Drug-coated Balloon-only Angioplasty for Native Coronary Disease Instead of Stents

Coronary angioplasty has vastly improved both in technique and devices since the first angioplasty in 1977. Currently, stent implantation is used almost ubiquitously, despite being developed originally to treat vessel threatening dissections. Newer concepts including absorbable polymers or fully bioabsorbable scaffolds are constantly being developed. However, we find the concept of no permanent implant whilst still delivering a chemotherapeutic drug to reduce restenosis very attractive given the long term implications of a metallic stent, which include restenosis, late thrombosis and neo-atheroma formation. The use of a drug-coated balloon-only approach to de novo angioplasty will avoid the late thrombotic problems whilst also reducing early restenosis, simplifying the procedure and reducing the dual antiplatelet duration to 1 month. We review the current literature and highlight our practice with regard to use of drug-coated balloons in treatment of de novo coronary artery disease.

Development of hydroxyapatite-mediated synthesis of collagen-based copolymers for application as bio scaffolds in bone regeneration

ABSTRACTHydroxyapatite (HAP) is a biocompatible bio-ceramic whose structure and composition is similar to bone. However, its lack of strength and toughness have seriously hampered its applications as a bone graft substitute material. Attempts have been made to overcome these mechanical properties deficiencies by combining HAP bioceramic material with absorbable polymers in order to improve its mechanical properties. However, poor interfacial bonding between the HAP and the polymers has limited the benefits of such biocomposite structures. At the other end of the biomaterials spectrum is collagen, which constitutes the most abundant proteins in the body and exhibits properties such as biodegradability, bioadsorbability with low antigenicity, high affinity to water, and the ability to interact with cells through integrin recognition. These favorable properties renders collagen as a natural candidate for the modification and compatibilization of the polymer-HAP biocomposite. In this study, we developed a novel approach to the synthesis of a potential bone graft material, where the HAP moiety acts not only as a bioceramic filler, but also constitutes the initiator surface that promotes the in-situ polymerization of the adsorbable polymer of choice. The synthesis of poly(D,L-lactide-co-glycolide) (PLGA) polymer was catalyzed by nano-hydroxyapatite (nHAP) particles and upon reaction completion, the biocomposite material was tethered with collagen. The synthesis was monitored by 1H NMR and FTIR spectroscopies and the products after each step were characterized by thermal analysis to probe both thermal stability, morphological integrity and mechanical properties.

Nanostructured Ceramic and Ceramic-Polymer Composites as Dual Functional Interface for Bioresorbable Metallic Implants

ABSTRACTMillions of medical implants and devices (e.g., screws, plates, and pins) are used each year worldwide in surgery, and traditionally the components have been limited to permanent metals (e.g., stainless steel, titanium alloys) and polyester-based absorbable polymers. Because of clinical problems associated with these traditional materials, a novel class of biodegradable metallic materials, i.e., magnesium-based alloys, attracted great attention and clinical interests. Magnesium (Mg) is particularly attractive for load-bearing orthopedic applications because it has comparable modulus and strength to cortical bone. Controlling the interface of Mg with the biological environment, however, is the key challenge that currently limits this biodegradable metal for broad applications in medical devices and implants. This paper will particularly focus on creating nanostructured interface between the biodegradable metallic implant and surrounding tissue for the dual purposes of (1) mediating the degradation of the metallic implants and (2) simultaneously enhancing bone tissue regeneration and integration. Nanophase hydroxyapatite (nHA) is an excellent candidate as a coating material due to its osteoconductivity that has been widely reported. Applying nHA coatings or nHA containing composite coatings on Mg alloys is therefore promising in serving the needed dual functions. The composite of nHA and poly(lactic-co-glycolic acid) (PLGA) as a dual functional interface provides additional benefits for medical implant applications. Specifically, the polymer phase promotes interfacial adhesion between the nHA and Mg, and the degradation products of PLGA and Mg neutralize each other. Our results indicate that nHA and nHA/PLGA coatings slow down Mg degradation rate and enhance adhesion of bone marrow stromal cells, thus promising as the next-generation multifunctional implant materials. Further optimization of the coatings and their interfacial properties are still needed to bring them into clinical applications.