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Drug-Coated Balloons Are Emerging As
the Alternative to Metal Stents One of the standard treatments for opening blocked arteries is to insert an
expandable metal tube (stent) covered with drugs via a catheter. Today about 95%
of angioplasty procedures use a metal stent to enlarge a blocked artery
permanently. The stent remains in the body permanently. In smaller arteries
there is a risk that tissue will grow inside the stent and narrow it, causing
the artery to become blocked a second time (in-stent restenosis), or that a
blood clot will develop on the stent (stent thrombosis) and cause a heart attack
or stroke.
But what if the patient is young, has multiple blocks, and has conditions that
may not give good results in such procedures?
Prof Antonio Colombo, director of Cardiac Cath Lab and Interventional Cardiology
Unit at EMO Centro Cuore Columbus, Milan in Italy, on Friday said that special
drug-coated balloons are emerging as the alternative to stents in several cases.
Prof Colombo, who is considered an international pioneer in several cardiac
procedures, was in the city to conduct a workshop for interventional
cardiologists.
“I had started stenting extensively several decades ago, and thus people are
surprised when I say that balloons can replace it. But I am not against stenting
– it’s essential in several cases, but where there are multiple blocks or where
a long stent is required, balloons can be a good alternative,” said Prof
Colombo. “Compared to about 20% patients internationally who have existing
co-morbidities like diabetes, India has number hovering around 35%. The age of
cardiac patients is also getting younger and re-procedure may be required. In
such scenario, it could be a good option.”
A removable balloon is as good as a permanent stent implant for opening small
blocked arteries, according to late breaking results from the BASKET-SMALL 2
trial presented in a Hot Line Session today at ESC Congress 20181 and
simultaneously published in The Lancet˛.
Principal investigator Professor Raban Jeger, of the University Hospital Basel,
Switzerland, said: “The results of this trial move us a step closer towards
treating small blocked arteries without having to insert a permanent implant.”
Balloons covered with drugs, also inserted using a catheter, are approved in
Europe to reopen stented arteries that have become blocked a second time. The
balloon is removed after the procedure.
“The potential benefits of a stent-free option to treat small blocked arteries
are numerous,” said Professor Jeger. “With no permanent implant left after the
procedure, the problem of tissue growth and clot formation within the stent is
eliminated. In addition, there may be no need for prolonged treatment with
anticlotting medicines, which has been controversial since it increases the risk
of bleeding.”
He concluded: “Drug coated balloon angioplasty has the possibility to become the
standard treatment for small blocked arteries. We will continue to monitor
patients in the trial for a further two years for major adverse cardiac events,
stent thrombosis, and bleeding.”
Dr Sameer Dani, director and chief interventional cardiologist at Apollo CVHF
Heart Institute, said that India along with several other countries is running a
trial with Made-in-India drug-coated balloons. “In this procedure, instead of
releasing the stent at a specific spot, the drug is released through the
mechanism which expands the arteries. It reduces the side-effects of stent. In
context of our practice, about 20-25% procedures can be carried out with
balloons,” he said.
Experts said that it’s still not covered in several insurance schemes, and is
about 20-30% costlier than a traditional stenting procedure. “But in the longer
run, it may emerge as an important tool in hands of cardiologists. The effects
of the procedure may start showing results in 2-3 years, which may also work as
deterrent for some,” said Prof Colombo.
References :
1.
https://www.escardio.org/The-ESC/Press-Office/Press-releases/Removable-balloon-is-as-good-as-permanent-stent-
implant-for-opening-small-blocked-arteriesAug. 28, 2018
2. https://timesofindia.indiatimes.com/city/ahmedabad/balloons-can-be-alternative-to-stents/articleshow/93532835.cms
Aug. 13, 2022 |
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