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    The Top 10 Health Stories of 2006

    Vaccines, Unsafe Food, Inhaled Insulin: WebMD Picks the Most Important Medical News of the Year

    5. Stents: Safe as We Thought?

    Before this year, there seemed no end to the popularity of drug-coated stents. Patients even demanded that their cardiologists use them to prop open their clogged arteries.

    Now, as 2006 draws to a close, an FDA advisory panel warns that drug-coated stents carry their own risk of fatal heart attack.

    Drug-coated stents are the latest thing in the evolving treatment of blocked arteries. But the stent story shows that solving one problem creates another.

    First, there were bypass operations. These open surgeries take a blood vessel from another part of the body and use it to bypass blockage in a heart artery.

    Then there was balloon angioplasty. It calls for a doctor to thread a catheter into a blocked artery. The catheter inflates a balloon that opens the blocked area.

    But the balloon-opened artery sometimes collapses again. So doctors used wire-mesh tubes -- stents -- to prop the artery open.

    Bare-metal stents sometimes get blocked by scar tissue. This led to the invention of stents coated with drugs that keeps the scar tissue from forming.

    Now it's clear that drug-coated stents have their own problem. To work properly, a lining of new blood-vessel cells have to heal over the inside of the stent. Drug-coated stents delay this process. Blood clots can form on the unhealed surface of the stent. This means that in rare cases, drug-eluting stents cause heart attacks and sudden death.

    How often does this happen? Deepak L. Bhatt, MD, associate director of The Cleveland Clinic's heart center, tells WebMD that patients "are not dropping in droves due to drug-coated stents."

    "The absolute risk to an individual patient is less than one in 200," Bhatt says. But "with a million stents going in each year in the U.S. and twice that number worldwide, this is not trivial."

    Fortunately, a combination of two anticlotting drugs -- aspirin and Plavix -- cuts the risk from drug-coated stents. Doctors used to wean stent patients off these drugs after six months. Now studies suggest that patients may have to stay on the drugs for at least a year.

    But this solution creates its own problem. Patients with bleeding problems -- or those who need surgery -- can't tolerate long-term anticlotting treatment.

    New kinds of stents eventually will solve this problem. And if history is any guide, they'll pose new challenges, too.

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