Assessing Patient-Explanted Stents and Novel Lab-Developed Alloys Towards Comprehensive Database for Next-Generation Cardiovascular Stenting – APEX-STENT

Cardiovascular diseases (CVD) are responsible for 32% of all global mortalities. Percutaneous Coronary Intervention (PCI), which employs stents—mainly composed of CoCr alloys and stainless steels—to maintain arterial openness, faces challenges due to the allergenic properties of Nickel and the potential toxicity of cobalt. Additionally, traditional stents can cause complications owing to their permanent presence and the release of toxic elements through corrosion. While extensive research exists on orthopedic and dental implants, cardiovascular applications remain significantly underexplored. The APEX-STENT project aims to conduct a thorough examination of traditional stents explanted from patients and to investigate next-generation alloys for both permanent and bioresorbable uses. Distinguished by our comprehensive collection of stent samples from patients, our project simultaneously pioneers new alloy research in animals. We have identified Ti and Zr alloys as promising candidates due to their excellent biocompatibility and corrosion resistance. Furthermore, our ongoing research into bioresorbable alloys shows considerable promise for their use in stent applications. Our goal is to create a high-impact, publicly accessible stent database, underpinned by detailed analyses, facilitating the optimal selection of stent materials. This database's development and its automated imaging will leverage CRESt technology (https://youtu.be/POPPVtGueb0), developed by the MIT team in collaboration as an external partner of the APEX project. In the customized CRESt-APEX system, a Machine Learning engine will be developed to assist in analyzing various types of images from the same sample, obtained through electron microscopy, histological staining, endovascular imaging, and multiphoton microscopy. Empowered with machine learning, the database promises to transform stent research by providing access to vast, high-quality raw data and advanced analytical tools to the public. This pioneering approach allows for the identification of links between specific stent-related complications and patient or stent characteristics, predicts new material performance in human patients based on animal testing data, and simulates complication progression in individual patients. APEX-STENT's ultimate aim is to carefully evaluate current stents explanted from patients and to compare with next-generation alloys (Ti, Zr, Fe, Zn, Mg) for both permanent and bioresorbable stents. With our exhaustive inventory of stent samples from patients and animals, and the unparalleled expertise of our consortium, we are uniquely positioned to construct a comprehensive, impactful stent database for public use, leveraging Artificial Intelligence to achieve our goals.