RESUMO
Bioactive glasses (BGs) are promising materials for bone repair due to their desirable properties such as osteoconductivity, biodegradability, angiogenic potential, and antibacterial activity. Ionic dissolution products from bioactive glasses increase the medium pH inhibiting surrounding bacteria proliferation. The activity of BGs against biofilm formation has been enhanced by incorporating organic antibacterial compounds. The aim of this review was to summarize evidence in literature which assesses the efficacy of antibacterial and anti-biofilm compounds embedded in bioactive glasses to prevent peri-implant infection during bone healing. A PubMed bibliographical research was carried out including articles published in the last 20 years. Most previous studies evaluated antibacterial efficiency in planktonic cultures but did not investigate biofilm inhibition, underestimating biofilm clinical relevance. Multifactorial features such as biocompatibility of embedded compounds, receptor site characteristics, and drug delivery efficiency have been found to influence the bioactive glass capability of acting both as an anti-biofilm agent and as a bone repairing biomaterial. Accordingly, further in vitro and in vivo studies are required to select the most promising anti-biofilm agents which should be incorporated into bioactive glasses to counteract biofilm proliferation, without inducing toxic effects on human cells, and with the added functionality of promoting bone regeneration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 672-679, 2017.
Assuntos
Anti-Infecciosos , Biofilmes/efeitos dos fármacos , Regeneração Óssea/efeitos dos fármacos , Substitutos Ósseos , Cerâmica , Materiais Revestidos Biocompatíveis , Animais , Anti-Infecciosos/química , Anti-Infecciosos/uso terapêutico , Biofilmes/crescimento & desenvolvimento , Substitutos Ósseos/química , Substitutos Ósseos/uso terapêutico , Cerâmica/química , Cerâmica/uso terapêutico , Materiais Revestidos Biocompatíveis/química , Materiais Revestidos Biocompatíveis/uso terapêutico , HumanosRESUMO
Introduction: megaprostheses are one of the most widely used treatments in oncological surgery, and one of its major complications is the high rate of infection. Methods: 30 patients underwent implantation of silver-coated Mutars® arthroplasty due to neoplastic disease or periprosthetic fracture. Clinical and analytical monitoring was performed with a minimum of 4 years follow-up. Results: During follow-up 3 infections (10% of patients) were detected, less than publications using non silver-coated prostheses. Conclusion: silver coating in megaprostheses seems to decrease infection rate. Methods: 30 patients underwent implantation of silver-coated Mutars® arthroplasty due to neoplastic disease or periprosthetic fracture. Clinical and analytical monitoring was performed with a minimum of 4 years follow-up. Results: During follow-up 3 infections (10% of patients) were detected, less than publications using non silver-coated prostheses. Conclusion: silver coating in megaprostheses seems to decrease infection rate. Results: During follow-up 3 infections (10% of patients) were detected, less than publications using non silver-coated prostheses. silver coating in megaprostheses seems to decrease infection rate. Conclusion: silver coating in megaprostheses seems to decrease infection rate.
Introducción: Las megaprótesis son uno de los tratamientos más usados en cirugía oncológica, y una de sus mayores complicaciones es la alta tasa de infección. Material y métodos: 30 pacientes fueron sometidos a la implantación de una artroplastia Mutars® con recubrimiento de plata debido a enfermedad neoplásica o fractura periprotésica. Se realizó un seguimiento clínico y analítico de los sujetos con un seguimiento mínimo de 4 años tras la intervención. Resultados: Durante el seguimiento se apreciaron 3 infecciones (10% de los pacientes) en la serie a estudio, cifra inferior a las publicaciones que usan prótesis sin recubrimiento de plata. Conclusión: el recubrimiento de plata en megaprótesis tumorales parece disminuir de la tasa de infección. Conclusión: el recubrimiento de plata en megaprótesis tumorales parece disminuir de la tasa de infección.
Assuntos
Artroplastia de Substituição/métodos , Neoplasias Ósseas/cirurgia , Materiais Revestidos Biocompatíveis/uso terapêutico , Neoplasias Femorais/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Compostos de Prata/uso terapêutico , Tíbia/lesões , Artroplastia de Substituição/efeitos adversos , Seguimentos , HumanosRESUMO
PURPOSE: To assess the systemic response of pigs to the intraperitoneal implantation of polypropylene mesh associated with chitosan-based film with a degree of deacetylation of 95%. METHODS: Blood samples were collected 24 hours before, and two and seven days after surgery. Systemic reactions were evaluated based on white blood cell count, C-reactive protein, and total serum protein, albumin and globulin levels. RESULTS: The systemic response was proportional to the composite response induced by polypropylene mesh, and the tissue inflammatory response was higher in the PP group (p=0.0033). CONCLUSION: The polypropylene mesh/chitosan-based film composite did not elicit a systemic response in pigs.
Assuntos
Parede Abdominal/cirurgia , Reação de Fase Aguda/etiologia , Quitosana/uso terapêutico , Materiais Revestidos Biocompatíveis/uso terapêutico , Polipropilenos/uso terapêutico , Telas Cirúrgicas , Animais , Proteína C-Reativa/análise , Contagem de Leucócitos , Masculino , Teste de Materiais , Cavidade Peritoneal/cirurgia , Distribuição Aleatória , Reprodutibilidade dos Testes , Albumina Sérica/análise , Soroglobulinas/análise , Suínos , Fatores de TempoRESUMO
PURPOSE:To assess the systemic response of pigs to the intraperitoneal implantation of polypropylene mesh associated with chitosan-based film with a degree of deacetylation of 95%.METHODS:Blood samples were collected 24 hours before, and two and seven days after surgery. Systemic reactions were evaluated based on white blood cell count, C-reactive protein, and total serum protein, albumin and globulin levels.RESULTS:The systemic response was proportional to the composite response induced by polypropylene mesh, and the tissue inflammatory response was higher in the PP group (p=0.0033).CONCLUSION:The polypropylene mesh/chitosan-based film composite did not elicit a systemic response in pigs.
Assuntos
Animais , Masculino , Parede Abdominal/cirurgia , Reação de Fase Aguda/etiologia , Quitosana/uso terapêutico , Materiais Revestidos Biocompatíveis/uso terapêutico , Polipropilenos/uso terapêutico , Telas Cirúrgicas , Proteína C-Reativa/análise , Contagem de Leucócitos , Teste de Materiais , Cavidade Peritoneal/cirurgia , Distribuição Aleatória , Reprodutibilidade dos Testes , Suínos , Albumina Sérica/análise , Soroglobulinas/análise , Fatores de TempoRESUMO
The use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.
Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis , Feminino , Humanos , Invenções , Engenharia Tecidual/métodosRESUMO
ABSTRACTThe use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.
Assuntos
Feminino , Humanos , Materiais Revestidos Biocompatíveis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis , Invenções , Engenharia Tecidual/métodosRESUMO
PURPOSE: To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS: Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL), ULTRAPRO® (UP), PROCEED® (PCD) or repairing without mesh (TRANSPALB). After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS: Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). PPL groups (p = 0.032) and PCD (p <0.001) showed greater meshes shrinkages when compared to UP. Microscopic: neutrophils: PCD> PPL, UP and TRANSPALB (p = 0.010); eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010); granulation tissue: PPL and PCD> UP and TRANSPALB (p <0.001); macrophages : PPL, UP and PCD> TRANSPALB (p <0.001); lymphocytes: PPL and PCD> UP (p = 0.009) and TRANSPALB (p <0.001); giant cells: PPL, UP and PCD> TRANSPALB (p <0.001); viscera adhered: PPL and UP> PCD and TRANSPALB (p <0.001). CONCLUSION: All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.
Assuntos
Parede Abdominal/cirurgia , Materiais Revestidos Biocompatíveis/uso terapêutico , Hérnia Abdominal/cirurgia , Telas Cirúrgicas , Cicatrização , Parede Abdominal/patologia , Animais , Masculino , Teste de Materiais , Polipropilenos/uso terapêutico , Coelhos , Reprodutibilidade dos Testes , Fatores de Tempo , Aderências Teciduais , Resultado do TratamentoRESUMO
PURPOSE: To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS: Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL), ULTRAPRO® (UP), PROCEED® (PCD) or repairing without mesh (TRANSPALB). After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS: Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). PPL groups (p = 0.032) and PCD (p <0.001) showed greater meshes shrinkages when compared to UP. Microscopic: neutrophils: PCD> PPL, UP and TRANSPALB (p = 0.010); eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010); granulation tissue: PPL and PCD> UP and TRANSPALB (p <0.001); macrophages : PPL, UP and PCD> TRANSPALB (p <0.001); lymphocytes: PPL and PCD> UP (p = 0.009) and TRANSPALB (p <0.001); giant cells: PPL, UP and PCD> TRANSPALB (p <0.001); viscera adhered: PPL and UP> PCD and TRANSPALB (p <0.001). CONCLUSION: All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.
Assuntos
Animais , Masculino , Coelhos , Parede Abdominal/cirurgia , Materiais Revestidos Biocompatíveis/uso terapêutico , Hérnia Abdominal/cirurgia , Telas Cirúrgicas , Cicatrização , Parede Abdominal/patologia , Teste de Materiais , Polipropilenos/uso terapêutico , Reprodutibilidade dos Testes , Fatores de Tempo , Aderências Teciduais , Resultado do TratamentoRESUMO
We aimed to test a new model of self-expanding tracheal stent so that it might be made available for clinical use. Using direct laryngoscopy, we placed polyurethane-coated, nitinol stents into the middle third of the trachea in 25 New Zealand rabbits. After a mean observation period of 26 days, we evaluated stent migration, degree of expansion, attachment, adherence, formation of granulation tissue, presence of inflammatory infiltrate, parietal involvement, and epithelial lining. The results showed complete radial expansion, little adherence to the tracheal mucosa, and low tissue attachment, as well as high rates of granuloma formation and stent migration. This new model proved to be biocompatible and showed a behavior similar to that of other stents on the market.
Assuntos
Ligas , Materiais Revestidos Biocompatíveis/uso terapêutico , Poliuretanos , Desenho de Prótese , Stents , Estenose Traqueal/cirurgia , Animais , Brasil , Coelhos , Stents/efeitos adversosRESUMO
Titanium surface texture and chemistry modification successfully improves the host response and consequently the bone-to-implant contact surrounding dental implants. The aim of the present study was to investigate, using histomorphometrical-analysis, the effects of titanium surface modification by laser-ablation (Nd:YAG) followed by thin chemical deposition of HA. Forty-eight rabbits received one implant by tibiae of AS-machined (MS), laser-modified (LMS), or biomimetic hydroxyapatite-coated (HA) surface. Bone-to-implant contact (BIC) and bone area (BBT) were evaluated after 4, 8, and 12 weeks, at cortical and cancellous regions. Average BIC in the cortical region was higher (P < 0.001) on the LMS and HA implants for all periods, with no differences between LMS and HA. For the cancellous area, the LMS and HA implants showed higher (P < 0.01) BIC than MS at the initial periods. The LMS and HA showed similar values in the cortical region, but a tendency of higher values for HA in the cancellous region was observed in all periods. For the BBT, the differences were found only between HA and MS after 4 weeks in the cortical region (P < 0.05), and after 12 weeks in the cancellous area (P < 0.05). Our results showed that HA biomimetic coating preceded by laser treatment induced the contact osteogenesis and allowed the formation of a more stable bone-implant interface, even in earlier periods.
Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Durapatita/uso terapêutico , Terapia a Laser , Próteses e Implantes , Titânio/efeitos adversos , Animais , Histocitoquímica , Microscopia Eletrônica de Varredura , Modelos Animais , Osteogênese , Coelhos , Tíbia/fisiologia , Tíbia/cirurgiaRESUMO
This study evaluated the arterial response to cobalt-chromium stents with and without polymer coating (Camouflage®, Hemoteq AG, Wuerselen, Germany) implanted in pigs. Cobalt-chromium balloon-expandable stents (4 × 16 mm) were implanted in the common carotid arteries of nine pigs. Histological analysis of endothelialization, inflammation and injury was performed one month later. All stents were successfully deployed, and all but one animal survived the 30 study days. All arteries were patent. Endothelialization was nearly complete in most sections of all carotid stents in both groups. There were mild inflammatory infiltrate and mild-to-moderate injury, which were associated with the stent shafts and not significantly different between groups. Our findings suggest that, in porcine carotid arteries, the histological response to balloon-expandable cobalt-chromium stents coated with polymer (Camouflage®, Hemoteq AG) is similar to the response to non-coated cobalt-chromium stents.
Assuntos
Artérias Carótidas , Materiais Revestidos Biocompatíveis , Reestenose Coronária/prevenção & controle , Stents Farmacológicos , Heparina/uso terapêutico , Polímeros/uso terapêutico , Animais , Artérias Carótidas/patologia , Ligas de Cromo/uso terapêutico , Materiais Revestidos Biocompatíveis/uso terapêutico , Modelos Animais de Doenças , Endotélio Vascular/patologia , Desenho de Prótese , Stents , SuínosRESUMO
A reestenose intra-stent coronário sofreu marcante redução com o surgimento dos stents liberadores de medicamentos, alcançando níveis de 10 por cento na maioria dos cenários clínicos e angiográficos. Desde então, novos dispositivos com diferentes fármacos vêm sendo testados com a finalidade de se obter perfil de eficácia pelo menos equivalente ao dos stents farmacológicos de primeira geração (Cypher e Taxus), mas com maior segurança tardia. Objetivo: Avaliar a segurança e a eficácia na inibição da proliferação neointimal com implante de stent liberador de novolimus. Método: Estudo unicêntrico, tipo first-in-man, com inclusão de 15 pacientes portadores de angina pectoris submetidos a implante de stent liberador de novolimus. Resultados: Análise por meio de angiografia coronária quantitativa (ACQ) e ultra-som intracoronário (USIC), realizada imediatamente após implante do stent e aos quatro meses, revelou perda tardia intra-stent de 0,15 mais ou menos 0,29 mm e no segmento, de 0,07 mais ou menos 0,3 mm. O volume de obstrução intra stent foi de 2,6 mais ou menos 2,6 por cento. Não foram observados casos de reestenose binária. O seguimento clínico aos seis meses foi obtido em todos os pacientes, não sendo observados eventos cardíacos adversos...
Background: Stent restenosis suffered a marked reduction with drug-eluting stents (DES) reaching levels below 10% in most clinical and angiographic scenarios. Since then, new devices with different drugs have been tested in order to obtain an efficiency equivalent to first generation DES (Cypher® and Taxus®), although with better long-term safety. Our objective was to evaluate safety and neointimal proliferation inhibition with novolimuseluting stent through clinical and angiographic endpoints. Methods: Single-center, first-in-man study, including 15 patients with angina pectoris submitted to novolimuseluting stent implantation. Results: Angiographic analysis with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) performed immediately after stent implantation and at 4-month follow-up revealed instent and in-segment late loss of 0.15 mm ± 0.29 mm and 0.07 mm ± 0.3 mm, respectively. In-stent volume obstruction was 2.6 ± 2.6%. No cases of binary restenosis were observed. The six-month clinical follow-up revealedno major acute cardiovascular events (MACE). Conclusion: The new novolimus-eluting stent proved to be efficient in reducing late loss and supressing neointimal proliferation. Late results in more complex group of patients are needed to confirm the safety of this new device...
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Stents , Angiografia Coronária/métodos , Angiografia Coronária , Materiais Revestidos Biocompatíveis/uso terapêutico , Infarto do Miocárdio/complicações , Sirolimo , Sirolimo/uso terapêuticoRESUMO
OBJECTIVE: Compounds considered for drug delivery from oral implant surfaces in support of local bone formation might themselves influence osseointegration. Phosphorylcholine (PC) polymers have been shown to enhance the biocompatibility of medical devices and to serve as drug delivery systems. The objective of this study was to evaluate local bone formation and osseointegration at PC and positively charged PC (PC+)-coated endosseous implants in an established rabbit model. MATERIAL AND METHODS: Sixteen adult female New Zealand White rabbits were used. Eight animals received PC-coated and control titanium porous oxide surface implants placed in the left and right distal femural condyle (trabecular bone) and proximal tibial metaphysis (cortical bone) using aseptic routines. The remaining eight animals similarly received PC+ and control implants. One implant was placed in each femural condyle and two implants in each tibial metaphysis. Experimental and control implants were alternated between the left and right hind legs. Fascia and skin were closed in layers. The animals were euthanized following a 6-week healing interval for biomechanical (removal torque) and histometric analyses. RESULTS: Peri-implant bone density was considerably greater at tibial compared with femoral sites within as well as immediately outside the implant threads. However, there were no significant differences in bone density among PC, PC+, and control implants. Nevertheless, bone-implant contact was significantly lower at PC compared with PC+ and control implants in cortical bone (p<0.05). Numerical differences in trabecular bone did not reach statistical significance. The removal torque evaluation revealed significantly lower values for PC compared with PC+ and control sites (p<0.05). CONCLUSION: The histometric and biomechanical analyses suggest that PC coating may influence biological processes and ultimately osseointegration of endosseous implants. Apparently, incorporation of cationic charges may reverse or compensate for this scenario. Nevertheless, both PC coatings exhibited clinically acceptable osseointegration. In perspective, PC technology appears to be a viable candidate delivery system for agents in support of local bone formation at endosseous implant surfaces.
Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Implantação Dentária Endóssea/instrumentação , Implantes Dentários , Osseointegração/efeitos dos fármacos , Fosforilcolina/uso terapêutico , Animais , Fenômenos Biomecânicos , Densidade Óssea/efeitos dos fármacos , Feminino , Fêmur/cirurgia , Coelhos , Tíbia/cirurgiaRESUMO
OBJECTIVE: To demonstrate our experience with self-expanding nitinol duodenal stents in the treatment of inoperable malignant gastroduodenal obstructions. MATERIALS AND METHODS: Seventy two (72) patients with malignant gastroduodenal obstruction, 42 men and 30 women, were treated with peroral application of a gastroduodenal nitinol stent. The average age was 61.3 years (range of 21 to 92 years). The gastroduodenal obstructions was caused by gastric tumors (38 patients), pancreatic tumors (15), gallbladder tumors (8), bile duct tumors (5), metastatic tumors (4) and two cases of duodenal invasion by regional tumor (colon and hypernephroma). These conditions were considered inoperable in all the patients. Using a flexible 20 Fr. intubator and assisted by endoscopy and fluoroscopy, 3 uncovered stents, 7 fully covered stents and 62 partially covered stents were inserted. RESULTS: A stent was inserted in 67 of the 72 patients (93%) and no patient showed any duodenal perforation nor needed surgery. As to the symptoms, of the 12 patients who did not tolerate any type of oral treatment, 10 improved after the duodenal stents were introduced. Stent migration was observed in 6 cases, 4 of these with fully covered stents. In these cases, the stents were removed by endoscopy and then replaced by a partially covered stent. Tumor colonization was observed in five cases, two of them with the uncovered stents initially used. Out of the 62 procedures with partially covered stents, migration was observed in two cases and only two stents were colonized by the tumor. Patients died between 1 and 96 weeks after introducing the stents (average survival was 20.7 weeks). CONCLUSIONS: Peroral placement of nitinol stents is an effective and easy method of mitigation for most patients with malignant gastro-duodenal obstructions. Migration of fully covered stents and tumor colonization of uncovered stents are important limitations, which can be avoided by using partially covered stents.
Assuntos
Ligas/uso terapêutico , Neoplasias Duodenais/cirurgia , Obstrução da Saída Gástrica/cirurgia , Stents , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Materiais Revestidos Biocompatíveis/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Duodenais/diagnóstico por imagem , Duodenoscopia , Feminino , Obstrução da Saída Gástrica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Complicações Pós-Operatórias , Estudos Prospectivos , Radiografia , Neoplasias Gástricas/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Although target lesion revascularization (TLR) has been dramatically decreased by using drug-eluting stents (DESs) in de-novo lesions, their efficacy for in-stent restenosis (ISR) has not yet been well established. METHODS: We retrospectively analysed patients treated for ISR with DESs from three referral hospitals. RESULTS: Eighty-seven consecutive patients, from June 2002 to April 2004, were included, with a mean age of 64+/-11 years; 83% were men, 32% had diabetes, 47% had had a previous myocardial infarction and 16% had low left ventricular ejection fraction. Angiographic characteristics were as follows: mean vessel diameter, 3.05+/-0.4 mm; lesion length, 17.8+/-7.7 mm; diameter stenosis, 84.0+/-10.7%; and complex lesion, 81%. The restenosis was focal in 45%, diffuse/proliferative in 51.3% and total occlusion in 3.7% of the cases. Sirolimus- and paclitaxel-eluting stents were used in 42 and 58% of the patients, respectively. Stent diameter was 3.1+/-0.3 mm and the length was 26.1+/-5.8 mm. Angiographic success was achieved in all patients, with one patient experiencing a post-procedural non-Q-wave myocardial infarction. At 6-month clinical follow-up, two patients had died from non-cardiac deaths, five had experienced a new TLR (5.7%, four percutaneous and one coronary artery bypass graft) and eight (9.2%) had had major adverse cardiac events. A stress test was performed in 60% of the population; target vessel ischemia was observed in one patient (3.3%). CONCLUSION: In this non-select cohort of patients, the use of DESs is a safe and effective strategy for ISR lesions.
Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Reestenose Coronária/terapia , Stents , Idoso , Implante de Prótese Vascular/métodos , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Paclitaxel/uso terapêutico , Padrões de Prática Médica , Estudos Retrospectivos , Sirolimo/uso terapêutico , Análise de Sobrevida , Resultado do Tratamento , Disfunção Ventricular Esquerda/terapiaRESUMO
AIMS: Coronary stenting is limited by a 10%-60% restenosis rate due to neointimal hyperplasia. Sirolimus is a macrocyclic lactone agent that interacts with cell-cycle regulating proteins and inhibits cell division between phases G1 and S1. The hypothesis tested in this study is that local delivery of sirolimus with an eluting stent can prevent restenosis. METHODS AND RESULTS: Fifteen patients were treated with 18 mm sirolimus eluting BX VELOCITY stents. Quantitative angiography and three-dimensional quantitative intravascular ultrasound were performed at implantation and at the 6 months follow-up. All stent implantations were successful. One patient died on day 2, of cerebral haemorrhage and one patient suffered a subacute stent occlusion due to edge dissection (re-PTCA, CKMB 42). At 9 months no further adverse events had occurred and all patients were angina free. Quantitative coronary angiography revealed no change in minimal lumen diameter and percent diameter stenosis and hence no in-lesion or in-stent restenosis. Quantitative intravascular ultrasound showed that intimal hyperplasia volume and percent obstruction volume at follow-up were negligible at 5.3 mm(3)and 1.8%, respectively. No edge effect was observed in the segments proximal and distal to the stents. CONCLUSION: Implantation of a sirolimus-eluting stent seems to effectively prevent intimal hyperplasia.
Assuntos
Materiais Revestidos Biocompatíveis/farmacologia , Materiais Revestidos Biocompatíveis/uso terapêutico , Reestenose Coronária/prevenção & controle , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Sirolimo/farmacologia , Sirolimo/uso terapêutico , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Coortes , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/etiologia , Creatina Quinase/sangue , Creatina Quinase Forma MB , Segurança de Equipamentos , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Isoenzimas/sangue , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/instrumentação , Ultrassonografia de IntervençãoRESUMO
Foram preparadas amostras de chapas de titânio com nove condiçöes de superfície, sendo três lixadas até lixa 600 e seis jateadas com óxido de alumínio (alumina com granulometria 65mm e 250mm). Seis condiçöes foram entäo submetidas a tratamento ácido com soluçäo de ácido sulfúrico/clorídico ou soluçäo contendo ácido fluorídrico. Essas superfícies foram caracterizadas por meio de técnicas, como microscopia eletrônica de varredura (MEV/EDS), espectroscopia de fotoelétrons por raio X (XPS) e medidas de rugosidade média. A soluçäo contendo ácido fluorídrico foi eletiva na remoçäo das partículas de alunina, provenientes do jateamento mecânico, e na criaçäo de uma microscopia homogeneamente rugorosa