A Breakthrough in Cardiac Care
Monday June 16, 2003
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However wonderful and lifesaving stents have been, they still have their faults. Some patients who receive stents develop restenosis - also known as neointimal hyperplasia - resulting from an overgrowth of the intimal layer of the artery. Although restenosis can be treated with radiation therapy, once a stent is restenosed, it is often difficult for cardiologists to keep it clear for the long term.
Now, the field of cardiology is looking forward to the latest option to bare metal stents, which may be approved by the FDA and become available as early as April 2003. Drug-eluting stents that prevent restenosis have been in clinical trials for several years and have long been viewed as a major breakthrough in the treatment of coronary artery disease. The Sirolimus stent, named for the immunosuppressive drug with which it is coated, is produced by the Cordis Corporation, a Johnson & Johnson company, and is the first of this new generation of devices expected to become available. Many in the medical community are eagerly awaiting this event due to the overwhelming success of the Sirolimus stent in preventing restenosis. During early and follow-up trials, only 3% of the trial stents restenosed.1 Sirolimus, the immunosuppressive agent, embedded in a polymer coating on the stent. The drug is then delivered directly to the artery, working on the cellular level to prevent hyperplasia and reocclusion.
The newest data from clinical follow-up studies indicate that drug-eluting stents remain clear for up to two years.1 Their design is the same as the standard metal stents, making them user-friendly for the interventional cardiologist. Their advent will help prevent the need for open-heart bypass surgery for those patients who otherwise would have suffered non-treatable restenosis. Recovery time is the same as with previous stent placement - an overnight stay in the hospital, with a return to normal activities in a few days.
This is only the beginning of a new era in interventional cardiology. Research continues with other drug coatings, types of metal, and systemic medications to develop permanent treatments for coronary artery disease. More drug-eluting stents, such as one that is coated with the chemotherapeutic agent Taxol, are expected to become available within the next year or two.
Anna Smith, RN, is a clinical educator in the Cardiac Catheterization Lab at St. Joseph Medical Center, Baltimore, MD.
Reference
1 . Schwarz, M. TCT: SIRIUS Trial Results Are Extremely Encouraging In Blocked Coronary Arteries. Doctor's Guide Global Edition Website. Available at: www.pslgroup.com/dg/21ebc6.htm. Accessed March 18, 2003.
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