Modeling of degradation and drug release from a biodegradable stent coating

Biodegradable polymeric coatings on cardiovascular stents can be used for local delivery of therapeutic agents to diseased coronary arteries after stenting procedures. This can minimize the occurrence of clinically adverse events such as restenosis after stent implantation. A validated mathematical model can be a very important tool in the design and development of such coatings for drug delivery. The model should incorporate the important physicochemical processes responsible for the polymer degradation and drug release. Such a model can be used to study the effect of different coating parameters and configurations on the degradation and the release of the drug from the coating. In this paper, a simultaneous transport-reaction model predicting the degradation and release of the drug Everolimus from a polylactic acid (PLA) based stent coating is presented. The model has been validated using in vitro testing data and was further used to evaluate the influence of various parameters such as partitioning coefficient of water, autocatalytic effect of the lactic acid and structural change of the matrix, on the PLA degradation and drug release. The model can be used as a tool for predicting drug delivery from other coating configurations designed using the same polymer-drug combination. In addition, this modeling methodology has broader applications and can be used to develop mathematical models for predicting the degradation and drug release kinetics for other polymeric drug delivery systems.     

Controlled Drug Release through a Plasma Polymerized Tetramethylcyclo-tetrasiloxane Coating Barrier

A plasma polymerized tetramethylcyclo-tetrasiloxane (TMCTS) coating was deposited onto a metallic biomaterial, 316 stainless steel, to control the release rate of drugs, including daunomycin, rapamycin and NPC-15199 (N-(9-fluorenylmethoxy-carbonyl)-leucine), from the substrate surface. The plasma-state polymerized TMCTS thin film was deposited in a vacuum plasma reactor operated at a radio-frequency of 13.56 MHz, and was highly adhesive to the stainless steel, providing a smooth and hard coating layer for drugs coated on the substrate. To investigate the influence of plasma coating thickness on the drug diffusion profile, coatings were deposited at various time lengths from 20 s to 6 min, depending on the type of drug. Atomic force spectroscopy (AFM) was utilized to characterize coating thickness. Drug elution was measured using a spectrophotometer or high-performance liquid chromatography (HPLC) system. The experimental results indicate that plasma polymerized TMCTS can be used as an over-coating to control drug elution at the desired release rate. The drug-release rate was also found to be dependent on the molecular weight of the drug with plasma coating barrier on top of it. The in vitro cytotoxicity test result suggested that the TMCTS plasma coatings did not produce a cytotoxic response to mammalian cells. The non-cytotoxicity of TMCTS coating plus its high thrombo-resistance and biocompatibility are very beneficial to drug-eluting devices that contact blood.     

Control of cilostazol release kinetics and direction from a stent using a reservoir-based design

Sustained release formulations of a potent antithrombotic drug, cilostazol, in poly-(lactic acid-co-glycolic acid) (PLGA) matrices were created for luminal release from a novel drug-eluting stent utilizing reservoirs (RES TECHNOLOGY?). The crystallinity of cilostazol and the morphology of the cilostazol/polymer matrix in the stent reservoirs were examined by cross-polarized optical microscopy and differential scanning calorimetry. An in vitro method was developed to study release kinetics of various cilostazol formulations and to examine correlation with in vivo release. Formulation parameters such as drug-to-polymer ratio and the use of a polymer barrier on the abluminal surface of the drug/polymer matrix were found to be effective in modulating drug release rate. Cilostazol/PLGA(75/25) in the weight ratio of 50/50 to 70/30 displayed first-order release kinetics for the majority of the drug load. Addition of an abluminal polymer barrier slowed cilostazol release rate when compared to the bidirectional reservoir design. Excellent correlation between cilostazol in vivo release profile from stents in a porcine coronary artery model and that measured in vitro in a modified USP-7 apparatus suggests that the in vitro release system is capable of predicting in vivo release of cilostazol from stent reservoirs.     

Hemocompatibility of drug-eluting coronary stents coated with sulfonated poly (styrene-block-isobutylene-block-styrene)

The presence of polymer coating on a coronary stent is a major mediator of coronary inflammation reaction thereby affects re-endothelialization. Poly(styrene-block-isobutylene-block-styrene) (SIBS) is one of the most attractive alternatives to serve as stent coating, but has shown less than optimal biocompatibility. Increasing the sulfonic acid content in the polymer can result in increased strength and hydrophilicity. The present study was undertaken to determine the mechanism of action and in?vivo efficacy of sulfonated SIBS (S-SIBS) designed specifically as a stent polymer with reduced inflammatory potential and greater endothelialization preservation potential. The blood compatibility of S-SIBS in?vitro and its ability to support the attachment of human umbilical vein endothelial cells (HUVECs) were first assessed to get some insight into its potential use in?vivo. Baer metal stent (BMS), S-SIBS-coated stent without drug (BMS Plus S-SIBS), standard drug-eluting stent (DES) and S-SIBS-coated drug-eluting stent (DES Plus S-SIBS) were then implanted in the coronary arteries of a porcine model. Neointimal hyperplasia was evaluated at 28 and 180 days, and re-endothelialization was evaluated at 7 and 28 days post stents implantation. The results showed that DES Plus S-SIBS exhibited similar ability to reduce neointimal hyperplasia but preserved endothelialization compared with standard DES. These results suggest potentially promising performance of S-SIBS-coated stent in human clinical applications of coronary stenting.     

Medical applications of poly(styrene-block-isobutylene-block-styrene) ("SIBS")

Poly(Styrene-block-IsoButylene-block-Styrene) ("SIBS") is a biostable thermoplastic elastomer with physical properties that overlap silicone rubber and polyurethane. Initial data collected with SIBS stent-grafts and coatings on metallic stents demonstrate hemocompatibility, biocompatibility and long-term stability in contact with metal. SIBS has been used successfully as the carrier for a drug-eluting coronary stent; specifically Boston Scientific's TAXUS stent, and its uses are being investigated for ophthalmic implants to treat glaucoma, synthetic heart valves to possibly replace tissue valves and other applications. At present, researchers developing medical devices utilizing SIBS have found the following: (1) SIBS does not substantially activate platelets in the vascular system; (2) polymorphonuclear leukocytes in large numbers are not commonly observed around SIBS implants in the vascular system or in subcutaneous implants or in the eye; (3) myofibroblasts, scarring and encapsulation are not clinically significant with SIBS implanted in the eye; (4) embrittlement has not been observed in any implant location; (5) calcification within the polymer has not been observed; and (6) degradation has not been observed in any living system to date. Some deficiencies of SIBS that need to be addressed include creep deformation in certain load-bearing applications and certain sterilization requirements. The reason for the excellent biocompatibility of SIBS may be due to the inertness of SIBS and lack of cleavable moieties that could be chemotactic towards phagocytes.     

Drug loading and elution from a phosphorylcholine polymer-coated coronary stent does not affect long-term stability of the coating in vivo

A drug eluting coronary stent was developed for use in preclinical and clinical trial evaluation. The stent was coated with a phosphorylcholine (PC)-based polymer coating containing the cell migration inhibitor batimastat. A pharmacokinetic study was conducted in a rabbit iliac model using (14)C-radiolabeled version of the drug; this showed the drug release to be first order with 94% of it being released within 28 days. Unloaded and drug-loaded stents were implanted in a porcine coronary artery model; a number were explanted at 5 days and scanning electron microscopy was used to show that the presence of the drug did not affect the rate of stent endothelialization. The remainder of the stents were removed after 6 months and the stents carefully removed from the arterial tissue. Fourier-transform infrared (FT-IR) spectroscopy (both attenuated total reflectance and microscopic imaging) was used to show the presence of the PC coating on control unloaded, drug-loaded and explanted stents, providing evidence that the coating was still present. This was further confirmed by use of atomic force microscopy (AFM) amplitude-phase, distance (a-p,d) curves which generated the characteristic traces of the PC coating. Further AFM depth-profiling techniques found that the thicknesses of the PC coatings on an control unloaded stent was 252+/-19 nm, on an control batimastat-loaded stent 906+/-224 nm and on an explanted stent 405+/-224 nm. The increase in thickness after the drug-loading process was a consequence of drug incorporation in the film, and the return to the unloaded dimensions for the explanted sample indicative of elution of the drug from the coating. The drug delivery PC coating was therefore found to be stable following elution of the drug and after 6 months implantation in vivo.     

Computational Investigation of the Delamination of Polymer Coatings During Stent Deployment

Recent advances in angioplasty have involved the application of polymer coatings to stent surfaces for purposes of drug delivery. Given the high levels of deformation developed in the plastic hinge of a stent during deployment, the achievement of an intact bond between the coating and the stent presents a significant mechanical challenge. Problems with coating delamination have been reported in recent experimental studies. In this paper, a cohesive zone model of the stent–coating interface is implemented in order to investigate coating debonding during stent deployment. Simulations reveal that coatings debond from the stent surface in tensile regions of the plastic hinge during deployment. The critical parameters governing the initiation of delamination include the coating thickness and stiffness, the interface strength between the coating and stent surface, and the curvature of the plastic hinge. The coating is also computed to debond from the stent surface in compressive regions of the plastic hinge by a buckling mechanism. Computed patterns of coating delamination correlate very closely with experimental images. This study provides insight into the critical factors governing coating delamination during stent deployment and offers a predictive framework that can be used to improve the design of coated stents.     

PLA药物涂层包被TiNi合金的表面特性与蛋白质吸附行为

研究PLA携载紫杉醇包被TiNi合金的表面特性与蛋白质吸附行为。采用原子力显微镜（AFM）和X射线光电子能谱（XPS）研究了药物涂层的表面形貌及化学成分；采用高效液相色谱（HPLC）研究了在pH为7．4的PBS溶液中紫杉醇从表面药物涂层中释放特性，同时研究了药物涂层表面蛋白质吸附动力学。试验结果表明经涂覆后TiNi合金表面化学组成及结构随着载药量的增加而改变。紫杉醇在涂层降解初期释放较快，随着时间的延长，累积释放量增加缓慢。蛋白质吸附结果随着吸附时间的延长蛋白净吸附量增加，但增加的趋势逐渐变慢，净吸附量在30min内基本上都能达到最大吸附量，随后在平衡位置变化不大。对于相同药物涂层表面纤维蛋白原的吸附量明显高于白蛋白的吸附量。     

The pre-clinical assessment of rapamycin-eluting, durable polymer-free stent coating concepts

All four currently FDA-approved drug-eluting stents (DESs) contain a durable polymeric coating which can negatively impact vascular healing processes and eventually lead to adverse cardiac events. Aim of this study was the pre-clinical assessment of two novel rapamycin-eluting stent (RES) coating technologies that abstain from use of a durable polymer. Two distinctive RES coating technologies were evaluated in vitro and in the porcine coronary artery stent model. The R-poly(S) stent platform elutes rapamycin from a biodegradable polymer that is top coated with the resin shellac to minimize the amount of polymer. The R-pro(S) stent platform allows dual drug release of rapamycin and probucol, blended by shellac. HPLC-based determination of pharmacokinetics indicated drug release for more than 28 days. At 30 days, neointimal formation was found to be significantly decreased for both DESs compared to bare-metal stents. Assessment of vascular healing revealed absence of increased inflammation in both DESs, which is commonly observed in DES with non-erodible polymeric coating. In conclusion, the pre-clinical assessment of RESs with resin-based or dual drug coating indicated an adequate efficacy profile as well as a beneficial effect for vascular healing processes. These results encourage the transfer of these technologies to clinical evaluation.     

Application of coherent anti-Stokes Raman scattering microscopy to image the changes in a paclitaxel-poly(styrene-b-isobutylene-b-styrene) matrix pre- and post-drug elution

Mapping the drug distribution in a polymeric film and following the subsequent changes that result during and after drug release is important to better understand the mechanism of drug release. This understanding leads to more efficiently designed tailor-made release profiles for drug-containing biomedical devices. Coherent anti-Stokes Raman scattering (CARS) microscopy was used for in situ imaging of local drug distribution in polymeric films, taking advantage of the three-dimensional (3D) resolution, high speed, high sensitivity, and noninvasiveness of the technology. Additionally, the morphological changes of poly(styrene-b-isobutylene-b-styrene) (SIBS) films during paclitaxel release were characterized by scanning electron microscopy, and drug release was quantitatively determined by high performance liquid chromatography. The time-dependent changes in the 3D distribution of paclitaxel in the polymer film were visualized using CARS microscopy. CARS images showed that the paclitaxel was uniformly distributed throughout the SIBS matrix. Changes in the paclitaxel distribution during release were monitored using depth intensity profiles and showed that, upon exposure of the paclitaxel-loaded film to a release medium, the quantitative CARS intensity of paclitaxel decreased. These results indicate that paclitaxel was dissolved and depleted from the SIBS film during in vitro drug elution, supporting the use of CARS microscopy as an effective nondestructive technique for chemical imaging of paclitaxel elution dynamics in polymer films.     

Electrocoating of stainless steel coronary stents for extended release of paclitaxel

Nonbiodegradable polymer coating based on N-(2-carboxyethyl)pyrrole (PPA) and butyl ester of PPA (BuOPy) were successfully electrodeposited on a stainless steel stent surface using cyclic voltammetry. Chemical composition of the coating was examined by X-ray photoelectron spectroscopy. Polymer stability was examined by immersing the coated stent into 1:1 solution of fetal calf serum:seline solution up to 1 year and implantation subcutaneously in mouse for 1 week. Morphology changes were then recorded by scanning electron microscopy. Paclitaxel loading was carried out by immersion into drug solution and its release was detected by HPLC. The results show that thin (single micrometers), uniform coating with various morphology and hydrophobicity can be created by electrochemical deposition. The polymer did not show significant histopathological or morphological changes in vitro and in vivo. The surface properties allow loading appropriate amounts of paclitaxel and release it slowly up to a month.     

Hydroxyapatite/poly(epsilon-caprolactone) composite coatings on hydroxyapatite porous bone scaffold for drug delivery

Hydroxyapatite (HA) porous scaffold was coated with HA and polycaprolactone (PCL) composites, and antibiotic drug tetracycline hydrochloride was entrapped within the coating layer. The HA scaffold obtained by a polymeric reticulate method, possessed high porosity ( approximately 87%) and controlled pore size (150-200 microm). Such a well-developed porous structure facilitated usage in a drug delivery system due to its high surface area and blood circulation efficiency. The PCL polymer, as a coating component, was used to improve the brittleness and low strength of the HA scaffold, as well to effectively entrap the drug. To improve the osteoconductivity and bioactivity of the coating layer, HA powder was hybridized with PCL solution to make the HA-PCL composite coating. With alteration in the coating concentration and HA/PCL ratio, the morphology, mechanical properties, and biodegradation behavior were investigated. Increasing the concentration rendered the stems thicker and some pores to be clogged; as well increasing the HA/PCL ratio made the coating surface be rough due to the large amount of HA particles. However, for all concentrations and compositions, uniform coatings were formed, i.e., with the HA particles being dispersed homogeneously in the PCL sheet. With the composite coating, the mechanical properties, such as compressive strength and elastic modulus were improved by several orders of magnitude. These improvements were more significant with thicker coatings, while little difference was observed with the HA/PCL ratio. The in vitro biodegradation of the composite coatings in the phosphate buffered saline solution increased linearly with incubation time and the rate differed with the coating concentration and the HA/PCL ratio; the higher concentration and HA amount caused the increased biodegradation. At short period (<2 h), about 20-30% drug was released especially due to free drug at the coating surface. However, the release rate was sustained for prolonged periods and was highly dependent on the degree of coating dissolution, suggesting the possibility of a controlled drug release in the porous scaffold with HA+PCL coating.     

Deposition of PLA/CDHA composite coating via electrospraying

Composite coatings composed of carbonated calcium deficient hydroxyapatite (CDHA) and polylactic acid (PLA) were deposited on a PLA substrate surface via electrospraying. The operation parameters, structural properties, bioactivity, cell adhesion, and growth capability of as-fabricated PLA/CDHA coatings were investigated. The composite coating showed good biocompatibility and bioactivity. The deposited coating was also applied as a carrier to assist alendronate sodium (AS) local release. AS, an approved bisphosphonate drug used for the treatment of osteoporosis, was incorporated into a composite coating matrix via coelectrospraying. Its release behavior showed a long-term sustained release. This approach can be a potential coating technique for the surface modification of biopolymer implants.     

Characterization of porous,dexamethasone-releasing polyurethane coatings for glucose sensors

Commercially available implantable needle-type glucose sensors for diabetes management are robust analytically but can be unreliable clinically primarily due to tissue–sensor interactions. Here, we present the physical, drug release and bioactivity characterization of tubular, porous dexamethasone (Dex)-releasing polyurethane coatings designed to attenuate local inflammation at the tissue–sensor interface. Porous polyurethane coatings were produced by the salt-leaching/gas-foaming method. Scanning electron microscopy and micro-computed tomography (micro-CT) showed controlled porosity and coating thickness. In vitro drug release from coatings monitored over 2 weeks presented an initial fast release followed by a slower release. Total release from coatings was highly dependent on initial drug loading amount. Functional in vitro testing of glucose sensors deployed with porous coatings against glucose standards demonstrated that highly porous coatings minimally affected signal strength and response rate. Bioactivity of the released drug was determined by monitoring Dex-mediated, dose-dependent apoptosis of human peripheral blood derived monocytes in culture. Acute animal studies were used to determine the appropriate Dex payload for the implanted porous coatings. Pilot short-term animal studies showed that Dex released from porous coatings implanted in rat subcutis attenuated the initial inflammatory response to sensor implantation. These results suggest that deploying sensors with the porous, Dex-releasing coatings is a promising strategy to improve glucose sensor performance.     

血管支架不定形碳膜脱层现象实验及有限元分析

目的研究不定形碳涂层的血管支架在握压-扩张过程中发生涂层脱层的现象,从材料选择和尺寸设计方面避免脱层的发生。方法通过化学气相沉积法在金属血管支架上沉积生成不定形碳膜,实验模拟该涂层血管支架的握压-扩张过程,并通过电子扫描显微镜观察涂层发生脱层的情况。采用有限元方法分析不定形碳膜在血管支架握压-扩张过程中发生脱层的受力机制及影响因素。结果有限元结果能够较好吻合实验现象。不定形碳膜厚度决定了支架各处脱层的难易程度,以及脱层的发生形式。不定形碳膜弹性模量越大,支架越容易发生脱层。此外,支架的弹性模量也会对支架脱层产生影响,且在不同位置处影响规律不同。结论在血管支架涂层时,需要仔细设计不定形碳膜厚度以及合理匹配不定形碳膜和支架的弹性模量以避免脱层的发生。     

The short-term effects on restenosis and thrombosis of echinomycin-eluting stents topcoated with a hydrophobic heparin-containing polymer

Although drug-eluting stents (DESs) have become the most effective means of treating coronary artery disease, safety concerns regarding their thrombogenicities remain to be surmounted. Here, we report on a novel type of DES capable of preventing restenosis and thrombosis. The DES was prepared by coating a bare metal stent with echinomycin (an anti-proliferative drug) in polyurethane by a spray drying method. Hydrophobic heparinized polymer was then topcoated onto stent over echinomycin/PU layer by dipping to improve hemocompatibility. The two-layered stent was characterized regarding surface and cross-sectional morphology, drug release pattern, platelet adhesion in vitro, and restenosis in vivo. It was found that the heparin topcoat acts as a diffusion barrier that allows the controlled release of drug in a sustained manner. Also, the heparin coated layer effectively reduced platelet adhesion, indicating excellent hemocompatibility. From the animal test using pigs, it was evident that the developed DESs can minimize neointimal proliferation and thrombus formation. The devised hydrophobic heparinized polymer-coated DES effectively reduced both restenosis and thrombosis, suggesting that they have potential as tools for the treatment of coronary artery diseases.     

Analysis of a phosphorylcholine-based polymer coating on a coronary stent pre- and post-implantation

There has been a move towards surface treatments for metallic coronary stents in an effort to improve their compatibility within the body and to provide a vehicle for the delivery of therapeutics. The Biodiv Ysio range of stents is characterised by a biocompatible coating comprised of a crosslinked phosphorylcholine (PC)-based polymer. In addition to a review of some of the data collected to support safety and efficacy of this device, this paper also describes a number of techniques that have been employed to both visualise and quantify the coating on the stent. Explantation of both coated and uncoated stents from porcine coronary arteries revealed that both coated and uncoated stents were >90% endothelialised after 5 days. Typical histological analysis of stented vessel sections after 4 and 12 weeks implantation showed the presence of cell types characteristic of the inflammatory response associated with the trauma caused by stent placement, with no evidence for any additional coating-related adverse inflammatory sequelae. Finally, it was demonstrated by AFM and SEM that both the thickness and force required to remove the coating were essentially unchanged after 6 months implantation. Thus, both the long-term stability and relative biological inertness of the coating has been confirmed in vivo, supporting its use as a vehicle for local drug delivery.     

Evaluation of electrospun PLLA/PEGDMA polymer coatings for vascular stent material

The field of percutaneous coronary intervention has seen a plethora of advances over the past few decades, which have allowed for its development into safe and effective treatments for patients suffering from cardiovascular diseases. However, stent thrombosis and in-stent restenosis remain clinically significant problems. Herein, we describe the synthesis and characterization of fibrous polymer coatings on stent material nitinol, in the hopes of developing a more suitable stent surface to enhance re-endothelialization. Electrospinning technique was used to fabricate polyethylene glycol dimethacrylate/poly l-lactide acid (PEGDMA/PLLA) blend fiber substrate with tunable elasticity and hydrophilicity for use as coatings. Attachment of platelets and arterial smooth muscle cells (SMC) onto the coatings as well as the secretory effect of mesenchymal stem cells cultured on the coatings on the proliferation and migration of arterial endothelial cells and SMCs were assessed. It was demonstrated that electrospun PEGDMA/PLLA coating with 1:1 ratio of the components on the nitinol stent-reduced platelet and SMC attachment and increased stem cell secretory factors that enhance endothelial proliferation. We therefore postulate that the fibrous coating surface would possess enhanced biological compatibility of nitinol stents and hold the potential in preventing stent failure through restenosis and thrombosis.