JP2007229123A - Stent - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a stent having a sustained-release property without using biodegradable polymer. <P>SOLUTION: This stent is provided with an expandable tubular stent body 10, and a polymer layer 12 covering the stent body and composed of soft segmented polyurethane. The polymer layer is bored with multiple pores. This stent is dipped in solution of argatroban and being dried so as to support argatroban. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a stent (intraluminal graft) used in recent years for endovascular therapy and surgery, in particular, stenotic coronary artery, stenotic carotid artery, bile duct, esophageal dilation, and aneurysm occlusion.

  Conventional treatment of ischemic heart disease is percutaneous transluminal coronary angioplasty (PTCA), that is, a balloon catheter is carried through a lumen in a blood vessel to, for example, a stenotic site, and then the balloon is expanded with a liquid such as physiological saline. Treatment methods were common. However, with this method, there is a high probability that coronary occlusion in the acute phase and re-stenosis (so-called restenosis) at the site where PTCA is performed occur. In order to solve these problems, an intraluminal graft called a stent has been developed and recently put into practical use and has become widespread. Recent data show that nearly 75% of balloon catheter surgery has already been replaced by stent surgery.

  The stent body is an intraluminal graft that is carried through the inside of a lumen such as a blood vessel and supported by an action from the inside by expanding its diameter at the treatment site of the lumen. Although it is mainly used in the above-mentioned coronary artery surgery, it will be described mainly here. However, the stent is a bile duct, esophagus, trachea, prostate, ureter, fallopian tube, aortic aneurysm, peripheral artery, kidney. It can also be used for other luminal parts of the human body such as arteries, carotid arteries, and cerebral blood vessels. In particular, the field of use of stents is expanding, so in the future, stents will be used in many operations such as stenosis site dilatation, aneurysm occlusion, and cancer therapy, especially in the field of neurosurgery. Expected to increase in importance.

  Restenosis can be drastically prevented by the spread of surgery using stents. However, since the metallic stent body is a foreign substance in the body, thrombosis develops within a few weeks after insertion of the stent body. In other words, since the metal stent itself has thrombogenicity, when exposed to blood, it contacts with plasma proteins such as albumin and fibrinogen and aggregation occurs due to adhesion of platelets. It is also pointed out that the placement of a metal stent body promotes thickening of the vascular endothelium, which is one cause of restenosis. Thus, WO 2004/022150 describes that a metal stent body is covered with a flexible polymer film such as segmented polyurethane having fine holes.

  In living tissue, inner surfaces such as blood vessels, that is, portions that come into contact with blood are covered with a cell layer called endothelial cells. Since the surface of these endothelial cells is covered with sugar and the endothelial cells themselves secrete substances that suppress platelet activation such as prostaglandins, thrombus and the like are unlikely to occur in living tissues. In the above-mentioned stent of WO2004 / 022150, by coating the metal stent body with a polymer film such as segmented polyurethane, it is possible to promote moderate endothelialization and reduce thrombogenicity.

This WO 2004/022150 describes that a polymer layer is covered with a biodegradable polymer, and that the biodegradable polymer contains an antithrombotic agent such as argatroban (sometimes referred to as argatropan).
WO2004 / 022150

  The above-mentioned WO 2004/022150 has the following improvement problems.

(1) The biodegradable polymer used in the above-mentioned WO 2004/022150 is often an acidic substance that adversely affects the living body, and may cause inflammation and thrombus.

(2) When a stent covered with segmented polyurethane is supported on argatroban by the method of WO2004 / 022150, the swollen segmented polyurethane film is in close contact with the stent body, and one stent body is complicated. Since it has a skeletal structure and the tension applied to the film is different between the partial portions, there are a portion where swelling is restricted and a portion where the swelling is open during swelling, and wrinkles are generated in the film.

(3) When wrinkles are generated in the film, the argatroban content is physically uneven. Furthermore, argatroban is a compound having a molecular weight of about 509 and having a guanidyl group and a sulfer-like skeleton, and is a sterically complex structure having a larger molecular weight than a compound having the same molecular weight and a linear structure. Therefore, if the degree of swelling differs between portions of the film, the amount of argatroban molecules penetrating between the segmented polyurethane molecules becomes non-uniform.

(4) When argatroban is supported on the film, the Young's modulus of the film changes. The amount of change depends on the amount carried. If the loading amount of argatroban is inhomogeneous and there are a portion where the loading amount is large and a portion where the loading amount is small, there will be a portion that is easily stretched and a portion that is difficult to stretch during stent expansion.

  An object of the present invention is to provide a stent which can eliminate such drawbacks and can provide sustained release of a drug without using a biodegradable polymer.

  The stent of the present invention is a stent comprising a tubular stent body that can be expanded in diameter and a flexible polymer layer that covers the stent body, in which a drug soluble in a solvent that swells the polymer layer is dissolved. The stent is immersed in, and then dried.

  The stent of claim 2 is characterized in that, in claim 1, the drug is an antithrombotic agent having a molecular weight of 1000 or less. The antithrombotic agent as used herein includes all agents having antithrombotic activity, such as platelet aggregation inhibitors, antithrombin agents, anticoagulants, and thrombolytic agents.

  The stent according to claim 3 is the stent according to claim 1 or 2, wherein the drug is heparin, low molecular weight heparin, hirudin, argatroban, formacolin, bapiprost, prostamorin, prostachyline homologue, dextran, lofepro-algchloromethylketone , Dipyridamole, glycoprotein platelet membrane receptor antibody, recombinant hirudin, thrombin inhibitor, vascular peptin, vascular tensin converting enzyme inhibitor, steroid, fibroblast growth factor antagonist, fish oil, omega-3 fatty acid, histamine , Antagonist, HMG-CoA reductase inhibitor, ceramine, serotonin blocking antibody, thioprotein inhibitor, trimazole pyridimine, interferon, vascular endothelial growth factor (VEGF), rapamycin, FK506 Mevalotin, is characterized in that fluvastatin, those selected from the group consisting of simvastatin and thrombomodulin.

  The stent according to claim 4 is characterized in that, in claim 2, the drug is argatroban.

  A stent according to a fifth aspect is the stent according to any one of the first to fourth aspects, wherein a plurality of micropores are formed in the polymer layer.

  A stent according to a sixth aspect is characterized in that, in the fifth aspect, the micropores are arranged at substantially uniform intervals.

  A stent according to a seventh aspect is characterized in that, in the fifth or sixth aspect, the micropores are provided at intervals of 51 to 10000 μm and have a diameter of 5 to 500 μm.

  The stent according to claim 8 is the stent according to any one of claims 1 to 7, wherein the polymer layer is made of segmented polyurethane.

  A stent according to a ninth aspect is characterized in that, in any one of the first to eighth aspects, a coating thickness of the polymer layer is 10 to 100 μm.

  In the stent of the present invention, since the flexible polymer layer is in close contact with the stent body, there is no problem of metal allergy, cell irritation by metal, and generation of rust. This polymer layer carries the drug by dipping and drying the drug solution, and has sustained release characteristics without using a biodegradable polymer.

  In the present invention, micropores are preferably perforated with regularity in the segmented polyurethane film covering the stent. When immersed in alcohol, the segmented polyurethane swells and is limited by the stent skeleton, but the arranged micropores function to correct the force distortion between the tensile load and open portions. Therefore, wrinkles generated in the film are minimized. Thereby, compared with the stent covered with the segmented polyurethane film without micropores, the amount of drug loaded such as argatroban becomes uniform.

  Hereinafter, embodiments will be described with reference to the drawings.

  The stent body constituting the stent of the present invention is preferably a tubular body having a length of about 1 to 200 mm and a diameter of about 1/50 to 1/2 of the length. Further, the thickness of the stent body (thickness of the tubular portion) is preferably 11 to 2000 μm, more preferably 51 to 500 μm, and particularly preferably 101 to 300 μm. The stent body is preferably in a mesh shape so that the diameter of the stent can be expanded flexibly, and in particular, it is preferably an oblique lattice shape as shown in FIG. 2 and the extending direction of the lattice is a spiral direction.

  The stent body is preferably made of a biocompatible metal. Examples of the biocompatible metal include stainless steel, titanium, tantalum, aluminum, tungsten, nickel / titanium alloy, cobalt / chromium / nickel / iron alloy, and the like. The metal stent body is preferably subjected to heat treatment in order to memorize the shape. By this heat treatment, self-expandability can be imparted to the stent body.

  As the material used for the flexible polymer layer, a high-flexibility polymer elastomer is suitable, for example, polystyrene, polyolefin, polyester, polyamide, silicone, urethane, fluorine resin, natural rubber, etc. Various elastomers and their copolymers or their polymer alloys can be used. Among them, segmented polyurethane, polyolefin polymer, and silicone polymer are preferable. Particularly, segmented polyurethane having high flexibility and high strength is optimal.

  A segmented polyurethane polymer has a flexible polyether portion as a soft segment and a portion rich in aromatic rings and urethane bonds as a hard segment, and the soft segment and the hard segment are phase-separated to form a fine structure. It is what. This segmented polyurethane polymer is excellent in antithrombotic properties. Moreover, it is excellent in properties such as strength and elongation, and can be sufficiently expanded without breaking even when the stent is expanded in diameter.

  The coating thickness of the polymer layer such as the segmented polyurethane polymer (d in FIG. 1 described later) preferably has a thickness of 1 μm to 100 μm, particularly 5 μm to 50 μm.

  This polymer layer is preferably provided with a plurality of micropores. The fine holes may be randomly arranged, but preferably the fine holes are perforated at substantially uniform intervals. The fact that the micropores are perforated at a substantially uniform interval does not mean that the intervals are the same, but that the micropores are arranged at a substantially constant interval by a controlled method. Accordingly, the substantially uniform interval includes diagonal, circular, and elliptical arrangements that appear to be randomly arranged at first glance. The micropore may have any size and shape as long as the endothelial cells can enter and exit. Preferably, it is a circle having a diameter of 5 to 500 μm, most preferably 10 to 100 μm. Needless to say, other shapes such as an ellipse, a square, and a rectangle are also included. These are the states before expansion, and when the stent body is expanded and placed in the lumen, the circle is deformed into an oval shape, and the diameter changes accordingly. Moreover, as an arrangement | positioning space | interval of a micropore, it arrange | positions on a some straight line by the space | interval of 51-10000 micrometers, Preferably 101-8000 micrometers, More preferably, 201-5000 micrometers. The plurality of straight lines include, for example, 10 to 50 straight lines arranged at a predetermined constant angular interval in the axial direction of the stent.

  In the present invention, a therapeutic agent such as an antiplatelet agent, an antithrombotic agent, a growth promoting agent, a growth inhibitory agent, or an immunosuppressive agent is supported on the polymer layer by dipping or drying the solution. This therapeutic agent is gradually released into the body to suppress thrombus formation, prevent smooth muscle cell proliferation to prevent stenosis, inhibit cancerous cell proliferation, and endothelial cell proliferation It is effective to promote endothelialization and obtain endothelialization at an early stage. It is preferable that the treatment loading of the therapeutic agent is performed after a perforation process described later.

  This treatment includes heparin, low molecular weight heparin, hirudin, argatroban, formacholine, bapiprost, prostamorin, prostakyrin congeners, dextran, lofepro-algchloromethylketone, dipyridamole, glycoprotein platelet membrane receptor antibody, combination Reversible hirudin, thrombin inhibitor, vascular peptin, vascular tensin converting enzyme inhibitor, steroid, fibroblast growth factor antagonist, fish oil, omega-3 fatty acid, histamine, antagonist, HMG-CoA reductase inhibitor, ceramine, Serotonin blocking antibody, thioprotein inhibitor, trimazole pyridimine, interferon, vascular endothelial growth factor (VEGF), rapamycin, FK506, mevalotin, fluvastatin, symbus Drugs such Chin and thrombomodulin can be mentioned.

  The polymer layer on the outer peripheral surface side of the stent may be coated with a lubricious substance on the outer surface in order to make the movement in the fine blood vessels in the human body smooth. Such lubricating substances include low molecular weight hydrophilic substances such as glycerin, biocompatible substances such as hyaluronic acid and gelatin, synthetic hydrophilic polymers such as polyethylene glycol, polyacrylamide, polydimethylacrylamide, and polyvinylpyrrolidone. Can be mentioned.

  For example, the following method (1) or (2) can be employed to cover the entire outer surface of the stent body with the polymer layer in close contact with each other. The methods (1) and (2) are not limited.

(1) A mold having a cylindrical inner hole is rotated about its axis, and a polymer solution is supplied into the mold to form an outer polymer layer, and then the stent body is placed in the mold. After supplying, a method of rotating the mold around its axis and supplying a polymer solution into the mold to form an inner polymer layer, and then removing from the mold.

  In this method, first, a cylindrical mold having a cylindrical inner surface is used, and the mold is rotated around its axis and a polymer solution for the outer polymer layer is placed therein. Feed and centrifuge outer polymer layer.

  The polymer solution may be a polymer solution or a polymerizable solution such as a monomer. As this polymer solution, for example, a segmented polyurethane polymer solution made of an organic solvent such as dioxane or tetrahydrofuran can be used. As the polymerizable solution such as a monomer, for example, a deacetone type, a dealcohol type, a deoxime type condensation-curing silicone rubber or the like can be used.

  Either the supply of the polymer solution or the rotation of the mold may be first, but it is preferable to supply the polymer solution into the rotating mold. Moreover, it is preferable to move the injection position of the polymer solution along the axial direction of the mold and supply the polymer solution uniformly over a wide range in the mold.

  After the film of the polymer solution for the outer layer is formed on the inner peripheral surface of the mold, the stent body is supplied to the inside of the mold, and then the polymer solution for forming the inner polymer layer is supplied to the mold. Centrifuge. Thereafter, after a curing process such as drying, ultraviolet irradiation, and heat treatment, the stent body is removed from the mold, and a perforation process is performed on the stent body.

  In addition, after forming the film | membrane of the polymer solution for outer layers along a shaping | molding die inner peripheral surface, it is preferable to supply a stent main body in a shaping | molding die after performing hardening processes, such as drying and ultraviolet irradiation. When supplying the stent body into the molding die, the stent body may be supplied as it is into the molding die, or may be supplied into the molding die after pre-wetting by dipping in the resin material liquid.

  As described above, fine holes are drilled with a laser or the like in the stent body removed from the mold. The formation of a biodegradable polymer or lubricious polymer coating layer and the drilling of micropores by laser processing can be performed first, but here a method of drilling micropores by laser processing is used later. Described.

(2) After the mandrill is immersed in the polymer solution, it is pulled up vertically to form the inner polymer layer, and then the stent body is mounted so as to be externally fitted to the mandrill having the inner polymer layer. After immersing the mandrill with the stent body in the polymer solution, it is pulled up to form the outer polymer layer, and then the mandrill is pulled out.

  That is, after slowly immersing the mandrill in the polymer solution so that bubbles are not involved, the mandrill is pulled up vertically and subjected to a curing treatment such as drying or ultraviolet irradiation as necessary to form an inner polymer layer. When this polymer solution is a polymer solution, drying is suitable as the curing treatment, and when the polymer solution is a monomer polymerizable solution, ultraviolet irradiation or heat curing is suitable as the curing treatment.

  Next, the stent body is mounted so as to be externally fitted to the mandrill having the inner polymer layer, the mandrill having the stent body mounted thereon is slowly immersed in the polymer solution, and then pulled up vertically to the outer polymer layer. Form. After the outer polymer layer is cured, the mandrill is pulled out to produce a stent body. In the manufactured stent element body, the inner polymer layer and the outer polymer layer usually protrude longer than both ends of the stent body, so that the excess protruding polymer layer is cut off.

  In the case of forming the biodegradable polymer layer, the mandrill is immersed in the biodegradable polymer solution prior to the formation of the inner polymer layer or after the outer polymer layer is formed, and the coating treatment is performed in the same manner as described above. Just do it. If a therapeutic agent is added to the biodegradable polymer solution, a coating containing the therapeutic agent can be formed, and the type, molecular weight, coating thickness, etc. of the biodegradable polymer are adjusted. As a result, it is possible to set the time and period for releasing the therapeutic agent into the body. The lubricating polymer layer can be formed in the same manner.

  The fine holes of the polymer layer can be provided by laser processing or the like so as to penetrate the inner polymer layer and the outer polymer layer before or after the mandrill is drawn.

  When pulling out a mandrill from a molded stent body, the mandrill can be easily immersed in an organic solvent that swells slightly, preferably swells with a volume expansion rate of 10% or less. It can be pulled out. Depending on the material of the polymer film, for example, when a segmented polyurethane resin is used for the polymer film, the mandrill is used in a lower alcohol, preferably methanol or ethanol, particularly preferably methanol, preferably 1 to 30 hours, particularly preferably 5 It is preferable to soak for ~ 20 hours. As a result, the mandrill can be easily pulled out. The reason for this is not necessarily clear, but the polymer film slightly swells and weakly adheres to the mandrill and has a low affinity for both the metal and polymer layers and is a low surface tension liquid. It is inferred that alcohol penetrates into the interface between the metal mandrill and the inner polymer layer to reduce the adhesion between the mandrill surface and the polymer layer and at the same time improve the slidability.

  For example, as shown in FIG. 1, the stent manufactured in this way has a polymer layer 12 in close contact with the entire outer surface of the stent strut 11 constituting the mesh-shaped stent body. The inner peripheral surface A is a smooth surface formed by the polymer layer 12. With such a stent, since there is no exposed surface of the metal stent body, the problems of metal allergy, metal irritation, and rust generation are eliminated. In addition, thrombus is prevented from being generated, and in particular, since the inner peripheral surface is a smooth surface without unevenness, the occurrence of thrombus in the uneven portion is eliminated. Moreover, there is no problem of misalignment between the polymer layer and the stent body before and after expansion of the stent.

  In addition, the coating thickness of the above-mentioned polymer layer shows the thickness part of the polymer layer 12 which has directly covered the stent strut 11 shown by d in FIG.

  Solvents for dissolving the therapeutic agent used for supporting the therapeutic agent on the polymer layer include alcohols such as methanol, ethanol, propanol, butanol, acetone, tetrahydrofuran, ethyl acetate, chloroform, hexane, dimethylformamide, N -Methylpyrrolidinone, pyridine, water, or a mixed solvent thereof can be used, and may be appropriately selected by those skilled in the art in consideration of the solubility of the therapeutic agent, but methanol and ethanol are particularly preferable. The concentration of the therapeutic agent is preferably about 1 mg / mL to 100 mg / mL.

  The immersion time is preferably about 1 to 120 minutes. At the time of immersion, the drug solution is uniformly and rapidly diffused to the inner wall side of the stent by the effect of the micropores arranged in the polymer layer. Drying can be performed by air drying, spraying with warm air, vacuum drying, etc., but it is preferable to dry in clean air through a HEPA filter in order to prevent bacterial growth and contamination.

  In addition, segmented polyurethane is suitable as the polymer layer when this immersion treatment is performed.

Example 1
As the stent body, a mesh-shaped stent body 10 having a diameter of 4 mm, a length of 20 mm, and a thickness of 0.2 mm shown in FIG. 2 was employed.

  FIG. 3 is a side view of the metallic stent body 10 'after expansion. The metal stent body 10 'has a diameter of 8 mm, a length of 20 mm, and a thickness of 0.2 mm.

  A stent having a segmented polyurethane polymer layer coated on the entire outer surface of the metal stent body 10 was manufactured. Specifically, a SUS316 mandrill is immersed in a polyurethane solution to coat the polyurethane layer on the cylindrical inner surface of the mandrill, and a slightly expanded metal stent body is overlaid on top of this, and further immersed in the polyurethane solution to form a film. After coating on both sides and further laser processing, the films on both ends were cut off and immersed in ethanol to extract the stent body from the mandrill.

  The polyurethane solution is a 10 wt% solution of Capdiomat ™ SPU: segmented polyurethane (manufactured by Kontoron Cardiovascular Inc.) in a mixed solution of tetrahydrofuran and dioxane.

  In the formed polyurethane polymer layer, holes having a diameter of 100 μm were formed substantially uniformly at intervals of 200 μm by an excimer laser. After drilling one row of holes in the long axis direction, the stent body was rotated 15 ° in the circumferential direction to drill 24 rows of holes on the entire circumference.

  The coating thickness d of the stent thus obtained was 25 μm.

  As shown in FIG. 1, this stent has a polyurethane polymer layer 12 covering the entire outer surface of a lattice strut 11 of the stent body with good adhesion, and even if the stent skeleton moves due to the expansion of the stent body, the polyurethane polymer It can be seen that the layer follows this and the positional relationship between the polymer layer and the stent is preserved. In addition, it can be seen that the protruding structure of the stent strut protruding from blood flow is smoothed by lamination with a polymer film.

Next, argatroban was supported on the stent as follows.
Argatroban was dissolved in methanol (Kanto Chemical, special grade reagent) in a bioclean bench to adjust the concentration to 25 mg / mL, and filtered through a hydrophobic membrane filter made of PTFE to prepare an argatroban solution for immersion. The above-mentioned stent was put into this argatroban solution and immersed for 30 minutes under gentle stirring. During this time, it was confirmed that the polymer film stretched between the stent struts swelled to loosen the film, but local deformation, that is, wrinkles, was not confirmed. Pull out the stent from the solution, wipe off excess droplets adhering to the surface, and leave it in a dust-free dryer (FA420, FA420) so that the long axis direction is up and down, and at 30 ° C. for 10 hours Dried. When the stent was confirmed after drying, the polymer film stretched between the stent struts was not loosened and returned to the same state as before the dipping treatment, and it was found that argatroban was uniformly supported on the entire surface of the polymer film. The amount of argatroban supported in the film was about 1 mg per 1 cm ^{2 when} confirmed by an immersion experiment using a flat film having the same thickness made by the same Capdiomat.

It is typical sectional drawing which shows the covering state by the polymer layer of the stent of this invention. It is a perspective view of a stent main body. It is a perspective view of the stent main body expanded in diameter.

Explanation of symbols

10 Stent Body 11 Stent Strut 12 Polymer Layer

Claims (9)

In a stent having an expandable tubular stent body and a flexible polymer layer covering the stent body,
A stent obtained by immersing the stent in a solution obtained by dissolving a drug soluble in a solvent that swells the polymer layer, and then drying the stent.   The stent according to claim 1, wherein the drug is an antithrombotic agent having a molecular weight of 1000 or less.   3. The drug according to claim 1, wherein the drug is heparin, low molecular weight heparin, hirudin, argatroban, formacholine, bapiprost, prostamorin, prostachyline homologue, dextran, lofepro-algchloromethyl ketone, dipyridamole, glycoprotein platelets Membrane receptor antibody, recombinant hirudin, thrombin inhibitor, vascular peptin, vascular tensin converting enzyme inhibitor, steroid, fibroblast growth factor antagonist, fish oil, omega-3 fatty acid, histamine, antagonist, HMG-CoA reductase Inhibitor, ceramine, serotonin blocking antibody, thioprotein inhibitor, trimazole pyridimine, interferon, vascular endothelial growth factor (VEGF), rapamycin, FK506, mevalotin, full bath Chin, stent, characterized in that a member selected from the group consisting of simvastatin and thrombomodulin.   The stent according to claim 2, wherein the drug is argatroban.   The stent according to any one of claims 1 to 4, wherein a plurality of micropores are formed in the polymer layer.   6. The stent according to claim 5, wherein the micropores are arranged at substantially uniform intervals.   The stent according to claim 5 or 6, wherein the micropores are provided at intervals of 51 to 10000 µm and have a diameter of 5 to 500 µm.   The stent according to any one of claims 1 to 7, wherein the polymer layer is made of segmented polyurethane.   The stent according to any one of claims 1 to 8, wherein a coating thickness of the polymer layer is 10 to 100 µm.

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