A specially coated device which holds open blocked heart arteries
and prevents re-clogging is tested in Israel for the first
time.
By Judy Siegel-Itzkovich
More than a third of heart disease patients in Western countries
undergo angioplasty - a procedure involving the use of a tiny
inflated balloon on the end of a catheter to compress fatty
deposits in a coronary artery and thus improve blood circulation
to the heart. This procedure greatly reduces the need for painful
and expensive open-heart surgery - a longer and more complicated
procedure involving the replacement of a clogged coronary artery
by a blood vessel taken from another part of the body, which
requires many weeks of recovery.
However, angioplasty can often result in the treated vessel walls
weakening and collapsing, thus reducing the blood supply to the
heart. This problem was solved with the invention of stents -
miniature mesh tubes made of stainless steel that hold open the
weakened sections of coronary arteries pushed open by
angioplasty. But within three to six months, some 40 to 50
percent of all stents get re-blocked with fatty deposits - a
condition known as restenosis.
Now Israeli researchers are among a select group to test a new
kind of stent, coated with a slow-release antibiotic which almost
completely prevents restenosis. Produced by Cordis (a company
belonging to the multinational health care product manufacturer
Johnson & Johnson), the stent is coated with the drug rapamycin,
used in recent years by kidney transplant recipients to prevent
organ rejection. The drug is released into the bloodstream over a
period of 45 days, stopping new fat cells from forming without
impairing the healing of the blood vessel; it also reduces
inflammation. Professor Chaim Lotan, head of the cardiology unit
at Jerusalem's Hadassah Hospital in Ein Kerem, implanted the
special stent into the coronary artery of a 40-year-old heart
patient. According to him, the new type of stent could herald a
"revolution" in cardiology that would significantly reduce the
number of heart bypass operations. He and his colleagues are
looking forward to carrying out the procedure on more patients
during the coming months.
In previous clinical trials of some 238 patients in Europe and
Latin America, only three percent of those who received the
coated stent suffered from further heart trouble in the
subsequent six months, compared with 27 percent of those who had
ordinary ones inserted. Speaking at the European Society of
Cardiology Annual Congress in Stockholm, Dr. Marie Claude Morice,
Head of Interventional Cardiology at the Institut Hospitalier
Jacques Cartier in Massy, France, said: "We are probably
witnessing the beginning of a new era in the treatment of
coronary disease."
Apart from Hadassah Hospital in Jerusalem, Rambam Hospital in
Haifa has also been invited to participate in the trials. The
teams expect the favorable results to lead to approval by the US
Food and Drug Administration. Professor Lotan notes that as
competitors enter the field, the price of the stent - now
standing at $2,000 - $3,000 (about double the cost of an uncoated
stent), is expected to drop, not only reducing the number of
bypass operations but also saving the health system a
considerable amount of money.