DE69801459T2 - Beschichteter endovaskulärer Stent - Google Patents
Beschichteter endovaskulärer StentInfo
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- DE69801459T2 DE69801459T2 DE69801459T DE69801459T DE69801459T2 DE 69801459 T2 DE69801459 T2 DE 69801459T2 DE 69801459 T DE69801459 T DE 69801459T DE 69801459 T DE69801459 T DE 69801459T DE 69801459 T2 DE69801459 T2 DE 69801459T2
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- heparin
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/08—Materials for coatings
- A61L31/10—Macromolecular materials
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L33/00—Antithrombogenic treatment of surgical articles, e.g. sutures, catheters, prostheses, or of articles for the manipulation or conditioning of blood; Materials for such treatment
- A61L33/0005—Use of materials characterised by their function or physical properties
- A61L33/0011—Anticoagulant, e.g. heparin, platelet aggregation inhibitor, fibrinolytic agent, other than enzymes, attached to the substrate
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0077—Special surfaces of prostheses, e.g. for improving ingrowth
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/92—Stents in the form of a rolled-up sheet expanding after insertion into the vessel, e.g. with a spiral shape in cross-section
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
- A61F2002/072—Encapsulated stents, e.g. wire or whole stent embedded in lining
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
- A61F2002/075—Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0067—Means for introducing or releasing pharmaceutical products into the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2420/00—Materials or methods for coatings medical devices
- A61L2420/08—Coatings comprising two or more layers
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S623/00—Prosthesis, i.e. artificial body members, parts thereof, or aids and accessories therefor
- Y10S623/92—Method or apparatus for preparing or treating prosthetic
- Y10S623/921—Blood vessel
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Transplantation (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
- Surgery (AREA)
- Epidemiology (AREA)
- Pulmonology (AREA)
- Gastroenterology & Hepatology (AREA)
- Chemical & Material Sciences (AREA)
- Materials Engineering (AREA)
- Hematology (AREA)
- Materials For Medical Uses (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Description
- Die vorliegende Erfindung betrifft endovaskuläre Stents und bezieht sich insbesondere auf Beschichtungen, die auf Stents aufgetragen sind, um die Thrombogenizität nach der Implantation zu reduzieren.
- Stents werden in Blutgefäße implantiert, mit dem Ziel, die Blutgefäße durchgängig zu halten, durch Verhindern eines Kollapses des Lumens und/oder durch Erschweren einer Restenose, einer erneuten Blockage des Gefäßes, wie sie etwa einer angioplastischen Behandlung folgen könnte, die durchgeführt wird, um eine vorherige Blockage aufzubrechen oder zu dilatieren. Unglücklicherweise könnte die Gegenwart eines Fremdkörpers in dem Blutflussweg einen thrombogenen Effekt haben. Daher erwies es sich als wünschenswert, verschiedene antikoagulante Medikamente mit dem Ziel zu verwenden, einen antithrombogenen Effekt vorzusehen und die Wahrscheinlichkeit der Entwicklung von Restenose zu reduzieren.
- Ein Medikament, das sich für solche Zwecke als besonders wirkungsvoll erwies, ist Heparin. Indem man die wirkungsvolle Konzentration des Medikaments in und um den Implantationsort beibehält, bis der Stent durch neues Körpergewebe umschlossen ist, kann das Thromboserisiko wesentlich gelindert werden. Hierzu wurden verschiedene Ansätze bei der Verabreichung von Heparin in Verbindung mit der Entfaltung der Stents angewendet.
- Während die systemische Verabreichung von Heparin bewirken kann, dass der Implantationsort einem effektiven Heparinpegel ausgesetzt wird, wäre ein solcher Heparinpegel notwendigerweise auch in gleicher Konzentration im gesamten Rest des Körpers des Patienten vorhanden, was zuunerwünschten Nebeneffekten führen kann, wie etwa schwer zu steuernden Blutungen. Es ist daher erkannt worden, dass ein Regime, in dem das Heparin weitgehend auf den Implantationsort beschränkt ist, viel wünschenswerter ist. Ein Ansatz, der zum derartigen Einschränken des Medikaments entwickelt wurde, beinhaltet das Beschichten oder Imprägnieren des Stents mit Heparin. Das Heparin wird hierdurch dort konzentriert, wo es am meisten benötigt wird, wobei aber die Konzentration des Medikaments und entsprechend die Einwirkung des Medikaments auf das System des Patienten lokalisiert ist.
- Beispielsweise offenbart die US-A-5,356,433 eine medizinische Vorrichtung oder Komponenten medizinischer Vorrichtungen, die metallische Oberflächen aufweisen, die verbesserte Biokompatibilitätseigenschaften haben. Die Oberflächen werden durch eine zweistufige Behandlung hergestellt, einschließlich dem kovalenten Koppeln eines Organosilans, das Amin-reaktive Stellen aufweist, mit der Oberfläche des metallischen Elements, typischerweise durch ein Metalloxid davon. Danach wird das biologisch aktive Mittel, wie etwa Heparin, kovalent mit der Organosilanbeschichtung gekoppelt. Der zweistufige Prozess soll besonders vorteilhaft zur Herstellung medizinischer Vorrichtungen in der Form von Stents sein, die während der Implantationsprozeduren gebogen und gebeugt werden müssen.
- Nachteile, die bei bisher bekannten heparinisierten Stents auftreten, beinhalten die begrenzte Lagerbeständigkeit solcher Vorrichtungen, die Tatsache, dass sich das Heparin zersetzt, wenn der Stent einer Vor- Entfaltungs-Sterilisation unterzogen wird (entweder durch Hitze oder durch eine chemische Lösung, wie etwa Ethylendioxid), die Unfähigkeit, die Dosierung zu ändern, der der Patient ausgesetzt wird, und die Unfähigkeit, etwaiges Heparin nachzufüllen, das verlorengegangen sein könnte, während sich der Stent in dem Entfaltungsprozess befindet. Zusätzlich waren die Kosten bisher bekannter heparinisierter Stentvorrichtungen sehr hoch, da solche Fälle notwendigerweise die Aufwendungen beinhalten, die aufgrund stringenter Regulationsanforderungen auftreten, die häufig mit dem Vorsehen einer medikamentenhaltigen Vorrichtung einhergehen.
- Die bisherige Technik war daher nicht in der Lage; diese Nachteile und Mängel zu überwinden, und es ist ein neuer Ansatz erforderlich, um Heparin sicher, effektiv und ökonomisch zu einem Implantationsort auszugeben.
- Die vorliegende Erfindung gibt eine Beschichtung einer implantierbaren endovaskulären Vorrichtung an, um das anschließende Auftragen von Heparin auf deren Oberfläche zu erleichtern. Das Auftragen des Heparins wird in vitro kurz vor dem Implantieren erreicht. Als Ergebnis dieses Timings des Beschichtungsprozesses hat die beschichtete Vorrichtung eine Lagerbeständigkeit, die beträchtlich länger ist als die Lagerbeständigkeit von vorbeschichteten heparinhaltigen Vorrichtungen, ist der Bedarf nach speziellen Handhabungs- und Sterilisationsprozeduren, die vorbeschichteten heparinhaltigen Vorrichtungen zugeordnet sind, überflüssig, und kann die Dosierung des Heparins leicht auf die Anforderungen eines Individuums zugeschnitten werden.
- Ein zusätzlicher Vorteil, der durch die erfindungsgemäße Vorrichtung erreicht wird, ist, dass die Vorrichtung keinen Anforderungen unterliegt, die medikamentenhaltigen Vorrichtungen häufig von Regierungsstellen auferlegt werden.
- Insbesondere sieht die vorliegende Erfindung einen verpackten, heparinlosen Stent vor, umfassend: eine Trägerstruktur, die in dem Gefäßsystem eines Patienten implantierbar ist; und eine Beschichtung, die auf die Trägerstruktur aufgetragen ist, wobei die Beschichtung aus einem oder mehreren Materialien gebildet ist, die an der Stentstruktur anhaften und die funktionelle Gruppen vorsehen, die in der Lage sind, Heparin anzuziehen, und mit denen Heparin Bindungen bildet, wenn dieses Material einer heparinhaltigen Lösung ausgesetzt wird.
- Bevorzugt bilden die Beschichtungsmaterialien Ionenbindungen mit den Stentoberflächen. Die in der Beschichtung enthaltenen funktionellen Gruppen können primäre, sekundäre und/oder tertiäre Amine oder andere Funktionalitäten aufweisen, wie etwa Carboxylgruppen.
- Die heparinanziehende Beschichtung kann aufgetragen werden, um den gesamten Stent zu umschließen, oder alternativ, nur gewählte Oberflächen davon zu bedecken. Durch Beschränken der Abdeckung auf nur die Innenfläche des Stents, d. h. die Oberfläche, die nach der Stententfaltung direkt dem Blutfluss ausgesetzt wird, kann ein viel höherer Heparinpegel auf den Stent aufgetragen werden, als er als sicher betrachtet werden könnte, wenn der gleiche Pegel indirektem Kontakt mit der Gefäßwand stünde. Somit wird ein toxischer Effekt auf die Gefäßwand vermieden, wobei jedoch das Blut in der Nähe der Vorrichtung nichtsdestoweniger einer effektiven Heparinkonzentration ausgesetzt wird. Alternativ könnte man es als ausreichend ansehen, nur die Enden des Stents zu beschichten, d. h. an den Nach-Entfaltungsstellen, an denen die Störung des Blutflusses am größten ist und wo Thrombosen am wahrscheinlichsten auftreten.
- Die Beschichtung kann durch verschiedene Prozesse aufgetragen werden, wie etwa durch Tauchen, Sprühen oder Formgießen. Das bevorzugte Verfahren ist eine Plasmaabscheidung, wobei eine Basisschicht, die nach ihrer Fähigkeit, an der Stentoberfläche anzuhaften, gewählt ist, zuerst auf den Stent aufgetragen wird, wonach eine Deckschicht darauf aufgetragen wird, die nach ihrer Fähigkeit zur Bindung an der Basisschicht und als Beitrag zu den geeigneten funktionellen Gruppen zur Bindung an dem Heparin gewählt ist.
- Die vorliegende Erfindung gibt auch ein in vitro-Verfahren zur Herstellung eines endovaskulären Stents an, der zur Ausgabe von Heparin zu einer bestimmten Stelle innerhalb des Gefäßsystems eines Patienten geeignet ist, das die Schritte aufweist: Vorsehen einer implantierbaren Trägerstruktur; Auftragen einer Beschichtung darauf, die an der Trägerstruktur anhaftet und die funktionelle Gruppen enthält, die in der Lage sind, Heparin anzuziehen und mit denen Heparin Bindungen bildet, wenn die Beschichtung einer heparinhaltigen Lösung ausgesetzt wird; Sterilisieren und Verpacken der Trägerstruktur mit der darauf aufgetragenen Beschichtung; Entfernen der beschichteten. Trägerstruktur aus ihrer Verpackung; und Aussetzen der beschichteten Trägerstruktur einer heparinhaltigen Lösung.
- Andere Merkmale und Vorteile von Ausführungen der Erfindung werden aus der folgenden detaillierten Beschreibung ersichtlich, die in Verbindung mit den beigefügten Zeichnungen Beispiele der Prinzipien der Erfindung erläutert.
- Fig. 1 ist einen Perspektivansicht eines implantierbaren Stents.
- Es sind eine weite Vielzahl verschiedener Stentkonfigurationen erdacht worden, die auf verschiedene Problemstellungen abzielen, die durch den beabsichtigten Gebrauch und die gewünschte Funktion der Vorrichtungen impliziert sind. Es wurden verschiedene Materialien bei der Konstruktion von Stents benutzt, die Metalle und Polymere einschließen. Sowohl der Turbulenzgrad, der durch eine bestimmte Stentkonfiguration verursacht wird, wenn sie dem Blutfluss ausgesetzt wird, als auch das Material, aus dem der Stent aufgebaut ist, beeinflussen beide den Grad an Thrombogenizität, der nach der Entfaltung erwartet werden kann. Die vorliegende Ausführung sieht eine Beschichtung für Stents vor, an denen Heparin angebracht wird und hierdurch die Tendenz hat, eine Thrombosebildung zu reduzieren oder zu beseitigen. Ferner ist die Eigenschaft der Beschichtung so, dass in sie das Heparin unmittelbar vor der Implantationsprozedur eingebracht werden kann.
- Eine Stentbeschichtung nach der vorliegenden Erfindung haftet auf der Stentoberfläche und besitzt funktionelle Gruppen, die Heparin anziehen und an die Heparin bindet. Funktionelle Gruppen, von denen bekannt ist, dass sie die erforderliche Affintität für Heparin besitzen, beinhalten primäre, sekundäre und tertiäre Amine. Primäre Amine sind aufgrund der außerordentlichen Affinität derselben für Heparin bevorzugt. Alternativ könnten Carboxylgruppen verwendet werden. Die funktionellen Gruppen müssen positiv geladene Ionen enthalten, die dazu dienen, die negativ geladenen Ionen anzuziehen, die dem Heparin zugeordnet sind. Diese Anziehung erleichtert die Bildung einer Ionenbindung.
- Die Beschichtung kann durch verschiedene Prozesse aufgetragen werden, wie etwa durch Tauchen, Sprühen, Formgießen oder durch Plasmaabscheidung. Plasmaabscheidung ist bevorzugt. In einem ersten Schritt der Plasmaabscheidung wird eine Basisschicht oder eine Grundierung auf der Stentoberfläche abgelegt, die die Oberfläche zur Aufnahme der Substanz vorbereitet, die die heparinanziehenden funktionellen Gruppen enthält. In der bevorzugten Ausführung wird ein metallischer Stent zuerst mit Methangasplasma behandelt, das einen Film auf der Oberfläche des Stents hinterlässt. Die Methanmoleküle in dem Film sind mit den Kohlenstoffatomen gegen den Stent hin orientiert, und die Wasserstoffatome liegen frei. Dann wird eine Deckschicht, die die gewünschten funktionellen Gruppen enthält, auf die Basisschicht aufgetragen. Die zweite Schicht kann durch die Plasmaabscheidung von Ammoniakgas gebildet werden, sodass die funktionellen primären Amingruppen verbleiben, die von der Stentoberfläche abstehen. Es können auch andere Chemikalien, wie etwa Alkylamin, Nitrilverbindungen oder aminhaltige Monomere verwendet werden, um aminfunktionelle Gruppen auf die Oberfläche plasmaabzuscheiden. Wenn ein Gemisch von primären, sekundären und tertiären Aminen durch solche Verfahren abgeschieden wird, ist es bevorzugt, dass die primären Amine einen größeren Prozentsatz des Gemisches bilden als die sekundären und tertiären Amine, und zwar aufgrund der größeren Affinität der primären Amine für Heparin. Alternativ kann die Abscheidung carboxylfunktioneller Gruppen durch die Plasmaabscheidung von Monomeren erreicht werden, wie etwa Methylmethacrylat oder Acrylsäure.
- Die Dicke der sich ergebenden Stentbeschichtung sollte 0,0254 mm (0,001 Zoll) oder weniger betragen, während eine Dicke von weniger als 1 Mikron bevorzugt ist. Obwohl eine gleichmäßige Konzentration funktioneller Gruppen erwünscht sein kann, die von der beschichteten Oberfläche absteht, ist dies für die gewünschte Funktion der Beschichtung nicht kritisch. Andererseits muss eine Konzentration von mindestens 54 Picamol/Stent erreicht werden, um sicherzustellen, dass das Heparin an der Beschichtung mit einem ausreichenden Pegel anhaftet.
- Die Beschichtung kann auf den gesamten Stent aufgetragen werden oder nur auf gewählte Oberflächen davon. Fig. 1 zeigt allgemein einen Stent 12 in einem entfalteten Zustand und dient zum Identifizieren der Oberfläche 14, die zur Wand des Gefäßes weist, in das der Stent implantiert wird, der Oberfläche 16, die zu dem Blutfluss durch den Stent freiliegt, des "stromaufwärtigen" Rands des Stents 18 sowie des "stromabwärtigen" Rands 20, die nacheinander zum Blut freiliegen, wenn es durch das betreffende Gefäß strömt. Indem man nur diejenigen Flächen beschichtet, die zu dem Blutfluss weisen, kann eine Heparinkonzentration darauf aufgetragen werden, die anderenfalls für das Gefäßwandgewebe toxisch wäre; wenn sie sich auf denjenigen Oberflächen befände, die nach der Entfaltung in direktem Kontakt mit der Gefäßwand stehen. Alternativ könnte es für eine in einem bestimmten Patienten implantierte bestimmte Stentkonfiguration ausreichen, ausschließlich die stromaufwärtigen und/oder stromabwärtigen Ränder des Stents zu beschichten, da aufgrund der Turbulenz, die durch das Vorhandensein des Stents in dem Blutflussweg induziert wird, die Thrombose am wahrscheinlichsten an diesen Grenzen entsteht.
- Nachdem der Beschichtungsprozess abgeschlossen ist, kann der beschichtete Stent gereinigt und sterilisiert und zur langfristigen Aufbewahrung geeignet verpackt werden. Wegen des Fehlens jeglicher abbaubarer Medikamente oder Substanzen an dem Stent kann eine ziemlich verlängerte nutzbare Lagerbeständigkeit erwartet werden.
- Bei Gebrauch behandelt der Arzt den Stent vor dem Implantieren durch Spülen mit beispielsweise einer heparinisierten Salzlösung vor. Auf diese Weise kann der Arzt leicht und präzise den Heparinpegel einstellen, indem er die Konzentration des Heparins in der Salzlösung steuert und/oder die Zeit steuert, über die der Stent und dessen Beschichtung dem Heparin ausgesetzt werden.
- Während eine bestimmte Ausführung der Erfindung dargestellt und beschrieben wurde, versteht es sich für den Fachmann, dass zahlreiche Modifikationen vorgenommen werden können, ohne vom Umfang der Erfindung abzuweichen, wie er in den beigefügten Ansprüchen definiert ist.
Claims (24)
1. Verpackter, heparinloser Stent, umfassend:
eine Trägerstruktur, die in dem Gefäßsystem eines Patienten
implantierbar ist; und
eine Beschichtung, die auf die Trägerstruktur aufgetragen ist, wobei die
Beschichtung aus einem oder mehreren Materialien gebildet ist, die an
der Stentstruktur anhaften und die funktionelle Gruppen vorsehen, die
in der Lage sind, Heparin anzuziehen, und mit denen Heparin
Bindungen bildet, wenn dieses Material einer heparinhaltigen Lösung
ausgesetzt wird.
2. Endovaskulärer Stent nach Anspruch 1, worin die heparinhaltige
Lösung heparinisiertes Blut aufweist.
3. Endovaskulärer Stent nach Anspruch 1, worin die heparinhaltige
Lösung heparinisierte Salzlösung aufweist.
4. Endovaskulärer Stent nach Anspruch 1, worin die Beschichtung auf die
gesamte Trägerstruktur aufgetragen ist.
5. Endovaskulärer Stent nach Anspruch 1, wobei die Trägerstruktur derart
konfiguriert ist, dass beim Implantieren in ein Blutgefäß diese
Trägerstruktur Oberflächen aufweist, die zu den Gefäßwänden weisen,
Oberflächen, die zu dem Blutfluss weisen, und einen stromaufwärtigen
Rand und einen stromabwärtigen Rand aufweist, wobei die
Beschichtung ausschließlich auf die zu dem Blutfluss weisende
Oberfläche aufgetragen ist.
6. Endovaskulärer Stent nach Anspruch 1, wobei die Trägerstruktur derart
konfiguriert ist, dass beim Implantieren in ein Blutgefäß diese
Trägerstruktur Oberflächen aufweist, die zu den Gefäßwänden weisen,
Oberflächen, die zu dem Blutfluss weisen, und einen stromaufwärtigen
Rand und einen stromabwärtigen Rand aufweist, wobei die
Beschichtung ausschließlich auf den stromaufwärtigen und den
stromabwärtigen Rand aufgetragen ist.
7. Endovaskulärer Stent nach Anspruch 1, worin die Bindungen, die in der
Lage sind, die heparinanziehenden funktionellen Gruppen mit Heparin
zu bilden, Ionenbindungen sind:
8. Endovaskulärer Stent nach Anspruch 7, worin die funktionellen
Gruppen ein primäres Amin aufweisen.
9. Endovaskulärer Stent nach Anspruch 7, worin die funktionellen
Gruppen ein sekundäres Amin aufweisen.
10. Endovaskulärer Stent nach Anspruch 7, worin die funktionellen
Gruppen ein tertiäres Amin aufweisen.
11. Endovaskulärer Stent nach Anspruch 7, worin die funktionellen
Gruppen Carboxylgruppen aufweisen.
12. Endovaskulärer Stent nach Anspruch 1, worin die Beschichtung eine
Basisschicht aufweist, wobei die Basisschicht nach ihrer Fähigkeit zur
Anhaftung an der Trägerstruktur ausgewählt ist, sowie eine
Deckschicht, wobei die Deckschicht nach ihrer Fähigkeit zur Bindung
an der Basisschicht ausgewählt ist und die funktionellen Gruppen
enthält, die in der Lage sind, Heparin anzuziehen, und mit denen
Heparin Bindungen bildet, wenn dieses Material einer heparinhaltigen
Lösung ausgesetzt wird.
13. Endovaskulärer Stent nach Anspruch 12, worin die Bindungen, die in
der Lage sind, die heparinanziehenden funktionellen Gruppen mit dem
Heparin zu bilden, Ionenbindungen sind.
14. Endovaskulärer Stent nach Anspruch 12, worin die Basisschicht an der
Trägerstruktur hydrophob angebracht ist.
15. Endovaskulärer Stent nach Anspruch 12, worin die Deckschicht mit der
Basisschicht kovalent gebunden ist.
16. In vitro-Verfahren zur Herstellung eines endovaskulären Stents, der zur
Ausgabe von Heparin zu einer bestimmten Stelle innerhalb des
Gefäßsystems eines Patienten geeignet ist, das die Schritte aufweist:
Vorsehen einer implantierbaren Trägerstruktur;
Auftragen einer Beschichtung darauf, die an der Trägerstruktur anhaftet
und die funktionelle Gruppen enthält, die in der Lage sind, Heparin
anzuziehen, und mit denen Heparin Bindungen bildet, wenn die
Beschichtung einer heparinhaltigen Lösung ausgesetzt wird;
Sterilisieren und Verpacken der Trägerstruktur mit der darauf
aufgetragenen Beschichtung;
Entfernen der beschichteten Trägerstruktur aus ihrer Verpackung; und
Aussetzen der beschichteten Trägerstruktur einer heparinhaltigen
Lösung.
17. Verfahren nach Anspruch 16, worin die Beschichtung auf die gesamte
Trägerstruktur aufgetragen ist.
18. Verfahren nach Anspruch 16, worin die Trägerstruktur derart
konfiguriert ist, dass beim Implantieren in ein Blutgefäß die
Trägerstruktur Oberflächen aufweist, die zu den Gefäßwänden weisen,
Oberflächen, die zu dem Blutfluss weisen, sowie einen
stromaufwärtigen Rand und einen stromabwärtigen Rand, wobei die
Beschichtung ausschließlich auf die Oberflächen aufgetragen ist, die zu
dem Blutfluss weisen.
19. Verfahren nach Anspruch 16, worin die Trägerstruktur derart
konfiguriert ist, dass beim Implantieren in ein Blutgefäß diese
Trägerstruktur Oberflächen aufweist, die zu den Gefäßwänden weisen,
Oberflächen, die zu dem Blutfluss weisen, sowie einen
tromaufwärtigen Rand und einen stromabwärtigen Rand, wobei die
Beschichtung ausschließlich auf den stromaufwärtigen und den
stromabwärtigen Rand aufgetragen ist.
20. Verfahren nach Anspruch 16, worin die Beschichtung durch Tauchen
auf die Trägerstruktur aufgetragen ist.
21. Verfahren nach Anspruch 16, worin die Beschichtung durch Sprühen
auf die Struktur aufgetragen ist.
22. Verfahren nach Anspruch 16, worin die Beschichtung durch
Formgießen auf die Trägerstruktur aufgetragen ist.
23. Verfahren nach Anspruch 16, worin die Beschichtung durch
Plasmaabscheidung auf die Trägerstruktur aufgetragen ist.
24. Verfahren nach. Anspruch 16, worin die Beschichtung aufgetragen ist
durch zuerst Auftragen einer Basisschicht, die nach ihrer Fähigkeit, auf
der Trägerstruktur zu haften, gewählt ist, und dann Auftragen einer
Deckschicht darauf, die nach ihrer Fähigkeit gewählt ist, an der
Basisschicht zu binden, und die die funkionellen Gruppen enthält, die in
der Lage sind, Heparin anzuziehen, und mit denen Heparin Bindungen
bildet, wenn die Beschichtung einer heparinhaltigen Lösung ausgesetzt
wird.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/847,763 US6776792B1 (en) | 1997-04-24 | 1997-04-24 | Coated endovascular stent |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| DE69801459D1 DE69801459D1 (de) | 2001-10-04 |
| DE69801459T2 true DE69801459T2 (de) | 2002-04-11 |
Family
ID=25301436
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| DE69801459T Revoked DE69801459T2 (de) | 1997-04-24 | 1998-04-24 | Beschichteter endovaskulärer Stent |
Country Status (4)
| Country | Link |
|---|---|
| US (4) | US6776792B1 (de) |
| EP (1) | EP0873732B1 (de) |
| JP (1) | JP3000076B2 (de) |
| DE (1) | DE69801459T2 (de) |
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-
1997
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-
1998
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- 1998-04-24 EP EP98303167A patent/EP0873732B1/de not_active Revoked
- 1998-04-24 JP JP10114431A patent/JP3000076B2/ja not_active Expired - Lifetime
-
1999
- 1999-10-29 US US09/430,230 patent/US6605114B1/en not_active Expired - Lifetime
-
2004
- 2004-06-24 US US10/877,527 patent/US7077860B2/en not_active Expired - Fee Related
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2006
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE102004018255A1 (de) * | 2004-04-15 | 2005-11-10 | Universitätsklinikum Schleswig-Holstein | Gefäßprothese |
Also Published As
| Publication number | Publication date |
|---|---|
| US20040236417A1 (en) | 2004-11-25 |
| EP0873732A1 (de) | 1998-10-28 |
| US6605114B1 (en) | 2003-08-12 |
| EP0873732B1 (de) | 2001-08-29 |
| JPH10309320A (ja) | 1998-11-24 |
| US7077860B2 (en) | 2006-07-18 |
| JP3000076B2 (ja) | 2000-01-17 |
| US6776792B1 (en) | 2004-08-17 |
| US20060178738A1 (en) | 2006-08-10 |
| DE69801459D1 (de) | 2001-10-04 |
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| 8380 | Miscellaneous part iii |
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