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1
Biodegradable Materials
Eliminates additional surgery to remove an
implant after it serves its function
Ideal when the “temporary presence” of
the implant is desired
replaced by regenerated tissue as the
implant degrades
2
Biodegradable Materials
Degradation  Short term applications
 sutures
 drug delivery
 orthopaedic fixation devices (requires
exceptionally strong polymers)
 adhesion prevention (requires polymers that
can form soft membranes or films)
 temporary vascular grafts (development
stage, blood compatibility is a problem)
3
Biodegradable Materials
Four main types of degradable implants:
 the temporary scaffold
 the temporary barrier
 the drug delivery device
 multifunctional devices
4
Biodegradable: Scaffold
provides support until the tissue heals
 weakened by disease, injury or surgery
 healing wound, broken bone, damaged blood vessel
 sutures, bone fixation devices, vascular grafts
Rate of degradation:
 implant should degrade at the rate the tissue heals
Sutures are most widely used
 polyglycolic acid (PGA) - Dexon®
 copolymers of PGA and PLA (polylactic acid), Vicryl®
 polydioxanone (PDS)
5
Biodegradable: Barrier
Prevent adhesion caused by clotting of
blood in the extravascular tissue space
 clotting  inflammation  fibrosis
 adhesions are common problems after
cardiac, spinal and tendon surgery
 barrier in the form of thin membrane or film
Another barrier use is artificial skin for
treatment of burns
6
Biodegradable: Drug Delivery
Most widely investigated application
PLA, PGA used frequently
Polyanhydrides for administering
chemotherapeutic agents to patients
suffering from brain cancer
7
Biodegradable: Multifunctional
Devices
Combination of
several functions
 mechanical function +
drug delivery :
biodegradable bone
nails and screws made
of ultrahigh-strength
PLA and treated with
BMP & TGF- for
stimulation of bone
growth
SEM image of biodegradable
polyurethane
8
Biodegradable: Multifunctional
Devices
Combination of
several functions
 mechanical support +
drug delivery:
biodegradable stents
to prevent collapse
and restenosis
(reblocking) of arteries
opened by balloon
angioplasty and
treated with anti-
inflammatory or anti-
thrombogenic agents
Biodegradable intravascular stent molded
from a blend of polylactide and trimethylene
carbonate. Photo: Cordis Corp. Prototype
Molded by Tesco Associates, Inc.
9
Biodegradable: Terminology
Confusion between biodegradation, bioerosion,
bioabsorption and bioresorption!
Consensus Conference of the European Society for
Biomaterials
Biodegradation: A biological agent (an enzyme, microbe
or cell) responsible for degradation
Bioerosion: Bioerosion contains both physical (such as
dissolution) and chemical processes (such as backbone
cleavage). A water-insoluble polymer that turns water-
soluble under physiological conditions.
Bioresorption, Bioabsorption: Polymer or its degradation
products removed by cellular activity (e.g. phagocytosis)
10
Biodegradable Polymers
Variety of available degradable polymers
is limited due to stringent requirements
 biocompatibility
 free from degradation related toxic products
(e.g. monomers, stabilizers, polymerization
initiators, emulsifiers)
Few approved by FDA
PLA, PGA, PDS used routinely
11
Biodegradable Polymers
ester bond
o
c
o
o

anhydride
12
Biodegradable Polymers
Effect of molecular
weight on the
mechanical
strength????
13
Biodegradable Polymers
Most degradable
polymers are
polyesters
ester is a covalent
bond with polar
nature, more reactive
can be broken down
by hydrolysis
the C-O bond breaks
ESTER BOND
14
Biodegradable Polymers
contain a peptide (or
amide) link
can be broken down
by hydrolysis
the C-N bond breaks
can be spun into
fibres for strength
AMIDE BOND
15
Biodegradable Polymers:
Hydrolysis
Breakdown of a molecule
in the presence of water
Hydrolysis of the ester
bond results in formation
of an acid and an alcohol
Inverse of reaction to
hydrolysis is
condensation (remember
condensation
polymerization)
hydrolysis
condensation
Hydrolysis of ester
Hydrolysis of anhydride
16
Biodegradable Polymers
polyhydroxybutyrate (PHB),
polyhydroxyvalerate (PHV) and
copolymers
 polyesters synthesized and used by
microorganisms for intracellular energy
storage
 70% PHB-30% PHV copolymer commercially
available as Biopol®
 rate of degradation controlled by varying
copolymer composition
17
Biodegradable Polymers
polyhydroxybutyrate (PHB), polyhydroxyvalerate
(PHV) and copolymers (cont)
 in vivo PHB degrades to hydroxybutyric acid which is
a normal constituent of human blood 
biocompatible, nontoxic
 PHB homopolymer is highly crystalline and brittle
 copolymer of PHB with hydroxyvaleric acid is less
crystalline, more flexible and more processible
 used in controlled drug release, suturing, artificial
skin, and paramedical disposables
18
Biodegradable Polymers
polycaprolactone
 semi-crystalline polymer
 slower degradation rate than PLA
 remains active as long as a year for drug delivery
 Capronor®, implantable biodegradable contraceptive
implanted under skin
dissolve in the body and does not require removal
degradation of the poly(epsilon-caprolactone) matrix occurs
through bulk hydrolysis of ester linkages
autocatalyzed by the carboxylic acid end groups of the
polymer, eventually forming carbon dioxide and water
19
Biodegradable Polymers
 Capronor®, implantable biodegradable
contraceptive (cont.)
Capronor II consists of 2 rods of poly(e-
caprolactone) each containing 18 mg of
levonorgestrel
Capronor III is a single capsule of copolymer
(caprolactone and trimethylenecarbonate) filled
with 32 mg of levonorgestrel
the implant remains intact during the first year of
use, thus could be removed if needed.
Over the second year, it biodegrades to carbon
dioxide and water, which are absorbed by the body
20
Biodegradable Polymers
polyanhydrides
 highly reactive and hydrolytically unstable
 degrade by surface degradation without the
need for catalysts
 aliphatic (CH2 in backbone and side chains)
polyanhydrides degrade within days
 aromatic (benzene ring as the side chain)
polyanhydrides degrade over several years
21
Biodegradable Polymers
polyanhydrides (cont.)
 aliphatic-aromatic copolymers can be used to
tailor degradation rate
 excellent biocompatibility
 used in drug delivery
 drug loaded devices prepared by
compression molding or microencapsulation
 insulin, bovine growth factors, angiogenesis
inhibitors, enzymes
22
Biodegradable Polymers
polyorthoesters
 formulated so that degradation occurs by
surface erosion
 drug release at a constant rate
23
Biodegradable Polymers
polyaminoacids
 poly-L-lysine, polyglutamic acid
 aminoacid side-chains offer sites for drug
attachment
 low-level systemic toxicity owing to their
similarity to naturally occurring amino acids
 investigated as suture materials
 artificial skin subtitutes
24
Biodegradable Polymers
polyaminoacids (cont.)
 limited applicability as biomaterials due to limited
solubility and processibility
 drug delivery (difficult to predict drug release rate due
to swelling)
 polymers containing more than three or more amino
acids may trigger antigenic response
“pseudo”- polyaminoacids
 backbone of polyaminoacids altered to circumvent
above problems
 tyrosine derived polycarbonates developed as high-
strength degradable orthopaedic implants
25
Biodegradable Polymers
polycyanocrylates
 used as bioadhesives
 use as implantable material is limited due to
significant inflammatory response
polyphosphazenes
 inorganic polymer
 backbone consists of nitrogen-phosphorus bonds
 use for drug delivery under investigation
26
Biodegradable Polymers
PGA and PLA
 most widely used biodegradable polymers
 PGA is the simplest aliphatic polyester
highly crystalline, high melting point, low solubility
appeared with the trade name Dexon
Dexon sutures lose strength within 2-4 weeks
sooner than desired
used as bone screws, Biofix®
27
Biodegradable Polymers
PGA and PLA (cont.)
 PLA
D,L-PLA amorphous polymer; thus, used for drug
delivery
L-PLA semicrystalline; thus, mechanical
applications such as sutures or orthopaedic
devices
compare mechanical properties of D,L-PLA and L-
PLA in the Table in slide #12
28
Biodegradable Polymers
PGA and PLA (cont.)
 copolymers of PGA and PLA used to adapt
material properties suitable for wider range of
applications
PLA is more hydrophobic than PGA
hydrophobicity of PLA limits water uptake of thin
films to about 2% and reduces the rate of
hydrolysis compared with PGA
sutures with trade names Vicryl® and Polyglactin
910®
29
Biodegradable Polymers:
Bioerosion
Bioerosion cause:
 changes in the appearance of the device
 changes in the physicomechanical properties
 swelling
 deformation
 structural disintegration
 weight loss
 loss of function
30
Biodegradable Polymers:
Bioerosion
Bioerosion is due to
 chemical degradation
cleavage of backbone
cleavage of crosslinks
side chains
 physical processes (e.g. changes in pH)
Two types of erosion
 bulk erosion
 surface erosion
31
Biodegradable Polymers:
Bioerosion
bulk erosion:
 water enters polymer
 causes hydrolytic
degradation
 component hollowed out
 finally crumbles (like sugar
cube in water)
 releases acid groups (slide
15) (a.k.a. acid bursting) 
possible inflammation
 characteristic of hydrophilic
polymers
H2O H2O
32
Biodegradable Polymers:
Bioerosion
surface erosion:
 water penetration limited,
 degradation occurs on the
surface
 thinning of the component over
time
 integrity is maintained over
longer time when compared to
bulk erosion
 hydrophobic polymers
experience surface erosion since
water intake limited
 acidic byproducts are released
gradually  acid burst less
likely, lower chance of
inflammation
 surface erosion can also occur
via enzymatic degradation
H2O H2O
33
Biodegradable Polymers:
Bioerosion
Factors that determine rate of erosion:
 chemical stability of the polymer backbone
(erosion rate anhydride > ester > amide)
 hydrophobicity of the monomer (addition of
hydrophobic comonomers reduce erosion
rate)
 morphology of polymer
crystalline vs. amorphous: ↑crystallinity  ↑
packing density  ↓ water penetration  ↓erosion
rate
34
Biodegradable Polymers:
Bioerosion
Factors that determine rate of erosion (cont.):
 initial molecular weight of the polymer
 fabrication process
 presence of catalysts, additives or plasticizers
 geometry of the implanted device (surface/volume
ratio)
 Polymer less permeable to water in glassy state: Tg of
the polymer should be greater than 37 C to maintain
resistance to hydrolysis under physiological
conditions
35
Biodegradable Polymers: Chemical
Degradation
Chemical degradation mediated by water,
enzymes, microorganisms
Mechanisms of chemical degradation
 cleavage of crosslinks between chains
 cleavage of side chains
 cleavage of polymer backbone
 combination of above
36
Biodegradable Polymers: Chemical
Degradation
CLEAVAGE OF CROSSLINKS
TRANSFORMATION OF SIDE CHAINS
CLEAVAGE OF BACKBONE
37
Biodegradable Polymers: Storage,
Sterilization and Packaging
minimize premature polymer degradation during
fabrication and storage
moisture can seriously degrade, controlled
atmosphere facilities
sterilization
 -irradiation or ethylene oxide
 both methods degrade physical properties
 choose lesser of two evils for a given polymer
 -irradiation dose at 2-3 Mrad (standard level to
reduce HIV) can induce significant backbone damage
 ethylene oxide highly toxic
38
Biodegradable Polymers: Storage,
Sterilization and Packaging
Packed in airtight, aluminum-backed,
plastic foil pouches.
Refrigeration may be necessary
39
Cutting Edge…
Drug-Coated Stents Transform Heart Care
 These devices, which slowly leach medication into
blood vessels to keep them from squeezing shut
 vastly better than the plain old metal stents that were
standard just a few years ago.
 on the market — Boston Scientific Corp.'s Taxus
stent, and Cypher, made by Cordis Corp., a Johnson
& Johnson company.
 very big blockages in very small vessels — some
nearly two inches long — can be fixed with such
stents, sometimes using overlapping ones.
 One novel type even dissolves in the body once its
job is done.
40
Cutting Edge…
Drug-Coated Stents Transform Heart Care (cont.)
 metal reclogged about one-fourth of the time until drug-coated ones
came along and cut the rate to around 5 percent.
 comparison study showed that eight months after treatment, rates of
heart attacks, strokes and repeat procedures were similar with both
stents, sponsored by Cypher's maker, Cordis.
 A different study led by doctors with no ties to Cordis showed Cypher
clearly outperformed Taxus in 250 diabetics
 Nearly nine out of 10 stents used in the United States now are drug-
coated, and two out of three are Taxus stents.
 Meanwhile, Medtronic Inc. reported that its experimental drug-coated
stent, Endeavor, outperformed plain metal stents in tests on 1,197
patients.
Competition should make drug-coated stents more affordable, said
Dr. Samin Sharma, co-director of the Cardiovascular Institute at
Mount Sinai Medical Center in New York. They used to cost more
than $3,000, sell for around $2,300 now, and could drop to less than
$2,000, he said.

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Bioresorbable Materials and used in the service

  • 1. 1 Biodegradable Materials Eliminates additional surgery to remove an implant after it serves its function Ideal when the “temporary presence” of the implant is desired replaced by regenerated tissue as the implant degrades
  • 2. 2 Biodegradable Materials Degradation  Short term applications  sutures  drug delivery  orthopaedic fixation devices (requires exceptionally strong polymers)  adhesion prevention (requires polymers that can form soft membranes or films)  temporary vascular grafts (development stage, blood compatibility is a problem)
  • 3. 3 Biodegradable Materials Four main types of degradable implants:  the temporary scaffold  the temporary barrier  the drug delivery device  multifunctional devices
  • 4. 4 Biodegradable: Scaffold provides support until the tissue heals  weakened by disease, injury or surgery  healing wound, broken bone, damaged blood vessel  sutures, bone fixation devices, vascular grafts Rate of degradation:  implant should degrade at the rate the tissue heals Sutures are most widely used  polyglycolic acid (PGA) - Dexon®  copolymers of PGA and PLA (polylactic acid), Vicryl®  polydioxanone (PDS)
  • 5. 5 Biodegradable: Barrier Prevent adhesion caused by clotting of blood in the extravascular tissue space  clotting  inflammation  fibrosis  adhesions are common problems after cardiac, spinal and tendon surgery  barrier in the form of thin membrane or film Another barrier use is artificial skin for treatment of burns
  • 6. 6 Biodegradable: Drug Delivery Most widely investigated application PLA, PGA used frequently Polyanhydrides for administering chemotherapeutic agents to patients suffering from brain cancer
  • 7. 7 Biodegradable: Multifunctional Devices Combination of several functions  mechanical function + drug delivery : biodegradable bone nails and screws made of ultrahigh-strength PLA and treated with BMP & TGF- for stimulation of bone growth SEM image of biodegradable polyurethane
  • 8. 8 Biodegradable: Multifunctional Devices Combination of several functions  mechanical support + drug delivery: biodegradable stents to prevent collapse and restenosis (reblocking) of arteries opened by balloon angioplasty and treated with anti- inflammatory or anti- thrombogenic agents Biodegradable intravascular stent molded from a blend of polylactide and trimethylene carbonate. Photo: Cordis Corp. Prototype Molded by Tesco Associates, Inc.
  • 9. 9 Biodegradable: Terminology Confusion between biodegradation, bioerosion, bioabsorption and bioresorption! Consensus Conference of the European Society for Biomaterials Biodegradation: A biological agent (an enzyme, microbe or cell) responsible for degradation Bioerosion: Bioerosion contains both physical (such as dissolution) and chemical processes (such as backbone cleavage). A water-insoluble polymer that turns water- soluble under physiological conditions. Bioresorption, Bioabsorption: Polymer or its degradation products removed by cellular activity (e.g. phagocytosis)
  • 10. 10 Biodegradable Polymers Variety of available degradable polymers is limited due to stringent requirements  biocompatibility  free from degradation related toxic products (e.g. monomers, stabilizers, polymerization initiators, emulsifiers) Few approved by FDA PLA, PGA, PDS used routinely
  • 12. 12 Biodegradable Polymers Effect of molecular weight on the mechanical strength????
  • 13. 13 Biodegradable Polymers Most degradable polymers are polyesters ester is a covalent bond with polar nature, more reactive can be broken down by hydrolysis the C-O bond breaks ESTER BOND
  • 14. 14 Biodegradable Polymers contain a peptide (or amide) link can be broken down by hydrolysis the C-N bond breaks can be spun into fibres for strength AMIDE BOND
  • 15. 15 Biodegradable Polymers: Hydrolysis Breakdown of a molecule in the presence of water Hydrolysis of the ester bond results in formation of an acid and an alcohol Inverse of reaction to hydrolysis is condensation (remember condensation polymerization) hydrolysis condensation Hydrolysis of ester Hydrolysis of anhydride
  • 16. 16 Biodegradable Polymers polyhydroxybutyrate (PHB), polyhydroxyvalerate (PHV) and copolymers  polyesters synthesized and used by microorganisms for intracellular energy storage  70% PHB-30% PHV copolymer commercially available as Biopol®  rate of degradation controlled by varying copolymer composition
  • 17. 17 Biodegradable Polymers polyhydroxybutyrate (PHB), polyhydroxyvalerate (PHV) and copolymers (cont)  in vivo PHB degrades to hydroxybutyric acid which is a normal constituent of human blood  biocompatible, nontoxic  PHB homopolymer is highly crystalline and brittle  copolymer of PHB with hydroxyvaleric acid is less crystalline, more flexible and more processible  used in controlled drug release, suturing, artificial skin, and paramedical disposables
  • 18. 18 Biodegradable Polymers polycaprolactone  semi-crystalline polymer  slower degradation rate than PLA  remains active as long as a year for drug delivery  Capronor®, implantable biodegradable contraceptive implanted under skin dissolve in the body and does not require removal degradation of the poly(epsilon-caprolactone) matrix occurs through bulk hydrolysis of ester linkages autocatalyzed by the carboxylic acid end groups of the polymer, eventually forming carbon dioxide and water
  • 19. 19 Biodegradable Polymers  Capronor®, implantable biodegradable contraceptive (cont.) Capronor II consists of 2 rods of poly(e- caprolactone) each containing 18 mg of levonorgestrel Capronor III is a single capsule of copolymer (caprolactone and trimethylenecarbonate) filled with 32 mg of levonorgestrel the implant remains intact during the first year of use, thus could be removed if needed. Over the second year, it biodegrades to carbon dioxide and water, which are absorbed by the body
  • 20. 20 Biodegradable Polymers polyanhydrides  highly reactive and hydrolytically unstable  degrade by surface degradation without the need for catalysts  aliphatic (CH2 in backbone and side chains) polyanhydrides degrade within days  aromatic (benzene ring as the side chain) polyanhydrides degrade over several years
  • 21. 21 Biodegradable Polymers polyanhydrides (cont.)  aliphatic-aromatic copolymers can be used to tailor degradation rate  excellent biocompatibility  used in drug delivery  drug loaded devices prepared by compression molding or microencapsulation  insulin, bovine growth factors, angiogenesis inhibitors, enzymes
  • 22. 22 Biodegradable Polymers polyorthoesters  formulated so that degradation occurs by surface erosion  drug release at a constant rate
  • 23. 23 Biodegradable Polymers polyaminoacids  poly-L-lysine, polyglutamic acid  aminoacid side-chains offer sites for drug attachment  low-level systemic toxicity owing to their similarity to naturally occurring amino acids  investigated as suture materials  artificial skin subtitutes
  • 24. 24 Biodegradable Polymers polyaminoacids (cont.)  limited applicability as biomaterials due to limited solubility and processibility  drug delivery (difficult to predict drug release rate due to swelling)  polymers containing more than three or more amino acids may trigger antigenic response “pseudo”- polyaminoacids  backbone of polyaminoacids altered to circumvent above problems  tyrosine derived polycarbonates developed as high- strength degradable orthopaedic implants
  • 25. 25 Biodegradable Polymers polycyanocrylates  used as bioadhesives  use as implantable material is limited due to significant inflammatory response polyphosphazenes  inorganic polymer  backbone consists of nitrogen-phosphorus bonds  use for drug delivery under investigation
  • 26. 26 Biodegradable Polymers PGA and PLA  most widely used biodegradable polymers  PGA is the simplest aliphatic polyester highly crystalline, high melting point, low solubility appeared with the trade name Dexon Dexon sutures lose strength within 2-4 weeks sooner than desired used as bone screws, Biofix®
  • 27. 27 Biodegradable Polymers PGA and PLA (cont.)  PLA D,L-PLA amorphous polymer; thus, used for drug delivery L-PLA semicrystalline; thus, mechanical applications such as sutures or orthopaedic devices compare mechanical properties of D,L-PLA and L- PLA in the Table in slide #12
  • 28. 28 Biodegradable Polymers PGA and PLA (cont.)  copolymers of PGA and PLA used to adapt material properties suitable for wider range of applications PLA is more hydrophobic than PGA hydrophobicity of PLA limits water uptake of thin films to about 2% and reduces the rate of hydrolysis compared with PGA sutures with trade names Vicryl® and Polyglactin 910®
  • 29. 29 Biodegradable Polymers: Bioerosion Bioerosion cause:  changes in the appearance of the device  changes in the physicomechanical properties  swelling  deformation  structural disintegration  weight loss  loss of function
  • 30. 30 Biodegradable Polymers: Bioerosion Bioerosion is due to  chemical degradation cleavage of backbone cleavage of crosslinks side chains  physical processes (e.g. changes in pH) Two types of erosion  bulk erosion  surface erosion
  • 31. 31 Biodegradable Polymers: Bioerosion bulk erosion:  water enters polymer  causes hydrolytic degradation  component hollowed out  finally crumbles (like sugar cube in water)  releases acid groups (slide 15) (a.k.a. acid bursting)  possible inflammation  characteristic of hydrophilic polymers H2O H2O
  • 32. 32 Biodegradable Polymers: Bioerosion surface erosion:  water penetration limited,  degradation occurs on the surface  thinning of the component over time  integrity is maintained over longer time when compared to bulk erosion  hydrophobic polymers experience surface erosion since water intake limited  acidic byproducts are released gradually  acid burst less likely, lower chance of inflammation  surface erosion can also occur via enzymatic degradation H2O H2O
  • 33. 33 Biodegradable Polymers: Bioerosion Factors that determine rate of erosion:  chemical stability of the polymer backbone (erosion rate anhydride > ester > amide)  hydrophobicity of the monomer (addition of hydrophobic comonomers reduce erosion rate)  morphology of polymer crystalline vs. amorphous: ↑crystallinity  ↑ packing density  ↓ water penetration  ↓erosion rate
  • 34. 34 Biodegradable Polymers: Bioerosion Factors that determine rate of erosion (cont.):  initial molecular weight of the polymer  fabrication process  presence of catalysts, additives or plasticizers  geometry of the implanted device (surface/volume ratio)  Polymer less permeable to water in glassy state: Tg of the polymer should be greater than 37 C to maintain resistance to hydrolysis under physiological conditions
  • 35. 35 Biodegradable Polymers: Chemical Degradation Chemical degradation mediated by water, enzymes, microorganisms Mechanisms of chemical degradation  cleavage of crosslinks between chains  cleavage of side chains  cleavage of polymer backbone  combination of above
  • 36. 36 Biodegradable Polymers: Chemical Degradation CLEAVAGE OF CROSSLINKS TRANSFORMATION OF SIDE CHAINS CLEAVAGE OF BACKBONE
  • 37. 37 Biodegradable Polymers: Storage, Sterilization and Packaging minimize premature polymer degradation during fabrication and storage moisture can seriously degrade, controlled atmosphere facilities sterilization  -irradiation or ethylene oxide  both methods degrade physical properties  choose lesser of two evils for a given polymer  -irradiation dose at 2-3 Mrad (standard level to reduce HIV) can induce significant backbone damage  ethylene oxide highly toxic
  • 38. 38 Biodegradable Polymers: Storage, Sterilization and Packaging Packed in airtight, aluminum-backed, plastic foil pouches. Refrigeration may be necessary
  • 39. 39 Cutting Edge… Drug-Coated Stents Transform Heart Care  These devices, which slowly leach medication into blood vessels to keep them from squeezing shut  vastly better than the plain old metal stents that were standard just a few years ago.  on the market — Boston Scientific Corp.'s Taxus stent, and Cypher, made by Cordis Corp., a Johnson & Johnson company.  very big blockages in very small vessels — some nearly two inches long — can be fixed with such stents, sometimes using overlapping ones.  One novel type even dissolves in the body once its job is done.
  • 40. 40 Cutting Edge… Drug-Coated Stents Transform Heart Care (cont.)  metal reclogged about one-fourth of the time until drug-coated ones came along and cut the rate to around 5 percent.  comparison study showed that eight months after treatment, rates of heart attacks, strokes and repeat procedures were similar with both stents, sponsored by Cypher's maker, Cordis.  A different study led by doctors with no ties to Cordis showed Cypher clearly outperformed Taxus in 250 diabetics  Nearly nine out of 10 stents used in the United States now are drug- coated, and two out of three are Taxus stents.  Meanwhile, Medtronic Inc. reported that its experimental drug-coated stent, Endeavor, outperformed plain metal stents in tests on 1,197 patients. Competition should make drug-coated stents more affordable, said Dr. Samin Sharma, co-director of the Cardiovascular Institute at Mount Sinai Medical Center in New York. They used to cost more than $3,000, sell for around $2,300 now, and could drop to less than $2,000, he said.