1 / 99

BIODEGRADABLE METAL STENTS

BIODEGRADABLE METAL STENTS. Dinuka Bandara Niloy Ghosh Antoine Kaeslin Liz Zaharko. Click to Begin!. Abstract.

alpha
Download Presentation

BIODEGRADABLE METAL STENTS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. BIODEGRADABLE METAL STENTS Dinuka Bandara NiloyGhosh Antoine Kaeslin Liz Zaharko Click to Begin!

  2. Abstract This learning module serves to introduce first the overarching concept of heart disease and solutions to heart disease. More specifically it focuses on the problem of atherosclerosis and stents as a solution to this prevalent problem. The final sections of this module go into even more detail concerning the composition, manufacturing, implantation and the future of biodegradable stents. Go to Main Menu Bare Metal Stents Drug Eluting Stents Biodegradable Stent

  3. Main Menu References Abstract • Materials Selection • Disease State • Surgical Implantation Procedure • Meet the Surgeon • Implant Example Controversies

  4. Main Menu References Abstract • Materials Selection Cardiovascular Disease Disease State Treatments for Cardiovascular Disease Surgical Implantation Procedure • Meet the Surgeon • Implant Example Controversies

  5. Main Menu References Abstract • Materials Selection • Disease State • Surgical Implantation Procedure Coming Soon • Meet the Surgeon • Implant Example Controversies

  6. Cardiovascular Disease Cardiovascular System

  7. Cardiovascular Disease Atherosclerosis Other Heart Disease States Cardiovascular System

  8. Cardiovascular Disease Atherosclerosis Coronary Artery Disease Other Heart Disease States Stroke Congenital Heart Disease Cardiovascular System

  9. Atherosclerosis Video Demo Atherosclerosis Symptoms Cardiovascular Disease Plaque Related Diseases What is it? • Disease in which plaque builds up in arteries • Limits supply of oxygen-rich blood to organs • Can lead to heart attack, stroke, and death [7] Learn more about plaque buildup

  10. Atherosclerosis Video Demo Atherosclerosis Symptoms Cardiovascular Disease Plaque Related Diseases How does plaque build up? • Inner lining of arteries are covered by endothelium • Maintains smooth lining • Bad cholesterol (LDL) enters wall of artery due to damaged endothelium • White blood cells accumulate to clear out LDL • Over time, this entanglement of cholesterol, cells, and various other substances that are secreted by nearby cells develop into plaque [8] See Video Demo

  11. Plaque Video Demo Atherosclerosis Symptoms Cardiovascular Disease Plaque Related Diseases • Consists of: • Calcium • Fat • Cholesterol • Cellular waste • Fibrin • Over time, the plaque can harden due to an increasing density in substance • Plaque begins to develop in childhood in a symptom-less condition [9] Atherosclerosis-related Diseases

  12. Atherosclerosis-related diseases Video Demo Atherosclerosis Symptoms Cardiovascular Disease Plaque Related Diseases • Coronary Artery Disease • Carotid Artery Disease • Plaque buildup on each side of neck (carotid arteries) • Limits oxygen-rich blood to brain; can lead to stroke • Peripheral Arterial Disease • Plaque buildup in arteries feeding the legs and arms • Symptoms include numbness, pain, and sometimes infection • Chronic Kidney Disease • Plaque buildup in renal arteries of the kidneys • Will slowly lead to kidney failure Symptoms The Cardiovascular System

  13. Symptoms of atherosclerosis Video Demo Atherosclerosis Symptoms Cardiovascular Disease Plaque Related Diseases Atherosclerosis in: ________ Neck Heart Arteries Kidneys Legs & Arms Hover over body part of interest [7]

  14. Causes of disease Causes of Disease Cardiovascular Disease Click on a cause of disease to learn more

  15. Cardiovascular Disease Quiz End Of Disease state Congrats! You have finished the first section. Click the link below to take quick self-assessment and test what you have learned so far!

  16. Current Treatments For Atherosclerosis [14]

  17. Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Medications/Lifestyle Changes • Therapeutic Lifestyle changes • Healthy diet • Physical Activity • Weight Control • Quit Smoking • Stress Management • Medicines • Antiplatelet Drugs • Anticoagulants • Digitalis • Medicine to lower blood pressure [15] [16]

  18. Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Balloon Angioplasty A minimally invasive method invented by Dr. Andrea Gruentzig in the 1970s A hollow flexible tube with a deflated balloon on the tip of the shaft is inserted through the artery of the groin and guided to a predetermined and often marked location The balloon is inflated at the necessary site and clears the blocked artery. The catheter and the balloon are removed Video Diagram of Balloon Angioplasty [17]

  19. Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Coronary Artery Bypass Surgery A more risky procedure, but widely performed. Over 800,000 are performed world wide each year Heart surgery where a blood vessel graft is taken from a patient’s thoracic artery, saphenous vein or radial artery The graft is inserted near the blocked artery to create a new path for blood to flow around the blockage and reach the heart [18] Click for definitions of bolded words [19]

  20. Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Endarterectomy The surgical removal of the plaque that is blocking the artery An incision is made in the affected artery and removes the plaque contained in the artery’s inner lining A less widely performed procedure [22]

  21. Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Thrombolytic Therapy A procedure that involves the injection of clot dissolving medication Sometimes the medication is injected some distance away from the heart and travels through the vein to the clot Other times physicians guide it to the right spot with a catheter This procedure is mainly used for an ischemic stroke (blood clot in the brain) [23]

  22. Comparison Of Current Methods Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Advantages Learn More About RESTENOSIS

  23. Comparison Of Current Methods Treatments Medications/Lifestyle Angioplasty CABS Endarterectomy Thrombolytic Therapy Advantages Disadvantages Disadvantages

  24. What IS A Stent? Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents • A coronary stent is a tube usually a metal mesh or polymer that is placed in the blood vessel to clear out plaque and keep the channel open in cases of cardiovascular disease. • An average stent has a diameter of 2-3 mm and is 25 mm long • The procedure for inserting a stent is called: [28] [27]

  25. Percutaneous Coronary intervention Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents • The stent is inserted via a catheter usually through the groin artery. • The stent is placed at the tip of the catheter tube often along with an oval shaped balloon. • The catheter is guided to the appropriate vessel location and the stent is decompressed. • The decompression of the stent rearranges the plaque so that blood can flow easily. It remains in place to support the blood vessel [25] Watch Video Diagram of PCI

  26. Types of Stents Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents The History of Stent Usage Balloon Angioplasty • Bare Metal Stents • 1994 • Drug Eluting Stents • 2003 • Bioabsorbable • Stents

  27. Bare Metal/Basic Stent Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents • Bare metal stents were approved by the FDA in 1994 • Two Types of Basic Stents: • Balloon deployed stents • Similar to angioplasty, but a stent is also inserted • Self-expanding stents • Expands upon insertion in the vessel [25] Learn More about Self-Expanding Stents

  28. Drug-Eluting Stent Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents [30] • In 2003 the FDA approved the use of drug eluting stents(DES). • DES address the problem of restenosis by a drug coating on the surface of the stent that prevents tissue re-growth. • In 2006 there was evidence the DES could lead to stent thrombosis. • Newer versions of DES and requiring post medication reduced the risk of late stent thrombosis but the risk is still prominent. Learn More about DES

  29. Comparison OF BMs/DES:Complications Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents Bare Metal Stents Drug Eluting Stents • Opening created by procedure is not smooth because balloon cannot inflate the mesh tube perfectly evenly or the self deploying stent cannot open evenly. • Compressed material springs back 15-25% of the time causing restenosis (30-60% for angioplasty) • The plaque build up does not disappear, it just gets rearranged by the stent so that blood can better flow around it. • Patient must take an anti-clotting or antiplatelet drug for a year or so after the stenting for present blood from thickening and clogging the new device • A smooth thin layer of endothelial cells is wanted to grow over the stent but then inserting a second stent in case of restenosis is very challenging.

  30. Treatment Stents PCI Types of Stents Bare Metal Stents Drug Eluting Stents Bioabsorbable Stents Bioabsorbable Stent This type of stent is very similar to a BMS with the addition of it being able to degrade in the vessel after a certain amount of time This would decrease the risk of blood clot formation on the implanted stent as well as make it easier to re-stent the same vein multiple times Biodegradable stents are especially useful when the patient is younger and will probably need another stent in their lifetime [31]

  31. Treatment Section Assessment End Of Treatment Section Congrats! You have finished another section. Click the link below to take quick self-assessment and test what you have learned so far!

  32. Implant Procedure • Pre-Procedure • Surgical Procedure • Post Procedure

  33. Pre-Procedure: General Prerequisites Implant Procedure Pre-Procedure Implantation Procedure Post Procedure Doctor Pre-procedures: • Electrocardiogram • Stress Tests • Imaging Testing: Chest X-ray, Echocardiography, CT Scan • Blood cholesterol and triglyceride measurements Patient Pre-procedures: • Quit Smoking and using tobacco products • Usually need to take aspirin or other blood thinning medication for several days before the procedure to avoid post procedure clotting Learn How Blood Thinners Work

  34. Implant Procedure Pre-Procedure Implantation Procedure Post Procedure Pre-Procedure:Day of Surgery • The insertion point for the catheter is decided. It is usually one of three places: • Arm • Wrist • Groin • Local anesthesia is applied to area of the site of insertion. The patient usually remains semi-conscious throughout the entire procedure. • Coronary Angiography is performed What is Coronary Angiography?

  35. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure Watch Video of Stent Implantation

  36. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure The surgeon uses the the coronary angiograph to advance a thin wire through the catheter to the treatment site to penetrate the blockage and allow a path for the stent and balloon. Watch Video of Stent Implantation

  37. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure A deflated balloon is lead along the inserted wire to the sight of blockage. Watch Video of Stent Implantation

  38. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure The balloon is inflated at the site to break up and remove the plaque and to clear a place for the stent. The balloon is then removed. Watch Video of Stent Implantation

  39. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure A second deflated balloon is inserted but this time with a stent mounted around the balloon. It is lead along the wire to the same spot that the previous balloon had cleared of plaque. Watch Video of Stent Implantation

  40. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure The balloon is inflated, deploying the stent. Sometimes to fully expand the stent, the balloon must be inflated multiple times. Watch Video of Stent Implantation

  41. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure Additional xrays or coronary aniograms are taken so that the doctor can verify that the stent was placed in an ideal location. Watch Video of Stent Implantation

  42. Implantation Procedure Implant Procedure Pre-Procedure Implantation Procedure Post Procedure Finally, the balloon catheter, guide catheter and guide wire are all removed and the insertion site is usually stitched closed for faster healing and less chance of infection. Watch Video of Stent Implantation

  43. Post Procedure:Day Of Surgery Implant Procedure Pre-Procedure Implantation Procedure Post Procedure • Procedure usually takes 90 minutes to perform but recovery time can add several hours to overall procedure time • Usually patients can go home by the evening but they must plan to stay the night in case of complications • Patients must stay flat in bed for 2-6 hours without bending their legs so the artery can heal. A stitch may be placed to heal the site of insertion. • The patient must be closely monitored especially during the immediate recovery period. • No eating post-procedure until the surgeon gives permission to get out of bed

  44. Post Procedure: Long Term Implant Procedure Pre-Procedure Implantation Procedure Post Procedure • A blood thinner is often prescribed for several months post procedure, sometimes the patient will be asked to take blood thinners for the remainder of their life. • The patient cannot undergo any MRI procedures in the 6 months following surgery because the magnetic field may remove the stent. • The stent on its own is not completely effective. The patient must commit to some lifestyle changes such as: • No smoking or Tobacco products • Lose weight/Manage weight • Maintain a low cholesterol diet

  45. Post Procedure: Risks/Complications Implant Procedure Pre-Procedure Implantation Procedure Post Procedure • Minor Complications include bleeding, swelling or bruising around the area where the catheter is placed. • More serious complications involve infection at site of stent deployment, damage to the hear or blood vessels and blood clots • 1% death rate as a result of stent placement procedure. • Any stent placement can lead to fibrosis, restenosisorthrombosis

  46. Implant Procedure Section Assessment End Of Implant Procedure Congrats! You have finished another section. Click the link below to take quick self-assessment and test what you have learned so far!

  47. Implant Materials Current Technologies New Technology Click to learn about important stent properties Take the Implant Materials Quiz

  48. Implant Materials Current Technologies Biodegradable Metals New Technology Click to learn about important stent properties Take the Implant Materials Quiz

  49. Implant Materials Current Technologies Bare Metal Drug Eluting New Technology Click to learn about important stent properties Take the Implant Materials Quiz

  50. All Stents Current Technologies Stent Properties Implant Materials Important Properties (mouse over to learn more) DEPLOYABILITY RESISTANCE TO FRACTURE LOW THROMBOGENECITY ADEQUATE RADIAL FORCE BIODEGRADABLE RADIOPACITY FLEXIBLE MATERIAL THIN STRUT DESIGN SELF EXPANDING

More Related