HYDROGEL JACKETED STENTS
Hydrogel jacketed stents provide the ability to fill in the stent frame in vivo to at least partially cover the interior of the surface of the stent following deployment while having the convenience of attaching the jacket to the exterior of the stent. The hydrogel can be pleated and/or folder over the exterior of the stent to provide for extension of the stent without damaging the hydrogel. The hydrogel sheet can be secured at one or more points along the circumference to associate the sheet of hydrogel with the exterior surface of the stent frame. The stent can be conveniently delivered using similar technology as conventional stents if desired. The hydrogel can provide for drug delivery if desired.
This application is a divisional of copending U.S. patent application Ser. No. 13/269,863 to Dardi, entitled “Hydrogel Jacketed Stents,” which claims priority to copending U.S. provisional patent application 61/391,736 filed on Oct. 11, 2010, entitled “Hydrogel Jacketed Stents,” both of which are incorporated herein by reference.
FIELD OF THE INVENTIONThe invention relates to stents used to open up occlusions within a vessel within a patient, such as a blood vessel, generally an artery. In particular, the invention relates to stents with a hydrogel jacket over a frame that swells in vivo to at least partially surround the frame to reduce contact of the frame with the flow through the vessel. The invention further pertains to methods for forming and using the stent.
BACKGROUND OF THE INVENTIONStents have found significant utility for facilitating the opening of clogged or narrowed vessels, such that the flow of blood or other biological fluid is restricted. In addition to blood vessels, stents have found utility for use in bile ducts, ducts of the reproductive system, and other similar vessels in the body. Of particular medical importance are coronary stents, which are placed in a coronary artery or other arteries to treat atheroscerosis. Stents used to open vessels generally have an elongate cylindrical structure with stent walls having an open construction that provides for tissue in growth around the stent frame. The stents are delivered in a low profile configuration and are extended out to the vessel within the patient either simultaneously or subsequently to a procedure to correspondingly expand the diameter of the vessel lumen. However, stents can be prone to restenosis, due to an inflammatory response induced by the foreign object in the body. In other words, in some cases thrombus formation or the like can take place at the site of the stent.
To reduce restenosis, polymer coatings have been used to coat stents, and the coatings generally are drug eluting. The coatings generally comprise a hydrophilic polymer that is coated over the frame elements. The coated stents maintain an open structure of the frame. Coated stents have met with considerable success commercially. However, studies have suggested cracking of the polymer coating that has been linked in studies with deleterious effects to the patient.
SUMMARY OF THE INVENTIONIn a first aspect, the invention pertains to jacketed stent for placement in a bodily vessel comprising an extendable stent frame having an exterior surface defined by the stent frame and a hydrogel sheet associated with the exterior surface of the scaffold such that the hydrogel forms a jacket over the stent frame upon extension of the stent frame to its extended configuration. In some embodiments, the hydrogel sheet can have a thickness and expansion in an aqueous fluid such that the expanded hydrogel sheet at least partially covers the inner surface of the extended stent in an aqueous environment. A medical device can comprise a delivery catheter, a delivery actuator supported by the delivery catheter and the jacketed stent operably connected with the delivery actuator to control deployment of the stent in a vessel.
In a further aspect, the invention pertains to a jacketed stent comprising a stent frame having an outer surface and a hydrogel sheet associated with the outer surface of the stent frame. In some embodiments, the hydrogel sheet is folded to accommodate a larger surface area of the hydrogel sheet relative to the outer surface of the stent frame and wherein the stent frame extends to a deployed configuration with the hydrogel sheet stretched along the outer surface of the stent frame.
In additional aspects, the invention pertains to a jacketed stent comprising a stent frame and a hydrogel sheet. The stent frame can have an open structure, an outer surface, and an extended configuration with a diameter at least about a factor of two greater than its initial configuration. The hydrogel sheet can be associated with the outer surface of the stent frame, and in some embodiments the hydrogel sheet hydrates to an expanded form with a thickness at least about 1.5 greater than its initial thickness.
In another aspect, the invention pertains to a method of forming a hydrogel jacketed stent, the method comprising securing a hydrogel sheet over an extendable stent frame in a low profile configuration, in which the hydrogel is structured to provide for expansion in diameter by at least of the stent frame by a factor of at least about 2 and in which the hydrogel expands upon hydration to a thickness at least about 1.5 times the initial thickness of the sheet. The hydrogel jacket can be folded and/or pleated around the stent frame in an un-deployed configuration such that the hydrogel jacket unfolds when deployed.
Furthermore, the invention pertains to a method for the delivery of a hydrogel jacketed stent comprising extending the stent to an extended configuration within the lumen of a vessel within a patient, wherein the stent comprises an open structured stent frame having an outer surface and a hydrogel jacket associated with the outer surface. In some embodiments, the extended stent has the hydrogel jacket secured between the vessel wall and the stent frame such that the hydrogel hydrates and expands to fill the open portions of the stent frame after sufficient time to provide for hydration of the hydrogel.
New stent designs have been developed that use a jacket of a hydrogel over an open scaffolding of the stent, such as a conventional stent frame. The hydrogel can function effectively as an alternative to a coating that is designed to avoid cracking, peeling or the like. The hydrogel can be selected to have reasonable elastic properties and expansion upon contact with aqueous liquid. The use of a jacket of expanding hydrogel addresses a range of issues in an effective and practical way with the potential of significantly improved clinical results. Even with significant elasticity, the hydrogel may not be able to accommodate the large expansion associated with stent deployment. However, the hydrogel can be pleated, folded or otherwise placed over the un-deployed stent so that the jacket opens up or unfolds to accommodate the expanding dimension of the stent allowing for more modest elasticity of the hydrogel. Expansion of the hydrogel jacket over the expanded stent can result in the hydrogel expanding through and around the open stent structure, and the expanded hydrogel may form an effective lining of the stent from an initially unlined structure. Through the expansion of the hydrogel, edges associated with the stent structure can be smoothed with the hydrogel polymer to reduce the incidence of thrombus formation as well as restenosis. Also, the hydrogel can be a very effective drug delivery system providing for the possibility of the controlled release of a significant quantity of a selected drug or drugs.
Stents have been used effectively to support the opening of blood vessels at occlusions for mammalian patients, especially human patients. For example, stents have been used in coronary arteries, carotid arteries, saphenous vein grafts, other blood vessels as well as other vessels, such as bile ducts, vessels of the urinary track, vessels of the reproductive track and the like. Stents generally have an approximately cylindrical shape with a structure having open walls. The stent generally is delivered in a narrow profile, and the stent can be deployed with a balloon or the like. In some embodiments, the stent is self extending, such as following release of the stent from a sheath or the like. The stent upon deployment generally increases very significantly in diameter. For example, the stent can be formed from a suitable material that is elastic and/or has a shape memory such that the stent material can expand as designed without breaking or excessively weakening. Due to this significant structural changes corresponding with stent delivery, significant forces are imposed on coatings during the deployment of the stent, and studies have suggested that some stents coatings that are drug eluting may be susceptible cracking of the coating. Regardless, the jacketed stents herein provide significant potential advantages since the material is not constrained as a coating.
The jacketed stents described herein comprise a stent frame and a jacket over the exterior of the stent frame. The jacket comprises a hydrogel. Generally, the stent frame can have any reasonable uncoated or coated stent design, such as existing designs. Stent frames can have an open design of interconnected struts arranged in a generally cylindrical shape. Commercial stents have been formed of resilient metal, although polymer stents have been proposed.
Stents may be, for example, balloon extendable, self-extendable or extendable using any other reasonable mechanism. Balloon extendable stents can be crimped to the balloon for delivery. Some balloon-stent structures are described further, for example, in U.S. Pat. No. 6,106,530, entitled “Stent Delivery Device,” U.S. Pat. No. 6,364,894, entitled “Method of Making an Angioplasty Balloon Catheter,” and U.S. Pat. No. 6,156,005, entitled “Ballon [sic] Catheter For Stent Implantation,” each of which are incorporated herein by reference.
Stents and balloons associated with therapeutic agents are described further in U.S. Pat. No. 6,491,617 to Ogle et al., entitled “Medical Articles That Resist Restenosis,” incorporated herein by reference. Drug coated stents have been sold commercially. Examples of commercial coronary stents include, Cypher™ from Cordis/Johnson & Johnson, which has a coating that elutes sirolimus from a PEVA and PBMA, Taxus™ from Boston Scientific, which has a coating that elutes paclitaxel from SIBS copolymer coating and Endeavour™ from Medtronic, which has a coating that elutes zotarolimus from phophorylcholine. These particular coated stents are for coronary use.
The jacket for the stent comprises a hydrogel that covers the exterior of the stent or a portion thereof. A hydrogel is a non-soluble hydrophilic polymer. Generally, a hydrogel is crosslinked to introduce the non-soluble feature. Due to the hydrophilicity, hydrogels generally swell when in contact with an aqueous solvent. Hydrogels can be formulated to be biocompatible for placement in a patient.
Hydrogels of particular interest can exhibit significant swelling with contact with an aqueous solution. In particular, the hydrogel can swell at least about 50% in volume, and in some embodiments at least about 100% relative to an initial volume. Thus, the swelling hydrogel can expand to file the spaces between structural elements of the stent, especially when the stent is deployed with the hydrogel wedged between the vessel wall and the stent frame. Thus, the expanding hydrogel can effectively remove the edges of the stent structure from contact with the blood flow to reduce surfaces that can induce thrombosis.
The hydrogel should have reasonable mechanical strength so that the hydrogel is not significantly damaged during expansion of the stent. In some embodiments, the hydrogel jacket can stretch a factor of two in diameter without rupturing. Correspondingly, in some embodiments, the hydrogel can be relatively elastic so that the hydrogel can expand somewhat during expansion of the stent. Suitable elastic hydrogels are described in U.S. Pat. No. 6,960,617 to Omidian et al. (the '617 patent), entitled “Hydrogels Having Enhanced Elasticity and Mechanical Strength Properties,” and published U.S. patent application 2009/0317442 to Banister et al. (the '442 application), entitled “Super Elastic Epoxy Hydrogel,” both of which are incorporated herein by reference. The '617 patent further discusses drug elution from hydrogels.
If the stent does not expand at deployment disproportionally to the expansion ability of hydrogel, then the hydrogel can be wrapped directly along the outer surface of the stent frame at delivery into the patient's vessel. However, in some embodiments, the hydrogel is not able to expand to the extent in which the stent expands. For these embodiments, the hydrogel can be placed around the stent such that the hydrogel unfolds upon deployment of the stent such that the hydrogel is jacketed in a stretched configuration over the exterior of the extended stent. For example, the hydrogel jacket can be pleated or wrapped over the exterior of the initial stent configuration. Once the stent is deployed into the extended configuration, the hydrogel swells as the hydrogel hydrates. The swelled hydrogel can be designed to expand through the openings in the wall of the stent to extend into the interior of the stent. Following expansion of the hydrogel, the swollen hydrogel may effectively form a coating along the interior of the stent within the vessel.
While it is generally desirable to limit the overall thickness of the deployed stent, the overall volume of the hydrogel jacket can be significantly greater than a stent coating since the thickness can be slightly greater and since the hydrogel fills the spaces between the structural elements of the stent. The hydrogel can be loaded with a drug that elutes into the vessel in a controlled fashion. Due to the larger volume of the hydrogel relative to a coating, a greater amount of drug can be effectively delivered than is practical with a coating. Also, hydrogels can be designed to control the release of the drug in a selected fashion based on experience with hydrogels. The drugs that elute form the hydrogels can include drugs that current elute from stent coatings, similar drugs, other drugs can be desirably delivered or combinations thereof.
When fully hydrated, the hydrogel swells, and the swelling can generally involve the hydrogel at least partially enveloping the stent frame. Depending on the degree of swelling and the hydrogel thickness, the hydrogel can have differing degrees of enveloping the stent frame. This enveloping of the stent frame by the swelling hydrogel can reduce the contact of blood with the stent frame along the interior of the stent. Thus, the hydrogel initially placed on the outside of the stent can improve the interface of the stent with the blood flow within the interior of the stent due to the swelling of the hydrogel. Thus, the hydrogel can reduce any incidence of embolism formation due to the presence of the stent in the vessel.
To form the hydrogel coated stent, a sheet of hydrogel with the selected dimensions can be associated with the unextended stent. The hydrogel can be placed over the stent frame . . . For example, the hydrogel can be manipulated in a moist condition in which it is very pliable, and then dried into the formed low profile configuration for delivery.
Stent Structure and MaterialsThe hydrogel jacketed stents provide for appropriate expansion of the stents while also providing a cover for the stent frame. The hydrogel jacket can be attached over the exterior of the stent in a way to provide for expansion of the stent without resulting in significant damage to the hydrogel jacket during stent deployment. In particular, if the expansion of the stent is not too large and the hydrogel is sufficiently compliant, the hydrogel can be wrapped over the unextended stent frame such that it expands sufficiently to cover the extended stent following deployment without significantly ripping. In further embodiments, the jacket can be pleated, folded, wrapped or otherwise attached such that the hydrogel jacket can at least partially unfurl, possibly with some stretching, when the stent is deployed. Swelling of the hydrogel jacket over the stent frame can provide for at least some encapsulation of the stent frame to reduce or eliminate contact of the flow through the vessel with the stent frame. Sufficient swelling of the hydrogel can result in effective covering of the stent from with the use of only a cover or jacket of hydrogel. In some embodiments the hydrogel can elute a selected drug or combination of drugs.
The stent can be appropriately sized for the particular use of the stent. For example, for placement in coronary arteries, the stents generally have an expanded diameter of about 2 mm to about 5 mm, and other ranges can be suitable for other arteries or other vessels, such as from about 1 mm to about 50 mm. In general, the ratio of the stent diameter following deployment divided by the stent diameter prior to deployment is at least about 1.5, in further embodiments from about 2 to about 6 and in additional embodiments from about 2.25 to about 5. For many applications, the stent can have a length from about 10 mm to 100 mm or more. Generally, a stent product is distributed with a selection of a few sizes for selection of the more appropriate size for a particular vessel in the procedure. The structure of the stent frame can be designed with a generally cylindrical open shape with a woven, bent, molded, coiled, formed or similar open structure of struts, beam, supports or the like that adjusts accordingly to accommodate the significant change in diameter without breaking. A large variety of stent structures are known in the art, which can be adapted for placement of a hydrogel jacket, and new stent designs may be developed in the future. In some embodiments, the hydrogel jacket can have a dry thickness from about 0.001 millimeters (mm) to about 0.5 mm, in other embodiments from about 0.0025 mm to about 0.25 mm, and in further embodiments from 0.005 mm to about 0.1 mm. A person of ordinary skill in the art will recognize that additional ranges of hydrogel thickness within the specific ranges above are contemplated and are within the present disclosure.
Stent frames are generally cylindrical, although the stent frame can have tappers or the like. Also, the stent frame when extended can adjust to the shape of the vessel, which can have irregularities or the like. Stent frames can be formed from, for example, stainless steel, tantalum, shape memory alloys, polymers and coated versions thereof. Suitable shape memory alloys include, for example, Nitinol®, a nickel-titanium alloy, cobalt alloys, such as Elgiloy®, a cobalt-chromium-nickel alloy, MP35N, a nickel-cobalt-chromium-molybdenum alloy, or combinations thereof. Shape memory metals can be used to form self extending stents which extend upon heating, such as to body temperature. Biocompatible polymers are known in the art, and suitable polymers can be bioresorbable. Gold, platinum and/or other radiopaque materials can be used for the stent or a portion thereof to facilitate imaging to facilitate placement of the device in the patient. For example, the stent can be gold plated at its ends to provide enhanced visualization with x-rays.
Various hydrogels have found use in medical applications. Hydrogels generally comprise soluble or hydroscopic polymers that are crosslinked to form to form an insoluble polymer material, although applicant does not want to be limited by particular polymer structure. Hydrogels are insoluble hydrophilic polymers that swell with water in an aqueous environment when contacting an aqueous liquid such that water dispersed through the polymer matrix comprises a significant fraction, and possibly a majority, of the weight of the material in the hydrated form. As noted above, the '617 patent and the '442 application describe specific hydrogels with desirable mechanical properties for use as a hydrogel jacket on a stent. A range of hydrogels have been described in the context of wound healing applications, and some of these hydrogels are suitable for formation of hydrogel jackets.
Suitable polymers compositions for the hydrogel include, for example, polyurethanes, polyacrylic acid and esters thereof, polymethacrylic acid and esters thereof, polyacrylonitrile, cellulose and derivatives thereof, polyethylene glycol and derivatives thereof, polyacrylamide, epoxy polymers, copolymers thereof and mixtures thereof. Crosslinked dendrimer polymers and other highly branched polymers have been proposed for the formation of superelastic epoxy polymers in the '422 application. Hydrogel materials for wound dressings that can be adapted for forming a hydrogel stent jacket are described, for example, in U.S. Pat. No. 4,909,244 to Quarfoot et al., entitled “Hydrogel Wound Dressing,” and published U.S. patent application 2010/0324464 to Kamakura et al., entitled “Wound-Covering Hydrogel Material,” both of which are incorporated herein by reference.
The hydrogel can be delivered with a drug or other therapeutic agent that gradually elutes from the hydrogel within the patient. Suitable therapeutic agents include, for example generic material, such as DNA fragments, DNA vectors, plasmids, RNA or the like. Suitable drugs include, for example, anti-thrombogenic agents, anti-proliferative agents, anti-inflammatory agents, growth factors, growth factor receptor agonists, growth factor inhibitors, cholesterol lowering agents, vasodilating agents, antibiotics, hormones, fibrinolytic agents and the like. Suitable time release agents, such as those known in the art can be used if desired. Therapeutic agents can also be delivered with suitable additives. Referring to
Referring to
The hydrogel may be sufficiently flexible for processing, such as the rolling process of
A pleated embodiment of a hydrogel jacket is shown in
The hydrogel jacket may or may not cover the entire stent frame. For example, as shown in
Upon contact of the hydrogel jacketed stent with the fluid of the vessel within the patient, the hydrogel proceeds to fully hydrate. Referring to
Referring to
A sheath can be used to cover a hydrogel jacked stent for delivery. The sheath can be used to control expansion of a self extending stent, to protect the stent from damage or dislocation, to control hydration of the hydrogel, combinations thereof or for other purposes. The sheath can be withdrawn to expose the stent at an appropriate time of the procedure, such as when the sheath is at the desired deployment location in the patient's vessel. Referring to
For distribution, a hydrogel jacketed stent can be packaged loaded onto a delivery catheter and placed in a sterile wrapper, envelope or the like. Based on the properties of the hydrogel, the hydrogel jacketed stent can be distributed with the hydrogel dried or partially hydrated. If the hydrogel is partially hydrated, the hydrogel jacketed stent can be wrapped in a water tight wrapping that is removed shortly prior to use. The devices can be distributed with proper instruction to properly trained health care professionals.
The hydrogel associated with the deployed stent can provide a desirable surface for contacting the tissue of the vessel as well as the blood flow. Similarly, the hydrogel can provide a suitable environment for the colonization of native cells. The hydrogel can be infused with a desired drug or other compound to provide an improved vascular state at the stent and downstream.
Use of the Jacketed StentIn general, the delivery of the hydrogel jacketed stent can be performed very similarly to the delivery of a conventional stent. The distal end of the delivery catheter is introduced into the patient, for example, with the use of one or more of hemostatic valves, fittings, introducers, guide catheters and the like. The stent then can be positioned in the vicinity of a constriction in the vessel. The delivery of the stent can be achieved with extension a balloon or other mechanical expanding element with appropriate actuation, or with the release of a self-extending device from a sheath or other constraint. The particular extension forces and speed of extension can be selected to be appropriate for the stent frame as well as the hydrogel jacket. In some embodiments, the hydrogel jacketed stent can be exposed to the fluid of the vessel for a period of time prior to stent deployment to provide for additional hydration of the hydrogel prior to deployment.
Referring to
The embodiments above are intended to be illustrative and not limiting. Additional embodiments are within the claims. In addition, although the present invention has been described with reference to particular embodiments, those skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the invention. Any incorporation by reference of documents above is limited such that no subject matter is incorporated that is contrary to the explicit disclosure herein.
Claims
1. A method of forming a hydrogel jacketed stent, the method comprising securing a hydrogel sheet over an extendable stent frame in a low profile configuration, wherein the jacketed stent has a generally cylindrical shape, wherein the hydrogel is structured to provide for expansion in diameter by at least of the stent frame by a factor of at least about 2 and wherein the hydrogel expands upon hydration to a thickness at least about 1.5 times the initial thickness of the sheet.
2. The method of claim 1 wherein hydrogel jacket is folded and/or pleated around the stent frame such that the hydrogel jacket unfolds when the stent scaffolding deployed to an extended configuration with a greater diameter.
3. The method of claim 1 wherein the hydrogel sheet is secured along a point on the circumference of the stent frame.
4. The method of claim 1 wherein the stent frame has an inner surface, an exterior surface, an extended configuration and an un-extended diameter, and the hydrogel sheet is associated with the exterior surface such that the hydrogel sheet forms a tubular jacket over and around the circumference of the stent frame upon extension of the stent frame to its extended configuration.
5. The method of claim 1 wherein the stent frame is non-self extendable and has an open wall, wherein the hydrogel sheet has a dry thickness from 0.05 mm to 0.3 mm, and wherein the hydrogel sheet is secured along a plurality of points on the circumference of the stent frame.
6. The method of claim 1 wherein the stent frame comprises a metal and wherein the hydrogel sheet comprises polyurethanes, polyacrylic acid and esters thereof, polymethacrylic acid and esters thereof, polyacrylonitrile, polyethylene glycol and derivatives thereof, polyacrylamide, epoxy polymers, copolymers thereof or mixtures thereof.
7. The method of claim 1 further comprising forming the hydrogel sheet in a cylindrical format.
8. A method for forming a delivery system for a stent, the method comprising placing a hydrogel jacketed stent over an uninflated balloon on a balloon catheter, wherein the hydrogel jacketed stent is formed by the method of claim 1.
9. The method of claim 8 further comprising placing a sheath over the catheter covering the hydrogel jacketed stent.
10. A method for the delivery of a hydrogel jacketed stent comprising extending the stent to an extended configuration within the lumen of a vessel within a patient, wherein the stent comprises an open structured stent frame having an outer surface and a hydrogel jacket associated with the outer surface, wherein the extended stent has the hydrogel jacket secured between the vessel wall and the stent frame such that the hydrogel hydrates and expands to fill the open portions of the stent frame after sufficient time to provide for hydration of the hydrogel.
11. The method of claim 10 further comprising positioning the stent in an unextended configuration on a balloon catheter in a blood vessel at a selection position for delivery.
12. The method of claim 11 wherein the selected position is within a coronary artery
13. The method of claim 12 wherein the stent frame is non-self extendable and has an open wall, wherein the hydrogel sheet has a dry thickness from 0.05 mm to 0.3 mm, and wherein the hydrogel sheet is secured along a plurality of points on the circumference of the stent frame.
14. The method of claim 10 wherein the hydrogel jacketed stent is covered with a sheath during delivery, and the method further comprising withdrawing the sheath in a proximal direction to expose the hydrogel jacketed stent prior to extending the stent.
15. The method of claim 14 wherein the sheath is designed to control hydration of the hydrogel when the sheath is covering the hydrogel jacketed stent.
16. The method of claim 10 wherein the hydrogel sheet is configured in a cylindrical shape in its unextended configuration.
17. The method of claim 10 wherein the hydrogel jacket is folded and/or pleated around the stent frame such that the hydrogel jacket unfolds when the stent scaffolding deployed to an extended configuration with a greater diameter.
18. The method of claim 10 wherein the hydrogel sheet has a dry thickness from 0.05 mm to 0.3 mm.
19. The method of claim 10 wherein the stent frame has an inner surface, an exterior surface, an extended configuration and an un-extended diameter, and the hydrogel sheet is associated with the exterior surface such that the hydrogel sheet forms a jacket over and around the circumference of the stent frame upon extension of the stent frame to its extended configuration.
20. The method of claim 10 the stent frame comprises a metal and wherein the hydrogel sheet comprises polyurethanes, polyacrylic acid and esters thereof, polymethacrylic acid and esters thereof, polyacrylonitrile, polyethylene glycol and derivatives thereof, polyacrylamide, epoxy polymers, copolymers thereof or mixtures thereof.
Type: Application
Filed: Jan 25, 2017
Publication Date: May 11, 2017
Inventor: Peter S. Dardi (Atlanta, GA)
Application Number: 15/415,783