Nonmetallic inclusion (NMI) populations in superelastic (SE) Nitinol fine wires (<140 μm in diameter) were investigated by combining plasma focused ion beam (PFIB) serial sectioning with scanning electron microscopy (SEM). High purity (HP)—lower oxygen content and standard purity (SP)—higher oxygen content Nitinol wires were sectioned and imaged. The three-dimensional (3D) reconstructions provided more complete connectivity of NMIs and pores as well as information about the distribution of the features within the wire volume that is not possible with traditional two-dimensional (2D) imaging techniques. NMIs were present alone and with pores in the leading and/or trailing edges of the inclusions, in addition to stringers (i.e., fractured, elongated NMI, and intermixed with pores adjacent to each other), all of which were parallel to the wire drawing axis. The area percentages for the NMIs were 0.01% (HP Nitinol) and 0.04% (SP Nitinol), while the volume percentages measured 0.09% (HP Nitinol) and 0.47% (SP Nitinol). The combined PFIB-SEM serial sectioning approach provided the requisite resolution necessary to distinguish between NMIs and pores at micron and submicron sizes. Information gathered from this technique can be used to better inform models and predictions for fatigue lifetimes based on statistical analyses of these feature populations.

Nitinol, being a shape memory and super elastic alloy, is used in medical industry. Surface modification of nitinol helps to reduce the nickel ion leaching in physiological environment. The purpose of this study is to modify the nitinol surface by the silanization technique and to conduct a comparative investigation with the bare nitinol in the aspect of leaching of nickel ion, hemocompatibility, and in vivo animal response. X-ray photoelectron spectroscopy and energy dispersive X-ray spectroscopy studies confirmed the addition of organofunctional alkoxysilane molecules through the silanization process. The histological study showed the presence of adequate number of osteoblasts in silanized nitinol. The fluorochrome labeling study depicted more new bone formation (8 and 21% higher) in silanized nitinol specimens than bare one at one and three months postoperatively. Radiology and SEM study also proved the better performance of silanized samples. The cumulative in vivo results indicate its suitability as the potential bioimplant in various orthopedic surgical uses.

Nitinol is a shape memory alloy based on the inter-atomic compound having a composition of 50  at% each of Ni and Ti, NiTi. The shape memory effect results from a reversible martensitic phase transformation. An increasing solubility range with temperature on the Ni-rich side can produce a precipitation reaction resulting in a slight matrix composition adjustment with appropriate heat treatment. Electrolytic phase extraction (Andrews and Hughes, 1957) is used to evaluate the secondary phases in the alloy and Ti2Ni and TiC are positively identified using powder wide-angle X-ray diffraction procedures. Two samples of an Ni-rich alloy at 57 and 60 at% are also analyzed. These Ni-rich samples show Ti2Ni and an additional phase, Ni3Ti.

Transcatheter closure of ventricular septal defects with the Amplatzer® Membranous VSD Occluder has yielded promising initial results, but disturbances of conduction, including complete heart block, have been reported. We report our experience with the Amplatzer occluder in 35 patients with a median age 4.5 years, the defects being sized angiographically at 4.4 plus or minus 1.1 millimetres, with a range from 3 to 8 millimetres, and the size of the occluder varying from 4 to 12 millimetres. Over a median follow-up of 2.5 years, the rate of complete closure was 87% and 91%, at 1 and 2 years respectively, while 2 patients required surgical closure of the defect subsequent to the insertion of the device. Persistent regurgitation across the tricuspid valve related to the occluder was observed in 3 patients, and in 6 patients across the aortic valve. Abnormalities of conduction related to the procedure were noted in 7 patients, one-fifth of the cohort. The disturbances were transient in 1 patient, but permanent in 6, in one of the latter progressing after 6 months from left bundle branch block to intermittent Mobitz II second-degree atrioventricular block in association with expansion of the occluder. We conclude that transcatheter closure of perimembranous ventricular septal defects with the Amplatzer occluder is effective with limited complications, but the incidence of immediate and progressive disturbances of conduction related to the proximity of conduction tissues to the rims of the occluder stress the importance of larger and longer studies to assess the safety of this procedure.

Purpose: Nitinol, a nickel-titanium alloy, is a valuable material in the construction of interventional endoluminal devices because of its biocompatibility, super elasticity, high resiliency and shape memory. The possibility of nickel toxicity has been raised with devices constructed of Nitinol. Our investigation examines the long-term corrosive behavior of this alloy in experimental and biological environments. Methods: We performed three levels of study. Microscopic examination was made of 64 devices of various sizes, randomly selected from 240 Amplatzer® Septal Occluders that had been exposed to saline solution at 37°C for fourteen months. All samples were studied by electron microscopy ranging from 50 to 5000 times magnification. We also studied microscopically 3 Amplatzer® devices explanted 18–36 months after implantation in dogs, and 2 Amplatzer Septal Occluders removed from patients 18 months (cardiac transplant) and 19 months (died of causes unrelated to device placement) after implantation, which were examined grossly and by electron microscopy up to 5000 times magnification. We then measured the levels of nickel in the blood using inductive plasma mass spectroscopy in 19 patients with implanted Amplatzer® devices, making measurements before and 6 months after implantation. Results: Electron microscopy showed an intact titanium oxide layer with no evidence of corrosion in vitro and in vivo. One explanted device in direct contact with the platinum leads of a pacemaker for eighteen months showed minor pitting of the titanium oxide layer believed to be galvanic in nature. No wire fractures were found in vitro after cycle testing with 400 million cycles, nor in devices taken from the animals and humans. Biochemical studies showed no significant elevation of levels of nickel levels after implantation. Conclusion: Nitinol wire of Amplatzer® septal occlusion devices is resistant to corrosion when exposed to physiologic saline solution, and in experimental animals as well as humans. A device in contact with a platinum pacemaker electrode developed minimal pitting of the titanium oxide layer, believed to be galvanic in nature and of no structural or clinical significance. There is no increase of concentrations of nickel in the blood of patients who have received Amplatzer® nitinol devices. These favorable testing results reveal that nickel-titanium is an inert, corrosion resistant alloy.

Nitinol stents have been used in the treatment of benign tracheal stenosis. A retrospective review of five patients treated at Stobhill Hospital over the last six and a half years is presented. Age at presentation ranged from 17 to 76 years. The minimum follow-up period was 23 months and the maximum was 78 months. All our patients were successfully decannulated, with none requiring recannulation. Four patients developed granulation tissue related to the stent at intervals ranging from three weeks to 41 months post stenting. Topical mitomycin C application has been useful after resection of granulations using the carbon dioxide (CO2) laser. Stent migration occurred in one patient three weeks after insertion. Nitinol stents are easy to insert and effective in the treatment of tracheal stenosis, but can have associated morbidity. Their use should be considered carefully, as insertion should be regarded as permanent. Publications reporting experience and outcome with the use of Nitinol stents in the trachea are reviewed.