Poly(L-lactide) (PLLA) is the structural material of the first clinically approved bioresorbable vascular scaffold (BVS), a promising alternative to permanent metal stents for treatment of coronary heart disease. BVSs are transient implants that support the occluded artery for 6 mo and are completely resorbed in 2 y. Clinical trials of BVSs report restoration of arterial vasomotion and elimination of serious complications such as late stent thrombosis. It is remarkable that a scaffold made from PLLA, known as a brittle polymer, does not fracture when crimped onto a balloon catheter or during deployment in the artery. We used X-ray microdiffraction to discover how PLLA acquired ductile character and found that the crimping process creates localized regions of extreme anisotropy; PLLA chains in the scaffold change orientation from the hoop direction to the radial direction on micrometer-scale distances. This multiplicity of morphologies in the crimped scaffold works in tandem to enable a low-stress response during deployment, which avoids fracture of the PLLA hoops and leaves them with the strength needed to support the artery. Thus, the transformations of the semicrystalline PLLA microstructure during crimping explain the unexpected strength and ductility of the current BVS and point the way to thinner resorbable scaffolds in the future. structural transformation | ductility | poly (L-lactide) | coronary heart disease | microdiffraction C ardiovascular disease (CVD) claims over 15 million lives per year-more lives than communicable, maternal, neonatal, and nutritional disorders combined and more than twice the number of deaths due to all cancers (1). Coronary heart disease (CHD), the narrowing of coronary arteries due to the deposition of plaque, accounts for nearly 50% of all CVD deaths (1). To restore blood flow, most patients receive minimally invasive balloon angioplasty followed by stent implantation (1 million in 2008 in the United States) (2). Stents are metal mesh tubes that are delivered to the target lesion while they are crimped onto a balloon. Once they are positioned at the lesion, inflation of the balloon compresses the plaque against the vessel wall and deploys the stent to provide support at the enlarged diameter after the balloon is deflated and withdrawn. Metal stents are permanent, and their stiffness prohibits vasomotion and dilation (3, 4). Further, they present a lifelong risk of late stent thrombosis (3-6). A new technology is poised to displace metal stents: bioresorbable vascular scaffolds (BVS), which have been deemed the "fourth revolution" in percutaneous coronary intervention (7,8).The goal of tissue scaffolds is to restore the healthy state of the tissue, rather than merely ameliorating the diseased state (9-11). Poly(L-lactide) (PLLA) was selected as the material for BVS because its semicrystalline structure gives it adequate radial strength [>300 mm Hg (12)], and it degrades into products that are metabolized by the human body (13-16). Clinically, bioresorption of PLLA vascular sca...

Experimental methodsMaterials: All manipulations of air and moisture-sensitive compounds are performed under nitrogen or argon atmosphere using standard high-vacuum Schlenk techniques or in a glovebox. Ethylene (grade 3.0) is purchased from BOC, and bis [N-(3-tert-butylsalicylidene) pentafluoroanilinate]titanium (IV) dichloride is obtained from MCat; both are used as received. Toluene (anhydrous 99.8%) and Methylaluminoxane (10 %wt toluene solution) are purchased from SigmaAldrich®.Synthesis: A 1.5 l jacketed Pyrex glass reactor assembled for polymerisation is equipped with a magnetic stirrer, a temperature probe, a gas inlet and a rubber septum for catalyst injection. The oven-dried reactor is purged from air with three vacuum-nitrogen (moistureand oxygen-free) cycles. The desired amount of ethylene-butene copolymer is introduced in the reactor under nitrogen stream and dissolved in the desired amount of toluene at 80ºC for 2 hours prior to cooling to 50°C; this step is skipped for the polymerisation of pure UHMWPE.

Biodegradable polymers open the way to treatment of heart disease using transient implants (bioresorbable vascular scaffolds, BVSs) that overcome the most serious complication associated with permanent metal stents-late stent thrombosis. Here, we address the long-standing paradox that the clinically approved BVS maintains its radial strength even after 9 mo of hydrolysis, which induces a ∼40% decrease in the poly l-lactide molecular weight (). X-ray microdiffraction evidence of nonuniform hydrolysis in the scaffold reveals that regions subjected to tensile stress during crimping develop a microstructure that provides strength and resists hydrolysis. These beneficial morphological changes occur where they are needed most-where stress is localized when a radial load is placed on the scaffold. We hypothesize that the observed decrease in reflects the majority of the material, which is undeformed during crimping. Thus, the global measures of degradation may be decoupled from the localized, degradation-resistant regions that confer the ability to support the artery for the first several months after implantation.