BETHESDA, MD -- Once a coronary stent becomes blocked with scar tissue,the likelihood it will become blocked again is 30 percent to 80percent. Inserting a second coronary stent that slowly releasesanti-scarring medication can markedly cut that risk, according to astudy in the just-published October 2005 issue of Catheterization andCardiovascular Interventions: Journal of the Society for CardiovascularAngiography and Interventions.
Researchers also showed that it was unnecessary to thread a high-techultrasound device into the artery to guide precise placement of thedrug-eluting stent. Instead, they reduced the risk of blood clotting byminimizing trauma to the artery--no stretching of the artery before orafter the procedure, for example--and prescribing a double dose ofanti-clotting drugs for two months.
"Our slogan is not 'Bigger is better,' but 'A nice, quick jobis better,'" said Dr. Philippe Commeau, of Centre Hospitalier PriveBeauregard in Marseille, France.
Twenty-three patients participated in the ISR II study. All hadin-stent restenosis (ISR), an overgrowth of scar tissue inside a baremetal stent. They also had chest pain and some other sign that toolittle blood was flowing to the heart.
Patients were treated by insertion of a Cypher stent (CordisCorp., Miami) on top of the original bare metal stent. The Cypher stentslowly releases sirolimus into the artery wall, a medication thatprevent the overgrowth of the tissue that causes in-stent restenosis.Interventional cardiologists used standard x-ray angiography todetermine the correct placement of the stent.
During two years of follow-up, four patients (17 percent) hadyet another procedure to open the stented artery. Two of the patientshad no chest pain and showed no evidence of a shortfall of blood flowto the heart. Therefore, the study's authors pegged the true clinicalrestenosis rate at only 8.5 percent.
Since the conclusion of the ISR II study, Dr. Commeau and hiscolleagues have followed the progress of 200 similar patients for morethan two years. They expect to publish the results of that study soon.
Headquartered in Bethesda, Md., the Society for CardiovascularAngiography and Interventions is a 3,400-member professionalorganization representing invasive and interventional cardiologists.SCAI's mission is to promote excellence in invasive and interventionalcardiovascular medicine through physician education and representation,and advancement of quality standards to enhance patient care. SCAI wasorganized in 1976 under the guidance of Drs. F. Mason Sones and MelvinP. Judkins. The first SCAI Annual Scientific Sessions were held inChicago in 1978.
Materials provided by Society for Cardiovascular Angiography and Interventions. Note: Content may be edited for style and length.
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