Damar İçi Stentlerde Malzeme Seçiminin ve Tasarımının Restenoz ve Diğer Stent Kaynaklı Problemlere Etkileri, Stentlerin Ekonomideki Yeri (Bir Genel Derleme)

Year 2020, Ejosat Special Issue 2020 (ARACONF), 204 - 215, 01.04.2020

Gülşen Akdoğan , Ömer Burak İstanbullu

https://doi.org/10.31590/ejosat.araconf26

Cited By: 4

Abstract

Damar yolu hastalıklarının tedavisinde kullanılan damar içi stentler, özellikle kardiyovasküler cerrahi alanında hayat kurtarıcı tedavi olarak önemli bir rol oynamaktadır. Stentlerin tasarımı ve üretiminde kullanılan malzemeler; operasyonel uygulama ve damar yolu tıkanıklıklarına çözüm sunma açısından oldukça etkilidir. İlk stent tasarımları 316L (düşük karbonlu medikal paslanmaz çelik) malzemelerin kullanıldığı kaplamasız metal stentler şeklinde geliştirilmiş ve günümüzde şekil hafızalı akıllı stent tasarımları, ilaç salınımlı stent teknolojileri ve biyobozunur stentler ortaya çıkmıştır. Yeni teknoloji stentlerin üretiminde polimerik malzemelerin yanı sıra nitinol, Ti alaşımları ve Mg tabanlı malzemeler öne çıksa da günümüzde halen 316L malzeme kullanılarak üretilen stentler de mevcuttur.
Korozif bir ortam olan damar yolu içerisine yerleştirilen kaplamasız metal stentlerde korozyon meydana gelmesi sonucunda stentin mekanik mukavemeti zayıflamakta ve bu da stentin kırılmasına yol açarak vasküler yolun tekrar tıkanmasına neden olabilmektedir. İlaç salınımlı stentlerde ise kullanılan antiproliferatif ajanların zamanla tükenmesi neticesinde stent kaynaklı tıkanma problemleri ile karşılaşılmaktadır. Biyobozunur stentlerde ise stentin bozunma süresinin kontrol altına alınması, çözüm bekleyen bir başka problemdir.
Vücut içerisine yerleştirilen stentlerde; üretimlerinde kullanılan malzeme fark etmeksizin, vücut sıvıları ile sürekli olan etkileşimleri sonucunda, zamanla tekrar damar tıkanıklığına yol açan problemler meydana gelmektedir. Dolayısıyla mevcut tüm stentlerin damar yolu hastalıklarına yalnızca geçici bir tedavi sağlayabildiği göze çarpmaktadır.
Stentlerin sunduğu tedavinin kalıcı olabilmesi için stent içi restenozun (yeniden tıkanma) giderilmesine yönelik çalışmalara büyük ölçüde ihtiyaç duyulmaktadır. Stent üretimi ve tasarımına yönelik güncel AR-GE çalışmaları bu doğrultuda ilerlemektedir. Bu derleme makalede, damar içi stentlerin gelişimi sürecinde ortaya çıkan farklı malzemelerden üretilmiş tasarımlar irdelenmektedir. Günümüzde klinik uygulamalarda kullanılan tüm stent gruplarında ortak olarak karşılaşılan restenoz problemine; stentin yüzey yapısının iyileştirilmesi yöntemleri ile çözüm sunulan yeni çalışmalar ortaya konulmaktadır.

Keywords

Damar içi stentler, Damar yolu tıkanıklığı, Biyomalzemeler, Restenoz, Stent trombozu, Stent korozyonu

Supporting Institution

Erciyes Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi

Project Number

FDK-2019-8754

Thanks

Bu çalışma Erciyes Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi tarafından FDK-2019-8754 numaralı proje ile desteklenmektedir.

Effects of Material Selection and Design on Restenosis and Other Stent Based Problems in Intravascular Stents, The Situation of Stents in the Economy (A Review)

Abstract

Intravascular stents used in the treatment of vascular diseases play an important role as a life-saving treatment especially in the field of cardiovascular surgery. Materials used in the design and manufacture of stents are very effective in terms of operational application and treatment of vascular occlusion. The first stent designs were developed in the form of bare metal stents using 316L (low carbon medical stainless steel) materials, and today, shape memory stent designs, drug eluting stent technologies and biodegradable stents have emerged. In addition to polymeric materials, nitinol, Ti alloys and Mg-based materials stand out in the production of new technology stents, there are still stents produced using 316L material today.
For bare metal stents placed in the vessel which is a corrosive environment, the mechanical strength of the stent weakens as a result of corrosion which may lead to breaking of the stent that result in blockage of the vascular pathway again. In drug eluting stents, as a result of the depletion of antiproliferative agents with time, stent-induced occlusion problems are encountered. In biodegradable stents, controlling the degradation duration of the stent is another problem that is waiting for a solution.
As a result of the continuous interaction of stents with body fluids, problems causing vascular occlusion occur over time in the stents which are placed inside the body regardless of the materials used in their production. Therefore, it is remarkable that all existing stent designs can only provide a temporary treatment to vascular diseases.
Researches which are aimed to overcome in-stent restenosis (re-occlusion) are highly necessary for making stent treatment to be permanent. Current R&D studies for stent production and design are progressing in this direction. In this review article, designs produced using various materials arising during the development of intravenous stents are examined. New studies that offer a solution to restenosis which is the common problem in all stent groups used in clinical practice today by using the techniques of improvement of the stent surface structure are presented.

Keywords

Intravascular stents, Vascular occlusion, Biomaterials, Restenosis, Stent thrombosis, Stent corrosion

Project Number

FDK-2019-8754

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