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とらふみいりぐら
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2 CH R C (CH 2 C) x (CH 2 ) x C CHCH 2 C n n n R R CH 2 CH 2 (CH 2 ) x C n n (CH 2 CH 2 CH 2 C) y n C (CH 2 ) x C n (CH 2 ) x C n (NH CH C) x R CN CH 2 C CR n R ( CH R C) y n P R N n

3 N H CH R C n N H CH R C n H H H H H CH H NHR H CH R CH 2 C n CH 2 CH H n B P ( ) n

4 H 2 Catalyst Enzyme Enzyme H 2 Catalyst Enzyme H 2 Catalyst (Tg < T) (Tg > T)

5 GPa GPa % L DL- G L = 9 1 = 9 1 ( ) ( ) [ ( ) ] [ ( ) ] [ ( ) ]

10 PGA

13 PTCA)

15 Coil type coronary stent Slotted tube type coronary stent Wiktor stent Palmaz-Schatz stent

16 (2002 )

Short and Long-term Vascular Tissue Response to the Duke Biodegradable Stent Zidar JP, Gammon RS, Chapman GD, Culp SC, Brott BC, Clark, H, Bauman RP, Waller BF, Phillips HR, Stack

17 Short and Long-term Vascular Tissue Response to the Duke Biodegradable Stent Zidar JP, Gammon RS, Chapman GD, Culp SC, Brott BC, Clark, H, Bauman RP, Waller BF, Phillips HR, Stack RS Presented at ACC, 1993 JACC vol.21,439a PLLA stent in dog femoral artery Conclusion: Hemocompatible and noninflammatory to the dog femoral artery Duke self-expandable PLLA stent

18 Marked Inflammatory Sequelae to Implantation of Biodegradable and Nonbiodegradable Polymers in Porcine Coronary Arteries van der Giessen WJ, Lincoff AM, Schwartz RS, van Beusekom HMM, Serruys PW, Holmes Jr DR, Ellis SG, Topol EJ Circulation ; 94: Five different biodegradable and some non-biodegradable polymers were implanted in pig coronary arteries Conclusion: Marked inflammatory and neointimal response to an array of biodegradable as well as nonbiodegradable polymers after implantation in the porcine coronary artery

19 Poly(L-lactic acid) Poly(glycolic acid) Glycolic acid/lactic acid copolymer (85/25) Poly(ε-caprolactone) Poly(hydroxybutyrate-co-hydroxyvalerate) (78/22) Polyurethane Poly(dimethyl siloxane) Poly(ethylene terephthalate) Internal Elastic lamina neointima Polymer Lumen Stent wire Wiktor stent

20 X Local drag delivery

23 Knitted PGA stent PGA Knitted PGA stent

24 Knitted PGA stent 2 weeks 12 weeks 24 weeks S : stent strut L : lumen M : media N : neointima

25 Knitted PGA Knitted PLLA stent PGA 2 weeks 4 weeks PLLA S : stent strut L : lumen M : media N : neointima 2 weeks 4 weeks

26 PGA PLLA PGA PGA ph PLLA

27 PLLA 2 weeks 4 weeks 2 weeks 4 weeks

Coil type PLLA stent (zig zag helical coil) Material :

Stent design : Zig zag helical coil self-expanding ability (+)

170mm) Radio-opaque markers : 2 gold markers Currently available

28 Coil type PLLA stent (zig zag helical coil) Material : PLLA(poly-L-lactic acid) medical grade 5, 6, 6 7, 8 /36mm 5 /78mm Stent design : Zig zag helical coil self-expanding ability (+) Strut thickness :.007inch (.170mm) Radio-opaque markers : 2 gold markers Currently available diameters : 3.0, 3.5, 4.0 mm Currently available length : 12 mm Surface area : 24% Deployment : balloon expandable

29 % stenosis PGA knit PLLA knit Palmaz-Schatz PLLA helical coil 20 Immediately 6 weeks 0 5 min 2 weeks 4 weeks Time after implantation Coil type 2 weeks 16 weeks

30 Histological Findings (Pigs) H.E. 2 weeks 6 weeks 16 weeks

31 Histological Findings (Pigs) H.E. 2 weeks 6 weeks 16 weeks

32 Mechanical Properties Inner tube Contracted stent Cover tube Force gauge Measurement of bending rigidity

33 Mechanical Properties 0.1 N ptical Microscope Stent Weight Measurement of compressive destruction 0.1 N

34 Biodegradable Polymer Stent 1. Knitted type PGA stent in dog coronary artery 2. Knitted type PGA stent in pig coronry artery 3. Knitted type PLLA stent in pig coronary artery 4. Coil type PLLA stent in pig coronary artery 5. Coil type PLLA stent in human coronary artery

35 Biodegradable Drug Eluting Stent 3.5 / 12 mm

PCI(percutaneous Coronary Intervention)

PCI(percutaneous Coronary Intervention) HP No.5 3 PCI HP No.5 3 PCI PCI Catheter Guide Wire Balloon Stent Guiding Catheter t-pa UK PCI PCI Filtering Collimating I.I. size X Framing I.I. Guiding Catheter Guide Wire size Balloon PCI PCI ACC American