Angioplasty Info and the Stent, Part 5
Drug Coated Stents versus Second Angioplasty
- Since the 1990s, cardiologists have used tiny wire mesh tubes called stents to help keep arteries open following angioplasty, but when an artery closes after a stent has been implanted, it's more effective to replace it with another stent coated with a clot-preventing drug than to perform another angioplasty, a new German study finds.
- The researchers, who looked at two types of stents coated with different drugs, found one type was more effective than the other, but each produced better results than angioplasty, which clears arteries by using an inflated balloon.
- Arteries remained blocked in forty-one of ninety-two patients, forty-four and six tenths percent, who underwent angioplasty, the doctors reported.
- Blockage occurred in only thirteen of ninety-one patients, 14.3 percent, were given stents coated with a drug called sirolimus, and twenty of ninety-two patients, 21.7 percent, who got stents coated with the drug pacliatexel.
- The study is important because it provides the first solid evidence to support what cardiologists in the United States have been doing for some time.
- It is a step forward, but it doesn't answer all the questions, said some scientists.
- The German study is a beat behind medical progress because all the patients had bare metal stents implanted originally.
- About a year and a half ago, they stopped using bare metal stents, and began using drug-eluting stents.
- The relevant question in the United States is whether these findings apply to restenosis [closing of the artery] after implant of a drug-eluting stent.
- Artery blockage happens in about twenty percent of patients who receive a bare-metal stent and ten percent of those who receive coated stents.
- If the problem does occur, it generally happens from twelve to eighteen months after the original stent implantation.
- In cases where blockage occurs in coated stents, cardiologists have been playing it by ear.
- If the patient has a sirolimus-coated stent, doctors will use a pacliatexel stent, and vice versa.
- The decision is based partly on intuition, with not a whole lot of science involved.
- One major change in treating clogged arteries has been the virtual abandonment by U.S. doctors of a third method, brachytherapy, in which a source of radiation is implanted to reopen the artery.
- Use of brachytherapy has plummeted, and at least two of the three companies that had been making the devices have stopped; however, brachytherapy is not dead in Europe.
- There are at least two running trials comparing drug-eluting stents with brachytherapy.
More information about angioplasty; as well as, the stent at the following links:
Angioplasty Info and the Stent, Part 1
Angioplasty Info and the Stent, Part 2
Angioplasty Info and the Stent, Part 3
Angioplasty Info and the Stent, Part 4
Angioplasty Info and the Stent, Part 6
Angioplasty Info and the Stent, Part 7