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Dissolving stents: what you need to know

July 25, 2017

Beebe Healthcare is the first hospital on Delmarva to offer a fully dissolving stent as part of advanced cardiac treatments for patients with coronary artery disease.

The dissolving heart stent received FDA approval last year following an independent review of clinical data that supported the safety of the device. In addition to being used in the United States, this type of stent is used in more than 100 countries, and has treated more than 125,000 people worldwide.

CAD affects millions of Americans. It is caused by the buildup of cholesterol and fatty deposits on the inner walls of the arteries. This buildup is called atherosclerosis, and it restricts blood flow to the heart. When blood flow is restricted, the heart receives less oxygen and nutrients, which can cause chest pain called angina. If the blood flow is stopped entirely, that's when a heart attack may occur.

Heart attacks often land patients in the emergency room. At Beebe, a dedicated heart team rushes into action to determine the best course of action for the patient. In many cases, patients require a heart catheterization procedure to "unclog" the blocked artery with angioplasty followed by implantation of a stent. The stent allows the artery to remain open while it heals, and blood can flow into the heart.

Most of the stents are made with stainless steel or nitinol and are coated with a drug to maintain the opening of the artery. However, these stents also become a permanent part of the artery, thus increasing the risk for future buildup of plaque. Metal stents may also restrict movement of the artery.

In addition, patients may need to take blood thinners for six to 12 months to keep the stents open.

Therefore, there was always a search for a more conformable scaffold that might keep the artery open just long enough for it to heal up without becoming a permanent leftover skeleton in the artery. Bioresorbable stents have fulfilled that role. These stents have been used in Europe for many years now. The Absorb bioresorbable vascular scaffold opens clogged arteries to restore blood flow, then gradually dissolves in the body, reducing the risk of future blockages that can occur with metal stents.

Absorb starts to dissolve and disappears completely in about three years, after it has done its job of keeping a clogged artery open and promoting healing of the treated artery segment. No metal means that the treated artery can pulse and flex naturally as demands on the heart change with everyday activities. It may also reduce the potential for future blockages.

Being the first-generation stent, bioresorbable scaffold or dissovabale stent has its limitations. It is a bulky stent and requires specialized additional imaging of the vessel for appropriate sizing. It is not suitable for small arteries or branching vessels. The delivery of the stent requires preparation and skill. Furthermore, patients are committed to at least one year of dual antiplatet drug therapy.

Appropriateness of an artery for a dissovabale stent can only be assessed after an angiogram or cardiac catheterization has been performed.

Beebe Healthcare is one of America's 100 Best Hospitals for Coronary Intervention Procedures in 2017, according to Healthgrades. Beebe is the only hospital on Delmarva to receive this recognition, and it is among the top 5 percent of hospitals in the nation for coronary intervention procedures. These procedures include the life-saving balloon angioplasties with stent insertions that open coronary arteries blocked during a heart attack.

For more information, go to www.beebehealthcare.org/cardiac-vascular-services or call 844-316-3334.

Dr. Ehtasham Qureshi is board certified in cardiology and interventional cardiology. He received his medical degree from St. Luke's Roosevelt Hospital/Columbia University in New York City and completed cardiology training at Lankenau Hospital/Thomas Jefferson University at Wynnewood, Pa.  Qureshi specializes in cardiology and interventional cardiology. In Beebe's Cardiac Cath Lab, Qureshi and his team perform intravascular ultrasounds, stent procedures, atherectomy and other specialized techniques. He practices at Delaware Cardiovascular Associates.

 

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