Millions of people suffer from coronary artery disease, a narrowing of the coronary arteries that can lead to a heart attack. Since the first dilatation of narrowed heart arteries with a balloon catheter 30 years ago, the treatment of coronary artery disease has evolved impressively. A milestone during this evolution was the introduction of stents – small vascular supports made of mesh wire designed to provide steady blood flow after doctors dilate the diseased blood vessel with the balloon catheter.
Drug-eluting stent: life-saving or life-threatening?
Drug-eluting stents were then hailed as another major advance. They ensure significantly improved protection against re-narrowing of the dilated blood vessel. However, the results of studies showing that these vascular supports simultaneously slightly increase the risk of subsequent, life-threatening blood clot formation in the stent caused uproar. Such stent thrombosis is comparable to a heart attack.
No differences in myocardial infarctions and deaths
Reports of this risk have caused anxiety and uncertainty among many heart patients. They can now be largely reassured. “That’s because a close review of all study data from about 29,000 patients showed that drug-eluting stents did not lead to more heart attacks and deaths than normal stents during the four-year observation period,” explains PD Thomas Voigtländer, MD, PhD, of the Scientific Advisory Board of the German Heart Foundation.
“However,” the cardiologist adds, “the use of a drug-eluting stent should be carefully considered.”
Weigh use of drug-eluting stents
Drug-eluting stents offer advantages especially in patients at increased risk for re-narrowing, for example, when a thin coronary vessel (smaller than 3 MIllimeters) is narrowed over a longer distance. The use of these stents, on the other hand, should be reserved if there is an increased risk of stent thrombosis, for example if several vessels have to be treated simultaneously in the case of advanced coronary artery disease.
If possible, coated stents should not be used at all – because of the longer-term use of anticoagulant medications prescribed for them – for example, before soon to be scheduled surgeries or in patients who suffer from multiple diseases and must take a large number of tablets.
Crucial: protection against blood clots
Crucial to the success of any stent therapy is that, as far as possible, there is no clumping of platelets and thus no thrombosis. Stent patients must therefore take acetylsalicylic acid (ASA) for life and, for a period of time after stent deployment, the additional drug clopidogrel: For the uncoated stent, this is four weeks; for the coated stent, six to twelve months.
“Even a successful stent therapy does not change the fact that the patient continues to suffer from coronary heart disease,” emphasizes the chairman of the German Heart Foundation, Prof. Dr. med. Hans-Jürgen Becker: “The heart patient has a great deal of control over his own future. Because he can slow down the progression of the disease – especially through a healthy diet with Mediterranean food, regular exercise and the consistent taking of prescribed medication.”
