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Bypassing open heart bypass surgery...

A breakthrough in the treatment of coronary artery disease promises to reduce the need for open heart bypass surgery. Medical research has come up with a drug-coated stent which once inserted after clearing a clogged artery has shown an ability to check the recurrence of blockages, a common problem with the angioplasty procedure.//

The results of this new procedure, based on a scientific study, were presented at the annual meeting of the European Society of Cardiology on Wednesday. The study, which selected over 100 patients spread over Europe and South America, has shown a zero incidence of recurrence of blockage with the use of the stent, which is basically a metal mesh which props open a narrowing artery.

According to Dr Upendra Kaul, Cardiologist, and one of the pioneers of non-surgical heart procedures, that this is as important a finding as the first case of angioplasty. It should allow cardiologists to do all kinds of complex cases, earlier left for bypass surgery,'' he said, while describing the development as ``thrilling''.

This would mean that patients who were earlier not considered for angioplasty such as those who are diabetic, or have a blockage in more than one artery or whose blocking lesions are long can now be treated with this method. ``Even patients with mild forms of angina (narrowing of arteries with no heart attack) can now undergo this procedure without having to bear recurrent episodes of pain,'' Kaul says.

Surgeons, however, temper this excitement with caution. Indian arteries are narrower than the western population. The number of diabetics are much more as well, who face the risk of recurring blockages,'' says well-known cardiac surgeon, Dr Naresh Trehan. Most of all, he says, ``apart from the clear indications necessary for a surgery, the personal economics of a patient and his interest has to be kept in mind''.

Unlike western nations, in India the cost of angioplasty and surgery are almost the same due to the high cost of the stent, he said. Some cardiologists also question the long-term effects as well as effective drug delivery on the required site.

While stents have been used for several years now, a recurrence of blockage has been a common problem. Medically known as restenosis, it occurs in a large number of patients within six to eight weeks of the procedure. It is basically the body's reaction following the trauma of the medical procedure. In other words, it is like a big scar. But as it restricts blood flow, it needs to be removed. Several methods were tried in the past to stop this but with little success. However, with the use of a drug, Rapamycine, essentially used to treat rejection following an organ transplant, researchers did not find even a single case of restonsis even six months after the procedure.

The drug, says Dr Kaul, takes about three to six weeks to disappear from its site of location. But by then, the body's initial response to healing has been checked and clot formation stopped, he adds.


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