Comparative study of the corrosion behavior of peripheral stents in an accelerated corrosion model: experimental in vitro study of 28 metallic vascular endoprostheses

PURPOSE

Clinical cases of stent-fractures show that corrosion behavior might play a role in these fractures. Implanted in vivo, especially in combination with other implanted foreign materials, these metallic products are exposed to special conditions, which can cause a process of corrosion. Here, we aimed to test the corrosion potential of stents made of different materials in an in vitro setting.

METHODS

A total of 28 peripheral stents of different materials (nitinol, cobalt-chromium-nickel, tantalum, V4A) and surface treatments (electropolish, mechanical polish, no polish) were tested in vitro. Corrosion was accelerated by applying a constant voltage of 3.5 V and amperage of 1.16 mA in 0.9% NaCl.

RESULTS

Nitinol stents showed the lowest susceptibility to corrosion and the longest period without damage. The Memotherm II^® (BARD Angiomed^®) was the only stent that showed neither macroscopic nor microscopic damages. The worst performing material was cobalt-chromium-nickel, which showed corrosion damages about ten times earlier compared to nitinol. Considering the reasons for termination of the test, nitinol stents primarily showed length deficits, while V4A and tantalum stents showed fractures. Cobalt-chromium-nickel stents had multiple fractures or a complete lysis in equal proportions. When placed in direct contact, nitinol stents showed best corrosion resistance, regardless of what material they were combined with. In terms of polishing treatments, electropolished stents performed the best, mechanical-polished stents and those without polishing treatment followed.

CONCLUSION

The analysis of corrosion behavior may be useful to select the right stent fulfilling the individual needs of the patient within a large number of different stents.Congenital stenosis or volume decreasing processes due to accumulation of tissues or by outside pressures are the most common indications for vascular interventional therapies. After the initial “cardiac catheterization” by Forssmann et al. (1) in 1929, percutaneous interventional techniques for treatment of vasoconstricting processes was continued constantly, whereby the use of permanent mechanical stents has gained an increasingly important role.Stents used in clinical practice should fulfill certain conditions to achieve an un-problematic application as well as an optimal result. The following properties apply to this ideal: good biocompatibility, low shortening, high-density in X-ray, high patency rates, low thrombogenicity, rapid endothelialization without excessive intimal hyperplasia, high flexibility and longitudinal elasticity, sufficient pressure stability at high centrifugal force, technical ability to secure application and exact positioning, and good expansion ratio for safe percutaneous application also with larger prostheses (2, 3). With the approval of stents for clinical use in 1986, the use of stents in peripheral vessels was also practiced on human patients. Palmaz et al. (4) published the first results of the clinical use in 1988 in one of the first multicenter trials on the use of stents in stenosed atherosclerotic iliac arteries. After the successful development of Palmaz^® stents and Wallstents^® as prototypes of balloon-expandable and self-expanding stents, a variety of new stents have been developed.The stents used today are made of different materials. These include nickel titanium alloys (nitinol), surgical stainless steel (V4A), tantalum, and cobalt compounds. Implanted in the human body, especially in combination with other implanted foreign materials, these metallic products are exposed to special conditions causing a process of corrosion. The higher the ionic conductivity of a liquid is, the faster the reaction. For this reason, liquids that contain a high proportion of electrolytes, such as blood with its high proportion of NaCl, cause much faster corrosion of materials (5).We aimed to perform a comparative study regarding the corrosion behavior of peripheral stents, to reffect the behavior of implanted stents in patients and contribute to find a safer indication in the selection of vascular prostheses. Likewise, we tested the hypothesis that the polishing process influences their corrosion behavior.     

Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients

This angiographically correlated study reports on, for the first time, age- and gender-based distribution of the volumetric calcium score in a large group of patients with suspected coronary artery disease. Volumetric calcium data predicted significant coronary artery disease (>/=50% lumen diameter stenosis) as well as the traditional Agatston score. Exclusion of any calcium was highly accurate in ruling out obstructive disease in symptomatic subjects >/=50 years of age.     

On the Ablation Behavior of Carbon Fiber-Reinforced Plastics during Laser Surface Treatment Using Pulsed Lasers

This contribution discusses the ablation phenomena observed during laser treatment of carbon fiber-reinforced plastics (CFRPs) with pulsed lasers observed employing laser sources with wavelengths of 355 nm, 1064 nm and 10.6 µm and pulse durations from picoseconds (11 ps) to microseconds (14 µs) are analyzed and discussed. In particular, the threshold fluence of the matrix material epoxy (EP) and the damage threshold of CFRP were calculated. Moreover, two general surface pretreatment strategies are investigated, including selective matrix removal and structure generation through indentation (ablation of both, matrix material and fibers) with a cross-like morphology. The surfaces obtained after the laser treatment are characterized by means of optical and scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy is employed for the analysis of composite and constituent materials epoxy and carbon fibers. As a result, different ablation mechanisms, including evaporation and delamination are observed, depending on the employed laser wavelength and pulse duration. For both 355 nm and 1064 nm wavelength, the laser radiation produces only partial ablation of the carbon fibers due to their higher absorption coefficient compared to the epoxy matrix. Although a selective matrix removal without residues is achieved using the pulsed CO₂ laser. Differently, both constituent materials are ablated with the nanosecond pulsed UV laser, producing indentations. The sum of the investigations has shown that existing theories of laser technology, such as the ablation threshold according to Liu et al., can be applied to composite materials only to a limited extent. Furthermore, it has been found that the pronounced heterogeneity of CFRP mostly leads to an inhomogeneous ablation result, both when creating grooves and during selective matrix removal, where the carbon fibers influence the ablation result by their thermal conductivity, depending on fiber direction. Finally, despite the material inhomogeneity, a scanning strategy has been developed to compensate the heterogeneous ablation results regarding structure depth, width and heat affected zone.     

Neutrophil Dependence of Vascular Remodeling after Mycoplasma Infection of Mouse Airways

Vascular remodeling is a feature of sustained inflammation in which capillaries enlarge and acquire the phenotype of venules specialized for plasma leakage and leukocyte recruitment. We sought to determine whether neutrophils are required for vascular remodeling in the respiratory tract by using Mycoplasma pulmonis infection as a model of sustained inflammation in mice. The time course of vascular remodeling coincided with the influx of neutrophils during the first few days after infection and peaked at day 5. Depletion of neutrophils with antibody RB6-8C5 or 1A8 reduced neutrophil influx and vascular remodeling after infection by about 90%. Similarly, vascular remodeling after infection was suppressed in Cxcr2^−/− mice, in which neutrophils adhered to the endothelium of venules but did not extravasate into the tissue. Expression of the venular adhesion molecule P-selectin increased in endothelial cells from day 1 to day 3 after infection, as did expression of the Cxcr2-receptor ligands Cxcl1 and Cxcl2. Tumor necrosis factor α (TNFα) expression increased more than sixfold in the trachea of wild-type and Cxcr2^−/− mice, but intratracheal administration of TNFα did not induce vascular remodeling similar to that seen in infection. We conclude that neutrophil influx is required for remodeling of capillaries into venules in the airways of mice with Mycoplasma infection and that TNFα signaling is necessary but not sufficient for vascular remodeling.Neutrophils are key effector cells of innate immunity that rapidly arrive at sites of tissue injury to kill bacteria and interact with macrophages and other cells to orchestrate a coordinated immune cell and cytokine response to injury.^1–4 Neutrophils are involved in many inflammatory diseases of the airways and lung, including pneumonia, acute lung injury, sepsis, asthma, cystic fibrosis, bronchitis, and chronic obstructive lung disease,⁵ also contribute to tissue damage in inflammatory conditions of other organs, and play a role in arterial remodeling in atherosclerosis.⁴The signals and events that bring neutrophils to sites of inflammation are well characterized.^6–8 These include expression of endothelial cell adhesion molecules to induce rolling and firm attachment, followed by extravasation into tissues where they release cytokines and other products that can kill bacteria and promote tissue remodeling. The dominant mechanism driving neutrophil influx may be organ-specific.^9,10 Blood vessels of the microcirculation undergo numerous changes in sustained inflammation, and these include structural and functional remodeling of endothelial cells and pericytes.^11–14 Among these changes, capillaries transform into venules that support plasma leakage and leukocyte influx. The contribution of neutrophils to this remodeling is not well understood. Circumferential vessel enlargement is a prominent feature of vascular remodeling–sustained airway inflammation^15–23 and is distinct from more familiar and better-documented types of sprouting angiogenesis.²⁴We asked whether incoming neutrophils contribute to the vascular remodeling, with the thought that the initial wave of leukocyte influx could render blood vessels more efficient for leukocyte adhesion and transmigration. Although leukocyte influx is known to accompany blood vessel remodeling,^15,18,22 it is unknown whether there is a causal relationship and, if so, what is the underlying mechanism? Neutrophils are attractive candidates for contributing to vascular remodeling because they are among the first leukocytes to enter inflamed tissues^4,6,25 and can produce cytokines, growth factors, proteases, and reactive oxygen species that have profound vascular effects.^2–4,26With this background, we sought to determine whether neutrophils are essential for the vascular remodeling that occurs soon after Mycoplasma pulmonis infection, when capillaries transform into venules. In particular, we asked whether neutrophil influx coincides spatially and temporally with vascular remodeling, can vascular remodeling be prevented by neutrophil depletion, and if Cxcr2 signaling is required for the neutrophil influx that accompanies vascular remodeling?To address these questions we examined the relationship between neutrophil influx and vascular remodeling during the first week after M. pulmonis infection of the respiratory tract of mice. The approach was to compare the time course of neutrophil influx and vascular remodeling in the trachea and then determine whether the remodeling was blocked by neutrophil depletion by either of two different antineutrophil antibodies: RB6-8C5 or 1A8. We also tested whether vascular remodeling was prevented by genetic deletion of Cxcr2, which mediates the actions of the chemotactic chemokines Cxcl1 and Cxcl2, which bring neutrophils into inflamed tissues. Because previous studies have shown that vascular remodeling was inhibited by blocking tumor necrosis factor α (TNFα) signaling,¹⁹ we asked whether TNFα expression was increased in wild-type and Cxcr2^−/− mice and whether intratracheal administration of TNFα was sufficient to induce vascular remodeling similar to that seen after infection. Other studies examined the expression of the Cxcr2 ligands, Cxcl1 and Cxcl2. Together, the experiments showed that neutrophil influx was required for vascular remodeling after M. pulmonis infection, and that TNF signaling was necessary but not sufficient for vascular remodeling.     

Preparation of unnatural N-to-N and C-to-C protein fusions

Standard genetic approaches allow the production of protein composites by fusion of polypeptides in head-to-tail fashion. Some applications would benefit from constructions that are genetically impossible, such as the site-specific linkage of proteins via their N or C termini, when a remaining free terminus is required for biological activity. We developed a method for the production of N-to-N and C-to-C dimers, with full retention of the biological activity of both fusion partners and without inflicting chemical damage on the proteins to be joined. We use sortase A to install on the N or C terminus of proteins of interest the requisite modifications to execute a strain-promoted copper-free cycloaddition and show that the ensuing ligation proceeds efficiently. Applied here to protein-protein fusions, the method reported can be extended to connecting proteins with any entity of interest.     

Spin electron paramagnetic resonance of albumin for diagnosis of oral squamous cell carcinoma (OSCC)

Objectives

Albumin has a known capability to modulate free serum concentrations of proteins produced by tumour cells. The technique of spin probe labelling of albumin followed by electron paramagnetic resonance (EPR) spectroscopy may allow identification of these structural and functional changes, which regularly occur as consequence of binding tumour metabolites as ligands. The aim of the present study was a proof of principle evaluation of EPR-analysis of peripheral blood samples as possible predictor for oral squamous cell carcinoma (OSCC).

Material and methods

The present study is designed as gender-matched cohort. EPR was tested after retrieval of peripheral blood samples. The study group is represented by 32 patients with OSCC, and the control group consisted of 30 healthy patients.

Results

Overall analysis exhibited a diagnostic sensitivity of 72% (23/32 OSCC group) and a specificity of 80% (24/30 control group). Subgroup analysis revealed ten patients with elevated leukocytes (>10,000/μl; n?=?9 [OSCC group] and n?=?1 [control group]). After exclusion of patients with elevated white blood cell count, sensitivity considerably increased to 87% and specificity to 83%.

Conclusion

EPR analysis of peripheral blood samples might be appropriate to support the clinician in primary and follow-up diagnosis of potential tumours such as OSCC. Unfortunately, subgroup analysis characterises the method vulnerable to inflammation.

Clinical relevance

Nevertheless, our preliminary results are intriguing, as diagnosis of OSCC appears possible by simple peripheral blood examination. Thus, further appraisal of this novel method with inclusion of different tumour entities, systemic conditions and inflammation in a larger study population appears highly valuable.