Shape memory polymers (SMP) are lightweight, have a high strain/shape recovery ability, are easy to process, and required properties can be tailored for variety of applications. Recently a number of medical applications have been considered and investigated, especially for polyurethane-based SMP. SMP materials were found to be biocompatible, non-toxic and non-mutagenic. The glass transition temperature (T(g)) can be tailored for shape restoration/self-deployment of clinical devices when inserted in the human body. Newly developed SMP foams, together with cold hibernated elastic memory (CHEM) processing, further broaden their potential biomedical applications. Polyurethane-based SMP are described here and major advantages are identified over other medical materials. Some SMP applications are already used in a clinical setting, whereas others are still in development. Lately, several important applications are being considered for CHEM foams as self-deployable vascular and coronary devices. One example is the endovascular treatment of aneurysms.
Background and Purpose-Endovascular treatment can improve the outcome of patients treated for ruptured intracranial aneurysms as compared with surgical clipping, but angiographic recurrences are frequent. Endothelial denudation before coil embolization may prevent recanalization and improve results of endovascular treatment. Methods-We compared angiographic and pathological results 3 months after coil occlusion of paired canine arteries (nϭ16), with or without previous denudation of the endothelial lining using an endovascular device. The technique was then used to denude the neck of carotid venous pouch bifurcation aneurysms before coil embolization in 8 dogs, and the angiographic evolution at 12 weeks was compared with 7 control aneurysms treated by coiling only. Qualitative scoring systems were used to compare angiographic results with time and neointimal coverage at the neck of aneurysm after necropsy. The evolution of angiographic scores was analyzed using Wilcoxon signed rank tests whereas angiographic and neointimal scores of the 2 groups were compared using the Mann-Whitney test. Results-All arteries embolized with platinum coils recanalized, whereas most arteries (12/16 or 75%) denuded before coil embolization remained occluded at 3 and 12 weeks (PϽ0.001). Aneurysms treated with coils without previous denudation tended to recur, with angiographic scores significantly worse at 12 weeks as compared with T 0 (Pϭ0.015). Median angiographic and neointimal scores were significantly better at 12 weeks with endothelial denudation (Pϭ0.011 and 0.026, respectively). Conclusion-Endothelial denudation can prevent recanalization after coil embolization.
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