Next Horizon: Using Angioplasty and Stents to Stop Stroke
ZURICH, Switzerland, Sept. 13 /PRNewswire/ -- Thirty years ago this week, a German doctor working in Switzerland used a small tube with a tiny balloon on the end, called a balloon-catheter, to open his patient's blocked heart artery.
The procedure, called angioplasty, restored normal blood flow to the heart, relieved the 38-year-old patient's chest pain and likely prevented a heart attack. It also marked a breakthrough that, three decades later, has saved the lives of millions of heart attack victims and enabled heart attack survivors to enjoy more normal lives. Before angioplasty, survivors of heart attacks often faced life-long disability and physical restriction.
Interventional cardiologists from around the world are in Zurich this weekend to celebrate angioplasty's 30 years of progress in stopping heart attacks and treating coronary artery disease. They are also looking ahead to new frontiers, including the promise of angioplasty and stent placement to stop stroke, America's third-largest killer and the leading cause of serious disability.
A special guest of the 30-Year Anniversary of Coronary Angioplasty Conference is the world's first angioplasty patient, Dolf Bachmann, now 68 years old. Bachmann is living testimony of the life-saving angioplasty procedure that the late Andreas Gruentzig, M.D., developed and taught to hundreds of cardiologists.
"Thirty years ago, one in four heart attack victims died," said Bonnie Weiner, M.D, President of The Society for Cardiovascular Angiography and Interventions (SCAI) and Professor of Medicine and Interim Chair of Cardiovascular Medicine at St. Vincent Hospital at Worcester Medical Center in Worcester, MA. "Today, more than 95 percent survive. And it's very typical for heart attack survivors to return to work and normal activities just a few days after angioplasty."
Improved cardiac care, including the minimally invasive therapy angioplasty, which opens blocked arteries, and stent insertion, which keeps them open, have contributed significantly to these improvements, according to Steven Bailey, M.D., SCAI Secretary and Interim Chief of the Division of Cardiology, Professor of Medicine, and Janey Briscoe Distinguished Chair of Cardiovascular Research at the University of Texas Health Sciences Center at San Antonio. "Although heart disease continues to be the number one killer in the United States, the success and progress of angioplasty is one of modern medicine's most inspiring stories," said Dr. Bailey.
Dr. Gruentzig's discovery that balloon catheters could serve as tools for delivering medical therapies to arteries launched a new era of "interventional cardiology." Until then, emergency coronary artery bypass surgery (CABG) and clot-busting drugs were the only interventions to stop heart attacks and treat coronary artery disease.
Angioplasty's ability to stop heart attacks, its low risk to patients and the quick recovery it makes possible often make angioplasty the preferred method of treatment for heart disease. Angioplasty, which is frequently accompanied by stent implantation, is a minimally invasive procedure that requires no general anesthesia. Compared with bypass surgery, angioplasty is a much less invasive procedure -- and patients are typically able to resume normal activities within days. In bypass surgery, a surgeon sews a blood vessel taken from the leg or other part of the body beyond blockages in heart arteries. This allows blood to "bypass" the blockage in the artery and restores normal flow to the heart. Recovery is typically much longer, with a minimum of several days' recovery in the hospital.
Steady advances in the techniques and tools of angioplasty have made the procedure a treatment option for more patients, according to Dr. Weiner.
In the early years, an estimated five to 10 percent of patients with heart disease were candidates for angioplasty, and it was successful just 65 percent of the time. Ten percent of patients experienced a serious complication, and approximately six percent of patients needed emergency bypass surgery.
Today, approximately two-thirds of patients with coronary artery disease are candidates for angioplasty, stenting and other catheter-based treatments. The treatments are successful in 98 percent of patients, and major complications occur in only 1.5 percent of cases. Just one patient in 1,000 needs emergency bypass surgery.
The 30-year legacy of interventional cardiology also includes pioneering evidence-based medicine -- the discipline of recording and evaluating the outcomes of various procedures to identify those that produce the best results for patients. "Interventional cardiology has led the medical field in taking an evidence-based approach and establishing best practice guidelines that enable cardiologists around the world to know what procedures yield the best patient outcomes," said Dr. Bailey.
Dr. Gruentzig tracked patient outcomes by hand, keeping notes on a chalkboard to record results and analyze trends, according to Dr. Bailey. "Compared with the computer tracking and reporting we do today, his methods may seem like using an abacus. But they laid the foundation for the widespread use of evidence-based medicine.
"Over the years, interventional cardiology has faced challenges," said Dr. Bailey. "In each case, we have responded with innovation, and then rigorously applied the discipline of evidence-based medicine to ensure the safety and efficacy of our solutions."
Refinements in catheters and balloons have been continuous. But dramatically improved patient outcomes are attributed to two other major advancements:
-- The bare metal stent, approved by the U.S. Food and Drug
Administration in 1994, was designed to address the problem of sudden
collapse of an artery following angioplasty. Arteries that collapsed
after balloon-catheter treatment were a major obstacle and a source of
poor outcomes in early angioplasty. Stents overcame this problem by
propping the artery open and restoring normal blood flow. This
innovation led to dramatically improved patient outcomes; and
-- The drug-eluting or coated stent, first approved in the U.S. in 2003
and designed to release medication over time to interrupt the biologic
processes that cause tissue growth and re-narrowing inside the stent
in some patients. Drug-eluting stents have reduced the incidence of
tissue build-up from 40 percent in the early days of stents to just
five to seven percent today.
Studies have found drug-eluting stents pose a small increase in the risk of blood clotting in the stent a year or more after it is inserted. Interventional cardiologists continue to innovate and are now working to find the causes of "late stent thrombosis" and a solution for this rare event. Already, new studies show that it is reduced when cardiologists improve both technique and patient selection and when patients better adhere to recommended drug regimens. Meanwhile, some researchers believe the promise of a solution may lie in dissolvable stent coatings or bio-absorbable stents.
Looking ahead, angioplasty's catheter-based procedures and tools offer exciting potential for treating other serious health issues effectively -- and less invasively. One of the most exciting areas of development is the treatment of diseased carotid arteries, the vessels that supply blood to the brain, to stop or prevent stroke. Catheter-based procedures are also being used to treat renal arteries that supply blood to the kidneys and arteries that provide oxygen- and nutrient-rich blood to the legs and feet. Even newer devices are being delivered via catheter to close a small, naturally occurring hole between the upper left and right chambers of the heart that puts some patients at a higher risk of stroke.
"Angioplasty was a true medical breakthrough," said Dr. Weiner. "It saves lives -- and it preserves and can even improve quality of life. That's its legacy and its future."
For more information, please visit the SCAI online press kit: http://www.redwoodeditor.com/content/SCAI/scai/
The Society for Cardiovascular Angiography and Interventions is a 3,800-member professional medical society whose mission is to promote excellence in invasive and interventional cardiovascular medicine. SCAI has undertaken this public education initiative with its own resources as well as support from Abbott Vascular, Boston Scientific Corporation, Cordis Corporation, and Medtronic CardioVascular. The Society gratefully acknowledges this support while taking sole responsibility for the accuracy and medical integrity of all content developed and disseminated through this effort.
|SOURCE The Society for Cardiovascular Angiography and|
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