Bioabsorbable implants

Abstract

A bioabsorbable implant including an elongated metallic element having more than 50% by weight a metal and being substantially free of rare earth elements, the elongated metallic element defining at least a portion of the bioabsorbable implant and including a wire formed into a discrete bioabsorbable expandable metal ring; at least two biostable ring elements, each biostable ring element having a biostable and radio-opaque metallic alloy, the bioabsorbable expandable metal ring being disposed adjacent to at least one of the biostable ring elements; at least one flexible longitudinal connector including a bioabsorbable polymer, the connector being disposed between at least two adjacent rings; and a coating having at least one pharmaceutically active agent disposed over at least a portion of one ring.

Claims

1. A bioabsorbable implant comprising: a directionally solidified and elongated metallic element comprising more than 50% by weight a metal and being substantially free of rare earth elements, the elongated metallic element defining at least a portion of the bioabsorbable implant and comprising a wire formed into a discrete bioabsorbable expandable metal ring, the metal defining at least one of (i) a continuous single grain having an aspect ratio of grain length to grain diameter of at least 10:1 and (ii) a columnar microstructure including one or more columnar grains extending substantially the entire length of the implant, the one or more columnar grains each having an average grain length of at least about 1 mm and an average grain diameter of less than about 3 mm; at least two biostable ring elements, each biostable ring element comprising a biostable and radio-opaque metallic alloy, the bioabsorbable expandable metal ring being disposed adjacent to at least one of the biostable ring elements; at least one flexible longitudinal connector comprising a bioabsorbable polymer, the connector being disposed between at least two adjacent rings; and a coating comprising at least one pharmaceutically active agent disposed over at least a portion of one ring; wherein the metal is configured to exhibit enhanced strength and physical integrity post-implantation by being substantially free of grain boundaries containing impurities.

2. The bioabsorbable implant of claim 1, wherein the metal is selected from the group consisting of magnesium, iron, zinc, calcium, manganese, and combinations thereof.

3. The bioabsorbable implant of claim 1, wherein at least two of the biostable ring elements comprise a laser-machined hypo-tube comprising at least one of cobalt, chrome, stainless steel, titanium, and iron.

4. The bioabsorbable implant of claim 1, wherein at least one of the biostable ring elements defines at least one of an aperture and a stud configured to couple with the at least one flexible longitudinal connector.

5. The bioabsorbable implant of claim 1, wherein the at least one flexible longitudinal connector comprises at least one of a biodegradable homopolymer and an aliphatic polyester selected from the group consisting of lactic acid, lactide, glycolic acid, glycolide, caprolactone, dioxanone, trimethylcarbonate, and co-polymers and blends thereof.

6. The bioabsorbable implant of claim 1, wherein the at least one flexible longitudinal connector comprises at least one of directionally oriented absorbable filaments extending along a length of the bioabsorbable implant and extruded tubes of absorbable polymer.

7. The bioabsorbable implant of claim 1, wherein the pharmaceutically active agent is selected from the group consisting of a potent anti-proliferative to human smooth muscle cells, taxane, an mTOR agent, and a chemoactive agent suitable for cancer treatment.

8. The bioabsorbable implant of claim 1, wherein the elongated metallic element defines at least a portion of the bioabsorbable implant and comprises more than about 80% by weight of the metal.

9. The bioabsorbable implant of claim 8, wherein the metal is selected from the group consisting of magnesium, iron, zinc, and manganese, and combinations thereof.

10. The bioabsorbable implant of claim 9, wherein the one or more columnar grains each have an average grain diameter of less than about 0.2 mm.

11. The bioabsorbable implant of claim 1, wherein the wire has a diameter of less than about 0.2 mm.

12. The bioabsorbable implant of claim 1, wherein the elongated metallic element comprises <0.1 weight percent of rare earth metals.

13. A bioabsorbable implant comprising: a directionally solidified and elongated metallic element substantially free of rare earth metals and comprising more than 50% by weight a metal selected from the group consisting of magnesium, iron, zinc, manganese and combinations thereof, the elongated metallic element defining at least a portion of the bioabsorbable implant and comprising a wire formed into a first bioabsorbable expandable metal ring and a second bioabsorbable expandable metal ring, the metal defining at least one of a continuous single grain and a columnar microstructure including one or more columnar grains extending substantially the entire length of the implant, the wire exhibiting enhanced strength and physical integrity post-implantation by being substantially free of grain boundaries containing impurities.

14. A bioabsorbable implant of claim 13, further comprising: at least one flexible longitudinal connector comprising an absorbable polymer, the at least one flexible longitudinal connector being configured to connect the first and second expandable metal rings; and a coating comprising a pharmaceutically active agent disposed over at least a portion of at least one of the first and second metal rings and the longitudinal connector.

15. The bioabsorbable implant of claim 14, wherein at least one of the expandable metal rings comprises a stud configured for coupling with an adjacent feature.

16. The bioabsorbable implant of claim 14, wherein at least one of the expandable rings forms an aperture adapted for coupling with the at least one flexible longitudinal connector.

17. The bioabsorbable implant of claim 14, wherein at least one flexible longitudinal connector comprises at least one of a biodegradable homopolymer and an aliphatic polyester selected from the group consisting of lactic acid, lactide, glycolic acid, glycolide, caprolactone, dioxanone, trimethylcarbonate, and co-polymers and blends thereof.

18. The bioabsorbable implant of claim 14, wherein the at least one flexible longitudinal connector comprises at least one of directionally oriented absorbable filaments extending along a length of the bioabsorbable implant and extruded tubes of absorbable polymer.

19. The bioabsorbable implant of claim 14, wherein the pharmaceutically active agent is selected from the group consisting of a potent anti-proliferative to human smooth muscle cells, taxane, an mTOR agent, and a chemoactive agent suitable for cancer treatment.

20. The bioabsorbable implant of claim 13, wherein the continuous single grain has an aspect ratio of grain length to grain diameter of at least 10:1 and the one or more columnar grains each have an aspect ratio of grain length to grain diameter of at least 10:1.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The following drawings are not necessarily to scale, emphasis instead being placed generally upon illustrating the principles of the invention. Moreover, the above-mentioned aspects of the present invention and the manner of obtaining them will become more apparent and the invention itself will be better understood by reference to the following description of the embodiments of the invention taken in conjunction with the accompanying drawings, wherein:

(2) FIG. 1 is a schematic diagram of a segment of an elongated implant or sub-component such as a wire or pin with a conventional polycrystalline grain structure;

(3) FIG. 2 is a schematic diagram of a segment of an elongated implant or sub-component processed by directional solidification that yields a plurality of columnar crystals in accordance with an embodiment of the invention;

(4) FIG. 3 is a schematic diagram of an elongated implant or sub-component formed of a single crystal that is essentially without grain boundaries in accordance with an embodiment of the invention;

(5) FIG. 4 is a schematic diagram of a segment of directionally solidified alloy formed into a sub-component of an implant, in accordance with an embodiment of the invention;

(6) FIG. 5 is a schematic diagram of a segment of directionally solidified alloy formed into a ligating clip, in accordance with an embodiment of the invention;

(7) FIG. 6 is a schematic diagram of directionally solidified alloy formed into a bone fixation device, in accordance with an embodiment of the invention;

(8) FIG. 7 is a schematic diagram of a segment of directionally solidified alloy blank formed into a bone anchor, in accordance with an embodiment of the invention;

(9) FIG. 8a is a schematic diagram of a wire formed into a continuous sinusoidal-like wave form in accordance with an embodiment of the invention;

(10) FIG. 8b is a schematic diagram illustrating the continuous sinusoidal-like wave form of FIG. 8a being wrapped around a mandrel, in accordance with an embodiment of the invention;

(11) FIG. 8c is a schematic diagram of a bioabsorbable continuous helical sinusoid, in accordance with an embodiment of the invention.

(12) FIG. 9 is a schematic diagram of a single expandable ring made of an absorbable magnesium alloy wire that has been mechanically formed and welded in accordance with an embodiment of the invention;

(13) FIG. 10 is a schematic diagram of a plurality of expandable metal rings connected by discrete loops of absorbable polymer in accordance with an embodiment of the invention;

(14) FIG. 11 is a schematic diagram of a plurality of expandable metal rings connected longitudinally by interwoven filaments made of absorbable polymer, with connectors extending continuously the full length of the implant in accordance with an embodiment of the invention;

(15) FIG. 12a is a schematic diagram of segments of expandable metal rings with stud features and a small diameter extruded tube of flexible absorbable polymer cut to length in accordance with an embodiment of the invention;

(16) FIG. 12b is a schematic diagram of an assembled composite implant with the tube connecting the stud features on adjacent segments in accordance with an embodiment of the invention;

(17) FIG. 13 is a longitudinal cross sectional view of a plurality of expandable metal rings connected by injection-molded longitudinal connectors of flexible absorbable polymer in accordance with an embodiment of the invention;

(18) FIG. 14 is a longitudinal cross-sectional view of a 3-layer sandwich construction of braided absorbable polymer filaments on outer and inner layers, encapsulating a middle layer of expandable metal rings in accordance with an embodiment of the invention;

(19) FIG. 15 is a schematic diagram of a hybrid stent including thin ring segments made from a biostable and radio-opaque material, a larger center ring segment made from an absorbable magnesium alloy, and filament connectors between segments made of absorbable polymer in accordance with an embodiment of the invention;

(20) FIG. 16 is a schematic diagram of eyelet design features that facilitate the interlacing of ring segments by continuous filament connectors in accordance with an embodiment of the invention; and

(21) FIG. 17 is a schematic diagram of a hybrid stent with a plurality of alternating biostable and absorbable ring segments and absorbable polymer connectors in accordance with an embodiment of the invention.

(22) Corresponding reference characters indicate corresponding parts throughout the several views. Although the exemplification set out herein illustrates embodiments of the invention, in several forms, the embodiments disclosed below are not intended to be exhaustive or to be construed as limiting the scope of the invention to the precise forms disclosed.

DETAILED DESCRIPTION

(23) In the following detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, drawings, and claims are not meant to be limiting. Other embodiments may be utilized, and other changes may be made, without departing from the spirit or scope of the subject matter presented herein. It will be readily understood that the disclosed aspects of the invention, as generally described herein, and illustrated in the Figures, may be arranged, substituted, combined, and designed in a wide variety of different configurations, all of which are explicitly contemplated and should be construed as being incorporated into this disclosure.

(24) Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any method and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the specific methods and materials are now described. Moreover, the techniques employed or contemplated herein are standard methodologies well known to one of ordinary skill in the art and the materials, methods and examples are illustrative only and not intended to be limiting.

(25) Referring to FIG. 1, a segment of an elongated implant 100 or sub-component such as a wire or pin with a conventional polycrystalline grain structure in cross-section A-A, has a plurality of grains 110 separated by grain boundaries 120. Grain boundaries 120′ that are aligned perpendicularly to the primary loading axis may be initiation points for premature failure due to accelerated corrosion or crack formation from fatigue.

(26) In contrast, the crystal structure in accordance with embodiments of the invention may be either single crystal (i.e., a continuous single grain) or columnar crystal structures (i.e., a columnar microstructure) that extend continuously for the length of the implant or implant sub-component. Referring to FIG. 2, a bioabsorbable implant may include an elongated metallic element or sub-component that may be formed by directional solidification that yields a columnar microstructure 200 plurality of columnar crystals 210 that extend essentially the full functional length of the implant 100. A single crystal structure 220 that is essentially without grain boundaries is shown for clarity, with dimensions of z>>x, z>>y.

(27) If the metal defines a columnar microstructure 200, the columnar microstructure may include grains having an average grain length of preferably at least about 1 mm, and an average grain diameter of preferably less than about 0.1 mm. In some embodiments, the average grain length may be at least about 10 mm. The average grain diameter is at least about 5 mm. The metal may include one or more grains having an aspect ratio of grain length to diameter of at least 10:1, preferably 100:1 or more.

(28) To achieve such a controlled microstructure, the implant or implant sub-component may processed from a melt by a process that controls the direction of solidification along its elongated axis. This may be achieved through controlled heat removal (under-cooling) at one end of the elongated structure so that crystal nucleation and propagation is driven down its length (z axis in FIG. 2), while crystal formation in the directions perpendicular to elongated axis are retarded by keeping those surfaces at an elevated temperature with insufficient under-cooling for nucleation. Additional mechanical forming processes can be practiced following directional solidification to achieve the final implant geometry, if the thermal treatments do not result in a re-crystallization that reverts the structure to polycrystalline.

(29) A suitable process for forming at least a portion of an implant from a melt is the Ohno process. The Ohno process, typically used to form copper wires, is described in the literature. See, e.g.: 1. A. Ohno Casting of Near Net Shape Products, Edited by Y. Bahai, The Metallurgical Society (1988) 177; 2. X. Fan, Y. Cai Y, P. Wei, J. Li and H. Fu, Continuous casting technology of single crystal metals, Chinese Journal of Materials Research (June 1996) Vol. 10, No. 3, pp. 264-266; 3. Z. M. Zhang, T. Lu, C. J. Xu and X. F. Guo, Microstructure of binary Mg—Al eutectic alloy wires produced by the Ohno continuous casting process, ACTA Metall. Sin. (Engl. Lett.) Vol. 21, No. 4 (August 2008) pp. 275-281; 4. M. H. Kim, H. H. Jo and H. Y. Cho, Operating parameters for the continuous unidirectional solidification of the Al-1 wt. % Si Alloy drawn to fine wire, Metals and Materials, Vol. 6, No. 6 (2000) pp. 491-495; and 5. Y. J. Kim and S. Kou, An Experimental Study on Process Variables in Crystal Growth by Ohno Continuous Casting, Metallurgical Transactions A, Volume 19A (July 1988) pp. 1849. Each of these references is incorporated by reference herein in its entirety.

(30) In particular, the Ohno process is a continuous casting process that uses a heated mold, rather than a cooled mold. The mold is heated slightly above the melting point of the metal to be solidified. This has the result that no new grains can nucleate at the mold wall. Solidification is restricted to the contact area between the melt and the dummy rod or single crystal seed, which is withdrawn from the melt. The mold can be positioned vertically upward, vertically downward, or horizontal. The melt stays in the mold even when the mold is not positioned vertically upward, as the die diameter is small, and grips or pinch rollers are needed to pull the wire out of the mold.

(31) An advantage of the Ohno process is that it can be used for directional solidification or crystal growth, and ingots or crystals of unlimited length may be produced. The resulting material has a smooth surface and inner quality due to the fact that impurities are moved to the boundaries, resulting in a pure crystal. In addition superior mechanical properties are achieved due to the resulting directionally solidified microstructure.

(32) One way to create a wire using the Ohno process is to utilize a crucible furnace with a melt level control, a heated mold with a small diameter channel, a cooling device to cool the wire after it exits the mold, and pinch rolls to pull the wire away from the mold.

(33) Wire/bar drawing, a metalworking process known to those of skill in the art, allows for successive reductions in diameter of the bar/wire by pulling the wire/bar through successively smaller diameter dies. The successive reductions in diameter result in expansion of the length of the wire. The die is typically mounted on a draw bench and the end of the wire is placed in grips so that the rest of the wire may be pulled through the die. The process of drawing improves the mechanical properties of the wire due to work hardening.

(34) In an exemplary process, eutectic Mg—Al wires of 5 mm in diameter with mirror-smooth surface may be continuously solidified with a casting speed 10 mm/min, a mold exit temperature of 450° C., a static pressure head of the melt of 5 mm, a flow rate of cooling water 30 L/h, and a mold-cooling water distance 20 mm. Under these casting conditions, the wires solidify just outside of the mold exit.

(35) Various metals may be suitable for embodiments of the invention, including metallic alloys of magnesium, iron, zinc, calcium, manganese and/or combinations thereof. In particular, an elongated metallic element may include more than about 50% by weight a metal, such as magnesium, iron, zinc, calcium, and/or manganese metals and/or combinations or alloys thereof, and is preferably substantially free of rare earth metals. Substantially free of rare earth metals, as used herein, means that less than 0.1% (by weight) of the metallic alloys includes rare earth metals. Anything less than 0.1% is in the hundreds parts per million range, which is below the FDA threshold in safety profiles of individual impurities in drugs. At that level, rare earth metals also do not have a significant effect on corrosion properties. Rare earth and other high atomic number metals and their compounds are undesirable in implants because they are largely insoluble in physiologic fluids, which significantly delays absorption by local tissue.

(36) In some embodiments, the metallic alloy may be at least 80% Mg, with the balance including one or more of the elements Ca, Mn, Zn, Fe, plus trace elements. It may be preferable to use pure Mg as a basis for the alloy, with no inclusion of rare earth metals.

(37) Referring to FIG. 3, in some embodiments, a segment of an elongated implant or sub-component processed by directional solidification yields a single columnar crystal 300 that extends essentially the full functional length of the implant.

(38) The elongated metallic element may define at least a portion of the bioabsorbable implant. The elongated metallic element may include a wire. The wire may have a diameter of less than about 02 mm. For intraluminal devices like stents, diameters above about 0.2 mm may create too much trauma to the vessel wall. On the other hand, in some embodiments such as ligating clips or suture anchors, diameters up to several mm may be preferred.

(39) As discussed below, the elongated metallic element may include a wire formed into at least one discrete bioabsorbable expandable metal ring, or a wire formed into a bioabsorbable continuous helical sinusoid. The metal ring may be formed from welded wire forms or by laser micro-machining of metal tubing.

(40) The bioabsorbable implant may be any one of various devices, such as an intraluminal device. Referring to FIG. 4, a segment of directionally solidified alloy may be formed into a sub-component of an implant, i.e., a ring element 400 of a balloon expandable coronary stent 410.

(41) The bioabsorbable implant may also be a ligating clip or a ligating clip component. In particular, referring to FIG. 5, a segment of directionally solidified alloy may be formed into a ligating clip 500 for tubular anatomical structures.

(42) Referring to FIG. 6, in some embodiments, the bioabsorbable implant is a bone fixation device 600 for fracture fixation, e.g., a plate 610, a pin, or a screw 620.

(43) In other embodiments, the bioabsorbable implant is a bone-to-soft-tissue fixation device, e.g., a suture anchor, an interference screw, or a cross pin. For example, referring to FIG. 7, a segment of directionally solidified formed alloy, produced as discussed above, in the form of a blank 700 may be formed into a bone anchor 710 (also referred to as a suture anchor) for soft tissue reattachment by means of a suture 720.

(44) Several key features of the directionally solidified structures differentiate their performance from polycrystalline alloys of the same alloy composition and geometry (cross-sectional area). First, they retain strength and physical integrity longer under corrosion conditions (in vivo) due to the elimination of vulnerable grain boundaries that contain Fe and other impurities that result in mini-galvanic cells with the Mg. For many implant applications, maintaining strength and integrity through the early healing periods is critical for both soft and hard tissue applications.

(45) Secondly, they inherently possess better ductility and fatigue resistance, since mechanical failure (in the absence of corrosion) is most often initiated at a micro-crack that forms at the interface of two grains under tensile or compressive load. This feature of directionally solidified alloys is currently utilized for critical load bearing non-implant applications such as turbine rotors.

(46) Thirdly, because the loss of strength and mass is through surface corrosion and erosion, they degrade more “gracefully” in vivo, i.e. fragmentation starts later and with smaller and less injurious intermediate fragments.

(47) A preferred embodiment of a bioabsorbable implant is a bioabsorbable helical continuous sinusoid. This structure may include a wire formed into the sinusoid; the wire may define either a continuous single grain or a columnar microstructure. Referring to FIGS. 8a and 8b, a helical continuous sinusoid may be defined as a wire-form tubular structure made from a wire that is first formed into a continuous sinusoidal-like wave form 800, and that is secondly wrapped in a helical configuration around a cylindrical mandrel 810 to form a tubular but mechanically unstable structure. Referring to FIG. 8c, thirdly, the adjacent rows of ring-like structures 820 of the wire wave form 800 are connected at discrete contact points 830 to provide mechanical integrity, either by longitudinal absorbable polymer connectors, or by known metal welding techniques to define a helical continuous sinusoid 840.

(48) A pharmaceutically active agent may be disposed over at least a portion of the helical continuous sinusoid 840. The pharmaceutically active agent may be one of many suitable materials. For example, it may be a potent anti-proliferative to human smooth muscle cells, and a chemoactive agent suitable for cancer treatment. The agent may be a taxane, such as Paclitaxel, its derivatives and prodrugs thereof. In some embodiments, the agent may be a known mTOR agent such as sirolimus or everolimus, their derivatives and prodrugs thereof. The implant may locally deliver both a taxane and a mTOR agent. The active agent may be eluted at a controlled rate through formulation with a biodegradable polymer.

(49) One key aspect of one design in accordance with an embodiment of the invention is a more controlled, graceful degradation process than that of existing fully absorbable metal stent designs. In previous attempts to form absorbable metal stents, the integral metal longitudinal connecting elements degraded at a similar rate to the structural ring elements. At intermediate fragmentation stages, long and wide stent fragments may be formed consisting of multiple ring fragments and intact metal connectors. The shape and size of these fragments make them problematic relative to obstructing the vessel lumen. In one embodiment, the fragment size is reduced by using longitudinal connectors comprised of an absorbable polymer with significantly faster degradation kinetics than the metal rings. In another embodiment, the high surface area and favorable surface chemistry of the polymeric longitudinal connectors contribute to rapid tissue coverage and integration of the implant into the vessel wall.

(50) Referring to FIG. 9, a single discrete bioabsorbable expandable metal ring 900 may be made from a wire of an absorbable magnesium alloy wire that has been mechanically formed and welded. The ring 900 may also be formed from any of the other alloys discussed above, including iron, zinc, calcium, and/or manganese metals or alloys, or any other material suitable for forming a bioabsorbable implant.

(51) Referring to FIG. 10, a plurality of expandable metal rings 900 formed from wire may be connected by discrete loops of absorbable polymer, i.e., flexible longitudinal connector 1000, and mounted on a balloon catheter 1010. The plurality of rings may include a first discrete bioabsorbable expandable metal ring and a second discrete bioabsorbable expandable metal ring, with at least one flexible longitudinal connector, including an absorbable polymer, connecting the first and second discrete expandable metal rings. A coating including a pharmaceutically active agent may be disposed over at least a portion of at least one of the first and second metal rings and the longitudinal connector. At least one of the expandable metal rings may include a wire defining a single grain or a columnar microstructure.

(52) One or more of the flexible longitudinal connectors may include a biodegradable homopolymer of an aliphatic polyester, such as lactic acid, lactide, glycolic acid, glycolide, caprolactone, dioxanone, trimethylcarbonate, and co-polymers and Mends thereof.

(53) The pharmaceutically active agent may be one of many suitable materials. For example, it may be a potent anti-proliferative to human smooth muscle cells, and a chemoactive agent suitable for cancer treatment. The agent may be a taxane, such as Paclitaxel, its derivatives and prodrugs thereof. In some embodiments, the agent may be a known mTOR agent such as sirolimus or everolimus, their derivatives and prodrugs thereof. The implant may locally deliver both a taxane and a mTOR agent. The active agent may be eluted at a controlled rate through formulation with a biodegradable polymer.

(54) Referring to FIG. 11, a plurality of expandable metal rings 900 or a helical continuous sinusoid may be connected longitudinally by interwoven filaments 1100 made of absorbable polymer. A longitudinal cross-sectional view shows the metallic rings 900 and interwoven filaments 1100. The helical continuous sinusoid 840 may also be similarly connected longitudinally by interwoven filaments 1100 (not shown).

(55) At least one of the flexible longitudinal connectors may include directionally oriented absorbable filaments extending along a length of the bioabsorbable implant.

(56) Referring to FIGS. 12a and 12b, at least one of the expandable metal rings 900 may define a stud feature 1200. The stud is configured to allow for mechanical connection of adjacent ring segments. A hollow, small diameter extruded tube of, e.g., flexible absorbable polymer of PLGA may be cut to length 1210 and interference fit over the opposing stud features 1200 to form a longitudinal connector 1220.

(57) Referring to FIG. 13, a plurality of expandable metal rings 900 or a helical continuous sinusoid 840 may be connected by injection-molded longitudinal connectors 1300 of flexible absorbable polymer. Accordingly, in some embodiments, the flexible longitudinal connectors may include extruded tubes of absorbable polymer.

(58) Referring to FIG. 14, a 3-layer sandwich construction may include braided absorbable polymer filaments on outer 1400 and inner layers 1410, encapsulating a middle layer of expandable metal rings 900.

(59) In some embodiments, at least one of the expandable rings form an eyelet adapted for coupling with the at least one flexible longitudinal connector (see eyelet 5 in FIG. 14).

(60) Referring to FIG. 15, a hybrid stent may include thin proximal and distal ring segments 1500, 1500′ made from a biostable and radio-opaque material, a larger center ring segment 1510 including, e.g., a plurality of rings 900 made of a bioabsorbable magnesium alloy (or any or the other bioabsorbable alloys discussed herein) or a helical continuous sinusoid 840, and filament connectors, e.g., longitudinal connectors 1000 made of a bioabsorbable polymer such as PLGA. As seen in the figure, the bioabsorbable expandable metal ring 900 may be disposed adjacent at least one of the biostable rings 1500, 1500′, and at least one flexible longitudinal connector 1000 is disposed between at least two adjacent rings. A coating including at least one pharmaceutically active agent may be disposed over at least a portion of one ring.

(61) At least one of the biostable rings may be a laser-machined hypo-tube including cobalt, chrome, stainless steel, titanium, and/or iron.

(62) At least one of the flexible longitudinal connectors may include a biodegradable homopolymer and/or an aliphatic polyester such as lactic acid, lactide, glycolic acid, glycolide, caprolactone, dioxanone, trimethylcarbonate, and/or co-polymers and blends thereof.

(63) At least one of the flexible longitudinal connectors may include directionally oriented absorbable filaments extending along a length of the bioabsorbable implant and/or extruded tubes of absorbable polymer such as PLGA.

(64) As in other embodiments described herein, the pharmaceutically active agent may be one of many suitable materials. For example, it may be a potent anti-proliferative to human smooth muscle cells, and a chemoactive agent suitable for cancer treatment. The agent may be a taxane, such as Paclitaxel, its derivatives and prodrugs thereof. In some embodiments, the agent may be a known mTOR agent such as sirolimus or everolimus, their derivatives and prodrugs thereof. The implant may locally deliver both a taxane and a mTOR agent. The active agent may be eluted at a controlled rate through formulation with a biodegradable polymer.

(65) Referring to FIG. 16, at least one of the discrete biostable rings 1500, 1500′ may define an eyelet 1600 and/or a stud configured to couple with at least one flexible longitudinal connector, e.g., interwoven filaments 1100. The eyelet design features 1600 facilitate the interlacing of the laser cut biostable proximal and distal ring segments 1500, 1500′ by continuous filament connectors 1100 that transverse the center bioabsorbable segment 1510 including a plurality of bioabsorbable rings 900 or a helical continuous sinusoid 840.

(66) Referring to FIG. 17, a hybrid stent may include a plurality of alternating biostable 1500 and bioabsorbable ring segments 1510 and bioabsorbable polymer connectors 1000.

(67) Advantages and improvements of the processes, methods and devices of the present invention are demonstrated in the following examples. These examples are illustrative only and are not intended to limit or preclude other embodiments of the present invention.

Example 1

(68) A 99.99% pure magnesium rod of 20 cm length and 5 mm diameter may be directionally solidified from the melt in an induction-heated graphite mold equipped with means for rapid cooling from a single end, e.g., the Easyheat 0112 system available from Ameritherm, based in Scottsville, N.Y. A center section of the rod may be mechanically reduced to a diameter of 1.5 mm, and the rod may then be drawn at an elevated temperature to a wire diameter of 125 microns. The wire may be cut to length, and bent on a wire forming machine into a sinusoidal geometry with a peak-to-valley height of 1.25 mm. A 6 crown ring may be formed by bending a cut length of the linear wire form around a circular mandrel, clamping it in place with opposing wire ends coming in direct contact and overlapped, followed by laser welding to form a lap joint. The metal stent rings may then be electro-polished to a final wire diameter of 120 microns while smoothing weld joints. A series of 12 rings may be welded together at 3 locations per ring to form a 15 mm long vascular stent. The stent platform may be spray coated with 200 microgram coating weight (dry) of D,L PLA-Paclitaxel with a 5% drug load, predominantly on the external or abluminal surface. The drug coated stent may be crimped on an angioplasty balloon catheter, and sterilized by e-beam sterilization.

Example 2

(69) A metal including, e.g., 100% magnesium may be continuously cast by the Ohno continuous casting process used for preparing single crystal fine copper wire, and then drawn to a final diameter of 110 microns, with a length of several miles. The wire may be cut to length sufficient to define one discrete ring, and bent on a wire forming machine into a sinusoidal geometry with a peak to valley height of 1.0 mm. A 6 crown ring may be formed by bending a cut length of the linear wire form around a circular mandrel, clamping it in place with opposing wire ends coming in direct contact and overlapped, followed by laser welding to form a lap joint. The metal stent rings may then be electro-polished to a final wire diameter of 100 microns while smoothing weld joints. Then a stable and dense MgO layer of approximately 1 micron may be formed through electrochemical techniques to passivate the implant surface. A series of 15 rings may be interconnected with filaments of absorbable co-polymer of 10% lactide-90% glycolide to form a vascular stent. The stent platform may be spray coated with 200 microgram coating weight (dry) of D,L PLA-Paclitaxel with a 7.5% drug load. The drug coated stent may be crimped on an angioplasty balloon catheter, and sterilized by ethylene oxide sterilization.

Example 3

(70) A ligating clip may be made from 1.5 mm×1.5 mm square stock a magnesium-based directionally solidified alloy. The square blank may be cast in a heated tool that is equipped for super cooling from one end, resulting in a microstructure of columnar grains extending for its entire length. The square blank may be cut to length, electro-polished, and then passivated with the formation of dense MgO layer. The blank may be formed into an open “V” clip by hot working to form the hinge point, and cold coining of the outer surfaces to form details for engagement and retention within the jaws of a clip applier. The cartridge of clips may be packaged and sterilized by conventional gamma sterilization at a minimum dose of 3.0 MRads. The clips may retain integrity for 4 weeks in vivo, and may be used for small vascular vessel ligation, or for reproductive sterilization.

Example 4

(71) A bone fixation device may be made from a high purity alloy of 98% Mg-2% Ca that is directionally solidified into a 2.5 mm cylindrical blank, which is subsequently tapered in a secondary grinding process. The pin may then be electro-polished to remove surface contaminants and then treated by electrochemical means to form a dense magnesium oxide layer. The pin preferably possesses the necessary mechanical strength and ductility for an interference fit for insertion into a pre-drilled hole in two bone fragments. The pin preferably retains physical integrity and prevents micro-motion between the fragments for period of 12 weeks, and is subsequently fully absorbed.

Example 5

(72) A directionally solidified wire of pure Mg with 10-90 PLGA filament longitudinal connectors and spray coated paclitaxel-PLA coating may be made as follows. High purity magnesium may be directionally solidified and drawn into a 125 micron diameter round wire. The wire may have an ultimate tensile strength of 125 MPa and elongation to break greater than 25%. The wire may be formed on a four slide wire forming machine into conventional sinusoidal or racetrack geometry with a ring height of 1.0 mm in the crimped state. A 6 crown ring may be formed by bending the linear wire form around a circular mandrel, clamping it place with opposing wire ends coming in direct contact and overlapped, followed by laser welding to form a lap joint. The metal stent rings may then electropolished to a final wire diameter of 120 microns while smoothing weld joints. Longitudinal connectors may be made from 10-90 PLGA, by taking 12 rings and lacing or weaving them together axially with 3 filament bundles, each equivalent to 5-0 Vicryl suture, and spaced at approximately 120 degrees apart around the ring circumference. The final composite assembly may be heat set at 60° C. to a final length of 15 mm. The assembly may be spray coated with 200 microgram coating weight (dry) of D,L PLA-Paclitaxel with a 5% drug load, predominantly on the external or abluminal surface. The drug-coated stent may be crimped on an angioplasty balloon catheter, and sterilized by e-beam sterilization.

Example 6

(73) A magnesium alloy laser-cut ring with extruded tubular 5050 PLGA polymer longitudinal connectors and a coating of 8020 PLGA polymer with 10% paclitaxel may be made as follows: A magnesium alloy may be formed into a 2.0 mm (outside diameter) hypo-tube. The hypo-tube may be laser cut into ring segments, with 8 crowns per ring. Each ring segment may have at least 2 elongated stud features of 0.4 mm length and facing matching studs on an opposing ring. The rings may then be connected by flexible longitudinal connectors of 1.0 mm long tubular extrusions of 50-50 PLGA placed over each stud. Fourteen rings with 13 sets of connectors may be assembled into a 20 mm stent, expandable to 3.0 mm diameter. The assembly may be spray coated with a 250 microgram coating weight (dry) of 8020 PLGA polymer pre-compounded with 10% (by weight) Paclitaxel drug. The drug coated stent may be crimped on an angioplasty balloon catheter and sterilized by e-beam.

Example 7

(74) Hyper-fine grain, Mg—Ca alloy wire with Polydioxanone polymer longitudinal connectors and a D,L-PLA-Sirolimus Drug Coating may be made as follows: High purity magnesium-1% Ca with grain size below 5 microns may be drawn and annealed into a 100 micron wire. The wire may be formed into a 6 crown design and welded into a ring. Twelve rings may be equally spaced in a cavity of a steel mold, and poyldioxanone (PDO) in a solvent solution may be vacuum injected into the cavity. Following secondary processes for solvent removal and annealing, the structure may be 15 mm long with 12 metal ring segments. The assembly may be spray coated with 200 microgram coating weight (dry) comprised of 50% D,L PLA and 50% Sirolimus.

Example 8

(75) A Mg-alloy wire-PGA fiber braid with high load chemo-active agent was made as follows: An alloy of magnesium was melted and processed into 160 micron wire. The wire was formed into continuous sinusoid wave form and then wrapped in a helical geometry around a 4.0 mm cylindrical mandrel. The tubular helical structure rings were coupled by longitudinal polymer connectors of Vicryl 6-0 suture (available from Ethicon Inc. of Somerville N.J.). The finished tubular stent-like implant was 12 mm long and was coated with 120 micrograms (dry weight) of a 95% PLA-5% paclitaxel formulation with a manual pipette system. Following mounting on a balloon catheter and ethylene oxide sterilization, the device was used as a short term, luminal drug delivery platform for treatment of cancer of the esophagus.

Example 9

(76) A 15 mm×3.5 mm diameter coronary stent may include 3 cylindrical or ring segments connected by longitudinal absorbable polymer element. The proximal and distal ring segment may be made from a 75 micron 316L stainless steel alloy wire that is formed into a sinusoidal waveform that is wrapped around a mandrel and welded to form a segment of 2.5 mm in length. The central ring segment may be formed from a Mg high purity alloy that is cast and drawn into a wire of 100 microns in diameter. The Mg wire may be formed on a multi-slide machine into a continuous sinusoidal waveform, wound on a mandrel, and laser welded at select connection points between subsequent rows of rings to form a segment of 8.0 mm in length. The three segments may be connected by interlacings of a 6-0 Vicryl absorbable PLGA suture, with an effective connector length of 0.5 mm each. The total length may equal 2.5+0.5+9+0.5+2.5=15 mm. The entire assembly may be coated with a formulation of approximately 6% Paclitaxel in 90-10 PLGA, crimped on an angioplasty catheter, packaged, and sterilized.

Example 10

(77) A 20 mm×3.5 mm diameter coronary stent may include 3 cylindrical or ring segments connected by longitudinal absorbable polymer elements. The proximal and distal ring segments may be made by laser cutting a cobalt chrome hypo tube into an open cell stent geometry followed by electro-polishing down to an 80 micron strut thickness. The effective length when expanded may be 4 mm, and the design may include eyelet features to facilitate interlacing with adjacent segments. The central segment may be made of mono-crystalline magnesium wire that is formed into a continuous sinusoidal waveform that is wrapped on a cylindrical mandrel and laser welded at given intervals to form a flexible segment 12 mm in length. The proximal, central and distal rings may be connected in a similar manner by interlacing with 6-0 PDO absorbable monofilament sutures to form an intraluminal implant of about 20 mm in length. The entire assembly may be coated with a 50-50 formulation of Sirolimus and DL-PLA with approximately 10 micrograms drug per stent mm in length. The stent assembly may be crimped on an angioplasty balloon catheter, packaged and sterilized.

Example 11

(78) A 30 mm×3.0 mm balloon expandable stent may be produced by means similar to the examples described as Example 10, with the exception of a third biostable segment at the center of the assembly. The stent may possess a proximal cobalt chrome laser cut segment of 4 mm, a magnesium wire form segment of 10 mm, a center cobalt chrome segment of 2 mm, another 10 mm magnesium segment, and the distal cobalt chrome ring segment of 4 mm, all interlaced together with 6-0 PDS absorbable monofilament suture. The entire assembly may be coated with a formulation of approximately 6% PT′ x in 90-10 PLGA, crimped on an angioplasty catheter, packaged, and sterilized.

(79) Those skilled in the art will readily appreciate that all parameters listed herein are meant to be exemplary and actual parameters depend upon the specific application for which the methods and materials of the present invention are used. It is, therefore, to be understood that the foregoing embodiments are presented by way of example only and that, within the scope of the appended claims and equivalents thereto, the invention may be practiced otherwise than as specifically described. Various materials, geometries, sizes, and interrelationships of elements may be practiced in various combinations and permutations, and all such variants and equivalents are to be considered part of the invention.