Take the Meds, Hold the Stent
From the annual American Heart Association meeting in Chicago: Part five in a series of web-exclusive articles
Reports have circulated for some weeks about possible risks posed by "drug eluting" stents–miniature metal cylinders coated with various medications and inserted into a coronary artery that has been reopened by an angioplasty balloon. The stent props the artery open, and the drug coating helps to keep it from closing up again. But the reports suggest that patients with this kind of stent run a significantly higher risk of developing lethal clots after a year than patients who got uncoated metal stents.
A study described at this week's American Heart Association meeting in Chicago and published online Tuesday in the New England Journal of Medicine describes a pilot trial that might offer the blockage-delaying benefit of the drug without the possible added risk imposed by a stent. Researchers put the drug on the outside of the angioplasty balloon and didn't use a stent at all.
In the small study, 52 heart-attack patients were treated with angioplasty balloons, half of them with an ordinary balloon and the other half with a balloon coated with paclitaxel, a medication employed in a popular drug-eluting stent. The balloon was inflated as usual inside the blocked portion of a coronary artery, remaining in contact with the inner wall of the vessel for about 80 seconds, and then deflated.
After six months, significant blockages had returned in almost half of the patients with uncoated balloons–but in only one patient who got a coated balloon. And after a year, heart attacks and other serious events occurred more often in the uncoated-balloon group.
The study was small but bears repeating. Any stent causes some damage to artery walls; it is a metal device that is pressed forcefully into the tissue, which reacts by scarring and growing layers of cells at an accelerated rate. Drug-coated stents were developed to slow tissue regrowth. A drug-coated balloon could be a kinder and gentler way to open an artery without causing the artery to fight back.
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