Biomaterials for Clinical Applications: Coronary Artery Disease

cardiac enzymes used to see if youre having a heart

nitroglycerin dilates blood vessels
heart compensates by englarging
heparin blocks clotting
myocardial = heart muscle, infarction = obstruction

ischemia = lack of oxygen

CAD is the leading killer of both men and women
10^9 myocardial cells can be lost in a heart attack
diet is a questionable factor
endothelial cells are thin, prone to injury, white blood cells recognize injury, vicious cycle
of reinjuring plaque, median cells start joining in
sources of injury: hypertension, hypercoagulable state, oxidized cholesterol,
smoking, stasis
Virchows triad (of factors that can lead to injury)
prolong life: fruits & veggies, good sleep, seatbelt, walk for thirty minutes, dont smoke
be careful when using stents/biomaterials: white blood cells can only see a smooth
endothelial surface or else it will respond badly
in dev of drug eluting-- many drugs eluted are the same used to prevent
transplant rejection
people w ath tend to have more selective molecules, pharmaceuticals addressing this
problem can have side effects that mess w white blood cells that can make a patient
prone to infection, etc
wbc try eating any weird cells, become dead form cells, also respond to mechanical
mismatch (if its not as soft, flexible, etc.) MUST achieve mechanical AND biological
match
filling effect in plaque filled arteries
would rather have stable plaque than unstable
occlusion of left anterior descending artery major cause
occulsion of right coronary artery = back pain instead of chest pain (maybe burping,
nausea)
extensive tissue necrosis and scarring (from bad or several heart attacks), thinning of
heart wall
end stage of coronary artery disease = heart loses ability to pump blood - fluid backs up
into organs and extremeties, known as congestive heart failure
current treatments (LOOK UP PROCESSES):
coronary artery bypass grafting: invasive, long recovery times, complications
(chest wall dehiscence*, graft infections, chest wall infections), bypasses
compromised artery, sometimes can be mechanical mismatches that further
complicate things
stenting - minimally invasive (insertion through femoral artery of leg) effective
although restenosis (reclosure) of arteries is an issue in long term
 balloon angioplasty
coronary artery stenting now used in >75% of all coronary artery procedures
worldwide
up to 25% of patients treated w bare-metal stents experience restenosis
complex arterial lesions such as long lesions, smaller-diameter lesions
vascular bifurcations are more prone to restenosis
rest. proven to be intractable to the systemic administration of drugs
bioactive stents = rationale for incorp. biolog. agents into stents is to
optimize the tissue response to stent implant., prevent restinosis, and
therby improve patient outcomes
stent limits diameter (expanding, contraction), disrupt, mechanical
mismatch
write down specs for bioactive stents
can crimp around balloon yet be strong enough to keep artery open
non thrombogenic surface
ASK ABOUT FLUID, HOW LONG FOR ENDOTHELIAL (STENTS)
drug eluting stents= metallic stent coated with drug loaded polymer (stable),
diffusion of drug out
drugs delivered:
paclitaxel wonder drug, prevents cell division, inhibits cell
mitosis
sirolimus is a powerful immunosuppressant and stop proliferation,
restenosis prevention, rejection of organs
everolimus = derivative of siro; immunosuppressants; anti prolif
zotarolimus =
why is targeted delivery desirable:
DRUGS PREVENT PROLIF OF SMOOTH MUSCLE CELLS, PREVENT
ENDOTHELIALIZATION, NO PROPER HEALING,
clinical trial
who is target patient pop:
what benefit would i expect to demonstrate: restenosis
endpoint: biostability, overall survival
s40: phosphorylcholine based polymer found naturally in cell membrane,
advantageous: biocompatible
s44: cost was an issue
look up VEGF, s46
why inhibit angiogenesis?
double edged sword
avastin

NEXT QUIZ COVERS CLINICAL TRIALS, CORONARY ARTERY DISEASE, AND CARDIAC
TISSUE ENGINEERING