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Better Way to Avoid Artery Reclog?

Study Looks at Drug-Coated Angioplasty Balloons as Alternative to Drug-Coated Stents in Heart

Drug-Coated Angioplasty Better?

But these stents aren't perfect. The new study presented here looked at people who developed restenosis, or reclogging of the artery, after getting a drug-coated stent.

After the reclogging, 23 people got simple angioplasty with an uncoated balloon. Twenty-two more got angioplasty with the new drug-coated balloon. None received new stents.

Over the following 12 months, arteries reclogged in 10 of those treated with the uncoated balloons.

In contrast, just one person who had a drug-coated balloon developed restenosis.

The bottom line: Just one person treated with a coated balloon needed a repeat procedure to open reclogged arteries, had a heart attack or stroke, or died; compared with eight people in the uncoated balloon group.

Smith says the fact that the coated balloons helped people who already had restenosis "makes the findings even more promising, although they need to be confirmed in a larger study."

Drug-Coated Stents Debate

Other research presented at the meeting set off a lively debate about the long-term safety of drug-coated stents.

Among the conflicting research:

  • A study of more than 9,000 people found those who got drug-coated stents were significantly more likely to die in the three years after the procedure, compared with those treated with bare metal stents. "Given the dominance of drug-eluting stents in current practice, we think these findings raise concern," says researcher Joseph B. Muhlestein, MD, professor of medicine at the University of Utah in Salt Lake City. "Further study is needed."

  • In a study of more than 3,000 people fitted with either bare metal stents or drug-coated stents, risk of having a blood clot, heart attack, or other adverse event was similar in both groups after one year. And those who got drug-coated stents were less likely to need another angioplasty or bypass surgery. "There is no evidence to support abandoning the routine use of drug-eluting stents," says researcher David Williams, MD, professor of medicine at Brown University Medical School in Providence, R.I.

Antiplatelet Therapy Stressed

None of the researchers is calling for an end to the use of drug-coated stents. But well-designed studies comparing the safety of bare stents and drug-coated stents are needed, they say.

In the meantime, researchers say, it might be best to continue antiplatelet therapy for at least a year after inserting a stent -- maybe longer.

The reason? Any added risk of heart attack or death in people fitted with drug-coated stents is thought to be due to an increased risk of blood clots. Antiplatelet therapy with aspirin and Plavix reduces the risk of clots.

Too many people stop taking the drugs earlier than they should, usually due to excess bruising or expense, Smith says. Plavix costs more than $135 a month.

"People don't understand how important it is to take the drugs for as long as their cardiologist advises," Smith says.


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