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Research Article Feasibility of Crosslinked Acrylic Shape Memory Polymer for a Thrombectomy ... PDF

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Hindawi Publishing Corporation Smart Materials Research Volume 2014, Article ID 971087, 12 pages http://dx.doi.org/10.1155/2014/971087 Research Article Feasibility of Crosslinked Acrylic Shape Memory Polymer for a Thrombectomy Device AndreaD.Muschenborn,KeithHearon,BrentL.Volk, JordanW.Conway,andDuncanJ.Maitland BiomedicalEngineeringDepartment,TexasA&MUniversity,3120TAMU,CollegeStation,TX77843,USA CorrespondenceshouldbeaddressedtoDuncanJ.Maitland;[email protected] Received29August2013;Revised25December2013;Accepted16January2014;Published25February2014 AcademicEditor:HidekiHosoda Copyright©2014AndreaD.Muschenbornetal. This is an open access article distributed under the Creative Commons AttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkis properlycited. Purpose.ToevaluatethefeasibilityofutilizingasystemofSMPacrylatesforathrombectomydevicebydetermininganoptimal crosslink density that provides both adequate recovery stress for blood clot removal and sufficient strain capacity to enable catheterdelivery.Methods.Fourthermosetacryliccopolymerscontainingbenzylmethacrylate(BzMA)andbisphenolAethoxylate diacrylate(Mn∼512,BPA)weredesignedwithdifferingthermomechanicalproperties.Finiteelementanalysis(FEA)wasperformed toensurethatthematerialswereabletoundergothestrainsimposedbycrimping,andfabricateddevicesweresubjectedtoforce- monitoredcrimping,constrainedrecovery,andbench-topthrombectomy.Results.Deviceswith25and35mole%BPAexhibitedthe highestrecoverystressandthehighestbrittleresponseastheybrokeuponconstrainedrecovery.Onthecontrary,the15mole%BPA devicesenduredalltestingandtheirrecoverystress(5kPa)enabledsuccessfulbench-topthrombectomyin2/3times,comparedto 0/3forthedeviceswiththelowestBPAcontent.Conclusion.Whilethe15mole%BPAdevicesprovidedthebesttrade-offbetween deviceintegrityandperformance,otherSMPsystemsthatofferrecoverystressesabove5kPawithoutincreasingbrittlenesstothe pointofcausingdevicefailurewouldbemoresuitableforthisapplication. 1.Introduction remain significantly limited. Only 2-3% of ischemic stroke patients are eligible to receive tPA because of its narrow Thrombectomydevicesareutilizedendovascularlytoremove treatment time window and other exclusion criteria [6, 7]. bloodclotsandreestablishbloodflowinanoccludedartery. Consequently,tPA-ineligiblepatientsareusuallytreatedwith When the occluded artery is part of the neurovasculature, oneoftheapprovedthrombectomydevices,whichareoften failure to reestablish blood flow in a timely manner results associated with other complications, including blood clot inasignificantreductionintheoxygenationofbraintissue. dislodgement and distal migration, limited device maneu- Such an event is called acute ischemic stroke and occurs verability,andarterialperforation[2,8–10].Thereremainsa approximately every minute to someone in the US [1–3]. needtoevaluatealternativematerialsanddevicedesignsthat Of all ischemic stroke cases, 8–12% are fatal, and the 6- canenablerapidandsuccessfulreestablishmentofbloodflow month poststroke period for survivors renders this disease inischemicstrokepatients. the leading cause of adult long-term disability [1, 2, 4, 5]. The emergence of smart materials has given rise to the To date, there is one drug, tissue plasminogen activator investigative development of numerous minimally invasive (tPA),andfourdevices,MerciRetriever(Stryker,California), endovasculardevicesthatexploitnovelmaterialcapabilities. Penumbra System (Penumbra Inc., California), Solitaire FR One such capability is shape memory, which is a material’s (ev3, California), and Trevo Retriever (Stryker, California), ability to store temporary shape(s) and then actuate to a thathavebeenapprovedbytheUSFoodandDrugAdmin- primary geometry when exposed to stimuli such as heat or istration(FDA)forthetreatmentofacuteischemicstroke[2, moisture[11–13].Shapememoryalloys(SMAs),particularly 3,6].However,thesuccessratesoftheseclinicaltreatments nickel titanium (nitinol), have been used in the biomedical 2 SmartMaterialsResearch field for over 20 years [14]. Three out of the four FDA- 0.50 approved devices for the treatment of ischemic stroke are made with nitinol. For example, the Merci Retriever is a nitinolwirethathasbeenpreshapedwithacorkscrewgeom- etry. The other two nitinol-based thrombectomy devices are self-expanding stents, Solitaire FR and Trevo. However, 6 one major drawback of these devices is their length, which 0.80 limitstheirplacementandmaneuverabilityduringtreatment [15]. Shapememorypolymers(SMPs)arebeinginvestigatedas alternativecandidatematerialsforendovascularapplications such as thrombectomy, primarily because SMPs exhibit recoverabledeformationsupto100timesgreaterthanthose reported for SMAs [13, 16, 17]. Consequently, many SMP- based endovascular devices are capable of undergoing the ∅0.60 significantshapechangesnecessaryforcatheterdelivery[11, 1.05 18–22].Thispropertyenablestheexplorationofnoveldevice designs that have the potential to address the issues with commerciallyavailablethrombectomydevices,forexample, Figure1:Flower-shapedthrombectomydevicedesignedinSolid- difficult maneuverability. For example, Buckley et al. [23] Workswithdimensionsinmm.Thisdesignwasadaptedfroman proposedadesignthatiscrimpedtoacylinderforcatheter originalthrombectomydeviceproposedbyBuckleyetal.[23]. delivery and is actuated to a flower shape distal to the occlusionsuchthatonlytheedgeofthe“petals”isincontact with the vessel during treatment minimizing device-vessel 2.1.DeviceDesign. Flower-shapeddevicesweredesignedin contactpoints. SolidWorks based on the geometry proposed by Buckley et While SMPs generally exhibit maximum recoverable al.[23].Modificationstothedesignwerenecessarytoprevent forces less than 1/100 times the recovery force of SMAs, portionsofthedevicefoldingoverthemselvesduringcrimp- another advantage is tunability of thermomechanical prop- ing and to reduce potential areas of stress concentrations. ertiesincludingrecoveryforce,modulus,actuationtemper- In order to better visualize the devices during testing, we ature (for thermally actuated SMPs), and recoverable strain designed them to be 4 times larger than they would be for to meet the material demands of various applications. One in vivo testing. The design used in this study is depicted in effective,demonstratedmethodoftailoringthermomechan- Figure1. ical properties of SMPs is controlling crosslink density [24, 25]. Increasing crosslink density of SMP systems has been generally shown to increase recovery stress [11, 26, 27]. At 2.2. Finite Element Analysis Simulations. The device design the same time, however, increasing crosslink density can was imported from the SolidWorks file created to fabricate alsohaveundesiredeffectssuchasincreasedbrittlenessand the device (see Figure1), and the crimping funnel (small decreasedstraincapacity[28]. inner diameter = 3.5mm, large inner diameter = 12.5mm) The objective of this study is to evaluate the feasibil- andball(outerdiameter=2mm)werecreatedinAbaqusas ity of fabricating SMP-based thrombectomy devices from analytical rigid parts. The device was modeled using 1/14th crosslinkedSMPacrylatesby(1)findingthecrosslinkdensity symmetryinacylindricalcoordinatesystem.Thedevicewas thatresultsinincreasedrecoverystresswithoutcompromis- meshed using approximately 12000 linear, 3D, hybrid brick ingthestraincapacitynecessaryforcrimpingandactuation elements(C3D8H)andwasmodeledasanisotropicMooney- and (2) determining whether the resulting thermomechan- Rivlin material with coefficients of C10 = 3.06865MPa and ical properties would be suitable for thrombectomy in a C01 = −0.94798MPa. These coefficients were obtained by bench-topmodel. analyzing,usingthematerialevaluatorfunctioninAbaqus, thetensiletestdataforeachofthepolymercompositionsand averagingtheresultingMooney-Rivlincoefficients.Because 2.MaterialsandMethods the strain—which is dictated by the geometry change in passing through the funnel—of the thrombectomy device After finalizing the device design, the deformation of the was the primary quantity of interest, efforts were not made device was modeled via finite element analysis (FEA) to to further optimize the constitutive response to the tensile estimate maximum strains. Then, a system of crosslinked test data. The nonlinear geometry feature was enabled for acrylic SMPs was designed with varying crosslink densities the simulation, and “hard” contact (i.e., no penetration) andwithstraincapacitiesgreaterthanthemaximumstrains was assumed between the funnel and the device, the ball predicted by FEA. Devices were subsequently machined and the device, and the analytical planes and the device andsubjectedtoforce-monitoredcrimpingandconstrained (tomodelself-contactintheloopsduringthecrimping).A recovery, and finally blood clot removal experiments were coefficientoffrictionof0.04wasassignedbetweenthefunnel performedinabench-topthromboticmodel. and the device based on a bench-top friction test between SmartMaterialsResearch 3 blocks of polytetrafluoroethylene (PTFE) and poly(methyl 50N load cell methacrylate) (PMMA). A value of 0.8 was assigned as the Manual screw coefficient of friction between the device and the analytical action grip planes(forself-contact)andbetweentheballandthedevice (toaccountforroughnessoftheball)basedonpublisheddata Alignment Wire ofthenominalcoefficientoffrictioninacrylic[29].Theball, hole device, and funnel were initially concentrically positioned, PMMA fixture andthentheballwasheldspatiallyfixedwhilethefunnelwas PTFE insert movedtoencompassthedevice. with funnel 2.3. Polymer Synthesis. The monomer benzyl methacrylate (BzMA), the crosslinker bisphenol A ethoxylate diacrylate Pneumatic (Mn∼512, BPA), and the photoinitiator 2,2-dimethoxy-2- grip phenylacetophenone (DMPA) were purchased from Sigma Aldrich and used as received without further purification. This monomer and difunctional crosslinker combination, whichissimilartothatreportedbySafranskiandGall[24], was selected because it enables the synthesis of a series of SMPswithtailorablecrosslinkdensitiesandglasstransitions Figure2:Sketchofcustom-madeapparatusforthecrimpingofthe above body temperature in the range of 65 to 75∘C. Benzyl thrombectomydevices.Theapparatuswasdesignedsothatitwas compatiblewiththeInstrontensiletester.Eachdevicewasinserted methacrylate was also selected because Safranski and Gall in the PTFE funnel, and after thermal equilibrium was achieved [24]demonstratedthatpoly(benzylmethacrylate)thermoset after1hour,thedevicewasslidupwardsbythemovementofthe SMPshavehighertoughnessthannumerousotherthermoset crossheadconnectedtothemanualscrewactiongrip.Thedevice acrylics. Four thermoset acrylic BzMA-BPA copolymers wasallowedtocooldowninthenarrowcylindricalfeatureofthe containing 5, 15, 25, and 35 mole% BPA and 0.5 weight% PTFEinsert,abovethefunnel. DMPA were prepared in 51 × 76 × 0.4mm sheets by bulk UV curing. After massing, the monomer, crosslinker, and photoinitiator mixtures were injected between 51 × 76mm glassslidescoatedwithRain-Xseparatedby0.4mmspacers 40W Gravograph LS100 CO2 laser machining device with andcuredfor99minutesusing365nmUVirradiationinside thesameinstrumentparametersusedtocuttherectangular aUVPCL-1000crosslinkingchamber.Thecuredthermoset DMA specimens. Specimens were cleaned with a methanol filmswerethenpostcuredat130∘Cwithvacuumat1torrfor damp Kimwipe, dried at 90∘C under vacuum at 1Torr, and 12hoursandsubsequentlystoredunderdesiccation. subsequentlystoredunderdesiccationpriortobeingtested. Specimen deformation was measured optically using an Instron Advanced Video Extensometer with a 60mm field- 2.4. Dynamic Mechanical Analysis. Dynamic mechanical of-view lens. Specimens were heated to target temperatures analysis (DMA) experiments were carried out in tension under zero loads (unclamped bottom grip) and were held usingaTAInstrumentsQ800dynamicmechanicalanalyzer isothermally for 30 minutes to allow thermal equilibrium and 4 × 30 × 0.4mm rectangular specimens (𝑛 = 5). The to be reached. The bottom grip was then clamped, and the rectangular specimens were machined with a 40W Gravo- strain-to-failureexperimentsweresubsequentlybegunusing graph LS100 CO2 laser machining device using a 38.1mm adeformationrateof10mm/min.Datawererecordedusing lens, a speed setting of 5, a power setting of 10, and a laser InstronBluehill3software. resolution of 1200 dots per inch. Specimens were cleaned ∘ withamethanoldampKimwipe,driedat90 Cundervacuum at 1Torr, and subsequently stored under desiccation prior 2.6. Device Fabrication. The postcured 51 × 76 × 0.4mm to being tested. DMA experiments were carried out from sheets of the four different copolymers were cut with the −20to140∘CintheDMAmultifrequency/straininstrument design pattern shown in Figure1 utilizing the 40W Gravo- mode using a frequency of 1Hz, a strain of 0.1%, a preload graph LS100 CO2 laser machining device. The same instru- force of 0.01N, a force track of 150%, and a heating rate mentparameterswereimplementedastheonesusedtocut of 2∘C/min. Data were recorded using TA Instruments Q- the DMA and dog bone specimens. Devices were carefully ∘ seriessoftwareandanalyzedusingTAInstrumentsUniversal cleaned with a methanol damp Kimwipe, dried at 90 C Analysissoftware. undervacuumat1Torrprior,andsubsequentlystoredunder desiccationpriortobeingtested. 2.5.TensileTesting. Uniaxialtensiletestingexperimentswere conductedtofailureonASTMtypeVdogbonesamples(𝑛= 2.7. Device Crimping. A custom fixture compatible with 5)usingadual-columnInstronmodel5965tensiletesterwith Instrontensiletestersystemswasfabricatedwithaminicom- a500Nloadcell,1000Nhightemperaturepneumaticgrips, puter numerically controlled (CNC) milling machine (see and a temperature chamber thermally controlled by forced Figure2).ItconsistedofaremovableportionmadeofPTFE convectionheating.Thedogbonesampleswerecutusinga with a funnel-like geometry on the inside and a stationary 4 SmartMaterialsResearch 50N load cell TT PP Catheter WB Q TB VM CD HW Blockwise radial tester TP DC TB DV Figure 4: Bench-top thrombotic stroke model. WB: water bath ∘ (37C); PP: peristaltic pump; TT: tensile tester (extension rate = 75mm/min);Q:experimentalflowrate(=57mL/min);TB:Touhy Figure 3: Sketch of Blockwise radial tester utilized in the con- Borst valve; CD: crimped device location; VM: vessel model; TP: strainedrecoveryexperiments(notdrawntoscale).Thediameter thermocoupleprobe;HW:hotwatersyringe;DV:dischargevalve; enclosed by the blades was set with a high accuracy gage pin, DC:dischargecontainer. and each device was inserted in its crimped configuration. The ∘ temperatureofthebladeswasrampedfrom30to55C,whilethe diameteroftheradialtesterwaskeptconstant.Asthethrombectomy devicerecovereditsshape,itexertedaloadontotheblades,which thecrimpeddevices(seeFigure3).Theradialtestertemper- wassensedbytheloadcell. ∘ ∘ aturewasrampedfrom30 Cto55 Candtherecoverystress ofthedevicesthatwerepreviouslycrimpedatlossmodulus peaktemperaturewasmeasuredat1HzusingInstronBluehill portion made of PMMA that was attached to the tensile 3software.Athermocouplewasinstalledincloseproximity tester’s bottom pneumatic grip. The maximum diameter of of each device, and temperature was also recorded at 1Hz thefunnelwas12.5mmanditcontractedgraduallyto3.5mm usingLabView.Thediameterofthetesterwaskeptconstant (the portion with the smallest diameter was 1cm long and at3.75mmaftersettingitwithahighaccuracygagepin.The it served to fit the length of the crimped device and allow blade heating effects of the radial tester were accounted for it to cool down). The stationary portion had a cap with a bysubtractingdatameasuredwiththeemptytesterfromthe 0.3mm hole machined with an excimer laser that helped dataofallmeasureddevicesforthesametemperaturerange. centerthewirethatheldthedevicesthroughoutthecrimping process.Thiswirehad∼2mmdiameterballof96.5Sn3.5Ag 2.9.Bench-TopBloodClotRemoval. Abench-topthrombotic solder purchased from Indium Corporation at the tip to strokemodelshowninFigure4wasconstructedtotest the hold the devices as they were pulled during crimping. By feasibility of the SMP flower-shaped devices for blood clot insertingathermocoupleinsidethefunneloftheassembled hold during removal. The blood clots were prepared with crimpingfixture,itwasdeterminedthatinordertoachieve bovine blood (10mL), which was acquired from Vet Med the target temperature inside the funnel within 45 minutes Park,CollegeStation,Texas.Bariumsulphate(1g)andbovine ∘ thetemperaturechamberwasrequiredtobeset4 Chigher. thrombin(25IU),bothpurchasedfromVWRInternational, Thus, devices were allowed to thermally equilibrate inside wereaddedtothebovineblood,andthemixturewasinjected the funnel for a minimum of 1 hour prior to testing. The intoasiliconetubewith10mminnerdiameter.Themixture tensile tester had a 50N load cell, rated with a resolution was gently agitated for about 5 minutes and was incubated of 0.00025N, and was set to extension mode at a strain atroomtemperatureforatleast1hourpriortotesting[30]. rateof5mm/min.DatawererecordedusingInstronBluehill Bloodclotsofroughly2cminlengthwerecutwithascalpel. 3 software. The crimping experiments were performed at Eachcrimpeddevicewasinsertedintothesiliconebifur- temperatures corresponding to the mechanical transition catedvesselmodel(purchasedfromShelleyMedicalImaging temperatures,DMAlossmoduluspeak,andtandeltapeak, Technologies, Ontario, Canada) followed by a blood clot. ofeachcopolymer’scomposition(𝑛=5). ∘ Water at 37 C was pumped into the main vessel segment (lumendiameter=8mm)ataflowrateof57mL/minviaa 2.8. DeviceConstrainedRecovery. Acommerciallyavailable peristaltic pump. The in vivo dynamically similar flow rate BlockwiseEngineeringRJA62radialstresstestercompatible via the matching of the Reynolds number that corresponds withInstrontensiletestersystemswitha50Nloadcellwas to the experimental flow rate is within the range of flow utilized to perform constrained recovery measurements of ratesrecordedinthemiddlecerebralartery,acommonsite SmartMaterialsResearch 5 LE, maximum. principal (avg:75%) 0.83 0.40 0.37 Device in funnel 0.33 0.30 0.27 0.23 0.20 0.17 0.13 0.10 0.07 0.03 0.00 Top view Side view Bottom view Figure5:Estimatesinthethrombectomydevicefortheprincipallogarithmicstrainsduringthecrimpingprocedure.Themaximumprincipal strainsareapproximately40%andarelocatedonthestrutsofthebottomloopsofthedeviceaswellasnearthecentercircle. forthromboembolicocclusionintheneurovasculature[31]. Table1:Rubberymodulusandmechanicaltransitiontemperature Each device was actuated by injecting water near boiling values. temperature with a syringe while shutting the valve that Rubbery Lossmoduluspeak Tandeltapeak connects one of the bifurcations of the vessel model to the Composition modulus temperature temperature dischargecontainer.Thedevicewasattachedtoaguidewire, (MPa) (∘C) (∘C) whichwasconnectedtoaSynergyMTStensiletesterthrough 5%BPA 1.67±0.18 62.3±0.16 72.3±0.16 a catheter. To ensure the repeatability of device testing, 15%BPA 5.92±0.08 53.6±0.17 66.9±0.16 the crosshead of the tensile tester pulled each device at an 25%BPA 11.0±0.32 50.8±0.25 62.8±0.24 extension rate of75mm/min to removetheblood clot. The temperaturebeforeandduringactuationwasrecordedat1Hz 35%BPA 15.6±1.02 50.8±0.11 61.5±0.12 byplacingathermocouplenearthelocationofthedevice. near the center hole of the device were a result of the large 3.Results deformation necessary to bend the petals upward, and the concentrations on the struts were a result of the twisting 3.1. FEA Simulations. Finite element simulations were per- necessarytoalignportionsofthepetalsforinsertionintothe formed using Abaqus 6.12-1 finite element software to esti- funnel. matethestrainsimposedonthethrombectomydeviceduring thecrimpingprocedure.Thegeometryofthethrombectomy device, adapted from Buckley et al. [23], was imported 3.2.MaterialPropertiesofCopolymers. Plotsofstoragemod- fromSolidWorks,andtheadditionalpartsnecessaryforthe ulus, loss modulus, and tan delta for acrylic SMP samples crimping—specifically, a funnel with a final inner diameter containing 5, 15, 25, and 35 mole% BPA are provided of 3.5mm and a rigid sphere with a diameter of 2mm— in Figures 6(a)–6(c), and numerical values for rubbery were created as analytical rigid parts in Abaqus. The ball modulus, loss modulus peak temperatures, and tan delta wasplacedincontactwiththethrombectomydeviceandthe peaktemperaturesareprovidedinTable1.Rubberymoduli funnelwasmovedsoastocrimpthedevicearoundtherigid were defined as the lowest value in the rubbery storage ball.Thismotionmimickedthatofpullingthedevicethrough moduluscurvesforallfourchemicalcompositions.AsBPA thefunnelusingawirethatwasterminatedbya2mmball. crosslinker was increased from 5 to 35 mole%, rubbery Figure5showsthestraincontoursonthedevicewhenitwas modulusincreasedfrom1.6to15.6MPa.Lossmoduluspeak ∘ inthefinalcrimpedstateinsidethefunnel.Inthisfigure,the temperatures were in the range of 50.8 to 62.3 C, tan delta ∘ device,whichwasmodeledusing1/14thsymmetryaboutthe peak temperatures were in the range of 61.5 to 72.3 C, longitudinalaxis,wasmirroredandthenpatterned7timesto and both loss modulus peak temperatures and tan delta be displayed in its entirety. The maximum principal strains peaktemperaturesdecreasedwithincreasingBPAcrosslinker were approximately 0.35–0.4mm/mm and were located at composition. Although increasing crosslink density often thebaseofthedevicenearthecircularcutoutaswellason resultsinincreasedglasstransitiontemperatureinthermoset thestrutsoftheinnermostloops.Thestrainconcentrations polymers, the decrease in glass transition with increasing 6 SmartMaterialsResearch 104 300 250 1000 5% BPA MPa) Pa) 200 15% BPA M dulus ( 100 ulus ( 150 25% BPA o d m o orage 35% BPA Loss m 100 35% BPA St 25% BPA 10 15% BPA 50 5% BPA 0 1 0 20 40 60 80 100 120 140 0 20 40 60 80 100 120 140 Temperature (∘C) Temperature (∘C) (a) (b) 2.5 2 5% BPA 1.5 15% BPA a elt d n 25% BPA Ta 1 35% BPA 0.5 0 0 20 40 60 80 100 120 140 Temperature (∘C) (c) Figure6:Dynamicmechanicalresponseofthefourcopolymers,storagemodulus(a),lossmodulus(b),andtandelta(c).Inpanel(a), thelowestpointofthecurve(i.e.,therubberymodulus)increasedasafunctionofincreasingcrosslinker.Additionally,anincreaseinthe temperaturethatcorrespondstolossmoduluspeakandtandeltapeakinpanels(b)and(c),respectively,wasobservedasaresultofincreasing crosslinker. BPA composition in this study was expected because the Figures7(a)and7(b),andaveragestress-at-failure,strain-to- BPA crosslinker contains flexible polyethylene oxide repeat failure, and toughness (area under the stress/strain curves) units,whichhaveacompetingeffectwithcrosslinkdensityon data is listed in Table2. For strain-to-failure experiments glasstransition.Itwasthiscompetingeffectthatwasusedto conducted at loss modulus peak temperatures, increasing enablethesynthesisoffourSMPswithsignificantlydifferent the BPA crosslinker from 5 to 35 mole% resulted in an crosslinkdensitiesandsimilarglasstransitiontemperatures. averagestress-at-failureincreasefrom11.9to23.0MPaandan Strain-to-failureexperimentswereperformedonallfour averagestrain-to-failuredecreasefrom1.43to0.48mm/mm. BPAcompositionsamplesatbothlossmoduluspeakandtan Forstrain-to-failureexperimentsconductedattandeltapeak deltapeaktemperatures.Allstress/strainresultsareshownin temperatures, increasing BPA composition resulted in an SmartMaterialsResearch 7 Table2:Rubberymodulusandmechanicaltransitiontemperaturevalues. Strain-to-failure Stress-at-failure Toughness Composition (mm/mm) (MPa) (MJ/m3) 5%BPA 1.43±0.0985 11.9±2.14 8.99±1.72 𝑇=temperatureatlossmoduluspeak 15%BPA 0.773±0.0906 14.2±1.51 6.21±0.992 25%BPA 0.609±0.119 13.2±1.07 3.96±0.747 35%BPA 0.475±0.0957 23.0±4.15 6.38±1.79 5%BPA 1.41±0.254 2.75±0.338 1.49±0.296 𝑇=temperatureattandeltapeak 15%BPA 0.590±0.182 2.87±0.254 0.697±0.169 25%BPA 0.357±0.0354 4.09±0.251 0.647±0.0723 35%BPA 0.376±0.0879 7.73±1.56 1.24±0.316 T= loss modulus peak temperature T= tan delta peak temperature 30 30 35% BPA 25 25 25% BPA 20 20 15% BPA a) 35% BPA Pa) MP Stress (M 15 5% BPA Stress ( 15 25% BPA15% BPA 10 10 5% BPA 5 5 0 0 0 0.5 1 1.5 0 0.5 1 1.5 Strain (mm/mm) Strain (mm/mm) (a) (b) Figure7:Tensilepropertiesofthefourcopolymersmeasuredateachcopolymer’slossmoduluspeak(a)andtandeltapeak(b)temperatures. Inbothtemperatures,thestraincapacityofthecopolymersdecreasedasaresultofincreasingcrosslinker;however,amorebrittleresponse wasobservedattandeltapeaktemperatures. averagestress-atfailureincreasefrom2.8to7.7MPaandan showplotsofforceversusextensionduringcrimpingatloss averagestrain-to-failuredecreasefrom1.41to0.37mm/mm. moduluspeaktemperaturesandtandeltapeaktemperatures, For both the loss modulus peak temperature and tan respectively. Figures 8(b) and 9(b) show images of the top, delta peak temperature strain-to-failure series, toughness side, and bottom views of crimped 35 mole% BPA devices decreased as BPA composition was increased from 5 to 15 at the two respective crimping temperatures. The crimping to 25 mole% and then increased for the 35% BPA samples. temperature had a significant effect on both the magnitude One possible explanation for this increase in toughness for oftheforcerequiredforcrimpingandonthepropensityfor the most highly crosslinked samples is that bisphenol A device failure during crimping. For devices crimped at loss groups have been shown to be capable of undergoing 𝜋- moduluspeaktemperature,themaximumaveragecrimping 𝜋 stacking, which increases toughness in materials such force increased from 0.41 to 1.05N as BPA composition as poly(bisphenol A carbonate) [32]. It is possible that, at increased from 5 to 35 mole%. For devices crimped at tan high enough BPA compositions, 𝜋-𝜋 stacking can become deltapeaktemperature,themaximumaveragecrimpingforce predominantenoughtoimprovetoughness. increasedfrom0.10to0.58NasBPAcompositionincreased from 5 to 35 mole%. None of the devices crimped at loss 3.3. Device Crimping. A total of five devices were crimped modulus peak temperature failed upon crimping. On the foreachofthefourBPAcompositions.Figures8(a)and9(a) contrary,thedevicescrimpedattandeltapeaktemperature 8 SmartMaterialsResearch T= loss modulus peak temperature Top view 1.4 35% BPA 1.2 1 Side view 25% BPA N) e ( 0.8 c or ng f 0.6 15% BPA pi m Cri 0.4 5% BPA Bottom view 0.2 0 No sample −0.2 0 50 100 Extension (%) (a) (b) Figure8:Forcemeasurementsofdevicescrimpedatlossmoduluspeaktemperature(a).Exampleofonedevicewith35mole%BPAcrimped atlossmoduluspeaktemperature(scalebar=1mm)(b).Imagesweretakenat2.5xmagnification. T= tan delta peak temperature Top view 1.4 35% BPA 1.2 1 25% BPA Side view N) e ( 0.8 15% BPA c or ng f 0.6 5% BPA pi m Cri 0.4 Bottom view 0.2 0 No sample −0.2 0 50 100 Extension (%) (a) (b) Figure9:Forcemeasurementsofdevicescrimpedattandeltapeaktemperature(a).Exampleofonedevicewith35mole%BPAcrimpedat tandeltapeaktemperature(scalebar=1mm)(b).Imagesweretakenat2.5xmagnification.Whitearrowpointsatacommonsiteforfailure. weremuchmoresusceptibletofailureduringcrimping:for 3.4.DeviceConstrainedRecovery. Becauseofthesignificant the 5, 15, 25, and 35 mole% BPA samples, the number of device failures that occurred during crimping at tan delta devicesthatfailedwas1,2,3,and5,respectively.Mostfailure peak temperatures, only devices crimped at loss modulus locationsconsistentlyoccurredatthebasesofthedevicesand peak temperatures were subjected to constrained recovery appearedtoinitiateattheedgesofthecenterholes,asshown tests.FivedevicesweretestedforeachBPAcomposition.In inFigure9(b). Figure10,aplotofaveragerecoverystressversustemperature SmartMaterialsResearch 9 20 35% BPA 15 25% BPA a) P ess (k 10 15% BPA y str er v o 5 c e R 5% BPA 0 −5 30 35 40 45 50 55 60 Temperature (∘C) Figure10:Recoverystressofthrombectomydevicesduringconstrainedrecovery.Increasingthecrosslinkeramountresultedinanincrease inrecoverystressmeasuredunderconstrainedconditions.However,forthetwohighestcrosslinkedcompositions,therecoverystresswas notsignificantlydifferent,becausefailureswereobservedinbothcompositionsbutweremoreprevalentindeviceswith35mole%BPA. T=33∘C T=37∘C T=43∘C T=46∘C T=49∘C T=54∘C T=55∘C A P B % 5 2 A P B % 5 3 T=31∘C T=38∘C T=43∘C T=47∘C T=50∘C T=53∘C T=55∘C Figure 11: Crack development in devices of each composition (i.e., 25 and 35 mole% BPA) during constrained recovery test at various temperaturepointsasthedevicewasrecoveringitsprimaryshape. isshownfordeviceswithvaryingBPAcomposition.AsBPA flowratesrecordedinthemiddlecerebralartery,acommon composition was increased from 5 to 35 mole%, average site for thromboembolic occlusion in the neurovasculature recoverystressincreasedfrom0.526to12.2kPa.Itisnotable [31]. Because the 25 and 35 mole% BPA devices developed thatduringtheconstrainedrecoverytests,twooutofthefive cracks during recovery under constrained conditions, they 25mole%BPAdevicesandfouroutofthefive35mole%BPA werenotconsideredforthebloodclotremovalexperiments. devices developed cracks and subsequently broke. Images Imagesofthethrombectomyexperimentsfora15mole%BPA ofcrackdevelopmentatdifferenttemperaturepointsduring deviceandadiagramofthesiliconevascularmodelusedin constrained recovery of 25 and 35 mole% BPA samples are the experiments are provided in Figure12. To demonstrate showninFigure11. that the crimped devices could maintain their crimped geometries under physiological conditions, they were first ∘ 3.5.BloodClotRemovalExperiments. Three5and15mole% immersedin37 Cwaterandpositionedpastthebovineblood BPA devices were subjected to blood clot removal experi- clotinthesiliconevesselmodel,aspicturedinFigure12(a). ∘ mentswithflow.Inordertobettersimulateinvivoconditions, After holding at 37 C to demonstrate shape fixity for 4- anexperimentalflowrateof57mL/minwaschosen.Thisflow 5min, the water temperature was elevated to ∼T𝑔 + 15 ∘C ∘ rateisequivalentto113mL/minafterdynamicsimilarityvia (maximum recorded temperature: 77 C) over the course of matchingtheReynoldsnumber,whichiswithintherangeof 45sbyinjectingwaternearboilingtemperaturetotheflow 10 SmartMaterialsResearch Catheter Blood clot (e) (d) (c) Q=57mL/min (e) (d) (c) Extension rate =75mm/min (b) (a) (b) Actuation: t=0s t=42s t=44s T=Tg−40∘C T=Tg+10∘C T=Tg+15∘C (a) Figure12:Actuationandclotremovalwith15mole%BPAdevice.Q:experimentalflowrate(=57mL/min).Panel(a)showsthedevice duringactuationasthehotwaterwasinjected.Panels(b)–(e)depicttheactuatedthrombectomydeviceasitiswithdrawnbythetensiletester successfullymovingthebloodclotfromtheoccludedvessel(panel(b))tothelocationofthecatheter(panel(e)). system.Thebenefitofincreasingcrosslinkdensityondevice Given the geometry of the device, recovery stress plays blood clot removal was demonstrated: 0/3 of the 5 mole% an important role in achieving blood clot entrapment and BPAdevicesresultedinasuccessfulextraction,while2/3of successful removal. The devices tested in the bench-top the15mole%BPAdevicesresultedinasuccessfulbloodclot thromboticstrokemodelinthisstudyconsistedof5and15 extraction(i.e.,thedeviceswereabletomovethebloodclot mole% BPA. The average recovery stress of the 15 mole% fromitsoriginatthebifurcationpicturedinFigure12(b)to BPAdeviceswasroughlyoneorderofmagnitudehigherthan thecathetertipattheendofthevasculaturemodel,pictured that of the 5 mole% BPA devices. This positive correlation inFigure12(e)). between crosslink density and recovery stress in SMPs has been reported in numerous previous studies [11, 26, 27]. In anidealrubber,elasticmodulusisinverselyproportionalto 4.Discussion theaveragemolecularweightbetweencrosslinks,soamore The motivation for this study is the need for a SMP-based highlycrosslinkedrubberwillhaveahigherstiffnessthana thrombectomy device that can exhibit sufficient recovery morelightlycrosslinkedrubber.Consequently,moreenergy stress to reduce the likelihood of blood clot dislodgement isrequiredtoachieveaspecificdeformationinamorehighly during thrombectomy, while also being able to undergo crosslinkedrubberthaninamorelightlycrosslinkedrubber. sufficient deformation for catheter delivery. Thrombectomy Since the energy required to achieve these deformations is isapromisingtreatmenttechniqueforthe∼97%ofischemic metastablystoredwhenthermallyactuatedSMPsarestrained stroke patients who are not eligible to receive tPA, the only andthencooledbelowtheirthermaltransitionregions,the FDA-approved drug for the treatment of ischemic stroke force exerted by an SMP during recovery is consequently [2,6]. higher for a more highly crosslinked SMP [11, 25–27, 30].

Description:
Introduction. Thrombectomy devices are failure to reestablish blood flow in a timely manner results . SolidWorks based on the geometry proposed by Buckley et al. [23]. the simulation, and “hard” contact (i.e., no penetration) stroke,” Annals of Emergency Medicine, vol. 46, no. 203–209,
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