This invention relates to endoprostheses.
The body includes various passageways such as arteries, other blood vessels and other body lumens. These passageways sometimes become occluded or weakened. For example, the passageways can be occluded by a tumor, restricted by plaque, or weakened by an aneurysm. When this occurs, the passageway can be reopened or reinforced with a medical endoprosthesis. An endoprosthesis is typically a tubular member that is placed in a lumen in the body. Examples of endoprostheses include stents, covered stents, and stent-grafts.
Endoprostheses can be delivered inside the body by a catheter that supports the endoprosthesis in a compacted or reduced-size form as the endoprosthesis is transported to a desired site. Upon reaching the site, the endoprosthesis is expanded, e.g., so that it can contact the walls of the lumen. Stent delivery is further discussed in Heath, U.S. Pat. No. 6,290,721.
The expansion mechanism may include forcing the endoprosthesis to expand radially. For example, the expansion mechanism can include the catheter carrying a balloon, which carries a balloon-expandable endoprosthesis. The balloon can be inflated to deform and to fix the expanded endoprosthesis at a predetermined position in contact with the lumen wall. The balloon can then be deflated, and the catheter withdrawn from the lumen.
In one aspect, the invention features a method of making an endoprosthesis from a perform having an abluminal surface and an adluminal surface. The method includes concurrently forming a first coating having an orange peel morphology on the adluminal surface and a second coating having a rice grain morphology on the abluminal surface.
In another aspect, the invention features a method of making an endoprosthesis from a perform having an adluminal surface. The method includes placing a mandrel adjacent to the adluminal surface an average distance of at least 20 nm from the adluminal surface while forming a coating on a surface of the perform.
Embodiments may include any one or more of the following features. A mandrel can be placed before forming the first coating and the second coating. The mandrel can be placed an average distance of at least 20 nm or about 5 mm or less (e.g., at most about 2 mm or about 3 mm) from the adluminal surface. When forming the first and second coatings, the mandrel can be rolled against the adluminal surface. The mandrel can include a pattern of grooves or knurls. The perform can include a material that has a first thermal mass and the mandrel can include a material that has a thermal mass different from the first thermal mass. A temperature gradient can be provided between the perform and the mandrel. The mandrel can include conducting materials, insulating materials, magnetic materials, and non-magnetic materials.
Embodiments may also include any one or more of the following features. A magnetic field or an electrical field can be applied when concurrently forming the first coating and the second coating. The first coating and the second coating can be formed using physical vapor deposition, glancing angle deposition, or sputtering. The first and second coatings can include a metal, for example, tantalum, chromium, titanium, or iridium, or a ceramic, for example, titanium nitride, titanium oxide, titanium oxi-nitride, or iridium oxide. The first coating can have a thickness of about 10 nm to about 50 nm. The second coating can have a thickness of about 200 nm to about 300 nm.
Embodiments may include one or more of the following advantages. Stents can be formed with ceramic coatings that have morphologies and/or compositions that enhance therapeutic performance. In particular, the ceramics are tuned to enhance mechanical performance and physiologic effect. Enhanced mechanical performance provides particular advantages during the challenging operations encountered in stent use, which typically includes collapsing the stent to a small diameter for insertion into the body, delivery though a tortuous lumen, and then expansion at a treatment site. Enhancing mechanical properties of the ceramic reduces the likelihood of cracking or flaking of the ceramic, and enhances adhesion of the ceramic to the stent body and to overcoatings, such as drug eluting materials. Improved physiologic effects include discouraging restenosis and encouraging endothelialization. The ceramics are tuned by controlling ceramic morphology and composition. For example, the ceramic can have a morphology that enhances endothelial growth, a morphology that enhances the adhesion of overcoatings such as polymers, e.g., drug eluting coatings, a morphology that reduces delamination, cracking or peeling, and/or a morphology that enhances catalytic activity to reduce inflammation, proliferation and restenosis. The ceramic coatings can be tuned along a continuum of their physical characteristics, chemistries, and roughness parameters to optimize function for a particular application. Different coating morphologies can be applied in different locations to enhance different functions at different locations. For example, a high roughness, low coverage, defined-grain morphology can be provided on abluminal surfaces to enhance adhesion of a drug-eluting polymer coating and a low roughness, high coverage, globular morphology can be provided on the luminal surface to enhance endothelialization. The composition is tuned to control hydrophobicity to enhance adhesion to a stent body or a polymer and/or control catalytic effects. The morphologies and composition can be formed by physical vapor deposition using methodologies that allow fine tuning of the morphology characteristics and permit highly uniform, predictable coatings across a desired region of the stent. Further, the two morphologies can be provided to different locations simultaneously or sequentially without taking the stent out of the deposition system, therefore, potential contamination due to vacuum breakdown and long operation time can be reduced or avoided.
Like reference symbols in the various drawings indicate like elements.
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Coatings 34 and 36 can include a metal or a ceramic. Examples of metals include tantalum, iridium, platinum, chromium, and niobium. Examples of ceramic include titanium nitride, titanium oxide, iridium oxide (IROX), chromium oxide, aluminum oxide, zirconium oxide and titanium oxi-nitride. Coating 34 has a thickness, for example, of about 200 nm to about 300 nm and has a rough morphology. Coating 36 has a thickness, for example, of about 10 nm to about 50 nm or about 20 nm to about 30 nm, and has a smooth morphology.
Referring to
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The coatings with select morphologies can be formed by sputtering. Referring to
The process parameters that affect the coating morphology can be modulated to select desired morphologies on the luminal and abluminal surfaces by providing a mandrel within the inner diameter of the stent. Referring to
Mandrel 50 can be selected to effect morphology by, for example, one or a combination of shadowing the deposition luminally, and/or modulating the plasma by varying the electric, magnetic or thermal properties. For example, the mandrel 50 can include a surface 56 that can reduce the energy of the sputtered material and lower the deposition rate so that coating 62 is smoother and denser. In some embodiments, the material property of mandrel can be used to adjust the properties of coating 60. For example, mandrel 50 may have a thermal mass different from stent body 42 to create a temperature gradient between abluminal surface 46 and adluminal surface 44, which can lead to different morphologies of coatings 60 and 62. For example, the temperature gradient can affect the mobility of the sputtered materials and produce sputtered coatings 60 and 62 with different densities and/or porosities. For another example, a mandrel 50 made of magnetic material, e.g., of iron, can affect the plasma and sputtering process when a magnetic field is applied to produce coatings 60 and 62 with desired properties.
Physical Shadowing
Sputtering is in general not a line of sight process due to the collision of the sputtered species with gas and ions in the chamber. But shadowing can affect the rate of coating deposition on any surface. In some embodiments, the luminal side of the stent has a thinner coating than that on the adluminal side due to shadowing by the struts. Inserting a mandrel in the luminal side of the stent allows further shadowing of the luminal side of the stent. The dimensions of mandrel 50 can be optimized to allow enough gap between the ID of the stent and the mandrel so as to achieve a difference in deposition rate that can create orange peel morphologies on the luminal surface 44 and rice grain morphologies on the abluminal surface 46. For example, the deposition rate of IROX on adluminal surface 44 is about 2 to about 10 times slower than the deposition rate of IROX on abluminal surface 46. Orange peel morphologies can be created at thicknesses around 20-30 nm while creation of rice grain morphologies occurs at a thickness of nearly 200-300 nm.
In some embodiments, the distance between surface 56 and surface 44 is at least, e.g., about 20 nm, 25 nm, 30 nm, 40 nm, or 50 nm and/or up to, e.g. about 10 mm, 5 mm, 3 mm, 2 mm, 1 mm, 800 μm, 500 μm, 100 μm, 1 μm, 800 nm, 500 nm, 200 nm, 180 nm, 150 nm, 130 nm, 110 nm, or 100 nm. The distance between two surfaces, as defined herein, is the average distance between surface 56 and the adluminal surface 44. Mandrels with different surface features and geometries can modulate the plasma on the adluminal side of the stent body 42 compared to that on the abluminal side. The deposition rate at the abluminal surface 46 versus at the adluminal surface 44 can also be modulated by utilizing mandrels with grooves, knurls, pyramid, columnar, dimpled, micro roughened or other textures or patterns.
In some embodiments, stent body 42 and/or mandrel 50 is movable. For example, mandrel 50 can roll against adluminal surface 44 during the deposition to allow occasional physical contacts between surface 56 and coated surface 44. The occasional physical contacts compress the deposited particles and help form a smooth and dense coating 62 on the adluminal surface 44 of the stent body 42. These contacts can also be realized by moving stent body 42 about mandrel 50. The mandrel and/or stent body can be moved, e.g., by a programmable positioner, such an xyz positioner
Electrical, Magnetic, and/or Thermal Mass Properties
Mandrels made of different materials can be used to mediate the properties of coatings formed on the stent body surfaces. Changing the electrical and magnetic properties of the mandrel can change the interaction of the plasma with adluminal surface 44 compared to that with the abluminal surface 46. For this purpose, mandrels made of conducting materials, insulating materials, magnetic materials or non-magnetic materials can be used. The materials can be selected to reduce outgasing of undesirable contaminates into the PVD chamber. The mandrel does not itself act as a sputtering target from which material is released. Examples of the magnetic material include iron, cobalt, chromium, and other ferro- or para-magnetic materials. Examples of the electrical material include silver, gold, aluminum, platinum, and other conductors.
Temperature can also affect the morphologies of the formed coatings on stent body 42. Mandrels made of a thermal mass different from the stent body 42 can create a temperature gradient between the adluminal side and the abluminal side of the stent body 42, which can lead to coatings with different morphologies on the abluminal surface 46 and the adluminal surface 44. Mandrel 50 can also include a material that has a thermal mass different from that of stent body 42 made, e.g., of stainless steel. Examples of such material include aluminum, tantalum, and ceramics.
Suitable target materials in the chamber include, for example, iridium, titanium, tantalum, chromium, silicon, aluminum, zirconium. A plasma, for example, argon plasma or krypton plasma, or oxygen plasma is introduced into the chamber. The plasma bombards the target and the target material is sputtered onto stent body 42. The above process can be extended to produce single layer coating of any metals, oxides or other ceramics, e.g., Tantalum, Titanium Nitride, Titanium Oxide, Titanium Oxi-nitride with different morphologies on the stent adluminal surface and abluminal surface. The processes discussed above can be applied with various sputtering conditions, for example, different partial pressure range, sputter power range, different gases and positive or negative substrate biases.
In some embodiments, a glancing angle deposition (GLAD) can be used to deposit coatings 60 and 62. Glancing angle deposition employs oblique angle physical vapor deposition and substrate motion to engineer thin film microstructure on a nanometer scale in three dimensions. The vapor flux arrives at stent body 42 at an oblique angle from the normal. A columnar microstructure is created by deposited material, e.g. IROX, and each column leaves a shadow area that the incident vapor flux does not reach. The amount, rate, and energy of the depositing material that reaches the adluminal side of stent body 42 is thus mediated, e.g., reduced. A detailed discussion on GLAD is provided in Zhou et al., Appl. Phys. Lett. 88, 203117 (2006).
In this illustrative example, a coating having a rice grain morphology and a coating having an orange peel morphology are formed concurrently on an abluminal surface and an adluminal surface of a stent. The stent is placed in a chamber having a pressure of about 2.47×10−4 Pa. A mandrel having a diameter of about 1.1 mm is placed adjacent to, but without contacting the adluminal surface of the stent. The mandrel has a cylindrical shape and is concentric to the stent. IROX is deposited onto both the abluminal surface and the adluminal surface of the stent concurrently. As a result, an IROX coating having a rice grain morphology is conformally formed on the abluminal surface of the stent, as shown in
In this illustrative example, a stent having IROX coatings concurrently formed on abluminal and adluminal surfaces as described in Example 1 undergoes an overexpansion. The stent is expanded 5-10 times its unexpanded diameter. Referring to
The terms “therapeutic agent”, “pharmaceutically active agent”, “pharmaceutically active material”, “pharmaceutically active ingredient”, “drug” and other related terms may be used interchangeably herein and include, but are not limited to, small organic molecules, peptides, oligopeptides, proteins, nucleic acids, oligonucleotides, genetic therapeutic agents, non-genetic therapeutic agents, vectors for delivery of genetic therapeutic agents, cells, and therapeutic agents identified as candidates for vascular treatment regimens, for example, as agents that reduce or inhibit restenosis. By small organic molecule is meant an organic molecule having 50 or fewer carbon atoms, and fewer than 100 non-hydrogen atoms in total.
Exemplary therapeutic agents include, e.g., anti-thrombogenic agents (e.g., heparin); anti-proliferative/anti-mitotic agents (e.g., paclitaxel, 5-fluorouracil, cisplatin, vinblastine, vincristine, inhibitors of smooth muscle cell proliferation (e.g., monoclonal antibodies), and thymidine kinase inhibitors); antioxidants; anti-inflammatory agents (e.g., dexamethasone, prednisolone, corticosterone); anesthetic agents (e.g., lidocaine, bupivacaine and ropivacaine); anti-coagulants; antibiotics (e.g., erythromycin, triclosan, cephalosporins, and aminoglycosides); agents that stimulate endothelial cell growth and/or attachment. Therapeutic agents can be nonionic, or they can be anionic and/or cationic in nature. Therapeutic agents can be used singularly, or in combination. Preferred therapeutic agents include inhibitors of restenosis (e.g., paclitaxel), anti-proliferative agents (e.g., cisplatin), and antibiotics (e.g., erythromycin). Additional examples of therapeutic agents are described in U.S. Published Patent Application No. 2005/0216074. In some embodiments, the drug can be incorporated within the porous regions in a polymer coating. Polymers for drug elution coatings are also disclosed in U.S. Published Patent Application No. 2005/019265A. A functional molecule, e.g., an organic, drug, polymer, protein, DNA, and similar material can be incorporated into groves, pits, void spaces, and other features of the stent.
Suitable polymers include, for example, polycarboxylic acids, cellulosic polymers, including cellulose acetate and cellulose nitrate, gelatin, polyvinylpyrrolidone, cross-linked polyvinylpyrrolidone, polyanhydrides including maleic anhydride polymers, polyamides, polyvinyl alcohols, copolymers of vinyl monomers such as EVA, polyvinyl ethers, polyvinyl aromatics such as polystyrene and copolymers thereof with other vinyl monomers such as isobutylene, isoprene and butadiene, for example, styrene-isobutylene-styrene (SIBS), styrene-isoprene-styrene (SIS) copolymers, styrene-butadiene-styrene (SBS) copolymers, polyethylene oxides, glycosaminoglycans, polysaccharides, polyesters including polyethylene terephthalate, polyacrylamides, polyethers, polyether sulfone, polycarbonate, polyalkylenes including polypropylene, polyethylene and high molecular weight polyethylene, halogenerated polyalkylenes including polytetrafluoroethylene, natural and synthetic rubbers including polyisoprene, polybutadiene, polyisobutylene and copolymers thereof with other vinyl monomers such as styrene, polyurethanes, polyorthoesters, proteins, polypeptides, silicones, siloxane polymers, polylactic acid, polyglycolic acid, polycaprolactone, polyhydroxybutyrate valerate and blends and copolymers thereof as well as other biodegradable, bioabsorbable and biostable polymers and copolymers. Coatings from polymer dispersions such as polyurethane dispersions (BAYHDROL®, etc.) and acrylic latex dispersions are also within the scope of the present invention. The polymer may be a protein polymer, fibrin, collagen and derivatives thereof, polysaccharides such as celluloses, starches, dextrans, alginates and derivatives of these polysaccharides, an extracellular matrix component, hyaluronic acid, or another biologic agent or a suitable mixture of any of these, for example. In one embodiment, the preferred polymer is polyacrylic acid, available as HYDROPLUS® (Boston Scientific Corporation, Natick, Mass.), and described in U.S. Pat. No. 5,091,205, the disclosure of which is hereby incorporated herein by reference. U.S. Pat. No. 5,091,205 describes medical devices coated with one or more polyiocyanates such that the devices become instantly lubricious when exposed to body fluids. In another preferred embodiment of the invention, the polymer is a copolymer of polylactic acid and polycaprolactone. Suitable polymers are discussed in U.S. Publication No. 2006/0038027.
In some embodiments, the polymer is capable of absorbing a substantial amount of drug solution. When applied as a coating on a medical device in accordance with the present invention, the dry polymer is typically on the order of from about 1 to about 50 microns thick. Very thin polymer coatings, e.g., of about 0.2-0.3 microns and much thicker coatings, e.g., more than 10 microns, are also possible. Multiple layers of polymer coating can be provided. Such multiple layers are of the same or different polymer materials.
Any stent described herein can be dyed or rendered radiopaque by addition of, e.g., radiopaque materials such as barium sulfate, platinum or gold, or by coating with a radiopaque material. The stent can include (e.g., be manufactured from) metallic materials, such as stainless steel (e.g., 316L, BioDur® 108 (UNS S29108), and 304L stainless steel, and an alloy including stainless steel and 5-60% by weight of one or more radiopaque elements (e.g., Pt, Ir, Au, W) (PERSS®) as described in US-2003-0018380-A1, US-2002-0144757-A1, and US-2003-0077200-A1), Nitinol (a nickel-titanium alloy), cobalt alloys such as Elgiloy, L605 alloys, MP35N, titanium, titanium alloys (e.g., Ti-6Al-4V, Ti-50Ta, Ti-10Ir), platinum, platinum alloys, niobium, niobium alloys (e.g., Nb-1Zr) Co-28Cr-6Mo, tantalum, and tantalum alloys. Other examples of materials are described in commonly assigned U.S. application Ser. No. 10/672,891, filed Sep. 26, 2003; and U.S. application Ser. No. 11/035,316, filed Jan. 3, 2005. Other materials include elastic biocompatible metal such as a superelastic or pseudo-elastic metal alloy, as described, for example, in Schetsky, L. McDonald, “Shape Memory Alloys”, Encyclopedia of Chemical Technology (3rd ed.), John Wiley & Sons, 1982, vol. 20. pp. 726-736; and commonly assigned U.S. application Ser. No. 10/346,487, filed Jan. 17, 2003.
The stents described herein can be configured for vascular, e.g., coronary and peripheral vasculature or non-vascular lumens. For example, they can be configured for use in the esophagus or the prostate. Other lumens include biliary lumens, hepatic lumens, pancreatic lumens, urethral lumens.
The stent can be of a desired shape and size (e.g., coronary stents, aortic stents, peripheral vascular stents, gastrointestinal stents, urology stents, tracheal/bronchial stents, and neurology stents). Depending on the application, the stent can have a diameter of between, e.g., about 1 mm to about 46 mm. In certain embodiments, a coronary stent can have an expanded diameter of from about 2 mm to about 6 mm. In some embodiments, a peripheral stent can have an expanded diameter of from about 4 mm to about 24 mm. In certain embodiments, a gastrointestinal and/or urology stent can have an expanded diameter of from about 6 mm to about 30 mm. In some embodiments, a neurology stent can have an expanded diameter of from about 1 mm to about 12 mm. An abdominal aortic aneurysm (AAA) stent and a thoracic aortic aneurysm (TAA) stent can have a diameter from about 20 mm to about 46 mm. The stent can be balloon-expandable, self-expandable, or a combination of both (e.g., see U.S. Pat. No. 6,290,721).
All publications, patent applications, patents, and other references mentioned herein are incorporated by reference herein in their entirety.
Still further embodiments are in the following claims.