Treatment Advances for Artery Blockages

By Seth Bilazarian, MD, FACC, FSCAI, RPVI
Clinical and Interventional Cardiologist

Coronary artery disease is the #1 killer of both men and women in our country, and more than 50% of Americans die as a result of problems with artery blockages. During the past decade however, we have seen tremendous advances in percutaneous coronary intervention (PCI) otherwise known as stents or angioplasty used to fix blocked arteries.

Coronary artery blockages develop for a variety of reasons.

The five most common risk factors are: high blood pressure (hypertension), high cholesterol, diabetes, cigarette smoking and a family history of heart disease. Other contributors include lack of exercise, a diet rich in fat or sugar, and being overweight.

What treatments are available for coronary artery disease?

For over a decade, physicians have been able to treat coronary artery disease and fix blockages without surgery. These catheter-based treatments use small, thin tubes placed in the groin artery and inserted into the heart. In the early 1990’s, balloon angioplasty was introduced, allowing the physician to insert small balloons that stretched the arteries and opened blockages. This, and bypass surgery (CABG or coronary artery bypass graft) were really the only options available to patients with arterial blockages.

In the mid 1990’s, stents became available. These thin, stainless steel metal coils have become very effective in helping to reduce the risk of re narrowing, or restenosis, after the procedure. About 40% of patients experience re-narrowing of the arteries within 6 months of treatment with balloon angioplasty alone. The degree of this renarrowing often necessitated repeat treatment. With the introduction of stents, the risk of renarrowing was reduced to about 30% during the 4-6month period following treatment.

In May 2003, the USA FDA approved a new innovation - a drug eluting stent.

The Cypher stent is made by Johnson & Johnson, and is coated with a drug called sirolimus. The re-narrowing risk has been shown to be as low as 8%-9% with the sirolimus-coated stent as opposed to a stent without a drug coating. A second drug eluting stent, made by Boston Scientific, will be released in early 2005, and many other manufactures are expected to bring new products to market in the coming years.

Drug eluting stents are a major innovation that has revolutionized stenting and the treatment of patients with coronary
artery disease. Like any new device or treatment, clinicians and patients need to be cautious and watchful in identifying potential problems. For example, one issue that is being watched very carefully by the medical community is the potential risk for clotting which may occur with this new drug eluting stent. However, at this point, physicians are using these stents with cautious enthusiasm in appropriate patients.

In summary, there are several important innovations that are occurring with percutaneous coronary intervention (PCI) or stenting. These new innovations are reducing the risk of recurrence and need for repeated treatments for patients and may change the evolution of future treatment options. Some patients, who might have been candidates for bypass surgery in the past, may now be able to be treated with stents given the reduced risk of renarrowing.

If you have additional questions about coronary artery disease or these treatment options, contact your doctor or cardiologist.