Drug-Eluting Stents Best After Artery Re-Closure

Study upholds the use of these devices to replace bare metal stents

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HealthDay Reporter

MONDAY, Jan. 29, 2007 (HealthDay News) -- Using drug-coated stents to replace bare metal stents that have become blocked may be the best solution to reopening cardiac arteries and keeping them open, European researchers report.

In fact, replacing bare metal stents with drug-coated stents cuts the risk of this re-closure, called restenosis, by 65 percent, compared with either balloon angioplasty or radiation treatment, the scientists added.

Drug-eluting stents are coated with medications aimed at keeping restenosis at bay. The devices are considerably more expensive than bare-metal stents, however.

But "patients who develop in-stent restenosis after implantation of bare metal stents carry a high risk for recurrence," the authors write in the Feb. 6 issue of the Journal of the American College of Cardiology. "Use of drug-eluting stents effectively reduces the risk of recurrence."

In-stent restenosis occurs in up to 50 percent of patients who receive bare mental stents to prop open an artery. There is also clinical evidence that drug-eluting stents produce better results than other treatments for this problem, but they are not yet approved for this use, according to study author Dr. Alban Dibra, a consultant cardiologist at the German Heart Center in Munich.

To find out which treatment was better, Dibra's team looked at four studies that compared two types of drug-eluting stents vs. balloon angioplasty or vascular brachytherapy (a type of radiation treatment). The stents used in the study were coated with either the drug sirolimus or another drug, paclitaxel.

The studies included 1,230 patients whose bare metal stent had undergone restenosis. The researchers evaluated the results at least nine months after the procedure to see if there was restenosis in the stented artery.

They found that using drug-eluting stents reduced the risk of further restenosis in the blood vessel by 65 percent, compared with the other procedures.

Moreover, the German team found no differences between patients treated with drug-eluting stents and those treated with other techniques in terms of death or heart attack.

They conclude that the use of drug-eluting stents in these cases "is associated with superior results compared with plain balloon angioplasty and vascular brachytherapy. These drug-eluting stents should be recommended as the treatment of choice for patients with restenosis of bare metal stents."

One expert believes the finding echoes the general consensus among cardiologists.

"This is not particularly new information," said Dr. David O. Williams, director of the Cardiovascular Laboratory and Interventional Cardiology at Rhode Island Hospital and a professor of medicine at Brown University Medical School in Providence.

"What the study says is what the general cardiology community had believed, and this is confirmatory," Williams said. He also noted there are fewer cases of restenosis from bare metal stents because there are fewer of these stents now being used. "About 94 percent of the stents used are drug-eluting stents," he said.

Williams noted, however, that new data suggests that people who get any type of stent are at higher risk of having a heart attack or of dying. "The association might not have to do with the procedure," he said.

In another study in the same journal issue, Italian researchers looked at drug-eluting stents to see which medication, sirolimus or paclitaxel, worked best.

In the study, Dr. Anna Sonia Petronio, from the department of cardiology at the Hospital Cisanello in Pisa, and colleagues looked at the outcomes of 100 patients who had received either type of stent.

They found that patients who received the sirolimus-eluting stent had significantly less thickening of the artery wall compared with patients who received the paclitaxel-eluting stent. This wall thickening, called neointimal hyperplasia, can cause the artery to narrow and possibly close.

However, Petronio's team also found that the differences between the stents in neointimal hyperplasia didn't cause higher rates of restenosis, either in the stent itself or in the stented blood vessel.

More information

There's more on stents at the American Heart Association.

SOURCES: David O. Williams, M.D., director, Cardiovascular Laboratory and Interventional Cardiology, Rhode Island Hospital, and professor, medicine, Brown University Medical School, Providence, RI; Feb. 6, 2007, Journal of the American College of Cardiology

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