strokes and stents

Here's the abstract...

My department performs these procedures. I'll try to get another perspective on this and get back to you all

bm

From my understanding, we perform this procedure on non-surgical candidates. These are patients whose stenosis is too high and under the jaw to get to surgically or the patient themselves are in a condition that they cannot withstand anesthesia. Some of our patients have the option of taking the risks associated with the stenting procedure or waiting for a debilitating stroke as a result of severe carotid stenosis.
I am not a physician, therefore would have to ask more questions to get more info.
Do you have the website address for this article?

Whoa!



They are successful in cardiac matters, though?

Or does this cast doubt on that, too?


They are surely expensive little buggers.

It's listed at the end of the abstract posted above, MB. It's a NEJM article and requires a subscription to get past the abstract.

One of the risks with the stenting is that while deploying the stent some small particles of plaque can be loosened and sent upstream to the smaller arteries in the head causing stroke. So a basket device is used to catch this poss. plaque and it is removed after stent deployment along with the other catheters.
Stenting is effective in m,ost areas of the body, not only the cardiac arteries but kidney,leg,visceral arteries as well.

Thank JPB, if anyone is interested I can ask the physicians I work with more on this topic.

Is someone out there in need of this procedure or was this an interesting article that came up?

You all got me started on something close to me and now I'm running late for work...gotta go!

and one more commentary from jwatch - Cardiology

Human tests under way on dissolving heart stents
POSTED: 8:46 p.m. EDT, October 24, 2006
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WASHINGTON (AP) -- Scientists are developing a novel way to prop open clogged heart arteries: using a stent designed to dissolve once it finishes the job.

Heart stents are tiny metal-mesh tubes that have been implanted in millions of people worldwide to hold arteries open after doctors push back fatty deposits that clog them.

Stents are credited with preventing heart attacks while avoiding open-heart surgery. But they are at the center of a heated controversy because doctors recently discovered that the most popular type, drug-coated ones, sometimes cause potentially fatal blood clots months or years after they are inserted.

So a stent that could help an artery heal and then dissolve would be "a major milestone," said Dr. John Ormiston of Auckland, New Zealand. He announced Tuesday that the first human experiment with just such a device is under way in his hospital and a few others in Europe.

Only 26 patients have received the devices in a study designed to test whether the new type of stent, made by Abbott Laboratories, is safe enough to be tried in larger experiments. Thirty days after receiving the device, all patients are faring well so far, Ormiston told a meeting of cardiologists.

It's called a bioabsorbable stent, made of the same kind of material as certain dissolvable stitches but designed to last longer.

Animal studies suggest the body completes its breakdown of the device in about two years.

Here's the issue: When a heart artery is clogged enough to risk a heart attack, doctors frequently use a balloon to push back the plaque so blood can flow freely again. Stents then are inserted to keep the newly widened artery from collapsing, and drug-coated ones prevent scar tissue from reclogging it.

But stents do not need to be permanent, Ormiston contended. If an artery stays open for six months after being unclogged, it essentially is healed, he said.

"There's not much sense in a permanent implant for a temporary problem," he said. "I think patients like the concept of a device that goes away."

The new absorbable stent is coated with a drug, as today's most-used versions are, to prevent reclogging. After the drug has permeated the artery walls, the stent should start dissolving.

In the spring, Ormiston is scheduled to announce how the first patients fared at that critical six-month period, the first hint of whether the approach might really work.

His announcement came as cardiologists vehemently debated just how big a problem the blood-clot risk is for today's devices. Apparently it occurs because the drug coating allows the stent's metal parts to remain exposed and act as a clot magnet, instead of gradually being overgrown with a thin layer of cells.

The risk seems very rare, occurring in about one of every 500 or so patients, Harvard Medical School's Dr. Donald Cutlip said at Tuesday's meeting of cardiologists who specialize in stenting.

But given that about 6 million people worldwide have the drug-coated devices, critics say that could translate into thousands of heart attacks or deaths. The Food and Drug Administration will assess the risk, and how it compares to older bare-metal stents that have their own side effects, at a meeting in early December.

bm