Coronary artery bypass surgery (CABG)

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Lankenau Heart Institute Team Completes Region's First Procedure To Clear Blocked Coronary Stent

LOWER MERION — In a medical milestone for the Philadelphia region, a cardiac team at Lankenau Heart Institute, part of Main Line Health, has successfully completed the area's first procedure using a new drug-coated balloon to clear a blocked stent previously placed in a treated artery.

More than 400,000 patients undergo percutaneous coronary intervention (PCI), also called angioplasty, to open blocked arteries every year. The procedure often is followed by placement of a stent: a small wire mesh coated with medicine to help keep the artery open. However, scar tissue can still gradually develop inside the stent in 5–10% of patients, causing the vessel to narrow again.

Interventional cardiologists Sarang Mangalmurti, MD, and Timothy Shapiro, MD, last month became the first in the region to treat a patient with this latest technology, which was implanted through a minimally invasive procedure. After reopening the coronary artery, they inserted the AGENTTM Drug-Coated Balloon through a catheter to deliver a drug called paclitaxel to the vessel wall to prevent re-narrowing. Data from a clinical trial enrolling 600 patients showed the drug-coated balloon to be more effective than an uncoated balloon, with the U.S. Food and Drug Administration earlier this year approving the device. The AGENT balloon has been used to treat more than 100,000 patients in other countries.

"The AGENT drug-coated balloon is a game changer in treating a problem that has challenged interventional cardiologists for decades," said William Gray, MD, System Chief of Cardiovascular Diseases and Co-Director of the Lankenau Heart Institute. "This device is a significant innovation that addresses the stubborn problem of restenosis of stented coronary arteries. We strive to give our patients the most advanced care, and the AGENT balloon is a cutting-edge option that we're proud to make available to them."

As with any heart blockage, patients with restenosis may experience chest pain, shortness of breath, nausea, weakness, irregular or fast heartbeat and sweating.

"It is exciting for us to have been the first health system in the region to use the AGENT drug-coated balloon," Dr. Shapiro said. "Traditional therapies besides uncoated balloon PCI include placing another layer of metal stents and radiation. Avoiding those options when possible is a real step forward."

Dr. Mangalmurti said paclitaxel is a potent anti-scar tissue drug that reduces the chance of the stent clogging again. "It's an important advance," he said. "When we clear a blocked stent, we don't want to have to keep bringing the patient back again for more procedures. Importantly, results from the AGENT trial indicate additional benefits to other treatment options, including a reduced risk of clotting and heart attack."

Coronary Heart Disease

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How To Treat Coronary Artery Disease

Coronary artery disease (CAD) is a condition where the arteries that supply blood to the heart become narrowed or blocked due to the build-up of plaque. This can lead to chest pain, heart attacks, and other serious heart problems.

Thankfully, there are several treatment options available to manage and treat CAD. Let's explore these options in an easy-to-understand way.

One of the most common approaches to treating CAD is through lifestyle changes. Making healthier choices can significantly improve heart health and reduce the progression of the disease.

This includes eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while avoiding foods high in saturated fats, trans fats, and cholesterol.

Regular exercise, such as walking, swimming, or cycling, can also help strengthen the heart and improve blood circulation. Quitting smoking and reducing alcohol intake are also crucial steps in managing CAD.

Medications are another important part of treating CAD. Doctors often prescribe medications to help manage symptoms and reduce the risk of complications. These medications can include:

Statins: These drugs help lower cholesterol levels in the blood, reducing the risk of plaque build-up in the arteries. Studies have shown that statins can significantly reduce the risk of heart attacks and other heart-related problems in people with CAD.

Beta-blockers: These medications help reduce the heart's workload by slowing down the heart rate and lowering blood pressure. This can help relieve chest pain (angina) and prevent heart attacks.

Aspirin: Low-dose aspirin can help prevent blood clots from forming in the arteries, reducing the risk of heart attacks. However, not everyone should take aspirin, so it's important to talk to your doctor about whether it's right for you.

ACE inhibitors and ARBs: These drugs help relax blood vessels, lowering blood pressure and making it easier for the heart to pump blood. They can also help protect the heart and kidneys in people with CAD.

Nitroglycerin: This medication can help relieve chest pain by relaxing and widening the blood vessels, allowing more blood to flow to the heart.

For some people, lifestyle changes and medications might not be enough to manage CAD effectively. In such cases, doctors might recommend medical procedures or surgery to improve blood flow to the heart. These options include:

Angioplasty and stenting: During this procedure, a small balloon is inserted into the narrowed artery and inflated to open it up. A tiny mesh tube called a stent is then placed in the artery to keep it open. This can help improve blood flow and reduce symptoms like chest pain.

Coronary artery bypass grafting (CABG): This is a type of surgery where a healthy blood vessel from another part of the body is used to bypass the blocked artery, creating a new pathway for blood to reach the heart. CABG can significantly improve blood flow and reduce the risk of heart attacks.

Enhanced external counterpulsation (EECP): This non-invasive procedure involves wearing cuffs on the legs that inflate and deflate to improve blood flow to the heart. EECP can help reduce symptoms like chest pain and improve overall heart function.

Research has shown that these treatments can be very effective in managing CAD and reducing the risk of complications. For example, a study published in the New England Journal of Medicine found that angioplasty and stenting significantly improved blood flow and reduced chest pain in people with CAD.

Another study in the Journal of the American College of Cardiology showed that CABG surgery reduced the risk of heart attacks and improved survival rates in people with severe CAD.

In conclusion, there are several treatment options available for managing coronary artery disease, including lifestyle changes, medications, and medical procedures. Each person's situation is unique, so it's important to work with your doctor to determine the best treatment plan for you.

By making healthy choices and following your doctor's recommendations, you can effectively manage CAD and reduce your risk of serious heart problems. Understanding these treatment options can help you take control of your heart health and lead a healthier, longer life.

If you care about health, please read studies about the benefits of low-dose lithium supplements, and what we know about egg intake and heart disease.

For more information about health, please see recent studies about potatoes and high blood pressure, and results showing 6 best breads for people with heart disease.

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