Coronary Artery Disease and The Evolution of Angioplasty Devices (SpringerBriefs in Materials) 3030424421, 9783030424428

In this concise but authoritative book, the authors take the reader through the epidemiology, risk factors and the basic

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Coronary Artery Disease and The Evolution of Angioplasty Devices (SpringerBriefs in Materials)
 3030424421, 9783030424428

Table of contents :
Abstract
Contents
Contents
Contents
Chapter 1: Epidemiology and Risk Factors
Heart Disease, Stroke and Cardiovascular Disease Risk Factors
Chapter 2: Definitions and Basic Mechanism of Coronary Artery Disease (CAD)
Chapter 3: Coronary Microvascular Dysfunction (CMD)
Chapter 4: Diagnosis of Coronary Artery Disease (CAD)
Chapter 5: Treatment of Coronary Artery Disease (CAD)
Chapter 6: Evolution of Angioplasty Devices
Balloon Catheter System for Angioplasty
Stent Angioplasty
Bare Metal Stent (BMS) Angioplasty
First-Generation Drug-Eluting Stent (DES) Angioplasty
Second-Generation Drug-Eluting Stent (DES) Angioplasty
Drugs Used in DES’s
Polymers Used in DES’s
Drug-Eluting Polymeric Stents
Recent Advances in Angioplasty Devices
References
Index

Citation preview

SPRINGER BRIEFS IN MATERIALS

Martin W. King Tushar Bambharoliya Harshini Ramakrishna Fan Zhang

Coronary Artery Disease and The Evolution of Angioplasty Devices 123

SpringerBriefs in Materials

The SpringerBriefs Series in Materials presents highly relevant, concise monographs on a wide range of topics covering fundamental advances and new applications in the field. Areas of interest include topical information on innovative, structural and functional materials and composites as well as fundamental principles, physical properties, materials theory and design. SpringerBriefs present succinct summaries of cutting-edge research and practical applications across a wide spectrum of fields. Featuring compact volumes of 50 to 125 pages, the series covers a range of content from professional to academic. Typical topics might include: • A timely report of state-of-the-art analytical techniques • A bridge between new research results, as published in journal articles, and a contextual literature review • A snapshot of a hot or emerging topic • An in-depth case study or clinical example • A presentation of core concepts that students must understand in order to make independent contributions Briefs are characterized by fast, global electronic dissemination, standard publishing contracts, standardized manuscript preparation and formatting guidelines, and expedited production schedules. More information about this series at http://www.springer.com/series/10111

Martin W. King • Tushar Bambharoliya Harshini Ramakrishna • Fan Zhang

Coronary Artery Disease and The Evolution of Angioplasty Devices

Martin W. King Wilson College of Textiles North Carolina State University Raleigh, NC, USA College of Textiles Donghua University Shanghai, China Harshini Ramakrishna Wilson College of Textiles North Carolina State University Raleigh, NC, USA

Tushar Bambharoliya Wilson College of Textiles North Carolina State University Raleigh, NC, USA Fan Zhang Wilson College of Textiles North Carolina State University Raleigh, NC, USA

ISSN 2192-1091     ISSN 2192-1105 (electronic) SpringerBriefs in Materials ISBN 978-3-030-42442-8    ISBN 978-3-030-42443-5 (eBook) https://doi.org/10.1007/978-3-030-42443-5 © The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Abstract

Coronary artery disease (CAD) is a major cause of death and disability in the world. Heart disease and strokes are among the top five leading causes of death. In 2010, ischemic heart disease was the cause of 13.3% of all deaths globally. The 2016 Heart Disease and Stroke Statistics update of the American Heart Association reports that 15.5 million adults (6.2% of the adult population) in the United States have CAD, including 7.6  million (2.8%) with myocardial infarction (MI) and 8.2 million (3.3%) with angina pectoris. By 2035, nearly half of the US population (45.1%) will have some form of cardiovascular disease. The direct medical costs from coronary artery disease and stroke are currently estimated to be $126 billion per year and are expected to rise to $309 billion by 2035. In this book we have attempted to provide the current issues related to coronary artery disease and take the reader through the epidemiology, risk factors, and the basic mechanism of coronary artery disease. In addition, we explain how coronary microvascular dysfunction can lead to angina, even after successful angioplasty following a heart attack. The methods for diagnosis and the options for treatment are explained, and we end with a discussion of the evolution of coronary angioplasty from balloon catheters to novel, fully resorbable polymeric drug-eluting stents. We have enclosed a list of currently available commercial devices, as well as a listing of experimental products under research and development, so that readers can appreciate the serious nature of this disease and have an understanding of how the medical device sector is attempting to address this major healthcare problem.

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Contents

1 Epidemiology and Risk Factors����������������������������������������������������������������   1 Heart Disease, Stroke and Cardiovascular Disease Risk Factors����������������   2 2 Definitions and Basic Mechanism of Coronary Artery Disease (CAD)��������������������������������������������������������������������������������   3 3 Coronary Microvascular Dysfunction (CMD)����������������������������������������  11 4 Diagnosis of Coronary Artery Disease (CAD)����������������������������������������  15 5 Treatment of Coronary Artery Disease (CAD) ��������������������������������������  21 6 Evolution of Angioplasty Devices�������������������������������������������������������������  31 Balloon Catheter System for Angioplasty����������������������������������������������������  32 Stent Angioplasty ����������������������������������������������������������������������������������������  35 Bare Metal Stent (BMS) Angioplasty������������������������������������������������������  36 First-Generation Drug-Eluting Stent (DES) Angioplasty������������������������  39 Second-Generation Drug-Eluting Stent (DES) Angioplasty��������������������  41 Drugs Used in DES’s ������������������������������������������������������������������������������  42 Polymers Used in DES’s��������������������������������������������������������������������������  43 Drug-Eluting Polymeric Stents����������������������������������������������������������������  46 Recent Advances in Angioplasty Devices����������������������������������������������������  49 References ����������������������������������������������������������������������������������������������������������  53 Index��������������������������������������������������������������������������������������������������������������������  63

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List of Figures

Fig. 2.1 Three layers of coronary artery wall consisting of tunica intima, media and adventitia [13, 15, 16]. (Created with BioRender.com)�������������������������������������������������������������������������������������� 4 Fig. 2.2 Cellular mechanism of atherosclerosis [20–22]. (Created with BioRender.com)�������������������������������������������������������������������������������������� 5 Fig. 2.3 Fracture of the plaque’s fibrous capsule, which causes the plaque to be exposed to the blood flow and the blood coagulation components. This event is called thrombosis, the ultimate complication of atherosclerosis which can cause obstruction of the blood flow [13, 26, 27]. (Created with BioRender.com)������������������ 6 Fig. 2.4 Progression of atherosclerosis and clinical findings at various stages [29–32]. (Created with BioRender.com)�������������������������������������� 7 Fig. 2.5 Time course of inflammation and calcification in atherosclerosis. Inflammation and calcification activity can be seen within atherosclerotic lesions with 18F-fluoro-deoxyglucose (FDG) and 18 F-sodium fluoride (NaF) as imaging biomarkers. Inflammation is the predominant mechanism active within plaque during early stages of atherosclerosis and FDG may be taken up by the lesion. As inflammation peaks, the risk of plaque rupture may increase. Inflammation also initiates calcium metabolism within lesions resulting in the formation of early calcium deposits that can be seen by uptake of both FDG and hydroxyapatite-specific 18 F-sodium fluoride (NaF). It becomes visible with CT once the density of calcium deposits exceeds a certain threshold. During active calcification, plaque may still be vulnerable and eventually, the calcification and mineralization processes exceed the inflammatory activity present within plaque, which might be demarcated by only NaF uptake (in the absence of FDG), as well as calcium deposits on CT. Ongoing calcification eventually leads to forming an end-stage stable atheroma that is densely calcified

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List of Figures

with only evidence for calcium on CT [33, 37, 38]. (Created with BioRender.com)������������������������������������������������������������������������������ 8 Fig. 2.6 Acute coronary syndrome (ACS) can be classified as unstable angina, STEMI and NSTEMI as determined by various diagnostic tools such as electrocardiography (ECG) and blood biomarkers. ECG electrocardiography, STEMI ST-elevated myocardial infarction, NSTEMI non-ST-elevated myocardial infarction [40–42]���������������������� 9 Fig. 2.7 Example of normal and abnormal ECG morphologies. (a) Normal ECG morphology and (b) abnormal ECG morphology [46] ���������������������������������������������������������������������������������� 10 Fig. 3.1 Coronary arterial system. (Diameter: Epicardial arteries >500 μm, main stimulus for vasomotion – flow, Main function – transport; small arteries