Abstract:
A scaffold strut is shaped to improve hemocompatibility. The scaffold is made from a tube having variable wall thickness. Methods are disclosed for modifying the thickness of the tube in such a way as to achieve a reduced hemodynamic profile, but without significantly affecting strength properties in areas where stress concentrations exist when the scaffold is loaded.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    Field of the Invention 
         [0002]    The present invention relates to bioresorbable scaffolds; more particularly, this invention relates to bioresorbable scaffolds for treating an anatomical lumen of the body. 
         [0003]    Description of the State of the Art 
         [0004]    Radially expandable endoprostheses are artificial devices adapted to be implanted in an anatomical lumen. An “anatomical lumen” refers to a cavity, duct, of a tubular organ such as a blood vessel, urinary tract, and bile duct. Stents are examples of endoprostheses that are generally cylindrical in shape and function to hold open and sometimes expand a segment of an anatomical lumen. Stents are often used in the treatment of atherosclerotic stenosis in blood vessels. “Stenosis” refers to a narrowing or constriction of the diameter of a bodily passage or orifice. In such treatments, stents reinforce the walls of the blood vessel and prevent restenosis following angioplasty in the vascular system. “Restenosis” refers to the reoccurrence of stenosis in a blood vessel or heart valve after it has been treated (as by balloon angioplasty, stenting, or valvuloplasty) with apparent success. 
         [0005]    The treatment of a diseased site or lesion with a stent involves both delivery and deployment of the stent. “Delivery” refers to introducing and transporting the stent through an anatomical lumen to a desired treatment site, such as a lesion. “Deployment” corresponds to expansion of the stent within the lumen at the treatment region. Delivery and deployment of a stent are accomplished by positioning the stent about one end of a catheter, inserting the end of the catheter through the skin into the anatomical lumen, advancing the catheter in the anatomical lumen to a desired treatment location, expanding the stent at the treatment location, and removing the catheter from the lumen. 
         [0006]    The following terminology is used. When reference is made to a “stent”, this term will refer to a permanent structure, usually comprised of a metal or metal alloy, generally speaking, while a scaffold will refer to a structure comprising a bioresorbable polymer and capable of radially supporting a vessel for a limited period of time, e.g., 3, 6 or 12 months following implantation. It is understood, however, that the art sometimes uses the term “stent” when referring to either type of structure. 
         [0007]    Scaffolds and stents traditionally fall into two general categories—balloon expanded and self-expanding. The later type expands (at least partially) to a deployed or expanded state within a vessel when a radial restraint is removed, while the former relies on an externally-applied force to configure it from a crimped or stowed state to the deployed or expanded state. 
         [0008]    Self-expanding stents are designed to expand significantly when a radial restraint is removed such that a balloon is often not needed to deploy the stent. Self-expanding stents do not undergo, or undergo relatively no plastic or inelastic deformation when stowed in a sheath or expanded within a lumen (with or without an assisting balloon). Balloon expanded stents or scaffolds, by contrast, undergo a significant plastic or inelastic deformation when both crimped and later deployed by a balloon. 
         [0009]    In the case of a balloon expandable stent, the stent is mounted about a balloon portion of a balloon catheter. The stent is compressed or crimped onto the balloon. Crimping may be achieved by use of an iris-type or other form of crimper, such as the crimping machine disclosed and illustrated in US 2012/0042501. A significant amount of plastic or inelastic deformation occurs both when the balloon expandable stent or scaffold is crimped and later deployed by a balloon. At the treatment site within the lumen, the stent is expanded by inflating the balloon. 
         [0010]    The stent must be able to satisfy a number of basic, functional requirements. The stent (or scaffold) must be capable of sustaining radial compressive forces as it supports walls of a vessel. Therefore, a stent must possess adequate radial strength. After deployment, the stent must adequately maintain its size and shape throughout its service life despite the various forces that may come to bear on it. In particular, the stent must adequately maintain a vessel at a prescribed diameter for a desired treatment time despite these forces. The treatment time may correspond to the time required for the vessel walls to remodel, after which the stent is no longer needed. 
         [0011]    The present application adopts the following definitions of radial strength and radial stiffness. Radial strength, which is the ability of a stent to resist radial compressive forces, relates to a stent&#39;s radial yield strength around a circumferential direction of the stent. A stent&#39;s “radial yield strength” or “radial strength” (for purposes of this application) may be understood as the compressive loading, which if exceeded, creates a yield stress condition resulting in the stent diameter not returning to its unloaded diameter, i.e., there is irrecoverable deformation of the stent. When the radial yield strength is exceeded the stent is expected to yield more severely and only a minimal force or no incremental force is required to cause major deformation. A radial “stiffness” refers to the amount net radial inward force (i.e., uniform radial inward pressure over the entire abluminal scaffold surface×the abluminal surface area) required to reversibly decrease a scaffold diameter by a certain amount. The slope of the curve from a force-deflection plot will be called the “absolute stiffness” or K. The units are N/mm and the stiffness is expressed for the linearly elastic range of response to the radial force. Thus, for a scaffold deployed to 6.5 mm and having a linear elastic range for radial compression between 6.5 mm and 5.5 mm and a radial stiffness of 20 N/mm, a net inward radial inward force of 10 N is needed to decrease the scaffold diameter from 6.5 mm to 6.0 mm. After the radial force is removed, the scaffold returns to the 6.5 mm diameter. 
         [0012]    Scaffolds have been made from a bioresorbable polymer. Examples of bioresorbable polymer scaffolds include those described in U.S. Pat. No. 8,002,817 to Limon, U.S. Pat. No. 8,303,644 to Lord, and U.S. Pat. No. 8,388,673 to Yang.  FIG. 1  shows an end segment of a bioresorbable polymer scaffold designed for delivery through anatomical lumen using a catheter and plastically expanded using a balloon. The scaffold has a cylindrical shape having a central axis  2  and includes a pattern of interconnecting structural elements, which will be called bar arms or struts  4 . Axis  2  extends through the center of the cylindrical shape formed by the struts  4 . The stresses involved during compression and deployment are generally distributed throughout the struts  4  but are focused at the bending elements, crowns or strut junctions. Struts  4  include a series of ring struts  6  that are connected to each other at crowns  8 . Ring struts  6  and crowns  8  form sinusoidal rings  5 . Rings  5  are arranged longitudinally and centered on an axis  2 . Struts  4  also include link struts  9  that connect rings  5  to each other. Rings  5  and link struts  9  collectively form a tubular scaffold having axis  2  represent a bore or longitudinal axis of the scaffold. Ring  5   d  is located at a distal end of the scaffold. Crowns  8  form smaller angles when the scaffold is crimped to a balloon and larger angles when plastically expanded by the balloon. After deployment, the scaffold is subjected to static and cyclic compressive loads from surrounding tissue. Rings  5  are configured to maintain the scaffold&#39;s radially expanded state after deployment. 
         [0013]    Scaffolds may be made from a biodegradable, bioabsorbable, bioresorbable, or bioerodable polymer. The terms biodegradable, bioabsorbable, bioresorbable, biosoluble or bioerodable refer to the property of a material or stent to degrade, absorb, resorb, or erode away from an implant site. The scaffold, as opposed to a metal stent, is intended to remain in the body for only a limited period of time. In many treatment applications, the presence of a stent in a body may be necessary for a limited period of time until its intended function of, for example, maintaining vascular patency and/or drug delivery is accomplished. Moreover, it has been shown that biodegradable scaffolds allow for improved healing of the anatomical lumen as compared to metal stents, which may lead to a reduced incidence of late stage thrombosis. In these cases, there is a desire to treat a vessel using a polymer scaffold, in particular a bioabsorable or bioresorbable polymer scaffold, as opposed to a metal stent, so that the prosthesis&#39;s presence in the vessel is temporary. 
         [0014]    Polymeric materials considered for use as a polymeric scaffold, e.g. poly(L-lactide) (“PLLA”), poly(L-lactide-co-glycolide) (“PLGA”), poly(D-lactide-co-glycolide), poly(L-lactide-co-caprolactone), poly(D,L-lactide-co-caprolactone) or poly(L-lactide-co-D-lactide) (“PLLA-co-PDLA”) with less than 10% D-lactide, and PLLD/PDLA stereo complex, may be described, through comparison with a metallic material used to form a stent, in some of the following ways. A suitable polymer has a low strength to volume ratio, which means more material is needed to provide an equivalent mechanical property to that of a metal. Therefore, struts must be made thicker and wider to have the required strength for a stent to support lumen walls at a desired radius. The scaffold made from such polymers also tends to be brittle or have limited fracture toughness. The anisotropic and rate-dependent inelastic properties (i.e., strength/stiffness of the material varies depending upon the rate at which the material is deformed, in addition to the temperature, degree of hydration, thermal history) inherent in the material, only compound this complexity in working with a polymer, particularly, bioresorbable polymer such as PLLA or PLGA. 
         [0015]    Intravascular drug eluting scaffolds and stents must fulfill many criteria simultaneously. In addition to the aforementioned acute mechanical demands for radial support, scaffolding, and expansion capability, the stent or scaffold must meet a pharmaceutical function of controlled drug release to prevent neointimal hyperplasia and its consequence of restenosis. While accomplishing this, there are many goals for biocompatibility. Intravascular scaffolds start as blood contacting devices. With time they become encapsulated in the vessel wall where they undergo a benign process of resorption. There is biocompatibility required for blood contact and the necessary compatibility with vascular tissue. 
         [0016]    There is a continuing need to improve the biocompatibility of a scaffold; in particular, there is a continuing need to improve upon on the biocompatibility of a scaffold shortly following implantation when a significant portion of the structure is in contact with blood passing through the vessel. 
       SUMMARY OF THE INVENTION 
       [0017]    What is disclosed is a polymeric, bioresorbable scaffold with hemodynamic struts and techniques for making these struts for such a scaffold. The scaffold material includes a bioresorbable, polyester polymer. Scaffolds made in accordance with the invention are balloon-expandable scaffolds configured for being plastically deformed when crimped to a balloon and later expanded from a crimped state by the balloon. 
         [0018]    In preferred embodiments, extrusion, injection molding, or dip coating on a mandrel may be used to form a polymer tube. The polymer may be a bioresorbable polymer such as polylactide (PLA) or PLA blended with another polymer, such as polycaprolactone (PCL). The tube may be annealed or expanded/drawn to orient the polymer. Methods are employed, when this tube is made or after making this tube, to vary the wall thickness of the tube over a circumference of the scaffold in accordance with a desired pattern for the scaffold; that is, the wall thickness of the tube is varied in registration to a scaffold pattern. After making the variable wall thickness tube, the scaffold pattern is laser-cut from the tube. 
         [0019]    According to one embodiment, regions of high wall thickness in the tube correspond to regions where the highest strains are expected to occur during crimping or balloon expansion of the crimped scaffold. These regions also tend to be where the scaffold experiences the highest degrees of mean and alternating stress during fatigue loading. And regions of low wall thickness in the tube correspond to regions where less strain is expected to occur. 
         [0020]    According to another embodiment a scaffold has selectively thickened areas for improving an attachment or retention to the scaffold structure. According to one such embodiment a tube is made to have one or more portions with a higher wall thickness in registration to a scaffold pattern, where the portions correspond to scaffold structure for holding a radiopaque marker. 
         [0021]    In one respect the invention provides a scaffold and method for making such a scaffold having improved blood compatibility by reducing a strut height or wall thickness in areas where the added structure is not needed, either to maintain structural integrity or for other reasons, e.g., retain a radiopaque marker in a hole. 
         [0022]    Blood compatibility, also known as hemocompatibility or thromboresistance, is a desired property for scaffolds and stents. The adverse event of scaffold thrombosis, while a very low frequency event, carries with it a high incidence of morbidity and mortality. To mitigate the risk of thrombosis, dual anti-platelet therapy is administered with all coronary scaffold and stent implantation. This is to reduce thrombus formation due to the procedure, vessel injury, and the implant itself. Scaffolds and stents are foreign bodies and they all have some degree of thrombogenicity. The thrombogenicity of a scaffold refers to its propensity to form thrombus and this is due to several factors, including strut thickness, strut width, strut shape, total scaffold surface area, scaffold pattern, scaffold length, scaffold diameter, surface roughness and surface chemistry. Some of these factors are interrelated. The effect of strut thickness on acute thrombogenicity has been documented and studied both in vivo and in silico. A scaffold must also occupy a minimum volume as needed to meet the radial strength goals. Consequently, the strut thickness, strut width, and total surface area of a scaffold have multiple constraints, in addition to the influence of these dimensions on its profile and hence its hemocompatibility. 
         [0023]    Computational fluid dynamics (CFD) analyses have shown that struts with square cross sections are not ideally hemodynamic and have large recirculating zones both proximal and distal to the strut.  FIG. 2  shows a steady-state flow (Re-282) around a square  3   a  strut. As shown by the arrows there are recirculation zones proximal and distal to the stent strut. Footprints of these zones (KL and MN, respectively) are shown. Shown is a laminar flow condition for the stent strut  3   a . The recirculating zones are regions where platelets have long residence time and will be prone to form thrombus. 
         [0024]      FIGS. 3A-3B  depict experimental results from porcine models for a thin strut (81 microns, μm) and thick strut (162 microns, μm). The drawings, based on images taken from explants (3 days after implantation), show how the in vivo thrombogenicity for the thin struts verses thick struts contributes to the pattern of thrombus formation for porcine coronary arteries (n=6 each).  FIG. 4  shows results from a morphometric analysis of adherent thrombus as assessed through luminal area measurement of stented sections of the porcine coronary artery. As shown there is a significant increase in the adherent thrombus when the strut thickness doubles in size. That is, there is a significant increase distally when the strut thickness doubles in size.  FIG. 5  is model prediction of the flow alterations surrounding the thin and thick struts (units are cm/sec). 
         [0025]    With regards to thrombogenicity of the scaffold in the artery, the most important factors are the minimum lumen diameter (MLD) or diameter of residual stenosis in the scaffold, degree of scaffold malapposition, strut thickness and strut shape.  FIGS. 2-5  provide evidence that a strut thickness has a direct effect on its thrombogenicity. Although not the only contributor, thick struts do play a role. 
         [0026]    In accordance with the objective of reducing thrombogencity by reducing strut or bar arm wall thickness, a scaffold is cut from a tube having an undulating outer or inner wall surface to produce thick and thin bands or sections arranged circumferentially. Each band extends over the tube length. Each thick band locates crowns and/or links in the scaffold pattern. The thickest portions at the crowns could be 100 microns while the thinnest portions (at a midpoint between crowns) might be 75 microns. Prior to cutting the scaffold pattern the tube is made with these bands that run over the length of the tube (constant cross-sectional profile of the bands with respect to a plane perpendicular to the tube longitudinal axis, e.g., as shown in  FIG. 7C ). For a pattern such as that shown in  FIG. 6A  this gives links and crowns a higher thickness than struts (or bar arms). 
         [0027]    The variable strut thickness therefore indicates the links being thicker. In preferred embodiments of a scaffold pattern, however, this is not expected to worsen thrombogenicity because a link&#39;s longitudinal axes are aligned parallel with the mean direction of blood flow (as opposed to the longitudinal axes of struts or bar arms, which are almost perpendicular to the mean direction of blood flow). Indeed, by making links with the same thickness profile as crowns there should be improved flow over a scaffold with thick crowns and thin links since the link&#39;s presence downstream of the crown can reduce backflow or high pressure zones immediately downstream of the crown. Moreover, link thickness is beneficial from a strength perspective, as follows. In designing bioresorbable scaffolds links are sometimes designed to be quite narrow in order to have a small crimped profile. This can make the links more prone to fracture during delivery and fatigue so being relatively thicker could be structurally advantageous. Thinner wall thickness exists at the bar arms or struts connecting crowns, which is beneficial for more rapid reendothelialization and reduced acute thrombogenicity since when deployed, they are more oriented at right angles to the blood flow. Strut thickness nearer to the crown may be made higher to maintain scaffold radial strength. 
         [0028]    One method to produce the variable thickness after expansion is by longitudinally machining the outer wall surface of a tube. A tube would is placed on a mandrel for support. This assembly is fixed in a chuck. The rest of the tubing is held in a precision milling machine with a rotating cutter which may be programmed under numerical control to cut one thin region (struts) and two adjacent halves of a thick region (crowns and links) at once. After making one longitudinal cut, the tubing is rotated the necessary amount, and another cut is made. This operation is repeated for each tube that will be used to make scaffolds. In preferred embodiments tubes that are strengthened by one or both of a blow molding or drawing process are used. Instead of machining by cutting or scrapping the outer wall of the tube to remove material, a laser may be used to ablate or vaporize material. Yet another methodology would be to injection mold the tube with the shape of the mold imposing the variable thickness morphology. 
         [0029]    Another method for making a variable wall thickness tube is to apply a mask or use eccentric lighting (heat lamps or multiple infra-red (IR) lasers) to vary heat distribution over the circumference of the tube during a blow molding process. It has been found that by intentionally creating local hot or cold spots one can cause the thickness of the tube to vary circumferentially and precisely enough to be in registration with the locations of crowns and struts and the desired thickness variation. In one embodiment a uniform heat source for the tubing is applied, such as by using two curved bulbs. A precision cylindrical mask is interposed between the lamps and the glass mold. The mask would contain a series of longitudinal slits, holes to vary the light transfer in a circumferential manner. The mask could be made of metal. Or the mask could be made of a transparent material and be tinted, colored or painted in a circumferentially varying manner. In an alternative embodiment local heat sources can be applied strategically to introduce controlled thick spots around the tubing circumference with an indexing scheme in order to make crown locations thicker than strut locations. 
         [0030]    In accordance with these objectives, there is a method for making a scaffold from a tube having a variable wall thickness, a scaffold having a variable wall thickness, making a tube having variable wall thickness, a medical device comprising such a scaffold, or a method for assembly of such a medical device having one or more, or any combination of the following concepts (1) through (17):
       (1) a polymer scaffold made from a tube;   (2) An aspect ratio (AR) of strut width (w) to wall thickness (t) (AR=w/t) is between 0.5 to 1.5, 0.7 to 1.5, 0.7 to 1.3, 0.9 to 1.5, 0.9 to 1.2, 1.0 to 1.5 or 1.5 to 2.0;   (3) A wall thickness for a scaffold (pre-crimp diameter of 3 to 4 mm) is less than 150 microns, less than 140 microns, less than 130 microns, about 100 micron, 80 to 100 microns, 80 to 120 microns, 90 to 100 microns, 90 to 110 microns, 110 to 120 microns, or 95 to 105 microns. More preferably a wall thickness is between 80 and 100 microns, and more preferably between 82 and 89 microns;   (4) A wall thickness for a scaffold (pre-crimp diameter of 5 to 10 mm) is less than 280 microns, less than 260 microns, less than 240 microns, about 190 micron, 149 to 186 microns, 149 to 220 microns, 170 to 190 microns, 170 to 210 microns, 210 to 220 microns. More preferably a wall thickness is between 150 and 190 microns for a scaffold having an outer diameter of 7, 8 or 9 mm;   (5) The scaffold has a pattern as described in US20100004735 at FIGS. 2, 4, 5A, 5B, 5C, 5D and paragraphs [0043]-[0062]. Or the scaffold has a pattern as described in US20110190872 at FIGS. 4, 5A, 6A, and paragraphs [0126]-[ 0130 ];   (6) For a maximum wall thickness t-max (or t 1 ), and minimum wall thickness t-min (or t 2 ), the ratio of t-max to t-min, or the quotient (t-max/t-min) is about 2, or between 2 and 1.2, or about 1.3. For example, t-max is equal to 158 microns and t-min is equal to 93 microns. In some embodiments t-max is equal to 120 to 130 microns and t-min is equal to 90 to 100 microns; t-max is about 100 microns, t-min is about 75 microns, t-min is between 75 and 85 microns, and t-max is between 90 and 100 microns;   (7) The outer wall surface is undulating to provide a variable wall thickness scaffold; or the inner wall surface is undulating to provide a variable wall thickness scaffold, or both the outer and inner wall surface is undulating to provide a variable wall thickness scaffold;   (8) The outer wall surface or the inner wall surface of the scaffold has a repeating pattern according to  FIG. 6C or 8B  over the circumference;   (9) The outer wall surface or inner wall surface has an undulating pattern as described in any of the embodiments discussed in connection with  FIGS. 6B-6C , or any of the embodiments discussed in connection with  FIGS. 7A-7B ;   (10) The tube is blow-molded to form an undulating inner wall surface, wherein a temperature difference of 5 Deg. Celsius to 50 Deg. Celsius between a hot and cold part of the tube exists when the tube is being radial expanded; or there is a temperature gradient of between 10 Deg. C./mm and 200 Deg. C./mm between a circumferential location corresponding to a crown center and a location corresponding to a midpoint of a strut;   (11) A scaffold having a higher wall thickness for a marker link than an adjacent link not holding a marker;   (12) A scaffold having a higher wall thickness for a pair of links spaced 180 degrees apart than all other links disposed between the links spaced 180 degrees apart and located anywhere along the scaffold longitudinal axis;   (13) A scaffold having a wall thickness of at least 120 microns for a link holding a radiopaque marker and crowns connected to the link, and between 80 and 110 microns for a plurality of struts and links adjacent the link holding the marker and the crowns connected to the link and holding the marker;   (14) A scaffold having rings connected by links, the rings including struts interconnecting crowns, wherein the links extend parallel to the longitudinal axis and between crowns, and wherein the crowns and links having a wall thickness that is between 1.2 and 2 times a wall thickness for struts;   (15) A process for making a tube according to the processing parameters of TABLE 1;   (16) A medical device, comprising: a tubular body made from a polymer material, the tubular body having one of an undulating inner wall surface and an undulating outer wall surface such that a ratio of a maximum wall thickness (t-max) to a minimum wall thickness (t-min) for the tubular body is between 2 and 1.2; wherein the one of an undulating inner wall surface and an undulating outer wall surface comprises a curved surface that repeats every 20, 30, 45, or 180 degrees about a circumference of the tubular body; and/or   (17) The medical device of (16) including one or more of, or any combination of items (a) through (t):
           (a) wherein the tubular body is a scaffold having interconnected elements comprising a first ring connected to a second ring by a link, wherein the first and second rings have crowns interconnected by struts, and wherein for the curved surface that repeats every 20 degrees the first and second rings have 18 crowns, wherein for the curved surface that repeats every 30 degrees the first and second rings have 12 crowns, wherein for the curved surface that repeats every 45 degrees the first and second rings have 8 crowns,   (b) wherein the curved surface is described by one period of a sinusoid, a portion of the curved surface is parabolic, or a portion of the curved surface is hyperbolic,   (c) wherein the curved surface is concave between rings,   (d) wherein the curved surface is convex between struts,   (e) wherein the curved surface comprises a first curvature centered over a crown and a second curvature centered over a midpoint between crowns, and wherein the first curvature is less than the second curvature,   (f) wherein the curved surface comprises a first curvature centered over a crown and a second curvature centered over a midpoint between crowns, and wherein the first curvature is greater than the second curvature,   (g) wherein the wall thickness is t-max at the crowns and the wall thickness monotonically decreases from t-max to t-min, wherein a strut midpoint has a wall thickness of t-min,   (h) wherein the links are arranged parallel to a longitudinal axis of the scaffold and have a wall thickness t-max, and a width less than a strut width to reduce occurrence of backflow downstream of a crown when the scaffold is implanted within a vessel and to reduce a crimped diameter for the scaffold,   (i) wherein crowns and links have a wall thickness of t-max and the struts have a wall thickness of t-min,   (j) wherein t-max and t-min are one of: 250 and 150 microns, respectively; 100 microns and 75 microns, respectively; 130 microns and 90 microns, respectively; or 150 microns and 100 microns, respectively,   (k) wherein t-max is between 160 and 130 microns or 130 and 100 microns,   (l) wherein t-min is between 100 and 75 microns or 90 and 70 microns,   (m) wherein the other of the outer wall surface and the inner wall surface describes a cylinder,   (n) wherein the medical device comprises a composition including poly(l-lactide),   (o) wherein the tubular body is a biaxial expanded tubular body,   (p) wherein the tubular body is a scaffold having interconnected elements comprising a first ring connected to a second ring by at least a first and second link, and the second ring is connected to a third ring by at least a third and fourth link, wherein the curved surface repeats every 180 degrees, the first and second links hold a radiopaque marker, the first and second links have a wall thickness of t-max, and the second and third links have a wall thickness of t-min,   (q) wherein the undulating wall surface is the outer wall surface of the tubular body, the method comprising: making a cylindrical tube having a longitudinal axis, and removing strips of material from the outer wall, wherein the removed strip extended over a length of the tube, and wherein a cross-section of the removed strip is constant over the longitudinal axis such that the cross-sectional shape of the tube having the undulating outer wall surface is constant along the longitudinal axis,   (r) wherein the undulating wall surface is the inner wall surface of the tubular body, a method comprising radially expanding a cylindrical tube within a mold, wherein the cylindrical tube is heated to create a temperature gradient about the tube circumference and hot and cold spots during expansion within the mold, and wherein a wall thickness of t-min for the medical device corresponds to a hot spot and a wall thickness of t-max for the medical device corresponds to a cold spot, and/or   (s) wherein the radially expanded tube has a temperature difference between a first location and a second location of 5 to 50 Deg. Celsius.   
               
 
       INCORPORATION BY REFERENCE 
       [0067]    All publications and patent applications mentioned in the present specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. To the extent there are any inconsistent usages of words and/or phrases between an incorporated publication or patent and the present specification, these words and/or phrases will have a meaning that is consistent with the manner in which they are used in the present specification. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0068]      FIG. 1  is a perspective view of a portion of a prior art scaffold. The scaffold is shown in a crimped state (balloon not shown). 
           [0069]      FIG. 2  shows fluid streamlines adjacent a square-cross-section of a scaffold strut. The streamlines show zones of fluid recirculation upstream and downstream of the strut. 
           [0070]      FIG. 3A  is a cross-sectional view of a thin strut of scaffold based on an explant of an implanted scaffold from a porcine model. 
           [0071]      FIG. 3B  is a cross-sectional view of a thick strut of scaffold based on an explant of an implanted scaffold from a porcine model. 
           [0072]      FIG. 4  compares the Adherent Thrombus property of the thin verses thick struts depicted in  FIGS. 3A and 3B . 
           [0073]      FIG. 5  describes, using a mathematical model, fluid flow immediately upstream and downstream of thin and thick struts for a scaffold. 
           [0074]      FIG. 6A  is a flattened, planar view of a portion of a scaffold showing a scaffold pattern of rings interconnected by links. 
           [0075]      FIG. 6B  is a cross-sectional view of the scaffold of  FIG. 6A  and a showing a variable wall thickness of the scaffold. The view of  FIG. 6B  is taken perpendicular to a longitudinal axis or along line A-A of the scaffold of  FIG. 6A . 
           [0076]      FIG. 6C  shows in close-up a portion IVC of the scaffold in  FIG. 6B . 
           [0077]      FIG. 6D  shows in close-up the portion IVC of a scaffold having an undulating outer surface and an undulating inner surface according to another embodiment. 
           [0078]      FIG. 6E  shows in close-up the portion IVC of a scaffold having an undulating outer surface or an undulating inner surface according to another embodiment. 
           [0079]      FIG. 6F  shows in close-up the portion IVC of a scaffold having an undulating outer surface or an undulating inner surface according to another embodiment. 
           [0080]      FIG. 7A  is the flattened, planar view of the scaffold from  FIG. 6A  but with lines indicating areas of thick or thin wall thickness. 
           [0081]      FIG. 7B  is a cross-sectional view of a tube used to make the scaffold of  FIGS. 6A-6B , prior to modifying the outer wall to have the undulating surface shown in  FIG. 6B . 
           [0082]      FIG. 7C  is a perspective view of the tube of  FIG. 7B  after modifying the outer wall. 
           [0083]      FIG. 8A  is a cross-sectional view of a scaffold made from a variable wall thickness tube according to another embodiment. The scaffold has an undulating inner wall surface. 
           [0084]      FIG. 8B  shows in close-up a portion VIIIB of the scaffold in  FIG. 8A . 
           [0085]      FIG. 8C  is a perspective view of a tube used to make the scaffold of  FIG. 8A . 
           [0086]      FIG. 9  is a schematic illustration of a first method for making the tube of  FIG. 8A . 
           [0087]      FIG. 10  is a schematic illustration of a second method for making the tube of  FIG. 8A . 
           [0088]      FIG. 11  shows an assembly for modifying the outer surface of a tube in the manner shown in  FIG. 7C . 
       
    
    
     DETAILED DESCRIPTION 
     Definitions 
       [0089]    In the description like reference numbers appearing in the drawings and description designate corresponding or like elements among the different views. 
         [0090]    For purposes of this disclosure, the following terms and definitions apply: 
         [0091]    The terms “about” or “approximately” mean 30%, 20%, 15%, 10%, 5%, 4%, 3%, 2%, 1.5%, 1%, between 1-2%, 1-3%, 1-5%, or 0.5%-5% less or more than, less than, or more than a stated value, a range or each endpoint of a stated range, or a one-sigma, two-sigma, three-sigma variation from a stated mean or expected value (Gaussian distribution). For example, d 1  about d 2  means d 1  is 30%, 20%, 15%, 10%, 5%, 4%, 3%, 2%, 1.5%, 1%, 0% or between 1-2%, 1-3%, 1-5%, or 0.5%-5% different from d 2 . If d 1  is a mean value, then d 2  is about d 1  means d 2  is within a one-sigma, two-sigma, or three-sigma variance from d 1 . 
         [0092]    It is understood that any numerical value, range, or either range endpoint (including, e.g., “approximately none”, “about none”, “about all”, etc.) preceded by the word “about,” “substantially” or “approximately” in this disclosure also describes or discloses the same numerical value, range, or either range endpoint not preceded by the word “about,” “substantially” or “approximately.” 
         [0093]    A “stent” means a permanent, durable or non-degrading structure, usually comprised of a non-degrading metal or metal alloy structure, generally speaking, while a “scaffold” means a temporary structure comprising a bioresorbable or biodegradable polymer, metal or combination thereof and capable of radially supporting a vessel for a limited period of time, e.g., 3, 6 or 12 months following implantation. It is understood, however, that the art sometimes uses the term “stent” when referring to either type of structure. 
         [0094]    “Inflated diameter” or “expanded diameter” refers to the diameter the scaffold attains when its supporting balloon is inflated to expand the scaffold from its crimped configuration to implant the scaffold within a vessel. The inflated diameter may refer to a post-dilation balloon diameter which is beyond the nominal balloon diameter, e.g., a 6.5 mm balloon (i.e., a balloon having a 6.5 mm nominal diameter when inflated to a nominal balloon pressure such as 6 times atmospheric pressure) has about a 7.4 mm post-dilation diameter, or a 6.0 mm balloon has about a 6.5 mm post-dilation diameter. The nominal to post dilation ratios for a balloon may range from 1.05 to 1.30 (i.e., a post-dilation diameter may be 5% to 30% greater than a nominal inflated balloon diameter). The scaffold diameter, after attaining an inflated diameter by balloon pressure, will to some degree decrease in diameter due to recoil effects related primarily to, any or all of, the manner in which the scaffold was fabricated and processed, the scaffold material and the scaffold design. 
         [0095]    “Post-dilation diameter” (PDD) of a scaffold refers to the diameter of the scaffold after being increased to its expanded diameter and the balloon removed from the patient&#39;s vasculature. The PDD accounts for the effects of recoil. For example, an acute PDD refers to the scaffold diameter that accounts for an acute recoil in the scaffold. For a deployed scaffold the PDD is usually the inner diameter of the scaffold. 
         [0096]    A “pre-crimp diameter” means an outer diameter (OD) of a tube from which the scaffold was made (e.g., the scaffold is cut from a dip coated, injection molded, extruded, radially expanded, die drawn, and/or annealed tube) or the scaffold before it is crimped to a balloon. Similarly, a “crimped diameter” means the OD of the scaffold when crimped to a balloon. The “pre-crimp diameter” can be about 2 to 2.5, 2 to 2.3, 2.3, 2, 2.5, 3.0 times greater than the crimped diameter and about 0.9, 1.0, 1.1, 1.3 and about 1-1.5 times higher than an expanded diameter, the nominal balloon diameter, or post-dilation diameter. Crimping, for purposes of this disclosure, means a diameter reduction of a scaffold characterized by a significant plastic deformation, i.e., more than 10%, or more than 50% of the diameter reduction is attributed to plastic deformation, such as at a crown in the case of a stent or scaffold that has an undulating ring pattern, e.g.,  FIG. 1 . When the scaffold is deployed or expanded by the balloon, the inflated balloon plastically deforms the scaffold from its crimped diameter. Methods for crimping scaffolds made according to the disclosure are described in US20130255853 (attorney docket 62571.628). 
         [0097]    An “undulating inner wall surface” or “undulating outer wall surface” of a tube or scaffold means an outer wall surface that is not an arc of a circle, or a surface of a cylinder. The undulating surface varies in periodic fashion over the outer wall of a tube or scaffold, e.g., every 20, 30 or 45 degrees. One example is a sinusoidal undulating surface that repeats every 20, 30 or 45 degrees. The repeating undulating surface may also vary in a fashion that is not purely sinusoidal but approximated in part by an arc of a circle (having a same or smaller radius of curvature than the outer or inner radius of the scaffold/tube at a crown center or midpoint of a strut), a parabolic surface or a hyperbolic surface. These two alternative outer surface shapes may describe the surface about the crown or on each side of the crown, respectively. Referring to  FIGS. 6A, 6B and 6C  there is shown a planar, cross-sectional, and partial cross-sectional view, respectively, of a scaffold  10  according to one aspect of the disclosure. The scaffold is made from a tube processed to have a variable wall thickness. The variable wall thickness is made in registration with a selected pattern for the scaffold  10 . 
         [0098]    Referring to  FIG. 6A  there is shown an example of the scaffold  10  having ring elements  12  interconnected by link elements  18 . Each ring  12  has crown elements, or crowns  14  interconnected by strut elements, or struts  16 . The line A-A in  FIG. 6A  is collinear with a longitudinal or bore axis for the scaffold  10 . The line B-B extends about the circumference of the scaffold  10  ( FIG. 6A  is a flattened view of the scaffold in the horizontal plane to show the pattern). The partial struts shown along the upper edge of  FIG. 6A  correspond to the same partial struts shown along the lower edge of  FIG. 6A . Thus, element  11   a  is the same as element  11   b  for ring  12   a.    
         [0099]    The scaffold  10  has eight crowns  14  per ring  12  and two links  18  connect a ring to an adjacent ring. Each link  18  connects to a crown  14  at a W-crown and a Y-crown. A “W-crown” refers to a crown where the angle extending between a strut  16  and the link  18  at the crown is an acute angle (less than 90 degrees). A “Y-crown” refers to a crown where the angle extending between a strut  16  and the link  18  at the crown  14  is an obtuse angle (greater than 90 degrees). Crown  14   a  is an example of a U-crown, which is not connected to a link  18 . Crown  14   b  is an example of a W-crown. And Crown  14   c  is an example of a Y-crown. 
         [0100]    Ring  12   b  connects to ring  12   c  through link elements  18   a  and  18   b , which connect to ring  12   b  at W-crowns and ring  12   c  at Y-crowns. There is one U-crown between every Y-crown and W-crown of rings  12   a  and  12   b . Ring  12   c  connects to ring  12   d  through link elements  18   c  and  18   d , which connect to ring  12   c  at W-crowns and ring  12   d  at Y-crowns. There is one U-crown between every respective Y-crown and W-crown of rings  12   c  and  12   d.    
         [0101]    Referring to the end ring  12   e , there is designated crown numbers C 1 , C 2 , C 3 , C 4 , C 5 , C 6 , C 7  and C 8 . These same crown numbers apply to the crowns of other rings, as follows. A crown of one ring has the same crown number as a crown of any other ring when the crown is located at the same circumferential location, or location on the line B-B in  FIG. 6A , as the other rings  12 . A crown for one ring is therefore differentiated from the crown for another ring based on its location along the line A-A. 
         [0102]    A midpoint or mid-distance between adjacent crowns is also indicated in  FIG. 6A  by the abbreviation “MPnm” where “n” and “m” refer to the adjacent crowns. The mid-distance or midpoint MPnm is located at half the distance from the geometric center of the adjacent crowns, or the midpoint between adjacent crowns. The midpoint may also be understood as the geometric center (or centroid) of the strut  16  that extends between the crowns. The midpoint between crowns C 1  and C 2  is indicated as MP 12 , the midpoint between crowns C 2  and C 3  is indicated as MP 23 , the midpoint between crowns C 3  and C 4  is indicated as MP 34 , etc. The same numbering convention applies for midpoints between the other crowns for scaffold  10 . 
         [0103]    Referring to  FIG. 6B  there is shown a view of the scaffold of  FIG. 6A  looking down the axis A-A or perpendicular to the longitudinal axis of the scaffold  10 . The crown numbers C 1 -C 8  for end ring  12   e  are shown. 
         [0104]    The scaffold has a circular inner wall surface or constant inner diameter. The outer wall surface varies, due to the outer surface being wavy or undulating. The outer wall surface  10   a  and circular inner wall surface  10   b  have the combined effect of producing a varying wall thickness about the circumference of the scaffold. The variation in wall thickness is constant along the longitudinal axis. Each of the rings  12  of the illustrated scaffold  10  therefore have the same shape as shown for ring  12   e  in  FIG. 6B . The scaffold  10  wall thickness is thickest at crowns C 1 -C 8  and thinnest at the midpoints MPnm between crowns. The thickness at each crown is designed by t 1  in  FIG. 6B  and the thickness at the midpoint is designated by t 2 . The ratio of t 1  to t 2 , or the quotient t 1 /t 2  is about 2. For example, t 1  is equal to 158 microns or about 100 microns, and t 2  is equal to 93 microns or about 75 microns. In some embodiments t 1  is equal to 120 to 130 microns and t 2  is equal to 90 to 100 microns. 
         [0105]    The variance in wall thickness or undulating outer wall surface for the scaffold  10  is periodic over θ degrees between crowns, or the curved surface segment (“curved surface”) for the outer wall repeats every 360/NC degrees where NC is the number of crowns in a ring. Thus, the curved surface repeats every θ=45 degrees for the illustrated 8 crown ring and every θ=30 degrees for a 12 crown ring. As an example of the scaffold having 12, instead of the illustrated 8 crowns ( FIG. 6B ), and also considered part of this disclosure is the scaffold pattern described in US20100004735 at FIGS. 2, 4, 5A, 5B, 5C, 5D and paragraphs [0043]-[0062]. The curved surface repeats every θ=20 degrees for an 18 crown ring. As an example of a scaffold having 18 crowns and also considered part of this disclosure is the scaffold pattern described in US20110190872 at FIGS. 4, 5A, 6A, and paragraphs [0126]-[0130]. 
         [0106]    Referring to  FIG. 6C  there is shown in close-up the portion VIC of the ring  12   e  between crowns C 4  and C 5  from  FIG. 6B . The curved surface described in  FIG. 6C  is the same as elsewhere over the outer wall surface for the scaffold  10 . The portions corresponding to the crowns C 4 , C 5  are designated as “thick” and the portion corresponding to the strut  16  having midpoint MP 45  and extending between the crown C 4  and C 5  is designated as “thin.” The crown or “thick” part is that part of a ring where the curved surface corresponding to an outer or inner radius of the crown  14  exists ( FIG. 6A ), as opposed to a straight surface of a strut  16  ( FIG. 6A ). 
         [0107]    The outer surface extending between the crowns C 4 , C 5  may be described as follows. The surfaces  15   a ,  15   b  at the crown are rounded (or have no sharp corners) and are symmetric about the geometric center C 4 , C 5  of the crown. Or the surfaces at the crown are rounded (or have no sharp corners) and symmetric about the idealized hinge point C 4 , C 5  for the crown, i.e., the theoretical point that the strut  14  on each side of the crown rotates about in  FIG. 6A  when the ring  12   e  is reduced in size or expanded during plastic deformation (crimping/balloon inflation from the crimped state). The thickness t 1  over surface  15   a  is about the same, or varies from 5 to 10% from the thickness t 1  at the center C 4 , C 5 . 
         [0108]    The strut  16  surface  17  extending between the surfaces  15   a ,  15   b  is convex, a continuously curved surface between the crowns, and/or monotonically decreases from left to right or right to left in  FIG. 6C  from the surface  15   a  and  15   b , respectively, to the midpoint that has the wall thickness t 2 . One example is a sinusoidal undulation periodic over the arc length between crown centers. The surface  17  according to other embodiments is defined by a radius of curvature, i.e., the convex shape follows the arc of a circle centered equidistant between the crowns, C 4 , C 5 , with the surface  17  being continuous with surfaces  15   a ,  15   b  to avoid sharp edges that can lead to stress concentrations during loading. Surface  17  may be sinusoidal. Alternatively, surface  17  may include a parabolic shape centered about the midpoint MP 45  and extending to near to, or to the crowns C 4 , C 5  on each side of the midpoint MP 45 . The surface  17  may also have a hyperbolic shape extending between the midpoint MP 45  and crowns C 4 , C 5 . And the curvature at the midpoint MP 45  may be the same as, less than or greater than the curvature at the crowns C 4 , C 5 . 
         [0109]    Referring to  FIGS. 6D, 6E and 6F  there are shown alternative embodiments of a scaffold having undulating outer surfaces and/or inner surfaces.  FIG. 6D  shows a scaffold repeating section where both the inner and outer surfaces are undulating surfaces, for example, both are sinusoidal. Both or either of the undulating inner and outer surfaces of  FIG. 6D  may, in other embodiments, correspond to any of the outer surfaces described earlier in connection with  FIG. 6C  or the undulating inner surface described in connection with  FIG. 8B , infra.  FIGS. 6E and 6F  show a repeating section of a scaffold where undulating surfaces are, in part, described by hyperbolic or parabolic shapes, respectively. 
         [0110]      FIG. 6E  shows undulating surfaces  151  that are hyperbolic between the strut midpoint MP 45  and crowns C 4 , C 5 . The hyperbolic outer surface portion is also indicated by  150 . The strut surface  152  and surfaces  15   a ,  15   b  at crown centers may have a surface described by a radius of curvature as discussed earlier. 
         [0111]      FIG. 6F  shows surfaces  156  that are parabolic. The parabolic portion  155  of the undulating outer surface would be centered about each crown, as shown. The surface  157  extending between parabolic surfaces  156  may be described by a radius of curvature as discussed earlier. 
         [0112]    Referring again to  FIG. 6A , each of the link elements  18  extending between the rings  12  have the same thickness t 1  as at the crowns. In one particular embodiment the thickness t 1  is chosen to improve the retention of a radiopaque marker in a link element. Such a link element is illustrated in  FIG. 6A  as link  30 , which has holes formed in it to hold radiopaque markers  32 . For embodiments having a thickness t 1  to improve retention of the marker  32  in the hole the thickness is between 120 and 150 microns, about 125 microns, or up to 160 microns. According to another embodiment of a scaffold for increasing retention of a marker, a tube is made to have only one, or two thick parts. These thick parts correspond to links where the markers will be held in the scaffold cut from the tube. For example, the thick parts corresponding to one or both of crowns C 3  and C 6 . Alternatively, the tube is made to have only two thick parts separated by 180 degrees. According to these embodiments the scaffold has a wall thickness of about 80 to 100 microns everywhere, except for the region between strut midpoints surrounding links where a marker will be held on the scaffold. There a wall thickness of at least 120 microns is made. 
         [0113]    A method for making the scaffold of  FIGS. 6A-6C  is described next. 
         [0114]    Referring to  FIG. 7A  there is shown the planar view of the scaffold  10  with registration lines (dashed lines) indicating the pattern  100  of cutting of a polymer tube to register the areas of high thickness (shaded area  101  for example) and low thickness (shaded area  102  for example) corresponding to where the crowns and struts, respectively, will be located when the pattern is cut from the tube. As indicated, the sections of the tube that will have a higher thickness (t 1 ) are indicated as “thick” and the sections having the lower thickness (t 2 ) are indicate as “thin.” Additionally, the bands of “thick” wall thickness  101  and “thin” wall thickness  102  are constant in cross section, i.e., the cross-section as viewed in the plane perpendicular to the longitudinal axis or line A-A. 
         [0115]    The information in  FIG. 7A , along with the rate of change or curvature between the center of a crown and center of a strut that repeats between crowns, may be registered with a numerically controlled machine, e.g., a lathe  50  shown in  FIG. 11 , to cut the tube that will be later formed into the scaffold  10  having the pattern of rings and connecting links shown in  FIGS. 6A-6C . 
         [0116]    Thus, after the tube is made the scaffold  10  pattern is registered in respect to the locations of the crowns and struts of rings  12 , the minimum and maximum thickness of those sections, curvatures of the outer surface for thick and thin parts and/or the shape of the curve between peaks, e.g., sinusoidal or arc of a circle over the length of the strut then continuous, rounded curve at crown or flat peak with rounded edges, and this information is fed into a numerical controlled machine for controlling a cutting piece for making the contoured outer surface of a tube. After making this contoured surface, the scaffold pattern may be laser cut using standard techniques well known in the art. Laser cutting a bioresorbable polymer scaffold where the wall or strut thickness varies within the scaffold pattern may require some modification of laser cutting parameters compared to those used to cut a scaffold of uniform strut thickness. The interaction of the varying strut thickness with the laser focal point may be accommodated using focusing optics with a lower numerical aperture with larger depth of field or choosing a focal point that is a compromise between the halfway point through the thin and thin wall thickness. Thicker tubing can often require higher laser power to cut fully through when a single pass process is being used. An alternative is to vary the linear speed of the laser cutter so that it is faster in the thinner regions and slower in the thicker ones. 
         [0117]    Referring to  FIG. 7B  there is shown a cross-sectional view (perpendicular to longitudinal axis) of a polymer tube  40  prior to making the outer curved surface. The outer and inner surfaces  40   a ,  40   b  of the tube describe a cylindrical surface. A pattern  41  for making the contoured outer surface is shown in phantom. The contoured surface is made, according to one embodiment, by removing the shaded material  42 , which extends longitudinally over the length of the tube  40 , leaving the body  44  that is then laser cut into the scaffold pattern of  FIG. 6A . The shaded areas may be thought of as grooves. Extending lengthwise over the tube. In some embodiments both the thick parts  101  and thin parts  102  ( FIG. 7A ) are cut away. In other embodiments the tube has a thickness t 1  when made and only edges of the thick parts  101  are cut to make a smooth transition to thin parts. 
         [0118]    As mentioned above, the material  42  removal according to the pattern  41  may be accomplished using a numerically controlled cutting tool, such as a numerically controlled lathe having a cutting piece. The tube  40  is mounted on a mandrel and a cutting piece is moved around the tube  40 , or the tube is rotated under the cutting piece to form the contoured outer surface. 
         [0119]    The cutting piece may be a rotating cutter which comprises one “period” or undulation of surface  41 . Such a rotating cutter may be made of hardening tool steel cobat alloy, or any one of a number of hard metal alloys. A rotating cutter would be moved relative to the tube in a longitudinal fashion to cut one groove along the tube length. The cutter or tube would then be repositioned and another groove cut. In one embodiment, the axis of the rotating cutter is perpendicular to the cylindrical axis of the tube, but tangent to the tube circumference. However, in another embodiment, the rotational axis of the cutter is perpendicular to the cylindrical axis of the tube and perpendicular to the tube surface. 
         [0120]    In another embodiment, the cutting piece extends over the length of the tube  40  so that all material  42  over the tube  40  length is removed at the same time. As an alternative to a cutting piece, the material  42  may be removed by ablation using a laser, or by a plume of abrasive material directed at the tube surface. 
         [0121]      FIG. 11  shows an embodiment of a lathe with the tube  40  secured to a mandrel  52 , motor  54  for rotating the mandrel  52  about the longitudinal axis, and a cutting piece  56  configured for cutting along the entire length of the tube  40  as the cutting piece  56  is moved onto the tube  40  surface (alternatively, a laser may be used to remove material from tube  40 ). The cutting piece  56  and motor  54  are controlled by a numeric controller  60 . The tube  40  is held in a chuck (not shown). The controller  60  sends control signals to the motor  54  to control its rotation rate while an actuator  61  is controlled to raise and lower the cutting piece  56  to control the depth of the cut into the tube outer surface  40   a . During machining it is desirable to control the tube temperature to prevent it from softening excessively or becoming tacky. Allowing the tube to warm above its Tg can lead to residual stresses in the tube from expansion inducing tube shrinkage. Cooling gas jets can be used to cool the tube. The entire apparatus can be placed in a temperature controlled chamber to assure the polymer stays below its Tg. The tube  40  may be made by extrusion, 3-D printing, injection molding, or dip coating on a mandrel. The tube material is a bioresorbable polymer such as polylactide (PLA) or PLA blended with another polymer, such polycaprolactone (PCL). The tube may be annealed or expanded/drawn to orient the polymer. The wall thickness of the tube may be t 1 , or greater than t 1 . In the former case the contoured outer surface would be made without removing material at the center of the crown (thick strip  101  from  FIG. 7A ) and in the latter case material is removed for strips  101  and  102  to arrive at the thickness t 1  at crowns and t 2  between crowns. 
         [0122]    Referring to  FIG. 7C  there is shown a perspective view of the tube  40 ′ after the tube  40  is machined using the lathe  50  to remove the shaded material  42  ( FIG. 7B ). The tube  40 ′ has a contoured outer surface  40   a ′ which shows the removed material along the length of the tube, thereby leaving material  44 . The inner surface  40   b ′ is unchanged. The scaffold pattern for scaffold  10  may be laser cut from the tube  40 ′ to produce scaffold  10  using standard techniques well known in the art. Laser cutting a bioresorbable polymer scaffold where the wall or strut thickness varies within the scaffold pattern may require some modification of laser cutting parameters compared to those used to cut a scaffold of uniform strut/wall thickness. The interaction of the varying strut thickness with the laser focal point may be accommodated by using focusing optics with a lower numerical aperture having a larger depth of field or choosing a focal point that is a compromise between the halfway point through the thin and thin wall thickness. Thicker tubing can often require higher laser power to cut fully through when a single pass process is being used. An alternative is to vary the linear speed of the laser cutter so that it is faster in the thinner regions and slower in the thicker ones. Prior to laser cutting the scaffold pattern the tube  40 ′ may optionally be annealed at 10-20 degrees above the glass transition temperature of the tube polymer to work out residual stresses in the material resulting from the cutting process. 
         [0123]    A second embodiment of a variable thickness scaffold is described next. In this description it is understood that use of the same element numbering for a scaffold described in connection with  FIGS. 8A-8C  carries with it the same meaning as in the prior discussion and the same description likewise applies for similar elements of the scaffold of  FIGS. 6A-6C . 
         [0124]    Referring to  FIG. 8A  there is shown a cross-sectional view of a scaffold according to a second embodiment. The scaffold  60  may have the same pattern of rings  12 , crowns  14 , struts  16 , and links  18  as shown and described for scaffold  10 . Similarly, the variance in wall thickness or undulating inner wall surface for the scaffold  60  may also be periodic over θ degrees between crowns, or the inner curved surface segment (“curved surface”) repeats every 360/NC degrees where NC is the number of crowns in a ring. Thus, the inner curved surface repeats every θ=45 degrees for the illustrated 8 crown ring  12 E and every θ=30 degrees for a 12 crown ring. As an example of the scaffold having 12, instead of the illustrated 8 crowns ( FIG. 6B ), and also considered part of this disclosure is the scaffold pattern described in US20100004735 at FIGS. 2, 4, 5A, 5B, 5C, 5D and paragraphs [0043]-[0062]. The inner curved surface repeats every θ=20 degrees for an 18 crown ring. As an example of a scaffold having 18 crowns and also considered part of this disclosure is the scaffold pattern described in US20110190872 at FIGS. 4, 5A, 6A, and paragraphs [0126]-[0130]. The variation in thickness for the scaffold  60  is between t 1  and t 2 , where the ratio of t 1  to t 2 , or t 1 /t 2  is about 2. 
         [0125]    The scaffold  60  differs from the scaffold  10  in that the inner wall surface  60   b  is undulating or wavy over the circumference, whereas scaffold  10  has a varying outer wall surface  10   a . Additionally, the shape of the inner wall surface  60   b  varies differently from the shape of the outer wall surface  10   a  for the scaffold  10 , as will now be described. 
         [0126]    Referring to  FIG. 8B  there is shown in close-up the portion VIIIB of the end ring  12   e  between midpoints MP 45  and MP 56  and showing crown C 5 . The curved surfaces described in  FIG. 8B  are the same as elsewhere over the inner wall surface for the scaffold  60 . The portions designated as “thin” corresponds to a portion of the strut, e.g., about 60% to 90% of its length. Thickness variation from t 2  over this portion of the strut length is 10% to 50% of t 2 , or the thickness t-thin satisfies the inequality t 2 &lt;t-thin&lt;1.5×t 2 . The thick part occupies the crown C 5  and the remaining portion of the strut. 
         [0127]    The outer surface extending between MP 45  and MP 56  may be described as follows. The surfaces  17   a ,  17   b  are rounded (or have no sharp corners) and are symmetric about the geometric center of the midpoints. Or the surfaces at the midpoints MP 54 , MP 56  are rounded (or have no sharp corners) and symmetric about the respective midpoint. 
         [0128]    The surface  15   c  extending between the surfaces  17   a ,  17   b  is concave, a continuously curved surface, and/or monotonically increasing from left to right or right to left in  FIG. 8B  from the surface  17   a  and  17   b , respectively, to the crown center C 5  that has the wall thickness t 1 . One example is a sinusoidal undulation periodic over the arc length between crown centers. The surface  15   c  according to other embodiments may be defined by a radius of curvature, i.e., the concave shape follows the arc of a circle centered equidistant between the midpoints MP 45 , MP 56 , with ends of the surface  15   c  being continuous with surfaces  17   a ,  17   b  to avoid sharp edges that can lead to stress concentrations during loading. One difference between the thickness variation shown for the scaffold  60  and scaffold  10  is that in scaffold  60  the struts are made thicker nearer to the crowns. Surface  17   a ,  17   b ,  15   c  may be sinusoidal. Alternatively, the surface may include parabolic shapes centered about the midpoints MP 45 , MP 56  and extending to near to, or to a crown on each side of the respective midpoints. The surface may alternatively include hyperbolic shapes extending between the midpoint MP 45  and crown C 4  and the midpoint MP 56  and the crown C 5 . And the curvature at the midpoints MP 45 , MP 56  may be the same as, less than or greater than the curvature at the crown C 5 . Examples of embodiments of inner curved surfaces according to other embodiments are shown and described in connection with  FIGS. 6D, 6E and 6F . 
         [0129]    Referring again to  FIG. 8A , each of the link elements  18  extending between the rings  12  have the same thickness t 1  as at the crowns for the scaffold  60 . In one particular embodiment the thickness t 1  is chosen to improve the retention of a radiopaque marker in a link element. Such a link element is illustrated in  FIG. 6A  as link  30 , which has holes formed in it to hold radiopaque markers  32 . For embodiments having a thickness t 1  to improve retention of the marker  32  in the hole the thickness is between 120 and 150 microns, about 125 microns, or up to 160 microns. According to another embodiment of a scaffold for increasing retention of a marker, a tube is made to have only one, or two thick parts. These thick parts correspond to links where the markers will be held in the scaffold cut from the tube. For example, the thick parts corresponding to one or both of crowns C 2  and C 6 . Alternatively, the tube is made to have only two thick parts separated by 180 degrees. According to these embodiments the scaffold has a wall thickness of about 80 to 100 microns everywhere, except for the region between strut midpoints surrounding links where a marker will be held on the scaffold. There a wall thickness of at least 120 microns is made. 
         [0130]    In alternative embodiments a scaffold may have the repeating curved surface illustrated in either  FIG. 6C  or  FIG. 8B  and the accompanying description, and the undulating surface may be found at either the inner wall or the outer wall. When it is desirable to make an undulating surface on the outer wall the method described above in connection with  FIGS. 7A-7C  and  FIG. 11  may be used to make this surface. When it is desirable to make an undulating surface on the inner wall one of the methods described in connection with  FIG. 9 or 10 , below, may be used. 
         [0131]    Referring to  FIG. 8C  there is shown a perspective view of a tube  70 ′ made to have a contoured inner wall surface  70 ′ b  for the scaffold  60  ( FIG. 8A ) and outer wall surface  70   a  that describes a cylinder. The tube  70 ′ may be made according to either of the processes described below. 
         [0132]    Referring to  FIG. 9  there is shown schematically a blow-molding process configured to make the tube  70 ′ with the contoured inner wall surface  70   b ′ (shown in phantom) and cylindrical outer surface. A precursor tube  72 , while being heated by light bulbs  82  (UV lights), is radially expanded lengthwise at a given processing rate (along the longitudinal axis) and expansion pressure/rate within a glass mold  80  while the tube  72  is under axial tension. Expansion occurs at an axial position near the moving light bulbs. Examples of processes that may be used to perform a biaxial expansion in this manner are described in US20110066222 at FIGS. 3A, 3B, 3C, 3D and paragraphs [0047] through [0062]. Processing parameters, e.g., heating temperature, translation rate, pressure, draw ratio radially and axially, that may be used for blow molding are described in paragraphs [0077] through [0097]. These aspects of the blow-molding process described in US20110066222 is modified in the following way to produce the contoured inner surface  70   b′.    
         [0133]    A cylindrical mask (illustrated schematically by mask elements M 1 -M 7 ) is interposed between the lamps  82  and the glass mold  80 . The mask may contain a series of longitudinal slits, holes to vary the light transfer in a circumferential manner. The mask could be made of metal. Or the mask could be made of a transparent material and be tinted, colored or painted in a circumferentially varying manner. 
         [0134]    The mask elements M 1 -M 7  blocking all or a portion of the light energy emitted from the lamps  82  are located on the exterior of the glass tube  80  at circumferential locations registered with the locations of thick parts  101  ( FIG. 7A ) or the locations of the crowns  14  links  18  that will be later cut from the biaxially expanded tube. For a scaffold having crowns C 1 , C 2 , C 3 , C 4 , C 5 , C 6 , C 7  and C 8  per ring there may be eight respective light blocking or filtering mask elements M 1 , M 2 , M 3 , M 4 , M 5 , M 6 , M 7  and M 8  that are configured to diffuse, reflect or filter light energy. The masks create local thick spots due to the lower temperature of these parts of the tube during biaxial expansion. The hotter portions that receive a greater amount of the light energy create local thin spots. By varying the temperature in this way during the biaxial expansion one may produce the wavy or undulating surface  70   b ′ for the expanded tube  70 ′. 
         [0135]    TABLE 1 provides processing parameters and mask characteristics for making a scaffold according to  FIGS. 8A and 9 , where the tube has a 400%-500% radial draw, the tube material is PLA or a blend of PLA and PCL, and the wall thickness varies between t 1 =130 microns and t 2 =80 microns. 
         [0000]    
       
         
               
               
               
             
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
             
             
               
                 Average temperature 
                 50-120 
                 Deg. C. 
               
               
                 Temperature difference (hot and cold spots) 
                 5-50 
                 Deg. C. 
               
               
                 Pressure 
                 100-125 
                 psi 
               
               
                 Bulb translation rate 
                 0.2-0.5 
                 mm/sec 
               
             
          
           
               
                 Mask properties 
                 0% to 50% transmittance 
               
               
                   
               
             
          
         
       
     
         [0136]    Referring to  FIG. 10  there is shown schematically an alternative method for producing a variable wall thickness tube during a biaxial expansion of the precursor tube  72 . Rather than disposing a mask between a uniform light source and the glass mold  80 , individual lighting elements L 1 , L 2 , L 3 , L 4 , L 5 , L 6 , L 7 , and L 8  are placed over the respective thin sections  102  or midpoints MPnm (n, m=1 . . . 8) where struts will be cut from the tube  70 ′. Thus, in this embodiment local heat sources are applied strategically to introduce controlled thin spots around the tubing circumference. Multiple light, or heat sources, are used. The number and spacing are chosen to produce the desired periodicity of thin regions between crowns for the scaffold pattern. For example, if there are 8 crowns per ring there are 8 lights translated, each of which positioned between crowns. 
         [0137]    The above description of illustrated embodiments of the invention, including what is described in the Abstract, is not intended to be exhaustive or to limit the invention to the precise forms disclosed. While specific embodiments of, and examples for, the invention are described herein for illustrative purposes, various modifications are possible within the scope of the invention, as those skilled in the relevant art will recognize. 
         [0138]    These modifications can be made to the invention in light of the above detailed description. The terms used in claims should not be construed to limit the invention to the specific embodiments disclosed in the specification.