2010-08-012024-05-15https://scholars.lib.ntu.edu.tw/handle/123456789/664863摘要：冠狀動脈血管支架置放手術已成為目前治療心肌梗塞的主要方法，這是一種打開血管阻塞的微創手術，自90年代推出後即得到醫學界的高度重視。在今天，血管支架這項革命性的技術，已擴大其應用範圍至許多其他的週邊血管疾病，包括頸動脈（頸部到大腦），腎動脈（腎臟），股動脈（下腹腔到腿），和大腿動脈（腿）等。 近年來，血管支架科技已由金屬支架演進到新一代的塗藥血管支架和人體可降解血管支架。塗藥血管支架的發明大量降低了支架手術後血管再狹窄的可能，使塗藥血管支架成為全球治療心腦血管疾病的黃金標準。更代表了下一個新科技的來臨，它們在支架手術後，提供了血管必需的支撐與藥物，然後在數個月後從人體內自動消失。 血管支架科技還有許多其他方面的潛在應用，比如利用血管支架作為藥物載具進行的概念便極具吸引力。標靶治療已成為一個極具潛力的治療癌症與慢性疼痛的療法，在最近幾年來更受到醫學界的高度重視。標靶治療可將高劑量的藥物直接注入特定器官或其週邊血管，如此病人即無需增加傳統口服或靜脈注射的藥物劑量。這一方法有助於減少全身藥物副作用，提高病人生活品質，並為病人延長生命。 當設計一個血管支架時，有幾個關鍵的功能需要特別予以重視，亦即，血管壁支撐度，血管順應性，尺寸大小，和傳送至定點的能力。迄今為止，大部分市場上的血管支架都未能將這些特點集合在一起，它們通常必須在各項功能中權衡以取得妥協。在這個研究計畫中，我們建議進行各類血管支架（包括冠狀動脈，頸動脈，腎動脈，和大腿動脈）的最佳化設計。我們的計劃將會探討以下幾個課題： (1) 選擇血管支架材料：探討適當的支架材料，以對特定的血管疾病達到最佳的效能。將對氣球擴張式和自動擴張式，以及金屬和人體可降解血管支架進行研究。 (2) 血管支架最佳化設計：進行各類血管支架的最佳化設計，以達到關鍵功能的最佳組合。這包括特殊支架圖案或幾何形狀的設計。 (3) 發展血管支架製造能力：與工研院合作開發血管支架雷射切削的能力，運用工研院的飛秒雷射來製造我們所設計的血管支架原型。 (4) 分析和測試血管支架性能與壽命：發展血管支架分析工具和測試設備，以研究所設計各式血管支架的性能與壽命。 我們相信，這個研究計畫將會大大的提升這一個非常重要的現代醫療技術。我們從此研究計畫所累積的知識和經驗將有助於推動台灣未來醫療器材的發展。<br> Abstract: Coronary stenting has emerged as the primary treatment of cardiovascular diseases and has received great attention from the medical community since its introduction in 1990s. It is a minimally-invasive method of opening blocked arteries that are impeding blood flow to the heart. With this revolutionary technology, stents today have extended their indications from coronary artery diseases to many other applications including carotid (neck leading to brain), renal (kidneys), iliac (lower abdomen leading to the legs), femoral (legs), and popliteal (legs) arteries. In recent years, the stent technology has advanced from bare metal stents to drug eluting stents and biodegradable stents. The use of drug eluting stents resulted in a dramatic lowering of restenosis after angioplasty, leading to worldwide uptake of this new technology for coronary artery diseases. Biodegradable stents present the next frontier; they hold the promise of a medical device that could support the artery after intervention, deliver drug, and disappear without permanently affecting the vessel once its job is done. Stent technology has other potential applications. For example, the concept of using stents as vehicles for prolonged local drug delivery to treat cancer and chronic pain is appealing. Direct medication into the specific organ or blood vessels supplying those organs allows for higher drug concentrations at the site without the need for the dose elevations associated with oral or intravenous administration. This strategy helps to reduce side effects, increase quality of life for patients, and extend lives. When designing a stent, there are several key stent features which need to be addressed, namely, scaffolding, conformability, profile, and deliverability. To date, most of the stents available in the market don’t have all the key features together. They usually have to trade off one feature for the others. In this project, we propose to develop and optimize stent design for treatment of various vascular diseases including coronary, carotid, renal, and femoral artery applications. We plan to address the following issues: (1) Selection of stent materials: investigate the appropriate stent materials to achieve the best performance for specific vascular disease. Both balloon-expandable and self-expanding stents as well as metallic and biodegradable polymeric stents will be studied. (2) Optimization of stent designs: optimize stent designs to achieve the best combination of key stent features including scaffolding, conformability, profile, and deliverability. This could involve the design of special stent patterns or geometries. (3) Development of stent manufacturing capabilities: work with ITRI staff to develop the stent laser-cutting capabilities using ITRI femto-laser machine to build prototypes for our stent designs. (4) Analysis and testing of stent performance and fatigue life: develop the analysis tools and testing equipments to investigate the performance and fatigue life of our designed stents with various stent materials and design patterns. We believe this project will greatly enhance the fundamental understanding of this very important medical technology. The knowledge and experience accumulated from this study will help advance the stent technology and site specific therapy in Taiwan in the future.血管支架心肌梗塞心導管塗藥血管支架人體可降解血管支架標靶治療血管支架最佳化設計StentCardiovascular DiseasesCatheterDrug Eluting StentBiodegradable StentTarget TherapyStent Design Optimization