Are cardiac stents the best treatment option and what is being done to improve cardiac surgery?

When cardiac stents became available there was a lot of excitement as they were viewed as the ideal way to repair the heart blood vessels and lend a new lease of life to patients following a heart attack. However, there was then growing evidence that the stents themselves then became responsible for causing further clogging of the arteries. In response, the next generation of ‘drug eluting stents’ were launched. These stents contained drugs to prevent clogging and some of these performed better than others.
News emerged yesterday of the start of the PIONEER trial the: “first coronary stent on drug eluting balloon has been implanted”, and that this innovation improves patient’s comfort and reduces procedure cost significantly.

The trial enables for the first time the delivery of a coronary stent that is mounted on a Drug Eluting Balloon. On placement of the stent a predetermined load of the plaque-busting drug Paclitaxel is delivered to the vessel wall to support the vessel in adapting to the stent and reducing adverse effects in the first days after implantation.

The Drug Eluting Balloon product in the PIONEER trial delivers drugs  during stent placement only, instead of continuous drug delivery by drug eluting stents. This reduces the period that follow-up medication is needed, which means total procedure costs are reduced significantly. The new procedure improves patient’s comfort, as the period for which daily antiplatelet medication is reduced from up to two years to one month.

A coronary balloon angioplasty is a minimally invasive procedure performed to improve blood flow to the heart muscle. In an angioplasty procedure a balloon is inflated to open the coronary artery. In addition a small wire mesh tube called a stent may be permanently placed to help the artery to remain open. Drug eluting stents, that release drug from the stent surface after implantation, are commonly used to prevent re-closure of the vessel. A downside is that patients are required to take antiplatelet medication daily for a long period with significant discomfort and risks associated. A new method is the laser balloon ablation pioneered by Dr Oliver Segal of the Heart Hospital, University College London Hospital.

Providing an expert comment on this news, UK Cardiologist, Professor Avijit Lahiri says: “This is a good idea. Avoiding intensive antiplatelet treatment (aspirin and clopidegrol) will definitely reduce some of the bleeding side effects. However, more data is required about these new stents. It will be important to know whether the prognostic data are similar or better than the current treatment options with drug eluting stents, that there are fewer complications, and also cost is always an important issue. In the UK private sector it is still less costly to have open heart coronary bypass surgery compared to having 2-3 stents.”

This is an interesting step forward to improve the outcome and performance of cardiac stents, and we await with interest the results from the PIONEER trial.