January 16, 2011
Europe approved the first bioabsorbable stent this week giving cardiac patients hope for a future without the need for Plavix or Effient.
Ever since stents became widely popular over 20 years ago the art of stent placement has been evolving. Stents are tiny wire-mesh tubes placed over a blockage in an artery of the heart. Initially bare metal stents were used but they were prone to inflammation and further bloackages within several years in some cases. Eventually drug coated or drug eluting stents were developed which lowered the rate of reblockage as long as the patient takes aspirin and either Plavix or Effient. Without Plavix or Effient, patients with drug coated stents are more likely to have a heart attack related to blockages within their stent.
The concept of stenting a heart artery at this point in time is not perfect. Europe hopes to bring it closer to perfection with the latest in stent technology. A bioabsorbable stent will soon be available for implanting in the general public of Europe. This new absorbable stent is absorbed by the artery wall and thereby nearly vanishes within years. The stent has been shown in studies to be at least one-third absorbed within 2 years. A stent that vanishes means patients will no longer be required to take Plavix or Effient.
Patients in the US may be able to enroll in a global trial using the new absorbable stents later this year. Don’t expect to see them going mainstream here anytime in the next few years though. Large-scale studies need to be completed long before a technology such as this can be FDA-approved in the US.
September 1, 2010
A new study reported in the Circulation medical journal has determined black patients are more likely to develop clots in heart artery stents.
The researchers looked at over 1500 black patients who recently had a stent placed in the heart due to blockages. When they compared the black patients to over 5,000 nonblack patients with recent stents, 3 times more black patients returned to the hospital with a clot in their stent (called “in-stent thrombosis”).
A stent clot is very dangerous and can cause heart attacks as well as significant damage to the heart. At this point, researchers can only speculate why black patients develop this stent complication more frequently than other races. The study claims they have ruled out the possibility of socioeconomic factors or lack of medications. If that’s true, then the most likely cause is genetics. A black person’s body may not respond as well to the drug Plavix which is prescribed to prevent stent clot.
More and more studies are leading up to a solution for Plavix resistance. Possibly, once we have a better option to the standard Plavix 75mg therapy, this higher rate of stent clot in black people may decline. In the meantime, black patients with stents should be aware of their increased risk and watch out for any suspicious symptoms.
January 22, 2010
I hate to be the one to break some bad news, but its important to understand the definition of heart disease. If you have had a heart stent, heart attack, angiogram showing heart artery blockages or bypass surgery….then YES, you have heart disease! I discussed this in my book but I feel it is imperative to stress this again. At this point in time, THERE IS NO CURE FOR HEART DISEASE! A stent, angioplasty or bypass are methods to help relieve symptoms and minimize damage to the heart. It is like putting a bandage over a cut. They do not stop further blockages from building up in the heart arteries. Heart disease is part of a continuous process of plaque buildup in your body.
To be fair, there are a select few people who have had heart attacks caused by medications like birth control or chemotherapy. These people may not actually have plaque in their arteries but instead develop a clot in the heart arteries which prevented blood flow to certain areas of the heart. However, these circumstances are rare.
Most likely, if you had a heart attack, stent, or bypass surgery you will have heart disease for the rest of your life….at least until a cure is found! This is why it is so important to commit to lifelong diet, exercise and heart medications. These are the only ways we have of reducing your future risk of heart attack or death from heart disease.