Blocked coronary arteries which invariably climaxed in a heart attack and the possibility of death were first overcome by major open-heart surgery. The block was bypassed and the patient lived with a long scar across the chest.
With the advancement of medical science came angioplasty or keyhole surgery, as an alternative, where a catheter with a balloon at its tip is inserted into a small incision in the groin or the wrist. This is guided through the aorta into the coronary artery affected by plaque build-up or cholesterol deposits. When the balloon is inflated it opens up the narrowed artery by pushing the plaque against the wall.
This was followed by the placement of a stent, a small metallic spring-like device, to serve as a scaffold to keep the artery open and the blood flowing to the heart muscle.
The first generation of these were bare metal stents. However, now newer drug-eluting stents are in the market. These stents are used in special circumstances to help keep the arteries open for longer and prevent re-narrowing. On the downside patients who have stents inserted have to be on long-term aspirin and in some cases clopidogrel as well. These drugs thin the blood and can pre-dispose to bleeding.
After stenting the vessel may become blocked again leading to in-stent restenosis, says Clinical and Interventional Cardiologist Dr. Vajira Senaratne.
Usually after stenting new tissue consisting of healthy cells from the lining of the vessel wall (endothelium) grows inside the stent, covering its struts. This is good as it allows the smooth flow of blood, without clotting, over the stented section. Later, however, scar tissue may form underneath the new healthy lining of the artery making it thick and obstructing the flow of blood, causing a blockage, he said.
Now angioplasty has been fine-tuned with the newest “boy” on the block – the Drug Eluting Balloon Catheter – not only overcoming certain limitations of stenting but also giving access to narrow blood vessels with long lesions or to bifurcations (forking) of vessels if plaque has built-up there, MediScene understands.
The first to undergo this procedure in Sri Lanka on August 4 at a private hospital was a 54-year-old whose arterial block was at a bifurcation. It was done under the guidance of Dr. Senaratne, assisted by Clinical and Interventional Cardiologist Dr. Mohan Rajakaruna.
Stressing that the best answer is prevention of heart disease by reducing the risk factors, Dr. Senaratne said that this new procedure would be a “good alternative” for long stents that have got blocked over time and for the treatment of very small vessels.
The Drug Eluting Balloon Catheter helps resolve this by delivering drugs to the in-stent lesion to clear it up.
The one currently available in Sri Lanka is DIOR (Dilatation of Restenosis).
Another advantage of the Drug Eluting Balloon Catheter, according to Dr. Senaratne, is that the patient need not be on long-term medication such as aspirin and clopidogrel.