EP2575917A2 - Revêtement d'endoprothèses d'une couche de fils polymères entrelacés à mailles serrées - Google Patents

Revêtement d'endoprothèses d'une couche de fils polymères entrelacés à mailles serrées

Info

Publication number
EP2575917A2
EP2575917A2 EP11738589.8A EP11738589A EP2575917A2 EP 2575917 A2 EP2575917 A2 EP 2575917A2 EP 11738589 A EP11738589 A EP 11738589A EP 2575917 A2 EP2575917 A2 EP 2575917A2
Authority
EP
European Patent Office
Prior art keywords
endoprosthesis
coating
stent
thread
tangle
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP11738589.8A
Other languages
German (de)
English (en)
Inventor
Erika Hoffmann
Michael Hoffmann
Roland Horres
Lutz Freitag
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Hemoteq AG
Original Assignee
Hemoteq AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE201010022589 external-priority patent/DE102010022589A1/de
Application filed by Hemoteq AG filed Critical Hemoteq AG
Publication of EP2575917A2 publication Critical patent/EP2575917A2/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • 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
    • 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
    • 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
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/14—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
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/54—Biologically active materials, e.g. therapeutic substances
    • 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
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/146—Porous materials, e.g. foams or sponges
    • 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
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/16—Biologically active materials, e.g. therapeutic substances
    • 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
    • A61L2420/02—Methods for coating medical devices

Definitions

  • the present invention relates to endoprostheses coated with a polymeric close-meshed thread tangle and to the production and use of these so-coated endoprostheses.
  • Pathological changes and injuries to the vascular walls in and at all body passages and exits may result in painful inflammation, constriction, occlusion, sloughing, and bleeding of these passages, so that the functions of the hollow organ are restricted or even impossible.
  • Degenerative vascular wall diseases are the most common cause of myocardial infarction or strokes in more than 80% of the cases.
  • Aneurysm formation can be just as life-threatening. These are sloughs of the vessel wall, which are attributable in particular to congenital connective tissue weakness, arteriosclerosis, inflammation or trauma and can also occur as a late consequence of a volume load on the vessel wall.
  • the aneurysm spurium which is called a false aneurysm, can also be mentioned in this connection.
  • a tear, the intima and the media of the vessel permeates.
  • This may be the result of a blunt or sharp injury, such as occurs after arterial puncture such as after puncture of the inguinal artery in performing a PTCA and / or stent implantation and also after cardiac catheterization, as the cause is here assumed insufficient pressure after pulling the catheter, so that the blood vessel is not properly closed and it comes to oozing hemorrhages in the surrounding tissue.
  • Another and equally common danger affecting all body passages is the growth of malignant and benign tumors.
  • malignant and benign tumors By rapid and uncontrolled cell division it comes to the spread of the tumor and in the hollow organs and so to the obstruction or even closures of the Body ravines.
  • Examples include esophageal cancer, hypopharyngeal cancer, nasopharynx and oropharynx, colon cancer, lung cancer, kidney cancer, biliary tract obstruction, pancreas, urethra, etc.
  • Other causes of restricted cavernous function may also be cyst and fistula formation.
  • Stenosis is generally understood to mean a mechanical obstruction or an interruption in the functions of vascular cavities. Restenosis is a recurrent stenosis, which can also be caused by the initial treatment of a stenosis.
  • the stent In addition to percutaneous transluminal angioplasty (PTA) or percutaneous transluminal coronary angioplasty (PTCA), the stent has been used as a permanent endoprosthesis in the last two decades to treat narrowed, blood-bearing body passageways and to treat stenoses and restenosis Proven effective with local drug therapy. It is inserted and fixed directly with a balloon catheter during the PTA or PTCA, ie the widening of the affected area with a balloon catheter or even after removal of the constriction at the affected site with atherectomy catheters. The stent in expanded form then pushes the vessel wall outward so that the native vessel diameter of the affected vessel is restored and should keep it open.
  • PTA percutaneous transluminal angioplasty
  • PTCA percutaneous transluminal coronary angioplasty
  • the same scaffold is used to repair or prevent any stenosis in all body passages, or to impede an imminent obstruction for at least as long as possible (as in palliative medicine or pain therapy), for example in the esophagus, bile duct, intestine , Lung, kidney, ureter, pancreas, brain vessels, trachea (bronchial), paranasal sinuses and other body cavities.
  • the object of the endoprostheses is therefore to stop in the lumen growing, excess, malignant, benign and / or generally disturbing tissue, to prevent inflammation or to reduce the risks of forming Aussackungen of hollow vessels to prevent or remedy.
  • vascular, stent-induced restenosis, tumor growth, inflammation and aneurysms as well as cyst formation, fistulas, trauma and scarring are the cause of the use of such endoprostheses.
  • these stents are provided with a preferably polymeric sheath enveloping the entire cylindrical stent body including the strut interstices, which also acts as a mechanical barrier and prevents or at least re-engulfing the tumor through the interstices into the lumen to slow down.
  • an endoprosthesis that is inserted into an artery there are other conditions of use than, for example, for an endoprosthesis that enters the esophagus, the bile duct, the trachea, a cerebral artery, the sinus access, the oropharynx, hypopharynx, etc. is used.
  • the vascular, coated and uncoated stent for the treatment of arteriosclerosis or stenosis and the prevention of stent-induced restenosis on the other hand has as little as possible foreign surface, as demonstrated by the products currently on the market.
  • an endoprosthesis serving as a barrier e.g. used in the treatment of tumors, only represent a barrier, if they can completely cover the affected area so the entire area. This is only possible if the interstices of the surface-minimized endoprostheses do not remain continuous, since only then is there a barrier that can obstruct or restrain a tumor growing into the lumen. Since the polymer-encased stent safely fulfill its site-adapted function and should ideally ensure undisturbed function of the target organ or support, but of course not adversely affect or even bother, in the past various concepts have been worked out with the help of a stent can be provided with a polymer shell.
  • WO 93/22986 A describes a self-expanding esophageal stent, in which a silicone tube is slipped over in the middle region and which compresses this region in such a way that the stent has a smaller diameter than in the tube-free proximal and distal end regions.
  • the proximal and distal End are not wrapped so that with the help of these free stent struts better fixation on the walls of the cavity is possible.
  • this stent has not proved successful because of the narrowing of the stent body problems arise, for example, during vomiting, the forces on the stent are reinforced so that the stent is moved and injured with the free stent ends of the esophageal wall.
  • the silicone tube may tear or peel off and between the vessel wall and silicone coating may mucus or food particles settle, which can trigger in addition to the possible risk of inflammation different extremely negative for the patient scenarios.
  • WO 2005/030086 describes a method for the full-surface coating of likewise self-expanding stent bodies, with a polyurethane sheath, in which after a first spray coating of the stent with the polymer, the polymer with the aid of a balloon or other suitable hollow template as a film from the inside of the Sentstreben is created.
  • the subsequent heating of the system above the softening temperature is intended to bind the polyurethane to the stent.
  • the polymer shell is not bound quantitatively or completely to the coated stent and therefore does not remain permanently on the stent under the given conditions.
  • the heating can cause small holes, which may possibly increase in the case of implantation and ultimately lead to the separation of coating material and even to stent dislocation.
  • heating above the softening point of the polymer can cause the coating applied to the abluminal surface of the stent struts to soften and penetrate into the strut interstices and thus adhere the polymer coating not only to the stent but also to the balloon also made of a polymer, so that during dilation, the coating can tear or the stent does not detach from the balloon.
  • the inner coating has adhesion problems such that it at least partially peels off the stent when the balloon is removed.
  • food or mucus can settle between the dissolving coating and the inner wall, which gradually separates the coating from the stent, but above all obstructs the undisturbed passage.
  • the loosening Material protrudes into the cavity and additionally leads to irritation, nausea or coughing, which promotes the dislocation of the entire stent or result.
  • the ALIMAXX-ES TM stent is currently being marketed as a completely encased stent with a smooth PU polymer sheath (as a foil).
  • stent-strut interstitial coated stents Another area of use for stent-strut interstitial coated stents is in the area of tracheal stenoses, mostly caused by bronchial carcinomas, which currently occupy second place in the industrialized countries with regard to the frequency of occurrence of malignant tumors. These tumors can hardly be cured surgically or with the aid of multimodal therapy, so that about 30% of the patients suffering from central airway stenosis still die from it.
  • a particular problem in this area stems from the unlike other cavities not round shape of the lung tube, so that the risk that a stent dissolves, and also that mucosa between coated stent and tracheal wall can accumulate in these stents particularly is great.
  • a similarly unfavorable situation arises when the coating dissolves from the stent under the given conditions and secretion can occur between the stent and the coating.
  • the risk of coating detachment must be observed for all coated stents in all, including cardiovascular, areas of application.
  • Dumontstent a tubular silicone tube with nubs for better fixation on the abluminal side, which was developed especially for the tracheai area, is still used, because it is easier to remove than most metal stents, because of the not rarely occurring subsequent complications a reimplantation is required.
  • the various metal stents on the market for example the Nitinolstent, Gianturco and Wallstent) are now frequently used coated over the entire surface, but likewise do not yet show the desired success.
  • DESs drug eluting stents
  • full surface ie like a tube consistently coated products
  • bronchial secretions which ultimately can only be surgically removed as a tough rubbery mass.
  • Another common cause of obstruction or increased adherence of mucosa is dehydration of the luminal stent surface, as the body-regulated moisture of a native inner wall is no longer present. This is necessary, however, so that bronchial secretions (mucosa) can drain off.
  • bronchial secretions will adhere to this dry area and accumulate more and more, since only the breath can not maintain the necessary moisture in this segment to ensure a natural balance that is ensured by the mucous membranes. Therefore, affected patients are dependent on regular inhalations with liquid nebulizers in order to be able to delay the inevitable secretion obstruction as long as possible.
  • Aneurysms are caused by morbid sagging of the vessel wall, in which blood collects and clots. Due to the weight load, the vessel wall expands more and more at this point, more Blood flows, stagnates and coagulates In addition to the growing risk of thrombosis, this process inevitably leads to vascular wall rupture.
  • US5951599 attempts to solve this problem by filling the free interstices of a vascular stent with a small meshed partially applied polymer network that comes to rest in the blood vessel above the outgrowth and covers the aneurysm so as to prevent blood flow into the outgrowth.
  • a solid thrombus forms in the outgrowth, thus stopping the enlargement of the aneurysm.
  • the polymeric cover should prevent the blood plug or parts of the clot from being flushed into the bloodstream and cause infarction elsewhere.
  • aneurysms are currently being treated by filling in the out-puff with metal wires (“coils”) that are designed to stop blood flow within the out-puff.
  • the object of the present invention is now to provide a coated endoprosthesis and in endoprostheses with interstices such as e.g. To provide stents interdisciplinary or Eisenraumabjod coated endoprostheses, which equally avoids the disadvantages described for all body passages including coronary applications and to provide an optimal, uniform manufacturing process for all such implants despite consideration of the existing site conditions.
  • the Fadengewirrbe Anlagenung is flexible, mechanically stable, consists of a polymeric material, consists of threads that randomly and randomly aligned and confused and connected to each other and has stitches, which are formed by the surrounding threads.
  • the individual threads of the Fadengewirrbe Anlagenung consist of the polymeric material and in particular the polymers mentioned herein. These polymers preferably have the highest possible average degree of polymerization.
  • This tangle of threads can be applied both as a coating of full-surface, tubular endoprostheses, such as bladder catheters, bypasses and artificial intestinal exits and on so-called stents.
  • stents are understood to be lattice-shaped or net-shaped endoprostheses.
  • a stent does not form a solid tube, but a grid mesh.
  • a stent it is made of a solid tube, e.g. cut by laser, so that there are individual, as thin as possible struts, which are interconnected.
  • struts as used herein is intended to mean the individual solid segments (stent struts) of the framework of the endoprostheses or stents which are interconnected at junctions and form the expandable and flexible structure of the endoprosthesis.
  • An endoprosthesis When cutting a stent, areas between the individual struts are cut out, which are referred to herein as "spaces".
  • An endoprosthesis therefore has a plurality of solid framework components (eg struts in the form of rings, coils, shafts and wires) which together form the endoprosthesis and a plurality of spaces between these massive components.
  • the struts In the common embodiment of endoprostheses, the struts converge at nodal points so that the gaps are defined by the surrounding struts and nodes.
  • the struts have, for example, the shape of rings or spirals.
  • interstitial spaces it is meant the open or circumscribed area between the solid components of the endoprosthesis.
  • An inventive Fadengewirrbe istung on a stent is applied across spaces. That is, it is also the gap coated, which is formed by the gap surrounding this gap. This coating thus spans the interstices of the individual struts like a bridge, which is attached only to the framework, the struts, and rests in the space on any solid surface.
  • the resulting sheath may affect both the entire cylindrical stent body and only selected portions thereof. For example, either proximal or distal segments, the central region, individual segments or longitudinally coated semipermeable stents and, of course, combinations of these regions can be coated depending on the indication.
  • the coating preferably lies on the outside, ie, on the side facing away from the lumen (i.e., abluminal). Depending on the indication, however, the side facing the lumen can also be coated with a coating of a polymeric, closely meshed thread tangle. It is also possible to coat both sides.
  • FIG. 3 shows how the thread-tangled coating is wound around the stent, and the torn-open areas reveal the luminal metallic surfaces of the stent struts.
  • the coating from the thread tangle is not wrapped around the individual stent struts, but only around the entire stent, abutting the abluminal surface of the stent struts.
  • FIG. 7C shows how the coating from the tangle of threads envelops the entire stent like a textile cover and the stent pattern in the interior of the thread-tang coating easily penetrates and is thus easily recognizable.
  • Used for coating are supports for all body passageways as well as body cavities, which are also commonly referred to herein as "vessels", such as veins, veins, esophagus, bile ducts, kidney ducts, sinus cavities in the nose and mouth, trachea, ducts in the bronchi, small bowel segments, colon or other approximately tubular body passageways, this preferred group of endoprostheses having a latticed or reticulated structure such as a stent.
  • body passages or "vessels” encompasses not only natural body passages or body channels, but also artificial body openings and body channels such as bypasses and artificial intestinal exits.
  • endoprostheses coated according to the invention are, for example, larynx implants, bypasses, catheters or artificial intestinal exits and in general, all areas in or on the living organism where the body passageway must remain free as well as movable, while the vessel walls are not completely isolated from the lumen side, so that the necessary contact between the vessel inner wall and lumen comes
  • the permeable coating also allows the exchange, removal and delivery of important subsurface subsurface components dance between the volume of lumen and the surface of the cavity, such as liquid, moisture, nutrients, or molecular substances necessary to maintain the functions.
  • such a coated endoprosthesis can be adjusted according to individual use on thread diameter, thread length, mesh size and mesh size, pore size and pore formation, degree of crosslinking and inter- and possibly additional intrinsic filament tangle according to the requirements in the target vessels.
  • a thread tangle as well as a thread tangle coating consists of loosely and disorderly connected fibers or threads, which are difficult to separate into individual fibers or threads due to the confused and random, disordered structure.
  • the strength of a thread weft and thread tangle coating is due to the inherent adhesion and tangled, random and disordered structure.
  • the thread tangle can be additionally solidified, for which various methods such as increased temperature, light, humidity and / or pressure can be applied.
  • a solidified thread tangle is preferred as a coating in the organism, as it is prevented that strings detach and can lead to complications.
  • the adhesion of the threads to each other and thus the solidification results in the ideal case already during the drying process by the evaporation of the solvent.
  • the Fadengewirrbe harshung is tear-resistant, expandable and compressible or crimpable (ie, for example, be placed on a catheter balloon).
  • the sterilization of the endoprosthesis heat sterilization with hot air, and steam, fractional sterilization or chemical sterilization with ETO, ozone formaldehyde, hydrogen peroxide or peracetic acid
  • ETO ozone formaldehyde
  • a thread tangle in the sense of the invention is therefore a textile fabric made of individual fibers or threads that are not woven, knitted or braided or otherwise connected or joined together according to a specific pattern.
  • woven, knitted and knitted fabrics of yarns and membranes are made of films that are subject to some organizing principles or weave patterns.
  • the fibrous coating from the yarn tangles consists of fibers or threads whose position can only be described by statistical methods.
  • the threads also referred to as fibers are confused, disordered and random to each other.
  • the openings which result between the threads are called stitches.
  • the term "mesh” as used herein thus refers to an opening between the surrounding filaments of the thread tangle coating. These openings are not necessarily round, but may take any shape, since the threads of the Fadengewirrbe Anlagenung are randomly distributed and aligned. Thus, an opening, ie a loop usually surrounded by several threads. In addition, the meshes have a certain size distribution. In this case, the maximum extension of this opening and the transverse diameter as the minimum diameter of this opening is understood as the longitudinal diameter of a mesh. The cross-sectional area of a mesh is the area of this opening, ie this mesh within the surrounding threads.
  • the totality of the meshes has an average longitudinal diameter as well as an average transverse diameter as well as an average cross-sectional area. there these are the averaged values of the sizes defined above the totality of the stitches.
  • the determination of the number, area and diameter of the individual meshes can be carried out spectroscopically.
  • a wedge-shaped mesh dark area in the center of FIG. 4, which tapers to the right in a wedge-shaped manner
  • the underlying tumor cell light area starting directly below the mesh, which extends oblongly oval to below
  • the threads of the Fadengewirrbe harshung have an average thread diameter in the range of 1 ⁇ to 30 pm, preferably in the range of 1 ⁇ to 20 pm, more preferably in the range of 1 pm to 15 pm, even more preferably in the range of 1 pm to 10 ⁇ and more preferably in the range of 2 pm to 7 pm.
  • the meshes of the thread tangle coating have an average diameter in the range from 0.01 ⁇ m to 1000 ⁇ m, preferably in the range from 1 ⁇ m to 1000 ⁇ m, more preferably in the range from 10 ⁇ m to 500 ⁇ m, even more preferably in the range from 25 ⁇ m to 250 ⁇ and particularly preferably in the range of 50 ⁇ to 150 pm.
  • the meshes of the Fadengewirrbe Anlagenung have a certain size distribution, wherein the size of the cross-sectional area of the individual mesh is called at a vertical plan view of the respective mesh and the two-dimensional representation thus obtained.
  • the endoprosthesis can be coated from a thread tangle consisting of a preferably linearly constructed polymer or a mixture of polymers which can be biodegradable or biostable.
  • the one or more polymers can be selected from the group comprising or consisting of:
  • Polyurethane polyethylene terephthalate, polyvinyl chloride, polyvinyl esters, polyvinyl acetal polyamides, polyimides, polyacrylonitriles, polyethers, polyesters such as poly-3-hydroxybutylates, poly-3-hydroxyalkanoates, polyamino acids, polysaccharides, polylactides, polyglycolides, polylactide glycolides, chitosans, carboxyalkyl chitosans such as carboxymethyl chitosans, collagen , Polyphosphazenes, polystyrenes, polysulfones, polysaccharides, silicones, as well as derivatives, block polymers, copolymers and mixtures of the aforementioned polymers. Basically all are biocompatible, uncrosslinked and soluble in a solvent polymers.
  • the present invention also relates to methods of coating biostable or biodegradable endoprostheses, in particular stents, but also of other prostheses and auxiliary materials remaining in the body in the longer term, these being coated with a polymeric, close-meshed thread tangle.
  • the invention therefore also encompasses methods for coating an endoprosthesis for holding open a vessel lumen, comprising the following steps:
  • a coating can also be carried out by means of electrospinning, wet spinning or melt spinning.
  • the solvents used are preferably those solvents which dissolve the polymer well and are volatile.
  • high vapor pressure solvents such as acetone, butanone, pentanone, tetrahydrofuran (THF), benzene, toluene, petroleum ether, dimethylformamide (DMF), dimethyl sulfoxide (D SO), xylene, ethylene glycol, water, methanol, ethanol, propanol, chloroform are preferable , Methylene chloride, ethyl acetate, n-hexane, isopropanol, phenol or mixtures thereof.
  • the threads of Fadenergirrs by the threads themselves, which are formed by the spraying of the solution, by these threads are attached with still sticky wet surface on contact and superimposed on each other and this also additives whose surfaces are not are sticky or at least do not have to be sticky, incorporate into the thread tangle such as drugs.
  • no additional adhesives or crosslinking or crosslinking reagents are needed, which would significantly change the yarn surfaces.
  • the threads of the yarn tangle are glued together at the contact points by the threads which are still sticky due to the presence of the solvent, so that a thread tangling according to the invention is produced.
  • the structure of the yarn tangles also has better capillary properties, which are favorable for the absorption of liquid and moisture.
  • the spraying of the solution to form the threads can preferably be effected by means of compressed air atomizing nozzles.
  • the structure of the thread tangle and the thread diameter can be varied via material pressure, nozzle opening variations, distance between endoprosthesis and nozzle as well as over polymer concentration. Since the bonding of the threads takes place only at their points of contact, the entire Fadengewirrbe- layering is thus flexible and movable, thereby tearing the Fadengewirrbe- coating is avoided during dilation.
  • the thread tangle coating may preferably be stretched by up to 10% of its length without cracking, more preferably being stretched by up to 100% of its length, more preferably being stretched by up to 200% of its length, and most preferably by up to 400% Their length can be stretched without causing cracks.
  • the inventive thread-tangled coating of the endoprosthesis preferably has a defined as air permeability porosity from 1 ml to 150 ml [1 to 150 ml / (cm 2 * 60s)] and even more preferably from 10 ml to 100 ml [10 to 100 ml / (cm 2 * 60s)], and more preferably from 20 ml to 50 ml of air per square centimeter per minute [ml / (cm z * 60s)] at a pressure difference of 1.2 KPa.
  • An endoprosthesis according to the invention is preferably characterized in that the thread-tangled coating according to the invention has meshes and consists of porous threads.
  • the thread tangle coating can be designed in such a way that a tumor cell has no possibility of penetrating between the threads into the inner lumen of the endoprosthesis (see FIG. 4).
  • the lumen-side surface of the hollow organ z. B. can dry out because the adjustable size of the mesh maintains the further supply of the inner surface with the necessary moisture because the coating from the thread tangles the inner surface of the hollow organ or body passage does not separate like a continuous impermeable film from the inner lumen of the endoprosthesis, but only excludes the passage of larger particles or cancer cells, but not the passage of liquid, water or air.
  • This disadvantage however, have stents with a polymeric film-like full-surface coating, which no longer allow moisture exchange or air exchange.
  • the stents coated according to the invention allow the necessary exchanges between the vessel wall and the lumen to continue, so that the expanded inner wall region of the vessel is not isolated from the necessary processes and / or substances, and consequently the healing process is optimally supported. Depending on the place of use, this also reduces or even eliminates the problem of bacterial colonization by the body's own germicidal processes.
  • a further luminal coating of the stent coated according to the invention with hydrophilic polymers can have a supporting effect.
  • a lumen-smooth surface may be desirable, such as in a tracheal stent, so that mucosal drainage can be ensured.
  • This can easily be achieved by placing the coating according to the invention on an endoprosthesis, which is placed on a cylindrical metal core adapted to the diameter of the endoprosthesis so that no threads can protrude into the lumen, but the thread-tangled structure nevertheless luminally and abluminally flawlessly is trained.
  • Fadengewirre be used or applied according to the invention, which further contain at least one antiproliferative, antimigrative, antiangiogenic, anti-inflammatory, antirestenotic, anti-inflammatory, cytostatic, cytotoxic and / or antithrombotic agent.
  • This active ingredient may be contained in covalently bound form or in adhesive or ionic bonded form.
  • the release of the active ingredient or of the active substance mixture from the thread worm coating according to the invention takes place not only where the stent struts are located, as is the case with conventional stents, but is ensured over the entire diseased area where the endoprosthesis coated according to the invention is implanted.
  • the rough thread tangle structure which is rough in comparison to the smooth coating of the struts of conventional stents, is helpful in colonizing the damaged areas with new cells, since the adhesion is facilitated.
  • the thread tangles envelop the resulting bumps of the body passages in the injury area and thus provides for a substantial and necessary protection as in the case of vascular stents against Platelet attachments in the area of the injury and thus forms a significant inhibition of initiated by the attachment of activated platelets coagulation cascade with the consequent life-threatening hemostasis.
  • the coating of a polymeric tight mesh tangle serves as a mechanical barrier against hyperproliferation, tumor growth, new fistula formation and cyst formation as well as outward bleeding.
  • At least the necessary minimum contact between the lumen and the vessel wall is maintained via the still permeable structure of the thread wad so that the most necessary conditions, such as e.g. Passage of nutrients,
  • the textured surface of the thread tangle coating provides additional support of the endoprosthesis in the vessel wall.
  • the coating of the invention in the simplest way can expand the selection of suitable active ingredients.
  • Active ingredients can be added to the thread tangle forming polymers directly during the spraying process in the spray solution.
  • Active ingredients can be introduced subsequently by filling the stitches formed by the threads of the thread tangle.
  • the active ingredients elute at different rates.
  • Active ingredients may be locally separated from each other, on the one hand in the porous or biodegradable polymer fiber itself and on the other between the yarn thread forming threads. 15. The distribution of active ingredients throughout the endoprosthesis is unrestricted even despite local separation.
  • the lumen side of such a coated endoprosthesis may be smooth as needed, coated or uncoated, with or without active ingredient.
  • Partial application of the coating from a polymeric, close-meshed tangle of yarns may specifically treat the diseased site, e.g. For example, a tumor growing into the lumen on the right side can be stopped by a stent coated only on this side. The opposite side of the endoprosthesis remains uncoated or is only coated as usual on the struts.
  • the pores formed by the thread tangle can be filled not only with active ingredient, but if necessary also with other materials and excipients, which elute after a short time with the active ingredient or degraded.
  • rapidly degradable polymers can be used as drug carriers and elution controls, as well as drug delivery enhancers, so-called transport mediators or mediators.
  • the coating can be used from a polymeric tight-meshed tangle with sufficient, preferably limited temporal stability without endoprosthesis.
  • the possibly drug-containing thread tangle is sprayed directly onto a mandrel.
  • the possibly drug-containing thread tangle is applied directly to the endoprosthesis (in the case of a bladder catheter, for example) or the transport unit.
  • temporary endoprostheses remaining in the body such as, for example, biased catheters or venous catheters coated with thread tangles and, for example, equipped with antibacterial or anti-inflammatory agents, can solve or at least significantly improve the problems of many patients with indwelling catheters.
  • a thread tangle used in this way as a coating of a degradable or biodegradable endoprosthesis can dissolve slowly and in a controlled manner after an adjustable time, without causing secondary complications, which may be associated, for example, with a non-degradable endoprosthesis.
  • a biostable or biodegradable thread tangles on a biodegradable stent makes sense.
  • a biodegradable thread tangle can also be advantageous on a removable implant, e.g. the removal of the endoprosthesis after dissolution of the biodegradable thread tangle.
  • coating and endoprosthesis can be made biodegradable. Again, the presence of active ingredients may be useful.
  • the at least one active ingredient in a separate coating step either directly on the surface of the endoprosthesis and thus under the Fadengewirrbe harshung as well as on the Fadengewirrbe scaffoldung or below and on the Fadengewirrbe harshung.
  • the concentration per active ingredient is preferably in the range of 0.001-500 mg per cm 2 coated surface of the endoprosthesis, ie, the surface is calculated taking into account the total surface of the Fadengewirr- coating according to the invention.
  • the active substance (s) may be below, in and / or on the thread-tangled coating.
  • antiproliferative, anti-inflammatory, antimigrative, anti-inflammatory, anti-angiogenic, cytostatic, cytotoxic, antirestenotic, antineoplastic, antibacterial and / or antifungal agents abciximab, acemetacin, acetylvismion B, aclarubicin, ademetionin, adriamycin, aescin, afromosone, akagerin
  • aldesleukin can be preferably used , Amidorone, aminoglutethemide, amsacrine, anakinra, anastrozole, anemontn, anopterin, antimycotics, antithrombotics, apocymarin, argatroban, aristolactam-all, aristolochic acid, ascomycin, asparaginase, aspirin, atorvastatin,
  • sulfur-containing amino acids such as cystine and salts, hydrates, solvates, enantiomers, racemates, enantiomer mixtures, diastereomer mixtures; Metabolites, prodrugs and mixtures of the aforementioned active ingredients.
  • the Fadengewirrbe slaughterung or the meshes of Fadengewirrbe harshung may optionally also be sealed with a resorbable or resistant to the application impregnation. This may also contain an active ingredient that is delivered in a controlled manner.
  • the stitches formed by the thread tangle can be filled with a resorbable polymer or oligomers or a viscous substance which contains an active ingredient, but may also itself be an active ingredient.
  • a hemocompatible layer can preferably be covatently bound to the uncoated surface of the endoprosthesis or immobilized on the surface by means of cross-linking, for example with glutardialdehyde.
  • a layer which does not activate blood clotting is useful if uncoated stent material can come into contact with blood. So it is preferable to equip a partially coated stent first with this inner hemocompatible layer.
  • an outer possibly additional haemocompatible layer can also be applied to the thread tangle coating.
  • the term "inner” layer or coating refers to the layer or coating applied directly to the stent surface. Layer or coating refers to the top or most distant layer or coating of the stent surface.
  • the preferably hemocompatible layer is prepared from the following preferred substances: heparin native origin as well as regioselectively prepared derivatives of different degrees of sulfation and degrees of acetylation in the molecular weight range of the pentasaccharide responsible for the antithrombotic effect up to the standard molecular weight of the commercially available heparin of about 13 kD, heparan sulfates and its derivatives, oligo and polysaccharides of erythrocyte glycolcalyx, oligosaccharides, polysaccharides, completely desulfated and N-reacetylated heparin, desulfated and N-reacetylated heparin, N-carboxymethylated and / or partially N-acetylated chitosan, polyacrylic acid, polyetheretherketones, polyvinylpyrrolidone, and / or polyethylene glycol and mixtures thereof substances.
  • the methods of the present invention are useful for coating, for example, endoprostheses, and particularly stents such as coronary stents, vascular stents, tracheal stents, bronchial stents, urethral stents, oesophageal stents, biliary stents, renal stents, small bowel stents, colon stents, brain stents, pharyngeal stents, peripheral stents, and other stents.
  • spirals, catheters, cannulas, tubes, guide wires and generally tubular or tubular implants or parts of the aforementioned medical devices can be coated according to the invention.
  • the endoprosthesis and in particular the stent, may be made of common materials such as medical grade stainless steel, titanium, chromium, vanadium, tungsten, molybdenum, gold, iron, cobalt-chromium, nitinol, magnesium, iron, alloys of the foregoing metals, as well as bioresorbable metals and metal alloys such as Magnesium, zinc, calcium, iron, etc., as well as polymeric material and preferably absorbable polymeric material, e.g. Chitosan, heparans, polyhydroxybutyrates (PHB), polyglycerides, polylactides and copolymers of the aforementioned substances exist.
  • a catheter may be made of any common materials, especially polymers such as polyamide, polyether, polyurethane, polyacrylates, polyethers and other polymers
  • the coated medical devices are used in particular for keeping open all gait-like structures, such as urinary tract, esophagus, trachea, biliary tract, kidney, blood vessels throughout the body including the brain, nose, duodenum, pilorus, small and large intestine but also to keep open artificial exits as used for the intestine or for the trachea, but are also provided for long-term necessary artificial inputs and outputs.
  • gait-like structures such as urinary tract, esophagus, trachea, biliary tract, kidney, blood vessels throughout the body including the brain, nose, duodenum, pilorus, small and large intestine
  • small and large intestine but also to keep open artificial exits as used for the intestine or for the trachea, but are also provided for long-term necessary artificial inputs and outputs.
  • the coated medical devices are for the prevention, reduction or treatment of stenosis, restenosis, in-stent restenosis, arteriosclerosis, atherosclerosis, tumors, fistula formation, cyst formation, aneurysms, bleeding into surrounding tissue and all other forms of vascular occlusion, vasoconstriction, vascular dilatation and injury of passageways or exits and also artificial entrances and exits.
  • a further embodiment of the present invention relates to an endoprosthesis having a porous wall made of synthetic polymer, wherein in the wall of the prosthesis microparticles are incorporated, on the surfaces of which anticoagulants are immobilized.
  • the blood coagulation inhibitors are preferably immobilized on the surfaces of the microparticles via so-called linkers (spacer molecules).
  • linkers are not covalently bonded, preferably adsorptively, to the microparticles.
  • the blood clotting inhibitors are preferably covalently linked to the linkers.
  • the covalent linkage is usually based on a chemical condensation reaction between functional groups, for example hydroxyl and / or amino groups, of the linker and suitable reactive groups of the inhibitors.
  • Microparticle surfaces are preferably based on adsorptive, especially electrostatic, interactions between the linkers and the microparticle surfaces.
  • the linkers are polymer molecules, which are suitably linearly constructed.
  • the linkers are preferably oligo- or polyalkylene glycols, in particular polyethylene glycol (PEG).
  • the blood coagulation inhibitors are preferably serine protease inhibitors, in particular thrombin inhibitors.
  • Thrombin is the central enzyme of plasmatic blood clotting, which cleaves fibrinogen to monomeric fibrin. This then polymerizes and cross-links adherent blood components to the thrombus wall to form a thrombus.
  • FIG. 1 shows a PLGA tangle around a partially pre-expanded stent that has been crimped and expanded after the thread mesh coating. It is easy to see that the PLGA case has remained intact.
  • Fig. 3 shows, in comparison to Figs. 1 and 2, a non-pre-expanded endoprosthesis with a burst PLGA-Fadengewirrbe harshung after crimping and expansion experiments.
  • the stent was overstretched in such a way that the thread-tangled coating tore open, as a result of which the thread-like coating structure can be seen particularly well. Under physiological conditions such stent overstretching does not take place, so that tearing of the thread-tangle coating need not be feared.
  • FIG. 5 shows an SEM image of a PU fiber spinning or fiber tangle produced on a spray process on stainless steel gauze (magnified 1000 times).
  • the white circles correspond to about 5pm and should give an impression of the fiber diameter.
  • the areal areas result from sticking together during the spraying process of fibers coming from one another.
  • the estimated pore size of the smallest pores for both materials is between 2 and 5 pm (estimate in 10k images based on the small circles corresponding to approximately 5 pm).
  • the structure of the inner and outer surface of the material does not differ significantly.
  • FIG. 6 shows an SEM image of a PU fiber spinning or fiber tangle produced by spraying on stainless steel gauze (enlarged 800 ⁇ ). The areal areas result from sticking together during the spraying process of fibers coming from one another.
  • the estimated pore size of the smallest pores varies between the two materials 2 and 5 ⁇ (estimate in 10k images based on the small circles corresponding to about 5 m).
  • the structure of the inner and outer surface of the material does not differ significantly. shows the endoprosthesis in different phases of the coating.
  • Example 1 Pre-coating of the Endoprosthesis Struts with a Polymer
  • the struts of an endoprosthesis are spray-coated with a 0.5% PLGA solution.
  • the stent is hung horizontally on a thin metal rod, which is inserted on the axis of rotation of the rotary and feed system and rotated at a defined speed of rotation.
  • the stent is sprayed with the spray solution. After drying at room temperature and storage in the fume hood overnight, weigh again.
  • the pre-coating of the stent struts or endoprosthesis struts ensures better adhesion of the Fadengewirres on the struts.
  • Example 2 Surface peripheral precoating of the struts of the endoprosthesis with an antiproliferative drug-containing polymer
  • Spray solution 145.2 mg PLGA or polysulfone and 48.4 mg rapamycin or a 33% spray solution of a corresponding active ingredient combination of rapamycin (proportion 20% -90%) with one or more further active ingredients such as paclitaxel, cyclosporin A, thalidomide, Fusadil etc. are made up to 22 g with chloroform.
  • This spray solution is applied to the stent as already described in Example 1.
  • the stent used may be a bare stent, a hemocompatible coated stent, and / or a stent coated with an active agent layer via spraying or dipping.
  • Example 3 Pre-coating of an endoprosthesis using the example of a transurethral or suprapubic catheter with an antibacterial active substance-containing polymer
  • the partially pre-expanded endoprostheses are sprayed on the same spray coater as in Example 1 with a 3% chloroform-containing PLGA solution to apply a dense moisture-permeable thread tangle.
  • Example 5 Production of a full-surface or striation-space-spanning full-surface thread-wound-coated endoprosthesis with a smooth inner wall and PU thread-tangled coating of the outer surface
  • An endoprosthesis is mounted tightly on a polished stainless steel rod and dipped in a viscous polyurethane solution (PU) in THF (about 16%) (e.g., Chronoflex C 65D ex Avansource Biomaterials Inc.).
  • PU viscous polyurethane solution
  • Example 6 Yarn spray coating of an endoprosthesis placed on a balloon catheter
  • the pretreated stent is crimped onto the balloon catheter and then completely coated with a 5% PLGA spray solution (Resomer RG504H from Evonik with an inherent viscosity of 0.54 dl / g) in chloroform according to Example 2.
  • the functionality of the coating was still present even after 5 days storage time without inert atmosphere.
  • Unexpanded stents made of LVM 316 medical grade stainless steel are degreased with acetone and ethanol in an ultrasonic bath for 15 minutes and dried in an oven at 100 ° C. Then they are immersed for 5 minutes in a 2% solution of 3-aminopropyltriethoxysilane in a mixture of ethanol / water (50/50: (v / v)) and then dried for 5 minutes at 100 ° C. Subsequently, the stents are washed overnight with demineralized water.
  • Example 8 Production of an endoprosthesis with a smooth inner wall and sprayed outer wall using the example of polyurethane
  • the substrate used for the dipping / spraying process to make the polyurethane vascular prosthesis is a polished stainless steel rod.
  • the metal rod is first dipped in a viscous PU solution (e.g., Carbothane PC-3575A) in THF to obtain a smooth inner wall. Subsequently, a 6% polyurethane-THF solution is sprayed onto the precoated metal rod. After drying, the endoprosthesis is dissolved after a 30 min long bath in 60 ° C SDS solution from the metal rod. The endoprosthesis obtained has a wall thickness of 1 mm.
  • a viscous PU solution e.g., Carbothane PC-3575A
  • the wall thickness can be adjusted via the spraying process.
  • the desired range of wall thickness is preferably between 1 and 1, 5 mm.
  • the diameter as well as the length of the endoprosthesis is variable and depends on the diameter and length of the stainless steel rod
  • the Sprühfadengewirr be prepared 1, 5% to 6% Poiycarbonaturethan - solutions in THF with 5%, 10% and 20% surfactant content based on the solids content of the solution.
  • the cylinder is moved back and forth in the longitudinal direction at a defined speed while simultaneously rotating about its longitudinal axis.
  • the thread worms have a wetting and spreading behavior that becomes better for water. (However, the different concentrations of the surfactant have little influence on the spreading behavior of water or water-like liquids or wetting behavior of the thread-weft surface.)
  • the thread tangle is applied as evenly as possible.
  • the layer thickness is varied. In the case of the surface described here, for example, it is not thicker than 20 m.
  • Polyethersulfone / PVP solution Weigh out 24.0 mg of PS and 1, 4 mg of PVP and make up to 3 g with chloroform - 0.80% PS, 0.047% PVP
  • Example 1 a base layer of polyethersulfone coated with only the struts, with or without active ingredient, with or without hydrophilic polymer addition to the polyethersulfone can be applied.
  • Active ingredients or active ingredient combinations can be mixed with up to about 40% by weight with polyethersulfone with the addition of an intrafilamentary permeability-increasing hydrogel such as PVP, PVA, u.a. Hydrophilic polymers are dissolved in chloroform, so that a solution is formed which contains at least 0.04% hydrogel and can be applied to an endoprosthesis.
  • polyethersulfone with the addition of an intrafilamentary permeability-increasing hydrogel such as PVP, PVA, u.a.
  • Hydrophilic polymers are dissolved in chloroform, so that a solution is formed which contains at least 0.04% hydrogel and can be applied to an endoprosthesis.
  • Example 11 Interfilamentary active substance-containing thread tangle coating of an endoprosthesis
  • a pure active substance layer can be applied to the thread-tangled coating by spraying the surface with a solution having a defined content of active ingredient and then drying it.
  • the Fadengewirrbe Anlagenung can also be loaded in a simple manner by immersion in a drug-containing solution with another or the same drug. Due to the capillary forces, the pores of the tangle of yarn are filled with active substance.
  • different active ingredients can be applied separately, for example, e) filling the pores of Fadengewirres with substances that accelerate the uptake of an active ingredient in the vessel wall. e) filling the pores with short-term biodegradable polymers such as PLGA 50/50, which controls the active ingredient and releases it with a time delay. f) Combinations of the previous variations

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Abstract

L'invention concerne des endoprothèses de type treillis ou réseau qui présentent une couche continue de fils entrelacés recouvrant des interstices, cette couche continue de fils entrelacés recouvrant des interstices couvrant à la fois les entretoises et les interstices entre les entretoises des endoprothèses.
EP11738589.8A 2010-05-27 2011-05-27 Revêtement d'endoprothèses d'une couche de fils polymères entrelacés à mailles serrées Withdrawn EP2575917A2 (fr)

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DE201010022589 DE102010022589A1 (de) 2010-05-27 2010-05-27 Filzbeschichtung von Gefäßstützen
US34452010P 2010-08-13 2010-08-13
DE102011009053 2011-01-21
US201161457450P 2011-03-31 2011-03-31
PCT/DE2011/001152 WO2011147409A2 (fr) 2010-05-27 2011-05-27 Revêtement d'endoprothèses d'une couche de fils polymères entrelacés à mailles serrées

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