Better Way to Avoid Artery Reclog?
Study Looks at Drug-Coated Angioplasty Balloons as Alternative to Drug-Coated Stents in Heart
Adding a Stent
To keep the vessel open, doctors often install a stent after deflating the balloon. The metal, mesh-like tube props open the clogged artery and restores blood flow.
Stents bring the rate of renarrowing down to about 15% to 25%.
In recent years, stents coated with drugs to reduce buildup of scar tissue have become increasingly popular.
They appear to provide additional protection against reblockage and now account for up to 90% of all stent placements in the U.S.
Research has shown these drug-coated stents can lower the risk of heart attack and reduce the need for repeat surgeries to clear clogged arteries.
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.