Don't Get Stent Out of Shape
Posted 2/9/2017 by UHBlog
For decades, interventional cardiologists have used metallic stents to open the clogged artery walls of heart attack victims. That technology has saved the lives of countless people who suffer from coronary artery disease (CAD), the No. 1 cause of death for both men and women in the U.S.
Now, there is a new, potentially game-changing therapy to treat CAD. It's called the Absorb stent – a completely bioresorbable stent – that is made by Abbott. Recently approved by the FDA for use in the U.S., the new stent is designed to dissolve completely in the body two to three years after implantation.
“The beauty of this device is that after three years, nothing is there,” says the director of interventional cardiologist Hiram Bezerra, MD, PhD.
According to Dr. Bezerra, there are a number of advantages that the Absorb stent offers to patients, including:
- It’s made of a naturally dissolving material, similar to dissolving sutures
- Like traditional metallic drug-eluding stents (DES), the Absorb stent keeps a clogged artery open and promotes healing of the treated artery segment. But with no metal left behind after three years, your vessel motion isn't restricted, enabling it to pulse and flex naturally.
- It doesn't interfere with repeating a stent procedure if it's needed.
“If you have a metallic implant and if, anytime down the road, you need another implant, it's harder for a re-intervention,” he says. “It's also harder - if not impossible - for the surgeon to find a place for a graft,” he says. “But the fact that the artery is now back to native status after absorption of the Absorb stent, we have more options where to place the stent.”
Still, the Absorb stent is a first-generation device and does have limitations.
“This stent isn't suitable for everyone,” Dr. Bezerra says. “There are anatomical factors and situational factors where we wouldn’t recommend the Absorb stent for a patient. We estimate that approximately 60 percent of the population who needs a stent could benefits from this new technology.”
For instance, 90 percent of patients will have an artery that is anatomically suited to accept the bioresorbable stent, but others have vessels that are either too small or too large.
The situational factor is a bigger hurdle, Dr. Bezerra says. In order to be a candidate for Absorb, you have to commit to antiplatelet therapy for a full year after the stenting.
“In the first year after implanting an Absorb stent, it's more demanding when it comes to taking medications,” he says. “If I realize in talking to the patient that he's not compliant with taking medicine, that's a red flag for me.”
University Hospitals Cleveland Medical Center is among the first in the country – and the first in Ohio – to offer and deploy this stent. Imaging expertise at UH is being used to teach and train staff and physicians around the world about the importance of vascular imaging and why it makes a difference in the proper deployment technique for Absorb.
To learn more about stenting, watch “Drug Eluting and Bioabsorbable Stents for Heart Attacks’.
Hiram Grando Bezerra, MD, PhD is a cardiologist and serves as the Medical Director of the Cardiac Catheterization Laboratory at University Hospitals Harrington Heart & Vascular Institute at UH Cleveland Medical Center. He also serves as an Associate Professor of Medicine at the Case Western Reserve University School of Medicine. You can request an appointment with Dr. Bezerra or any other doctor online.