This invention relates to bioerodible polymeric stent, and more particularly to a scaffolding pattern for a bioerodible polymeric stent.
Stents are generally cylindrically shaped devices, which function to hold open and sometimes expand a segment of a blood vessel or other anatomical lumen such as urinary tracts and bile ducts. Stents are often used in the treatment of atherosclerotic stenosis in blood vessels. “Stenosis” refers to a narrowing or constriction of the diameter of a bodily passage or orifice. In such treatments, stents reinforce body vessels and prevent restenosis following angioplasty in the vascular system. “Restenosis” refers to the reoccurrence of stenosis in a blood vessel or heart valve after it has been treated (as by balloon— angioplasty, stenting, or valvuloplasty) with apparent success.
The treatment of a diseased site or lesion with a stent involves both delivery and deployment of the stent. “Delivery” refers to introducing and transporting the stent through a bodily lumen to a region, such as a lesion, in a vessel that requires treatment. “Deployment” corresponds to the expanding of the stent within the lumen at the treatment region. Delivery and deployment of a stent are accomplished by positioning the stent about one end of a catheter, inserting the end of the catheter through the skin into a bodily lumen, advancing the catheter in the bodily lumen to a desired treatment location, expanding the stent at the treatment location, and removing the catheter from the lumen.
In the case of a balloon expandable stent, the stent is mounted about a balloon disposed on the catheter. Mounting the stent typically involves compressing or crimping the stent onto the balloon. The stent is then expanded by inflating the balloon. The balloon may then be deflated and the catheter withdrawn. In the case of a self expanding stent, the stent may be secured to the catheter via a retractable sheath or a sock. When the stent is in a desired bodily location, the sheath may be withdrawn which allows the stent to self expand.
The stent must be able to satisfy a number of mechanical requirements. First, the stent must be capable of withstanding the structural loads, namely radial compressive forces, imposed on the stent as it supports the walls of a vessel. Therefore, a stent must possess adequate radial strength. Radial strength, which is the ability of a stent to resist radial compressive forces, is due to strength and rigidity around a circumferential direction of the stent. Radial strength and rigidity, therefore, may also be described as, hoop or circumferential strength and rigidity.
Once expanded, the stent must adequately maintain its size and shape throughout its service life despite the various forces that may come to bear on it, including the cyclic loading induced by the beating heart. For example, a radially directed force may tend to cause a stent to recoil inward. Generally, it is desirable to minimize recoil.
In addition, the stent must possess sufficient ductility to allow for crimping, expansion, and cyclic loading. Longitudinal flexibility is important to allow the stent to be maneuvered through a tortuous vascular path and to enable it to conform to a deployment site that may not be linear or may be subject to flexure. Finally, the stent must be biocompatible so as not to trigger any adverse vascular responses.
The structure of a stent is typically composed of scaffolding that includes a pattern or network of interconnecting structural elements often referred to in the art as struts or bar arms. The scaffolding can be formed from wires, tubes, or sheets of material rolled into a cylindrical shape. The scaffolding is designed so that the stent can be radially compressed (to allow crimping) and radially expanded (to allow deployment). A conventional stent is allowed to expand and contract through movement of individual structural elements with respect to each other.
A medicated stent may be fabricated by coating the surface of either a metallic or polymeric scaffolding with a polymeric carrier that includes an active or bioactive agent or drug. Polymeric scaffolding may also serve as a carrier of an active agent or drug.
Frequently, only a temporary presence of the stent in the body is necessary to fulfill the medical purpose. Surgical intervention to remove stents, however, can cause complications and may not even be possible. One approach for avoiding a permanent presence of all or part of an endoprosthesis is to form all or part of the endoprosthesis out of bioerodible material. The term “bioerodible” as used herein is understood as the sum of microbial procedures or processes solely caused by the presence of endoprosthesis within a body, which results in a gradual erosion of the structure formed of the bioerodible material.
At a specific time, the stent, or at least the part of the stent that includes the bioerodible material, loses its mechanical integrity. The erosion products are mainly absorbed by the body, although small residues can remain under certain conditions. A variety of different bioerodible polymers (both natural and synthetic) and bioerodible metals (particularly magnesium and iron) have been developed and are under consideration as candidate materials for particular types of stents. Many of these bioerodible materials, however, have significant drawbacks. These drawbacks include the erosion products, both in type and in rate of release, as well as the mechanical properties of the material. Polymers have been used to make stent scaffolding, but a variety of factors that affect a polymeric stent's ability to retain its structural integrity when subjected to external loadings, such as crimping and balloon expansion forces. In comparison to metals, polymers typically have a low strength to weight ratio, which means that additional material is used to provide an equivalent mechanical property to that of a metal. Polymeric scaffolding can also be brittle or have limited fracture toughness. Anisotropic and rate-dependant inelastic properties (i.e., strength/stiffness of the material varies depending upon the rate at which the material is deformed) of polymeric materials can complicate the working of a polymeric material, particularly, a bioerodible polymer such as PLLA and PLGA.
A stent provided herein includes a tubular network of struts including a bierodible polymer. In some cases, the tubular network can cut from a bioerodible polymer tube. The tubular network can include a plurality of bands and a plurality of connectors, with each band including at least nine peaks, and with each band being connected to one or more adjacent bands by at least two connectors. In some cases, each band is connected to one or more adjacent bands by at least three connectors. In some cases, each band includes exactly nine peaks. In some cases, a stent having bands each having exactly nine peaks can have an outer diameter of between 2.0 mm and 5.0 mm when each peak is expanded to have a peak angle of 90 degrees for each peak. In some cases, each band includes more than nine peaks. For example, a band including ten peaks can have an outer diameter of 3.5 mm or greater when expanded to have a peak angle of 90 degrees for each peak.
Stents provided herein can include any suitable number of bands. In some cases, stents provided herein can include at least six bands including two end bands and at least four internal bands. In some cases, stents provided herein can include at least ten bands including two end bands and at least eight internal bands. In some cases, each end band is connected to an internal band by more than four or more connectors while each internal band is connected to at least one other internal band by three or fewer connectors. In some cases, each end band is connected to an internal band by nine connectors. In some cases, one or more connectors connecting an end band to an internal band includes a radiopaque marker. In some cases, stents provided herein include at least 3 radiopaque markers at each end of the stent. Stents provided herein can include connectors that connect two opposite peaks of adjacent bands.
Stents provided herein can having a wall thickness of less than 150 microns. In some cases, stents provided herein can have a wall thickness of less than 140 microns, less than 130 microns, less than 120 microns, less than 110 microns, or less than 100 microns. In some cases, a stent provided herein can have a wall thickness of about 120 microns.
The bands and connectors of a stent provided herein can be formed to have widths of between 180 and 250 microns. In some cases, bands and connectors of a stent provided herein can be formed to have a width of between 200 and 230 microns, between 180 and 200 microns, or between 230 and 250 microns. In some cases, peaks provided herein can be formed to have a wider width than other sections of the bands or the connectors. For example, peaks can be formed to have a width of between 230 and 250 microns and other portions of the bands and connectors can have a width of between 180 microns and 230 microns. In some cases, peaks can define an aperture there through. Stents provided herein can have any suitable peak width to strut width ratio. In some cases, each band is formed to have a peak width to strut width ratio of between 0.9 and 1.25. In some cases, each band is formed to have a peak width to strut width ratio of between 1.0 and 1.1 mm.
Stents provided herein can be crimped into a configuration adapted for delivery through a body lumen. In some cases, stents provided herein can have an expanded diameter of between 2.0 mm and 5.0 mm when each peak has a peak angle of 90 degrees and be crimped to a diameter of less than 1.4 mm. For example, a stent having an expanded diameter of about 3 mm when each peak is expanded to a peak angle of 90 degrees can be crimped to a crimped diameter of between 1.1 mm and 1.25 mm.
Stents provided herein can include any suitable bierodible polymer. In some cases, the bioerodible polymer can be selected from the group consisting of PLGA, PDLA, PLLA, PCL, PHBV, POE, PEO/PBTP, one or more polyamides, one or more polyanhides, and a combination thereof. In some cases, stents provided herein can include PLLA having a molecular weight of at least 30,000 Daltons. In some cases, stents provided herein can include PLLA having a Tg of at least 40° C. In some cases, stents provided herein can include PLLA having a molecular weight of at least 30,000 Daltons and a Tg of at least 40° C.
Stents provided herein provide suitable ductility to allow for crimping, expansion, and cyclic loading. Stents provided herein can provide improved longitudinal flexibility to allow the stent to be maneuvered through a tortuous vascular path and to enable it to conform to a deployment site that may not be linear or may be subject to flexure.
Like reference symbols in the various drawings indicate like elements.
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Stents provided herein can have any suitable stent wall thickness. As shown in
Stents provided herein can have struts having any suitable width. Referring to
Stents provided herein can have any suitable offset. In some cases, stents provided herein can have a peak offset of between 0.1 mm and 0.4 mm, between 0.15 mm and 0.3 mm, or between 0.2 mm and 0.25 mm.
Stents provided herein can have any suitable ratio of peak width to strut width. As shown in
The pattern of stents provided herein can allow for radial expansion and compression and longitudinal flexure. The pattern includes struts that are straight or relatively straight and bending elements. Bending elements bend inward when a stent is crimped to allow radial compression of the stent in preparation for delivery through an anatomical lumen. Bending elements also bend outward when a stent is deployed to allow for radial expansion of the stent within the anatomical lumen. After deployment, stents provided herein can be subjected to static and cyclic compressive loads from the vessel walls. Thus, bending elements may deform during use.
Stents provided herein include a bioerodible polymer. In some cases, stents provided herein are bioerodible. In some cases, bioerodible polymer in a stent provided herein is the primary source of the radial strength of the stent. In some cases, stents provided herein are completely or primarily composed of bioerodible polymer. In some cases, bands of stents provided herein are substantially free metallic material. In some cases, only radiopaque markers include metallic materials.
Stents provided herein can include any suitable bierodible polymer. In some cases, the bioerodible polymer can be selected from the group consisting of poly(lactide-co-glycolide) (PLGA), poly(D,L-lactic acid) (PDLA), poly(L-lactic acid) (PLLA), poly(caprolactone) (PCL), polyhydroxy-butyrate/-valerate copolymer (PHBV), polyorthoester (POE), polyethyleneoxide/polybutylene terephthalate copolymer (PEO/PBTP), one or more polyamides (such as Nylon 66 and polycaprolactam), one or more polyanhidride, and a combination thereof. In some cases, stents provided herein can include PLLA having a molecular weight of at least 30,000 Daltons. In some cases, stents provided herein can include PLLA having a Tg of at least 40° C. In some cases, stents provided herein can include PLLA having a molecular weight of at least 30,000 Daltons and a Tg of at least 40° C. Additional examples of polymers that may be used to fabricate a stent provided herein include, but are not limited to, poly(N-acetylglucosamine) (Chitin), Chitosan, poly(hydroxyvalerate), poly(hydroxybutyrate), poly(hydroxybutyrate-co-valerate), polyanhydride, poly(glycolic acid), poly(glycolide), poly(L-lactide), poly(D,L-lactic acid), poly(D,L-lactide), polyester amide, poly(glycolic acid-co-trimethylene carbonate), co-poly (ether-esters) (e.g. PEO/PLA), polyphosphazenes, and biomolecules (such as fibrin, fibrinogen, cellulose, starch, collagen and hyaluronic acid). Another type of polymer based on poly(lactic acid) that can be used includes graft copolymers, and block copolymers, such as AB block-copolymers (“diblock-copolymers”) or ABA block-copolymers (“triblock-copolymers”), or mixtures thereof.
Bioerodible polymers used in stents provided herein can be completely amorphous, partially crystalline, or almost completely crystalline. A partially crystalline polymer includes crystalline regions separated by amorphous regions. The crystalline regions do not necessarily have the same or similar orientation of polymer chains. However, a high degree of orientation of crystallites may be induced by applying stress to a semi-crystalline polymer. The stress may also induce orientation in the amorphous regions. An oriented amorphous region also tends to have high strength and high modulus along an axis of alignment of polymer chains. Additionally, for some polymers under some conditions, induced alignment in an amorphous polymer may be accompanied by crystallization of the amorphous polymer into an ordered structure. This is known as stress induced crystallization.
Stents provided herein, such as stents 100 and 200, may be fabricated from a polymeric tube or a polymeric sheet that has been rolled and bonded to form a tube. For example, the stent pattern may be formed on the polymeric tube or sheet by laser cutting away portions of the tube or sheet, leaving only struts and other members that function as scaffolding to support the walls of an anatomical lumen. Representative examples of lasers that may be used include, but are not limited to excimer, carbon dioxide, and YAG. In some cases, chemical etching may be used to form a pattern on a tube.
In some embodiments, a stent substrate in the form of a polymeric tube may be deformed by blow molding. In blow molding, the tube can be radially deformed or expanded by increasing a pressure in the tube by conveying a fluid into the tube. The fluid may be a gas, such as air, nitrogen, oxygen, or argon. The polymer tube may be deformed or extended axially by applying a tensile force by a tension source at one end while holding the other end stationary. Alternatively, a tensile force may be applied at both ends of the tube. The tube may be axially extended before, during, and/or after radial expansion.
Polymer chains in a stent substrate may initially have a preferential orientation in the axial direction as a result of extrusion, injection molding, tensile loading, machining, or other process used to form the stent substrate. In some cases, radial expansion of a stent substrate having polymer chains with an initial axial orientation will reorient or induce the polymer chains to have a circumferential orientation. In a biaxial orientation, the polymer chains are oriented in a direction that is neither preferentially circumferential nor preferentially axial. In this way, polymer chains can be oriented in a direction substantially parallel to the lengthwise axis of individual stent struts so as to increase the overall radial strength of the stent.
Optionally, after making the stent pattern, the stent may be crimped onto a balloon catheter or other stent delivery device. Prior to or during crimping, the stent may be heated to a crimping temperature Tc. In some embodiments, Tc is greater than ambient room temperature Ta to minimize or prevent outward recoil of the stent to a larger diameter after crimping. Outward recoil undesirably increases the delivery profile of the stent and may cause the stent to prematurely detach from the catheter during delivery to a target treatment site within a vessel. Also, Tc can be below Tg to reduce or eliminate stress relaxation during crimping. Stress relaxation during or after crimping leads to a greater probability of cracking during subsequent deployment of the stent. To reduce or prevent such cracking, the difference between Tc and Tg can be maximized by increasing Tg through stress induced crystallization.
After manufacturing, the stent can be deployed inside a blood vessel from a crimped diameter to a deployed outer diameter. In some cases, the deployed outer diameter is less than the expanded diameter. If the stent was crimped onto a balloon catheter, the deployment of the stent can include inflating the balloon catheter to urge the stent to move from its crimped configuration to an expanded, deployed configuration. In some cases, the stent may be self-expanding and deployment of the stent can include removing a sheath or other constraining device from around the stent to allow the stent to self-expand.
A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, other embodiments are within the scope of the following claims.
This application claims priority under 35 U.S.C. §119 to U.S. Provisional Application Ser. No. 62/045,974, filed Sep. 4, 2014, the entirety of which is incorporated herein by reference.
Number | Date | Country | |
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62045974 | Sep 2014 | US |