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WO1998017331A1 - Dispositif medical implantable et contenant de l'argent - Google Patents

Dispositif medical implantable et contenant de l'argent Download PDF

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Publication number
WO1998017331A1
WO1998017331A1 PCT/US1997/019188 US9719188W WO9817331A1 WO 1998017331 A1 WO1998017331 A1 WO 1998017331A1 US 9719188 W US9719188 W US 9719188W WO 9817331 A1 WO9817331 A1 WO 9817331A1
Authority
WO
WIPO (PCT)
Prior art keywords
silver
stent
layer
base material
bioactive
Prior art date
Application number
PCT/US1997/019188
Other languages
English (en)
Inventor
Brian L. Bates
Thomas A. Osborne
Joseph W. Roberts
Neal E. Fearnot
Thomas G. Kozma
Anthony O. Ragheb
William D. Voorhees, Iii
Original Assignee
Cook Incorporated
Med Institute, Inc.
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 US08/484,532 external-priority patent/US5609629A/en
Priority claimed from US08/741,565 external-priority patent/US5824049A/en
Application filed by Cook Incorporated, Med Institute, Inc. filed Critical Cook Incorporated
Priority to AU49959/97A priority Critical patent/AU4995997A/en
Publication of WO1998017331A1 publication Critical patent/WO1998017331A1/fr

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    • 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
    • A61L29/00—Materials for catheters, medical tubing, cannulae, or endoscopes or for coating catheters
    • A61L29/08—Materials for coatings
    • A61L29/085—Macromolecular materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
    • A61K51/12—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by a special physical form, e.g. emulsion, microcapsules, liposomes, characterized by a special physical form, e.g. emulsions, dispersions, microcapsules
    • A61K51/1282—Devices used in vivo and carrying the radioactive therapeutic or diagnostic agent, therapeutic or in vivo diagnostic kits, 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
    • A61L27/28—Materials for coating prostheses
    • A61L27/30—Inorganic materials
    • A61L27/306—Other specific inorganic materials not covered by A61L27/303 - A61L27/32
    • 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
    • A61L29/00—Materials for catheters, medical tubing, cannulae, or endoscopes or for coating catheters
    • A61L29/08—Materials for coatings
    • A61L29/10—Inorganic materials
    • A61L29/106—Inorganic materials other than carbon
    • 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
    • A61L29/00—Materials for catheters, medical tubing, cannulae, or endoscopes or for coating catheters
    • A61L29/14—Materials characterised by their function or physical properties, e.g. lubricating compositions
    • A61L29/16—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
    • 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
    • A61L31/082—Inorganic materials
    • A61L31/088—Other specific inorganic materials not covered by A61L31/084 or A61L31/086
    • 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
    • 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
    • A61L33/00—Antithrombogenic treatment of surgical articles, e.g. sutures, catheters, prostheses, or of articles for the manipulation or conditioning of blood; Materials for such treatment
    • A61L33/02—Use of inorganic materials
    • A61L33/022—Metal or alloys
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0067—Means for introducing or releasing pharmaceutical products into the body
    • A61F2250/0068—Means for introducing or releasing pharmaceutical products into the body the pharmaceutical product being in a reservoir
    • 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
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/10—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing inorganic materials
    • A61L2300/102—Metals or metal compounds, e.g. salts such as bicarbonates, carbonates, oxides, zeolites, silicates
    • A61L2300/104—Silver, e.g. silver sulfadiazine
    • 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
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
    • A61L2300/404—Biocides, antimicrobial agents, antiseptic agents
    • 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
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/60—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a special physical form
    • A61L2300/606—Coatings
    • 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
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/60—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a special physical form
    • A61L2300/606—Coatings
    • A61L2300/608—Coatings having two or more layers
    • A61L2300/61—Coatings having two or more layers containing two or more active agents in different layers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
    • A61N5/1002—Intraluminal radiation therapy

Definitions

  • This invention relates generally to human and veterinary medical devices, and, particularly, to implantable medical devices with or without incorporating drugs or bioactive agents and, more particularly, to an implantable device including silver with or without incorporating drugs or bioactive agents.
  • an implantable medical device partly or completely into the esophagus, trachea, colon, biliary tract, urinary tract, vascular system or other location within a human or veterinary patient.
  • many treatments of the vascular system entail the introduction of a device such as a stent, a catheter, a balloon, a wire guide, a cannula, or the like.
  • a device such as a stent, a catheter, a balloon, a wire guide, a cannula, or the like.
  • the blood vessel walls can be disturbed or injured. Clot formation or thrombosis often results at the injured site, causing stenosis or occlusion of the blood vessel.
  • thrombus often forms on the device itself, again causing stenosis or occlusion.
  • the patient is placed at risk of a variety of complications, including heart attack, pulmonary embolism, and stroke.
  • the use of such a medical device can entail the risk of precisely the problems that its use was intended to ameliorate.
  • Atherosclerosis is a condition which commonly affects the coronary arteries, the aorta, the iliofemoral arteries and the carotid arteries. Atherosclerotic plaques of lipids, fibroblasts, and fibrin proliferate and cause obstruction of an artery or arteries. As the obstruction increases, a critical level of stenosis is reached, to the point where the flow of blood past the obstruction is insufficient to meet the metabolic needs of the tissue distal to (downstream of) the obstruction. The result is ischemia.
  • PTA percutaneous transluminal angioplasty
  • a balloon-tipped catheter is inserted in a patient's artery, the balloon being deflated.
  • the tip of the catheter is advanced to the site of the atherosclerotic plaque to be dilated.
  • the balloon is placed within or across the stenotic segment of the artery, and then inflated. Inflation of the balloon "cracks" the atherosclerotic plaque and expands the vessel, thereby relieving the stenosis, at least in part.
  • the blood vessel may suffer acute occlusion immediately after or within the initial hours after the dilation procedure. Such occlusion is referred to as "abrupt closure.” Abrupt closure occurs in perhaps five percent or so of the cases in which PTA is employed, and can result in myocardial infarction and death if blood flow is not restored promptly.
  • the primary mechanisms of abrupt closures are believed to be elastic recoil, arterial dissection and/or thrombosis. It has been postulated that the delivery of an appropriate agent (such as an antithrombic) directly into the arterial wall at the time of angioplasty could reduce the incidence of thrombotic acute closure, but the results of attempts to do so have been mixed.
  • re-narrowing A second major problem encountered in PTA is the re-narrowing of an artery after an initially successful angioplasty. This re-narrowing is referred to as “restenosis” and typically occurs within the first six months after angioplasty. Restenosis is believed to arise through the proliferation and migration of cellular components from the arterial wall, as well as through geometric changes in the arterial wall referred to as “remodeling.” It has similarly been postulated that the delivery of appropriate agents directly into the arterial wall could interrupt the cellular and/or remodeling events leading to restenosis. However, like the attempts to prevent thrombotic acute closure, the results of attempts to prevent restenosis in this manner have been mixed. Non-atherosclerotic vascular stenosis may also be treated by PTA.
  • Takayasu arteritis or neurofibromatosis may cause stenosis by fibrotic thickening of the arterial wall. Restenosis of these lesions occurs at a high rate following angioplasty, however, due to the fibrotic nature of the diseases. Medical therapies to treat or obviate them have been similarly disappointing.
  • a device such as an intravascular stent can be a useful adjunct to PTA, particularly in the case of either acute or threatened closure after angioplasty.
  • the stent is placed in the dilated segment of the artery to mechanically prevent abrupt closure and restenosis.
  • Unfortunately even when the implantation of the stent is accompanied by aggressive and precise antiplatelet and anticoagulation therapy
  • devices and methods which can deliver an antithrombic or other medication to the region of a blood vessel which has been treated by PTA, or by another interventional technique such as atherectomy, laser ablation, or the like. It would also be desirable that such devices would deliver their agents over both the short term (that is, the initial hours and days after treatment) and the long term (the weeks and months after treatment). It would also be desirable to provide precise control over the delivery rate for the agents, drugs or bioactive materials, and to limit systemic exposure to them.
  • the foregoing problems are solved and a technical advance is achieved in an illustrative silver vascular stent or other silver implantable medical device that advantageously reduces if not minimizes the proliferation of fibroblasts and the incidents of restenosis in stented vessels.
  • the silver containing vascular stents can be balloon expandable, self-expanding, or any combination thereof.
  • the balloon expandable silver stent can be deployed at the same time an angioplasty procedure is performed, thus advantageously requiring only one medical procedure.
  • a solid silver vascular stent lends itself well to use in balloon expandable stents because of the malleable nature of the silver.
  • the balloon expandable silver stent can also be made from a base material with good mechanical properties for stenting that is coated with silver by any one of a number of processes. These processes include electroplating, electrostatic, electrolytic ion beam deposition or implantation, sputtering, vacuum deposition or other known application processes over base stent metals such as stainless steel, tantalum, nickel titanium alloys such as nitinol, polymer or copolymer plastics, copper, zinc, platinum, silver or gold, etc.
  • the silver coating (which is used generically to indicate the application or inclusion in silver in any of the above-referenced application processes) can be applied directly to the base material or to an intermediate coating such as parylene or an other metallic coating, e.g. Ti and Pd.
  • the vascular stent or implantable medical device can also be made entirely of silver.
  • a coating of silver with only a 3,000 angstroms thickness is adequate to be effective.
  • Silver can be alloyed with other materials both in the base stent or device material and/or in the coating.
  • the addition of small amount of copper to silver will increase its tensile strength. Pure silver has a maximum tensile strength of about 56 Kpsi. 85% silver and 1 5% copper has a maximum tensile strength of about 91 Kpsi, whereas a mixture of 50% silver with 50% copper can have maximum tensile strength of over 200 Kpsi.
  • the silver can be used in conjunction with other drugs or medicaments on the stent such as Heparin, Taxol, Dexamethosone along with others here after described to further enhance the stents or medical device or implantable medical devices' antithrombogenic or antiproliferative ability.
  • drugs or medicaments on the stent such as Heparin, Taxol, Dexamethosone along with others here after described to further enhance the stents or medical device or implantable medical devices' antithrombogenic or antiproliferative ability.
  • Both the balloon expandable stent as well as the self-expanding stent can be assembled and/or completely coated or tinned with a silver barring solder (for example, 70% silver, 1 5% copper, 1 5% zinc) which can provide or supplement the antiproliferative action.
  • silver can be used alone, as a coating, in combination with other carrier, drug or medicament materials, as one of several other layers of materials, and with base materials that are used to improve the adhesion of silver to any other carrier, drug, medicament or base material.
  • silver can be ion beam bombarded or implanted to provide a specific surface energy density in the preferred range of 20 to 30 dynes per centimeter. In this particular range, not only is the antiproliferative effect of the stent or device enhanced but the outer surface of the stent or device is resistant to the formation of thrombus, fungus, bacteria, and encrustations thereon.
  • Silver coatings, implantations, impregnations or dispersions having a thickness in the range of 3,000 angstroms to .005 inches are contemplated dependent on the thickness of the base material or intermediate layers thereon.
  • Stents or other implantable medical devices using a base material with a silver coating deposited directly thereon is one example of a coating configuration.
  • Another configuration of the stent is to include a base material with a coating of a carrier or dispersant material such as parylene positioned thereon or therein along with a coating, deposition, impregnation, or implantation and the like thereon is also contemplated.
  • Another configuration of the silver stent can include a base material with alternating layers of a carrier material, silver, drug or medicament is also contemplated.
  • Various recesses or cavities included in the surface or made part of the stent or implantable medical device are also contemplated and included with the silver device.
  • vascular stent or other implantable medical device that provides a controlled release of an agent, drug or bioactive material into the vascular or other system, or other location in the body, in which a stent or other device is positioned.
  • Applicants have discovered that the degradation of an agent, a drug or a bioactive material applied to such a device can be avoided by covering the agent, drug or bioactive material with a porous layer of a biocompatible polymer that is applied without the use of solvents, catalysts, heat or other chemicals or techniques, which would otherwise be likely to degrade or damage the agent, drug or material.
  • biocompatible polymers may be applied preferably by vapor deposition or plasma deposition, and may polymerize and cure merely upon condensation from the vapor phase, or may be photolytically polymerizable and are expected to be useful for this purpose. However, it should be recognized that other coating techniques may also be employed.
  • the present invention is directed in its simplest form to an implantable medical device comprising a structure adapted for introduction into the esophagus, trachea, colon, biliary tract, urinary tract, vascular system or other location in a human or veterinary patient, the structure being composed of a base material; at least one layer of a bioactive material posited on one surface of the structure or posited in wells, holes, grooves, slots and the like contained in the structure; and at least one porous layer posited over the bioactive material layer and the bioactive-material-free surface, the porous layer being composed of a polymer and having a thickness adequate to provide a controlled release of the bioactive material.
  • the bioactive material in the at least one layer is heparin or another antiplatelet or antithrombotic agent, or dexamethasone, dexamethasone acetate, dexamethasone sodium phosphate, or another dexamethasone derivative or anti-inflammatory steroid.
  • bioactive materials can be employed, including, but not limited to, the following categories of agents: thrombolytics, vasodilators, antihypertensive agents, antimicrobials or antibiotics, antimitotics, antiproliferatives, antisecretory agents, non-steroidal anti-inflammatory drugs, immunosuppressive agents, growth factors and growth factor antagonists, antitumor and/or chemotherapeutic agents, antipolymerases, antiviral agents, photodynamic therapy agents, antibody targeted therapy agents, prodrugs, sex hormones, free radical scavengers, antioxidants, biologic agents, radiotherapeutic agents, radiopaque agents and radiolabeled agents.
  • agents include, but not limited to, the following categories of agents: thrombolytics, vasodilators, antihypertensive agents, antimicrobials or antibiotics, antimitotics, antiproliferatives, antisecretory agents, non-steroidal anti-inflammatory drugs, immunosuppressive agents, growth factors and growth factor antagonists,
  • the bioactive material must be able to withstand the coating techniques, for example, the vacuum employed during vapor deposition or plasma deposition of the at least one porous layer.
  • the bioactive material must have a relatively low vapor pressure at the deposition temperature, typically, near or at room temperature.
  • the at least one porous layer is preferably composed of a polyamide, parylene or a parylene derivative applied by catalyst-free vapor deposition and is conveniently about 5,000 to 250,000 A thick, which is adequate to provide a controlled release of the bioactive material.
  • "Parylene” is both a generic name for a known group of polymers based on p-xylylene and made by vapor phase polymerization, and a name for the unsubstituted form of the polymer; the latter usage is employed herein. More particularly, parylene or a parylene derivative is created by first heating p-xylene or a suitable derivative at an appropriate temperature
  • the resultant solid can be separated in pure form, and then cracked and pyrolyzed at an appropriate temperature (for example, at about 680°C) to produce a monomer vapor of p-xylylene (or derivative); the monomer vapor is cooled to a suitable temperature (for example, below 50°C) and allowed to condense on the desired object, for example, on the at least one layer of bioactive material.
  • the resultant polymer has the repeating structure - CH 2 C 6 H 4 CH 2 - n , with n equal to about 5,000, and a molecular weight in the range of 500,000.
  • parylene and parylene derivative coatings applicable by vapor deposition are known for a variety of biomedical uses, and are commercially available from or through a variety of sources, including Specialty Coating Systems (1 00 Deposition Drive, Clear Lake, Wl 54005), Para Tech Coating, Inc. (35 Argonaut, Aliso Viejo, CA 92656) and Advanced Surface Technology, Inc. (9 Linnel Circle, Billerica, MA 01 821 -3902).
  • the at least one porous layer can alternatively be applied by plasma deposition.
  • Plasma is an ionized gas maintained under vacuum and excited by electrical energy, typically in the radiofrequency range. Because the gas is maintained under vacuum, the plasma deposition process occurs at or near room temperature.
  • Plasma can be used to deposit polymers such as poly(ethylene oxide), poly(ethylene glycol), and poly(propylene oxide), as well as polymers of silicone, methane, tetrafluoroethylene (including TEFLON brand polymers), tetramethyldisiloxane, and others.
  • polymers such as poly(ethylene oxide), poly(ethylene glycol), and poly(propylene oxide), as well as polymers of silicone, methane, tetrafluoroethylene (including TEFLON brand polymers), tetramethyldisiloxane, and others.
  • the device may include two or more layers of different bioactive materials atop the structure.
  • the same bioactive material will generally not be posited on the different surfaces of the device within the same layer.
  • each surface of the device structure will carry a different bioactive material or materials except where the bioactive material is the innermost or outermost layer, e.g. heparin may form the innermost layer or the outermost layer or both.
  • these additional layers may be placed directly atop one another or can be separated by additional porous polymer layers between each of them.
  • the layers of bioactive materials can comprise a mixture of different bioactive materials.
  • the porous layers are also preferably composed of parylene or a parylene derivative.
  • the two or more bioactive materials can have different solubilities, and the layer containing the less soluble bioactive material (for example, dexamethasone) is preferably posited above the layer containing the more soluble bioactive material (for example, heparin).
  • the layer containing the less soluble bioactive material for example, dexamethasone
  • the more soluble bioactive material for example, heparin
  • the structure included in the device may be configured in a variety of ways, the structure is preferably configured as a vascular stent composed of a biocompatible metal such as stainless steel, nickel, silver, platinum, gold, titanium, tantalum, iridium, tungsten, Nitinol, Inconel, or the like.
  • An additional substantially nonporous coating layer of parylene or a parylene derivative or other biocompatible polymer of about 50,000 to 500,000 A thick may be posited directly atop the vascular stent, beneath the at least one layer of bioactive material.
  • the additional coating layer can merely be relatively less porous than the at least one porous layer, but preferably is substantially nonporous, that is, sufficiently nonporous to render the stent essentially impervious to blood during normal circumstances of use.
  • the present invention is directed to a method of making an implantable medical device of the type disclosed above, in which the method comprises the steps of: depositing at least one layer of a bioactive material on one surface of the structure; and depositing at least one porous layer over the at least one bioactive material layer and the bioactive-material-free surface, the at least one porous layer being composed of a polymer and being of a thickness adequate to provide a controlled release of the bioactive material.
  • the at least one porous layer is polymerized from a monomer vapor which is free of any solvent or polymerization catalyst, and cures by itself upon condensation, without any additional heating or curing aid (for example, visible or ultraviolet light).
  • the at least one layer of the bioactive material may be deposited on the one surface of the structure by any convenient method such as dipping, rolling, brushing, spraying, electrostatic deposition, or the like.
  • the present invention is directed to an improvement in a method of medically treating a human or veterinary patient by the step of inserting an implantable medical device into the body of the patient, the device comprising a structure adapted for introduction into an applicable system of or location in the patient, and the structure being composed of a base material, in which the procedure comprises the preliminary steps of: depositing at least one layer of a bioactive material on one surface of the structure; and depositing at least one porous layer over the at least one bioactive material layer and the bioactive-material- free surface, the at least one porous layer being composed of a polymer having a thickness adequate to provide a controlled release of the bioactive material.
  • the device and methods of the present invention are useful in a wide variety of locations within a human or veterinary patient, such as in the esophagus, trachea, colon, biliary tract, urinary tract and vascular system, as well as for subdural and orthopedic devices, implants or replacements. They are particularly advantageous for reliably delivering suitable bioactive materials during or following an intravascular procedure, and find particular use in preventing abrupt closure and/or restenosis of a blood vessel. More particularly, they permit, for example, the delivery of an antithrombotic, an antiplatelet, an anti-inflammatory steroid, or another medication to the region of a blood vessel which has been opened by PTA.
  • bioactive material for example, the lumen of a blood vessel and another bioactive material to the vessel wall.
  • a porous polymer layer permits the release rate of a bioactive material to be carefully controlled over both the short and long terms.
  • FIG. 1 is a cross-sectional view of a first preferred embodiment of the present invention
  • FIG. 2 is a cross-sectional view of another preferred embodiment of the present invention.
  • FIG. 3 is a cross-sectional view of yet another preferred embodiment of the present invention
  • FIG. 4 is a cross-sectional view of a further preferred embodiment of the present invention
  • FIG. 5 is a cross-sectional view of an additional preferred embodiment of the present invention.
  • FIGs. 6A and 6B are cross-sectional views of an additional preferred embodiment of the present invention.
  • FIG. 7 is a cross-sectional view of an additional preferred embodiment of the present invention.
  • FIG. 8 is a partial, enlarged top view of FIG. 7;
  • FIG. 9 is an enlarged, sectional view along lines 9-9 of FIG. 8;
  • FIGs. 10A-10D are enlarged cross-sectional views along lines 1 0-1 0 of
  • FIG. 8
  • FIG. 1 1 is a pictorial view of a balloon expandable vascular stent with silver included therein;
  • FIG. 1 2 is a cross-sectional view of the cylindrical wire of the stent of FIG. 1 1 ;
  • FIG. 1 3 is side view of the silver vascular stent of FIG. 1 1 in a collapsed condition on a balloon catheter;
  • FIG. 14 is a side view of the stent of FIG. 1 3 in an expanded condition on a balloon catheter;
  • FIG. 1 5 is a pictorial view of another embodiment of a silver endovascular stent etched from a sheet of a base material;
  • FIG. 1 6-1 8 depict various cross-sectional views with silver, carrier, drug, or medicament layers positioned on a base material of, for example, a waveform leg of the stent of FIG. 1 5;
  • FIG. 1 9 depicts a side view of another embodiment of a self-expanding, silver "Z" endovascular stent;
  • FIG. 20 depicts an end view of the Z stent of FIG. 1 9;
  • FIG. 21 depicts the Z stent of FIG. 1 9 deployed in a blood vessel
  • FIG. 22 depicts a balloon expandable, silver stent formed from a cylindrical tube.
  • an implantable medical device 1 0 in accordance with the present invention is shown and first comprises a structure 1 2 adapted for introduction into a human or veterinary patient.
  • “Adapted” means that the structure 1 2 is shaped and sized for such introduction. For clarity, only a portion of the structure 1 2 is shown in FIG. 1 .
  • the structure 1 2 is configured as a vascular stent particularly adapted for insertion into the vascular system of the patient.
  • this stent structure can be used in other systems and sites such as the esophagus, trachea, colon, biliary ducts, urethra and ureters, subdural among others.
  • the structure 1 2 can alternatively be configured as any conventional vascular or other medical device, and can include any of a variety of conventional stents or other adjuncts, such as helical wound strands, perforated cylinders, or the like.
  • the inserted structure 1 2 need not be an entire device, but can merely be that portion of a vascular or other device which is intended to be introduced into the patient.
  • the structure 1 2 can be configured as at least one of, or any portion of, a catheter, a wire guide, a cannula, a stent, a vascular or other graft, a cardiac pacemaker lead or lead tip, a cardiac defibrillator lead or lead tip, a heart valve, or an orthopedic device, appliance, implant, or replacement.
  • the structure 1 2 can also be configured as a combination of portions of any of these.
  • the structure 1 2 is configured as a vascular stent such as the commercially available Gianturco-Roubin FLEX-STENT coronary stent from Cook Incorporated, Bloomington, Indiana.
  • vascular stents are typically about 1 0 to about 60 mm in length and designed to expand to a diameter of about 2 to about 6 mm when inserted into the vascular system of the patient.
  • the Gianturco- Roubin stent in particular is typically about 1 2 to about 25 mm in length and designed to expand to a diameter of about 2 to about 4 mm when so inserted.
  • stent dimensions are, of course, applicable to exemplary stents employed in the coronary arteries. Structures such as stents or catheter portions intended to be employed at other sites in the patient, such as in the aorta, esophagus, trachea, colon, biliary tract, or urinary tract will have different dimensions more suited to such use. For example, aortic, esophageal, tracheal and colonic stents may have diameters up to about 25 mm and lengths about 100 mm or longer.
  • the structure 1 2 is composed of a base material 14 suitable for the intended use of the structure 1 2.
  • the base material 1 4 is preferably biocompatible, although cytotoxic or other poisonous base materials may be employed if they are adequately isolated from the patient. Such incompatible materials may be useful in, for example, radiation treatments in which a radioactive material is positioned by catheter in or close to the specific tissues to be treated. Under most circumstances, however, the base material 14 of the structure 1 2 should be biocompatible.
  • the base material 14 may be either elastic or inelastic, depending upon the flexibility or elasticity of the polymer layers to be applied over it.
  • the base material may be either biodegradable or non-biodegradable, and a variety of biodegradable polymers are known.
  • some biologic agents have sufficient strength to serve as the base material 14 of some useful structures 1 2, even if not especially useful in the exemplary coronary stent.
  • the base material 1 4 can include at least one of stainless steel, tantalum, titanium, nitinol, gold, platinum, Inconel, iridium, silver, tungsten, or another biocompatible metal, or alloys of any of these; carbon or carbon fiber; cellulose acetate, cellulose nitrate, silicone, polyethylene teraphthalate, polyurethane, polyamide, polyester, polyorthoester, polyanhydride, polyether sulfone, polycarbonate, polypropylene, high molecular weight polyethylene, polytetrafluoroethylene, or another biocompatible polymeric material, or mixtures or copolymers of these; polylactic acid, polyglycolic acid or copolymers thereof, a polyanhydride, polycaprolactone, polyhydroxybutyrate valerate or another biodegradable polymer, or mixtures or copolymers of these; a protein, an extracellular matrix component, collagen, fibrin or another biologic agent; or a suitable mixture of any of these.
  • the vascular device 10 of the present invention next comprises at least one layer 1 8 of a bioactive material posited on one surface of the structure 1 2.
  • a bioactive material is posited on one surface of the structure 1 2, and the other surface will either contain no bioactive material or one or more different bioactive materials.
  • one or more bioactive materials or drugs may be delivered, for example, with a vascular stent, to the blood stream from the lumen surface of the stent, and a different treatment may be delivered on the vessel surface of the stent.
  • a vast range of drugs, medicaments and materials may be employed as the bioactive material in the layer 1 8, so long as the selected material can survive exposure to the vacuum drawn during vapor deposition or plasma deposition.
  • Particularly useful in the practice of the present invention are materials which prevent or ameliorate abrupt closure and restenosis of blood vessels previously opened by stenting surgery or other procedures.
  • Thrombolytics which dissolve, break up or disperse thrombi
  • antithrombogenics which interfere with or prevent the formation of thrombi
  • thrombolytics are urokinase, streptokinase, and the tissue plasminogen activators.
  • Particularly preferred antithrombogenics are heparin, hirudin, and the antipiatelets.
  • Urokinase is a plasminogen activating enzyme typically obtained from human kidney cell cultures. Urokinase catalyzes the conversion of plasminogen into the fibrinolytic plasmin, which breaks down fibrin thrombi.
  • Heparin is a mucopolysaccharide anticoagulant typically obtained from porcine intestinal mucosa or bovine lung. Heparin acts as a thrombin inhibitor by greatly enhancing the effects of the blood's endogenous antithrombin III. Thrombin, a potent enzyme in the coagulation cascade, is key in catalyzing the formation of fibrin. Therefore, by inhibiting thrombin, heparin inhibits the formation of fibrin thrombi. Alternatively, heparin may be covalently bound to the outer layer of structure 1 2. Thus, heparin would form the outermost layer of structure 1 2 and would not be readily degraded enzymatically, and would remain active as a thrombin inhibitor.
  • bioactive materials having other functions can also be successfully delivered by the device 1 0 of the present invention.
  • an antiproliferative agent such as methotrexate will inhibit over-proliferation of smooth muscle cells and thus inhibit restenosis of the dilated segment of the blood vessel.
  • the antiproliferative is desirably supplied for this purpose over a period of about four to six months.
  • localized delivery of an antiproliferative agent is also useful for the treatment of a variety of malignant conditions characterized by highly vascular growth.
  • the device 1 0 of the present invention could be placed in the arterial supply of the tumor to provide a means of delivering a relatively high dose of the antiproliferative agent directly to the tumor.
  • a vasodilator such as a calcium channel blocker or a nitrate will suppress vasospasm, which is common following angioplasty procedures.
  • Vasospasm occurs as a response to injury of a blood vessel, and the tendency toward vasospasm decreases as the vessel heals. Accordingly, the vasodilator is desirably supplied over a period of about two to three weeks.
  • trauma from angioplasty is not the only vessel injury which can cause vasospasm, and the device 10 may be introduced into vessels other than the coronary arteries, such as the aorta, carotid arteries, renal arteries, iliac arteries or peripheral arteries for the prevention of vasospasm in them.
  • an anti-cancer chemotherapeutic agent can be delivered by the device 1 0 to a localized tumor. More particularly, the device 10 can be placed in an artery supplying blood to the tumor or elsewhere to deliver a relatively high and prolonged dose of the agent directly to the tumor, while limiting systemic exposure and toxicity.
  • the agent may be a curative, a pre-operative debulker reducing the size of the tumor, or a palliative which eases the symptoms of the disease.
  • the bioactive material in the present invention is delivered across the device 10, and not by passage from an outside source through any lumen defined in the device 10, such as through a catheter employed for conventional chemotherapy.
  • the bioactive material of the present invention may, of course, be released from the device 10 into any lumen defined in the device, or to tissue in contact with the device and that the lumen may carry some other agent to be delivered through it.
  • tamoxifen citrate, Taxol ® or derivatives thereof Proscar ® , Hytrin ® , or Eulexin ® may be applied to the tissue-exposed surface of the device for delivery to a tumor located, for example in breast tissue or the prostate.
  • Dopamine or a dopamine agonist such as bromocriptine mesylate or pergolide mesylate is useful for the treatment of neurological disorders such as Parkinson's disease.
  • the device 1 0 could be placed in the vascular supply of the thalamic substantia nigra for this purpose, or elsewhere, localizing treatment in the thalamus.
  • a wide range of other bioactive materials can be delivered by the device
  • the bioactive material contained in the layer 1 8 includes at least one of heparin, covalent heparin, or another thrombin inhibitor, hirudin, hirulog, argatroban, D-phenylalanyl-L-poly-L-arginyl chloromethyl ketone, or another antithrombogenic agent, or mixtures thereof; urokinase, streptokinase, a tissue plasminogen activator, or another thrombolytic agent, or mixtures thereof; a fibrinolytic agent; a vasospasm inhibitor; a calcium channel blocker, a nitrate, nitric oxide, a nitric oxide promoter or another vasodilator; Hytrin ® or other antihypertensive agents; an antimicrobial agent or antibiotic; aspirin, ticlopidine, a glycoprotein llb/llla inhibitor or another inhibitor of surface glycoprotein receptors, or another antiplatelet agent; colchi
  • the layer of bioactive material contains preferably from about 0.01 mg to about 10 mg and more preferably from about 0.1 mg to about 4 mg of the bioactive material per cm 2 of the gross surface area of the structure.
  • “Gross surface area” refers to the area calculated from the gross or overall extent of the structure, and not necessarily to the actual surface area of the particular shape or individual parts of the structure. In other terms, about 100 ⁇ g to about 300 ⁇ g of drug per 0.001 inch of coating thickness may be contained on the device surface.
  • the total loading or amount of bioactive material that can be contained on the device can range from 10 g to about 1000 ⁇ g. This range will vary depending on the specific bioactive material or drug, method of application and the like.
  • the device 1 0 of the present invention also comprises at least one porous layer 20 posited over the layer 1 8 of bioactive material and the bioactive-material-free surface.
  • the purpose of the porous layer 20 is to provide a controlled release of the bioactive material when the device 1 0 is positioned in the vascular system of a patient.
  • the thickness, porosity and the like of the porous layer 20 is selected so as to provide such control.
  • the porous layer 20 is composed of a polymer deposited on the bioactive material layer 1 8, preferably by vapor deposition. Plasma deposition may also be useful for this purpose.
  • the layer 20 is one that is polymerized from a vapor which is free of any solvent, catalysts or similar polymerization promoters.
  • the polymer in the porous layer 20 is one which automatically polymerizes upon condensation from the vapor phase, without the action of any curative agent or activity such as heating, the application of visible or ultraviolet light, radiation, ultrasound, or the like.
  • the polymer in the porous layer 20 is polyimide, parylene or a parylene derivative.
  • the parylene or parylene derivative When first deposited, the parylene or parylene derivative is thought to form a network resembling a fibrous mesh, with relatively large pores. As more is deposited, the porous layer 20 not only becomes thicker, but it is believed that parylene or parylene derivative is also deposited in the previously formed pores, making the existing pores smaller. Careful and precise control over the deposition of the parylene or parylene derivative therefore permits close control over the release rate of material from the at least one layer 1 8 of bioactive material. It is for this reason that the bioactive material lies under the at least one porous layer 20, rather than being dispersed within or throughout it.
  • the porous layer 20 also protects the bioactive material layer 1 8 during deployment of the device 1 0, for example, during insertion of the device 1 0 through a catheter and into the vascular system or elsewhere in the patient.
  • the device 1 0 of the present invention can further comprise at least one additional coating layer 1 6 posited between the structure 1 2 and the at least one layer 1 8 of bioactive material.
  • the additional coating layer 1 6 can simply be a medical grade primer, the additional coating layer 1 6 is preferably composed of the same polymer as the at least one porous layer 20.
  • the additional coating layer 1 6 is also preferably less porous than the at least one porous layer 20, and is more preferably substantially nonporous.
  • substantially nonporous means that the additional coating layer 1 6 is sufficiently impervious to prevent any appreciable interaction between the base material 14 of the structure 1 2 and the blood to which the device 1 0 will be exposed during use.
  • the use of an additional coating layer 1 6 which is substantially nonporous would permit the use of a toxic or poisonous base material 14, as mentioned above. Even if the base material 14 of the structure 1 2 is biocompatible, however, it may be advantageous to isolate it from the blood by use of a substantially nonporous coating layer 1 6.
  • polymers derived from photopolymerizable monomers such as liquid monomers preferably having at least two cross linkable C-C (Carbon to Carbon) double bonds and being a non-gaseous addition polymerizable ethylenically unsaturated compound, having a boiling point above 100°C, at atmospheric pressure, a molecular weight of about 100-1 500 and being capable of forming high molecular weight addition polymers readily.
  • the monomer is preferably an addition photopolymerizable polyethylenically unsaturated acrylic or methacrylic acid ester containing two or more acrylate or methacrylate groups per molecule or mixtures thereof.
  • a few illustrative examples of such multifunctional acrylates are ethylene glycol diacrylate, ethylene glycol dimethacrylate, trimethylolpropane triacrylate, trimethylolpropane trimethacrylate, pentaerythritol tetraacrylate or pentaerythritol tetramethacrylate, 1 ,6-hexanediol dimethacrylate, and diethyleneglycol dimethacrylate.
  • monoacrylates such as n-butyl- acrylate, n-butyl methacrylate, 2-ethylhexyl acrylate, lauryl-acrylate, and 2-hydroxy- propyl acrylate.
  • Small quantities of amides of (meth)acrylic acid such as N-methylol methacrylamide butyl ether are also suitable, N-vinyl compounds such as N-vinyl pyrrolidone, vinyl esters of aliphatic monocarboxylic acids such as vinyl oleate, vinyl ethers of diols such as butanediol-1 , 4-divinyl ether and allyl ether and allyl ester are also suitable.
  • photopolymerizable liquid dispersing medium can be modified for the specific purpose by a suitable selection of monomers or mixtures thereof.
  • polystents include a polymer that is biocompatible and minimizes irritation to the vessel wall when the stent is implanted.
  • the polymer may be either a biostable or a bioabsorbable polymer depending on the desired rate of release or the desired degree of polymer stability, but a bioabsorbable polymer is preferred for this embodiment since, unlike a biostable polymer, it will not be present long after implantation to cause any adverse, chronic local response.
  • Bioabsorbable polymers that could be used include poly(L-lactic acid), polycaprolactone, poly(lactide-co-glycolide), poly(hydroxybutyrate), poly(hydroxybutyrate-co-valerate), polydioxanone, polyorthoester, polyanhydride, poly(glycolic acid), poly(D,L-lactic acid), poly(glycolic acid-co-trimethylene carbonate), polyphosphoester, polyphosphoester urethane, poly(amino acids), cyanoacrylates, poly(trimethylene carbonate), poly(iminocarbonate), copoly(ether-esters) (e.g., PEO/PLA), polyalkylene oxalates, polyphosphazenes and biomolecules such as fibrin, fibrinogen, cellulose, starch, collagen and hyaluronic acid.
  • PEO/PLA polyalkylene oxalates
  • biomolecules such as fibrin, fibrinogen, cellulose,
  • biostable polymers with a relatively low chronic tissue response such as polyurethanes, silicones, and polyesters could be used and other polymers could also be used if they can be dissolved and cured or polymerized on the stent such as polyolefins, polyisobutylene and ethylene- alphaolefin copolymers; acrylic polymers and copolymers, vinyl halide polymers and copolymers, such as polyvinyl chloride; polyvinyl ethers, such as polyvinyl methyl ether; polyvinylidene halides, such as polyvinylidene fluoride and polyvinylidene chloride; polyacrylonitrile, polyvinyl ketones; polyvinyl aromatics, such as polystyrene, polyvinyl esters, such as polyvinyl acetate; copolymers of vinyl monomers with each other and olefins, such as ethylene-methyl methacrylate copolymers, acrylonitrile-
  • plasma deposition and vapor phase deposition may be a preferred method for applying the various coatings on the stent surfaces
  • other techniques may be employed.
  • a polymer solution may be applied to the stent and the solvent allowed to evaporate, thereby leaving on the stent surface a coating of the polymer and the therapeutic substance.
  • the solution can be applied to the stent by either spraying the solution onto the stent or immersing the stent in the solution.
  • the layer 1 8 of bioactive material contains a relatively soluble material such as heparin
  • the at least one porous layer 20 is preferably about 5,000 to 250,000 A thick, more preferably about 5,000 to 100,000 A thick, and optimally about 50,000 A thick.
  • the at least one additional coating layer 1 6 is composed of parylene or a parylene derivative
  • the at least one additional coating is preferably about 50,000 to 500,000 A thick, more preferably about 100,000 to 500,000 A thick, and optimally about 200,000 A thick.
  • the at least one layer 1 8 of bioactive material contains a relatively soluble material such as heparin
  • the at least one layer 1 8 preferably contains a total of about 0.1 to 4 mg of bioactive material per cm 2 of the gross surface area of the structure 1 2.
  • This provides a release rate for the heparin (measured in vitro) which is desirably in the range of 0.1 to 0.5 mg/cm 2 per day, and preferably about 0.25 mg/cm 2 per day, under typical blood flows through vascular stents.
  • the solubility of dexamethasone can be adjusted as desired, with or without the inclusion of heparin, by mixing it with one or more of its relatively more soluble derivatives, such as dexamethasone sodium phosphate.
  • the device 10 of the present invention is not limited to the inclusion of a single layer 1 8 of bioactive material.
  • the device 1 0 can, for example, comprise a second layer 22 of a bioactive material posited over the structure 1 2.
  • the bioactive material of the second layer 22 can be, but need not necessarily be, different from the bioactive material of the first bioactive material layer 18, only that they not be posited on the same surface of the device 10 without the intermediate porous layer 24.
  • the use of different materials in the layers 1 8 and 22 allows the device 10 to perform more than a single therapeutic function.
  • the device 10 of the present invention can further comprise an additional porous layer 24 of the polymer posited between each of the layers 1 8 and 22 of bioactive material. It is reiterated that bioactive material 1 8 is on one surface of structure 1 2. The other surface may be free of bioactive material or may comprise one or more different bioactive materials.
  • the additional porous layer 24 can give the bioactive materials in the layers 1 8 and 22 different release rates.
  • the device 10 may employ bioactive materials in the two layers 1 8 and 22 which are different from one another and have different solubilities. In such a case, it is advantageous and preferred to position the layer 22 containing the less soluble bioactive material above the layer 1 8 containing the more soluble bioactive material.
  • the bioactive material 18 may be contained in holes, wells, slots and the like occurring within the stent surface as illustrated in FIGs. 8-10 and will further be discussed in greater detail.
  • the at least one layer 1 8 when the structure 1 2 of the device 10 is configured as a vascular stent, it is advantageous for the at least one layer 1 8 to contain relatively soluble heparin, and the second layer 22 to contain relatively less soluble dexamethasone.
  • the heparin promotes the release of the dexamethasone, increasing its release rate many times over the release rate of dexamethasone in the absence of heparin.
  • the release rate of the heparin is also lowered, somewhat less dramatically than the increase of the dexamethasone release rate.
  • dexamethasone when dexamethasone is disposed by itself beneath a porous parylene layer 20 dimensioned as disclosed above, its release rate is negligible; an adequate release rate is obtained only when the thickness of the porous layer 20 is reduced by a factor of ten or more.
  • the dexamethasone when a layer 22 of dexamethasone is disposed over a layer 1 8 of heparin, and beneath a porous parylene layer 20 dimensioned as above, the dexamethasone may be released at a desirable rate of about 1 to 1 0 ⁇ g/cm 2 per day.
  • this increased release rate for the dexamethasone is thought to be maintained even after all of the heparin has been released from the layer 1 8.
  • the bioactive material layers 1 8 and/or 22 are applied to the device 10 independent of the application of the porous polymer layers 20 and/or 24. Any mixing of a bioactive material from the layers 1 8 and/or 22 into the porous layers 20 and/or 24, prior to introducing the device 10 into the vascular system of the patient, is unintentional and merely incidental. This gives significantly more control over the release rate of the bioactive material than the simple dispersal of a bioactive material in a polymeric layer.
  • the device 10 need not include the additional porous layer 24 when two or more layers 1 8 and 22 of bioactive material are present. As shown in FIG. 3, the layers 1 8 and 22 do not have to be separated by a porous layer, but can instead lie directly against one another. It is still advantageous in this embodiment to position the layer 22 containing the relatively less soluble bioactive material above the layer 1 8 containing the relatively more soluble bioactive material.
  • the layers 1 8 and 22 contain about 0.05 to 2.0 mg of each of heparin and dexamethasone, respectively, per 1 cm 2 of the gross surface area of the structure 1 2.
  • the total amount of bioactive material posited in the layers 1 8 and 22 over the structure 1 2 is thus preferably in the range of about 0.1 to 10 mg/cm 2 .
  • Some dexamethasone derivatives, such as dexamethasone sodium phosphate, are substantially more soluble than dexamethasone itself. If a more soluble dexamethasone derivative is used as the bioactive material in the device 1 0 of the present invention, the thickness of the at least one porous layer 20 (and of the additional porous layer 24) should be adjusted accordingly.
  • the particular structure of the device 10 as disclosed may be adapted to specific uses in a variety of ways.
  • the device 10 may include further layers of the same or different bioactive materials. These additional layers of bioactive material may or may not be separated by additional porous layers, as convenient or desired. Alternatively, additional porous layers may separate only some of the additional layers of bioactive material.
  • one bioactive material may be placed on one portion of the structure 1 2 of the device 1 0, and another bioactive material placed on a different portion of the structure 1 2 of the device 10.
  • the device 10 need not include the additional coating layer 1 6 at all.
  • FIG. 4 Such a configuration is shown in FIG. 4, in which the bioactive material layer 1 8 is posited directly atop the base material 14 of the structure 1 2.
  • Surface processing and surface activation can also selectively alter the release rate of the bioactive material.
  • Such processing can also be used to promote the deposition or adhesion of the additional coating layer 1 6, if present, on the base material 14.
  • the additional coating layer 1 6 itself, or any second or additional porous layer 24 itself can similarly be processed to promote the deposition or adhesion of the bioactive material layer 1 8, or to further control the release rate of the bioactive material.
  • Useful methods of surface processing can include any of a variety of such procedures, including: cleaning; physical modifications such as etching, drilling, cutting, or abrasion; and chemical modifications such as solvent treatment, the application of primer coatings, the application of surfactants, plasma treatment, ion bombardment and covalent bonding. It has been found particularly advantageous to plasma treat the additional coating layer 1 6 (for example, of parylene) before depositing the bioactive material layer 1 8 atop it. The plasma treatment improves the adhesion of the bioactive material, increases the amount of bioactive material that can be deposited, and allows the bioactive material to be deposited in a more uniform layer.
  • additional coating layer 1 6 for example, of parylene
  • any of the porous polymer layers 20 and 24 may also be surface processed by any of the methods mentioned above to alter the release rate of the bioactive material or materials, and/or otherwise improve the biocompatibility of the surface of the layers.
  • the application of an overcoat of polyethylene oxide, phosphatidylcholine or a covalently bound bioactive material, e.g., covalently attached heparin to the layers 20 and/or 24 could render the surface of the layers more blood compatible.
  • the plasma treatment or application of a hydrogel coating to the layers 20 and/or 24 could alter their surface energies, preferably providing surface energies in the range of 20 to 30 dyne/cm, thereby rendering their surfaces more biocompatible.
  • a mechanical bond or connector 26 is provided between (a) any one of the porous layers 20 and 24, and (b) any or all of the other of the porous layers 20 and 24, the additional coating layer 1 6 and the base material 14.
  • the connector 26 reliably secures the layers 1 6, 20 and/or 24 to each other, and or to the base material 14.
  • the connector 26 lends structural integrity to the device 10, particularly after the bioactive material layer or layers 1 8 and/or 20 have been fully released into the patient.
  • the connector 26 is shown in FIG. 5 as a plurality of projections of the base material 14 securing a single porous layer 20 to the base material 14.
  • the connector 26 may alternatively extend from the porous layer 20, through the bioactive material layer 1 8, and to the base material 1 4. In either case, a single layer 18 of bioactive material, divided into several segments by the connector 26, is posited between the porous layer 20 and the base material 14.
  • the connectors can also function to partition the different bioactive agents into different regions of the device's surface.
  • the connector 26 may be provided in a variety of ways.
  • the connector 26 can be formed as a single piece with the base material 14 during its initial fabrication or molding into the structure 1 2.
  • the connector 26 can instead be formed as a distinct element, such as a bridge, strut, pin or stud added to an existing structure 1 2.
  • the connector 26 can also be formed as a built-up land, shoulder, plateau, pod or pan on the base material 14. Alternatively, a portion of the base material 14 between the desired locations of plural connectors 26 may be removed by etching, mechanical abrasion, or the like, and the bioactive material layer 1 8 deposited between them.
  • the connector 26 can also be formed so as to extend downwards towards the base material 1 4, by wiping or etching away a portion of a previously applied bioactive material layer 1 8, and allowing the porous layer 20 to deposit by vapor deposition or plasma deposition directly on the bare portions of the base material 14. Other ways to expose a portion of the base material 14 to direct connection to the porous layer 20 will be evident to those skilled in this area.
  • a bioactive material 1 8 is posited on the one surface of base material 14 making up structure 1 2 in FIG. 6A.
  • FIG. 7 shows a stent 1 0 in its flat or planar state prior to being coiled and showing porous layer 20 applied to its outermost surface.
  • FIGs. 6A and 6B are section views along line 6-6 of FIG. 7.
  • the bioactive material 1 8 posited on the one surface of base material 14 in FIG. 6A may be a number of different therapeutic and/or diagnostic agents.
  • the device 10 may be a stent which is placed in the body of a patient near a tumor to deliver a chemotherapeutic agent, such as tamoxifen citrate or Taxol ® , directly to the tumor.
  • a chemotherapeutic agent such as tamoxifen citrate or Taxol ®
  • a porous layer 20 is posited over the bioactive material 1 8 to provide a smoother surface as well as a more controlled release of the bioactive material 1 8.
  • the opposite surface of the device may have, for example, heparin 1 8' covalently bonded to porous layer 20, particularly where this surface faces, for example, the lumen of a blood vessel, to provide antithrombotic effect and blood compatibility.
  • a third but different bioactive material may be posited (not shown) on the opposite surface of base material 14 from the first bioactive material 1 8 and on the same side of base material 14 as the covalently bound heparin or any other bioactive material including other covalently bound bioactive materials and separated by porous layer 20.
  • a bioactive material can be silver either posited on or impregnated in the surface matrix of porous layer 20.
  • FIG. 6A A variation of the embodiment shown in FIG. 6A is illustrated in FIG 6B, where two bioactive materials 1 8 and 1 8' are posited on the same surface of base material 14 of structure 1 2.
  • a porous layer 20 may be deposited over the bioactive materials 1 8 and 1 8' as well as the bioactive-material-free surface of based material 14.
  • This embodiment illustrates a situation where it may be desirable to deliver two agents to the tissue to which the particular surface of device 10 is exposed, e.g., an antiinflammatory agent and an antiviral agent.
  • the opposite surface of the device free of bioactive material is available for positing one or more bioactive materials or therapeutic agents, e.g., an antithrombotic agent or silver.
  • the device of the present invention includes apertures within the device for containing the bioactive material. This embodiment is illustrated in FIGs. 8, 9, 10A, 10B, 10C and 10D.
  • FIG. 8 shows an arm of the stent of FIG. 7 wherein the arm includes holes 28 into which a bioactive material is contained.
  • FIG. 9 shows a section of the arm of the stent along lines 9-9 of FIG. 8.
  • Bioactive material 1 8 is contained within the hole 28 where the base material 14 contains coating 1 6 and further where porous layer 20 forms the outer most layer for the bioactive material 1 8 to diffuse through.
  • wells 28' may be cut, etched or stamped into the base material 14 of the device in which a bioactive material 1 8 may be contained. This embodiment is illustrated in FIGs. 10A, 10B, 1 0C and 10D which are sectional FIGs. taken along line 10-10 of FIG. 8.
  • the wells 28' may also be in the form of slots or grooves in the surface of the base material 1 4 of the medical device. This aspect of the invention provides the advantage of better controlling the total amount of the bioactive material 18 to be released as well as the rate at which it is released.
  • a V-shape well 28' as illustrated in FIG. 10D, will contain less quantity of bioactive material 1 8 and release the material at geometric rate as compared to a square shaped well 28', as illustrated in FIG. 10B, which will have a more uniform, linear release rate.
  • the holes, wells, slots, grooves and the like, described above, may be formed in the surface of the device 10 by a variety of techniques.
  • such techniques include drilling or cutting by utilizing lasers, electron-beam machining and the like or employing photoresist procedures and etching the desired apertures.
  • bioactive materials discussed above that may be coated on the surface of the device 10 may be used to be contained within the apertures of this aspect of the invention.
  • layers of bioactive materials and porous layers may be applied and built up on the exterior surfaces of the device as described previously with regard to other aspects of the invention, e.g., heparin, may be covalently bound to one surface of the device illustrated in FIG. 9.
  • the method comprises the steps of depositing the at least one layer 1 8 of bioactive material over the structure 1 2, followed by depositing the at least one porous layer 20, preferably by vapor deposition or plasma deposition, over the at least one bioactive material layer 1 8 on the one surface of structure 1 2.
  • the at least one porous layer 20 being composed of a biocompatible polymer and being of a thickness adequate to provide a controlled release of the bioactive material.
  • the 1 6 is first posited by vapor deposition directly on the base material 1 4 of the structure 1 2.
  • Such deposition is carried out by preparing or obtaining di-p-xylylene or a derivative thereof, sublimating and cracking the di-p-xylylene or derivative to yield monomeric p-xylylene or a monomeric derivative, and allowing the monomer to simultaneously condense on and polymerize over the base material 14.
  • the deposition step is carried out under vacuum, and the base material 14 maintained at or near room temperature during the deposition step.
  • the deposition is carried out in the absence of any solvent or catalyst for the polymer, and in the absence of any other action to aid polymerization.
  • One preferred derivative for carrying out the deposition step is dichloro-di-p-xylylene.
  • the parylene or parylene derivative is preferably applied at the thickness disclosed above, to yield a coating layer 1 6 which is substantially nonporous, but in any event less porous than the at least one porous layer 20 to be applied. If required by the composition of the coating layer 1 6, the layer 1 6 is then surface processed in an appropriate manner, for example, by plasma treatment as disclosed above. The at least one layer 1 8 of the desired bioactive material or materials is then applied to the one surface of the structure 1 2, and in particular, onto the additional coating layer 1 6.
  • This application step can be carried out in any of a variety of convenient ways, such as by dipping, rolling, brushing or spraying a fluid mixture of the bioactive material onto the additional coating layer 1 6, or by electrostatic deposition of either a fluid mixture or dry powder of the bioactive material, or by any other appropriate method.
  • Different bioactive agents may be applied to different sections or surfaces of the device.
  • the fluid is preferably ethyl alcohol.
  • the bioactive material is preferably applied in an amount as disclosed above.
  • bioactive material layer 1 8 over the structure 1 2
  • Other methods of depositing the bioactive material layer 1 8 over the structure 1 2 would be equally useful. Without regard to the method of application, however, what is important is that the bioactive material need only be physically held in place until the porous layer 20 is deposited over it. This can avoid the use of carriers, surfactants, chemical binding and other such methods often employed to hold a bioactive agent on other devices.
  • the additives used in such methods may be toxic, or the additives or methods may alter or degrade the bioactive agent, rendering it less effective, or even toxic itself. Nonetheless, if desired these other methods may also be employed to deposit the bioactive material layer 1 8 of the present invention.
  • the bioactive material may, of course, be deposited on the one surface of the structure 1 2 as a smooth film or as a layer of particles. Moreover, multiple but different bioactive materials may be deposited in a manner that different surfaces of the device contain the different bioactive agents. In the latter case, the particle size may affect the properties or characteristics of the device 10, such as the smoothness of the uppermost porous coating 20, the profile of the device 1 0, the surface area over which the bioactive material layer 1 8 is disposed, the release rate of the bioactive material, the formation of bumps or irregularities in the bioactive material layer 1 8, the uniformity and strength of adhesion of the bioactive material layer 1 8, and other properties or characteristics.
  • bioactive materials that is, materials which have been processed to a small particle size, typically less than 10 ⁇ m in diameter.
  • the bioactive material may also be deposited as microencapsulated particles, dispersed in liposomes, adsorbed onto or absorbed into small carrier particles, or the like.
  • the bioactive material may be posited on the one surface of structure 1 2 in a specific geometric pattern.
  • the tips or arms of a stent may be free of bioactive material, or the bioactive material may be applied in parallel lines, particularly where two or more bioactive materials are applied to the same surface.
  • the at least one porous layer 20 is then applied over the at least one bioactive material layer 1 8 in the same manner as for the application of the at least one additional coating 1 6.
  • a polymer such as parylene or a parylene derivative is applied at the lesser thickness disclosed above, however, so as to yield the at least one porous layer 20.
  • any other layers such as the second bioactive material layer 22 or the additional porous layer 24, are applied in the appropriate order and in the same manner as disclosed above.
  • the steps of the method are preferably carried out with any of the bioactive materials, structures, and base materials disclosed above.

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Abstract

Ce dispositif médical implantable et contenant de l'argent (29) comprend une structure (12) conçue pour être introduite dans le système vasculaire, l'oesophage, la trachée, le colon, les voies biliaires ou urinaires, au moins une couche (18) d'une matière bio-active, déposée sur une surface de cette structure (12) ainsi qu'au moins une couche poreuse (20) déposée et sur la couche (18) de matière bio-active, déposée elle-même sur une surface de la structure (12), et sur la surface dépourvue de matière bio-active. Ce dispositif présente également une couche ou imprégnation d'argent (45). De préférence, cette structure est un extenseur coronarien. La couche poreuse (20) se compose préférablement d'un polymère appliqué par un dépôt en phase vapeur ou activé par plasma, et elle permet une libération prolongée de la matière bio-active. En tant que polymère, on préfère notamment un polyamide, un parylène ou un dérivé de parylène, lequel se dépose sans l'aide de solvants, de chaleur ou de catalyseurs, simplement par condensation d'une vapeur monomère. On a inclus l'argent en tant que matériau de base ou de revêtement, ou on l'a inclus dans une matière de support ou médicamenteuse, utilisée avec l'extenseur implantable.
PCT/US1997/019188 1995-06-07 1997-10-23 Dispositif medical implantable et contenant de l'argent WO1998017331A1 (fr)

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Application Number Priority Date Filing Date Title
AU49959/97A AU4995997A (en) 1996-10-24 1997-10-23 Silver implantable medical device

Applications Claiming Priority (8)

Application Number Priority Date Filing Date Title
US08/484,532 US5609629A (en) 1995-06-07 1995-06-07 Coated implantable medical device
US08/645,646 US6096070A (en) 1995-06-07 1996-05-16 Coated implantable medical device
US2915896P 1996-10-24 1996-10-24
US60/029,158 1996-10-24
US08/741,565 US5824049A (en) 1995-06-07 1996-10-31 Coated implantable medical device
US08/741,565 1996-10-31
US08/803,843 US5873904A (en) 1995-06-07 1997-02-24 Silver implantable medical device
US08/803,843 1997-02-24

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