Partially covered
self-expandable metallic esophageal stent (SEMS)
placement is the most frequently applied palliative treatment in esophageal
cancer. Structural characterization of explanted 16 nitinol-polyurethane
SEMS (the group of 6 females, 10 males, age 40–80) was performed
after their removal due to dysfunction. The adverse bulk changes in
the polymer structure were identified using differential scanning
calorimetry (DSC), differential mechanical thermal analysis (DMTA),
and attenuated total reflectance infrared spectroscopy (ATR-IR) and
discussed in terms of melting point shift (9 °C), glass-transition
shift (4 °C), differences in viscoelastic behavior, and systematic
decrease of peaks intensities corresponding to C–H, C=O,
and C–N polyurethane structural bonds. The scanning electron
and confocal microscopic observations revealed all major types of
surface degradation, i.e., surface cracks, peeling off of the polymer
material, and surface etching. The changes in the hydrophobic polyurethane
surfaces were also revealed by a significant decrease in wettability
(74°) and the corresponding increase of the surface free energy
(31 mJ/m
2
). To understand the
in vivo
degradation,
the
in vitro
tests in simulated salivary and gastric
fluids were performed, which mimic the environments of proximal and
distal ends, respectively. It was concluded that the differences in
the degradation of the proximal and distal ends of prostheses strongly
depend on the physiological environment, in particular stomach content.
Finally, the necessity of the
in vivo
tests for SEMS
degradation is pointed out.