Dissolving stent reduces clot, fracture risks in heart patients


Lugging heavy groceries used to be exhausting for John Brinker. His energy level had crashed. An angiogram revealed a dangerous blockage in his coronary artery, severely reducing blood flow to his heart.

Stent researcher Dr. Dean Kereiakes used a new mesh scaffold to prop open Brinker's clogged artery. It releases medication into the blood vessel, then, unlike a metal stent, disappears after the artery heals.

"It slowly dissolves like a lollipop in your mouth and goes away, leaving behind a normal-appearing and normal-functioning artery," said Kereiakes.

No metal left behind means a lower risk of clotting and stent fractures. Brinker is one of the first patients in the U.S. to receive a dissolving stent. Today Brinker's heart is healthy.

The dissolving stent, called Absorb, is already approved for use in Europe and parts of Asia and Latin America. It's currently being tested in the United States.

BACKGROUND: Affecting more than 13 million Americans, coronary heart disease is the number one killer in America. Heart disease happens when plaque buildup in the coronary arteries, a condition called atherosclerosis, which leads to blockages. The arteries start out smooth and elastic, then they become narrow and rigid, restricting blood flow to the heart. Plaque can start to deposit in the blood vessel walls at a young age. As you grow older, the plaque builds up as well, increasing the risk of heart attacks and blood clots. Plaque releases chemicals that promote the process of healing, but make the inner walls of the blood vessel sticky. Substances like lipoproteins and calcium that travel in the bloodstream will stick to the inside of the vessel walls. The narrowed coronary artery can eventually develop new blood vessels that can escape the blockage. During times of increased stress, the new arteries may not be able to supply a sufficient amount of oxygen-infused blood to the heart.

SIGNS: The most common symptom of coronary artery disease is angina, or chest pain. It can be described as pressure, heaviness, aching, numbness, fullness, pressure, painful feeling or squeezing. Angina is sometimes mistaken for heartburn. Other symptoms can include: dizziness, weakness, shortness of breath, palpitations, nausea, sweating and a faster heartbeat.

TREATMENT: Treatment for coronary artery disease involves making lifestyle changes, taking medications, and sometimes undergoing invasive surgery. Common procedures can include balloon angioplasty (PTCA), stent placement and coronary artery bypass surgery. All of these will increase blood supply to the heart, but they do not cure coronary heart disease. New innovative ways doctors are exploring are angiogenesis and EECP (Enhanced External Counterpulsation). Angiogenesis involves giving substances like stem cells through the vein or directly into the damaged heart tissue. Patients who have bad angina, but do not get relieve through medications or who do not qualify for surgeries, may use EECP. It is an outpatient procedure that uses treatment cuffs placed on the legs that inflate and deflate, increasing the blood supply that feeds coronary arteries.

NEW TECHNOLOGY: One of the newest advances for blocked arteries is a device called Absorb. After opening blocked arteries, it dissolves. Absorb is the first drug-eluting, bioresorbable vascular scaffold (BVS) for the treatment of coronary artery disease. The device is made by a health care company called Abbott. It is a tiny mesh tubular scaffold made of polylactide, a biocompatible material used in medical implants like dissolvable sutures. Absorb will provide support to the heart vessel until normal functioning is restored and dissolves naturally. Absorb is in stage III clinical trials. Approximately 2,250 patients are enrolled so far. The trial will compare Absorb BVS to traditional drug-eluting stents. The device is not approved for sale in the United States, but in Europe, Asia and Latin America there are more than 3,000 patients with this device in clinical trials and commercial use. Researchers believe that this new device has the potential to help with blockages without leaving a permanent metallic stent behind. The blood vessels have an opportunity to return to a natural state, resulting in a reduced risk for some patients who require future interventions. (Source: webmd.com and thechristhospital.com)

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