Bare metal stenting
(BMS) does not adequately address the atheroembolic
characteristic of carotid artery stenosis. While simple covered stents
(CS) may prevent dislodged fragments of the atherosclerotic plaque
from entering the blood stream, they also block blood flow into the
major branches of the artery alongside the lesion, which is not desirable.
Preferential covered stents (PCS) behave as a covered stent in a tubular
part of a vessel but maintain side-branch flow over the bifurcation
region by means of slits in the membrane. Stent design, membrane material,
and slits configuration are the three main components contributing
to stent performance. Optimization of PCS designs was conducted and
tested. Methods: A newly designed BMS was developed and compared to
a commercially available peripheral stent. Two materials (expanded
poly(tetrafluoroethylene)) and silicone polyurethane co-polymers (Elast-eon
E2A) were used as stent coverings with slits applied using various
cutting methods to form the PCS. These PCS samples were tested for
physical resilience, flexibility, ability to preserve side-branch
flow, slit edge roughness, and platelet activation. Results: Fabrication
of E2A-coated stents required pretreatment of the stent with poly(ethylene
glycol) to achieve firm attachment. The newly designed BMS with nine
crowns design and larger cell size showed higher flexibility than
commercially available stents. A combination of a larger stent cell
size, E2A membrane coating, and three slits per stent cell unit configuration
resulted in preserved side-branch flow similar to physiological conditions
in the flow experiment. Slit edge roughness changed with different
cutting methods and laser machine cutting parameters. In vitro studies
showed platelet activation was minimal with lower slit edge roughness
samples. Conclusion: An optimized PCS prototype was developed consisting
of a newly designed stent, E2A membrane, and a three-slit pattern
created by specific femtosecond laser cutting.