Cardiologists at PSG Hospitals in Coimbatore have used a drug-coated balloon (of 1 mm) to enable normal blood flow in the artery of a 52-year-old man's heart as blocks recurred in spite of two stents put in already.
V. Raghunathan, a driver at the Sub-Collector's office at Gobichettipalayam in Erode District, was provided with this option as the cardiologists were convinced that the troubled blood vessel could not take the burden of another stent.
Normally, a pain in the chest may indicate a problem in the heart. And, when an angiogram reveals a block in an artery, an angioplasty is done by passing a stent through a blood vessel in the thigh or the hand to the problem zone in the heart.
Cardiologist and Medical Director (Super Speciality) of the hospital J.S. Bhuvaneshwaran explains that the stent, initially made of stainless steel and later of alloys for greater biocompatibility, is placed where the passage for the blood is narrowed by atherosclerosis (accumulation of plaque on the inner wall of the blood vessel). It is then expanded to broaden the passage and left in that position so that the blood supply is not choked.
But, cardiologists and the patients were confronted with another problem later: re-stenosis (recurrent growth of smooth muscles that blocked the passage within the stent).
“When the first generation stents showed 30 per cent possibility of re-stenosis, drug-eluting stents were introduced. Microscopic pits were created in the stent to store the drug that was released gradually into the blood vessel to prevent the proliferation of smooth muscles,” Dr. Bhuvaneshwaran said.
“The drug-eluting stent reduced the risk of re-stenosis to five per cent. But, it can still occur if the patient fails to take the prescribed anti-platelet drugs. The other reasons for such rare instance of re-stenosis are diabetes or problems with the kidney. As for Raghunathan, it was a clear case of skipping the drug intake schedule,” he said.
“I could not take the drugs only on two days during the Assembly elections (when the administration was into close monitoring of the campaign and expenses by parties/candidates). That landed me in trouble again,” Mr. Raghunathan said.
Dr. Bhuvaneshwaran said: “We caution angioplasty patients against skipping drugs. It can prove dangerous. And, what we point out through this case is the possibility of using the drug-eluting balloon if the stent option is too burdensome for the patient”.
Dr. Bhuvaneshwaran and fellow Cardiologists Sajan Narayanan and P. Arun Kumar made a quick assessment of the patient's condition, specifically that of the already double-stented blood vessel and settled for the balloon procedure. The balloon was passed into the stent and inflated to increase the size of the passage. It was kept in that position for 30 seconds in the blood vessel till the drug was fully transferred and then withdrawn.
Apart from this instance in Coimbatore, this procedure was being done only in very few places such as Chennai, Vellore and Kerala, he said.
“We cannot remove a stent and place a new one. That is why we decided against adding one more,” he said.
According to him, the stent is always a better option than the balloon. Trials are being carried out on the efficacy of a biodegradable or bio-absorbable stent. If that is a success, the risky procedure of overloading a blood vessel with stents can be avoided.
