Latest stent to open heart arteries lessens risk of clotting
The broken escalator loomed with a towering set of stairs.
Zenon Piotrowski, a sales executive for IBM, figured he could handle it.
In Las Vegas for a business convention in early November, he trudged up the stationary steps and encountered unfamiliar tightness in his chest on reaching the top.
“I was a little short of breath,” recalled Piotrowski, 59, of Upper St. Clair. “It felt like something I hadn't felt before. It went away after a couple minutes, but I did not feel normal.”
He took the warning signs to heart — literally.
When he returned home, he made an appointment with cardiologist Jeff Friedel, who found two blockages in heart arteries that needed repairing.
One option would be open-heart, invasive triple-bypass surgery.
Another would be a small, malleable drug-coated cardiac stent designed to promote healing inside the artery, while reducing the risk of subsequent blood clotting or thrombosis.
By chance, Piotrowski became the first patient in the region on Nov. 17 to receive a new type of drug-eluting stent approved by the Food and Drug Administration. Friedel, chief of the cardiology division at St. Clair Hospital in Mt. Lebanon, implanted it through Piotrowski's right wrist.
Stents are tiny mesh or metal cages that expand to open arteries clogged with plaque.
“I'm really lucky these were available when I needed them,” said Piotrowski, who returned to work a week after the procedure. “Triple bypass would have been a lot more dramatic.”
Drug-eluting stents — in which anti-inflammation medications are attached to a polymer within the stent — are not new. However, the two stents placed in Piotrowski's chest contain a coating designed to dissolve safely over time.
Friedel said earlier versions of drug-eluting stents led to health problems because the polymer caused inflammation and blood clots.
“Now in these newer stents, the polymer eventually dissolves and is absorbed by the body,” he said.
Boston Scientific Corp. developed the Synergy stents, which the FDA approved in October.
“I believe this will replace the majority of stents currently being used,” Friedel said. “They combine all the good technology of several stents we have on the market.”
The market is rapidly evolving with good reason. About 610,000 people die of heart disease in the United States every year, according to the Centers for Disease Control and Prevention. Coronary heart disease is the most common, killing more than 370,000 people annually.
Health systems UPMC and Allegheny Health Network are involved in clinical trials with stents that completely dissolve over two years. Abbott Vascular's Absorb stent, sold in Europe, is made of degradable material that's designed to stay intact and release medicine, then dissolve over the next two years.
The devices leave vessels free of a permanent metallic implant.
UPMC cardiologist Catalin Toma said the Absorb stents could be FDA approved as soon as next year.
“There certainly is a lot of interest in the field,” Toma said. “These could lead to a paradigm shift.”
Dr. Tony Farah, chief medical officer for AHN, said the dissolving stents are designed to keep the artery open long enough to heal and then regain its original characteristics and structure.
“From a clinical perspective, I would predict cardiologists would migrate toward using these,” Farah said. “It has become apparent that the most effective and safe means of restoring natural blood vessel function in the setting of coronary disease is ultimately a treatment that leaves nothing behind in the vessel, which was the original idea of angioplasty.”
Under Farah's direction, Allegheny General Hospital became involved in the Absorb trial in 2013.
Patients receiving stents usually need blood-thinning medications for long periods to prevent clots from forming within the device, which may cause sudden heart attacks and other health problems.
“Because of these concerns, there has always been a desire to find a better way to accomplish the pivotal short-term function of stents, without the long-term complications,” Farah said.
Until then, Piotrowski is thrilled to be up and around with the most recently approved stent.
“I'm feeling great,” he said. “I'm sticking to a new diet, and I picked up my cardio exercises.”
Ben Schmitt is a Trib Total Media staff writer. Reach him at 412-320-7991 or firstname.lastname@example.org.